Texas 2019 - 86th Regular

Texas Senate Bill SB2225 Compare Versions

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

Old	New	Differences
1	1	86R11984 KFF-D
2	2	By: Zaffirini S.B. No. 2225
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to early childhood intervention and rehabilitative and
8	8	habilitative services.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter A, Chapter 533, Government Code, is
11	11	amended by adding Section 533.00521 to read as follows:
12	12	Sec. 533.00521. PRIOR AUTHORIZATION NOT REQUIRED FOR
13	13	CERTAIN EARLY CHILDHOOD INTERVENTION SERVICES. (a) A managed care
14	14	organization that contracts with the commission to provide health
15	15	care services to recipients under the STAR Health program or the
16	16	STAR Kids managed care program may not require prior authorization
17	17	for the provision of early childhood intervention program services
18	18	under Chapter 73, Human Resources Code, to a child eligible for the
19	19	program, including services specified in the child's
20	20	individualized family service plan issued by the commission under
21	21	the program.
22	22	(b) A contract between a managed care organization and the
23	23	commission for the organization to provide health care services to
24	24	recipients under the STAR Health program or the STAR Kids managed
25	25	care program must contain a requirement that the organization:
26	26	(1) proactively review and monitor recipient access
27	27	and utilization of early childhood intervention services under
28	28	Chapter 73, Human Resources Code; and
29	29	(2) demonstrate to the commission that the
30	30	organization is in compliance with Subsection (a), including a
31	31	requirement that the organization submit quarterly reports to the
32	32	commission that verify that the organization did not include a
33	33	prior authorization request for early childhood intervention
34	34	services under Chapter 73, Human Resources Code, as part of a
35	35	medical necessity determination.
36	36	SECTION 2. Section 73.009(a), Human Resources Code, is
37	37	amended to read as follows:
38	38	(a) The commission [department] shall develop and the
39	39	executive commissioner shall establish policies concerning
40	40	services described by this section. A child under three years of
41	41	age and the child's parent, guardian, or other legally authorized
42	42	representative [family] may be referred for services described by
43	43	this section if the child is:
44	44	(1) identified as having a developmental delay;
45	45	(2) suspected of having a developmental delay; or
46	46	(3) considered at risk of developmental delay.
47	47	SECTION 3. Chapter 73, Human Resources Code, is amended by
48	48	adding Sections 73.0111 and 73.012 to read as follows:
49	49	Sec. 73.0111. PROVIDER OMBUDSMAN. (a) In this section,
50	50	"ombudsman" means the individual designated as the ombudsman for
51	51	providers of services authorized under this chapter.
52	52	(b) The executive commissioner shall designate an ombudsman
53	53	for providers of services authorized under this chapter.
54	54	(c) The ombudsman's office is administratively attached to
55	55	the office of the ombudsman of the commission.
56	56	(d) The commission may use an alternate title for the
57	57	ombudsman in provider-directed materials if the commission
58	58	determines that the alternate title would benefit providers'
59	59	understanding of or access to ombudsman services.
60	60	(e) The ombudsman serves as a neutral party to assist
61	61	providers of services authorized under this chapter in resolving
62	62	issues related to providing early childhood intervention services
63	63	under this chapter, including through the STAR Kids managed care
64	64	program.
65	65	(f) The ombudsman shall:
66	66	(1) provide dispute and complaint resolution
67	67	services;
68	68	(2) perform provider protection and advocacy
69	69	functions;
70	70	(3) collect inquiry and complaint data; and
71	71	(4) at least annually, submit a report to the
72	72	commission relating to the inquiry and complaint data collected
73	73	under Subdivision (3) and make recommendations to the commission on
74	74	how to improve the provision of early childhood intervention
75	75	services under this chapter.
76	76	(g) The executive commissioner by rule shall adopt and
77	77	ensure the use of procedures for the reporting, monitoring, and
78	78	resolution of disputes and complaints described by Subsection (f)
79	79	that are consistent with the procedures adopted and used under
80	80	Medicaid.
