By: Noble H.B. No. 3462
A BILL TO BE ENTITLED
AN ACT
relating to the consolidation of ombudsman programs administered by
the Health and Human Services Commission.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subchapter Y, Chapter 531,
Government Code, is amended to read as follows:
SUBCHAPTER Y. COMMISSION OMBUDSMAN PROGRAMS [FOR THE DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES]
SECTION 2. Section 531.991, Government Code, is amended by
amending Subdivision (2) and adding Subdivisions (3), (4) and (5)
to read as follows:
(1) "Department" means the Department of Family and
Protective Services.
(2) "Ombudsman" means the individual appointed as the
ombudsman for an ombudsman program [the Department of Family and
Protective Services].
(3) "Ombudsman program" means an ombudsman program
administered by the commission under this subchapter.
(4) "Commission" means the Health and Human Services
Commission.
(5) "Commissioner" means the executive commissioner
of the Health and Human Services Commission.
SECTION 3. Subchapter Y, Chapter 531, Government Code, is
amended by adding Section 531.9912 to read as follows:
Sec. 531.9912. ESTABLISHMENT OF OMBUDSMAN PROGRAMS. The
executive commissioner shall establish the following ombudsman
programs:
(1) the health and human services office of the
ombudsman in accordance with Section 531.9915;
(2) the ombudsman for children and youth in foster
care in accordance with Section 531.9931;
(3) the ombudsman for managed care assistance in
accordance with Section 531.9932;
(4) the ombudsman for behavioral health access to care
in accordance with Section 531.9933; and
(5) the ombudsman for individuals with an intellectual
or developmental disability in accordance with Section 531.9934.
SECTION 4. Section 531.0171, Government Code, is
transferred to Subchapter Y, Chapter 531, Government Code, and
redesignated as Section 531.9915, Government Code, to read as
follows:
Sec. 531.9915 [531.0171]. OFFICE OF OMBUDSMAN. (a) The
executive commissioner shall establish the commission's office of
the ombudsman with authority and responsibility over the health and
human services system in performing the following functions:
(1) providing dispute resolution services for the
health and human services system;
(2) performing consumer protection and advocacy
functions related to health and human services, including assisting
a consumer or other interested person with:
(A) raising a matter within the health and human
services system that the person feels is being ignored; and
(B) obtaining information regarding a filed
complaint; and
(3) collecting inquiry and complaint data related to
the health and human services system.
(b) The office of the ombudsman does not have the authority
to provide a separate process for resolving complaints or appeals.
(c) The executive commissioner shall develop a standard
process for tracking and reporting received inquiries and
complaints within the health and human services system. The process
must provide for the centralized tracking of inquiries and
complaints submitted to field, regional, or other local health and
human services system offices.
(d) Using the process developed under Subsection (c), the
office of the ombudsman shall collect inquiry and complaint data
from all offices, agencies, divisions, and other entities within
the health and human services system. To assist with the collection
of data under this subsection, the office may access any system or
process for recording inquiries and complaints used or maintained
within the health and human services system.
SECTION 5. Section 531.992, Government Code, is amended to
read as follows:
Sec. 531.992. APPOINTMENT OF OMBUDSMAN [FOR THE DEPARTMENT
OF FAMILY AND PROTECTIVE SERVICES]. [(a)] The executive
commissioner [governor] shall appoint an ombudsman for each
ombudsman program under Section 531.9912 [the Department of Family
and Protective Services] to serve at the will of the executive
commissioner [governor].
[(b) The ombudsman is administratively attached to the
office of the ombudsman for the commission.
(c) Subject to the appropriation of money for that purpose,
the ombudsman may employ staff to assist the ombudsman in
performing the ombudsman's duties under this subchapter.
(d) The ombudsman may not use the name or any logo of the
department on any forms or other materials produced and distributed
by the ombudsman.]
SECTION 6. Section 531.9921, Government Code, is amended to
read as follows:
Sec. 531.9921. CONFLICT OF INTEREST. A person may not serve
as ombudsman in an ombudsman program under Section 531.9912 if the
person or the person's spouse:
(1) is employed by or participates in the management
of a business entity or other organization receiving funds from the
commission [department];
(2) owns or controls, directly or indirectly, any
interest in a business entity or other organization receiving funds
from the commission [department]; or
(3) is required to register as a lobbyist under
Chapter 305 because of the person's activities for compensation on
behalf of a profession related to the operation of the commission
[department].
