Texas 2019 - 86th Regular

Texas House Bill HB4561 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	By: Klick H.B. No. 4561
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the system redesign for delivery of Medicaid acute care
7	7	services and long term services and supports to persons with an
8	8	intellectual or developmental disability and a pilot for certain
9	9	populations with similar functional needs receiving services in
10	10	managed care.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 534.001, Subchapter A, Chapter 534,
13	13	Government Code, is amended to read as follows:
14	14	Sec. 534.001. DEFINITIONS. In this chapter:
15	15	(3) ["Department" means the Department of Aging and
16	16	Disability Services.] "Commission" means the Health and Human
17	17	Services Commission or an agency operating part of the state
18	18	Medicaid managed care program, as appropriate.
19	19	(4) "Comprehensive long term services and supports
20	20	provider" is defined as a provider of long term services and
21	21	supports specified under this chapter that ensures the coordinated,
22	22	seamless provision of the full range of services as approved in
23	23	participants' program plans as described under Section 534.1045
24	24	(b), (b-2),(c), and (d). A comprehensive service provider includes:
25	25	(A) an ICF/IID program provider who is authorized
26	26	to deliver services in the program defined under Section 534.001
27	27	(8), and
28	28	(B) a Medicaid waiver program provider who is
29	29	authorized to deliver services in the programs specified under
30	30	Section 534.001 (12) and certified in accordance with 534.301 (b).
31	31	[(4)] (5) "Functional need" means the measurement of
32	32	an individual's services and supports needs, including the
33	33	individual's intellectual, psychiatric, medical, and physical
34	34	support needs.
35	35	[(5)] (6) "Habilitation services" includes assistance
36	36	provided to an individual with acquiring, retaining, or improving:
37	37	(A) skills related to the activities of daily
38	38	living; and
39	39	(B) the social and adaptive skills necessary to
40	40	enable the individual to live and fully participate in the
41	41	community.
42	42	[(6)] (7) "ICF-IID" means the program under Medicaid
43	43	serving individuals with an intellectual or developmental
44	44	disability who receive care in intermediate care facilities other
45	45	than a state supported living center.
46	46	[(7)] (8) "ICF-IID program" means a program under
47	47	Medicaid serving individuals with an intellectual or developmental
48	48	disability who reside in and receive care from:
49	49	(A) intermediate care facilities licensed under
50	50	Chapter 252, Health and Safety Code; or
51	51	(B) community-based intermediate care facilities
52	52	operated by local intellectual and developmental disability
53	53	authorities.
54	54	[(8)] (9) "Local intellectual and developmental
55	55	disability authority" has the meaning assigned by Section 531.002,
56	56	Health and Safety Code.
57	57	[(9)] (11) "Managed care organization," "managed care
58	58	plan," and "potentially preventable event" have the meanings
59	59	assigned under Section 536.001.
60	60	(10) Repealed by Acts 2015, 84th Leg., R.S., Ch. 1,
61	61	Sec. 2.287(17), eff. April 2, 2015.
62	62	[(11)] (12) "Medicaid waiver program" means only the
63	63	following programs that are authorized under Section 1915(c) of the
64	64	federal Social Security Act (42 U.S.C. Section 1396n(c)) for the
65	65	provision of services to persons with an intellectual or
66	66	developmental disability:
67	67	(A) the community living assistance and support
68	68	services (CLASS) waiver program;
69	69	(B) the home and community-based services (HCS)
70	70	waiver program;
71	71	(C) the deaf-blind with multiple disabilities
72	72	(DBMD) waiver program; and
73	73	(D) the Texas home living (TxHmL) waiver program.
74	74	(13) "Residential Services" means services provided
75	75	for an individual with intellectual or developmental disability in
76	76	a community-based ICF/IID, a three or four persons home and host
77	77	home/companion service offered through the 1915(c) home and
78	78	community-based waiver services program, or a group home in the
79	79	Deaf Blind Multiple Disabilities program.
80	80	[(12)] (14) "State supported living center" has the
81	81	meaning assigned by Section 531.002, Health and Safety Code.
82	82	SECTION 2. Section 534.051, Subchapter B, Chapter 534,
83	83	Government Code, is amended to read as follows:
84	84	Sec. 534.051. ACUTE CARE SERVICES AND LONG-TERM SERVICES
85	85	AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR
86	86	DEVELOPMENTAL DISABILITY. In accordance with this chapter, the
87	87	commission [and the department] shall [jointly] design and
88	88	implement an acute care services and long-term services and
89	89	supports system for individuals with an intellectual or
90	90	developmental disability that supports the following goals:
91	91	(1) provide Medicaid services to more individuals in a
92	92	cost-efficient manner by providing the type and amount of services
93	93	most appropriate to the individuals' needs and preferences in the
94	94	most integrated and least restrictive setting;
95	95	SECTION 3. Section 534.052, Subchapter B, Chapter 534,
96	96	Government Code, is amended to read as follows:
97	97	Sec. 534.052. IMPLEMENTATION OF SYSTEM REDESIGN. The
98	98	commission [and department] shall, in consultation and
99	99	collaboration with the advisory committee, [jointly] implement the
100	100	acute care services and long-term services and supports system for
101	101	individuals with an intellectual or developmental disability in the
102	102	manner and in the stages described in this chapter.
103	103	SECTION 4. Section 534.053, Subchapter B, Chapter 534,
104	104	Government Code, is amended to read as follows:
105	105	Sec. 534.053. INTELLECTUAL AND DEVELOPMENTAL DISABILITY
106	106	SYSTEM REDESIGN ADVISORY COMMITTEE. (a) The Intellectual and
107	107	Developmental Disability System Redesign Advisory Committee shall
108	108	advise the commission [and the department] on the implementation of
109	109	the acute care services and long-term services and supports system
110	110	redesign under this chapter. Subject to Subsection (b), the
111	111	executive commissioner [and the commissioner of aging and
112	112	disability services] shall [jointly] appoint members of the
113	113	advisory committee who are stakeholders from the intellectual and
114	114	developmental disabilities community, including:
115	115	(b) To the greatest extent possible, the executive
116	116	commissioner [and the commissioner of aging and disability
117	117	services] shall appoint members of the advisory committee who
118	118	reflect the geographic diversity of the state and include members
119	119	who represent rural Medicaid recipients.
120	120	(e-1) The advisory committee may establish work groups that
121	121	meet at other times for purposes of studying and making
122	122	recommendations on issues the committee considers appropriate.
123	123	[(g) On January 1, 2026:
124	124	(1) the advisory committee is abolished ; and
125	125	(2) this section expires].
126	126	(g) On the [one year] two-year anniversary of the date the
127	127	commission completes implementation of the transition required
128	128	under Section 534.202:
129	129	(1) the advisory committee is abolished; and
130	130	(2) this section expires.
131	131	SECTION 5. Section 534.054, Subchapter B, Chapter 534,
132	132	Government Code, is amended to read as follows:
133	133	Sec. 534.054. ANNUAL REPORT ON IMPLEMENTATION.
134	134	(b) On the two-year anniversary of the date the commission
135	135	completes implementation of the transition required under Section
136	136	534.202 this [This] section expires [January 1, 2026].
