77R12017 KLA-D
By Naishtat H.B. No. 967
Substitute the following for H.B. No. 967:
By Naishtat C.S.H.B. No. 967
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to ensuring an appropriate care setting for a person with
1-3 a disability.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 531, Government Code, is
1-6 amended by adding Sections 531.0244, 531.02441, 531.02442, and
1-7 531.02443 to read as follows:
1-8 Sec. 531.0244. ENSURING APPROPRIATE CARE SETTING FOR PERSONS
1-9 WITH DISABILITIES. (a) The commission and appropriate health and
1-10 human services agencies shall implement a comprehensive,
1-11 effectively working plan that provides a system of services and
1-12 support that fosters independence and productivity and provides
1-13 meaningful opportunities for a person with a disability to live in
1-14 the community.
1-15 (b) The comprehensive, effectively working plan required by
1-16 Subsection (a) must require appropriate health and human services
1-17 agencies to:
1-18 (1) provide to a person with a disability living in an
1-19 institution and to any other person as required by Sections 531.042
1-20 and 531.02443 information regarding care and support options
1-21 available to the person with a disability, including
1-22 community-based services appropriate to the needs of that person;
1-23 (2) recognize that certain persons with disabilities
1-24 are represented by legally authorized representatives as defined by
2-1 Section 241.151, Health and Safety Code, whom the agencies must
2-2 include in any decision-making process facilitated by the plan's
2-3 implementation;
2-4 (3) facilitate a timely and appropriate transfer of a
2-5 person with a disability from an institution to an appropriate
2-6 setting in the community if:
2-7 (A) the person chooses to live in the community;
2-8 (B) the person's treating professionals
2-9 determine the transfer is appropriate; and
2-10 (C) the transfer can be reasonably accommodated,
2-11 considering the state's available resources and the needs of other
2-12 persons with disabilities; and
2-13 (4) develop strategies to prevent the unnecessary
2-14 placement in an institution of a person with a disability who is
2-15 living in the community but is in imminent risk of requiring
2-16 placement in an institution because of a lack of community
2-17 services.
2-18 (c) For purposes of developing the strategies required by
2-19 Subsection (b)(4), a person with a mental illness who is admitted
2-20 to a facility of the Texas Department of Mental Health and Mental
2-21 Retardation for inpatient mental health services three or more
2-22 times during a 180-day period is presumed to be in imminent risk of
2-23 requiring placement in an institution. The strategies must be
2-24 developed in a manner that presumes the person's eligibility for
2-25 and the appropriateness of intensive community-based services and
2-26 support.
2-27 (d) In implementing the plan required by Subsection (a), a
3-1 health and human services agency may not deny an eligible person
3-2 with a disability access to an institution or remove an eligible
3-3 person with a disability from an institution if the person prefers
3-4 the type and degree of care provided in the institution and that
3-5 care is appropriate for the person.
3-6 (e) Not later than December 1 of each even-numbered year,
3-7 the commissioner shall submit to the governor and the legislature a
3-8 report on the status of the implementation of the plan required by
3-9 Subsection (a). The report must include recommendations on any
3-10 statutory or other action necessary to implement the plan.
3-11 Sec. 531.02441. INTERAGENCY WORK GROUP ON ENSURING
3-12 APPROPRIATE CARE SETTINGS FOR PERSONS WITH DISABILITIES. (a) The
3-13 commissioner shall establish an interagency work group to assist
3-14 the commission and appropriate health and human services agencies
3-15 in developing a comprehensive, effectively working plan to ensure
3-16 appropriate care settings for persons with disabilities.
3-17 (b) The commissioner shall determine the number of members
3-18 of the work group. The commissioner shall appoint as members of
3-19 the work group:
3-20 (1) representatives of appropriate health and human
3-21 services agencies; and
3-22 (2) representatives of other related work groups,
3-23 including representatives of the work groups established under
3-24 Sections 22.034 and 22.035, Human Resources Code.
3-25 (c) The commissioner shall designate a member of the work
3-26 group to serve as presiding officer. The members of the work group
3-27 shall elect any other necessary officers.
4-1 (d) The work group shall meet at the call of the presiding
4-2 officer.
4-3 (e) A member of the work group serves at the will of the
4-4 commissioner.
4-5 (f) A member of the work group may not receive compensation
4-6 for serving on the work group, but is entitled to reimbursement for
4-7 travel expenses incurred by the member while conducting the
4-8 business of the work group, as provided by the General
4-9 Appropriations Act.
