MINUTES
SENATE COMMITTEE ON HOME HEALTH & ASSISTED LIVING
FACILITIES(INT)
Tuesday, July 28, 1998
9:30 am
Capitol Extension, Room E1.036
*****
Pursuant to a notice posted in accordance with Senate Rule
11.11, a public hearing of the Senate Committee on Home Health
& Assisted Living Facilities(Int) was held on Tuesday, July
28, 1998 in the Capitol Extension, Room E1.036, at Austin,
Texas.
*****
MEMBERS PRESENT: MEMBERS ABSENT:
Senator Mike Moncrief Senator Mario
Gallegos, Jr.
Senator Gonzalo Barrientos
Senator Jane Nelson
Senator Drew Nixon
*****
The Chair called the meeting to order at 9:40 am. There being
a quorum present, the following business was transacted.
The following members arrived after the roll was called:
none.
The Chair introduced and welcomed Representative Elliott
Naishtat from District 49, Travis County, Austin, Texas.
The Chair made opening remarks, welcomed the public and state
agency staff. The Chair announced that this was the final
hearing to adopt the Committee's recommendations for the 76th
Legislature.
There being a quorum present, Senator Jane Nelson moved that
the reading of the minutes from the last hearing in Tyler on
May 12, 1998 be dispensed with and approved by unanimous
consent. There being no objection, the minutes were approved.
The Chair then called Michael Crowe, Committee Director, to
discuss staff recommendations and to respond to questions from
the Committee Members.
The members discussed Committee staff's recommendations common
to both assisted living and home health. Senator Gonzalo
Barrientos moved that the following recommendations common to
both assisted living and home health be adopted by the
Committee:
Restate the general goals of the state for regulation; that
is, to promote quality of care and quality of life for Texans.
This would be similar to the opening clause in SB 190.
Designate a state agency to deliver long-term care services
and develop long-term care policy in Texas.
The Texas Health and Human Services Commission, the Texas
Department of Protective and Regulatory Services, the Texas
Department of Human Services, the Texas Department of Health
and other state agencies as appropriate should develop a
strategic plan for the creation of a single state intake
system for all complaints involving abuse, neglect and
exploitation and a strategic plan for the creation of a state
registry to track health care workers found to have abused or
neglected clients that also protects the due process rights of
individuals.
The Texas Workforce Commission, the Texas Department of Human
Services, the Texas Rehabilitation Commission, the Texas
Commission for the Blind, the Texas Commission for the Deaf
and Hard of Hearing and the Texas Higher Education
Coordinating Board should review and develop recommendations
for the improvement of programs for training opportunities for
personal attendants.
Require that state agencies register complaints involving
abuse, neglect and exploitation with the Texas Department of
Protective and Regulatory Services, and that PRS register
complaints with appropriate licensing and contracting state
agencies. Allow licensing and contracting state agencies
access to DHS and PRS investigative reports.
Codify that retaliation by a provider against any person for
reporting a complaint is grounds for license revocation.
Termination for cause with documentation should not be
considered retaliation.
Expand the definition of "controlling person" in SB 190 to
apply to and include assisted living facilities and home
health agencies.
Require health and human services agencies and the Texas
Department of Housing and Community Affairs to investigate
models linking home and community support services with low
income housing options, including the identification of
funding sources for services, buildings and architectural
upgrades.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
The Committee discussed Committee staff's recommendations
specific to assisted living. Senator Jane Nelson moved that
the Committee adopt the following recommendations specific to
assisted living:
Require Assisted Living Facilities to use a standard, consumer
disclosure form promulgated by the Texas Department of Human
Services.
Require DHS to identify unlicenced Assisted Living Facilities
and enforce licensure.
Give the Texas Department of Human Services administrative
remedy authority over Assisted Living Facilities.
Allow any resident to remain in an Assisted Living Facility if
the facility can meet the needs of all the residents either
through the facility's services or services contracted for by
the resident.
Clarify that all health professionals can work within their
scope of practice in assisted living facilities.
The Texas Department of Human Services should create an
additional licensing category for Assisted Living Facilities
that provide for the general supervision or oversight of the
physical and mental well being of persons who need assistance
with medication supervision and to maintain private and
independent residences in Assisted Living Facilities.
The Texas Department of Licensing and Regulation and the Texas
Department of Human Services should form a work group that
includes consumer advocates and assisted living developers and
providers to address issues regarding the Texas Accessibility
Standards. Issues to be addressed should include the
development of standard information materials relating to the
modification and construction of Assisted Living Facilities,
possible consolidation of architectural plan reviews by the
two agencies and reviewing bathroom accessibility standards.
Allow providers to voluntarily submit building plans to the
Texas Department of Human Services, for a fee, for advanced
review of compliance with the department's regulations
regarding life and safety. Develop time lines for the Texas
Department of Human Services to review plans.
Specify that the Texas Department of Mental Health and Mental
Retardation personnel are allowed to enter Assisted Living
Facilities to do outreach to their clients.
Specify that the Office of the Attorney General has the
authority to pursue civil penalties against licensed and
unlicenced Assisted Living Facilities on behalf of the Texas
Department of Human Services.