137	137	SECTION 6. Section 534.101, Subchapter C, Chapter 534,
138	138	Government Code, is amended to read as follows:
139	139	Sec. 534.101. Pilot Program Workgroup [DEFINITIONS]. In
140	140	accordance with Section 534.053 (e-1), for puposes of [In] this
141	141	subchapter the advisory committee shall establish a h Workgroup
142	142	that includes representatives from the advisory committee,
143	143	stakeholders representing individuals with an intellectual and
144	144	developmental disability, individuals with similar functional
145	145	needs, and the STAR+PLUS managed care organizations. [:]
146	146	[(1) "Capitation" means a method of compensating a
147	147	provider on a monthly basis for providing or coordinating the
148	148	provision of a defined set of services and supports that is based on
149	149	a predetermined payment per services recipient.]
150	150	[(2) "Provider" means a person with whom the
151	151	commission contracts for the provision of long-term services and
152	152	supports under Medicaid to a specific population based on
153	153	capitation.]
154	154	SECTION 7. Section 534.102, Subchapter C, Chapter 534,
155	155	Government Code, is amended to read as follows:
156	156	Sec. 534.102. PILOT PROGRAM [S] TO TEST PERSON-CENTERED
157	157	MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. The
158	158	commission [and the department may] ,in consultation and
159	159	collaboration with the advisory committee and Pilot Program
160	160	Workgroup, shall develop and implement a pilot program[s] in
161	161	accordance with this subchapter to test, through the STAR+PLUS
162	162	Medicaid managed care program, the delivery of [one or more service
163	163	delivery models involving] long term services and supports [a
164	164	managed care strategy based on capitation to deliver long-term
165	165	services and supports under Medicaid] to individuals [with an
166	166	intellectual or developmental disability]specified under Section
167	167	534.1065.
168	168	SECTION 8. Section 534.103, Subchapter C, Chapter 534,
169	169	Government Code, is amended to read as follows:
170	170	Sec. 534.103. STAKEHOLDER INPUT. As part of developing and
171	171	implementing a pilot program under this subchapter, the
172	172	[department] commission, in consultation and collaboration with
173	173	the advisory committee and Pilot Program Workgroup, shall develop a
174	174	process to receive and evaluate input from statewide stakeholders
175	175	and stakeholders from the STAR+PLUS service area [region] of the
176	176	state in which the pilot program will be implemented and other
177	177	evaluations and data.
178	178	SECTION 9. Chaoter 534, Government Code is amended to add
179	179	new Section 534.1035, SELECTION OF MANAGED CARE ORGANIZATION
180	180	VENDORS, to read as follows:
181	181	Sec.534.1035. SELECTON OF MANAGED CARE ORGANIZATION PILOT
182	182	VENDORS. (a) The commission shall select and contract with no more
183	183	than two managed care organizations contracted to provide services
184	184	under the STAR+PLUS Medicaid managed care program to participate in
185	185	the pilot.
186	186	(b) The commission, in consultation and collaboration with
187	187	the advisory committee and Pilot Program Workgroup, shall develop
188	188	criteria regarding the selection of managed care organizations to
189	189	conduct the pilot program.
190	190	SECTION 10. Section 534.104, Subchapter C, Chapter 534,
191	191	Government Code, is amended to read as follows:
192	192	Sec. 534.104. PILOT DESIGN [MANAGED CARE STRATEGY
193	193	PROPOSALS; PILOT PROGRAM SERVICE PROVIDERS].
194	194	[(a) The department, in consultation and collaboration with
195	195	the advisory committee, shall identify private services providers
196	196	or managed care organizations that are good candidates to develop a
197	197	service delivery model involving a managed care strategy based on
198	198	capitation and to test the model in the provision of long-term
199	199	services and supports under Medicaid to individuals with an
200	200	intellectual or developmental disability through a pilot program
201	201	established under this subchapter].
202	202	[(b) The department shall solicit managed care strategy
203	203	proposals from the private services providers and managed care
204	204	organizations identified under Subsection (a). In addition, the
205	205	department may accept and approve a managed care strategy proposal
206	206	from any qualified entity that is a private services provider or
207	207	managed care organization if the proposal provides for a
208	208	comprehensive array of long-term services and supports, including
209	209	case management and service coordination.]
210	210	[(c)] (a) [A managed care strategy based on capitation
211	211	developed for implementation through a] The pilot program under
212	212	this subchapter must be designed to:
213	213	(1) increase access to long-term services and
214	214	supports;
215	215	(2) improve quality of acute care services and
216	216	long-term services and supports;
217	217	(3) promote informed choice and meaningful outcomes by
218	218	using person-centered planning, flexible consumer directed
219	219	services, individualized budgeting, and self-determination, and
220	220	promote community inclusion and engagement;
221	221	(4) promote integrated service coordination of acute
222	222	care services and long-term services and supports;
223	223	(5) promote efficiency and the best use of funding
224	224	based on the individual's needs and preferences;
225	225	(6) promote [the placement of an individual in]
226	226	housing stability through housing supports and navigation services
227	227	that is the most integrated and least restrictive setting
228	228	appropriate to the individual's needs and preferences;
229	229	(7) promote employment assistance and customized,
230	230	integrated, and competitive employment;
231	231	(8) provide fair hearing and appeals processes in
232	232	accordance with applicable federal and state law; and
233	233	(9) promote sufficient flexibility to achieve the
234	234	goals listed in this section through the pilot program [.] ;
235	235	(10) promote the use of innovative technology and
236	236	benefits, including telemonitoring and testing of remote
237	237	monitoring for individuals participating in the pilot. The remote
238	238	monitoring and telemonitoring is voluntary and shall ensure an
239	239	individual's privacy and health and welfare and allow access to
240	240	housing in the most integrated and least restrictive environment.
241	241	Innovations may include transportation and other innovations that
242	242	support community integration. If a pilot participant voluntarily
243	243	decides to use telemonitoring or remote monitoring or other
244	244	innovative technologies, the managed care organization providing
245	245	the pilot services shall deliver the telemonitoring, remote
246	246	monitoring and/or innovative technology services in a way that:
247	247	(A) assesses individual needs and preferences in
248	248	a manner that promotes autonomy, self-determination, consumer
249	249	directed services, privacy and increases personal independence;
250	250	(B) determines the extent in which remote
251	251	monitoring, telemedicine and other innovative technologies will be
252	252	used, including but not limited to, times of day, where the
253	253	equipment can be used, what types of telemonitoring and/or remote
254	254	monitoring, for what tasks;
255	255	(C) is identified and agreed to through the
256	256	person centered planning process;
257	257	(D) ensures the staff overseeing remote
258	258	monitoring, telemedicine and other innovative technologies review
259	259	person-centered plans and implementation plans of each individual
260	260	they are monitoring prior to monitoring that individual and
261	261	demonstrate competency regarding the support needs of each
262	262	individual they are monitoring; and
263	263	(E) ensures an individual can request to remove
264	264	the remote monitoring and other innovative technology equipment at
265	265	any point during the IDD pilot and the managed care organizations
266	266	must remove the equipment immediately.
267	267	(F) ensures individuals can choose not to use
268	268	telemedicine at any point during participation in the pilot and
269	269	that the pilot participating managed care organization must arrange
270	270	for services that do not require the use of telemedicine.
