86R3638 KFF-F
By: Kolkhorst S.B. No. 2167
A BILL TO BE ENTITLED
AN ACT
relating to implementation of the system redesign for the delivery
of Medicaid benefits to persons with intellectual or developmental
disabilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 534.053(g), Government Code, as amended
by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523),
Acts of the 84th Legislature, Regular Session, 2015, is reenacted
and amended to read as follows:
(g) On January 1, 2027 [the one-year anniversary of the date
the commission completes implementation of the transition required
under Section 534.202]:
(1) the advisory committee is abolished; and
(2) this section expires.
SECTION 2. Chapter 534, Government Code, is amended by
adding Subchapter C-1 to read as follows:
SUBCHAPTER C-1. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES PILOT
PROGRAM
Sec. 534.121. DEFINITION. In this subchapter:
(1) "Health care service region" has the meaning
assigned by Section 533.001.
(2) "Pilot program" means the pilot program
established under Section 534.122.
Sec. 534.122. STAR+PLUS HOME AND COMMUNITY-BASED SERVICES
PILOT PROGRAM IMPLEMENTATION. (a) Notwithstanding Subchapter C
and not later than September 1, 2022, the commission shall develop
and implement a pilot program in accordance with this subchapter to
test the delivery through the STAR+PLUS Medicaid managed care
program of home and community-based services to adults with
intellectual or developmental disabilities who are receiving
Medicaid benefits:
(1) under the STAR+PLUS Medicaid managed care program;
or
(2) as residents of state supported living centers.
(b) The commission shall design the pilot program to meet
the following goals and objectives:
(1) provide access to home and community-based
services to recipients who are pilot program participants;
(2) promote meaningful outcomes by using
person-centered planning that focuses on the unique needs of
individuals with intellectual or developmental disabilities and
their families and caregivers;
(3) promote integrated service coordination of acute
care services and home and community-based services;
(4) promote efficiency and the best use of funding;
(5) promote housing stability through housing
supports and navigation services;
(6) promote community inclusion and placement through
enhanced behavioral health supports and crisis intervention
services;
(7) promote employment assistance and customized,
integrated, and competitive employment;
(8) promote fair hearing and appeals processes
provided in accordance with applicable federal law;
(9) promote the use of innovative technology and
benefits, including home monitoring, telemonitoring,
transportation, and other innovations that support community
integration; and
(10) promote sufficient flexibility to achieve these
goals.
(c) The pilot program must operate:
(1) for at least 24 months; and
(2) in one or more health care service regions, as
determined by the commission.
(d) The commission shall consult the advisory committee
regarding the design, implementation, and evaluation of the pilot
program.
Sec. 534.123. PARTICIPATING MANAGED CARE ORGANIZATIONS.
The commission shall select and contract with one or more managed
care organizations participating in the STAR+PLUS Medicaid managed
care program to participate in the pilot program.
Sec. 534.124. BENEFITS PROVIDED. The pilot program must
ensure that managed care organizations participating in the pilot
program provide:
(1) all Medicaid state plan benefits available under
the STAR+PLUS program, including:
(A) acute care services, including physical
health, behavioral health, specialty care, inpatient hospital, and
outpatient pharmacy services; and
(B) long-term services and supports, including:
(i) Community First Choice services;
(ii) personal assistance services;
(iii) day activity health services; and
(iv) home and community-based services,
including assisted living, personal assistance services,
employment assistance, supported employment, adult foster care,
dental care, nursing care, respite care, home-delivered meals, and
therapy services;
(2) the following additional home and community-based
services:
(A) enhanced behavioral health services;
(B) behavioral supports;
(C) day habilitation;
(D) housing supports;
(E) community support transportation; and
(F) crisis intervention services; and
(3) other home and community-based services the
commission determines appropriate.
Sec. 534.125. RECIPIENT PARTICIPATION. (a) The executive
commissioner shall by rule establish recipient eligibility
criteria, including financial and functional criteria, for
participation in the pilot program. In establishing rules under
this section, the executive commissioner shall ensure the following
recipients are allowed to enroll in the pilot program:
(1) a recipient receiving services under the STAR+PLUS
Medicaid managed care program who has an intellectual or
developmental disability, including a recipient with autism,
regardless of whether the recipient is:
(A) receiving home and community-based services
under the STAR+PLUS program; or
(B) on a Medicaid waiver program interest list;
(2) a recipient receiving services under the STAR+PLUS
Medicaid managed care program who has a traumatic brain injury that
occurred after the recipient reached 21 years of age; and
(3) a state supported living center resident who, by
virtue of participating in the pilot program, is able to transition
to a community placement.
