86R4305 KFF-D
By: Davis of Harris H.B. No. 1295
A BILL TO BE ENTITLED
AN ACT
relating to early childhood intervention and rehabilitative and
habilitative services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.00521 to read as follows:
Sec. 533.00521. STAR HEALTH PROGRAM: EARLY CHILDHOOD
INTERVENTION SERVICES. (a) A managed care organization that
contracts with the commission to provide health care services to
recipients under the STAR Health program may not require prior
authorization for the provision of early childhood intervention
program services under Chapter 73, Human Resources Code, to a child
eligible for the program, including services specified in the
child's individualized family service plan issued by the commission
under the program.
(b) A contract between a managed care organization and the
commission for the organization to provide health care services to
recipients under the STAR Health program must contain a requirement
that the organization:
(1) proactively review and monitor recipient access
and utilization of early childhood intervention services under
Chapter 73, Human Resources Code; and
(2) demonstrate to the commission that the
organization is in compliance with Subsection (a), including a
requirement that the organization submit quarterly reports to the
commission that verify that the organization did not include a
prior authorization request for early childhood intervention
services under Chapter 73, Human Resources Code, as part of a
medical necessity determination.
SECTION 2. Section 73.001, Human Resources Code, is amended
by adding Subdivision (5) to read as follows:
(5) "Medicaid" means the medical assistance program
established under Chapter 32, Human Resources Code.
SECTION 3. Section 73.0051(l), Human Resources Code, is
redesignated as Section 73.0052, Human Resources Code, and amended
to read as follows:
Sec. 73.0052. SYSTEM OF PAYMENTS. (a) Subject to the
requirements of this section, the [(l) The] executive
commissioner by rule may establish a system of payments by families
of children receiving services under this chapter, including a
schedule of sliding fees, in a manner consistent with 34 C.F.R.
Sections 303.13(a)(3), 303.520, and 303.521.
(b) In adopting a system of payments under this section and
to the extent permitted by federal law, the executive commissioner
shall require that if a child has private health benefits coverage,
the health benefits plan provider that provides the coverage is the
primary payor of services provided under this chapter, except as
provided by Subsection (c).
(c) If the child covered by private health benefits coverage
described by Subsection (b) would be required to pay any amount
out-of-pocket for a service provided under this chapter, including
any deductible, copayment, coinsurance, or other cost-sharing
payment, the executive commissioner shall ensure the claim for
services is paid using money from the following sources in the
following order:
(1) federal funds received under Part C, Individuals
with Disabilities Education Act (IDEA) (20 U.S.C. Section 1431 et
seq.);
(2) Medicaid, if applicable; and
(3) to the extent money is appropriated for that
purpose, general revenue.
SECTION 4. Chapter 73, Human Resources Code, is amended by
adding Sections 73.00521 and 73.00522 to read as follows:
Sec. 73.00521. DELIVERY OF SERVICES. (a) Notwithstanding
any other law and except as provided by Subsection (b), the
commission shall provide services under this chapter to each
eligible child through the STAR Kids managed care program
established under Section 533.00253, Government Code, regardless
of the child's Medicaid eligibility.
(b) Notwithstanding any other law, the commission shall
provide through the STAR Health program services under this chapter
to each eligible child who is in the conservatorship of the
Department of Family and Protective Services.
Sec. 73.00522. OMBUDSMAN FOR CERTAIN STAR KIDS MANAGED CARE
PROGRAM ENROLLEES. (a) In this section, "ombudsman" means the
individual designated as the ombudsman for children receiving early
childhood intervention services through the STAR Kids managed care
program under Section 73.00521(a).
(b) The executive commissioner shall designate an ombudsman
for children receiving early childhood intervention services
through the STAR Kids managed care program under Section
73.00521(a).
(c) The ombudsman's office is administratively attached to
the office of the ombudsman of the commission.
(d) The commission may use an alternate title for the
ombudsman in consumer-directed materials if the commission
determines that the alternate title would benefit consumers'
understanding of or access to ombudsman services.
(e) The ombudsman serves as a neutral party to assist
children who are eligible to receive or receiving early childhood
intervention services through the STAR Kids managed care program
under Section 73.00521(a) and their parents and guardians in
resolving issues related to applying for and receiving those
services.