271	271	(11) ensure an adequate provider network that includes
272	272	comprehensive long term services and supports providers as
273	273	described in Section 534.001 (4) and Section 534.107 (a)(2) and
274	274	choice from among these providers;
275	275	(12) ensure timely initiation and consistent
276	276	provision of long term services and supports in accordance with an
277	277	individual's person centered care plan;
278	278	(13) ensure individuals with complex behavioral,
279	279	medical and physical needs receive services based on assessed needs
280	280	and in the most integrated, least restrictive setting according to
281	281	the each individual's needs and preferences;
282	282	(14) increase, expand flexibility and promote use of
283	283	the consumer directed services model ; and
284	284	(15) promote independence, self-determination,
285	285	consumer directed services and decision making by using
286	286	alternatives to guardianship, including supported decision-making
287	287	agreements under Chapter 1357, Estates Code.
288	288	(b) The pilot program shall be designed to test innovations
289	289	and payment models for the provision of long-term services and
290	290	supports to achieve the goals outlined in subsection (a) utilizing
291	291	methods such as:
292	292	(1) payment of a bundled amount without downside risk
293	293	to a long term services and supports provider for some or all
294	294	services delivered as part of a comprehensive array of long term
295	295	services and supports;
296	296	(2) enhanced incentive payments to providers of long
297	297	term services and supports based on meeting pre-determined outcome
298	298	or quality metrics; and
299	299	(3) any other payment models approved by the
300	300	commission.
301	301	(c) The alternative payment rates or methodologies tested
302	302	under subsection (b) must be agreed to in writing by the managed
303	303	care organization and participating long term services and supports
304	304	provider. In developing the alternative payment rates or
305	305	methodologies, the parties must utilize:
306	306	(1) the historical costs of long term services and
307	307	supports, including Medicaid fee-for-service rates; and
308	308	(2) reasonable cost estimates for new pilot program
309	309	services; and
310	310	(3) whether alternative payment rates or
311	311	methodologies are sufficient to ensure the provider's continued
312	312	participation in the pilot program and promote quality outcomes.
313	313	(d) For long term services and supports delivered under the
314	314	pilot, the alternative payment models tested under subsection (b)
315	315	shall not reduce the minimum payment to providers below the current
316	316	fee for service reimbursement rates.
317	317	(e) The pilot program must allow existing providers of
318	318	long-term services and supports for persons with intellectual and
319	319	developmental disabilities, as defined in Section 534.001 (4), and
320	320	providers of long term services and supports for persons with
321	321	similar functional needs to voluntarily participate in one or more
322	322	pilot projects. Failure to participate in a pilot project does not
323	323	affect the contracting status of any provider as a significant
324	324	traditional provider.
325	325	[(d) The department, in consultation and collaboration with
326	326	the advisory committee, shall evaluate each submitted managed care
327	327	strategy proposal and determine whether:
328	328	(1) the proposed strategy satisfies the requirements
329	329	of this section; and
330	330	(2) the private services provider or managed care
331	331	organization that submitted the proposal has a demonstrated ability
332	332	to provide the long-term services and supports appropriate to the
333	333	individuals who will receive services through the pilot program
334	334	based on the proposed strategy, if implemented.]
335	335	[(e) Based on the evaluation performed under Subsection
336	336	(d), the department may select as pilot program service providers
337	337	one or more private services providers or managed care
338	338	organizations with whom the commission will contract.]
339	339	(f) [For each pilot program service provider, the
340	340	department__shall develop and implement a pilot program.] Under a
341	341	pilot program, the [pilot program service provider] the
342	342	participating managed care organizations shall provide long-term
343	343	services and supports under Medicaid to persons with an
344	344	intellectual or developmental disability, and other individuals
345	345	with disabilities with similar functional needs, to test its
346	346	managed care strategy based on capitation.
347	347	(g) The [department] commission, in consultation and
348	348	collaboration with the advisory committee and Pilot Program
349	349	Workgroup, shall analyze information provided by the [pilot program
350	350	service providers] participating managed care organizations and
351	351	any information collected by the [department] commission during the
352	352	operation of the pilot program[s] for purposes of making a
353	353	recommendation about a system of programs and services for
354	354	implementation through future state legislation or rules.
355	355	(h) The analysis under Subsection (g) must include an
356	356	assessment of the effect of the managed care strategies implemented
357	357	in the pilot program[s] on the goals specified under Subsections
358	358	(a), (b), (c) and (d). [:]
359	359	[(1) access to long-term services and supports;
360	360	(2) the quality of acute care services and long-term
361	361	services and supports;
362	362	(3) meaningful outcomes using person-centered
363	363	planning, individualized budgeting, and self-determination,
364	364	including a person's inclusion in the community;
365	365	(4) the integration of service coordination of acute
366	366	care services and long-term services and supports;
367	367	(5) the efficiency and use of funding;
368	368	(6) the placement of individuals in housing that is
369	369	the least restrictive setting appropriate to an individual's needs;
370	370	(7) employment assistance and customized, integrated,
371	371	competitive employment options; and
372	372	(8) the number and types of fair hearing and appeals
373	373	processes in accordance with applicable federal law.]
374	374	(i) Prior to implementation of the pilot program, the
375	375	commission, in consultation and collaboration with the advisory
376	376	committee and Pilot Program Workgroup, shall develop a process to
377	377	ensure 12 months continuous Medicaid eligibility for pilot
378	378	participants.
379	379	SECTION 11. Chapter 534, Government Code is amended to add
380	380	new section 534.1045, PILOT BENEFITS AND PROVIDER QUALIFICATIONS as
381	381	follows:
382	382	Sec. 534.1045. PILOT BENEFITS AND PROVIDER QUALIFICATIONS.
383	383	(a) The pilot program must ensure that participating managed care
384	384	organizations provide:
385	385	(1) all Medicaid state plan acute care benefits
386	386	available under the STAR+PLUS program;
387	387	(2) long term services and supports in the Medicaid
388	388	state plan, including:
389	389	(A) Community First Choice services;
390	390	(B) Personal Assistant services;
391	391	(C) Day Activity Health Services;
392	392	(D) Habilitation services defined under Section
393	393	534/001 (6);
394	394	(3) long term services and supports in the STAR+PLUS
395	395	home and community-based services waiver, including:
396	396	(A) assisted living
397	397	(B) personal assistance services;
398	398	(C) employment assistance;
399	399	(D) supported employment;
400	400	(E) adult foster care;
401	401	(F) dental care;
402	402	(G) nursing care;
403	403	(H) respite care;
404	404	(I) home-delivered meals;
405	405	(J) cogniticve rehabilitative therapy;
406	406	(K) physical therapy;
407	407	(L) occupational therapy;
408	408	(M) speech-language pathology;
409	409	(N) medical supplies;
410	410	(O) minor home modifcations;
411	411	(P) adaptive aids;
412	412	(4) long term services and supports available in the
413	413	Medicaid waiver programs defined in Section 534.001 (12),
414	414	including:
415	415	(A) enhanced behavioral health services;
416	416	(B) behavioral supports;
417	417	(C) day habilitation;
418	418	(D) community support transporation;
419	419	(5) additional long term services and supports,
420	420	including:
421	421	(A) housing supports;
422	422	(B) behavioral health crisis intervention;
423	423	(C) high medical needs services; and
424	424	(6) Other non-residential long term services and
425	425	supports the commission, in consultation and coordination with the
426	426	advisory committee and Pilot Program Workgroup, determines
427	427	appropriate and consistent with the regulations governing the 1915
428	428	(c) waiver programs defined in Section 534.001 (12),
429	429	person-centered approaches, home and community-based settings
430	430	requirements, and the most integrated and least restrictive setting
431	431	according to an individual's needs and preferences.
