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Amend CSHB 2292 by adding the appropriately numbered section 
as follows:   
	SECTION .  Subchapter B, Chapter 531, Government Code, is 
amended by adding a new  Section 531.076 to read as follows:
	Section 531.076    UP TO SIX-BED FACILITY MODEL AUTHORIZED.  
(a)  The  commission shall develop a plan to permit the use of a 
residential program model of a facility of up to six beds in the 
Mental Retardation Medicaid Waiver program under the authority of 
the Department of Mental Health and Mental Retardation.
	(b)  The plan described in this section shall provide for 
retaining a three-bed facility model and a planned, organized 
transition from the four-bed facility model to the six-bed facility 
model, which shall include:
		(1)  the evaluation of the feasibility of, and legal 
and liability considerations related to, the use of contracted 
workers in a residential setting, including any impediments in 
current state regulations relating to the elimination of the staff 
live-in limits and consumer residential assistance delegations, 
and
		(2)  the development of a reimbursement rate for each 
residential model that considers cost factors including but not 
limited to:
			(A)  the adequacy of the current rate structure of 
the three-bed and four-bed facility models and the rate for the 
six-bed facility model;
			(B)  the adequacy of the occupancy factor;                            
			(C)  the adequacy of the resident leave factor;                       
			(D)  the transition costs, including those 
related to real estate, vehicles, federal safety standards, and 
consumer movement cost factors; and
			(E)  the inclusion of the same wage assumptions 
for direct support staff that are provided under the reimbursement 
methodology for ICF-MR facilities.
		(3)  The plan shall be developed with the assistance of 
a work group which shall include members of the staff of the 
commission, representatives of public providers, private 
providers, and advocates.  The plan shall be submitted to the 
Governor's Office of Budget and Planning, the House Appropriations 
Committee, and the Senate Finance Committee not later than 
September 1, 2004.