81	81	Sec. 73.012. GUIDANCE ON REIMBURSEMENT METHODOLOGY FOR CASE
82	82	MANAGEMENT SERVICES. (a) The executive commissioner shall request
83	83	clear direction and guidance from the federal Centers for Medicare
84	84	and Medicaid Services on the reimbursement methodology that may be
85	85	used for the provision of case management services under this
86	86	chapter, including direction on allowable and unallowable costs.
87	87	(b) This section expires September 1, 2021.
88	88	SECTION 4. Subtitle B, Title 3, Human Resources Code, is
89	89	amended by adding Chapter 74 to read as follows:
90	90	CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
91	91	Sec. 74.0001. DEFINITIONS. In this chapter:
92	92	(1) "Commission" means the Health and Human Services
93	93	Commission.
94	94	(2) "Eligible child" means a child who is eligible for
95	95	early childhood intervention services under Chapter 73.
96	96	(3) "Executive commissioner" means the executive
97	97	commissioner of the Health and Human Services Commission.
98	98	(4) "Tele-connective pilot program" means the program
99	99	developed and implemented under Section 74.0002.
100	100	(5) "Telehealth service" and "telemedicine medical
101	101	service" have the meanings assigned by Section 111.001, Occupations
102	102	Code.
103	103	Sec. 74.0002. TELE-CONNECTIVE PILOT PROGRAM. (a) The
104	104	commission shall develop and implement a pilot program to provide
105	105	early childhood intervention services under Chapter 73 to eligible
106	106	children through the provision of telehealth and telemedicine
107	107	medical services delivered using access points established in
108	108	schools and in school districts selected to participate in the
109	109	program.
110	110	(b) In developing and implementing the tele-connective
111	111	pilot program, the commission shall ensure the program aligns with
112	112	the provision of existing telemedicine medical services.
113	113	Sec. 74.0003. SCHOOL DISTRICT SELECTION. The commission in
114	114	cooperation with the Texas Education Agency shall select the school
115	115	districts in which to implement the tele-connective pilot program.
116	116	In determining the school districts in which to implement the
117	117	program, the commission and the Texas Education Agency shall:
118	118	(1) consider each school district in which there is:
119	119	(A) a low or inadequate number of service
120	120	providers authorized under Chapter 73; or
121	121	(B) a significant risk of losing service
122	122	providers authorized under Chapter 73; and
123	123	(2) implement the program only in school districts in
124	124	which the implementation is reasonable and feasible.
125	125	Sec. 74.0004. PROVIDER PARTICIPATION. (a) The commission
126	126	shall ensure that providers of services under Chapter 73 other than
127	127	school districts are allowed to participate as providers in the
128	128	tele-connective pilot program and provide services both inside and
129	129	outside a school-based setting.
130	130	(b) The commission shall collaborate with the Texas
131	131	Education Agency to establish any school-based provider access
132	132	points for the program.
133	133	(c) The commission shall track the service hours of
134	134	providers participating in the tele-connective pilot program.
135	135	Sec. 74.0005. ADEQUATE NETWORK OF ACCESS POINTS. (a) The
136	136	commission, in consultation with the Texas Education Agency, shall
137	137	ensure that an adequate number of school-based and non-school-based
138	138	tele-connective pilot program access points are established in a
139	139	school district participating in the program. Access points may be
140	140	established at schools, regional education service centers, and
141	141	other entities, locations, and modes the commission determines
142	142	appropriate.
143	143	(b) When selecting access points in which to implement the
144	144	tele-connective pilot program, the commission and the Texas
145	145	Education Agency shall consider the availability of existing
146	146	infrastructure.
147	147	Sec. 74.0006. AUTOMATIC AND VOLUNTARY PARTICIPATION OF
148	148	CERTAIN ELIGIBLE CHILDREN. (a) Subject to Subsection (b), the
149	149	executive commissioner shall, after receiving recommendations from
150	150	the advisory committee established under Section 73.004, by rule
151	151	establish which eligible children will be automatically enrolled in
152	152	the tele-connective pilot program.
