JKC C.S.H.B. 2084 75(R)BILL ANALYSIS HUMAN SERVICES H.B. 2084 By: Hilderbran 4-28-97 Committee Report (Substituted) BACKGROUND In December, 1996, the interim report on long-term care from the Texas House Committee on Human Services was published. The report recommended: "Direct Department of Human Services and the appropriate state agencies to develop a voucher system of long-term care services as a pilot program." Rather than creating a separate program to pilot vouchers, this bill creates a voucher option in two existing long-term service programs. Both the Texas Department of Human Services (DHS) Client-Managed Attendant Services (CMAS) program and the Texas Rehabilitation Commission (TRC) Personal Attendant Services Program currently have two payment options: 10 agency delivered (where the assistant is the employee of the provider agency) and 20 block grant "flow through" (where a consumer can receive a lump sum and pay the assistant directly, and the assistant is the employee of the consumer). The intent is not to eliminate these options, but rather to create a true choice model, with a spectrum of payment options. The DHS Client-Managed Attendant Services and TRC Personal Attendant Service Programs are logical points at which to integrate a voucher option, because these programs are state funded, rather than Medicaid funded, and thus allow more flexibility to test new payment models. HB 2084 also calls for investigating the expansion of the voucher payment models into Medicaid-funded community based long-term services, where the potential is enormous for increasing consumer choice and control, as well as increasing efficiency. The voucher model espoused in HB 2084 maximizes consumer control, while reducing the administrative burden on the consumer and potentially achieving cost savings. It increases consumer and worker compliance with filing federal and state employment taxes and adherence to labor laws. Further, this model allows a person with a disability to retain control over the selection, management, and dismissal, if necessary, of his or her personal assistant, and at the same time, it relieves that person of the administrative requirements of handling employer-related payroll and tax functions on behalf of the personal assistant. PURPOSE This bill requires the Department of Human Services (DHS), the Texas Rehabilitation Commission (TRC), the comptroller and other appropriate agencies, to establish a voucher pilot in the DHS Client-Managed Attendant Services Program and the TRC Personal Attendant Services program. This pilot ensures that consumers will be provided appropriate information to choose a payment option for their service delivery, and that consumers sign a statement that they have been informed of these options. Under this pilot, a private entity or local government serves as an IRS-designated agent (fiscal intermediary) to act on behalf of the consumer for the purpose of handling federal and state employment taxes, preparing and filing tax forms and reports, and distributing money to a personal assistant, after a deduction for employment taxes. RULEMAKING AUTHORITY Section 1, Section 22.032 (b) of the Huamn Resource Code, grants rulemaking authority to the Department of Human Services. Subsection (c) provides direction for the department in adopting the rules. SECTION BY SECTION ANALYSIS SECTION 1.Amends Chapter 22, Human Resource Code, by adding sections 22.032 and 22.033. Section 22.032. Voucher Pilot Project (a)Definitions are provided for consumer, long-term care, personal assistance services, and respite services. (b)Directs the Department of Human Services, by rule, to develop and ensure the implementation a pilot project establishing vouchers as a payment option for the delivery of long-term care services, personal assistance services, and respite services. (c)Provides the following guidelines for the department to utilize when adopting rules under this section: (1)consult with the work group created under section 22.033; (2)work with TRC, the comptroller, and other agencies; (3)design the pilot so that a private or local government entity may seek approval by the IRS to act as a consumer's agent in order to compute federal and state employment taxes, preparing and filing income tax forms, and distributing money to a long-term care, personal assistance, or respite services provider following employment tax deductions. (4)ensure that the pilot complies with federal and state laws; (5)ensure that the consumer controls selecting, managing, and dismissing his or her provider; (6)ensure that a potential consumer participating in the pilot project has adequate and appropriate information; (7)require each consumer to sign a statement acknowledging receipt of the information in (6); (8)monitor the pilot project to ensure adherence to current program standards, appropriate use of funds, and consumer satisfaction. (d)Directs TRC and the comptroller to provide appropriate information to the department to facilitate development of the pilot. (e)Directs the department to implement the pilot statewide as part of the TRC personal attendant services program and the DHS CMAS program. (f)Direct DHS to submit a report to the governor and the 76th Legislature by March 1, 1999 on the feasibility of expanding the pilot statewide to Medicaid- funded community-based service programs. (g)Expiration Date: September 1, 2002. Sec. 22.033. Work Group. Creates a work group to assist the department in developing, implementing and evaluating the voucher payment pilot program. Provides for the composition, serving capacity, appointing of members and officers, meetings, and compensation of the work group. The work group is not subject to Article 6252- 33, Revised Statutes. This section expires September 1, 2002. SECTION 2.(a)Effective Date: September 1, 1997. (b)Directs DHS to establish the pilot project by January 1, 1998. SECTION 3.Emergency Clause. COMPARISON OF ORIGINAL TO SUBSTITUTE H.B. 2084 C.S.H.B. 2084 Amends Chapter 531, Government Code by adding Sec. 531.047 as follows: Amends Chapter 22, Human Resource Code by adding Sec. 22.032 and 22.033 as follows: SECTION 1. (1)The pilot program is established by the Health and Human Services Commission (HHSC). (2)Definitions are given for "consumer", "Long term care", "Personal assistance services", and "respite services." (3)In adopting rules to implement the project, the HHSC is directed to: consult with consumers and advocates for persons with disabilities; work with DHS, TWC, the comptroller, and other appropriate agencies; and design the program in a manner in which a private or local governmental entity may act as the agent for the consumer; ensure the program complies with federal and state tax laws; ensure consumer control over service provided; ensure provision of information before a consumer chooses a payment option; and require a consumer to sign a statement that the information has been provided. (4)DHS, TRC, and the comptroller shall provide necessary information to HHSC, which shall implement the pilot project as part of both the TRC personal attendant service program and the DHS client-managed attendant service program. DHS and TRC shall report to HHSC, and HHSC shall report to the governor and the 76th Legislature. Expires Sept. 1, 2002. SECTION 1. Same as original except for the following: (1)The pilot program is established by the Department of Human Services (DHS). (2)"Personal assistance services" is assigned the meaning in Section 142.001, Health and Safety Code. (3)Rulemaking authority is granted to DHS, which is directed to consult with and seek input from the work group created in Section 2, not consumers and advocates as reflected in the original bill. Additionally, DHS is directed to develop a system to monitor the pilot project. The substitute clarifies the information to be provided to the consumer. (4)Information is to be provided to DHS for the development and implementation of the project, and DHS is directed to report to the governor and the 76th Legislature. No such provision is made. SECTION 2. A work group is created to assist the development of the project. SECTION 2. Effective Date: September 1, 1997. SECTION 3. Effective Date: same as original. SECTION 3: Emergency Clause.