(f) The ombudsman shall for children and the parents and
guardians of children eligible to receive or receiving early
childhood intervention services through the STAR Kids managed care
program under Section 73.00521(a):
(1) provide dispute and complaint resolution
services;
(2) perform consumer protection and advocacy
functions; and
(3) collect inquiry and complaint data.
(g) The executive commissioner by rule shall adopt and
ensure the use of procedures for the reporting, monitoring, and
resolution of disputes and complaints described by Subsection (f)
that are consistent with the procedures adopted and used under
Medicaid.
SECTION 5. Section 73.009(a), Human Resources Code, is
amended to read as follows:
(a) The commission [department] shall develop and the
executive commissioner shall establish policies concerning
services described by this section. A child under three years of
age and the child's parent, guardian, or other legally authorized
representative:
(1) [family] may be referred for services described by
this section if the child is:
(A) [(1)] identified as having a developmental
delay;
(B) [(2)] suspected of having a developmental
delay; or
(C) [(3)] considered at risk of developmental
delay; and
(2) shall be referred for services described by this
section if the child is:
(A) in the conservatorship of the Department of
Family and Protective Services; and
(B) at least one year of age unless an earlier
referral for services is made.
SECTION 6. Chapter 73, Human Resources Code, is amended by
adding Sections 73.0105, 73.0111, and 73.012 to read as follows:
Sec. 73.0105. COMBINED OR CONCURRENT APPOINTMENTS. The
commission shall ensure that:
(1) the parent, guardian, or other legally authorized
representative of siblings who are eligible for the same service
under this chapter is allowed to elect to have the siblings receive
the service from the same provider at the same appointment if the
provider agrees that the provision of services in this manner is
appropriate treatment for the needs of each child; or
(2) if the siblings' parent, guardian, or other
legally authorized representative does not make the election under
Subdivision (1) or the siblings are eligible for different services
under this chapter that are available from the same provider, the
parent, guardian, or legally authorized representative may
schedule the appointments for the services near in time to each
other.
Sec. 73.0111. PROVIDER OMBUDSMAN. (a) In this section,
"ombudsman" means the individual designated as the ombudsman for
providers of services authorized under this chapter.
(b) The executive commissioner shall designate an ombudsman
for providers of services authorized under this chapter.
(c) The ombudsman's office is administratively attached to
the office of the ombudsman of the commission.
(d) The commission may use an alternate title for the
ombudsman in provider-directed materials if the commission
determines that the alternate title would benefit providers'
understanding of or access to ombudsman services.
(e) The ombudsman serves as a neutral party to assist
providers of services authorized under this chapter in resolving
issues related to providing early childhood intervention services
under this chapter, including through the STAR Kids managed care
program.
(f) The ombudsman shall:
(1) provide dispute and complaint resolution
services;
(2) perform provider protection and advocacy
functions; and
(3) collect inquiry and complaint data.
(g) The executive commissioner by rule shall adopt and
ensure the use of procedures for the reporting, monitoring, and
resolution of disputes and complaints described by Subsection (f)
that are consistent with the procedures adopted and used under
Medicaid.
Sec. 73.012. REIMBURSEMENT METHODOLOGY FOR CASE MANAGEMENT
SERVICES. (a) The executive commissioner shall:
(1) apply for and actively pursue from the federal
Centers for Medicare and Medicaid Services or other appropriate
federal agency any waiver or other authorization necessary to
provide reimbursement under Medicaid for case management services
provided under this chapter; and
(2) pending authorization under Subdivision (1),
request clear direction and guidance from the federal Centers for
Medicare and Medicaid Services on the reimbursement methodology
that may be used for the provision of case management services under
this chapter, including direction on allowable and unallowable
costs.
(b) If appropriate and based on the guidance received under
Subsection (a), the executive commissioner shall amend rules
governing reimbursement for the provision of case management
services under this chapter to ensure providers are reimbursed for
all allowable costs.
(c) This section expires September 1, 2021.
