86R13606 JG-F
By: Klick H.B. No. 4533
A BILL TO BE ENTITLED
AN ACT
relating to the system redesign for delivery of Medicaid acute care
services and long-term services and supports to persons with an
intellectual or developmental disability.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 534.001, Government Code, is amended by
amending Subdivision (3) and adding Subdivision (11-a) to read as
follows:
(3) "Comprehensive long-term services and supports
provider" means a provider of long-term services and supports under
this chapter that ensures the coordinated, seamless delivery of the
full range of services in a recipient's program plan. The term
includes:
(A) a provider under the ICF-IID program; and
(B) a provider under a Medicaid waiver program
["Department" means the Department of Aging and Disability
Services].
(11-a) "Residential services" means services provided
to an individual with an intellectual or developmental disability
through a community-based ICF-IID or three- or four-person home or
host home setting under the home and community-based services (HCS)
waiver program.
SECTION 2. Sections 534.051 and 534.052, Government Code,
are amended to read as follows:
Sec. 534.051. ACUTE CARE SERVICES AND LONG-TERM SERVICES
AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR
DEVELOPMENTAL DISABILITY. In accordance with this chapter, the
commission [and the department] shall [jointly] design and
implement an acute care services and long-term services and
supports system for individuals with an intellectual or
developmental disability that supports the following goals:
(1) provide Medicaid services to more individuals in a
cost-efficient manner by providing the type and amount of services
most appropriate to the individuals' needs;
(2) improve individuals' access to services and
supports by ensuring that the individuals receive information about
all available programs and services, including employment and least
restrictive housing assistance, and how to apply for the programs
and services;
(3) improve the assessment of individuals' needs and
available supports, including the assessment of individuals'
functional needs;
(4) promote person-centered planning, self-direction,
self-determination, community inclusion, and customized,
integrated, competitive employment;
(5) promote individualized budgeting based on an
assessment of an individual's needs and person-centered planning;
(6) promote integrated service coordination of acute
care services and long-term services and supports;
(7) improve acute care and long-term services and
supports outcomes, including reducing unnecessary
institutionalization and potentially preventable events;
(8) promote high-quality care;
(9) provide fair hearing and appeals processes in
accordance with applicable federal law;
(10) ensure the availability of a local safety net
provider and local safety net services;
(11) promote independent service coordination and
independent ombudsmen services; and
(12) ensure that individuals with the most significant
needs are appropriately served in the community and that processes
are in place to prevent inappropriate institutionalization of
individuals.
Sec. 534.052. IMPLEMENTATION OF SYSTEM REDESIGN. The
commission [and department] shall, in consultation and
collaboration with the advisory committee, [jointly] implement the
acute care services and long-term services and supports system for
individuals with an intellectual or developmental disability in the
manner and in the stages described in this chapter.
SECTION 3. Section 534.053, Government Code, is amended by
amending Subsections (a) and (b) and adding Subsection (f-1) to
read as follows:
(a) The Intellectual and Developmental Disability System
Redesign Advisory Committee shall advise the commission [and the
department] on the implementation of the acute care services and
long-term services and supports system redesign under this
chapter. Subject to Subsection (b), the executive commissioner
[and the commissioner of aging and disability services] shall
[jointly] appoint members of the advisory committee who are
stakeholders from the intellectual and developmental disabilities
community, including:
(1) individuals with an intellectual or developmental
disability who are recipients of services under the Medicaid waiver
programs, individuals with an intellectual or developmental
disability who are recipients of services under the ICF-IID
program, and individuals who are advocates of those recipients,
including at least three representatives from intellectual and
developmental disability advocacy organizations;
(2) representatives of Medicaid managed care and
nonmanaged care health care providers, including:
(A) physicians who are primary care providers and
physicians who are specialty care providers;
(B) nonphysician mental health professionals;
and
(C) providers of long-term services and
supports, including direct service workers;
(3) representatives of entities with responsibilities
for the delivery of Medicaid long-term services and supports or
other Medicaid service delivery, including:
(A) representatives of aging and disability
resource centers established under the Aging and Disability
Resource Center initiative funded in part by the federal
Administration on Aging and the Centers for Medicare and Medicaid
Services;
(B) representatives of community mental health
and intellectual disability centers;
(C) representatives of and service coordinators
or case managers from private and public home and community-based
services providers that serve individuals with an intellectual or
developmental disability; and
(D) representatives of private and public
ICF-IID providers; and
(4) representatives of managed care organizations
contracting with the state to provide services to individuals with
an intellectual or developmental disability.