153	153	(b) The parent, guardian, or other legally authorized
154	154	representative of an eligible child may, at any time, elect to opt
155	155	the child out of the tele-connective pilot program.
156	156	(c) A child who is enrolled in the tele-connective pilot
157	157	program may receive early childhood intervention services through
158	158	the program only to the extent the services are available and
159	159	suitable. Enrollment in the tele-connective pilot program does not
160	160	prevent a child from receiving early childhood intervention
161	161	services in the child's home or other natural environment.
162	162	Sec. 74.0007. SCHOOL DISTRICT EMPLOYEE TRAINING. The Texas
163	163	Education Agency shall develop a training course on the
164	164	tele-connective pilot program to be given to appropriate school
165	165	district employees.
166	166	Sec. 74.0008. INITIAL SCREENING AND EVALUATION. (a) The
167	167	parent, guardian, or other legally authorized representative of an
168	168	eligible child must be:
169	169	(1) present during an initial screening or evaluation
170	170	under the tele-connective pilot program; and
171	171	(2) given the opportunity to opt the child out of the
172	172	tele-connective pilot program at the time of the child's initial
173	173	screening or evaluation.
174	174	(b) Notwithstanding any other law, after a child is enrolled
175	175	in the tele-connective pilot program, early childhood intervention
176	176	services, including any initial treatment or prescription, that are
177	177	delivered or issued by a physician or by a health care provider
178	178	acting under the delegation or supervision of the physician or
179	179	under the health care provider's license may be provided using
180	180	telecommunications or other information technology.
181	181	Sec. 74.0009. PROVIDER REIMBURSEMENT. The executive
182	182	commissioner in adopting rules governing the tele-connective pilot
183	183	program shall ensure that provider reimbursement for a telehealth
184	184	or telemedicine medical service is made at a rate that is comparable
185	185	to the rate paid under Medicaid for the provision of the same or
186	186	substantially similar services.
187	187	Sec. 74.0010. CONFIDENTIALITY OF INFORMATION. The
188	188	commission shall ensure that the tele-connective pilot program
189	189	complies with federal and state law regarding confidentiality of
190	190	medical information, including the Health Insurance Portability
191	191	and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
192	192	the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.
193	193	Section 1232g).
194	194	Sec. 74.0011. ACCESS POINT EVALUATION. Not later than
195	195	September 1, 2020, the commission shall conduct an evaluation of
196	196	the tele-connective pilot program to ensure that an adequate number
197	197	of access points have been established in each school district
198	198	participating in the program. This section expires January 1,
199	199	2021.
200	200	Sec. 74.0012. REPORT. Not later than January 1, 2021, the
201	201	commission shall submit an initial report to the governor, the
202	202	lieutenant governor, the speaker of the house of representatives,
203	203	and the presiding officers of the standing committees of the senate
204	204	and house of representatives having primary jurisdiction over the
205	205	early childhood intervention program authorized by Chapter 73. The
206	206	report must evaluate the operation of the tele-connective pilot
207	207	program and make recommendations regarding the continuation or
208	208	expansion of the program.
209	209	Sec. 74.0013. FUNDING. The commission shall actively seek
210	210	and apply for any available federal money to support the
211	211	tele-connective pilot program, including federal money made
212	212	available by the:
213	213	(1) Federal Communications Commission, including
214	214	money available under the federal Rural Health Care Program;
215	215	(2) United States Health Resources and Services
216	216	Administration's Office for the Advancement of Telehealth; and
217	217	(3) United States Department of Agriculture,
218	218	including the Distance Learning and Telemedicine Grant Program
219	219	established under 7 C.F.R. Part 1734.
220	220	Sec. 74.0014. EXPIRATION. This chapter expires September
221	221	1, 2023.
