BILL ANALYSIS



C.S.H.B. 2698
By: McDonald et al
04-19-95
Committee Report (Substituted)


BACKGROUND

     Long-term care services for distinct categories of clients are
provided through several health and human services agencies. 
Although long term care providers primarily support children and
elderly clients, many providers specialize in clients with
functional limitations.  

     Each agency defines its mission and goals independently and
operates without coordinating policy statements or visions.  The
need for a unifying vision statement was identified by the members
of the Long-Term Care Task Force, a diverse group of 29 members
appointed by the Commissioner of Health and Human Services.  The
task force met in 1993 and 1994 and made recommendations in its
final report to HHSC in the fall of 1994.


PURPOSE

     H.B. 2698 would incorporate into state law the concepts
developed by the task force in its vision statement.  The
legislation would establish a vision statement and guiding
principles for long-term care services, thus formalizing state
policies for integration of the various systems of long-term care
services.  The vision statement defines "long-term care" and
focuses on delivery of services based on the functional limitations
of individuals, encouraging the greatest degree of consumer choice
to assist individuals and their families in maintaining and
achieving independence, autonomy, and quality of life.


RULEMAKING AUTHORITY

     It is the committee's opinion that H.B. 2698 does not
expressly grant any additional rulemaking authority to a state
officer, department, agency or institution.


SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 10, Coordinated Strategic Plan for
Health and Human Services, in Article 4413 (502), Health and Human
Services Commission, by adding a new Section 10A as follows: 

Section 10A.  LONG-TERM CARE VISION.  

(a)  Directs the Commissioner of Health & Human Services, in
conjunction with the appropriate state agencies, to develop a plan
for access to individualized long-term care services for persons
with functional limitations or medical needs and their families in
an effort to assist them to maintain and achieve independence,
autonomy, and quality of life.  

(b)  Requires that guiding principles and goals focusing on the
individual and his or her family include:

     (1)  recognizing that children should grow up in families
     and people with disabilities and elderly persons should
     live in the setting of their choice; and 

     (2)  ensuring that persons needing assistance will have
     maximum possible control over their services; choice of
     a broad, comprehensive array of services; and easiest
     possible access to appropriate care and support.

(c)  Requires that guiding principles focusing on services and
service delivery by the state must: 

     (1)  emphasize on home-based or community-based services
     and housing alternatives to complement existing services;

     (2)  ensure that services will be of highest possible
     quality, with minimum amount of regulation, structure and
     complexity;

     (3)  recognize that maximum independence and autonomy
     represent major goals, and with those comes some risk;

     (4)  maximize resources to greatest extent possible, with
     consumer receiving only the services he or she prefers
     and are indicated through functional assessment of need;
     and

     (5)  structure service delivery to support the above
     goals, ensuring any complexity falls at the
     administrative level, not the client level.

(d)  Requires HHSC to coordinate state services to ensure that
roles and responsibilities of agencies providing long-term care
services are clear and duplication is minimized.

(e)  Defines "long-term care" to mean provision of health care,
personal care, and assistance related to health and social services
over a sustained period to people of all ages, and their families,
regardless of the setting in which care is given.

SECTION 2.  Emergency clause, effective in 90 days.


COMPARISON OF ORIGINAL TO SUBSTITUTE

     The substitute took the original language from the task
force's report and refined it to fit into the enabling statute of
the Health & Human Services Commission, requiring the commissioner
to develop a plan for long-term care services, and reorganizing the
subsections set out in the original bill. 


SUMMARY OF COMMITTEE ACTION

     The Human Services Committee convened in a public hearing on
April 10, 1995, and the Chairman laid out H.B. 2698, recognizing
Rep. McDonald to explain the bill.  Rep. Maxey offered a committee
substitute for H.B. 2698.  The following witnesses testified for
H.B. 2698:  Roy Ray, representing himself, American Ass'n for
Retired Persons (AARP), and Texas Senior Advocacy Coalition; Mary
Jo Magruder, Texas Planning Council for Developmental Disabilities;
Christine Devall, Mental Health Ass'n in Texas; Denise Brady, The
ARC of Texas (Ass'n of Retarded Citizens); Bob Kafka, ADAPT of
Texas; Barrett Markland, Advocacy Inc.; and Laura K. Brown, Austin. 
No one testified against or neutral on H.B. 2698.  The committee
substitute was withdrawn and H.B. 2698 was left pending.

     On April 19, the committee convened and took up H.B. 2698
which had been pending.  Rep. Naishtat offered a committee
substitute and moved adoption.  Hearing no objection, the committee
substitute for H.B. 2698 was adopted.  The Chairman recognized Rep.
Naishtat who moved to report H.B. 2698 favorably as substituted and
send the bill to the Committee on the Local and Consent Calendars;
Rep. Denny seconded.  The motion prevailed by a record vote of 9
Ayes, 0 Nays, 0 PNV, and 0 Absent.