4-10 (g) The work group shall study and make recommendations to
4-11 the commission on:
4-12 (1) developing the comprehensive, effectively working
4-13 plan required by Section 531.0244(a) to ensure appropriate care
4-14 settings for persons with disabilities; and
4-15 (2) identifying appropriate components of the pilot
4-16 program established under Section 22.037, Human Resources Code, for
4-17 coordination and integration among the Texas Department of Human
4-18 Services, the Texas Department of Mental Health and Mental
4-19 Retardation, and the Department of Protective and Regulatory
4-20 Services.
4-21 (h) Not later than September 1 of each year, the work group
4-22 shall report to the commissioner and the advisory committee
4-23 established under Section 531.02442 on its findings and
4-24 recommendations.
4-25 (i) The work group is not subject to Chapter 2110.
4-26 Sec. 531.02442. ADVISORY COMMITTEE ON ENSURING APPROPRIATE
4-27 CARE SETTINGS FOR PERSONS WITH DISABILITIES. (a) The commissioner
5-1 shall establish an advisory committee to advise the commissioner
5-2 and appropriate health and human services agencies on ensuring
5-3 appropriate care settings for persons with disabilities.
5-4 (b) The advisory committee consists of 12 members appointed
5-5 by the commissioner as follows:
5-6 (1) seven representatives of consumer or family
5-7 advocacy groups;
5-8 (2) three representatives of community-based services
5-9 providers for persons with disabilities;
5-10 (3) one representative of the Texas Department of
5-11 Mental Health and Mental Retardation; and
5-12 (4) one representative of the Texas Department of
5-13 Human Services.
5-14 (c) The advisory committee shall advise the commission and
5-15 appropriate health and human services agencies with respect to
5-16 implementing the comprehensive, effectively working plan required
5-17 by Section 531.0244(a), giving primary consideration to:
5-18 (1) methods to identify and assess each person who
5-19 resides in an institution but chooses to live in the community and
5-20 for whom a transfer from an institution to the community is
5-21 appropriate, as determined by the person's treating professionals;
5-22 (2) determining the availability of community care and
5-23 support options for persons described by Subdivision (1);
5-24 (3) identifying, addressing, and monitoring barriers
5-25 to implementation of the plan to improve that implementation; and
5-26 (4) identifying funding options for the plan.
5-27 (d) A member of the advisory committee may not receive
6-1 compensation for serving on the committee, but is entitled to
6-2 reimbursement for travel expenses incurred by the member while
6-3 conducting the business of the committee, as provided by the
6-4 General Appropriations Act.
6-5 (e) The advisory committee is not subject to Chapter 2110.
6-6 Sec. 531.02443. COMMUNITY LIVING OPTIONS INFORMATION PROCESS
6-7 FOR CERTAIN PERSONS WITH MENTAL RETARDATION. (a) In this section:
6-8 (1) "Institution" means:
6-9 (A) a residential care facility operated or
6-10 maintained by the Texas Department of Mental Health and Mental
6-11 Retardation to provide 24-hour services, including residential
6-12 services, to persons with mental retardation; or
6-13 (B) an ICF-MR, as defined by Section 531.002,
6-14 Health and Safety Code.
6-15 (2) "Legally authorized representative" has the
6-16 meaning assigned by Section 241.151, Health and Safety Code.
6-17 (3) "Local mental retardation authority" has the
6-18 meaning assigned by Section 531.002, Health and Safety Code.
6-19 (b) In addition to providing information regarding care and
6-20 support options as required by Section 531.042, the Texas
6-21 Department of Mental Health and Mental Retardation shall implement
6-22 a community living options information process in each institution
6-23 to inform persons with mental retardation who reside in the
6-24 institution and their legally authorized representatives of
6-25 alternative community living options.
6-26 (c) The department shall provide the information required by
6-27 Subsection (b) through the community living options information
7-1 process at least annually. The department shall also provide the
7-2 information at any other time on request by a person with mental
7-3 retardation who resides in an institution or the person's legally
7-4 authorized representative.
7-5 (d) If a person with mental retardation residing in an
7-6 institution or the person's legally authorized representative
7-7 indicates a desire to pursue an alternative community living option
7-8 after receiving the information provided under this section, the
7-9 department shall refer the person or the person's legally
7-10 authorized representative to the local mental retardation
7-11 authority. The local mental retardation authority shall place the
7-12 person in an alternative community living option or on a waiting
7-13 list for those options if the options are not available to the
7-14 person on or before the 30th day after the date the person or the
7-15 person's legally authorized representative is referred to the local
7-16 mental retardation authority.
7-17 (e) The department shall document in the records of each
7-18 person with mental retardation who resides in an institution the
7-19 information provided to the person or the person's legally
7-20 authorized representative through the community living options
7-21 information process and the results of that process.
