Texas 2019 - 86th Regular

Texas House Bill HB4533 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	H.B. No. 4533
	1	+	By: Klick, Raymond (Senate Sponsor - Kolkhorst) H.B. No. 4533
	2	+	(In the Senate - Received from the House May 13, 2019;
	3	+	May 13, 2019, read first time and referred to Committee on Health &
	4	+	Human Services; May 17, 2019, reported favorably by the following
	5	+	vote: Yeas 9, Nays 0; May 17, 2019, sent to printer.)
	6	+	Click here to see the committee vote
2	7
3	8
	9	+	A BILL TO BE ENTITLED
4	10		AN ACT
5		-	relating to the administration and operation of Medicaid, including
6		-	Medicaid managed care and the delivery of Medicaid acute care
7		-	services and long-term services and supports to certain persons.
	11	+	relating to the system redesign for delivery of Medicaid acute care
	12	+	services and long-term services and supports to persons with an
	13	+	intellectual or developmental disability or with similar
	14	+	functional needs.
8	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9		-	SECTION 1. Section 531.001, Government Code, is amended by
10		-	adding Subdivision (4-c) to read as follows:
11		-	(4-c) "Medicaid managed care organization" means a
12		-	managed care organization as defined by Section 533.001 that
13		-	contracts with the commission under Chapter 533 to provide health
14		-	care services to Medicaid recipients.
15		-	SECTION 2. Subchapter B, Chapter 531, Government Code, is
16		-	amended by adding Sections 531.021182, 531.02131, 531.02142,
17		-	531.024162, and 531.0511 to read as follows:
18		-	Sec. 531.021182. USE OF NATIONAL PROVIDER IDENTIFIER
19		-	NUMBER. (a) In this section, "national provider identifier
20		-	number" means the national provider identifier number required
21		-	under Section 1128J(e), Social Security Act (42 U.S.C. Section
22		-	1320a-7k(e)).
23		-	(b) The commission shall transition from using a
24		-	state-issued provider identifier number to using only a national
25		-	provider identifier number in accordance with this section.
26		-	(c) The commission shall implement a Medicaid provider
27		-	management and enrollment system and, following that
28		-	implementation, use only a national provider identifier number to
29		-	enroll a provider in Medicaid.
30		-	(d) The commission shall implement a modernized claims
31		-	processing system and, following that implementation, use only a
32		-	national provider identifier number to process claims for and
33		-	authorize Medicaid services.
34		-	Sec. 531.02131. GRIEVANCES RELATED TO MEDICAID. (a) The
35		-	commission shall adopt a definition of "grievance" related to
36		-	Medicaid and ensure the definition is consistent among divisions
37		-	within the commission to ensure all grievances are managed
38		-	consistently.
39		-	(b) The commission shall standardize Medicaid grievance
40		-	data reporting and tracking among divisions within the commission.
41		-	(c) The commission shall implement a no-wrong-door system
42		-	for Medicaid grievances reported to the commission.
43		-	(d) The commission shall establish a procedure for
44		-	expedited resolution of a grievance related to Medicaid that allows
45		-	the commission to:
46		-	(1) identify a grievance related to a Medicaid access
47		-	to care issue that is urgent and requires an expedited resolution;
48		-	and
49		-	(2) resolve the grievance within a specified period.
50		-	(e) The commission shall verify grievance data reported by a
51		-	Medicaid managed care organization.
52		-	(f) The commission shall:
53		-	(1) aggregate Medicaid recipient and provider
54		-	grievance data to provide a comprehensive data set of grievances;
55		-	and
56		-	(2) make the aggregated data available to the
57		-	legislature and the public in a manner that does not allow for the
58		-	identification of a particular recipient or provider.
59		-	Sec. 531.02142. PUBLIC ACCESS TO CERTAIN MEDICAID DATA.
60		-	(a) To the extent permitted by federal law, the commission in
61		-	consultation and collaboration with the appropriate advisory
62		-	committees related to Medicaid shall make available to the public
63		-	on the commission's Internet website in an easy-to-read format data
64		-	relating to the quality of health care received by Medicaid
65		-	recipients and the health outcomes of those recipients. Data made
66		-	available to the public under this section must be made available in
67		-	a manner that does not identify or allow for the identification of
68		-	individual recipients.
69		-	(b) In performing its duties under this section, the
70		-	commission may collaborate with an institution of higher education
71		-	or another state agency with experience in analyzing and producing
72		-	public use data.
73		-	Sec. 531.024162. NOTICE REQUIREMENTS REGARDING DENIAL OF
74		-	COVERAGE OR PRIOR AUTHORIZATION. (a) The commission shall ensure
75		-	that notice sent by the commission or a Medicaid managed care
76		-	organization to a Medicaid recipient or provider regarding the
77		-	denial of coverage or prior authorization for a service includes:
78		-	(1) information required by federal law;
79		-	(2) a clear and easy-to-understand explanation of the
80		-	reason for the denial for the recipient; and
81		-	(3) a clinical explanation of the reason for the
82		-	denial for the provider.
83		-	(b) To ensure cost-effectiveness, the commission may
84		-	implement the notice requirements described by Subsection (a) at
85		-	the same time as other required or scheduled notice changes.
86		-	Sec. 531.0511. MEDICALLY DEPENDENT CHILDREN WAIVER
87		-	PROGRAM: CONSUMER DIRECTION OF SERVICES. Notwithstanding Sections
88		-	531.051(c)(1) and (d), a consumer direction model implemented under
89		-	Section 531.051, including the consumer-directed service option,
90		-	for the delivery of services under the medically dependent children
91		-	(MDCP) waiver program must allow for the delivery of all services
92		-	and supports available under that program through consumer
93		-	direction.
94		-	SECTION 3. Section 533.00253(a)(1), Government Code, is
95		-	amended to read as follows:
96		-	(1) "Advisory committee" means the STAR Kids Managed
97		-	Care Advisory Committee described by [established under] Section
98		-	533.00254.
99		-	SECTION 4. Section 533.00253, Government Code, is amended
100		-	by amending Subsection (c) and adding Subsections (f), (g), and (h)
101		-	to read as follows:
102		-	(c) The commission may require that care management
103		-	services made available as provided by Subsection (b)(7):
104		-	(1) incorporate best practices, as determined by the
105		-	commission;
106		-	(2) integrate with a nurse advice line to ensure
107		-	appropriate redirection rates;
108		-	(3) use an identification and stratification
109		-	methodology that identifies recipients who have the greatest need
110		-	for services;
111		-	(4) provide a care needs assessment for a recipient
112		-	[that is comprehensive, holistic, consumer-directed,
113		-	evidence-based, and takes into consideration social and medical
114		-	issues, for purposes of prioritizing the recipient's needs that
115		-	threaten independent living];
116		-	(5) are delivered through multidisciplinary care
117		-	teams located in different geographic areas of this state that use
118		-	in-person contact with recipients and their caregivers;
119		-	(6) identify immediate interventions for transition
120		-	of care;
121		-	(7) include monitoring and reporting outcomes that, at
122		-	a minimum, include:
123		-	(A) recipient quality of life;
124		-	(B) recipient satisfaction; and
125		-	(C) other financial and clinical metrics
126		-	determined appropriate by the commission; and
127		-	(8) use innovations in the provision of services.
128		-	(f) Using existing resources, the executive commissioner in
129		-	consultation and collaboration with the advisory committee shall
130		-	determine the feasibility of providing Medicaid benefits to
131		-	children enrolled in the STAR Kids managed care program under:
132		-	(1) an accountable care organization model in
133		-	accordance with guidelines established by the Centers for Medicare
134		-	and Medicaid Services; or
135		-	(2) an alternative model developed by or in
136		-	collaboration with the Centers for Medicare and Medicaid Services
137		-	Innovation Center.
138		-	(g) Not later than December 1, 2022, the commission shall
139		-	prepare and submit a written report to the legislature of the
140		-	executive commissioner's determination under Subsection (f).
141		-	(h) Subsections (f) and (g) and this subsection expire
142		-	September 1, 2023.
143		-	SECTION 5. Subchapter A, Chapter 533, Government Code, is
144		-	amended by adding Sections 533.00254 and 533.0031 to read as
145		-	follows:
146		-	Sec. 533.00254. STAR KIDS MANAGED CARE ADVISORY COMMITTEE.
147		-	(a) The STAR Kids Managed Care Advisory Committee established by
148		-	the executive commissioner under Section 531.012 shall:
149		-	(1) advise the commission on the operation of the STAR
150		-	Kids managed care program under Section 533.00253; and
151		-	(2) make recommendations for improvements to that
152		-	program.
153		-	(b) On December 31, 2023:
154		-	(1) the advisory committee is abolished; and
155		-	(2) this section expires.