222	222	SECTION 5. The heading to Subchapter E, Chapter 1367,
223	223	Insurance Code, is amended to read as follows:
224	224	SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
225	225	DEVELOPMENTAL DELAYS
226	226	SECTION 6. Section 1367.201, Insurance Code, is amended to
227	227	read as follows:
228	228	Sec. 1367.201. DEFINITION. In this subchapter,
229	229	rehabilitative and habilitative therapies and related services
230	230	include:
231	231	(1) occupational therapy evaluations and services;
232	232	(2) physical therapy evaluations and services;
233	233	(3) speech therapy evaluations and services; [and]
234	234	(4) dietary or nutritional evaluations;
235	235	(5) specialized skills training by a person certified
236	236	as an early intervention specialist; and
237	237	(6) case management provided by a person certified as
238	238	an early intervention specialist.
239	239	SECTION 7. Section 1367.202, Insurance Code, is amended to
240	240	read as follows:
241	241	Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
242	242	subchapter applies only to a health benefit plan that:
243	243	(1) provides benefits for medical or surgical expenses
244	244	incurred as a result of a health condition, accident, or sickness,
245	245	including an individual, group, blanket, or franchise insurance
246	246	policy or insurance agreement, a group hospital service contract,
247	247	or an individual or group evidence of coverage that is offered by:
248	248	(A) an insurance company;
249	249	(B) a group hospital service corporation
250	250	operating under Chapter 842;
251	251	(C) a fraternal benefit society operating under
252	252	Chapter 885;
253	253	(D) a stipulated premium company operating under
254	254	Chapter 884;
255	255	(E) a health maintenance organization operating
256	256	under Chapter 843; or
257	257	(F) a multiple employer welfare arrangement
258	258	subject to regulation under Chapter 846;
259	259	(2) is offered by an approved nonprofit health
260	260	corporation that holds a certificate of authority under Chapter
261	261	844; or
262	262	(3) provides health and accident coverage through a
263	263	risk pool created under Chapter 172, Local Government Code,
264	264	notwithstanding Section 172.014, Local Government Code, or any
265	265	other law.
266	266	(b) Notwithstanding any other law, this subchapter also
267	267	applies to a standard health benefit plan provided under Chapter
268	268	1507.
269	269	(c) Notwithstanding any provision in Chapter 1575 or 1579 or
270	270	any other law, this subchapter applies to:
271	271	(1) a basic plan under Chapter 1575; and
272	272	(2) a primary care coverage plan under Chapter 1579.
273	273	SECTION 8. Section 1367.203, Insurance Code, is amended to
274	274	read as follows:
275	275	Sec. 1367.203. EXCEPTION. (a) This subchapter does not
276	276	apply to:
277	277	(1) a plan that provides coverage:
278	278	(A) only for a specified disease or for another
279	279	limited benefit;
280	280	(B) only for accidental death or dismemberment;
281	281	(C) for wages or payments in lieu of wages for a
282	282	period during which an employee is absent from work because of
283	283	sickness or injury;
284	284	(D) as a supplement to a liability insurance
285	285	policy;
286	286	(E) for credit insurance;
287	287	(F) only for dental or vision care; or
288	288	(G) only for indemnity for hospital confinement;
289	289	(2) a small employer health benefit plan written under
290	290	Chapter 1501;
291	291	(3) a Medicare supplemental policy as defined by
292	292	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
293	293	(4) a workers' compensation insurance policy;
294	294	(5) medical payment insurance coverage provided under
295	295	a motor vehicle insurance policy; or
296	296	(6) a long-term care insurance policy, including a
297	297	nursing home fixed indemnity policy, unless the commissioner
298	298	determines that the policy provides benefit coverage so
299	299	comprehensive that the policy is a health benefit plan as described
300	300	by Section 1367.202.
301	301	(b) This subchapter does not apply to a qualified health
302	302	plan to the extent that a determination is made under 45 C.F.R.