7-22 SECTION 2. Section 531.042, Government Code, is amended to
7-23 read as follows:
7-24 Sec. 531.042. [COMMUNITY-BASED SERVICES] INFORMATION AND
7-25 ASSISTANCE REGARDING CARE AND SUPPORT OPTIONS; REPORTS. (a) The
7-26 commissioner by rule shall require each health and human services
7-27 agency to provide to each patient or client of the agency and to at
8-1 least one family member of the patient or client, if possible,
8-2 information regarding all care and support options available to the
8-3 patient or client, including community-based services appropriate
8-4 to the needs of the patient or client, before the agency allows the
8-5 patient or client to be placed in a care setting, including a
8-6 nursing home, intermediate care facility for the mentally retarded,
8-7 or institution for the mentally retarded licensed or operated by
8-8 the Department of Protective and Regulatory Services, to receive
8-9 care or services provided by the agency or by a person under an
8-10 agreement with the agency.
8-11 (b) The rules must require each health and human services
8-12 agency to provide information about all [community-based] long-term
8-13 care options and long-term support options available to the patient
8-14 or client, including community-based options and options available
8-15 through another agency or a private provider. The information must
8-16 be provided in a manner designed to maximize the patient's or
8-17 client's understanding of all available options. If the patient or
8-18 client has a legally authorized representative, as defined by
8-19 Section 241.151, Health and Safety Code [guardian], the information
8-20 must also be provided to that representative [the guardian]. If
8-21 the patient or client is in the conservatorship of a health and
8-22 human services agency, the information must be provided to the
8-23 patient's or client's agency caseworker and foster parents, if
8-24 applicable. An agency may obtain the assistance of a
8-25 community-based organization in providing each person as required
8-26 by this section with information as provided by commission rules.
8-27 (c) A health and human services agency that provides a
9-1 patient, client, or other person as required by this section
9-2 [guardian] with information as provided by commission rules shall
9-3 obtain a statement signed by the patient or client, and each other
9-4 person as required by this section[, if the patient or client has a
9-5 guardian, by the patient's or client's guardian], that the patient
9-6 or client has been informed about all care and support options
9-7 available to the patient or client, including community-based care
9-8 and support options, as required by commission rules. The agency
9-9 shall retain a copy of each signed statement in the patient's or
9-10 client's case records.
9-11 (d) A health and human services agency that provides a
9-12 patient, client, or other person as required by this section with
9-13 information regarding care and support options available to the
9-14 patient or client shall assist the patient, client, or other person
9-15 in taking advantage of an option selected by the patient, client,
9-16 or other person. If the selected option is not immediately
9-17 available, the agency shall provide assistance in placing the
9-18 patient or client on a waiting list for that option.
9-19 (e) Each health and human services agency annually and as
9-20 provided by commission rule shall report to the legislature
9-21 [commission] the number of community-based service placements and
9-22 residential-care placements the agency makes.
9-23 SECTION 3. Subchapter B, Chapter 531, Government Code, is
9-24 amended by adding Section 531.055 to read as follows:
9-25 Sec. 531.055. VOUCHER PROGRAM FOR TRANSITIONAL LIVING
9-26 ASSISTANCE FOR PERSONS WITH DISABILITIES. (a) In this section:
9-27 (1) "Institutional housing" means:
10-1 (A) an ICF-MR, as defined by Section 531.002,
10-2 Health and Safety Code;
10-3 (B) a nursing facility;
10-4 (C) a state hospital, state school, or state
10-5 center maintained and managed by the Texas Department of Mental
10-6 Health and Mental Retardation; or
10-7 (D) an institution for the mentally retarded
10-8 licensed or operated by the Department of Protective and Regulatory
10-9 Services.
10-10 (2) "Integrated housing" means housing in which a
10-11 person with a disability resides or may reside that is found in the
10-12 community but that is not exclusively occupied by persons with
10-13 disabilities and their care providers.
10-14 (b) The commission shall coordinate with the Texas
10-15 Department of Human Services, the Texas Department of Housing and
10-16 Community Affairs, and the Texas Department of Mental Health and
10-17 Mental Retardation to develop a housing assistance program to
10-18 assist persons with disabilities in moving from institutional
10-19 housing to integrated housing. In developing the program, the
10-20 agencies shall address:
10-21 (1) eligibility requirements for assistance;
10-22 (2) the period during which a person with a disability
10-23 may receive assistance;
10-24 (3) the types of housing expenses to be covered under
10-25 the program; and
10-26 (4) the locations at which the program will be
10-27 operated.