(b) To the greatest extent possible, the executive
commissioner [and the commissioner of aging and disability
services] shall appoint members of the advisory committee who
reflect the geographic diversity of the state and include members
who represent rural Medicaid recipients.
(f-1) The advisory committee is abolished January 1, 2029,
unless the commission makes a determination under Section 534.202
to not proceed with the transition described by that section and to
abolish the advisory committee on an earlier date. If the
commission makes that determination, the commission shall publish
notice of the determination in the Texas Register not later than 30
days after making the determination. The notice must specify a date
not later than January 1, 2029, on which the advisory committee is
abolished.
SECTION 4. Section 534.053(g), Government Code, as amended
by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523),
Acts of the 84th Legislature, Regular Session, 2015, is reenacted
and amended to read as follows:
(g) This section expires [On] January 1, 2029 [2026:
[(1) the advisory committee is abolished; and
[(2) this section expires].
SECTION 5. Section 534.054, Government Code, is amended by
amending Subsection (b) and adding Subsection (c) to read as
follows:
(b) If the commission makes a determination under Section
534.202 to not proceed with the transition described by that
section, the commission shall publish notice of the determination
in the Texas Register not later than 30 days after making the
determination. Notwithstanding Subsection (a), the commission is
not required to submit the report under that subsection after
publishing the notice under this subsection.
(c) This section expires January 1, 2029 [2026].
SECTION 6. The heading to Subchapter C, Chapter 534,
Government Code, is amended to read as follows:
SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING [PROGRAMS TO
IMPROVE] SERVICE DELIVERY MODELS
SECTION 7. Section 534.101, Government Code, is amended by
amending Subdivision (2) and adding Subdivision (3) to read as
follows:
(2) "Health care service region" has the meaning
assigned by Section 533.001 ["Provider" means a person with whom
the commission contracts for the provision of long-term services
and supports under Medicaid to a specific population based on
capitation].
(3) "Pilot program" means the pilot program
established under this subchapter.
SECTION 8. Sections 534.102 and 534.103, Government Code,
are amended to read as follows:
Sec. 534.102. PILOT PROGRAM [PROGRAMS] TO TEST MANAGED CARE
STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. The commission,
in consultation and collaboration with the advisory committee,
shall [and the department may] develop and implement a pilot
program [programs] in accordance with this subchapter to test,
through the STAR+PLUS Medicaid managed care program, the delivery
of home and community-based services [one or more service delivery
models involving a managed care strategy based on capitation to
deliver long-term services and supports under Medicaid] to adults
[individuals] with an intellectual or developmental disability,
subject to Section 534.1065.
Sec. 534.103. STAKEHOLDER INPUT. As part of developing and
implementing the [a] pilot program [under this subchapter], the
commission, in consultation and collaboration with the advisory
committee, [department] shall develop a process to receive and
evaluate:
(1) input from statewide stakeholders and
stakeholders from a health care service [the] region [of the state]
in which the pilot program will be implemented; and
(2) other evaluations and data.
SECTION 9. The heading to Section 534.104, Government Code,
is amended to read as follows:
Sec. 534.104. SELECTION OF [MANAGED CARE STRATEGY
PROPOSALS;] PILOT PROGRAM SERVICE DELIVERY PARTICIPANTS
[PROVIDERS].
SECTION 10. Sections 534.104(a), (b), (c), (f), (g), and
(h), Government Code, are amended to read as follows:
(a) The commission shall select and contract with one or
more managed care organizations participating in the STAR+PLUS
Medicaid managed care program to participate in the pilot program.
(b) The commission [department], in consultation and
collaboration with the advisory committee, shall develop criteria
regarding the selection of one or more managed care organizations
to participate in the pilot program [identify private services
providers or managed care organizations that are good candidates to
develop a service delivery model involving a managed care strategy
based on capitation and to test the model in the provision of
long-term services and supports under Medicaid to individuals with
an intellectual or developmental disability through a pilot program
established under this subchapter].
[(b) The department shall solicit managed care strategy
proposals from the private services providers and managed care
organizations identified under Subsection (a). In addition, the
department may accept and approve a managed care strategy proposal
from any qualified entity that is a private services provider or
managed care organization if the proposal provides for a
comprehensive array of long-term services and supports, including
case management and service coordination.]
