Texas 2019 - 86th Regular

Texas Senate Bill SB2167 Compare Versions

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

Old	New	Differences
1	1	86R3638 KFF-F
2	2	By: Kolkhorst S.B. No. 2167
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to implementation of the system redesign for the delivery
8	8	of Medicaid benefits to persons with intellectual or developmental
9	9	disabilities.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 534.053(g), Government Code, as amended
12	12	by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523),
13	13	Acts of the 84th Legislature, Regular Session, 2015, is reenacted
14	14	and amended to read as follows:
15	15	(g) On January 1, 2027 [the one-year anniversary of the date
16	16	the commission completes implementation of the transition required
17	17	under Section 534.202]:
18	18	(1) the advisory committee is abolished; and
19	19	(2) this section expires.
20	20	SECTION 2. Chapter 534, Government Code, is amended by
21	21	adding Subchapter C-1 to read as follows:
22	22	SUBCHAPTER C-1. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES PILOT
23	23	PROGRAM
24	24	Sec. 534.121. DEFINITION. In this subchapter:
25	25	(1) "Health care service region" has the meaning
26	26	assigned by Section 533.001.
27	27	(2) "Pilot program" means the pilot program
28	28	established under Section 534.122.
29	29	Sec. 534.122. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES
30	30	PILOT PROGRAM IMPLEMENTATION. (a) Notwithstanding Subchapter C
31	31	and not later than September 1, 2022, the commission shall develop
32	32	and implement a pilot program in accordance with this subchapter to
33	33	test the delivery through the STAR+PLUS Medicaid managed care
34	34	program of home and community-based services to adults with
35	35	intellectual or developmental disabilities who are receiving
36	36	Medicaid benefits:
37	37	(1) under the STAR+PLUS Medicaid managed care program;
38	38	or
39	39	(2) as residents of state supported living centers.
40	40	(b) The commission shall design the pilot program to meet
41	41	the following goals and objectives:
42	42	(1) provide access to home and community-based
43	43	services to recipients who are pilot program participants;
44	44	(2) promote meaningful outcomes by using
45	45	person-centered planning that focuses on the unique needs of
46	46	individuals with intellectual or developmental disabilities and
47	47	their families and caregivers;
48	48	(3) promote integrated service coordination of acute
49	49	care services and home and community-based services;
50	50	(4) promote efficiency and the best use of funding;
51	51	(5) promote housing stability through housing
52	52	supports and navigation services;
53	53	(6) promote community inclusion and placement through
54	54	enhanced behavioral health supports and crisis intervention
55	55	services;
56	56	(7) promote employment assistance and customized,
57	57	integrated, and competitive employment;
58	58	(8) promote fair hearing and appeals processes
59	59	provided in accordance with applicable federal law;
60	60	(9) promote the use of innovative technology and
61	61	benefits, including home monitoring, telemonitoring,
62	62	transportation, and other innovations that support community
63	63	integration; and
64	64	(10) promote sufficient flexibility to achieve these
65	65	goals.
66	66	(c) The pilot program must operate:
67	67	(1) for at least 24 months; and
68	68	(2) in one or more health care service regions, as
69	69	determined by the commission.
70	70	(d) The commission shall consult the advisory committee
71	71	regarding the design, implementation, and evaluation of the pilot
72	72	program.
73	73	Sec. 534.123. PARTICIPATING MANAGED CARE ORGANIZATIONS.
74	74	The commission shall select and contract with one or more managed
75	75	care organizations participating in the STAR+PLUS Medicaid managed
76	76	care program to participate in the pilot program.
77	77	Sec. 534.124. BENEFITS PROVIDED. The pilot program must
78	78	ensure that managed care organizations participating in the pilot
79	79	program provide:
80	80	(1) all Medicaid state plan benefits available under
81	81	the STAR+PLUS program, including:
82	82	(A) acute care services, including physical
83	83	health, behavioral health, specialty care, inpatient hospital, and
84	84	outpatient pharmacy services; and
85	85	(B) long-term services and supports, including:
86	86	(i) Community First Choice services;
87	87	(ii) personal assistance services;
88	88	(iii) day activity health services; and
89	89	(iv) home and community-based services,
90	90	including assisted living, personal assistance services,
91	91	employment assistance, supported employment, adult foster care,
92	92	dental care, nursing care, respite care, home-delivered meals, and
93	93	therapy services;
94	94	(2) the following additional home and community-based
95	95	services:
96	96	(A) enhanced behavioral health services;
97	97	(B) behavioral supports;
98	98	(C) day habilitation;
99	99	(D) housing supports;
100	100	(E) community support transportation; and
101	101	(F) crisis intervention services; and
102	102	(3) other home and community-based services the
103	103	commission determines appropriate.
104	104	Sec. 534.125. RECIPIENT PARTICIPATION. (a) The executive
105	105	commissioner shall by rule establish recipient eligibility
106	106	criteria, including financial and functional criteria, for
107	107	participation in the pilot program. In establishing rules under
108	108	this section, the executive commissioner shall ensure the following
109	109	recipients are allowed to enroll in the pilot program:
110	110	(1) a recipient receiving services under the STAR+PLUS
111	111	Medicaid managed care program who has an intellectual or
112	112	developmental disability, including a recipient with autism,
113	113	regardless of whether the recipient is:
114	114	(A) receiving home and community-based services
115	115	under the STAR+PLUS program; or
116	116	(B) on a Medicaid waiver program interest list;
117	117	(2) a recipient receiving services under the STAR+PLUS
118	118	Medicaid managed care program who has a traumatic brain injury that
119	119	occurred after the recipient reached 21 years of age; and
120	120	(3) a state supported living center resident who, by
121	121	virtue of participating in the pilot program, is able to transition
122	122	to a community placement.