432	432	(b) A comprehensive long term services and supports
433	433	provider is authorized to deliver services listed under under
434	434	subsections (a)(2)(A), (a)(2)(D), (a)(3)(B), (a)(3)(C), (a)(3)(D),
435	435	(a)(3)(G), (a)(3)(H), (a)(3)(J), (a)(3)(K), (a)(3)(L), (a)(3)(M),
436	436	and (a)(3)(4),if they also deliver the service in a Medicaid waiver
437	437	defined under Section 534.001 (12).
438	438	(b-2) A comprehensive long term services and supports
439	439	provider may deliver services under subsections (a)(5) and (a)(6)
440	440	if agreed to under contract with the pilot participating managed
441	441	care organization.
442	442	(c) Day habilitation services under (a)(4)(c) may be
443	443	delivered by a provider who is contracted or subcontracted under a
444	444	1915 (c) Medicaid waiver as defined under Section 534.001 (12) or an
445	445	ICF/IID program as defined under Section 534.001 (8).
446	446	(d) A comprehensive long term services and supports
447	447	provider works in consultation with the pilot participating managed
448	448	care organization's care coordinators to ensure the seamless
449	449	delivery of acute care and long term services and supports on a
450	450	day-to-day basis in accordance with an individual's plan of care
451	451	and may be reimbursed by the managed care organization for this
452	452	coordination.
453	453	(e) Prior to implementation of the pilot program, the
454	454	commission, in consultation and collaboration with the advisory
455	455	committee and Pilot Program Workgroup, shall:
456	456	(1) develop recommendations to modify, for the pilot
457	457	program only, the Adult Foster Care, Supported Employment and
458	458	Employment Assistance benefits to ensure increased access to and
459	459	availability of this service, and
460	460	(2) as needed, definitions for services described
461	461	under subsection (a)(4) and (5), and any services added under
462	462	subsection (6).
463	463	SECTION 12. Section 534.105, Subchapter C, Chapter 534,
464	464	Government Code, is amended to read as follows:
465	465	Sec. 534.105. PILOT PROGRAM: MEASURABLE GOALS. (a) The
466	466	[department] commission, in consultation and collaboration with
467	467	the advisory committee and Pilot Program Workgroup, shall identify
468	468	measurable goals using National Core Indicators, National Quality
469	469	Forum LTSS measures and other appropriate CAHPS measures to be
470	470	achieved by [each] the pilot program implemented under this
471	471	subchapter. [The identified goals must:
472	472	(1) align with information that will be collected
473	473	under Section 534.108(a); and
474	474	(2) be designed to improve the quality of outcomes for
475	475	individuals receiving services through the pilot program.]
476	476	(b) The [department] commission, in consultation and
477	477	collaboration with the advisory committee and Pilot Program
478	478	Workgroup, shall [propose] develop specific strategies and
479	479	performance measures for achieving the identified goals. A proposed
480	480	strategy may be evidence-based if there is an evidence-based
481	481	strategy available for meeting the pilot program's goals.
482	482	(c) The commission, in consultation and collaboration with
483	483	the advisory committee and Pilot Program Workgroup, shall ensure
484	484	that the mechanisms to report, track and assess the specific
485	485	strategies and performance measures for achieving the identified
486	486	goals are established prior to implementation of the pilot program.
487	487	SECTION 13. Section 534.106, Subchapter C, Chapter 534,
488	488	Government Code, is amended to read as follows:
489	489	Sec. 534.106. IMPLEMENTATION, LOCATION, AND DURATION. (a)
490	490	The commission [and the department] shall implement [any] the pilot
491	491	program[s] established under this subchapter [not later than] on
492	492	September 1, [2017] 2023.
493	493	(b) A pilot program established under this subchapter [may]
494	494	shall operate for at least [up to] 24 months. [A pilot program may
495	495	cease operation if the pilot program service provider terminates
496	496	the contract with the commission before the agreed-to termination
497	497	date.]
498	498	(c) A pilot program established under this subchapter shall
499	499	be conducted in [one or more] the STAR+PLUS service area [regions]
500	500	selected by the [department] commission.
501	501	SECTION 14. Section 534.1065, Subchapter C, Chapter 534,
502	502	Government Code, is amended to read as follows:
503	503	Sec. 534.1065. RECIPIENT ENROLLMENT, PARTICIPATION AND
504	504	ELIGIBILITY [IN PROGRAM VOLUNTARY]. (a) Enrollment
505	505	[Participation]in a pilot program established under this
506	506	subchapter by an individual [with an intellectual or developmental
507	507	disability] shall occur using an opt-out process [is voluntary,
508	508	and] with the decision whether to participate in a program and
509	509	receive long-term services and supports from a provider through
510	510	that program [may] to be made only by the individual or the
511	511	individual's legally authorized representative.
512	512	(1) The commission, in consultation and collaboration
513	513	with the advisory committee and Pilot Program Workgroup, shall
514	514	develop a timeline and process for and informational materials
515	515	related to educating pilot participants about the pilot including
516	516	its benefits, impact on current services and other related
517	517	information to ensure prospective pilot participants are able to
518	518	make an informed decision regarding participation. The process must
519	519	ensure:
520	520	(A) the timeline for development and
521	521	distribution of the pilot informational materials allows for
522	522	sufficient advance notification to and education of individuals
523	523	eligible for pilot participation, their families and other
524	524	individuals actively involved in their lives;
525	525	(B) individuals eligible for pilot
526	526	participation, including new and current STAR+PLUS enrollees and
527	527	other individuals specified in subsection (a) (1) (A), receive oral
528	528	and written information about the pilot prior to participation,
529	529	(C) the information provided is written in clear,
530	530	simple language and presented in a manner individuals are able to
531	531	understand and, at a minimum, explains that:
532	532	(i) upon conclusion of the pilot,
533	533	individuals will be requested to provide input on their pilot
534	534	participation experience, including whether the pilot was able to
535	535	meet their unique support needs;
536	536	(ii) participation in the pilot does not
537	537	remove individuals from any Interest List or, in accordance with
538	538	Section 534.1065 (c), the right to select an enrollment, transition
539	539	or diversion offer; and
540	540	(iii) individuals have choice among acute
541	541	care and long term services providers, including the consumer
542	542	directed services model and the comprehensive services model.
543	543	(b) The commission, in consultation and coordination with
544	544	the advisory committee and Pilot Program Workgroup, shall develop
545	545	pilot program participant eligibility criteria. The criteria must
546	546	ensure pilot participants include:
547	547	(1) individuals with an intellectual and
548	548	developmental disability including autism and individuals with
549	549	significant complex behavioral, medical and physical needs
550	550	receiving home and community-based services through STAR+PLUS or a
551	551	STAR+PLUS member who is also on a Medicaid Waiver Interest List or
552	552	is a STAR+PLUS member meeting criteria for intellectual
553	553	disabilities. It does not include individuals who are receiving
554	554	only acute care services under STAR+PLUS and enrolled in the
555	555	community-based ICF/IID program or one of the Medicaid waiver
556	556	programs defined under Section 534.001 (12).
557	557	(2) individuals receiving services under the
558	558	STAR+PLUS Medicaid managed care program who have a traumatic brain
559	559	injury that occurred after the age of 22; and
560	560	(3) other individuals with disabilities who have
561	561	similar functional needs independent of age of onset or diagnosis.
