BILL ANALYSIS
C.S.H.B. 2377
By: Delisi
04-20-95
Committee Report (Substituted)
BACKGROUND
New roles and changes in the service delivery system, including the
recent designation of the Texas Department of Mental Health and
Mental Retardation (Department) as a Medicaid operating agency,
expansion of the mental health and mental retardation provider base
beyond Department facilities and community centers, and emerging
changes in the health care delivery system point to the need for
clear articulation of the role of a mental health and mental
retardation authority and a clear delineation of the differences
between the authority role and the more traditional role of
provider.
To address these issues, in January 1994 the Texas Board of Mental
Health and Mental Retardation (Board) Chair appointed a "blue
ribbon" task force charged with exploring issues related to
organizing, financing, and delivering mental health and mental
retardation services and making recommendations to the Commissioner
and the Board about future directions and needed changes. H.B.
2377 incorporates the legislative changes necessary to begin to
implement the recommendations of the task force on authority and
provider roles.
PURPOSE
H.B. 2377 clarifies and amends the role of the mental health and
mental retardation authority in Texas, as recommended by the task
force appointed by the Chair of the Board.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill grants additional
rulemaking authority to the Board in Section 10(d) of this bill,
(Sec. 533.087, Subchapter D, Chapter 533, Health and Safety Code),
and in Section 16(d) of this bill, (Sec. 551.022(d), Health and
Safety Code).
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Sections 531.001(a)(b) and (e) and adds Sec.
531.001(h) of the Health and Safety Code to clarify that the
Department's role as the state mental health and mental retardation
authority responsible for ensuring that mental health and mental
retardation services are provided to consumers. Establishes the
Board as the state mental health and mental retardation authority
with responsibility for planning, policy, and allocation of
resources and services throughout the state. States that the Board
is authorized to delegate aspects of its authority role to a single
local entity in each region of the state as it deems appropriate.
SECTION 2. Amends Sec. 531.002(8) and (9) of the Health and Safety
Code to delete previous language describing the local mental health
or local mental retardation authority as a local service provider
selected by the Department for a specific service area, and adds
that it is an entity to which the Board delegates its authority and
responsibility for planning, policy development, coordination,
resource development and allocation, and for supervising and
ensuring the provision of mental health and mental retardation
services for one or more service areas.
SECTION 3. Amends Sec. 532.001(a) to delete from the composition
of the Department the medical director, the deputy commissioners
for mental health services and for mental retardation services, and
now, staff is just under the direction of the Commissioner.
SECTION 4. Amends Sec. 532.003(b) and (c) of the Health and Safety
Code to require that Board members have a demonstrated interest in
mental health, mental retardation, developmental disabilities, or
the health and human services system. Adds a requirement that at
least one Board member be or have been a primary consumer of mental
health or mental retardation services.
SECTION 5. Amends Sec. 532.011(e) and (g) of the Health and Safety
Code as follows:
(e) Deletes assistant deputy commissioners and important
department personnel from the qualifications requirements
established by the
Commissioner, leaving that the
Commissioner must establish
qualifications for Department
personnel.
(g) States that the Commissioner is responsible for
implementation of the Board's planning, policy, resource
development and allocation and
oversight services, and deletes
that the Commissioner is the
state mental health and mental
retardation authority.
SECTION 6. Amends Sec. 532.012(a) of the Health and Safety Code to
allow the Commissioner to appoint a medical director, as required,
without the appointment being subject to Board approval.
SECTION 7. Amends Sec. 532.014(a) of the Health and Safety Code to
allow the Commissioner to appoint the head of each facility the
Department administers, as required, without the appointment being
subject to Board approval.
SECTION 8. Amends Sec. 533.035(a)(b) and (c) of the Health and
Safety Code as follows:
(a) Clarifies that the Commissioner is required to designate
a local mental health authority and a local mental retardation
authority in one or more
service areas. Adds that the
Board is allowed to delegate
this authority and
responsibility to the local
authorities for the planning,
policy development,
coordination, resource
allocation, and resource
development for and oversight
of mental health and mental
retardation services in that
area. Allows the Commissioner
to designate a single entity as
the mental health and mental
retardation authority for a
service area.