123	123	(b) A recipient's participation in the pilot program is
124	124	voluntary. The decision whether to participate in the program and
125	125	receive long-term services and supports from a provider through the
126	126	program may be made only by the recipient or the recipient's legally
127	127	authorized representative.
128	128	Sec. 534.126. PERSON-CENTERED PLANNING. The commission
129	129	shall ensure that each recipient who participates in the pilot
130	130	program, or the recipient's legally authorized representative, has
131	131	access to a facilitated, person-centered plan that identifies
132	132	outcomes for the recipient and drives the development of the
133	133	individualized budget. The consumer direction model, as defined in
134	134	Section 531.051, may be an outcome of the plan.
135	135	Sec. 534.127. ANNUAL REPORT ON IMPLEMENTATION. Not later
136	136	than September 30 of each year, the commission shall prepare and
137	137	submit a report to the legislature on the implementation of the
138	138	pilot program. The report must include:
139	139	(1) an assessment of the implementation of the pilot
140	140	program, including appropriate information regarding the provision
141	141	of acute care and home and community-based services to recipients
142	142	participating in the pilot program;
143	143	(2) recommendations regarding implementation and
144	144	improvements to Medicaid waiver programs, including
145	145	recommendations regarding appropriate statutory changes; and
146	146	(3) an assessment of the effect of the pilot program on
147	147	the following:
148	148	(A) recipient access to home and community-based
149	149	services, including the additional services included in the pilot
150	150	program in accordance with Sections 534.124(2) and (3);
151	151	(B) the quality of services provided under the
152	152	pilot program;
153	153	(C) meaningful outcomes for recipients using
154	154	person-centered planning, individualized budgeting, and
155	155	self-determination, including outcomes related to community
156	156	inclusion;
157	157	(D) the integration of service coordination of
158	158	acute care services and home and community-based services;
159	159	(E) the efficiency and use of funding and impact
160	160	for future transitions of Medicaid waiver programs;
161	161	(F) the placement and retention of recipients in
162	162	housing that is the least restrictive setting appropriate to the
163	163	recipients' needs;
164	164	(G) employment assistance and customized,
165	165	integrated, competitive employment options; and
166	166	(H) the number and types of fair hearings and
167	167	appeals sought by participants in the pilot program.
168	168	Sec. 534.128. This subchapter expires September 30, 2025.
169	169	SECTION 3. Section 534.201(b), Government Code, is amended
170	170	to read as follows:
171	171	(b) On September 1, 2024 [2020], the commission shall
172	172	transition the provision of Medicaid benefits to individuals to
173	173	whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid
174	174	managed care program delivery model or the most appropriate
175	175	integrated capitated managed care program delivery model, as
176	176	determined by the commission based on cost-effectiveness and the
177	177	experience of the STAR+PLUS [STAR + PLUS] Medicaid managed care
178	178	program in providing basic attendant and habilitation services and
179	179	of the pilot programs established under Subchapters [Subchapter] C
180	180	and C-1, subject to Subsection (c)(1).
181	181	SECTION 4. Section 534.202(b), Government Code, is amended
182	182	to read as follows:
183	183	(b) After implementing the transition required by Section
184	184	534.201, on September 1, 2025 [2021], the commission shall
185	185	transition the provision of Medicaid benefits to individuals to
186	186	whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid
187	187	managed care program delivery model or the most appropriate
188	188	integrated capitated managed care program delivery model, as
189	189	determined by the commission based on cost-effectiveness and the
190	190	experience of the transition of Texas home living (TxHmL) waiver
191	191	program recipients to a managed care program delivery model under
192	192	Section 534.201, subject to Subsections (c)(1) and (g).
193	193	SECTION 5. Section 534.203, Government Code, is amended to
194	194	read as follows:
195	195	Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER
196	196	SUBCHAPTER. In administering this subchapter, the commission shall
197	197	ensure:
198	198	(1) that the commission is responsible for setting the
199	199	minimum reimbursement rate paid to a provider of ICF-IID services
200	200	or a group home provider under the integrated managed care system,
201	201	including the staff rate enhancement paid to a provider of ICF-IID
202	202	services or a group home provider;
203	203	(2) that an ICF-IID service provider or a group home
204	204	provider is paid not later than the 10th day after the date the
205	205	provider submits a clean claim in accordance with the criteria used
206	206	by the commission [department] for the reimbursement of ICF-IID
207	207	service providers or a group home provider, as applicable; and
208	208	(3) the establishment of an electronic portal through
209	209	which a provider of ICF-IID services or a group home provider
210	210	participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care
211	211	program delivery model or the most appropriate integrated capitated
212	212	managed care program delivery model, as appropriate, may submit
213	213	long-term services and supports claims to any participating managed
214	214	care organization.
215	215	SECTION 6. Notwithstanding Section 534.127, Government
216	216	Code, as added by this Act, the Health and Human Services Commission
217	217	shall submit the initial report required by that section not later
218	218	than September 30, 2020.
219	219	SECTION 7. If before implementing any provision of this Act
220	220	a state agency determines that a waiver or authorization from a
221	221	federal agency is necessary for implementation of that provision,
222	222	the agency affected by the provision shall request the waiver or
223	223	authorization and may delay implementing that provision until the
224	224	waiver or authorization is granted.
225	225	SECTION 8. This Act takes effect September 1, 2019.