562	562	(c) Individuals participating in the pilot who, during the
563	563	pilot's implementation, are offered enrollment in one of the 1915
564	564	(c) Medicaid waiver programs defined under Section 534.001 (12)
565	565	shall be eligible to accept the enrollment, transition or diversion
566	566	offer.
567	567	SECTION 15. Section 534.107, Subchapter C, Chapter 534,
568	568	Government Code, is amended to read as follows:
569	569	Sec. 534.107. [COORDINATING SERVICES] COMMISSION
570	570	RESPONSIBILTIES. (a) [In providing long-term services and supports
571	571	under Medicaid to individuals with an intellectual or developmental
572	572	disability,] The commission [a pilot program service provider]
573	573	shall require managed care organizations participating in the pilot
574	574	program to:
575	575	(1) ensure individuals participating in the pilot have
576	576	choice among acute care and comprehensive long term services and
577	577	supports providers and service delivery options including the
578	578	consumer directed services model as specified under Section
579	579	534.109. [coordinate through the pilot program institutional and
580	580	community-based services available to the individuals, including
581	581	services provided through:
582	582	(A) a facility licensed under Chapter 252, Health
583	583	and Safety Code;
584	584	(B) a Medicaid waiver program; or
585	585	(C) a community-based ICF-IID operated by local
586	586	authorities] ;
587	587	(2) demonstrate to the satisfaction of the commission
588	588	that their network of acute care, long term services and supports
589	589	and comprehensive service providers have experience and expertise
590	590	providing services for individuals with an intellectual or
591	591	developmental disability and individuals with similar functional
592	592	needs;
593	593	[collaborate with managed care organizations to provide
594	594	integrated coordination of acute care services and long-term
595	595	services and supports, including discharge planning from acute care
596	596	services to community-based long-term services and supports];
597	597	(3) have a process for preventing inappropriate
598	598	institutionalizations of individuals; and
599	599	(4) ensure timely initiation and consistent provision
600	600	of services in accordance with an individual's person-centered plan
601	601	[accept the risk of inappropriate institutionalizations of
602	602	individuals previously residing in community settings].
603	603	(b) For the duration of the pilot the commission must ensure
604	604	that comprehensive long term services and supports providers as
605	605	defined under Section 534.001(4) are deemed significant
606	606	traditional providers and included in the provider network of the
607	607	managed care organizations participating in the pilot.
608	608	SECTION 16. Section 534.108, Subchapter C., Chapter 534,
609	609	Government Code, is amended to read as follows:
610	610	Section 534.108. Pilot Program Information. (a) The
611	611	commission [and the department, in consultation and coordination
612	612	with the advisory committee and Pilot Program Workgroup, shall
613	613	determine the information to be collected from each managed care
614	614	organization participating in the pilot for use in the evaluation
615	615	and reports required under Section 534.121. [collect and compute
616	616	the following information with respect to each pilot program
617	617	implemented under this subchapter to the extent it is available:]
618	618	(b) For the duration of the pilot each managed care
619	619	organization participating in the pilot shall submit to the
620	620	commission and the advisory committee a quarterly report on the
621	621	services provided to each pilot participant that includes the
622	622	following information:
623	623	(A) the level of services requested, and the
624	624	authorization and utilization rates of services for each pilot
625	625	service;
626	626	(B) timeliness of services requested,
627	627	authorized, initiated, and number and duration of unplanned service
628	628	breaks;
629	629	(C) number of pilot participants using
630	630	employment assistance and supported employment services;
631	631	(D) number of service denials and fair hearings,
632	632	and disposition of fair hearings;
633	633	(E) number of complaints and inquiries received
634	634	by the commission and managed care organizations participating in
635	635	the pilot and the outcome of the complaints; and
636	636	(F) number of participants who select the
637	637	consumer directed services model and reasons participants did not
638	638	select the service model.
639	639	(c) The commission shall ensure that the mechanisms to
640	640	report and track the information and data required in subsections
641	641	(a) and (b) are established prior to implementation of the pilot
642	642	program.
643	643	[(1) the difference between the average monthly cost
644	644	per person for all acute care services and long-term services and
645	645	supports received by individuals participating in the pilot program
646	646	while the program is operating, including services provided through
647	647	the pilot program and other services with which pilot program
648	648	services are coordinated as described by Section 534.107, and the
649	649	average monthly cost per person for all services received by the
650	650	individuals before the operation of the pilot program;
651	651	(2) the percentage of individuals receiving services
652	652	through the pilot program who begin receiving services in a
653	653	nonresidential setting instead of from a facility licensed under
654	654	Chapter 252, Health and Safety Code, or any other residential
655	655	setting;
656	656	(3) the difference between the percentage of
657	657	individuals receiving services through the pilot program who live
658	658	in non-provider-owned housing during the operation of the pilot
659	659	program and the percentage of individuals receiving services
660	660	through the pilot program who lived in non-provider-owned housing
661	661	before the operation of the pilot program;
662	662	(4) the difference between the average total Medicaid
663	663	cost, by level of need, for individuals in various residential
664	664	settings receiving services through the pilot program during the
665	665	operation of the program and the average total Medicaid cost, by
666	666	level of need, for those individuals before the operation of the
667	667	program;
668	668	(5) the difference between the percentage of
669	669	individuals receiving services through the pilot program who obtain
670	670	and maintain employment in meaningful, integrated settings during
671	671	the operation of the program and the percentage of individuals
672	672	receiving services through the program who obtained and maintained
673	673	employment in meaningful, integrated settings before the operation
674	674	of the program;
675	675	(6) the difference between the percentage of
676	676	individuals receiving services through the pilot program whose
677	677	behavioral, medical, life-activity, and other personal outcomes
678	678	have improved since the beginning of the program and the percentage
679	679	of individuals receiving services through the program whose
680	680	behavioral, medical, life-activity, and other personal outcomes
681	681	improved before the operation of the program, as measured over a
682	682	comparable period; and
683	683	(7) a comparison of the overall client satisfaction
684	684	with services received through the pilot program, including for
685	685	individuals who leave the program after a determination is made in
686	686	the individuals' cases at hearings or on appeal, and the overall
687	687	client satisfaction with services received before the individuals
688	688	entered the pilot program.
689	689	(b) The pilot program service provider shall collect any
690	690	information described by Subsection (a) that is available to the
691	691	provider and provide the information to the department and the
692	692	commission not later than the 30th day before the date the program's
693	693	operation concludes.
694	694	(c) In addition to the information described by Subsection
695	695	(a), the pilot program service provider shall collect any
696	696	information specified by the department for use by the department
697	697	in making an evaluation under Section 534.104(g).
698	698	(d) The commission and the department, in consultation and
699	699	collaboration with the advisory committee, shall review and
700	700	evaluate the progress and outcomes of each pilot program
701	701	implemented under this subchapter and submit, as part of the annual
702	702	report to the legislature required by Section 534.054, a report to
703	703	the legislature during the operation of the pilot programs. Each
704	704	report must include recommendations for program improvement and
705	705	continued implementation.]