11-1 (c) The commission shall require the Texas Department of
11-2 Human Services to implement and administer the housing assistance
11-3 program under this section. The department may coordinate with the
11-4 Texas Department of Housing and Community Affairs in implementing
11-5 and administering the program.
11-6 (d) The Texas Department of Human Services shall provide
11-7 information to the commission as necessary to facilitate the
11-8 development and implementation of the housing assistance program.
11-9 SECTION 4. Chapter 22, Human Resources Code, is amended by
11-10 adding Sections 22.037 and 22.038 to read as follows:
11-11 Sec. 22.037. PILOT PROGRAM FOR COMMUNITY-BASED ALTERNATIVES
11-12 FOR PERSONS WITH DISABILITIES. (a) In this section:
11-13 (1) "Institution" means:
11-14 (A) an ICF-MR, as defined by Section 531.002,
11-15 Health and Safety Code;
11-16 (B) a nursing facility;
11-17 (C) a state hospital, state school, or state
11-18 center maintained and managed by the Texas Department of Mental
11-19 Health and Mental Retardation; or
11-20 (D) an institution for the mentally retarded
11-21 licensed or operated by the Department of Protective and Regulatory
11-22 Services.
11-23 (2) "Legally authorized representative" has the
11-24 meaning assigned by Section 241.151, Health and Safety Code.
11-25 (b) The department, in cooperation with the Texas Department
11-26 of Mental Health and Mental Retardation and the Department of
11-27 Protective and Regulatory Services in accordance with the
12-1 memorandum of understanding adopted under Section 22.038, shall
12-2 develop and implement in at least five sites a pilot program to
12-3 provide a system of services and support that fosters independence
12-4 and productivity and provides meaningful opportunities for persons
12-5 with disabilities to live in the community. The department shall
12-6 determine the pilot sites.
12-7 (c) The pilot program, subject to the availability of funds,
12-8 shall include the following components:
12-9 (1) a comprehensive system of improved policies and
12-10 procedures to avoid inappropriately placing a person with a
12-11 disability in an institution, including policies and procedures
12-12 that require:
12-13 (A) a preadmission screening for the person that
12-14 includes the participation of hospital discharge staff and the
12-15 person's physician; and
12-16 (B) an analysis of the costs, benefits, and
12-17 effectiveness of placing the person in a community-based
12-18 alternative care setting;
12-19 (2) a program under which physicians who treat persons
12-20 with disabilities and hospital discharge staff are:
12-21 (A) trained and educated regarding the
12-22 availability of community-based alternatives to
12-23 institutionalization to reduce the number of persons
12-24 inappropriately placed in an institution;
12-25 (B) required to inform a person with a
12-26 disability and any other person required to be provided information
12-27 under Section 531.042, Government Code, of all care and support
13-1 options available to the person with the disability, including
13-2 community-based care and support options, before that person makes
13-3 a decision regarding a long-term care placement; and
13-4 (C) required to contact and offer the assistance
13-5 of a permanency planning specialist to a person with a disability
13-6 before that person makes a decision regarding a long-term care
13-7 placement;
13-8 (3) a program, including a program implemented through
13-9 grants to community-based organizations, to provide a transition
13-10 case manager to:
13-11 (A) assist a person with a disability in making
13-12 a transition from an institution to a community-based alternative
13-13 care setting after that person or the person's legally authorized
13-14 representative decides the person should make that transition; and
13-15 (B) coordinate with the local mental health or
13-16 mental retardation authority, as defined by Section 531.002, Health
13-17 and Safety Code, in:
13-18 (i) providing services to the person
13-19 related to the assistance described by Paragraph (A), if
13-20 applicable;
13-21 (ii) conducting outreach initiatives under
13-22 Subdivision (4); and
13-23 (iii) implementing the community living
13-24 options information process under Section 531.02443, Government
13-25 Code;
13-26 (4) a program to provide grants to community-based
13-27 organizations to conduct outreach initiatives to identify persons
14-1 with disabilities who may inappropriately reside in an institution;
14-2 and
14-3 (5) a program under which presumptive eligibility is
14-4 authorized for community-based care and support programs for a
14-5 person with a disability.
14-6 (d) Outreach activities required by Subsection (c)(4) shall
14-7 be conducted in addition to information provided through the
14-8 community living options information process under Section
14-9 531.02443, Government Code, if applicable.
14-10 (e) The department by rule shall establish qualifications
14-11 for a person not affiliated with the department, the Texas
14-12 Department of Mental Health and Mental Retardation, the Department
14-13 of Protective and Regulatory Services, or a state school who
14-14 implements a component of the pilot program by providing outreach
14-15 services to a resident of a state school. The department shall
14-16 require that the person meet those qualifications.