156		-	Sec. 533.0031. MEDICAID MANAGED CARE PLAN ACCREDITATION.
157		-	(a) A managed care plan offered by a Medicaid managed care
158		-	organization must be accredited by a nationally recognized
159		-	accreditation organization. The commission may choose whether to
160		-	require all managed care plans offered by Medicaid managed care
161		-	organizations to be accredited by the same organization or to allow
162		-	for accreditation by different organizations.
163		-	(b) The commission may use the data, scoring, and other
164		-	information provided to or received from an accreditation
165		-	organization in the commission's contract oversight processes.
166		-	SECTION 6. Section 534.001, Government Code, is amended by
	16	+	SECTION 1. Section 534.001, Government Code, is amended by
167	17		amending Subdivision (3) and adding Subdivisions (3-a) and (11-a)
168	18		to read as follows:
169	19		(3) "Comprehensive long-term services and supports
170	20		provider" means a provider of long-term services and supports under
171	21		this chapter that ensures the coordinated, seamless delivery of the
172	22		full range of services in a recipient's program plan. The term
173	23		includes:
174	24		(A) a provider under the ICF-IID program; and
175	25		(B) a provider under a Medicaid waiver program
176	26		["Department" means the Department of Aging and Disability
177	27		Services].
178	28		(3-a) "Consumer direction model" has the meaning
179	29		assigned by Section 531.051.
180	30		(11-a) "Residential services" means services provided
181	31		to an individual with an intellectual or developmental disability
182	32		through a community-based ICF-IID, three- or four-person home or
183	33		host home setting under the home and community-based services (HCS)
184	34		waiver program, or a group home under the deaf-blind with multiple
185	35		disabilities (DBMD) waiver program.
186		-	SECTION 7. Sections 534.051 and 534.052, Government Code,
	36	+	SECTION 2. Sections 534.051 and 534.052, Government Code,
187	37		are amended to read as follows:
188	38		Sec. 534.051. ACUTE CARE SERVICES AND LONG-TERM SERVICES
189	39		AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR
190	40		DEVELOPMENTAL DISABILITY. In accordance with this chapter, the
191	41		commission [and the department] shall [jointly] design and
192	42		implement an acute care services and long-term services and
193	43		supports system for individuals with an intellectual or
194	44		developmental disability that supports the following goals:
195	45		(1) provide Medicaid services to more individuals in a
196	46		cost-efficient manner by providing the type and amount of services
197	47		most appropriate to the individuals' needs and preferences in the
198	48		most integrated and least restrictive setting;
199	49		(2) improve individuals' access to services and
200	50		supports by ensuring that the individuals receive information about
201	51		all available programs and services, including employment and least
202	52		restrictive housing assistance, and how to apply for the programs
203	53		and services;
204	54		(3) improve the assessment of individuals' needs and
205	55		available supports, including the assessment of individuals'
206	56		functional needs;
207	57		(4) promote person-centered planning, self-direction,
208	58		self-determination, community inclusion, and customized,
209	59		integrated, competitive employment;
210	60		(5) promote individualized budgeting based on an
211	61		assessment of an individual's needs and person-centered planning;
212	62		(6) promote integrated service coordination of acute
213	63		care services and long-term services and supports;
214	64		(7) improve acute care and long-term services and
215	65		supports outcomes, including reducing unnecessary
216	66		institutionalization and potentially preventable events;
217	67		(8) promote high-quality care;
218	68		(9) provide fair hearing and appeals processes in
219	69		accordance with applicable federal law;
220	70		(10) ensure the availability of a local safety net
221	71		provider and local safety net services;
222	72		(11) promote independent service coordination and
223	73		independent ombudsmen services; and
224	74		(12) ensure that individuals with the most significant
225	75		needs are appropriately served in the community and that processes
226	76		are in place to prevent inappropriate institutionalization of
227	77		individuals.
228	78		Sec. 534.052. IMPLEMENTATION OF SYSTEM REDESIGN. The
229	79		commission [and department] shall, in consultation and
230	80		collaboration with the advisory committee, [jointly] implement the
231	81		acute care services and long-term services and supports system for
232	82		individuals with an intellectual or developmental disability in the
233	83		manner and in the stages described in this chapter.
234		-	SECTION 8. Sections 534.053(a) and (b), Government Code,
	84	+	SECTION 3. Sections 534.053(a) and (b), Government Code,
235	85		are amended to read as follows:
236	86		(a) The Intellectual and Developmental Disability System
237	87		Redesign Advisory Committee shall advise the commission [and the
238	88		department] on the implementation of the acute care services and
239	89		long-term services and supports system redesign under this
240	90		chapter. Subject to Subsection (b), the executive commissioner
241	91		[and the commissioner of aging and disability services] shall
242	92		[jointly] appoint members of the advisory committee who are
243	93		stakeholders from the intellectual and developmental disabilities
244	94		community, including:
245	95		(1) individuals with an intellectual or developmental
246	96		disability who are recipients of services under the Medicaid waiver
247	97		programs, individuals with an intellectual or developmental
248	98		disability who are recipients of services under the ICF-IID
249	99		program, and individuals who are advocates of those recipients,
250	100		including at least three representatives from intellectual and
251	101		developmental disability advocacy organizations;
252	102		(2) representatives of Medicaid managed care and
253	103		nonmanaged care health care providers, including:
254	104		(A) physicians who are primary care providers and
255	105		physicians who are specialty care providers;
256	106		(B) nonphysician mental health professionals;
257	107		and
258	108		(C) providers of long-term services and
259	109		supports, including direct service workers;
260	110		(3) representatives of entities with responsibilities
261	111		for the delivery of Medicaid long-term services and supports or
262	112		other Medicaid service delivery, including:
263	113		(A) representatives of aging and disability
264	114		resource centers established under the Aging and Disability
265	115		Resource Center initiative funded in part by the federal
266	116		Administration on Aging and the Centers for Medicare and Medicaid
267	117		Services;
268	118		(B) representatives of community mental health
269	119		and intellectual disability centers;
270	120		(C) representatives of and service coordinators
271	121		or case managers from private and public home and community-based
272	122		services providers that serve individuals with an intellectual or
273	123		developmental disability; and
274	124		(D) representatives of private and public
275	125		ICF-IID providers; and
276	126		(4) representatives of managed care organizations
277	127		contracting with the state to provide services to individuals with
278	128		an intellectual or developmental disability.
279	129		(b) To the greatest extent possible, the executive
280	130		commissioner [and the commissioner of aging and disability
281	131		services] shall appoint members of the advisory committee who
282	132		reflect the geographic diversity of the state and include members
283	133		who represent rural Medicaid recipients.
284		-	SECTION 9. Section 534.053(g), Government Code, as amended
	134	+	SECTION 4. Section 534.053(g), Government Code, as amended
285	135		by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523),
286	136		Acts of the 84th Legislature, Regular Session, 2015, is reenacted
287	137		and amended to read as follows:
288	138		(g) On the second [one-year] anniversary of the date the
289	139		commission completes implementation of the transition required
290	140		under Section 534.202:
291	141		(1) the advisory committee is abolished; and
292	142		(2) this section expires.
293		-	SECTION 10. Section 534.054(b), Government Code, is amended
	143	+	SECTION 5. Section 534.054(b), Government Code, is amended
294	144		to read as follows:
295	145		(b) This section expires on the second anniversary of the
296	146		date the commission completes implementation of the transition
297	147		required under Section 534.202 [January 1, 2026].
298		-	SECTION 11. The heading to Subchapter C, Chapter 534,
	148	+	SECTION 6. The heading to Subchapter C, Chapter 534,
299	149		Government Code, is amended to read as follows:
300	150		SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING [PROGRAMS TO
301	151		IMPROVE] SERVICE DELIVERY MODELS
302		-	SECTION 12. Section 534.101, Government Code, is amended by
	152	+	SECTION 7. Section 534.101, Government Code, is amended by
303	153		amending Subdivision (2) and adding Subdivision (3) to read as
304	154		follows:
305	155		(2) "Pilot program" means the pilot program
306	156		established under this subchapter ["Provider" means a person with
307	157		whom the commission contracts for the provision of long-term
308	158		services and supports under Medicaid to a specific population based
309	159		on capitation].
310	160		(3) "Pilot program workgroup" means the pilot program
311	161		workgroup established under Section 534.1015.
312		-	SECTION 13. Subchapter C, Chapter 534, Government Code, is
	162	+	SECTION 8. Subchapter C, Chapter 534, Government Code, is
313	163		amended by adding Section 534.1015 to read as follows:
314	164		Sec. 534.1015. PILOT PROGRAM WORKGROUP. (a) The executive
315	165		commissioner, in consultation with the advisory committee, shall
316	166		establish a pilot program workgroup to provide assistance in
317	167		developing and advice concerning the operation of the pilot
318	168		program.