SECTION 7. Section 531.993, Government Code, is amended to
read as follows:
Sec. 531.993. DUTIES OF OMBUDSMAN. (a) An [The] ombudsman
serves as an [a] impartial [neutral] party in assisting:
(1) children and youth in the conservatorship of the
department with complaints regarding issues within the authority of
the department or commission [another health and human services
agency]; and
(2) persons with a complaint against the commission
[department] regarding case-specific activities of the programs
within the health and human services system of the commission
[department, including adult protective services, child protective
services, child-care licensing, and statewide intake].
(b) An [The] ombudsman shall:
(1) develop and implement statewide procedures to:
(A) receive complaints from:
(i) children and youth in the
conservatorship of the department; and
(ii) other persons with a complaint against
the programs within the health and human services system of the
commission [department];
(B) review complaints filed with an [the]
ombudsman and take appropriate action, including:
(i) conducting an investigation into
individual complaints that allege violations of department or
[agency] commission procedures, policies, [procedure or policy] or
other violations; and
(ii) referring to the commission
[department or agency management] for resolution, any trends or
systemic issues identified in complaints;
(C) provide any necessary assistance to:
(i) children and youth in the
conservatorship of the department in making complaints and
reporting allegations of abuse, [or] neglect, or exploitation in
accordance with Chapter 48, Human Resources Code [to the
department]; and
(ii) other persons in making complaints and
reporting allegations of abuse, neglect, or exploitation against
the programs within the health and human services system of the
commission in accordance with Chapter 48, Human Resources Code;
(D) maintain the confidentiality of:
(i) an [the] ombudsman's communications and
records;
(ii) records of another person that have
been provided to an [the] ombudsman; and
(iii) communications of another person with
an [the] ombudsman; and
(E) ensure that the [department and any] person
[or a child or youth in the conservatorship of the department] who
files a complaint with an [the] ombudsman is [are] informed of the
results of the ombudsman's investigation of the complaint,
including whether the ombudsman was able to substantiate the
[person's, child's, or youth's] complaint;
(2) collaborate with the commission [department] to
develop and implement an annual outreach plan to promote awareness
of [the] ombudsman programs among the public and stakeholders [,
children and youth in the conservatorship of the department, family
members and caretakers of those children, and facilities licensed
by the department and] that includes:
(A) how an ombudsman [the office] may be
contacted;
(B) the purpose of an ombudsman [the office]; and
(C) the services an ombudsman [the office]
provides;
(3) issue and file with the commission [department and
any applicable health and human services agency] a report that
contains an [the] ombudsman's final determination regarding a
complaint and any recommended corrective actions to be taken as a
result of the complaint;
(4) establish a secure form of communication with any
individual who files a complaint with an [the] ombudsman;
(5) collaborate with the commission [department] to
identify consequences for any retaliatory action related to a
complaint filed with an [the] ombudsman, in accordance with Section
531.997 [40.0041(g), Human Resources Code]; and
(6) monitor and evaluate [the department's] corrective
actions taken in response to a recommendation by an [the]
ombudsman.
(c) An [The] ombudsman's final determination in a report
described by Subsection (b)(3) must include a determination of
whether there was wrongdoing or negligence by the commission or
department or an agent of the commission or department and [or]
whether the complaint was frivolous or [and] without merit. If the
ombudsman determines there was wrongdoing or negligence, the
ombudsman shall recommend corrective actions to be taken by the
commission or department.
(c-1) The department and the commission shall provide
written notice to an ombudsman on adoption or rejection of the
ombudsman's recommended corrective action. A rejection of a
recommended corrective action shall include the reason for the
rejection.
(d) An [The] ombudsman may attend any judicial proceeding
related to a complaint filed with the ombudsman program [office].
SECTION 8. The heading to Section 531.9931, Government
Code, is amended to read as follows:
Sec. 531.9931. [DIVISION OF] OMBUDSMAN FOR CHILDREN AND
YOUTH IN FOSTER CARE.
