BILL ANALYSIS

C.S.H.B. 3550

By: Rose

Human Services

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Prescribed pediatric extended care centers (PPECCs) are non-institutional facilities that provide medical care to children with complex conditions and needs. Although PPECCs offer substantial benefits to vulnerable children and their families, complex statutory language and overly burdensome regulations prevent them from operating as they were intended. Today, PPECCs are regulated like non-comparable providers and face numerous arbitrary and inapplicable requirements that serve as a basis to deny reimbursement. Pursuant to rules adopted by the Health and Human Services Commission, the reimbursement rate for PPECCs is capped at 70 percent of the reimbursement for private duty nursing. PPECCs and private duty nursing serve the same populations, but because of higher costs and lower reimbursement rates there are very few PPECCs operating in Texas. C.S.H.B. 3550 seeks to address these issues by distinguishing the services and goals of PPECCs, increasing the current cap on reimbursement rates, removing onerous documentation requirements, and allowing parents the freedom to make treatment decisions for their children.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTION 2 of this bill.

ANALYSIS

C.S.H.B. 3550 amends the Health and Safety Code to require the executive commissioner of the Health and Human Services Commission (HHSC) by rule to establish minimum standards for transportation services provided by prescribed pediatric extended care centers (PPECCs). The bill does the following with respect to the adoption of those rules:

· requires the executive commissioner to authorize a PPECC, in coordination with a client's parent, guardian, or other responsible adult, to determine the schedule of transportation services and determine by provider type whether a provider must be present to supervise the client during transportation; and

· prohibits the executive commissioner from:

o requiring a plan of care or physician's order to document a client's need for transportation services to access PPECC services;

o requiring the PPECC to obtain the signature of a client's parent, guardian, or other responsible adult on each occasion the client boards or deboards the transportation or any confirmation of the exact time the client boards or deboards the transportation; or

o prohibiting a client from declining transportation offered by a PPECC, including declining transportation entirely or only on a specific date.

C.S.H.B. 3550 requires the executive commissioner by rule to establish a reimbursement rate for services a PPECC provides to clients, including transportation service to and from the PPECC. The executive commissioner must clearly identify the documentation a PPECC is required to obtain and maintain to be eligible for reimbursement. The bill does the following with respect to the adoption of the rules:

· requires the executive commissioner to establish a reimbursement rate that, when converted to an hourly rate, is equal to the average hourly unit rate for private duty nursing provided under the Texas Health Steps Comprehensive Care Program; and

· prohibits the executive commissioner from:

o authorizing a PPECC to combine documentation for transportation with documentation for other services provided by the PPECC;

o conditioning reimbursement for transportation services on obtaining the signature of a client's parent, guardian, or other responsible adult on each occasion the client boards or deboards the transportation or obtaining any confirmation of the exact time the client boards or deboards the transportation; or

o conditioning reimbursement of non-transportation services on a client's decision to use transportation services on a specific date or on an ongoing basis or a PPECC obtaining and maintaining transportation documentation.

C.S.H.B. 3550 prohibits any rules the executive commissioner adopts in exercising the powers and duties of the executive commissioner with respect to PPECCs from interfering with the authority of a parent, guardian, or other responsible adult of a minor client to make decisions regarding the treatment provided to the child, including by doing any of the following:

· requiring the PPECC and the parent, guardian, or other responsible adult of a minor client to adhere to a set schedule of treatment determined in advance;

· conditioning payment to a PPECC on the parent, guardian, or other responsible adult of a minor client providing an explanation of any discrepancies between the treatment scheduled and treatment provided; and

· preventing the PPECC and the parent, guardian, or other responsible adult of a minor client from modifying the treatment and schedule of treatment consistent with the changing medical needs of the client.

The bill authorizes the executive commissioner by rule to limit the maximum amount of authorized services provided to a client.

C.S.H.B. 3550 revises the requirement for the nursing services provided by a PPECC to be a replacement of private duty nursing or other skilled nursing services unless additional nursing services are medically necessary to remove the specification that the services must be a one-to-one replacement. The bill authorizes a PPECC to provide nursing services in a group setting, consistent with appropriate staffing ratios.

C.S.H.B. 3550 authorizes a PPECC, before a patient's admission, to obtain all required parent or legal guardian signatures for the patient on one consent document. The bill requires the consent document to illustrate the involvement of the parent or legal guardian in developing and establishing the care and treatment to be provided to the patient in the PPECC.

C.S.H.B. 3550 requires the executive commissioner, as soon as practicable after the bill's effective date, to adopt the rules necessary to implement the bill's provisions and to update any relevant procedure manuals, including the Children's Services Handbook, to conform to the bill's provisions.

EFFECTIVE DATE

September 1, 2023.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 3550 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

The substitute corrects an error in the introduced. As a result, rather than requiring the executive commissioner to do the following in adopting the rules for reimbursement, as in the introduced, the substitute prohibits the executive commissioner from doing any of the following in adopting those rules:

· authorizing a PPECC to combine documentation for transportation with documentation for other services provided by the PPECC;

· conditioning reimbursement for transportation services on obtaining the signature of a client's parent, guardian, or other responsible adult on each occasion the client boards or deboards the transportation or obtaining any confirmation of the exact time the client boards or deboards the transportation; or 

conditioning reimbursement of non-transportation services on a client's decision to use transportation services on a specific date or on an ongoing basis or a PPECC obtaining and maintaining transportation documentation.