319	169		(b) The pilot program workgroup is composed of:
320	170		(1) representatives of the advisory committee;
321	171		(2) stakeholders representing individuals with an
322	172		intellectual or developmental disability;
323	173		(3) stakeholders representing individuals with
324	174		similar functional needs as those individuals described by
325	175		Subdivision (2); and
326	176		(4) representatives of managed care organizations
327	177		that contract with the commission to provide services under the
328	178		STAR+PLUS Medicaid managed care program.
329	179		(c) Chapter 2110 applies to the pilot program workgroup.
330		-	SECTION 14. Sections 534.102 and 534.103, Government Code,
	180	+	SECTION 9. Sections 534.102 and 534.103, Government Code,
331	181		are amended to read as follows:
332	182		Sec. 534.102. PILOT PROGRAM [PROGRAMS] TO TEST
333	183		PERSON-CENTERED MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON
334	184		CAPITATION. The commission, in consultation and collaboration with
335	185		the advisory committee and pilot program workgroup, shall [and the
336	186		department may] develop and implement a pilot program [programs] in
337	187		accordance with this subchapter to test, through the STAR+PLUS
338	188		Medicaid managed care program, the delivery of [one or more service
339	189		delivery models involving a managed care strategy based on
340	190		capitation to deliver] long-term services and supports [under
341	191		Medicaid] to individuals participating in the pilot program [with
342	192		an intellectual or developmental disability].
343	193		Sec. 534.103. STAKEHOLDER INPUT. As part of developing and
344	194		implementing the [a] pilot program [under this subchapter], the
345	195		commission, in consultation and collaboration with the advisory
346	196		committee and pilot program workgroup, [department] shall develop a
347	197		process to receive and evaluate:
348	198		(1) input from statewide stakeholders and
349	199		stakeholders from a STAR+PLUS Medicaid managed care service area
350	200		[the region of the state] in which the pilot program will be
351	201		implemented; and
352	202		(2) other evaluations and data.
353		-	SECTION 15. Subchapter C, Chapter 534, Government Code, is
	203	+	SECTION 10. Subchapter C, Chapter 534, Government Code, is
354	204		amended by adding Section 534.1035 to read as follows:
355	205		Sec. 534.1035. MANAGED CARE ORGANIZATION SELECTION. (a)
356	206		The commission, in consultation and collaboration with the advisory
357	207		committee and pilot program workgroup, shall develop criteria
358	208		regarding the selection of a managed care organization to
359	209		participate in the pilot program.
360	210		(b) The commission shall select and contract with not more
361	211		than two managed care organizations that contract with the
362	212		commission to provide services under the STAR+PLUS Medicaid managed
363	213		care program to participate in the pilot program.
364		-	SECTION 16. Section 534.104, Government Code, is amended to
	214	+	SECTION 11. Section 534.104, Government Code, is amended to
365	215		read as follows:
366	216		Sec. 534.104. [MANAGED CARE STRATEGY PROPOSALS;] PILOT
367	217		PROGRAM DESIGN [SERVICE PROVIDERS]. (a) The [department, in
368	218		consultation and collaboration with the advisory committee, shall
369	219		identify private services providers or managed care organizations
370	220		that are good candidates to develop a service delivery model
371	221		involving a managed care strategy based on capitation and to test
372	222		the model in the provision of long-term services and supports under
373	223		Medicaid to individuals with an intellectual or developmental
374	224		disability through a pilot program established under this
375	225		subchapter.
376	226		[(b) The department shall solicit managed care strategy
377	227		proposals from the private services providers and managed care
378	228		organizations identified under Subsection (a). In addition, the
379	229		department may accept and approve a managed care strategy proposal
380	230		from any qualified entity that is a private services provider or
381	231		managed care organization if the proposal provides for a
382	232		comprehensive array of long-term services and supports, including
383	233		case management and service coordination.
384	234		[(c) A managed care strategy based on capitation developed
385	235		for implementation through a] pilot program [under this subchapter]
386	236		must be designed to:
387	237		(1) increase access to long-term services and
388	238		supports;
389	239		(2) improve quality of acute care services and
390	240		long-term services and supports;
391	241		(3) promote:
392	242		(A) informed choice and meaningful outcomes by
393	243		using person-centered planning, flexible consumer-directed
394	244		services, individualized budgeting, and self-determination;[,] and
395	245		(B) [promote] community inclusion and
396	246		engagement;
397	247		(4) promote integrated service coordination of acute
398	248		care services and long-term services and supports;
399	249		(5) promote efficiency and the best use of funding
400	250		based on an individual's needs and preferences;
401	251		(6) promote through housing supports and navigation
402	252		services stability [the placement of an individual] in housing that
403	253		is the most integrated and least restrictive based on [setting
404	254		appropriate to] the individual's needs and preferences;
405	255		(7) promote employment assistance and customized,
406	256		integrated, and competitive employment;
407	257		(8) provide fair hearing and appeals processes in
408	258		accordance with applicable federal and state law; [and]
409	259		(9) promote sufficient flexibility to achieve the
410	260		goals listed in this section through the pilot program;
411	261		(10) promote the use of innovative technologies and
412	262		benefits, including telemedicine, telemonitoring, the testing of
413	263		remote monitoring, transportation services, and other innovations
414	264		that support community integration;
415	265		(11) ensure an adequate provider network that includes
416	266		comprehensive long-term services and supports providers and ensure
417	267		that pilot program participants have a choice among those
418	268		providers;
419	269		(12) ensure the timely initiation and consistent
420	270		provision of long-term services and supports in accordance with an
421	271		individual's person-centered plan;
422	272		(13) ensure that individuals with complex behavioral,
423	273		medical, and physical needs are assessed and receive appropriate
424	274		services in the most integrated and least restrictive setting based
425	275		on the individuals' needs and preferences;
426	276		(14) increase access to, expand flexibility of, and
427	277		promote the use of the consumer direction model; and
428	278		(15) promote independence, self-determination, the
429	279		use of the consumer direction model, and decision making by
430	280		individuals participating in the pilot program by using
431	281		alternatives to guardianship, including a supported
432	282		decision-making agreement as defined by Section 1357.002, Estates
433	283		Code.
434	284		(b) An individual is not required to use an innovative
435	285		technology described by Subsection (a)(10). If an individual
436	286		chooses to use an innovative technology described by that
437	287		subdivision, the commission shall ensure that services associated
438	288		with the technology are delivered in a manner that:
439	289		(1) ensures the individual's privacy, health, and
440	290		well-being;
441	291		(2) provides access to housing in the most integrated
442	292		and least restrictive environment;
443	293		(3) assesses individual needs and preferences to
444	294		promote autonomy, self-determination, the use of the consumer
445	295		direction model, and privacy;
446	296		(4) increases personal independence;
447	297		(5) specifies the extent to which the innovative
448	298		technology will be used, including:
449	299		(A) the times of day during which the technology
450	300		will be used;
451	301		(B) the place in which the technology may be
452	302		used;
453	303		(C) the types of telemonitoring or remote
454	304		monitoring that will be used; and
455	305		(D) for what purposes the technology will be
456	306		used;
457	307		(6) is consistent with and agreed on during the
458	308		person-centered planning process;
459	309		(7) ensures that staff overseeing the use of an
460	310		innovative technology:
461	311		(A) review the person-centered and
462	312		implementation plans for each individual before overseeing the use
463	313		of the innovative technology; and
464	314		(B) demonstrate competency regarding the support
465	315		needs of each individual using the innovative technology;
466	316		(8) ensures that an individual using an innovative
467	317		technology is able to request the removal of equipment relating to
468	318		the technology and, on receipt of a request for the removal, the
469	319		equipment is immediately removed; and
470	320		(9) ensures that an individual is not required to use
471	321		telemedicine at any point during the pilot program and, in the event
472	322		the individual refuses to use telemedicine, the managed care
473	323		organization providing health care services to the individual under
474	324		the pilot program arranges for services that do not include
475	325		telemedicine.
476	326		(c) The pilot program must be designed to test innovative
477	327		payment rates and methodologies for the provision of long-term
478	328		services and supports to achieve the goals of the pilot program by
479	329		using payment methodologies that include:
480	330		(1) the payment of a bundled amount without downside
481	331		risk to a comprehensive long-term services and supports provider
482	332		for some or all services delivered as part of a comprehensive array
483	333		of long-term services and supports;
484	334		(2) enhanced incentive payments to comprehensive
485	335		long-term services and supports providers based on the completion
486	336		of predetermined outcomes or quality metrics; and
487	337		(3) any other payment models approved by the
488	338		commission.