SECTION 7. Subtitle B, Title 3, Human Resources Code, is
amended by adding Chapter 74 to read as follows:
CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
Sec. 74.0001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Developmental delay" has the meaning assigned by
Section 73.001.
(3) "Eligible child" means a child who is eligible for
early childhood intervention services under Chapter 73.
(4) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(5) "Tele-connective pilot program" means the program
developed and implemented under Section 74.0002.
(6) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
Sec. 74.0002. TELE-CONNECTIVE PILOT PROGRAM. The
commission shall develop and implement a pilot program to provide
early childhood intervention services under Chapter 73 to eligible
children through the provision of telehealth and telemedicine
medical services delivered using access points established in
school districts selected to participate in the program.
Sec. 74.0003. SCHOOL DISTRICT SELECTION. The commission in
cooperation with the Texas Education Agency shall select the school
districts in which to implement the tele-connective pilot program.
In determining the school districts in which to implement the
program, the commission and the Texas Education Agency:
(1) shall consider each school district in which there
is:
(A) a low or inadequate number of service
providers authorized under Chapter 73; or
(B) a significant risk of losing service
providers authorized under Chapter 73; and
(2) may implement the program only in school districts
in which the implementation is reasonable and feasible.
Sec. 74.0004. PROVIDER PARTICIPATION. (a) The commission
shall ensure that providers of services under Chapter 73 other than
school districts are allowed to participate as providers in the
tele-connective pilot program and provide services outside the
school-based setting.
(b) The commission shall collaborate with the Texas
Education Agency to establish school-based provider access points
for the program.
Sec. 74.0005. ADEQUATE NETWORK OF ACCESS POINTS. The
commission and the Texas Education Agency shall ensure that an
adequate number of school-based and non-school-based
tele-connective pilot program access points are established in a
school district participating in the program.
Sec. 74.0006. AUTOMATIC AND VOLUNTARY PARTICIPATION OF
CERTAIN ELIGIBLE CHILDREN. (a) Subject to Subsection (b) and
notwithstanding Section 73.0051(j), the commission shall
automatically enroll an eligible child in the tele-connective pilot
program if the child has a developmental delay of at least 30
percent but less than 70 percent in only one area. An eligible
child may not be enrolled in the tele-connective pilot program and
may receive services in an in-person setting if the child has a
developmental delay:
(1) in any degree in at least two areas; or
(2) of at least 70 percent in one area.
(b) The parent, guardian, or other legally authorized
representative of an eligible child may, at any time, elect to opt
the child out of the tele-connective pilot program.
Sec. 74.0007. SCHOOL DISTRICT EMPLOYEE TRAINING. The Texas
Education Agency shall develop a training course on the
tele-connective pilot program to be given to appropriate school
district employees.
Sec. 74.0008. INITIAL SCREENING AND EVALUATION. (a) An
initial screening or evaluation under the tele-connective pilot
program must:
(1) be an in-person consultation; and
(2) have the parent, guardian, or other legally
authorized representative of the eligible child present.
(b) The parent, guardian, or other legally authorized
representative of an eligible child must be given the opportunity
to opt the child out of the tele-connective pilot program at the
time of the child's initial screening or evaluation.
(c) Notwithstanding any other law, after a child is enrolled
in the tele-connective pilot program, health care services,
including any initial treatment or prescription, that are delivered
or issued by a physician or by a health care provider acting under
the delegation or supervision of the physician or under the health
care provider's license may be provided using telecommunications or
other information technology.
Sec. 74.0009. PROVIDER REIMBURSEMENT. The executive
commissioner in adopting rules governing the tele-connective pilot
program shall ensure that provider reimbursement for a telehealth
or telemedicine medical service is made at a rate that is comparable
to the rate paid under private health benefit plans.
Sec. 74.0010. CONFIDENTIALITY OF INFORMATION. The
commission shall ensure that the tele-connective pilot program
complies with federal and state law regarding confidentiality of
medical information, including the Health Insurance Portability
and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.
Section 1232g).
Sec. 74.0011. ACCESS POINT EVALUATION. Not later than
September 1, 2020, the commission shall conduct an evaluation of
the tele-connective pilot program to ensure that an adequate number
of access points have been established in each school district
participating in the program. This section expires January 1,
2021.