SECTION 9. Section 531.9931, Government Code, is amended to
read as follows:
Sec. 531.9931. [DIVISION OF] OMBUDSMAN FOR CHILDREN AND
YOUTH IN FOSTER CARE. (a) The commission shall establish an
ombudsman program to provide support and information services to
children and youth in foster care.
(b)[(a)] An [The division of the] ombudsman appointed under
this section shall [for children and youth in foster care is created
within the office of the ombudsman for the purpose of]:
(1) receive [receiving] complaints from children and
youth in the conservatorship of the department as provided under
Section 531.993(b)(1)(A)(i) [531.993(a)(1)];
(2) inform [informing] children and youth in the
conservatorship of the department who file a complaint under this
subchapter about the result of an [the] ombudsman's investigation
of the complaint, including whether the ombudsman was able to
substantiate the child's or youth's complaint; and
(3) collaborate [collaborating] with the department
to develop an outreach plan for children and youth in the
conservatorship of the department to promote awareness of the
ombudsman program.
[(b) If a child or youth in the conservatorship of the
department contacts the ombudsman by telephone call to report a
complaint under this subchapter, the call shall be transferred
directly to a person employed by the division of the ombudsman
created under this section.]
SECTION 10. Section 531.0213, Government Code, is
transferred to Subchapter Y, Chapter 531, Government Code,
redesignated as Section 531.9932, Government Code, and amended to
read as follows:
Sec. 531.9932 [531.0213]. OMBUDSMAN FOR MANAGED CARE
ASSISTANCE [SUPPORT SERVICES FOR MEDICAID RECIPIENTS]. (a) The
commission shall establish an ombudsman program to provide support
and information services to a person enrolled in or applying for
Medicaid coverage who experiences barriers to receiving health care
services.
(b) An [The] ombudsman appointed under this section
[commission] shall give emphasis to assisting a person with an
urgent or immediate medical or support need.
(b-1) The commission shall provide support and information
services required by this section through a network of entities
coordinated by the commission's [office of the] ombudsman program
[or other division of the commission designated by the executive
commissioner] and composed of:
(1) the commission's [office of the] ombudsman program
or other division of the commission designated by the executive
commissioner to coordinate the network;
(2) the office of the state long-term care ombudsman
required under Subchapter F, Chapter 101A, Human Resources Code;
(3) the division within the commission responsible for
oversight of Medicaid managed care contracts;
(4) area agencies on aging;
(5) aging and disability resource centers established
under the Aging and Disability Resource Center initiative funded in
part by the federal Administration on Aging and the Centers for
Medicare and Medicaid Services; and
(6) any other entity the executive commissioner
determines appropriate[, including nonprofit organizations with
which the commission contracts under Subsection (c)].
(c) [The commission may provide support and information
services by contracting with nonprofit organizations that are not
involved in providing health care, health insurance, or health
benefits.
(d)] As a part of the support and information services
required by this section, the ombudsman [commission] shall:
(1) operate a statewide toll-free assistance
telephone number that includes relay services for persons with
speech or hearing disabilities and assistance for persons who speak
Spanish;
(2) intervene promptly with the state Medicaid office,
managed care organizations and providers, and any other appropriate
entity on behalf of a person who has an urgent need for medical
services;
(3) assist a person who is experiencing barriers in
the Medicaid application and enrollment process and refer the
person for further assistance if appropriate;
(4) educate persons so that they:
(A) understand the concept of managed care;
(B) understand their rights under Medicaid,
including grievance and appeal procedures; and
(C) are able to advocate for themselves;
(5) [collect and maintain statistical information on a
regional basis regarding calls received by the assistance lines and
publish quarterly reports that:
(A) list the number of calls received by region;
(B) identify trends in delivery and access
problems;
(C) identify recurring barriers in the Medicaid
system; and
(D) indicate other problems identified with
Medicaid managed care;]
[(6)] assist the state Medicaid office and managed care
organizations and providers in identifying and correcting
problems, including site visits to affected regions if necessary;
(6)[(7)] meet the needs of all current and future
Medicaid managed care recipients, including children receiving
dental benefits [and other recipients receiving benefits, under
the:
(A) STAR Medicaid managed care program;
(B) STAR + PLUS Medicaid managed care program,
including the Texas Dual Eligible Integrated Care Demonstration
Project provided under that program;
(C) STAR Kids managed care program established
under Section 533.00253; and
(D) STAR Health program];
(7) [(8)] incorporate support services for children
enrolled in the child health plan established under Chapter 62,
Health and Safety Code; and
(8)[(9)] ensure that staff providing support and
information services receives sufficient training, including
training in the Medicare program for the purpose of assisting
recipients who are dually eligible for Medicare and Medicaid, and
has sufficient authority to resolve barriers experienced by
recipients to health care and long-term services and supports.