(c) The [A managed care strategy based on capitation
developed for implementation through a] pilot program [under this
subchapter] must be designed to:
(1) increase access to home and community-based
services [long-term services and supports];
(2) improve quality of acute care services and home
and community-based services [long-term services and supports];
(3) promote meaningful outcomes by using
person-centered planning, individualized budgeting, and
self-determination, and promote community inclusion;
(4) promote integrated service coordination of acute
care services and home and community-based services [long-term
services and supports];
(5) promote efficiency and the best use of funding;
(6) promote [the placement of an individual in]
housing stability through housing supports and navigation services
[that is the least restrictive setting appropriate to the
individual's needs];
(7) promote employment assistance and customized,
integrated, and competitive employment;
(8) provide fair hearing and appeals processes in
accordance with applicable federal law; [and]
(9) promote sufficient flexibility to achieve the
goals listed in this section through the pilot program;
(10) promote the use of innovative technology and
benefits, including home monitoring, telemonitoring,
transportation, and other innovations that support community
integration;
(11) ensure an adequate provider network that includes
comprehensive long-term services and supports providers; and
(12) ensure that individuals with complex behavioral,
medical, and physical needs are appropriately served.
(f) A managed care organization participating in the [For
each pilot program service provider, the department shall develop
and implement a pilot program. Under a] pilot program[, the pilot
program service provider] shall provide long-term services and
supports under Medicaid to persons with an intellectual or
developmental disability to test its managed care strategy based on
capitation.
(g) The commission [department], in consultation and
collaboration with the advisory committee, shall analyze
information provided by the managed care organizations
participating in the pilot program [service providers] and any
information collected by the commission [department] during the
operation of the pilot program [programs] for purposes of making a
recommendation about a system of programs and services for
implementation through future state legislation or rules.
(h) The analysis under Subsection (g) must include an
assessment of the effect of the managed care strategies implemented
in the pilot program [programs] on the services required to be
provided under Subsection (f) [:
[(1) access to long-term services and supports;
[(2) the quality of acute care services and long-term
services and supports;
[(3) meaningful outcomes using person-centered
planning, individualized budgeting, and self-determination,
including a person's inclusion in the community;
[(4) the integration of service coordination of acute
care services and long-term services and supports;
[(5) the efficiency and use of funding;
[(6) the placement of individuals in housing that is
the least restrictive setting appropriate to an individual's needs;
[(7) employment assistance and customized,
integrated, competitive employment options; and
[(8) the number and types of fair hearing and appeals
processes in accordance with applicable federal law].
SECTION 11. Subchapter C, Chapter 534, Government Code, is
amended by adding Section 534.1045 to read as follows:
Sec. 534.1045. PILOT PROGRAM BENEFITS PROVIDED. The pilot
program must ensure that a managed care organization participating
in the pilot program provides:
(1) all Medicaid state plan benefits available under
the STAR+PLUS program, including:
(A) acute care services, including physical
health, behavioral health, specialty care, inpatient hospital, and
outpatient pharmacy services; and
(B) long-term services and supports, including:
(i) Community First Choice services;
(ii) personal assistance services;
(iii) day activity health services;
(iv) habilitation services; and
(v) home and community-based services,
including assisted living, personal assistance services,
employment assistance, supported employment, adult foster care,
dental care, nursing care, respite care, home-delivered meals, and
therapy services;
(2) the following additional home and community-based
services:
(A) enhanced behavioral health services;
(B) behavioral supports;
(C) day habilitation;
(D) housing supports;
(E) community support transportation; and
(F) crisis intervention services; and
(3) other home and community-based services the
commission, in consultation and coordination with the advisory
committee, determines appropriate.
SECTION 12. Sections 534.105, 534.106, 534.1065, 534.107,
534.109, and 534.111, Government Code, are amended to read as
follows:
Sec. 534.105. PILOT PROGRAM: MEASURABLE GOALS. (a) The
commission [department], in consultation and collaboration with
the advisory committee, shall identify measurable goals to be
achieved by the [each] pilot program [implemented under this
subchapter. The identified goals must:
[(1) align with information that will be collected
under Section 534.108(a); and
[(2) be designed to improve the quality of outcomes
for individuals receiving services through the pilot program].
(b) The commission [department], in consultation and
collaboration with the advisory committee, shall develop [propose]
specific strategies for achieving the identified goals. A proposed
strategy may be evidence-based if there is an evidence-based
strategy available for meeting the pilot program's goals.