Increase the maximum cap on licensing fees.
Require surveyors of Assisted Living Facilities to receive
special training.
Require Assisted Living Providers to disclose that they are
licensed by the Texas Department of Human Services.
The Texas Department of Human Services should conduct regional
training sessions for state agencies and local governments
regarding Assisted Living Facility standards.
The Texas Department of Human Services should develop a new
Community Based Alternatives program reimbursement methodology
for assisted living facilities that does not focus on room
occupancy.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
The Committee discussed a Committee staff recommendation
specific to assisted living. Senator Gonzalo Barrientos moved
that the Committee adopt the following recommendation specific
to assisted living:
Amend the Personal Care Facility Statute (Health and Safety
Code chapter 247) to become Texas' Assisted Living Facility
statute. References to Personal Care Facilities would instead
reference Assisted Living Facilities. Decrease the resident
census for classification as an Assisted Living Facility from
four to three. Require facilities that operate with on-site
Home and Community Support Services Agencies so as to be
indistinguishable from Assisted Living Facilities to be
licensed as Assisted Living Facilities.
The motion carried with a vote of 3 ayes, 1 nay and 1 absent.
The Committee discussed a Committee staff recommendation
specific to minimum requirements for administrators of
assisted living facilities. Senator Jane Nelson moved that
the Committee adopt the following recommendation specific to
assisted living:
Codify minimum standards for Assisted Living Facility
administrators of facilities seventeen beds or larger that
considers the experience or education of administrators.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
Senator Jane Nelson moved that the Committee adopt the
following recommendation:
Codify minimum standards for Alzheimer Facility
Administrators.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
The Committee discussed Committee staff's recommendations
specific to home health.
Senator Jane Nelson moved to add an additional recommendation
that rates in Texas' home health programs should place a
priority on "cost-effective" services to clients. Senator
Nelson withdrew her motion.
The Committee recessed at 12:00 Noon, subject to the call of
the Chair.
The Committee reconvened at 1:12 p.m., subject to the call of
the Chair
Senator Drew Nixon moved that the Committee adopt the
following recommendations specific to home health:
Move Home and Community Support Services Agency licensing to
the Texas Department of Human Services.
Rates in Texas' home health programs should place a priority
on the delivery of quality, cost-effective services to
clients.
Require that Home and Community Support Services Agencies
report all abuse and neglect, as defined in the Texas Human
Resources Code, to both the Texas Department of Protective and
Regulatory Services and the licensing agency.
Codify what records can be released by the licensing agency.
The licensing agency should upgrade its computer system to
increase public access to complaints data about HCSSAs.
The licensing agency should create more meaningful
classifications of complaints, particularly those involving
abuse and neglect.
Develop specialized surveyor training for Personal Attendant
Services and Hospice.
Codify that solicitation of patients for remuneration is
illegal under Texas Health and Safety Code Chapter 142.
The 76th Legislature should give serious consideration to
three upcoming reports regarding consolidation of waivers,
functional assessments and vouchers.
Require the Texas Department of Human Services and Texas
Health and Human Services Commission to seek access to
Medicare cost data in order to develop a system to determine
home health costs delivered by both Medicare and Medicaid.
The Health and Human Services Commission should develop policy
recommendations and determine what caseload projections, if
any, can be made in response to Medicare home health changes
prior to the 76th Legislative Session.
The Texas Department of Health and the Texas Department of
Human Services should coordinate their efforts in tracking the
closure of Home and Community Support Services Agencies in
response to the Medicare home health changes.
Clarify the Board of Medical Examiner's authority to hold
doctors accountable for improper or fraudulent billing.
Eliminate physician referrals to home health agencies in which
the physician has a significant financial interest.
The motion carried with a vote of 4 ayes, 0 nays and 1
absent.
The Committee discussed Committee staff's recommendations
specific to assisted living. Senator Drew Nixon moved that
the Committee adopt the following recommendations specific to
rehabilitation:
The Texas Rehabilitation Commission should form a workgroup,
which includes providers and consumers, to study how national
accreditation standards for brain injury rehabilitation
services could be used to certify brain injury rehabilitation
programs in Texas. The TRC should report its findings and
recommendations to the 77th Legislature.
The Texas Department of Human Services' personal care facility
consumer disclosure form should specify that licensure as a
personal care facility in no way speaks to the credentials or
competence of a rehabilitation center's personnel or programs.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
Senator Jane Nelson moved that the Committee staff should
qualify in the Committee's report that the identity of certain
agencies specified in the recommendations could change if a
single state agency for long-term care services is created or
designated by the 76th Legislature. The motion was seconded
by Senator Drew Nixon.
The motion carried with a vote of 4 ayes, 0 nays and 1 absent.
Senator Gonzalo Barrientos stated that the employees of the
State of Texas should receive a pay increase. The Chair
requested that the record reflect Senator Gonzalo Barrientos'
message of contemplation of a state employee pay increase.
There being no further business, at 1:32 p.m., Senator
Moncrief announced that the Committee would stand recessed
subject to the call of the Chair. Without objection, it was
so ordered.
______________________
Senator Mike Moncrief, Chair
______________________
Judy Daugherty, Clerk