(b) A recipient's participation in the pilot program is
voluntary. The decision whether to participate in the program and
receive long-term services and supports from a provider through the
program may be made only by the recipient or the recipient's legally
authorized representative.
Sec. 534.126. PERSON-CENTERED PLANNING. The commission
shall ensure that each recipient who participates in the pilot
program, or the recipient's legally authorized representative, has
access to a facilitated, person-centered plan that identifies
outcomes for the recipient and drives the development of the
individualized budget. The consumer direction model, as defined in
Section 531.051, may be an outcome of the plan.
Sec. 534.127. ANNUAL REPORT ON IMPLEMENTATION. Not later
than September 30 of each year, the commission shall prepare and
submit a report to the legislature on the implementation of the
pilot program. The report must include:
(1) an assessment of the implementation of the pilot
program, including appropriate information regarding the provision
of acute care and home and community-based services to recipients
participating in the pilot program;
(2) recommendations regarding implementation and
improvements to Medicaid waiver programs, including
recommendations regarding appropriate statutory changes; and
(3) an assessment of the effect of the pilot program on
the following:
(A) recipient access to home and community-based
services, including the additional services included in the pilot
program in accordance with Sections 534.124(2) and (3);
(B) the quality of services provided under the
pilot program;
(C) meaningful outcomes for recipients using
person-centered planning, individualized budgeting, and
self-determination, including outcomes related to community
inclusion;
(D) the integration of service coordination of
acute care services and home and community-based services;
(E) the efficiency and use of funding and impact
for future transitions of Medicaid waiver programs;
(F) the placement and retention of recipients in
housing that is the least restrictive setting appropriate to the
recipients' needs;
(G) employment assistance and customized,
integrated, competitive employment options; and
(H) the number and types of fair hearings and
appeals sought by participants in the pilot program.
Sec. 534.128. This subchapter expires September 30, 2025.
SECTION 3. Section 534.201(b), Government Code, is amended
to read as follows:
(b) On September 1, 2024 [2020], the commission shall
transition the provision of Medicaid benefits to individuals to
whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid
managed care program delivery model or the most appropriate
integrated capitated managed care program delivery model, as
determined by the commission based on cost-effectiveness and the
experience of the STAR+PLUS [STAR + PLUS] Medicaid managed care
program in providing basic attendant and habilitation services and
of the pilot programs established under Subchapters [Subchapter] C
and C-1, subject to Subsection (c)(1).
SECTION 4. Section 534.202(b), Government Code, is amended
to read as follows:
(b) After implementing the transition required by Section
534.201, on September 1, 2025 [2021], the commission shall
transition the provision of Medicaid benefits to individuals to
whom this section applies to the STAR+PLUS [STAR + PLUS] Medicaid
managed care program delivery model or the most appropriate
integrated capitated managed care program delivery model, as
determined by the commission based on cost-effectiveness and the
experience of the transition of Texas home living (TxHmL) waiver
program recipients to a managed care program delivery model under
Section 534.201, subject to Subsections (c)(1) and (g).
SECTION 5. Section 534.203, Government Code, is amended to
read as follows:
Sec. 534.203. RESPONSIBILITIES OF COMMISSION UNDER
SUBCHAPTER. In administering this subchapter, the commission shall
ensure:
(1) that the commission is responsible for setting the
minimum reimbursement rate paid to a provider of ICF-IID services
or a group home provider under the integrated managed care system,
including the staff rate enhancement paid to a provider of ICF-IID
services or a group home provider;
(2) that an ICF-IID service provider or a group home
provider is paid not later than the 10th day after the date the
provider submits a clean claim in accordance with the criteria used
by the commission [department] for the reimbursement of ICF-IID
service providers or a group home provider, as applicable; and
(3) the establishment of an electronic portal through
which a provider of ICF-IID services or a group home provider
participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care
program delivery model or the most appropriate integrated capitated
managed care program delivery model, as appropriate, may submit
long-term services and supports claims to any participating managed
care organization.
SECTION 6. Notwithstanding Section 534.127, Government
Code, as added by this Act, the Health and Human Services Commission
shall submit the initial report required by that section not later
than September 30, 2020.
SECTION 7. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 8. This Act takes effect September 1, 2019.