489	339		(d) An alternative payment rate or methodology described by
490	340		Subsection (c) may be used for a managed care organization and
491	341		comprehensive long-term services and supports provider only if the
492	342		organization and provider agree in advance and in writing to use the
493	343		rate or methodology [The department, in consultation and
494	344		collaboration with the advisory committee, shall evaluate each
495	345		submitted managed care strategy proposal and determine whether:
496	346		[(1) the proposed strategy satisfies the requirements
497	347		of this section; and
498	348		[(2) the private services provider or managed care
499	349		organization that submitted the proposal has a demonstrated ability
500	350		to provide the long-term services and supports appropriate to the
501	351		individuals who will receive services through the pilot program
502	352		based on the proposed strategy, if implemented].
503	353		(e) In developing an alternative payment rate or
504	354		methodology described by Subsection (c), the commission, managed
505	355		care organizations, and comprehensive long-term services and
506	356		supports providers shall consider:
507	357		(1) the historical costs of long-term services and
508	358		supports, including Medicaid fee-for-service rates;
509	359		(2) reasonable cost estimates for new services under
510	360		the pilot program; and
511	361		(3) whether an alternative payment rate or methodology
512	362		is sufficient to promote quality outcomes and ensure a provider's
513	363		continued participation in the pilot program [Based on the
514	364		evaluation performed under Subsection (d), the department may
515	365		select as pilot program service providers one or more private
516	366		services providers or managed care organizations with whom the
517	367		commission will contract].
518	368		(f) An alternative payment rate or methodology described by
519	369		Subsection (c) may not reduce the minimum payment received by a
520	370		provider for the delivery of long-term services and supports under
521	371		the pilot program below the fee-for-service reimbursement rate
522	372		received by the provider for the delivery of those services before
523	373		participating in the pilot program.
524	374		(g) The pilot program must allow a comprehensive long-term
525	375		services and supports provider for individuals with an intellectual
526	376		or developmental disability or similar functional needs that
527	377		contracts with the commission to provide services under Medicaid
528	378		before the implementation date of the pilot program to voluntarily
529	379		participate in the pilot program. A provider's choice not to
530	380		participate in the pilot program does not affect the provider's
531	381		status as a significant traditional provider.
532	382		(h) [(f) For each pilot program service provider, the
533	383		department shall develop and implement a pilot program.] Under the
534	384		[a] pilot program, a participating managed care organization [the
535	385		pilot program service provider] shall provide long-term services
536	386		and supports under Medicaid to persons with an intellectual or
537	387		developmental disability and persons with similar functional needs
538	388		to test its managed care strategy based on capitation.
539	389		(i) [(g)] The commission [department], in consultation and
540	390		collaboration with the advisory committee and pilot program
541	391		workgroup, shall analyze information provided by the managed care
542	392		organizations participating in the pilot program [service
543	393		providers] and any information collected by the commission
544	394		[department] during the operation of the pilot program [programs]
545	395		for purposes of making a recommendation about a system of programs
546	396		and services for implementation through future state legislation or
547	397		rules.
548	398		(j) [(h)] The analysis under Subsection (i) [(g)] must
549	399		include an assessment of the effect of the managed care strategies
550	400		implemented in the pilot program [programs] on the goals described
551	401		by this section [:
552	402		[(1) access to long-term services and supports;
553	403		[(2) the quality of acute care services and long-term
554	404		services and supports;
555	405		[(3) meaningful outcomes using person-centered
556	406		planning, individualized budgeting, and self-determination,
557	407		including a person's inclusion in the community;
558	408		[(4) the integration of service coordination of acute
559	409		care services and long-term services and supports;
560	410		[(5) the efficiency and use of funding;
561	411		[(6) the placement of individuals in housing that is
562	412		the least restrictive setting appropriate to an individual's needs;
563	413		[(7) employment assistance and customized,
564	414		integrated, competitive employment options; and
565	415		[(8) the number and types of fair hearing and appeals
566	416		processes in accordance with applicable federal law].
567	417		(k) Before implementing the pilot program, the commission,
568	418		in consultation and collaboration with the advisory committee and
569	419		pilot program workgroup, shall develop and implement a process to
570	420		ensure pilot program participants remain eligible for Medicaid
571	421		benefits for 12 consecutive months during the pilot program.
572		-	SECTION 17. Subchapter C, Chapter 534, Government Code, is
	422	+	SECTION 12. Subchapter C, Chapter 534, Government Code, is
573	423		amended by adding Section 534.1045 to read as follows:
574	424		Sec. 534.1045. PILOT PROGRAM BENEFITS AND PROVIDER
575	425		QUALIFICATIONS. (a) Subject to Subsection (b), the commission
576	426		shall ensure that a managed care organization participating in the
577	427		pilot program provides:
578	428		(1) all Medicaid state plan acute care benefits
579	429		available under the STAR+PLUS Medicaid managed care program;
580	430		(2) long-term services and supports under the Medicaid
581	431		state plan, including:
582	432		(A) Community First Choice services;
583	433		(B) personal assistance services;
584	434		(C) day activity health services; and
585	435		(D) habilitation services;
586	436		(3) long-term services and supports under the
587	437		STAR+PLUS home and community-based services (HCBS) waiver program,
588	438		including:
589	439		(A) assisted living services;
590	440		(B) personal assistance services;
591	441		(C) employment assistance;
592	442		(D) supported employment;
593	443		(E) adult foster care;
594	444		(F) dental care;
595	445		(G) nursing care;
596	446		(H) respite care;
597	447		(I) home-delivered meals;
598	448		(J) cognitive rehabilitative therapy;
599	449		(K) physical therapy;
600	450		(L) occupational therapy;
601	451		(M) speech-language pathology;
602	452		(N) medical supplies;
603	453		(O) minor home modifications; and
604	454		(P) adaptive aids;
605	455		(4) the following long-term services and supports
606	456		under a Medicaid waiver program:
607	457		(A) enhanced behavioral health services;
608	458		(B) behavioral supports;
609	459		(C) day habilitation; and
610	460		(D) community support transportation;
611	461		(5) the following additional long-term services and
612	462		supports:
613	463		(A) housing supports;
614	464		(B) behavioral health crisis intervention
615	465		services; and
616		-	(C) high medical needs services;
	466	+	(C) high medical needs services; and
617	467		(6) other nonresidential long-term services and
618	468		supports that the commission, in consultation and collaboration
619	469		with the advisory committee and pilot program workgroup, determines
620	470		are appropriate and consistent with applicable requirements
621	471		governing the Medicaid waiver programs, person-centered
622	472		approaches, home and community-based setting requirements, and
623	473		achieving the most integrated and least restrictive setting based
624		-	on an individual's needs and preferences; and
625		-	(7) dental services benefits in accordance with
626		-	Subsection (a-1).
627		-	(a-1) In developing the pilot program, the commission
628		-	shall:
629		-	(1) evaluate dental services benefits provided
630		-	through Medicaid waiver programs and dental services benefits
631		-	provided as a value-added service under the Medicaid managed care
632		-	delivery model;
633		-	(2) determine which dental services benefits are the
634		-	most cost-effective in reducing emergency room and inpatient
635		-	hospital admissions due to poor oral health; and
636		-	(3) based on the determination made under Subdivision
637		-	(2), provide the most cost-effective dental services benefits to
638		-	pilot program participants.
	474	+	on an individual's needs and preferences.
639	475		(b) A comprehensive long-term services and supports
640	476		provider may deliver services listed under the following provisions
641	477		only if the provider also delivers the services under a Medicaid
642	478		waiver program:
643	479		(1) Subsections (a)(2)(A) and (D);
644	480		(2) Subsections (a)(3)(B), (C), (D), (G), (H), (J),
645	481		(K), (L), and (M); and
646	482		(3) Subsection (a)(4).
647	483		(c) A comprehensive long-term services and supports
648	484		provider may deliver services listed under Subsections (a)(5) and
649	485		(6) only if the managed care organization in the network of which
650	486		the provider participates agrees to, in a contract with the
651	487		provider, the provision of those services.
652	488		(d) Day habilitation services listed under Subsection
653	489		(a)(4)(C) may be delivered by a provider who contracts or
654	490		subcontracts with the commission to provide day habilitation
655	491		services under the home and community-based services (HCS) waiver
656	492		program or the ICF-IID program.
657	493		(e) A comprehensive long-term services and supports
658	494		provider participating in the pilot program shall work in
659	495		coordination with the care coordinators of a managed care
660	496		organization participating in the pilot program to ensure the
661	497		seamless delivery of acute care and long-term services and supports
662	498		on a daily basis in accordance with an individual's plan of care. A
663	499		comprehensive long-term services and supports provider may be
664	500		reimbursed by a managed care organization for coordinating with
665	501		care coordinators under this subsection.