Sec. 74.0012. REPORT. Not later than January 1, 2021, the
commission shall submit an initial report to the governor, the
lieutenant governor, the speaker of the house of representatives,
and the presiding officers of the standing committees of the senate
and house of representatives having primary jurisdiction over the
early childhood intervention program authorized by Chapter 73. The
report must evaluate the operation of the tele-connective pilot
program and make recommendations regarding the continuation or
expansion of the program.
Sec. 74.0013. FUNDING. The commission shall actively seek
and apply for any available federal money to support the
tele-connective pilot program, including federal money made
available by the:
(1) Federal Communications Commission, including
money available under the federal Rural Health Care Program;
(2) United States Health Resources and Services
Administration's Office for the Advancement of Telehealth; and
(3) United States Department of Agriculture,
including the Distance Learning and Telemedicine Grant Program
established under 7 C.F.R. Part 1734.
Sec. 74.0014. EXPIRATION. This chapter expires September
1, 2023.
SECTION 8. The heading to Subchapter E, Chapter 1367,
Insurance Code, is amended to read as follows:
SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
DEVELOPMENTAL DELAYS
SECTION 9. Section 1367.201, Insurance Code, is amended to
read as follows:
Sec. 1367.201. DEFINITION. In this subchapter,
rehabilitative and habilitative therapies and related services
include:
(1) occupational therapy evaluations and services;
(2) physical therapy evaluations and services;
(3) speech therapy evaluations and services; [and]
(4) dietary or nutritional evaluations;
(5) specialized skills training by a person certified
as an early intervention specialist;
(6) applied behavior analysis treatment by a board
certified behavior analyst or licensed psychologist; and
(7) case management provided by a person certified as
an early intervention specialist.
SECTION 10. Section 1367.202, Insurance Code, is amended to
read as follows:
Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or an individual or group evidence of coverage that is offered by:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a fraternal benefit society operating under
Chapter 885;
(D) a stipulated premium company operating under
Chapter 884;
(E) a health maintenance organization operating
under Chapter 843; or
(F) a multiple employer welfare arrangement
subject to regulation under Chapter 846;
(2) is offered by an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844; or
(3) provides health and accident coverage through a
risk pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code, or any
other law.
(b) Notwithstanding any other law, this subchapter also
applies to a standard health benefit plan provided under Chapter
1507.
(c) Notwithstanding any provision in Chapter 1575 or 1579 or
any other law, this subchapter applies to:
(1) a basic plan under Chapter 1575; and
(2) a primary care coverage plan under Chapter 1579.
SECTION 11. Section 1367.203, Insurance Code, is amended to
read as follows:
Sec. 1367.203. EXCEPTION. (a) This subchapter does not
apply to:
(1) a plan that provides coverage:
(A) only for a specified disease or for another
limited benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) only for dental or vision care; or
(G) only for indemnity for hospital confinement;
(2) a small employer health benefit plan written under
Chapter 1501;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Section 1367.202.
(b) This subchapter does not apply to a qualified health
plan to the extent that a determination is made under 45 C.F.R.
Section 155.170 that:
(1) this subchapter requires the plan to offer
benefits in addition to the essential health benefits required
under 42 U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this subchapter.
SECTION 12. Section 1367.204, Insurance Code, is amended to
read as follows:
Sec. 1367.204. PROVISION [OFFER] OF COVERAGE REQUIRED.
[(a)] A health benefit plan issuer must provide [offer] coverage
that complies with this subchapter.
[(b) The individual or group policy or contract holder may
reject coverage required to be offered under this section.]
SECTION 13. Section 1367.205, Insurance Code, is amended by
amending Subsections (a) and (b) and adding Subsection (d) to read
as follows:
(a) A health benefit plan required to provide [that
provides] coverage for rehabilitative and habilitative therapies
and related services under this subchapter may not prohibit or
restrict payment for covered services provided to a child and
determined to be necessary to and provided in accordance with an
individualized family service plan issued by the Health and Human
Services Commission [Interagency Council on Early Childhood
Intervention] under Chapter 73, Human Resources Code.