706	706	SECTION 17. Section 534.109, Subchapter C, Chapter 534,
707	707	Government Code, is amended to read as follows:
708	708	Sec. 534.109. PERSON-CENTERED PLANNING. The commission, in
709	709	consultation and collaboration [cooperation] with the [department]
710	710	advisory committee and Pilot Program Workgroup, shall ensure that
711	711	each individual[with an intellectual or developmental disability]
712	712	who receives services and supports under Medicaid through a pilot
713	713	program established under this subchapter, or the individual's
714	714	legally authorized representative, has access to a comprehensive
715	715	facilitated, person-centered plan that identifies outcomes for the
716	716	individual and drives the development of the individualized budget.
717	717	The consumer directed services[direction] model, as defined by
718	718	Section 531.051, [may be an outcome of the plan] must be an
719	719	available option for individuals to achieve self-determination,
720	720	choice and control.
721	721	SECTION 18. Section 534.110, Subchapter C., Chapter 534,
722	722	Government Code, is amended to read as follows:
723	723	Sec. 534.110. TRANSITION BETWEEN PROGRAMS; CONTINUITY OF
724	724	SERVICES. (a) During the evaluation of the pilot required under
725	725	Section 534.121,[The] the commission may continue the pilot to
726	726	protect continuity of care. If the commission determines not to
727	727	continue the pilot during the evaluation, the commission, in
728	728	consultation and collaboration with the advisory committee and
729	729	Pilot Program Workgroup, shall ensure that there is a comprehensive
730	730	plan for transitioning the provision of Medicaid benefits provided
731	731	to pilot participants to the services provided before the pilot.
732	732	[between a Medicaid waiver program or an ICF-IID program and a pilot
733	733	program under this subchapter to protect continuity of care.]
734	734	(b) The transition plan shall be developed in consultation
735	735	and collaboration with the advisory committee and with stakeholder
736	736	input as described by Section 534.103.
737	737	SECTION 19. Section 534.111, Subchapter C, Chapter 534,
738	738	Government Code, is amended to read as follows:
739	739	Sec. 534.111. CONCLUSION OF PILOT PROGRAM[S]; EXPIRATION.
740	740	Contingent on the decision made under Section 534.110, [On] on
741	741	September 1, [2019] 2025:
742	742	(1) [each] the pilot program established under this
743	743	subchapter [that is still in operation] either continues or must
744	744	conclude. [; and
745	745	(2) this subchapter expires.]
746	746	SECTION 21. Chapter 534, Government Code,is amended to add
747	747	new Subchapter C-1 to read as follows: SUBCHAPTER C-1. PILOT
748	748	EVALUATION AND REPORT
749	749	Section 534.121. EVALUATION OF AND REPORT ON PILOT PROGRAM.
750	750	(a) The commission, in consultation and collaboration with the
751	751	advisory committee and Pilot Program Workgroup, shall review and
752	752	evaluate the progress and outcomes of the pilot program implemented
753	753	under Subchapter C of this Chapter and submit, as part of the annual
754	754	report required by Section 534.054, a report on the status of the
755	755	pilot program. The report must include recommendations for program
756	756	improvement.
757	757	(b) Upon conclusion of the pilot program required under
758	758	Subchapter C, the commission, in consultation and collaboration
759	759	with the advisory committee and Pilot Program Workgroup, shall
760	760	evaluate the pilot program and prepare and submit a report to the
761	761	legislature based on a comprehensive analysis of the pilot.
762	762	(c) The comprehensive analysis must:
763	763	(1) include an assessment of the effect of the pilot
764	764	on:
765	765	(A) access to and improved quality of long-term
766	766	services and supports;
767	767	(B) informed choice and meaningful outcomes
768	768	using person-centered planning, flexible consumer directed
769	769	services, individualized budgeting, and self-determination,
770	770	including a person's inclusion in the community;
771	771	(C) the integration of service coordination of
772	772	acute care services and long-term services and supports;
773	773	(D) employment assistance and customized,
774	774	integrated, competitive employment options;
775	775	(E) the number, types and dispositions of fair
776	776	hearing and appeals processes in accordance with applicable federal
777	777	and state law;
778	778	(F) increasing use and flexibility of the
779	779	consumer directed service model;
780	780	(G) increasing use of alternatives to
781	781	guardianship, including supported decision-making agreements under
782	782	Chapter 1357, Estates Code;
783	783	(H) achieving cost effectiveness and best use of
784	784	funding based on individuals' needs and preferences; and
785	785	(I) attendant recruitment and retention;
786	786	(2) provide an analysis of the experience and outcome
787	787	of the following systems changes:
788	788	(A) the IDD assessment tool required under
789	789	Chapter 533, Subchapter B, Section 533.0335, Health and Safety
790	790	Code;
791	791	(B) the 21st Century Cures Act;
792	792	(C) implementation of the federal HCBS Settings
793	793	regulations; and
794	794	(D) the provision of basic attendant and
795	795	habilitation services required under Section 534.152 of this
796	796	Chapter, and
797	797	(E) the benefits of providing STAR+PLUS services
798	798	to persons based on functional needs;
799	799	(3) include input from the individuals with
800	800	intellectual and developmental disabilities and participants of
801	801	similar functional needs, families and other individuals actively
802	802	involved in the lives of the individuals; and providers of long term
803	803	services and supports programs defined under Section 534.001 (8)
804	804	and (12) who participated in the pilot about their experiences;
805	805	(4) be incorporated into the annual report to the
806	806	legislature required under Section 534.054; and
807	807	(5) include recommendations about a system of programs
808	808	and services for consideration by the legislature, including
809	809	recommendations for needed statutory changes and whether to
810	810	transition the pilot to a statewide program under the STAR+PLUS
811	811	program for individuals who meet the eligibility criteria specified
812	812	in Section 534.1065.
813	813	SECTION 22. The heading to Subchapter E, Chapter 534,
814	814	Government Code, is amended to read as follows: SUBCHAPTER E. STAGE
815	815	TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS AND LONG-TERM CARE
816	816	MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED MANAGED CARE
817	817	SYSTEM
818	818	SECTION 23. Section 534.201, Subchapter E, Chapter 534,
819	819	Government Code, is repealed:
820	820	[Sec. 534.201. TRANSITION OF RECIPIENTS UNDER TEXAS HOME
821	821	LIVING (TxHmL) WAIVER PROGRAM TO MANAGED CARE PROGRAM.] [(a)[This
822	822	section applies to individuals with an intellectual or
823	823	developmental disability who are receiving long-term services and
824	824	supports under the Texas home living (TxHmL) waiver program on the
825	825	date the commission implements the transition described by
826	826	Subsection (b).]
827	827	[(b) On September 1, 2020, the commission shall transition
828	828	the provision of Medicaid benefits to individuals to whom this
829	829	section applies to the STAR + PLUS Medicaid managed care program
830	830	delivery model or the most appropriate integrated capitated managed
831	831	care program delivery model, as determined by the commission based
832	832	on cost-effectiveness and the experience of the STAR + PLUS
833	833	Medicaid managed care program in providing basic attendant and
834	834	habilitation services and of the pilot programs established under
835	835	Subchapter C, subject to Subsection (c)(1).]
836	836	[(c) At the time of the transition described by Subsection
837	837	(b), the commission shall determine whether to:
838	838	(1) continue operation of the Texas home living
839	839	(TxHmL) waiver program for purposes of providing supplemental
840	840	long-term services and supports not available under the managed
841	841	care program delivery model selected by the commission; or
842	842	(2) provide all or a portion of the long-term services
843	843	and supports previously available under the Texas home living
844	844	(TxHmL) waiver program through the managed care program delivery
845	845	model selected by the commission.]