(b) Expands federal funds potentially available for a local
mental health and mental retardation authority by deleting
the stipulation that the federal
funds be federal "mental health
funds."
(c) Requires the local mental health and mental retardation
authority to ensure that services are provided instead of
necessarily providing them directly. Adds a stipulation
requiring the local authority to consider public input,
ultimate cost-benefit, and client care issues to ensure
consumer choice and the best use of public money in several
areas, not including the deleted subcontracting for those
services.
SECTION 9. Adds Sec. 533.0355 to Subchapter B, Chapter 533, Health
and Safety Code, as follows:
(a) Allows the Board, notwithstanding other law, to implement
a pilot project to study an authority structure for service
delivery at the local or regional
level for a local mental health or
mental retardation authority.
Requires the project to provide an
organizational separation between
this pilot project and the service
providers. Allows the Board to
delegate to a pilot local mental
health or mental retardation
authority the responsibility for the
distribution, allocation and
coordination of mental health or
mental retardation service resources
in one or more service areas.
(b) Allows the Board to establish one or more pilot local
mental health or mental retardation authorities under this
Section.
(c) If a pilot program is established, the Department is
required to annually evaluate the pilot project to determine the
feasibility of employing it in
other areas of the state,
prepare a report on the success
of the project, and submit the
report to the 75th and 76th
Legislatures. Establishes that
this Section expires September
1, 1999.
SECTION 10. Adds Sec. 533.087 to Subchapter D, Chapter 533,
Health and Safety Code, by allowing the Department to lease real
property regardless of whether it is surplus property. Requires
leases to be competitively bid at the prevailing market rate, but
provides for exceptions in Board determined cases of leases to
specified parties when the lease will result in sufficient public
benefit. Requires the Department to advertise a proposal for lease
at least once a week for four consecutive weeks in the local
newspaper and in a statewide newspaper. Requires the Board to adopt
leasing rules, forms and contracts to protect the State's interest,
and allows the Board to reject any bid. Establishes that this
Section does not authorize the Department to close or consolidate
a facility used for mental health or mental retardation services
without legislative approval.
SECTION 11. Adds Subsection (e) to Sec. 534.022, Health and
Safety Code, to establish that a community center acting alone, or
two community centers acting together pursuant to interlocal
contract, may create a public facility corporation to act on its or
their behalf. Sets forth the powers that may be exercised by the
community centers and any such corporation, and prohibits one
community center from being liable for another when two or more
community centers sponsor a corporation.
SECTION 12. Amends Sec. 534.054(a) and (d), Health and Safety
Code, to change the Department's and a local mental health and
mental retardation authority's role from providing services to
patients and clients to ensuring that the services are provided.
Adds that the required services must be provided in a service area
directly through the community services division of a Department
facility rather than the Department outreach program, or contract
with another agency, entity or organization if a community center
is not available.
SECTION 13. Amends Sec. 534.055(d) and (e), Health and Safety
Code, as follows:
(d) Deletes the language prohibiting a mental health or mental
retardation authority from requiring competitive bidding on the
renewal of a contract. The new language requires the Department to
design a competitive procurement or similar system that a mental
health or mental retardation authority must use to award an initial
contract.
(e) Adds that the mental health or mental retardation
authority must ensure public participation in the authority's
decisions regarding whether to provide or contract for services.
SECTION 14. Amends Sec. 534.064, Health and Safety Code, to
change "providers" to "entities" in reference to who the
Commissioner may select to be the local mental health or mental
retardation authority if refusing to renew a contract with a local
mental health or mental retardation authority.
SECTION 15. Amends Sec. 534.065(b)(4), Health and Safety Code,
to add that the mental health or mental retardation authority is
required to renew the contract if the authority finds that the
provider is providing a reasonably adequate level of service "at a
reasonable cost," as well as in accordance with the contract.