(b) Rehabilitative and habilitative therapies and related
services described by Subsection (a) must be covered in the amount,
duration, scope, and service setting established in the child's
individualized family service plan.
(d) A health benefit plan prior authorization requirement,
or another requirement that a service be authorized, otherwise
applicable to a covered rehabilitative or habilitative therapy
service or a related service is satisfied if the service is
specified in a child's individualized family service plan.
SECTION 14. Section 1367.206, Insurance Code, is amended to
read as follows:
Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
required to be provided [offered] under this subchapter, a health
benefit plan issuer may not:
(1) apply the cost of rehabilitative and habilitative
therapies and related services described by Section 1367.205(a) to
an annual or lifetime maximum plan benefit or similar provision
under the plan; or
(2) use the cost of rehabilitative or habilitative
therapies and related services described by Section 1367.205(a) as
the sole justification for:
(A) increasing plan premiums; or
(B) terminating the insured's or enrollee's
participation in the plan.
SECTION 15. Subchapter A, Chapter 302, Labor Code, is
amended by adding Section 302.0061 to read as follows:
Sec. 302.0061. WORKFORCE DEVELOPMENT GRANTS FOR PROVIDERS
UNDER EARLY CHILDHOOD INTERVENTION PROGRAM. (a) In this section,
"early childhood intervention program" means the program
established under Chapter 73, Human Resources Code, to provide
early childhood intervention services in accordance with Part C,
Individuals with Disabilities Education Act (IDEA)(20 U.S.C.
Section 1431 et seq.).
(b) The commission shall actively seek and apply for federal
funding to establish a program designed to provide workforce
development grants to providers participating in the early
childhood intervention program for purposes of improving the
provision of program services by offering providers appropriate
education and training.
SECTION 16. (a) The Health and Human Services Commission,
after consulting with the Texas Education Agency, other appropriate
state agencies, and the advisory committee established under
Section 73.004, Human Resources Code, shall conduct a financial
evaluation of the early childhood intervention services provided
under Chapter 73, Human Resources Code, and report on that
evaluation. The report must quantify the amount by which providing
early childhood intervention services in this state affects other
budget strategies.
(b) Not later than September 1, 2020, the Health and Human
Services Commission shall submit the report prepared under
Subsection (a) of this section to the governor, the lieutenant
governor, the speaker of the house of representatives, and the
presiding officers of the standing committees of the senate and
house of representatives having primary jurisdiction over the early
childhood intervention program authorized by Chapter 73, Human
Resources Code.
SECTION 17. Not later than December 1, 2019, the Health and
Human Services Commission shall issue guidance to health benefit
plan issuers clarifying that providers of early childhood
intervention services under Chapter 73, Human Resources Code, as
amended by this Act, must file claims using the national provider
identifier number and Texas provider identifier number.
SECTION 18. Section 533.00521(b), Government Code, as added
by this Act, applies to a contract entered into or renewed on or
after the effective date of this Act. A contract entered into or
renewed before that date is governed by the law in effect on the
date the contract was entered into or renewed, and that law is
continued in effect for that purpose.
SECTION 19. Subchapter E, Chapter 1367, Insurance Code, as
amended by this Act, applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2020. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2020, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 20. (a) As soon as practicable after the effective
date of this Act, but not later than January 1, 2020, the Health and
Human Services Commission shall develop and implement the
tele-connective pilot program required by Chapter 74, Human
Resources Code, as added by this Act.
(b) Immediately after the effective date of this Act, the
Health and Human Services Commission shall apply for and actively
pursue from the federal Centers for Medicare and Medicaid Services
or other appropriate federal agency any waiver or other
authorization necessary to implement Section 73.00521, Human
Resources Code, as added by this Act. The commission may delay
implementing Section 73.00521, Human Resources Code, as added by
this Act, until the waiver or authorization is granted.
(c) If before implementing any provision of this Act other
than Sections 73.00521 and 73.012(a)(1), Human Resources Code, as
added by this Act, a state agency determines that a waiver or
authorization from a federal agency is necessary for implementation
of that provision, the agency affected by the provision shall
request the waiver or authorization and may delay implementing that
provision until the waiver or authorization is granted.
SECTION 21. This Act takes effect September 1, 2019.