846	846	[(d) In implementing the transition described by Subsection
847	847	(b), the commission, in consultation and collaboration with the
848	848	advisory committee, shall develop a process to receive and evaluate
849	849	input from interested statewide stakeholders.]
850	850	[(e) The commission, in consultation and collaboration with
851	851	the advisory committee, shall ensure that there is a comprehensive
852	852	plan for transitioning the provision of Medicaid benefits under
853	853	this section that protects the continuity of care provided to
854	854	individuals to whom this section applies.]
855	855	[(f) In addition to the requirements of Section 533.005, a
856	856	contract between a managed care organization and the commission for
857	857	the organization to provide Medicaid benefits under this section
858	858	must contain a requirement that the organization implement a
859	859	process for individuals with an intellectual or developmental
860	860	disability that:
861	861	(1) ensures that the individuals have a choice of
862	862	providers;
863	863	(2) to the greatest extent possible, protects those
864	864	individuals' continuity of care with respect to access to primary
865	865	care providers, including the use of single-case agreements with
866	866	out-of-network providers; and
867	867	(3) provides access to a member services phone line
868	868	for individuals or their legally authorized representatives to
869	869	obtain information on and assistance with accessing services
870	870	through network providers, including providers of primary,
871	871	specialty, and other long-term services and supports].
872	872	[(g)] [The commission, in consultation and collaboration
873	873	with the advisory committee, shall analyze the outcomes of the
874	874	transition of the long-term services and supports under the Texas
875	875	home living (TxHmL) Medicaid waiver program to a managed care
876	876	program delivery model.] [The analysis must:]
877	877	[(1) include an assessment of the effect of the
878	878	transition on:]
879	879	[(A) access to long-term services and supports;]
880	880	[(B) meaningful outcomes using person-centered
881	881	planning, individualized budgeting, and self-determination,
882	882	including a person's inclusion in the community;
883	883	[(C) the integration of service coordination of
884	884	acute care services and long-term services and supports;]
885	885	[(D) employment assistance and customized,
886	886	integrated, competitive employment options; and]
887	887	[(E) the number and types of fair hearing and
888	888	appeals processes in accordance with applicable federal law;]
889	889	[(2) be incorporated into the annual report to the
890	890	legislature required under Section 534.054; and]
891	891	(3) include recommendations for improvements to the
892	892	transition implementation for consideration by the legislature,
893	893	including recommendations for needed statutory changes.]
894	894	SECTION 24. Section 534.202, Subchapter E, Chapter 534,
895	895	Government Code, is amended to read as follows:
896	896	Sec. 534.202. DETERMINATION TO TRANSITION [OF] ICF-IID
897	897	PROGRAM RECIPIENTS AND CERTAIN [OTHER] MEDICAID WAIVER PROGRAM
898	898	RECIPIENTS TO MANAGED CARE PROGRAM. (a) This section applies to
899	899	individuals with an intellectual or developmental disability who
900	900	[ , on the date the commission implements the transition
901	901	described by Subsection (b), ] are receiving long-term services and
902	902	supports under:
903	903	(1) a Medicaid waiver program as defined under Section
904	904	534.001 (12) [other than the Texas home living (TxHmL) waiver
905	905	program]; or
906	906	(2) an ICF-IID program.
907	907	(b) After implementing the pilot [transition] required by
908	908	Subchapter C of this Chapter, completing the evaluation required
909	909	under Section 534.121, and subject to subsection (g)[on September
910	910	1, 2021], the commission, in consultation and collaboration with
911	911	the advisory committee, shall develop a plan for the transition of
912	912	all or a portion of the services provided through the programs
913	913	defined in Sections 534.001 (8) and (12) which were not included in
914	914	the pilot under Subchapter C. The plan must include:
915	915	(1) The process for transitioning the services in the
916	916	programs defined in Sections 534.001 (8) and (12) in a phased-in
917	917	manner as follows:
918	918	(A) Texas Home Living;
919	919	(B) CLASS;
920	920	(C) non-residential services provided through
921	921	the 1915 (c) Home and Community-based Services and DBMD waivers;
922	922	and
923	923	(D) subject to subsection (b) (3), the
924	924	residential services offered through the ICF/IID program and the
925	925	HCS and DBMD waiver programs.
926	926	(2) With the exception of the residential services
927	927	provided through the programs specified in subsection (b) (1)(D),
928	928	the schedule for transitioning the services and individuals into
929	929	managed care must occur in the order specified under subsection
930	930	(b)(1)beginning with TxHmL on September 1, 2027; CLASS on September
931	931	1, 2029,; and the non-residential services provided through the
932	932	Home and Community-based services and DBMD waivers on September 1,
933	933	2031.
934	934	(3) The process for evaluating the feasibility and
935	935	cost efficiency of transitioning the residential services offered
936	936	through the ICF/IID program and the HCS and DBMD waiver programs,
937	937	and, as appropriate, transitioning to the managed care program.
938	938	(A) The process for determining the transition of
939	939	the residential services must be based on an evaluation of a two
940	940	year pilot.
941	941	[transition the provision of Medicaid benefits to individuals to
942	942	whom this section applies to the STAR + PLUS Medicaid managed care
943	943	program delivery model or the most appropriate integrated capitated
944	944	managed care program delivery model, as determined by the
945	945	commission based on cost-effectiveness and the experience of the
946	946	transition of Texas home living (TxHmL) waiver program recipients
947	947	to a managed care program delivery model under Section 534.201
948	948	subject to Subsections (c)(1) and (g).]
949	949	(c) [At the time of] Prior to the transition [described by]
950	950	dates specified under Subsection (b) (2) and subject to subsection
951	951	(g), the commission shall determine whether to:
952	952	(1) continue operation of the Medicaid waiver programs
953	953	only for purposes of providing, if applicable:
954	954	(A) supplemental long-term services and supports
955	955	not available under the managed care program delivery model
956	956	selected by the commission; or
957	957	(B) long term services and supports to Medicaid
958	958	waiver program recipients who choose to continue receiving benefits
959	959	under the waiver programs who choose to continue receiving benefits
960	960	under the waiver program as provided by Subsection (g); or
961	961	(2) subject to Subsection (g), provide all or a
962	962	portion of the long-term services and supports previously available
963	963	under the Medicaid waiver programs through the managed care program
964	964	delivery model selected by the commission.
965	965	(d) In implementing the transition described by Subsection
966	966	(b)(2), the commission shall develop a process to receive and
967	967	evaluate input from interested statewide stakeholders that is in
968	968	addition to the input provided by the advisory committee.
969	969	(e) The commission shall ensure that there is a
970	970	comprehensive plan for transitioning the provision of Medicaid
971	971	benefits under this section that protects the continuity of care
972	972	provided to individuals to whom this section applies and ensures
973	973	individuals have a choice among acute care and comprehensive long
974	974	term services and supports providers and service delivery options
975	975	including the consumer directed services model as specified under
976	976	Subsection (i).
977	977	(f) Before transitioning the provision of Medicaid benefits
978	978	for children under this section, a managed care organization
979	979	providing services under the managed care program delivery model
980	980	selected by the commission must demonstrate to the satisfaction of
981	981	the commission that the organization's network of providers has
982	982	experience and expertise in the provision of services to children
983	983	with an intellectual or developmental disability. Before
984	984	transitioning the provision of Medicaid benefits for adults with an
985	985	intellectual or developmental disability under this section, a
986	986	managed care organization providing services under the managed care
987	987	program delivery model selected by the commission must demonstrate
988	988	to the satisfaction of the commission that the organization's
989	989	network of providers has experience and expertise in the provision
990	990	of services to adults with an intellectual or developmental
991	991	disability.