14-17 (f) The Texas Department of Mental Health and Mental
14-18 Retardation shall ensure that:
14-19 (1) the legally authorized representative of a
14-20 resident of a state school is present during each contact between
14-21 the resident and a person described by Subsection (e) who provides
14-22 outreach services if the representative requests to be present; and
14-23 (2) a person described by Subsection (e) who provides
14-24 outreach services does not have contact with a resident of a state
14-25 school if the resident's legally authorized representative opposes
14-26 that contact.
14-27 (g) The department shall implement each component of the
15-1 pilot program described by Subsection (c) for which the legislature
15-2 appropriates sufficient money. The department is not required to
15-3 implement a component if the legislature does not appropriate
15-4 sufficient money for that component.
15-5 (h) Not later than January 15, 2005, the department shall
15-6 submit a report concerning the effectiveness of the pilot program
15-7 to the presiding officers of both houses of the legislature and to
15-8 the governor. The report must include:
15-9 (1) an evaluation of the strengths and weaknesses of
15-10 each implemented component of the pilot program;
15-11 (2) a recommendation regarding the feasibility of
15-12 expanding the pilot program statewide; and
15-13 (3) a recommendation regarding adopting improved
15-14 policies and procedures with statewide applicability, as determined
15-15 from the information obtained in operating the pilot program, to
15-16 ensure appropriate care settings for persons with disabilities.
15-17 Sec. 22.038. MEMORANDUM OF UNDERSTANDING ON PILOT PROGRAM
15-18 FOR COMMUNITY-BASED ALTERNATIVES FOR PERSONS WITH DISABILITIES.
15-19 (a) The department, the Texas Department of Mental Health and
15-20 Mental Retardation, and the Department of Protective and Regulatory
15-21 Services shall adopt a memorandum of understanding to implement the
15-22 pilot program under Section 22.037.
15-23 (b) The memorandum of understanding must:
15-24 (1) define the responsibilities of each agency in
15-25 implementing the components of the pilot program; and
15-26 (2) provide for interagency coordination and
15-27 integration with respect to appropriate components of the pilot
16-1 program, including any components:
16-2 (A) that serve persons for whom each of the
16-3 agencies otherwise provides services;
16-4 (B) for which coordination and integration among
16-5 the agencies will result in the more efficient accomplishment of
16-6 the goals of the comprehensive, effectively working plan
16-7 implemented under Section 531.0244, Government Code; or
16-8 (C) that are recommended by the interagency work
16-9 group under Section 531.02441, Government Code, for coordination
16-10 and integration.
16-11 (c) Not later than September 1 of each year, the department,
16-12 the Texas Department of Mental Health and Mental Retardation, and
16-13 the Department of Protective and Regulatory Services shall review
16-14 and update the memorandum.
16-15 (d) Each agency by rule shall adopt the memorandum of
16-16 understanding and all revisions to the memorandum.
16-17 SECTION 5. Not later than December 1, 2001, the commissioner
16-18 of health and human services shall:
16-19 (1) establish the interagency work group under Section
16-20 531.02441, Government Code, as added by this Act;
16-21 (2) establish the advisory committee under Section
16-22 531.02442, Government Code, as added by this Act; and
16-23 (3) adopt rules under Section 531.042, Government
16-24 Code, as amended by this Act.
16-25 SECTION 6. Not later than March 1, 2002, the Texas
16-26 Department of Mental Health and Mental Retardation shall implement
16-27 the community living options information process required by
17-1 Section 531.02443, Government Code, as added by this Act.
17-2 SECTION 7. Notwithstanding Section 531.042(a), Government
17-3 Code, as amended by this Act, not later than March 1, 2002, each
17-4 health and human services agency shall provide to each patient or
17-5 client of the agency who is in a care setting on the effective date
17-6 of this Act and to each other person as required by Section
17-7 531.042, Government Code, as amended by this Act, the information
17-8 required by that section and shall obtain the statement required by
17-9 that section.
17-10 SECTION 8. Not later than December 1, 2002, the Texas
17-11 Department of Human Services shall, subject to the availability of
17-12 funds, implement the pilot program under Section 22.037, Human
17-13 Resources Code, as added by this Act.
17-14 SECTION 9. Not later than September 1, 2002, the Texas
17-15 Department of Human Services, the Texas Department of Mental Health
17-16 and Mental Retardation, and the Department of Protective and
17-17 Regulatory Services shall adopt the memorandum of understanding
17-18 under Section 22.038, Human Resources Code, as added by this Act.
17-19 SECTION 10. This Act takes effect September 1, 2001.