SECTION 16. Amends Sec. 534.066(b), Health and Safety Code, to
require that the Department establish a local match requirement for
community service divisions of Department facilities, instead of
Department facility outreach programs.
SECTION 17. Amends Sec. 551.022(c) and (d), Health and Safety
Code, to (c) change the required role of the superintendent from
admitting and discharging patients and clients to overseeing this
process, and to change the money from being entrusted to the
superintendent to the superintendent ensuring that this facility
money is spent judiciously and economically.
(d) Changes the superintendent's role from establishing rules to
establishing policy in accordance with Board rules and Departmental
operating procedures. Deletes attendants from the employees the
superintendent appoints, and deletes the requirement for the
Board's consent for the superintendent to remove an officer,
teacher, or employee for good cause.
SECTION 18. Repeals Sections 532.013, 533.064, 534.062, 551.021 and
551.023, Health and Safety Code, as follows:
(1) Sec. 532.013, regarding the medical director who is
appointed by the Commissioner. (2) Sec. 533.064, regarding a
memorandum of understanding on ICF-MR services.
(3) Sec. 534.062, regarding the review of crisis residential
and hospitalization services by the Board of Trustees of a
community center.
(4) Sec. 551.021, regarding the qualifications for appointment
of certain superintendents.
(5) Sec. 551.023, regarding reports from the superintendent.
SECTION 19. Establishes that the changes made by this Act apply
only to the Board, the Department, the Commissioner or to an
appointment made by the Governor after September 1, 1995. Clarifies
that the provisions of this bill do not affect actions or
appointments made before September 1, 1995, and that the
qualification changes made by this Act in reference to the members
of the Board do not affect those appointed before September 1,
1995.
SECTION 20. Establishes that nothing in this Act authorizes the
Department to privatize the administration of state facilities.
SECTION 21. Effective Date: September 1, 1995.
SECTION 22. Emergency Clause.
COMPARISON OF ORIGINAL TO SUBSTITUTE
To address issues raised by local mental health and mental
retardation authorities, the substitute for H.B. 2377 gives more
responsibility to the local mental health and mental retardation
authority to assure consumer choice and the best use of public
dollars in assembling a network of providers and determining
whether to be a provider of a particular service or to contract
that service to another organization.
The substitute deletes statutory references to specific positions
within the Department, giving the Commissioner the flexibility to
define as organizational structure best suited to carry out both
the authority and provider roles. Previous amendments regarding the
ICF-MR program are removed to keep the bill clearly focused on
delineating authority and provider roles. Additionally, outdated
terminology referring to "outreach programs" is updated, an
inaccurate reference to "retardation" is corrected to read
"health," and "provider" is amended to read "entity" to more
clearly delineate authority and provider roles.
SUMMARY OF COMMITTEE ACTION
H.B. 2377 was considered by the Public Health Committee in a public
hearing on April 19, 1995.
The committee considered a complete substitute for the bill. The
substitute was adopted without objection.The committee considered
two amendments to the bill. Both of those amendments were adopted
without objection.
The following persons testified for the bill:
Cynthia Hopkins, representing Texas Mental Health Consumers.
Barrett Markland, representing Advocacy, Inc.
Mary Jo Magruder, representing Texas Planning Council for
Developmental Disabilities.
Barbara Harris, representing P.A.R.T. Parent Association Retarded
of Texas.
Kenneth W. Brace, representing self.
Spencer McClure, representing self and The Texas Council of
Community MHMR Centers, Incorporated.
Mike Bright, representing the Arc of Texas.
The bill was left pending.
H.B. 2377 was considered by the Public Health Committee in a formal
meeting on April 20, 1995. The committee considered a complete
substitute for the bill. The committee considered two amendments to
the bill. Both of those amendments were adopted without objection.
The substitute as amended was adopted without objection.
The bill was reported favorably as substituted, with the
recommendation that it do pass and be printed, by a record vote of
5 AYES, 0 NAYS, 0 PNV, 4 ABSENT.