303	303	Section 155.170 that:
304	304	(1) this subchapter requires the plan to offer
305	305	benefits in addition to the essential health benefits required
306	306	under 42 U.S.C. Section 18022(b); and
307	307	(2) this state is required to defray the cost of the
308	308	benefits mandated under this subchapter.
309	309	SECTION 9. Section 1367.204, Insurance Code, is amended to
310	310	read as follows:
311	311	Sec. 1367.204. PROVISION [OFFER] OF COVERAGE REQUIRED.
312	312	[(a)] A health benefit plan issuer must provide [offer] coverage
313	313	that complies with this subchapter.
314	314	[(b) The individual or group policy or contract holder may
315	315	reject coverage required to be offered under this section.]
316	316	SECTION 10. Section 1367.205, Insurance Code, is amended by
317	317	amending Subsections (a) and (b) and adding Subsection (d) to read
318	318	as follows:
319	319	(a) A health benefit plan required to provide [that
320	320	provides] coverage for rehabilitative and habilitative therapies
321	321	and related services under this subchapter may not prohibit or
322	322	restrict payment for covered services provided to a child and
323	323	determined to be necessary to and provided in accordance with an
324	324	individualized family service plan issued by the Health and Human
325	325	Services Commission [Interagency Council on Early Childhood
326	326	Intervention] under Chapter 73, Human Resources Code.
327	327	(b) Rehabilitative and habilitative therapies and related
328	328	services described by Subsection (a) must be covered in the amount,
329	329	duration, scope, and service setting established in the child's
330	330	individualized family service plan.
331	331	(d) A health benefit plan prior authorization requirement,
332	332	or another requirement that a service be authorized, otherwise
333	333	applicable to a covered rehabilitative or habilitative therapy
334	334	service or a related service is satisfied if the service is
335	335	specified in a child's individualized family service plan.
336	336	SECTION 11. Subchapter E, Chapter 1367, Insurance Code, is
337	337	amended by adding Section 1367.2055 to read as follows:
338	338	Sec. 1367.2055. MEDICAID PAY PARITY. A health benefit plan
339	339	issuer shall reimburse a health care provider providing a
340	340	rehabilitative and habilitative therapy or related service at a
341	341	rate that is at least equal to the reimbursement rate the health
342	342	care provider would receive for providing the same or a
343	343	substantially similar service under Medicaid.
344	344	SECTION 12. Section 1367.206, Insurance Code, is amended to
345	345	read as follows:
346	346	Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
347	347	required to be provided [offered] under this subchapter, a health
348	348	benefit plan issuer may not:
349	349	(1) apply the cost of rehabilitative and habilitative
350	350	therapies and related services described by Section 1367.205(a) to
351	351	an annual or lifetime maximum plan benefit or similar provision
352	352	under the plan; or
353	353	(2) use the cost of rehabilitative or habilitative
354	354	therapies and related services described by Section 1367.205(a) as
355	355	the sole justification for:
356	356	(A) increasing plan premiums; or
357	357	(B) terminating the insured's or enrollee's
358	358	participation in the plan.
359	359	SECTION 13. Subchapter A, Chapter 302, Labor Code, is
360	360	amended by adding Section 302.0061 to read as follows:
361	361	Sec. 302.0061. WORKFORCE DEVELOPMENT GRANTS FOR PROVIDERS
362	362	UNDER EARLY CHILDHOOD INTERVENTION PROGRAM. (a) In this section,
363	363	"early childhood intervention program" means the program
364	364	established under Chapter 73, Human Resources Code, to provide
365	365	early childhood intervention services in accordance with Part C,
366	366	Individuals with Disabilities Education Act (IDEA)(20 U.S.C.
367	367	Section 1431 et seq.).
368	368	(b) The commission shall actively seek and apply for federal
369	369	funding to establish a program designed to provide workforce
370	370	development grants to providers participating in the early
371	371	childhood intervention program for purposes of improving the
372	372	provision of program services by offering providers appropriate
373	373	education and training.