Sec. 534.106. IMPLEMENTATION, LOCATION, AND DURATION. (a)
The commission [and the department] shall implement the [any] pilot
program [programs established under this subchapter] not later than
September 1, 2023 [2017].
(b) The [A] pilot program [established under this
subchapter] shall [may] operate for [up to] 24 months. [A pilot
program may cease operation if the pilot program service provider
terminates the contract with the commission before the agreed-to
termination date.]
(c) The [A] pilot program [established under this
subchapter] shall be conducted in one or more health care service
regions selected by the commission [department].
Sec. 534.1065. RECIPIENT PARTICIPATION AND ELIGIBILITY [IN
PROGRAM VOLUNTARY]. (a) Participation in the [a] pilot program
[established under this subchapter] by an individual [with an
intellectual or developmental disability] is voluntary, and the
decision whether to participate in the pilot [a] program and
receive [long-term] services under the pilot [and supports from a
provider through that] program may be made only by the individual or
the individual's legally authorized representative.
(b) The commission, in consultation and coordination with
the advisory committee, shall develop pilot program participant
eligibility criteria, including financial and functional need
criteria. The criteria must ensure pilot program participants:
(1) include:
(A) individuals with an intellectual or
developmental disability who:
(i) have significant complex behavioral,
medical, and physical needs;
(ii) are receiving home and community-based
services through the STAR+PLUS Medicaid managed care program; or
(iii) are on a Medicaid waiver program
interest list;
(B) individuals receiving services under the
STAR+PLUS Medicaid managed care program who have a traumatic brain
injury that occurred after the age of 21; and
(C) other populations determined by the
commission; and
(2) do not include individuals who are receiving only
acute care services under the STAR+PLUS Medicaid managed care
program and are enrolled in the community-based ICF-IID program or
another Medicaid waiver program.
(c) Individuals who choose to participate in the pilot
program and who, during the pilot program's implementation, are
offered enrollment in a Medicaid waiver program may accept the
enrollment offer.
Sec. 534.107. COMMISSION RESPONSIBILITIES [COORDINATING
SERVICES]. (a) The commission [In providing long-term services
and supports under Medicaid to individuals with an intellectual or
developmental disability, a pilot program service provider] shall
require that a managed care organization participating in the pilot
program:
(1) ensures that individuals participating in the
pilot program have a choice among acute care and comprehensive
long-term services and supports providers and service delivery
options, including the consumer direction model, as defined by
Section 531.051 [coordinate through the pilot program
institutional and community-based services available to the
individuals, including services provided through:
[(A) a facility licensed under Chapter 252,
Health and Safety Code;
[(B) a Medicaid waiver program; or
[(C) a community-based ICF-IID operated by local
authorities];
(2) demonstrates to the commission's satisfaction that
the organization's network of acute care and comprehensive
long-term services and supports providers have experience and
expertise in providing services for individuals with an
intellectual or developmental disability [collaborate with managed
care organizations to provide integrated coordination of acute care
services and long-term services and supports, including discharge
planning from acute care services to community-based long-term
services and supports]; and
(3) has [have] a process for preventing inappropriate
institutionalizations of individuals[; and
[(4) accept the risk of inappropriate
institutionalizations of individuals previously residing in
community settings].
(b) For purposes of the pilot program, the commission shall
ensure that comprehensive long-term services and supports
providers are considered significant traditional providers and
included in the provider network of the managed care organizations
participating in the pilot program.
Sec. 534.109. PERSON-CENTERED PLANNING. The commission,
in consultation and collaboration [cooperation] with the advisory
committee [department], shall ensure that each individual with an
intellectual or developmental disability who receives services and
supports under Medicaid through the [a] pilot program [established
under this subchapter], or the individual's legally authorized
representative, has access to a facilitated, person-centered plan
that identifies outcomes for the individual and drives the
development of the individualized budget. The consumer direction
model, as defined by Section 531.051, must be an available option
for individuals to achieve self-determination, choice, and control
[may be an outcome of the plan].
Sec. 534.111. CONCLUSION OF PILOT PROGRAM [PROGRAMS];
EXPIRATION. On September 1, 2025 [2019]:
(1) the [each] pilot program [established under this
subchapter that is still in operation] must conclude; and
(2) this subchapter expires.