(d)[(e)] The [commission's office of the] ombudsman's
[ombudsman] program [, or other division of the commission
designated by the executive commissioner to coordinate the network
of entities responsible for providing support and information
services under this section,] must be sufficiently independent from
other aspects of Medicaid managed care to represent the best
interests of recipients in problem resolution.
SECTION 11. Section 531.02251, Government Code, is
transferred to Subchapter Y, Chapter 531, Government Code,
redesignated as Section 531.9933, Government Code, and amended to
read as follows:
Sec. 531.9933 [531.02251]. OMBUDSMAN FOR BEHAVIORAL HEALTH
ACCESS TO CARE. (a) The commission shall establish an ombudsman
program to provide support and information services to a person
enrolled in or applying for behavioral health programs. [In this
section, "ombudsman" means the individual designated as the
ombudsman for behavioral health access to care.]
(b) [The executive commissioner shall designate an
ombudsman for behavioral health access to care.]
[(c) The ombudsman is administratively attached to the
office of the ombudsman for the commission.]
[(d)] The commission may use an alternate title for the
ombudsman in consumer-facing materials if the commission
determines that an alternate title would be beneficial to consumer
understanding or access.
(c)[(e)] An [The] ombudsman serves as an [a] impartial
[neutral] party to help consumers, including consumers who are
uninsured or have public or private health benefit coverage, and
behavioral health care providers navigate and resolve issues
related to consumer access to behavioral health care, including
care for mental health conditions and substance use disorders.
(d)[(f)] An [The] ombudsman shall:
(1) interact with consumers and behavioral health care
providers with concerns or complaints to help the consumers and
providers resolve behavioral health care access issues;
(2) identify, track, and help report potential
violations of state or federal rules, regulations, or statutes
concerning the availability of, and terms and conditions of,
benefits for mental health conditions or substance use disorders,
including potential violations related to quantitative and
nonquantitative treatment limitations;
(3) report concerns, complaints, and potential
violations described by Subdivision (2) to the appropriate
regulatory or oversight agency;
(4) receive and report concerns and complaints
relating to inappropriate care or mental health commitment;
(5) provide appropriate information to help consumers
obtain behavioral health care;
(6) develop appropriate points of contact for
referrals to other state and federal agencies; and
(7) provide appropriate information to help consumers
or providers file appeals or complaints with the appropriate
entities, including insurers and other state and federal agencies.
[(g) Expired.]
(e)[(h)] The Texas Department of Insurance shall appoint a
liaison to an [the] ombudsman to receive reports of concerns,
complaints, and potential violations described by Subsection
(d)[(f)](2) from an [the] ombudsman, consumers, or behavioral
health care providers.
SECTION 12. Chapter 531, Subchapter Y, Government Code, is
amended by adding Section 531.9934 to read as follows:
Sec. 531.9934. OMBUDSMAN FOR INDIVIDUALS WITH AN
INTELLECTUAL OR DEVELOPMENTAL DISABILITY. The executive
commissioner shall appoint an ombudsman to assist a client, or a
person acting on behalf of a person with an intellectual disability
or a group of persons with an intellectual disability, with a
complaint or grievance regarding the infringement of the rights of
a person with an intellectual disability or the delivery of
intellectual disability services submitted under Section 592.039,
Health and Safety Code.