992	992	(g) If the commission determines that all or a portion of
993	993	the long-term services and supports previously available under the
994	994	Medicaid waiver programs should be provided through a managed care
995	995	program delivery model under Subsection (c)(1), the commission
996	996	shall, at the time of the transition, allow each recipient
997	997	receiving long-term services and supports under a Medicaid waiver
998	998	program the option of:
999	999	(1) continuing to receive the services and supports
1000	1000	under the Medicaid waiver program; or
1001	1001	(2) receiving the services and supports through the
1002	1002	managed care program delivery model selected by the commission.
1003	1003	(h) A recipient who chooses to receive long-term services
1004	1004	and supports through a managed care program delivery model under
1005	1005	Subsection (g) may not, at a later time, choose to receive the
1006	1006	services and supports under a Medicaid waiver program.
1007	1007	(i) In addition to the requirements of Section 533.005, a
1008	1008	contract between a managed care organization and the commission for
1009	1009	the organization to provide Medicaid benefits under this section
1010	1010	must contain a requirement that the organization implement a
1011	1011	process for individuals with an intellectual or developmental
1012	1012	disability that:
1013	1013	(1) ensures that the individuals have a choice among
1014	1014	acute care and comprehensive long term services and supports
1015	1015	providers and service delivery options including the consumer
1016	1016	directed services model;
1017	1017	(2) to the greatest extent possible, protects those
1018	1018	individuals' continuity of care with respect to access to primary
1019	1019	care providers, including the use of single-case agreements with
1020	1020	out-of-network providers; and
1021	1021	(3) provides access to a member services phone line
1022	1022	for individuals or their legally authorized representatives to
1023	1023	obtain information on and assistance with accessing services
1024	1024	through network providers, including providers of primary,
1025	1025	specialty, and other long-term services and supports.
1026	1026	SECTION 25. Section 534.203, Subchapter E, Chapter 534,
1027	1027	Government Code, is amended to read as follows:
1028	1028	Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER
1029	1029	SUBCHAPTER. In administering this subchapter, the commission shall
1030	1030	ensure that upon a determination to transition services in the
1031	1031	programs defined under Sections 534.001 (8) and (12):
1032	1032	(1) that the commission is responsible for setting the
1033	1033	minimum reimbursement rate paid to a provider of ICF-IID services
1034	1034	or a group home provider under the integrated managed care system,
1035	1035	including the staff rate enhancement paid to a provider of ICF-IID
1036	1036	services or a group home provider;
1037	1037	(2) that an ICF-IID service provider or a group home
1038	1038	provider is paid not later than the 10th day after the date the
1039	1039	provider submits a clean claim in accordance with the criteria used
1040	1040	by the department for the reimbursement of ICF-IID service
1041	1041	providers or a group home provider, as applicable; and
1042	1042	(3) the establishment of an electronic portal through
1043	1043	which a provider of ICF-IID services or a group home provider
1044	1044	participating in the STAR + PLUS Medicaid managed care program
1045	1045	delivery model or the most appropriate integrated capitated managed
1046	1046	care program delivery model, as appropriate, may submit long-term
1047	1047	services and supports claims to any participating managed care
1048	1048	organization [. ] ; and
1049	1049	(4) that each individual with an intellectual or
1050	1050	developmental disability and the individual's legally authorized
1051	1051	representative has access to a comprehensive facilitated,
1052	1052	person-centered plan that identifies outcomes for the individual.
1053	1053	The consumer directed services model must be promoted as an
1054	1054	available option for individuals to achieve self-determination,
1055	1055	choice and control.
1056	1056	SECTION 26. Chapter 534, Government Code, is amended to add
1057	1057	Subchapter F. to read as follows:
1058	1058	SUBCHAPTER F. OTHER IMPLEMENTATION REQUIREMENTS AND
1059	1059	RESPONSIBILITIES UNDER THIS CHAPTER
1060	1060	Sec. 534.301. IMPLEMENTATION AND RESPONSIBILITIES UNDER
1061	1061	THIS CHAPTER. (a) The commission is authorized to delay
1062	1062	implementation of this Chapter or its subchapters without further
1063	1063	investigation or adjustments or legislative intervention, if it
1064	1064	determines any provision under the Chapter or other related mandate
1065	1065	or initiative integral to implementation adversely affects the
1066	1066	system of services and supports to persons and programs to which the
1067	1067	Chapter applies.
1068	1068	(b) For purpose of the pilot under Subchpater C. of this
1069	1069	Chapter and any subsequent transition of recipients receiving
1070	1070	services under certain Medicaid waiver programs defined under
1071	1071	Section 534.001 (12) to a managed care program as specified under
1072	1072	Section 534.202 (c), the commission must:
1073	1073	(1) maintain a certification process and regulatory
1074	1074	oversight of Texas Home Living and Home and Community-based
1075	1075	Services providers; and
1076	1076	(2) require managed care organizations include in
1077	1077	their network of qualified long term services and supports
1078	1078	providers certified Texas Home Living and Home and Community-based
1079	1079	Services providers that specialize in services for persons with
1080	1080	intellectual disabilities.
1081	1081	(c) Subject to Section 534.202 (b) and (c), upon a decision
1082	1082	to transition the long term services and supports under a Medicaid
1083	1083	waiver program defined under Section 534.001 (12), the commission
1084	1084	shall ensure individuals do not lose the benefits they are
1085	1085	receiving through these Medicaid waiver programs.
1086	1086	(d) For purposes of the pilot under Subchapter C. and any
1087	1087	future transition of services specified under Section 534.202 into
1088	1088	the STAR+PLUS program, the comprehensive long term services and
1089	1089	supports provider defined in Section 534.001 (4):
1090	1090	(1) must report encounters of any directly contracted
1091	1091	services to the managed care organization; provide quarterly
1092	1092	reporting of coordinated services and timeframes to the managed
1093	1093	care organization, and provide quarterly progress on goals and
1094	1094	objectives set by an individual's person centered plan; and
1095	1095	(2) will not be held accountable for the provision of
1096	1096	services on an individual's service plan for which a managed care
1097	1097	organization denies or does not authorize access to in a timely
1098	1098	manner.
1099	1099	SECTION 27. If before implementing any provision of this
1100	1100	Act a state agency determines that a waiver or authorization from a
1101	1101	federal agency is necessary for implementation of that provision,
1102	1102	the agency affected by the provision shall request the waiver or
1103	1103	authorization and may delay implementing that provision until the
1104	1104	waiver or authorization is granted.
1105	1105	SECTION 28. If the Health and Human Services Commission
1106	1106	determines that it is cost effective, the commission shall apply
1107	1107	for and actively seek a waiver or authorization from the
1108	1108	appropriate federal agency to allow the state to provide medical
1109	1109	assistance under the waiver or authorization to medically fragile
1110	1110	individuals;
1111	1111	(1) Who are at least 21 years of age; and
1112	1112	(2) Whose costs to receive care exceed cost limits
1113	1113	under existing Medicaid waiver programs.
1114	1114	SECTION 29. This act takes effect September 1, 2019.