666	502		(f) Before implementing the pilot program, the commission,
667	503		in consultation and collaboration with the advisory committee and
668	504		pilot program workgroup, shall:
669	505		(1) for purposes of the pilot program only, develop
670	506		recommendations to modify adult foster care and supported
671	507		employment and employment assistance benefits to increase access to
672	508		and availability of those services; and
673	509		(2) as necessary, define services listed under
674	510		Subsections (a)(4) and (5) and any other services determined to be
675	511		appropriate under Subsection (a)(6).
676		-	SECTION 18. Sections 534.105, 534.106, 534.1065, 534.107,
	512	+	SECTION 13. Sections 534.105, 534.106, 534.1065, 534.107,
677	513		534.108, and 534.109, Government Code, are amended to read as
678	514		follows:
679	515		Sec. 534.105. PILOT PROGRAM: MEASURABLE GOALS. (a) The
680	516		commission [department], in consultation and collaboration with
681	517		the advisory committee and pilot program workgroup and using
682	518		national core indicators, the National Quality Forum long-term
683	519		services and supports measures, and other appropriate Consumer
684	520		Assessment of Healthcare Providers and Systems measures, shall
685	521		identify measurable goals to be achieved by the [each] pilot
686	522		program [implemented under this subchapter. The identified goals
687	523		must:
688	524		[(1) align with information that will be collected
689	525		under Section 534.108(a); and
690	526		[(2) be designed to improve the quality of outcomes
691	527		for individuals receiving services through the pilot program].
692	528		(b) The commission [department], in consultation and
693	529		collaboration with the advisory committee and pilot program
694	530		workgroup, shall develop [propose] specific strategies and
695	531		performance measures for achieving the identified goals. A
696	532		proposed strategy may be evidence-based if there is an
697	533		evidence-based strategy available for meeting the pilot program's
698	534		goals.
699	535		(c) The commission, in consultation and collaboration with
700	536		the advisory committee and pilot program workgroup, shall ensure
701	537		that mechanisms to report, track, and assess specific strategies
702	538		and performance measures for achieving the identified goals are
703	539		established before implementing the pilot program.
704	540		Sec. 534.106. IMPLEMENTATION, LOCATION, AND DURATION. (a)
705	541		The commission [and the department] shall implement the [any] pilot
706	542		program on [programs established under this subchapter not later
707	543		than] September 1, 2023 [2017].
708	544		(b) The [A] pilot program [established under this
709	545		subchapter] shall [may] operate for at least [up to] 24 months. [A
710	546		pilot program may cease operation if the pilot program service
711	547		provider terminates the contract with the commission before the
712	548		agreed-to termination date.]
713	549		(c) The [A] pilot program [established under this
714	550		subchapter] shall be conducted in a STAR+PLUS Medicaid managed care
715	551		service area [one or more regions] selected by the commission
716	552		[department].
717	553		Sec. 534.1065. RECIPIENT ENROLLMENT, PARTICIPATION, AND
718	554		ELIGIBILITY [IN PROGRAM VOLUNTARY]. (a) An individual who is
719	555		eligible for the pilot program will be enrolled automatically
720	556		[Participation in a pilot program established under this subchapter
721	557		by an individual with an intellectual or developmental disability
722	558		is voluntary], and the decision whether to opt out of participation
723	559		[participate] in the pilot [a] program and not receive long-term
724	560		services and supports under the pilot [from a provider through
725	561		that] program may be made only by the individual or the individual's
726	562		legally authorized representative.
727	563		(b) To ensure prospective pilot program participants are
728	564		able to make an informed decision on whether to participate in the
729	565		pilot program, the commission, in consultation and collaboration
730	566		with the advisory committee and pilot program workgroup, shall
731	567		develop and distribute informational materials on the pilot program
732	568		that describe the pilot program's benefits, the pilot program's
733	569		impact on current services, and other related information. The
734	570		commission shall establish a timeline and process for the
735	571		development and distribution of the materials and shall ensure:
736	572		(1) the materials are developed and distributed to
737	573		individuals eligible to participate in the pilot program with
738	574		sufficient time to educate the individuals, their families, and
739	575		other persons actively involved in their lives regarding the pilot
740	576		program;
741	577		(2) individuals eligible to participate in the pilot
742	578		program, including individuals enrolled in the STAR+PLUS Medicaid
743	579		managed care program, their families, and other persons actively
744	580		involved in their lives, receive the materials and oral information
745	581		on the pilot program;
746	582		(3) the materials contain clear, simple language
747	583		presented in a manner that is easy to understand; and
748	584		(4) the materials explain, at a minimum, that:
749	585		(A) on conclusion of the pilot program, pilot
750	586		program participants will be asked to provide feedback on their
751	587		experience, including feedback on whether the pilot program was
752	588		able to meet their unique support needs;
753	589		(B) participation in the pilot program does not
754	590		remove individuals from any Medicaid waiver program interest list;
755	591		(C) individuals who choose to participate in the
756	592		pilot program and who, during the pilot program's operation, are
757	593		offered enrollment in a Medicaid waiver program may accept the
758	594		enrollment, transition, or diversion offer; and
759	595		(D) pilot program participants have a choice
760	596		among acute care and comprehensive long-term services and supports
761	597		providers and service delivery options, including the consumer
762	598		direction model and comprehensive services model.
763	599		(c) The commission, in consultation and collaboration with
764	600		the advisory committee and pilot program workgroup, shall develop
765	601		pilot program participant eligibility criteria. The criteria must
766	602		ensure pilot program participants:
767	603		(1) include individuals with an intellectual or
768	604		developmental disability or a cognitive disability, including:
769	605		(A) individuals with autism;
770	606		(B) individuals with significant complex
771	607		behavioral, medical, and physical needs who are receiving home and
772	608		community-based services through the STAR+PLUS Medicaid managed
773	609		care program;
774	610		(C) individuals enrolled in the STAR+PLUS
775	611		Medicaid managed care program who:
776	612		(i) are on a Medicaid waiver program
777	613		interest list;
778	614		(ii) meet the criteria for an intellectual
779	615		or developmental disability; or
780	616		(iii) have a traumatic brain injury that
781	617		occurred after the age of 21; and
782	618		(D) other individuals with disabilities who have
783	619		similar functional needs without regard to the age of onset or
784	620		diagnosis; and
785	621		(2) do not include individuals who are receiving only
786	622		acute care services under the STAR+PLUS Medicaid managed care
787	623		program and are enrolled in the community-based ICF-IID program or
788	624		another Medicaid waiver program.
789	625		Sec. 534.107. COMMISSION RESPONSIBILITIES [COORDINATING
790	626		SERVICES]. (a) The commission [In providing long-term services
791	627		and supports under Medicaid to individuals with an intellectual or
792	628		developmental disability, a pilot program service provider] shall
793	629		require that a managed care organization participating in the pilot
794	630		program:
795	631		(1) ensures that individuals participating in the
796	632		pilot program have a choice among acute care and comprehensive
797	633		long-term services and supports providers and service delivery
798	634		options, including the consumer direction model [coordinate
799	635		through the pilot program institutional and community-based
800	636		services available to the individuals, including services provided
801	637		through:
802	638		[(A) a facility licensed under Chapter 252,
803	639		Health and Safety Code;
804	640		[(B) a Medicaid waiver program; or
805	641		[(C) a community-based ICF-IID operated by local
806	642		authorities];
807	643		(2) demonstrates to the commission's satisfaction that
808	644		the organization's network of acute care, long-term services and
809	645		supports, and comprehensive long-term services and supports
810	646		providers have experience and expertise in providing services for
811	647		individuals with an intellectual or developmental disability and
812	648		individuals with similar functional needs [collaborate with
813	649		managed care organizations to provide integrated coordination of
814	650		acute care services and long-term services and supports, including
815	651		discharge planning from acute care services to community-based
816	652		long-term services and supports];
817	653		(3) has [have] a process for preventing inappropriate
818	654		institutionalizations of individuals; and
819	655		(4) ensures the timely initiation and consistent
820	656		provision of services in accordance with an individual's
821	657		person-centered plan [accept the risk of inappropriate
822	658		institutionalizations of individuals previously residing in
823	659		community settings].
824	660		(b) For the duration of the pilot program, the commission
825	661		shall ensure that comprehensive long-term services and supports
826	662		providers are considered significant traditional providers and
827	663		included in the provider network of a managed care organization
828	664		participating in the pilot program.