374	374	SECTION 14. (a) The Health and Human Services Commission
375	375	shall request guidance from the federal Centers for Medicare and
376	376	Medicaid Services or other appropriate federal agency regarding the
377	377	feasibility of receiving a waiver or other authorization necessary
378	378	to provide through Medicaid early childhood intervention services
379	379	to children who are eligible to receive those services under
380	380	Chapter 73, Human Resources Code, as amended by this Act, but who
381	381	are not eligible for Medicaid and do not have private health
382	382	benefits coverage.
383	383	(b) As soon as practicable after receiving guidance under
384	384	Subsection (a) of this section, the Health and Human Services
385	385	Commission shall prepare a report on how best to provide to children
386	386	the coverage described by that subsection. The commission shall
387	387	submit the report to the governor, the lieutenant governor, the
388	388	speaker of the house of representatives, and the presiding officers
389	389	of the standing committees of the senate and house of
390	390	representatives having primary jurisdiction over the early
391	391	childhood intervention program authorized by Chapter 73, Human
392	392	Resources Code, as amended by this Act.
393	393	SECTION 15. (a) As soon as practicable after the effective
394	394	date of this Act, the Health and Human Services Commission, after
395	395	consulting with the Texas Education Agency, other appropriate state
396	396	agencies, and the advisory committee established under Section
397	397	73.004, Human Resources Code, shall conduct a financial evaluation
398	398	of the early childhood intervention services provided under Chapter
399	399	73, Human Resources Code, as amended by this Act, and report on that
400	400	evaluation. The report must quantify the amount by which providing
401	401	early childhood intervention services in this state affects other
402	402	budget strategies, including the budget strategies of school
403	403	districts, regional education service centers, and other affected
404	404	governmental entities.
405	405	(b) Not later than September 1, 2020, the Health and Human
406	406	Services Commission shall submit the report prepared under
407	407	Subsection (a) of this section to the governor, the lieutenant
408	408	governor, the speaker of the house of representatives, and the
409	409	presiding officers of the standing committees of the senate and
410	410	house of representatives having primary jurisdiction over the early
411	411	childhood intervention program authorized by Chapter 73, Human
412	412	Resources Code, as amended by this Act.
413	413	SECTION 16. Not later than December 1, 2019, the Health and
414	414	Human Services Commission shall issue guidance to health benefit
415	415	plan issuers clarifying that providers of early childhood
416	416	intervention services under Chapter 73, Human Resources Code, as
417	417	amended by this Act, must file claims using the national provider
418	418	identifier number and Texas provider identifier number.
419	419	SECTION 17. Section 533.00521(b), Government Code, as added
420	420	by this Act, applies to a contract entered into or renewed on or
421	421	after the effective date of this Act. A contract entered into or
422	422	renewed before that date is governed by the law in effect on the
423	423	date the contract was entered into or renewed, and that law is
424	424	continued in effect for that purpose.
425	425	SECTION 18. Subchapter E, Chapter 1367, Insurance Code, as
426	426	amended by this Act, applies only to a health benefit plan
427	427	delivered, issued for delivery, or renewed on or after January 1,
428	428	2020. A health benefit plan delivered, issued for delivery, or
429	429	renewed before January 1, 2020, is governed by the law as it existed
430	430	immediately before the effective date of this Act, and that law is
431	431	continued in effect for that purpose.
432	432	SECTION 19. As soon as practicable after the effective date
433	433	of this Act, but not later than January 1, 2020, the Health and
434	434	Human Services Commission shall develop and implement the
435	435	tele-connective pilot program required by Chapter 74, Human
436	436	Resources Code, as added by this Act.
437	437	SECTION 20. If before implementing any provision of this
438	438	Act a state agency determines that a waiver or authorization from a
439	439	federal agency is necessary for implementation of that provision,
440	440	the agency affected by the provision shall request the waiver or
441	441	authorization and may delay implementing that provision until the
442	442	waiver or authorization is granted.
443	443	SECTION 21. This Act takes effect September 1, 2019.