SECTION 13. Section 534.151(b), Government Code, is amended
to read as follows:
(b) The commission [and the department], in consultation
and collaboration with the advisory committee, shall analyze the
outcomes of providing acute care Medicaid benefits to individuals
with an intellectual or developmental disability under a model
specified in Subsection (a). The analysis must:
(1) include an assessment of the effects on:
(A) access to and quality of acute care services;
and
(B) the number and types of fair hearing and
appeals processes in accordance with applicable federal law;
(2) be incorporated into the annual report to the
legislature required under Section 534.054; and
(3) include recommendations for delivery model
improvements and implementation for consideration by the
legislature, including recommendations for needed statutory
changes.
SECTION 14. Sections 534.152(b), (c), (f), and (g),
Government Code, are amended to read as follows:
(b) The commission shall require that each managed care
organization that contracts with the commission for the provision
of basic attendant and habilitation services under the STAR+PLUS
[STAR + PLUS] Medicaid managed care program in accordance with this
section:
(1) include in the organization's provider network for
the provision of those services:
(A) home and community support services agencies
licensed under Chapter 142, Health and Safety Code, with which
there is [the department has] a contract to provide services under
the community living assistance and support services (CLASS) waiver
program; and
(B) persons exempted from licensing under
Section 142.003(a)(19), Health and Safety Code, with which there is
[the department has] a contract to provide services under:
(i) the home and community-based services
(HCS) waiver program; or
(ii) the Texas home living (TxHmL) waiver
program;
(2) review and consider any assessment conducted by a
local intellectual and developmental disability authority
providing intellectual and developmental disability service
coordination under Subsection (c); and
(3) enter into a written agreement with each local
intellectual and developmental disability authority in the service
area regarding the processes the organization and the authority
will use to coordinate the services of individuals with an
intellectual or developmental disability.
(c) The commission [department] shall contract with and
make contract payments to local intellectual and developmental
disability authorities to conduct the following activities under
this section:
(1) provide intellectual and developmental disability
service coordination to individuals with an intellectual or
developmental disability under the STAR+PLUS [STAR + PLUS] Medicaid
managed care program by assisting those individuals who are
eligible to receive services in a community-based setting,
including individuals transitioning to a community-based setting;
(2) provide an assessment to the appropriate managed
care organization regarding whether an individual with an
intellectual or developmental disability needs attendant or
habilitation services, based on the individual's functional need,
risk factors, and desired outcomes;
(3) assist individuals with an intellectual or
developmental disability with developing the individuals' plans of
care under the STAR+PLUS [STAR + PLUS] Medicaid managed care
program, including with making any changes resulting from periodic
reassessments of the plans;
(4) provide to the appropriate managed care
organization [and the department] information regarding the
recommended plans of care with which the authorities provide
assistance as provided by Subdivision (3), including documentation
necessary to demonstrate the need for care described by a plan; and
(5) on an annual basis, provide to the appropriate
managed care organization [and the department] a description of
outcomes based on an individual's plan of care.
(f) A local intellectual and developmental disability
authority with which the commission [department] contracts under
Subsection (c) may subcontract with an eligible person, including a
nonprofit entity, to coordinate the services of individuals with an
intellectual or developmental disability under this section. The
executive commissioner by rule shall establish minimum
qualifications a person must meet to be considered an "eligible
person" under this subsection.
(g) The commission [department] may contract with providers
participating in the home and community-based services (HCS) waiver
program, the Texas home living (TxHmL) waiver program, the
community living assistance and support services (CLASS) waiver
program, or the deaf-blind with multiple disabilities (DBMD) waiver
program for the delivery of basic attendant and habilitation
services described in Subsection (a) for individuals to which that
subsection applies. The commission [department] has regulatory and
oversight authority over the providers with which the commission
[department] contracts for the delivery of those services.
SECTION 15. The heading to Subchapter E, Chapter 534,
Government Code, is amended to read as follows:
SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS
AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED
MANAGED CARE SYSTEM
SECTION 16. The heading to Section 534.201, Government
Code, is amended to read as follows:
Sec. 534.201. EVALUATION AND REPORT ON PILOT PROGRAM
[TRANSITION OF RECIPIENTS UNDER TEXAS HOME LIVING (TxHmL) WAIVER
PROGRAM TO MANAGED CARE PROGRAM].