829	665		Sec. 534.108. PILOT PROGRAM INFORMATION. (a) The
830	666		commission, in consultation and collaboration with the advisory
831	667		committee and pilot program workgroup, [and the department] shall
832	668		determine which information will be collected from a managed care
833	669		organization participating in the pilot program to use in
834	670		conducting the evaluation and preparing the report under Section
835	671		534.112 [collect and compute the following information with respect
836	672		to each pilot program implemented under this subchapter to the
837	673		extent it is available:
838	674		[(1) the difference between the average monthly cost
839	675		per person for all acute care services and long-term services and
840	676		supports received by individuals participating in the pilot program
841	677		while the program is operating, including services provided through
842	678		the pilot program and other services with which pilot program
843	679		services are coordinated as described by Section 534.107, and the
844	680		average monthly cost per person for all services received by the
845	681		individuals before the operation of the pilot program;
846	682		[(2) the percentage of individuals receiving services
847	683		through the pilot program who begin receiving services in a
848	684		nonresidential setting instead of from a facility licensed under
849	685		Chapter 252, Health and Safety Code, or any other residential
850	686		setting;
851	687		[(3) the difference between the percentage of
852	688		individuals receiving services through the pilot program who live
853	689		in non-provider-owned housing during the operation of the pilot
854	690		program and the percentage of individuals receiving services
855	691		through the pilot program who lived in non-provider-owned housing
856	692		before the operation of the pilot program;
857	693		[(4) the difference between the average total Medicaid
858	694		cost, by level of need, for individuals in various residential
859	695		settings receiving services through the pilot program during the
860	696		operation of the program and the average total Medicaid cost, by
861	697		level of need, for those individuals before the operation of the
862	698		program;
863	699		[(5) the difference between the percentage of
864	700		individuals receiving services through the pilot program who obtain
865	701		and maintain employment in meaningful, integrated settings during
866	702		the operation of the program and the percentage of individuals
867	703		receiving services through the program who obtained and maintained
868	704		employment in meaningful, integrated settings before the operation
869	705		of the program;
870	706		[(6) the difference between the percentage of
871	707		individuals receiving services through the pilot program whose
872	708		behavioral, medical, life-activity, and other personal outcomes
873	709		have improved since the beginning of the program and the percentage
874	710		of individuals receiving services through the program whose
875	711		behavioral, medical, life-activity, and other personal outcomes
876	712		improved before the operation of the program, as measured over a
877	713		comparable period; and
878	714		[(7) a comparison of the overall client satisfaction
879	715		with services received through the pilot program, including for
880	716		individuals who leave the program after a determination is made in
881	717		the individuals' cases at hearings or on appeal, and the overall
882	718		client satisfaction with services received before the individuals
883	719		entered the pilot program].
884	720		(b) For the duration of the pilot program, a managed care
885	721		organization participating in the pilot program shall submit to the
886	722		commission and the advisory committee quarterly reports on the
887	723		services provided to each pilot program participant that include
888	724		information on:
889	725		(1) the level of each requested service and the
890	726		authorization and utilization rates for those services;
891	727		(2) timelines of:
892	728		(A) the delivery of each requested service;
893	729		(B) authorization of each requested service;
894	730		(C) the initiation of each requested service; and
895	731		(D) each unplanned break in the delivery of
896	732		requested services and the duration of the break;
897	733		(3) the number of pilot program participants using
898	734		employment assistance and supported employment services;
899	735		(4) the number of service denials and fair hearings
900	736		and the dispositions of fair hearings;
901	737		(5) the number of complaints and inquiries received by
902	738		the managed care organization and the outcome of each complaint;
903	739		and
904	740		(6) the number of pilot program participants who
905	741		choose the consumer direction model and the reasons why other
906	742		participants did not choose the consumer direction model [The pilot
907	743		program service provider shall collect any information described by
908	744		Subsection (a) that is available to the provider and provide the
909	745		information to the department and the commission not later than the
910	746		30th day before the date the program's operation concludes].
911	747		(c) The commission shall ensure that the mechanisms to
912	748		report and track the information and data required by this section
913	749		are established before implementing the pilot program [In addition
914	750		to the information described by Subsection (a), the pilot program
915	751		service provider shall collect any information specified by the
916	752		department for use by the department in making an evaluation under
917	753		Section 534.104(g).
918	754		[(d) The commission and the department, in consultation and
919	755		collaboration with the advisory committee, shall review and
920	756		evaluate the progress and outcomes of each pilot program
921	757		implemented under this subchapter and submit, as part of the annual
922	758		report to the legislature required by Section 534.054, a report to
923	759		the legislature during the operation of the pilot programs. Each
924	760		report must include recommendations for program improvement and
925	761		continued implementation].
926	762		Sec. 534.109. PERSON-CENTERED PLANNING. The commission, in
927	763		consultation and collaboration [cooperation] with the advisory
928	764		committee and pilot program workgroup [department], shall ensure
929	765		that each individual [with an intellectual or developmental
930	766		disability] who receives services and supports under Medicaid
931	767		through the [a] pilot program [established under this subchapter],
932	768		or the individual's legally authorized representative, has access
933	769		to a comprehensive, facilitated, person-centered plan that
934	770		identifies outcomes for the individual and drives the development
935	771		of the individualized budget. The consumer direction model must be
936	772		an available option for individuals to achieve self-determination,
937	773		choice, and control[, as defined by Section 531.051, may be an
938	774		outcome of the plan].
939		-	SECTION 19. Section 534.110, Government Code, is amended to
	775	+	SECTION 14. Section 534.110, Government Code, is amended to
940	776		read as follows:
941	777		Sec. 534.110. TRANSITION BETWEEN PROGRAMS; CONTINUITY OF
942	778		SERVICES. (a) During the evaluation of the pilot program required
943	779		under Section 534.112, the [The] commission may continue the pilot
944	780		program to ensure continuity of care for pilot program
945	781		participants. If the commission does not continue the pilot
946	782		program following the evaluation, the commission shall ensure that
947	783		there is a comprehensive plan for transitioning the provision of
948	784		Medicaid benefits for pilot program participants to the benefits
949	785		provided before participating in the pilot program [between a
950	786		Medicaid waiver program or an ICF-IID program and a pilot program
951	787		under this subchapter to protect continuity of care].
952	788		(b) A [The] transition plan under Subsection (a) shall be
953	789		developed in consultation and collaboration with the advisory
954	790		committee and pilot program workgroup and with stakeholder input as
955	791		described by Section 534.103.
956		-	SECTION 20. Section 534.111, Government Code, is amended to
	792	+	SECTION 15. Section 534.111, Government Code, is amended to
957	793		read as follows:
958	794		Sec. 534.111. CONCLUSION OF PILOT PROGRAM [PROGRAMS;
959	795		EXPIRATION]. (a) On September 1, 2025, the pilot program is
960	796		concluded unless the commission continues the pilot program under
961	797		Section 534.110 [2019:
962	798		[(1) each pilot program established under this
963	799		subchapter that is still in operation must conclude; and
964	800		[(2) this subchapter expires].
965	801		(b) If the commission continues the pilot program under
966	802		Section 534.110, the commission shall publish notice of the pilot
967	803		program's continuance in the Texas Register not later than
968	804		September 1, 2025.
969		-	SECTION 21. Subchapter C, Chapter 534, Government Code, is
	805	+	SECTION 16. Subchapter C, Chapter 534, Government Code, is
970	806		amended by adding Section 534.112 to read as follows:
971	807		Sec. 534.112. PILOT PROGRAM EVALUATIONS AND REPORTS. (a)
972	808		The commission, in consultation and collaboration with the advisory
973	809		committee and pilot program workgroup, shall review and evaluate
974	810		the progress and outcomes of the pilot program and submit, as part
975	811		of the annual report required under Section 534.054, a report on the
976	812		pilot program's status that includes recommendations for improving
977	813		the program.
978	814		(b) Not later than September 1, 2026, the commission, in
979	815		consultation and collaboration with the advisory committee and
980	816		pilot program workgroup, shall prepare and submit to the
981	817		legislature a written report that evaluates the pilot program based
982	818		on a comprehensive analysis. The analysis must:
983	819		(1) assess the effect of the pilot program on:
984	820		(A) access to and quality of long-term services
985	821		and supports;
986	822		(B) informed choice and meaningful outcomes
987	823		using person-centered planning, flexible consumer-directed
988	824		services, individualized budgeting, and self-determination,
989	825		including a pilot program participant's inclusion in the community;
990	826		(C) the integration of service coordination of
991	827		acute care services and long-term services and supports;
992	828		(D) employment assistance and customized,
993	829		integrated, competitive employment options;
994	830		(E) the number, types, and dispositions of fair
995	831		hearings and appeals in accordance with applicable federal and
996	832		state law;
997	833		(F) increasing the use and flexibility of the
998	834		consumer direction model;
999	835		(G) increasing the use of alternatives to
1000	836		guardianship, including supported decision-making agreements as
1001	837		defined by Section 1357.002, Estates Code;
1002	838		(H) achieving the best and most cost-effective
1003	839		use of funding based on a pilot program participant's needs and
1004	840		preferences; and
1005	841		(I) attendant recruitment and retention;
1006	842		(2) analyze the experiences and outcomes of the
1007	843		following systems changes:
1008	844		(A) the comprehensive assessment instrument
1009	845		described by Section 533A.0335, Health and Safety Code;
1010	846		(B) the 21st Century Cures Act (Pub. L. No.
