BILL ANALYSIS
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Senate Research Center |
C.S.H.B. 3550 |
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88R30347 MPF-F |
By: Rose; Jetton (LaMantia) |
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Health & Human Services |
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5/20/2023 |
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Committee Report (Substituted) |
AUTHOR'S / SPONSOR'S STATEMENT OF INTENT
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. 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.
H.B. 3550 seeks to address these issues by distinguishing the services and goals of PPECCs, removing onerous documentation requirements, and allowing parents the freedom to make treatment decisions for their children.
(Original Author's/Sponsor's Statement of Intent)
C.S.H.B. 3550 amends current law relating to standards for and services provided by prescribed pediatric extended care centers, including Medicaid reimbursement for those services.
RULEMAKING AUTHORITY
Rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTION 2 (Sections 248A.1015 and 248A.105, Health and Safety Code) and SECTION 5 (Section 32.0287, Human Resources Code) of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 248A.101(b), Health and Safety Code, as follows:
(b) Provides that to protect the health and safety of the public and ensure the health, safety, and comfort of the minors served by a prescribed pediatric extended care center (center), the rules adopted by the executive commissioner of the Health and Human Services Commission (executive commissioner; HHSC) are required to establish minimum center standards, including:
(1)-(8) makes no changes to these subdivisions;
(9) standards relating to transportation services and as required by Section 248A.1015; and
(10) makes no changes to this subdivision.
SECTION 2. Amends Subchapter C, Chapter 248A, Health and Safety Code, by adding Sections 248A.1015 and 248A.105, as follows:
Sec. 248A.1015. TRANSPORTATION STANDARDS. Requires the executive commissioner by rule to establish minimum standards for transportation services as required under Section 248A.101(b)(9) (relating to requiring the executive commissioner to adopt rules to establish minimum standards for the transportation services of prescribed pediatric extended care centers). Provides that in adopting rules under this section, the executive commissioner:
(1) is required to authorize a center to determine:
(A) in coordination with a minor client's parent, guardian, or other legal authorized representative, the schedule of transportation services; and
(B) in coordination with the client's prescribing physician, the necessary type of provider who is required to be present during transportation;
(2) is required to permit a minor client's parent, guardian, or other legally authorized representative to decline a center's transportation services entirely or only on a specific date; and
(3) is prohibited from:
(A) requiring a plan of care or physician's order to document a client's need for transportation services to access a center's services; or
(B) consider transportation services as nursing services included in a client's plan of care.
Sec. 248A.105. INTERFERENCE WITH RIGHTS TO DETERMINE TREATMENT.� (a) Prohibits any rules the executive commissioner adopts under Subchapter C (Powers and Duties of Executive Commissioner, Commission, and Department), except as provided by Subsection (b), from interfering with the authority of a parent, guardian, or legally authorized representative of a minor client to make decisions regarding the treatment provided to the child.
(b) Authorizes the executive commissioner, by rule, to limit the maximum amount of authorized services provided to a client.
SECTION 3. Amends Section 248A.158, Health and Safety Code, as follows:
Sec. 248A.158. RELATION TO NURSING SERVICES. (a) Creates this subsection from existing text.� Requires that nursing services provided to a client by a center, subject to Subsection (b), be a replacement of private duty nursing or other skilled nursing services provided in a setting other than a center unless additional nursing services are medically necessary. Deletes existing text requiring that nursing services provided by a center be a one-to-one replacement of private duty nursing or other skilled nursing services unless additional nursing services are medically necessary.
(b) Authorizes a center to provide nursing services in a group setting, consistent with appropriate staffing ratios as the executive commissioner determines.
SECTION 4. Amends Subchapter D, Chapter 248A, Health and Safety Code, by adding Section 248A.159, as follows:
Sec. 248A.159. ADMISSION FORMS.� (a) Authorizes a center, before admission to the center, to obtain all required parent or legal guardian signatures for a patient on one consent document.
(b) Requires that the consent document 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 center.
SECTION 5. Amends Subchapter B, Chapter 32, Human Resources Code, by adding Section 32.0287, as follows:
Sec. 32.0287. PRESCRIBED PEDIATRIC EXTENDED CARE CENTER REIMBURSEMENT. (a) Defines "center."
(b) Requires the executive commissioner, in adopting rules governing the reimbursement of a center for services provided under the medical assistance program, to clearly identify the documentation a center is required to obtain and maintain to be eligible for reimbursement. Prohibits the rules from:
(1) authorizing a center to combine documentation for transportation with documentation for other services provided by the center; or
(2) conditioning reimbursement of non-transportation services on:
(A) a recipient's decision to use transportation services on a specific date or on an ongoing basis; or
(B) a center's obtaining and maintaining transportation documentation.
SECTION 6. Requires the executive commissioner, as soon as practicable after the effective date of this Act, to:
(1) adopt the rules necessary to implement the changes in law made by this Act; and
(2) update any relevant procedure manuals, including the Children's Services Handbook, to conform to the changes in law made by this Act.
SECTION 7. Requires a state agency, if necessary for implementation of a provision of this Act, to request a waiver or authorization from a federal agency, and authorizes a delay of implementation until such a waiver or authorization is granted.
SECTION 8. Effective date: September 1, 2023.