SECTION 17. Sections 534.201(a), (b), and (g), Government
Code, are amended to read as follows:
(a) The commission, in consultation and collaboration with
the advisory committee, shall review and evaluate the progress and
outcomes of the pilot program established under Subchapter C and
submit, as part of the annual report required by Section 534.054, a
report on the status of the pilot program. The report must include
recommendations for pilot program improvement [This section
applies to individuals with an intellectual or developmental
disability who are receiving long-term services and supports under
the Texas home living (TxHmL) waiver program on the date the
commission implements the transition described by Subsection (b)].
(b) On conclusion of the pilot program established under
Subchapter C, the commission, in consultation and collaboration
with the advisory committee, shall conduct a comprehensive analysis
of the pilot program's success and prepare and submit to the
legislature a report based on that analysis [On September 1, 2020,
the commission shall transition the provision of Medicaid benefits
to individuals to whom this section applies to the STAR + PLUS
Medicaid managed care program delivery model or the most
appropriate integrated capitated managed care program delivery
model, as determined by the commission based on cost-effectiveness
and the experience of the STAR + PLUS Medicaid managed care program
in providing basic attendant and habilitation services and of the
pilot programs established under Subchapter C, subject to
Subsection (c)(1)].
(g) The comprehensive [commission, in consultation and
collaboration with the advisory committee, shall analyze the
outcomes of the transition of the long-term services and supports
under the Texas home living (TxHmL) Medicaid waiver program to a
managed care program delivery model. The] analysis conducted under
Subsection (b) must:
(1) include an assessment of the effect of the pilot
program [transition] on:
(A) access to long-term services and supports;
(B) meaningful outcomes using person-centered
planning, individualized budgeting, and self-determination,
including a person's inclusion in the community;
(C) the integration of service coordination of
acute care services and long-term services and supports;
(D) employment assistance and customized,
integrated, competitive employment options; and
(E) the number and types of fair hearing and
appeals processes in accordance with applicable federal law;
(2) provide an analysis of the experience and outcome
of the following systems changes:
(A) the comprehensive assessment instrument
described by Section 533A.0335, Health and Safety Code;
(B) the 21st Century Cures Act (Pub. L.
No. 114-255);
(C) implementation of the federal rule
establishing the home and community-based settings that are
eligible for reimbursement under the STAR+PLUS home and
community-based services (HCBS) waiver program; and
(D) the provision of basic attendant and
habilitation services under Section 534.152;
(3) include input from individuals and comprehensive
long-term services and supports providers who participated in the
pilot program about their experiences;
(4) be incorporated into the annual report to the
legislature required under Section 534.054; and
(5) [(3)] include recommendations about a system of
programs and services [for improvements to the transition
implementation] for consideration by the legislature, including
recommendations for needed statutory changes.
SECTION 18. The heading to Section 534.202, Government
Code, is amended to read as follows:
Sec. 534.202. DETERMINATION TO TRANSITION [OF] ICF-IID
PROGRAM RECIPIENTS AND CERTAIN OTHER MEDICAID WAIVER PROGRAM
RECIPIENTS TO MANAGED CARE PROGRAM.
SECTION 19. Sections 534.202(a), (b), (c), (e), and (i),
Government Code, are amended to read as follows:
(a) This section applies to individuals with an
intellectual or developmental disability who[, on the date the
commission implements the transition described by Subsection (b),]
are receiving long-term services and supports under:
(1) a Medicaid waiver program [other than the Texas
home living (TxHmL) waiver program]; or
(2) an ICF-IID program.
(b) After completing the comprehensive analysis under
[implementing the transition required by] Section 534.201(g)
[534.201], [on September 1, 2021,] the commission shall determine
whether to:
(1) establish a new pilot program to test the
provision of residential services to individuals with an
intellectual or developmental disability under the managed care
program; or
(2) transition ICF-IID and other Medicaid waiver
program recipients to the managed care program delivery model for
the provision of long-term supports and services [transition the
provision of Medicaid benefits to individuals to whom this section
applies to the STAR + PLUS Medicaid managed care program delivery
model or the most appropriate integrated capitated managed care
program delivery model, as determined by the commission based on
cost-effectiveness and the experience of the transition of Texas
home living (TxHmL) waiver program recipients to a managed care
program delivery model under Section 534.201, subject to
Subsections (c)(1) and (g)].