1011	847		114-255);
1012	848		(C) implementation of the federal rule adopted by
1013	849		the Centers for Medicare and Medicaid Services and published at 79
1014	850		Fed. Reg. 2948 (January 16, 2014) related to the provision of
1015	851		long-term services and supports through a home and community-based
1016	852		services (HCS) waiver program under Section 1915(c), 1915(i), or
1017	853		1915(k) of the federal Social Security Act (42 U.S.C. Section
1018	854		1396n(c), (i), or (k));
1019	855		(D) the provision of basic attendant and
1020	856		habilitation services under Section 534.152; and
1021	857		(E) the benefits of providing STAR+PLUS Medicaid
1022	858		managed care services to persons based on functional needs;
1023	859		(3) include feedback on the pilot program based on the
1024	860		personal experiences of:
1025	861		(A) individuals with an intellectual or
1026	862		developmental disability and individuals with similar functional
1027	863		needs who participated in the pilot program;
1028	864		(B) families of and other persons actively
1029	865		involved in the lives of individuals described by Paragraph (A);
1030	866		and
1031	867		(C) comprehensive long-term services and
1032	868		supports providers who delivered services under the pilot program;
1033	869		(4) be incorporated in the annual report required
1034	870		under Section 534.054; and
1035	871		(5) include recommendations on:
1036	872		(A) a system of programs and services for
1037	873		consideration by the legislature;
1038	874		(B) necessary statutory changes; and
1039	875		(C) whether to implement the pilot program
1040	876		statewide under the STAR+PLUS Medicaid managed care program for
1041	877		eligible individuals.
1042		-	SECTION 22. The heading to Subchapter E, Chapter 534,
	878	+	SECTION 17. The heading to Subchapter E, Chapter 534,
1043	879		Government Code, is amended to read as follows:
1044	880		SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS
1045	881		AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED
1046	882		MANAGED CARE SYSTEM
1047		-	SECTION 23. The heading to Section 534.202, Government
	883	+	SECTION 18. The heading to Section 534.202, Government
1048	884		Code, is amended to read as follows:
1049	885		Sec. 534.202. DETERMINATION TO TRANSITION [OF] ICF-IID
1050	886		PROGRAM RECIPIENTS AND CERTAIN OTHER MEDICAID WAIVER PROGRAM
1051	887		RECIPIENTS TO MANAGED CARE PROGRAM.
1052		-	SECTION 24. Sections 534.202(a), (b), (c), (e), and (i),
	888	+	SECTION 19. Sections 534.202(a), (b), (c), (e), and (i),
1053	889		Government Code, are amended to read as follows:
1054	890		(a) This section applies to individuals with an
1055	891		intellectual or developmental disability who[, on the date the
1056	892		commission implements the transition described by Subsection (b),]
1057	893		are receiving long-term services and supports under:
1058	894		(1) a Medicaid waiver program [other than the Texas
1059	895		home living (TxHmL) waiver program]; or
1060	896		(2) an ICF-IID program.
1061	897		(b) Subject to Subsection (g), after [After] implementing
1062	898		the pilot program under Subchapter C and completing the evaluation
1063	899		under Section 534.112 [transition required by Section 534.201, on
1064	900		September 1, 2021], the commission, in consultation and
1065	901		collaboration with the advisory committee, shall develop a plan for
1066	902		the transition of all or a portion of the services provided through
1067	903		an ICF-IID program or a Medicaid waiver program to a Medicaid
1068	904		managed care model. The plan must include:
1069	905		(1) a process for transitioning the services in phases
1070	906		as follows:
1071	907		(A) beginning September 1, 2027, the Texas home
1072	908		living (TxHmL) waiver program services;
1073	909		(B) beginning September 1, 2029, the community
1074	910		living assistance and support services (CLASS) waiver program
1075	911		services;
1076	912		(C) beginning September 1, 2031, nonresidential
1077	913		services provided under the home and community-based services (HCS)
1078	914		waiver program and the deaf-blind with multiple disabilities (DBMD)
1079	915		waiver program; and
1080	916		(D) subject to Subdivision (2), the residential
1081	917		services provided under an ICF-IID program, the home and
1082	918		community-based services (HCS) waiver program, and the deaf-blind
1083	919		with multiple disabilities (DBMD) waiver program; and
1084	920		(2) a process for evaluating and determining the
1085	921		feasibility and cost efficiency of transitioning residential
1086	922		services described by Subdivision (1)(D) to a Medicaid managed care
1087	923		model that is based on an evaluation of a separate pilot program
1088	924		conducted by the commission, in consultation and collaboration with
1089	925		the advisory committee, that operates after the transition process
1090	926		described by Subdivision (1) [transition the provision of Medicaid
1091	927		benefits to individuals to whom this section applies to the STAR +
1092	928		PLUS Medicaid managed care program delivery model or the most
1093	929		appropriate integrated capitated managed care program delivery
1094	930		model, as determined by the commission based on cost-effectiveness
1095	931		and the experience of the transition of Texas home living (TxHmL)
1096	932		waiver program recipients to a managed care program delivery model
1097	933		under Section 534.201, subject to Subsections (c)(1) and (g)].
1098	934		(c) Before implementing the [At the time of the] transition
1099	935		described by Subsection (b), the commission shall, subject to
1100	936		Subsection (g), determine whether to:
1101	937		(1) continue operation of the Medicaid waiver programs
1102	938		or ICF-IID program only for purposes of providing, if applicable:
1103	939		(A) supplemental long-term services and supports
1104	940		not available under the managed care program delivery model
1105	941		selected by the commission; or
1106	942		(B) long-term services and supports to Medicaid
1107	943		waiver program recipients who choose to continue receiving benefits
1108	944		under the waiver programs [program] as provided by Subsection (g);
1109	945		or
1110	946		(2) [subject to Subsection (g),] provide all or a
1111	947		portion of the long-term services and supports previously available
1112	948		under the Medicaid waiver programs or ICF-IID program through the
1113	949		managed care program delivery model selected by the commission.
1114	950		(e) The commission shall ensure that there is a
1115	951		comprehensive plan for transitioning the provision of Medicaid
1116	952		benefits under this section that protects the continuity of care
1117	953		provided to individuals to whom this section applies and ensures
1118	954		individuals have a choice among acute care and comprehensive
1119	955		long-term services and supports providers and service delivery
1120	956		options, including the consumer direction model.
1121	957		(i) In addition to the requirements of Section 533.005, a
1122	958		contract between a managed care organization and the commission for
1123	959		the organization to provide Medicaid benefits under this section
1124	960		must contain a requirement that the organization implement a
1125	961		process for individuals with an intellectual or developmental
1126	962		disability that:
1127	963		(1) ensures that the individuals have a choice among
1128	964		acute care and comprehensive long-term services and supports
1129	965		providers and service delivery options, including the consumer
1130	966		direction model;
1131	967		(2) to the greatest extent possible, protects those
1132	968		individuals' continuity of care with respect to access to primary
1133	969		care providers, including the use of single-case agreements with
1134	970		out-of-network providers; and
1135	971		(3) provides access to a member services phone line
1136	972		for individuals or their legally authorized representatives to
1137	973		obtain information on and assistance with accessing services
1138	974		through network providers, including providers of primary,
1139	975		specialty, and other long-term services and supports.
