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Amend CSHB 2292 (Senate committee printing) by adding the 
following appropriately numbered SECTION to Article 2 of the bill 
and renumbering subsequent SECTIONS accordingly:
	SECTION ____.  (a)  Subchapter B, Chapter 32, Human 
Resources Code, is amended by adding Section 32.057 to read as 
this section:
		(1)  "Consumer" means a participant in the 
consumer-directed services program established under this section 
who receives a stipend under the program.
		(2)  "Home and community-based services" include:                      
			(A)  personal care services;                                          
			(B)  a home modification and assistive device that 
may increase the consumer's independence;
			(C)  respite services, as defined by Section 
142.001, Health and Safety Code; and
			(D)  personal assistance services, as defined by 
Section 142.001, Health and Safety Code.
		(3)  "Medical assistance waiver program" means:                        
			(A)  the community-based alternatives program;                        
			(B)  the community living assistance and support 
services program;  
			(C)  the deaf-blind/multiple disabilities 
			(D)  the consolidated waiver pilot program; or                        
			(E)  the medically dependent children program.                        
	(b)  The department by rule shall establish a 
consumer-directed services program in which certain individuals 
enrolled in a medical assistance waiver program are given a monthly 
stipend to direct the delivery of home and community-based services 
provided to the individual under the waiver program.
	(c)  The department shall  work in conjunction with the Texas 
Rehabilitation Commission, the comptroller, and any other 
appropriate agency to develop the consumer-directed services 
	(d)  In establishing the consumer-directed services program, 
the department shall:
		(1)  ensure that the amount of a consumer's stipend is 
based on the assessed functional needs of a consumer and the 
financial resources available to the medical assistance waiver 
program providing services to the consumer;
		(2)  develop purchasing guidelines to assist consumers 
in using the stipend to purchase necessary and cost-effective home 
and community-based services;
		(3)  design the program in a manner in which a private 
entity or local governmental entity may apply with the department 
for approval to act as the fiscal intermediary for a consumer for 
the limited purpose of:
			(A)  managing the consumer's stipend;                                 
			(B)  computing federal and state employment 
			(C)  preparing and filing income tax forms and 
reports; and         
			(D)  distributing money to a service provider;                        
		(4)  ensure that a consumer is the employer of and 
retains control over the selection, management, and dismissal of an 
individual providing home and community-based services; and
		(5)  develop a system to monitor the program to ensure:                
			(A)  adherence to existing applicable program 
			(B)  appropriate use of funds; and                                    
			(C)  consumer satisfaction with the delivery of 
	(e)  The Texas Rehabilitation Commission and comptroller 
shall provide information to the department as necessary to 
facilitate the development and implementation of the 
consumer-directed services program.
	(f)  The department may not implement the consumer-directed 
services program within the consolidated waiver pilot program 
before January 2, 2004.
	(g)  The department, in consultation with the Centers for 
Medicare and Medicaid Services, shall:
		(1)  determine which state or other government-funded 
programs are appropriate for inclusion in the consumer-directed 
services program; and
		(2)  provide for the inclusion of cost-sharing 
provisions as practicable.
	(h)  Not later than February 1 of each year, the department 
shall submit to the governor, the lieutenant governor, and the 
clerks of the standing committees of the senate and house of 
representatives with primary jurisdiction over long-term care 
services a report on the effectiveness, including the 
cost-effectiveness, of the consumer-directed services program.  
The report must include recommendations for improvements to the 
	(i)  This section expires September 1, 2007.                            
	(b)  The state agency responsible for implementing the 
consumer-directed services program required by Section 32.057, 
Human Resources Code, as added by this section, shall request and 
actively pursue any necessary waivers or authorizations from the 
Centers for Medicare and Medicaid Services or other appropriate 
entities to enable the agency to implement the program not later 
than January 1, 2004.  The agency may delay implementing the program 
until the necessary waivers or authorizations are granted.