SECTION 13. Sections 531.994, Government Code, is amended
to read as follows:
Sec. 531.994. INVESTIGATION OF UNREPORTED COMPLAINTS. If,
during the investigation of a complaint, an [the] ombudsman
discovers unreported violations of the commission's [department's
or a health and human services agency's] rules and policies, the
ombudsman shall open a new investigation for each unreported
violation.
SECTION 14. Section 531.995, Government Code, is amended to
read as follows:
Sec. 531.995. ACCESS TO INFORMATION. The commission
[department and each health and human services agency] shall
provide an [the] ombudsman access to [the department's or agency's]
records that relate to a complaint the ombudsman is reviewing or
investigating.
SECTION 15. Section 531.996, Government Code, is amended to
read as follows:
Sec. 531.996. COMMUNICATION AND CONFIDENTIALITY. (a) A
person may communicate with an [the] ombudsman relating to a
complaint by telephone, by mail, by electronic mail, or by any other
means the ombudsman determines to be feasible, secure, and
accessible [to children and youth].
(b) A communication with an [the] ombudsman is confidential
during an investigation or review of a complaint and remains
confidential after the complaint is resolved.
(c) The records of an [the] ombudsman are confidential and
must be maintained in a manner that preserves the confidentiality
of the records.
(d) The disclosure of confidential information to an [the]
ombudsman under this subchapter [section or Section 531.995] does
not constitute a waiver of confidentiality. Any information
disclosed to an [the] ombudsman [under this section or Section
531.995] remains confidential and privileged following disclosure.
(e) An [The] ombudsman is not prohibited from communicating
with the commission [department or another health and human
services agency] regarding confidential information disclosed to
the ombudsman [by the department or agency].
(f) An [The] ombudsman may make reports relating to an
investigation of a complaint public after the complaint is
resolved. A report may not include information that identifies an
individual complainant, client, parent, or employee or any other
person involved in the complaint.
SECTION 16. Section 531.997, Government Code, is amended to
read as follows:
Sec. 531.997. RETALIATION PROHIBITED. The commission
[department or another health and human services agency] may not
retaliate against a commission [department] employee [, a child or
youth in the conservatorship of the department,] or any [other]
person who in good faith makes a complaint to an [the] ombudsman or
against any person who cooperates with the ombudsman in an
investigation.
SECTION 17. Section 531.998, Government Code, is amended to
read as follows:
Sec. 531.998. REPORT. (a) Each [The] ombudsman shall
prepare an annual report that contains:
(1) a description of an [the] ombudsman's work;
(2) any change made by the commission or department
[or another health and human services agency] in response to a
substantiated complaint;
(3) a description of any trends in the nature of
complaints received by an [the] ombudsman or any systemic issues
identified in the investigation of individual complaints, any
recommendations related to addressing those trends and systemic
issues, and an evaluation of the feasibility of an [the]
ombudsman's recommendations;
(4) a glossary of terms used in the report;
(5) a description of the methods used to promote
awareness of an [the] ombudsman under this subchapter [Section
531.993(b)] and an [the] ombudsman's promotion plan for the next
year; and
(6) any public feedback received by an [the] ombudsman
relating to the ombudsman's previous annual reports.
(b) Each [The] report must be submitted to the governor, the
lieutenant governor, each standing committee of the legislature
with jurisdiction over matters involving the commission
[department], each member of the legislature, and the executive
commissioner, [and the commissioner of the department] not later
than December 1 of each year. On receipt of the report, [the
department and] the commission shall make the report publicly
available on [the department's and] the commission's Internet
websites.
SECTION 18. Section 592.039, Health and Safety Code, is
amended to read as follows:
Sec. 592.039. GRIEVANCES. A client, or a person acting on
behalf of a person with an intellectual disability or a group of
persons with an intellectual disability, has the right to submit
complaints or grievances regarding the infringement of the rights
of a person with an intellectual disability or the delivery of
intellectual disability services against a person, group of
persons, organization, or business to the HHSC Ombudsman for
Individuals with an Intellectual or Developmental Disability
[department's Office of Consumer Rights and Services for
investigation and appropriate action].
SECTION 19. REPEALER. Section 531.9941, Government Code,
is repealed.
SECTION 20. 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 21. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2023.