1140		-	SECTION 25. Section 534.203, Government Code, is amended to
	976	+	SECTION 20. Section 534.203, Government Code, is amended to
1141	977		read as follows:
1142	978		Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER
1143	979		SUBCHAPTER. In administering this subchapter, the commission shall
1144	980		ensure, on making a determination to transition services under
1145	981		Section 534.202:
1146	982		(1) that the commission is responsible for setting the
1147	983		minimum reimbursement rate paid to a provider of ICF-IID services
1148	984		or a group home provider under the integrated managed care system,
1149	985		including the staff rate enhancement paid to a provider of ICF-IID
1150	986		services or a group home provider;
1151	987		(2) that an ICF-IID service provider or a group home
1152	988		provider is paid not later than the 10th day after the date the
1153	989		provider submits a clean claim in accordance with the criteria used
1154	990		by the commission [department] for the reimbursement of ICF-IID
1155	991		service providers or a group home provider, as applicable; [and]
1156	992		(3) the establishment of an electronic portal through
1157	993		which a provider of ICF-IID services or a group home provider
1158	994		participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care
1159	995		program delivery model or the most appropriate integrated capitated
1160	996		managed care program delivery model, as appropriate, may submit
1161	997		long-term services and supports claims to any participating managed
1162	998		care organization; and
1163	999		(4) that the consumer direction model is an available
1164	1000		option for each individual with an intellectual or developmental
1165	1001		disability who receives Medicaid benefits in accordance with this
1166	1002		subchapter to achieve self-determination, choice, and control, and
1167	1003		that the individual or the individual's legally authorized
1168	1004		representative has access to a comprehensive, facilitated,
1169	1005		person-centered plan that identifies outcomes for the individual.
1170		-	SECTION 26. Chapter 534, Government Code, is amended by
	1006	+	SECTION 21. Chapter 534, Government Code, is amended by
1171	1007		adding Subchapter F to read as follows:
1172	1008		SUBCHAPTER F. OTHER IMPLEMENTATION REQUIREMENTS AND
1173	1009		RESPONSIBILITIES
1174	1010		Sec. 534.251. DELAYED IMPLEMENTATION AUTHORIZED.
1175	1011		Notwithstanding any other law, the commission may delay
1176	1012		implementation of a provision of this chapter without further
1177	1013		investigation, adjustments, or legislative action if the
1178	1014		commission determines the provision adversely affects the system of
1179	1015		services and supports to persons and programs to which this chapter
1180	1016		applies.
1181	1017		Sec. 534.252. REQUIREMENTS REGARDING TRANSITION OF
1182	1018		SERVICES. (a) For purposes of implementing the pilot program under
1183	1019		Subchapter C and transitioning the provision of services provided
1184	1020		to recipients under certain Medicaid waiver programs to a Medicaid
1185	1021		managed care delivery model following completion of the pilot
1186	1022		program, the commission shall:
1187	1023		(1) implement and maintain a certification process for
1188	1024		and maintain regulatory oversight over providers under the Texas
1189	1025		home living (TxHmL) and home and community-based services (HCS)
1190	1026		waiver programs; and
1191	1027		(2) require managed care organizations to include in
1192	1028		the organizations' provider networks providers who are certified in
1193	1029		accordance with the certification process described by Subdivision
1194	1030		(1).
1195	1031		(b) For purposes of implementing the pilot program under
1196	1032		Subchapter C and transitioning the provision of services described
1197	1033		by Section 534.202 to the STAR+PLUS Medicaid managed care program,
1198	1034		a comprehensive long-term services and supports provider:
1199	1035		(1) must report to the managed care organization in
1200	1036		the network of which the provider participates each encounter of
1201	1037		any directly contracted service;
1202	1038		(2) must provide to the managed care organization
1203	1039		quarterly reports on:
1204	1040		(A) coordinated services and time frames for the
1205	1041		delivery of those services; and
1206	1042		(B) the goals and objectives outlined in an
1207	1043		individual's person-centered plan and progress made toward meeting
1208	1044		those goals and objectives; and
1209	1045		(3) may not be held accountable for the provision of
1210	1046		services specified in an individual's service plan that are not
1211	1047		authorized or subsequently denied by the managed care organization.
1212	1048		(c) On transitioning services under a Medicaid waiver
1213	1049		program to a Medicaid managed care delivery model, the commission
1214	1050		shall ensure that individuals do not lose benefits they receive
1215	1051		under the Medicaid waiver program.
1216		-	SECTION 27. Section 534.201, Government Code, is repealed.
1217		-	SECTION 28. The Health and Human Services Commission shall
1218		-	issue a request for information to seek information and comments
1219		-	regarding contracting with a managed care organization to arrange
1220		-	for or provide a managed care plan under the STAR Kids managed care
1221		-	program established under Section 533.00253, Government Code, as
1222		-	amended by this Act, throughout the state instead of on a regional
1223		-	basis.
1224		-	SECTION 29. (a) Using available resources, the Health and
1225		-	Human Services Commission shall report available data on the 30-day
1226		-	limitation on reimbursement for inpatient hospital care provided to
1227		-	Medicaid recipients enrolled in the STAR+PLUS Medicaid managed care
1228		-	program under 1 T.A.C. Section 354.1072(a)(1) and other applicable
1229		-	law. To the extent data is available on the subject, the commission
1230		-	shall also report on:
1231		-	(1) the number of Medicaid recipients affected by the
1232		-	limitation and their clinical outcomes; and
1233		-	(2) the impact of the limitation on reducing
1234		-	unnecessary Medicaid inpatient hospital days and any cost savings
1235		-	achieved by the limitation under Medicaid.
1236		-	(b) Not later than December 1, 2020, the Health and Human
1237		-	Services Commission shall submit the report containing the data
1238		-	described by Subsection (a) of this section to the governor, the
1239		-	legislature, and the Legislative Budget Board. The report required
1240		-	under this subsection may be combined with any other report
1241		-	required by this Act or other law.
1242		-	SECTION 30. The Health and Human Services Commission shall
1243		-	implement:
1244		-	(1) the Medicaid provider management and enrollment
1245		-	system required by Section 531.021182(c), Government Code, as added
1246		-	by this Act, not later than September 1, 2020; and
1247		-	(2) the modernized claims processing system required
1248		-	by Section 531.021182(d), Government Code, as added by this Act,
1249		-	not later than September 1, 2023.
1250		-	SECTION 31. The Health and Human Services Commission shall
1251		-	require that a managed care plan offered by a managed care
1252		-	organization with which the commission enters into or renews a
1253		-	contract under Chapter 533, Government Code, on or after the
1254		-	effective date of this Act comply with Section 533.0031, Government
1255		-	Code, as added by this Act, not later than September 1, 2022.
1256		-	SECTION 32. Not later than September 1, 2020, and only if
	1052	+	SECTION 22. Section 534.201, Government Code, is repealed.
	1053	+	SECTION 23. Not later than September 1, 2020, and only if
1257	1054		the Health and Human Services Commission determines it would be
1258	1055		cost effective, the executive commissioner of the Health and Human
1259	1056		Services Commission shall seek a waiver or authorization from the
1260	1057		appropriate federal agency to provide Medicaid benefits to
1261	1058		medically fragile individuals:
1262	1059		(1) who are 21 years of age or older; and
1263	1060		(2) whose health care costs exceed cost limits under
1264	1061		appropriate Medicaid waiver programs, as defined by Section
1265	1062		534.001, Government Code.
1266		-	SECTION 33. As soon as practicable after the effective date
	1063	+	SECTION 24. As soon as practicable after the effective date
1267	1064		of this Act, the executive commissioner of the Health and Human
1268	1065		Services Commission shall adopt rules as necessary to implement the
1269	1066		changes in law made by this Act.
1270		-	SECTION 34. If before implementing any provision of this
	1067	+	SECTION 25. If before implementing any provision of this
1271	1068		Act a state agency determines that a waiver or authorization from a
1272	1069		federal agency is necessary for implementation of that provision,
1273	1070		the agency affected by the provision shall request the waiver or
1274	1071		authorization and may delay implementing that provision until the
1275	1072		waiver or authorization is granted.
1276		-	SECTION 35. The Health and Human Services Commission is
1277		-	required to implement a provision of this Act only if the
1278		-	legislature appropriates money specifically for that purpose. If
1279		-	the legislature does not appropriate money specifically for that
1280		-	purpose, the commission may, but is not required to, implement a
1281		-	provision of this Act using other appropriations available for that
1282		-	purpose.
1283		-	SECTION 36. This Act takes effect September 1, 2019.
1284		-	______________________________ ______________________________
1285		-	President of the Senate Speaker of the House
1286		-	I certify that H.B. No. 4533 was passed by the House on May
1287		-	10, 2019, by the following vote: Yeas 134, Nays 5, 2 present, not
1288		-	voting; and that the House concurred in Senate amendments to H.B.
1289		-	No. 4533 on May 24, 2019, by the following vote: Yeas 142, Nays 0,
1290		-	2 present, not voting.
1291		-	______________________________
1292		-	Chief Clerk of the House
1293		-	I certify that H.B. No. 4533 was passed by the Senate, with
1294		-	amendments, on May 20, 2019, by the following vote: Yeas 31, Nays
1295		-	0.
1296		-	______________________________
1297		-	Secretary of the Senate
1298		-	APPROVED: __________________
1299		-	Date
1300		-	__________________
1301		-	Governor
	1073	+	SECTION 26. This Act takes effect September 1, 2019.
	1074	+	* * * * *