(c) If the commission determines to [At the time of the]
transition the provision of benefits as described by Subsection
(b), the commission shall, not later than September 1, 2027, and
subject to Subsection (g), determine whether to:
(1) continue operation of the Medicaid waiver programs
or ICF-IID program only for purposes of providing, if applicable:
(A) supplemental long-term services and supports
not available under the managed care program delivery model
selected by the commission; or
(B) long-term services and supports to Medicaid
waiver program recipients who choose to continue receiving benefits
under the waiver programs [program] as provided by Subsection (g);
or
(2) [subject to Subsection (g),] provide all or a
portion of the long-term services and supports previously available
under the Medicaid waiver programs or ICF-IID program through the
managed care program delivery model selected by the commission.
(e) The commission shall ensure that there is a
comprehensive plan for transitioning the provision of Medicaid
benefits under this section that protects the continuity of care
provided to individuals to whom this section applies and ensures
individuals have a choice among acute care and comprehensive
long-term services and supports providers and service delivery
options, including the consumer direction model, as defined by
Section 531.051.
(i) In addition to the requirements of Section 533.005, a
contract between a managed care organization and the commission for
the organization to provide Medicaid benefits under this section
must contain a requirement that the organization implement a
process for individuals with an intellectual or developmental
disability that:
(1) ensures that the individuals have a choice among
acute care and comprehensive long-term services and supports
providers and service delivery options, including the consumer
direction model, as defined by Section 531.051;
(2) to the greatest extent possible, protects those
individuals' continuity of care with respect to access to primary
care providers, including the use of single-case agreements with
out-of-network providers; and
(3) provides access to a member services phone line
for individuals or their legally authorized representatives to
obtain information on and assistance with accessing services
through network providers, including providers of primary,
specialty, and other long-term services and supports.
SECTION 20. Section 534.203, Government Code, is amended to
read as follows:
Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER
SUBCHAPTER. In administering this subchapter, the commission shall
ensure:
(1) that the commission is responsible for setting the
minimum reimbursement rate paid to a provider of ICF-IID services
or a group home provider under the integrated managed care system,
including the staff rate enhancement paid to a provider of ICF-IID
services or a group home provider;
(2) that an ICF-IID service provider or a group home
provider is paid not later than the 10th day after the date the
provider submits a clean claim in accordance with the criteria used
by the commission [department] for the reimbursement of ICF-IID
service providers or a group home provider, as applicable; [and]
(3) the establishment of an electronic portal through
which a provider of ICF-IID services or a group home provider
participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care
program delivery model or the most appropriate integrated capitated
managed care program delivery model, as appropriate, may submit
long-term services and supports claims to any participating managed
care organization; and
(4) that the consumer direction model, as defined by
Section 531.051, is an available option for each individual with an
intellectual or developmental disability who receives Medicaid
benefits in accordance with this subchapter to achieve
self-determination, choice, and control, and that the individual or
the individual's legally authorized representative has access to a
facilitated, person-centered plan that identifies outcomes for the
individual.
SECTION 21. Chapter 534, Government Code, is amended by
adding Subchapter F to read as follows:
SUBCHAPTER F. IMPLEMENTATION AND TRANSITION OF SERVICES
Sec. 534.251. DELAYED IMPLEMENTATION AUTHORIZED.
Notwithstanding any other law, the commission may delay
implementation of a provision of this chapter if the commission
determines the provision adversely affects the system of services
and supports to persons and programs to which this chapter applies.
Sec. 534.252. REQUIREMENTS REGARDING TRANSITION OF
SERVICES. For purposes of implementing the pilot program under
Subchapter C and transitioning the provision of long-term services
and supports to recipients to a Medicaid managed care delivery
model following completion of the pilot program, the commission
shall:
(1) implement and maintain a credentialing process for
and maintain regulatory oversight over providers under the Texas
home living (TxHmL) and home and community-based services (HCS)
waiver programs; and
(2) require managed care organizations to include in
the organizations' provider networks qualified comprehensive
long-term services and supports providers and providers under the
Texas home living (TxHmL) and home and community-based services
(HCS) waiver programs that specialize in services for persons with
intellectual disabilities.
SECTION 22. The following provisions of the Government Code
are repealed:
(1) Sections 534.104(d) and (e);
(2) Section 534.108;
(3) Section 534.110; and
(4) Sections 534.201(c), (d), (e), and (f).
SECTION 23. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules as necessary to implement the
changes in law made by this Act.
SECTION 24. If before implementing any provision of 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 25. This Act takes effect September 1, 2019.