79R12998 JJT-F
By: Davis of Harris, Uresti, Eissler, H.B. No. 470
Farabee
Substitute the following for H.B. No. 470:
By: Davis of Harris C.S.H.B. No. 470
A BILL TO BE ENTITLED
AN ACT
relating to local delivery of aging, disability, behavioral health,
and mental retardation services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 531, Government Code, is amended by
adding Subchapter M to read as follows:
SUBCHAPTER M. REGIONAL SERVICE COORDINATION BY LOCAL SERVICE
AUTHORITIES
Sec. 531.451. RELATION TO OTHER LAW. This subchapter
prevails over any other law related to the regulation or delivery of
services by health and human services agencies to the extent that
the other law is in conflict or inconsistent with this subchapter.
Sec. 531.452. DEFINITIONS. (a) In this subchapter:
(1) "Aging and disability services" includes:
(A) aging services;
(B) mental retardation services; and
(C) community care services for elderly persons
or persons with disabilities.
(2) "Behavioral health services" includes mental
health services and chemical dependency services.
(3) "Chemical dependency" has the meaning assigned by
Section 461.002, Health and Safety Code.
(4) "Chief elected officials" means the county judge
of each county included in a local service region or a person the
judge designates to act for the judge under this subchapter.
(5) "Community center" has the meaning assigned by
Section 531.002, Health and Safety Code.
(6) "Local service authority" means a local aging and
disability authority or a local behavioral health authority.
(7) "Mental health services" has the meaning assigned
by Section 531.002, Health and Safety Code.
(8) "Mental retardation services" has the meaning
assigned by Section 531.002, Health and Safety Code.
(b) A reference in other law to a "local mental health
authority" means a "local behavioral health authority."
(c) A reference in other law to a "local mental retardation
authority" means a "local aging and disability authority."
(d) A reference in other law to the Texas Department of
Mental Health and Mental Retardation means:
(1) the executive commissioner when used in relation
to the authority to adopt rules or make policy regarding mental
health services or mental retardation services;
(2) the Department of State Health Services when used
in relation to the authority to administer mental health services;
and
(3) the Department of Aging and Disability Services
when used in relation to the authority to administer mental
retardation services.
Sec. 531.453. DELIVERY SYSTEM FOR AGING, DISABILITY, AND
BEHAVIORAL HEALTH SERVICES. (a) In accordance with this
subchapter, the executive commissioner shall establish a system for
aging and disability services and behavioral health services to be
coordinated by local service authorities, with each local service
authority having jurisdiction over a local service region and
coordinating the provision of services under contract with the
Department of Aging and Disability Services or the Department of
State Health Services.
(b) The executive commissioner shall develop and adopt
policies and rules governing the provision of services in the local
regions. Rules adopted under this subsection must:
(1) address the procedures, methods, and criteria for
the Department of Aging and Disability Services or the Department
of State Health Services to place a local service authority in
receivership for mismanagement or poor performance; and
(2) establish comprehensive contract management
practices and principles to ensure that:
(A) the service delivery systems are both
effective and financially accountable at the local service region
level;
(B) barriers in the application for and delivery
of local services are eliminated to the greatest extent
practicable; and
(C) contract management by each department and
local service authority is effective.
(c) The executive commissioner shall ensure that a local
service authority conducts its assessments of a potential client's
financial eligibility for services according to the commission's
eligibility system.
(d) The Department of Aging and Disability Services and the
Department of State Health Services, as appropriate, shall consult
with the commission to coordinate the provision of Medicaid
services through the local service authorities.
(e) The executive commissioner shall develop rules and
guidelines for the screening of and coordination of services to
persons who require both behavioral health services and aging and
disability services.
Sec. 531.454. LOCAL SERVICE REGIONS. The local service
regions must have the same geographical boundaries as the uniform
regional boundaries established for health and human services
agencies under Section 531.024.
Sec. 531.455. STATE-OPERATED LOCAL SERVICE AUTHORITIES.
(a) At the request of the chief elected officials of a region, the
Department of Aging and Disability Services or the Department of
State Health Services, or both, in consultation with the commission
shall establish a state-operated local service authority.
(b) The chief elected officials who request a
state-operated local service authority for behavioral health
services or for aging and disability services must establish an
advisory council to guide and inform the decisions of the
department responsible for operating the state-operated local
service authority. The chief elected officials in establishing the
advisory council shall appoint members to that council that conform
to the standards for membership of a board of directors of a local
service authority provided by Section 531.464.
Sec. 531.456. INNOVATIVE PROJECTS. (a) At the request of
one or more chief elected officials of a local service region, the
Department of Aging and Disability Services or the Department of
State Health Services, as appropriate, may designate in a local
service region a service delivery area to implement an innovative
project for improving the provision of behavioral health services
or aging and disability services.
(b) The chief elected official or officials, the local
service authority, the appropriate department, and the commission
shall enter into an agreement that establishes whether an
innovative project will be operated through the local service
authority or by the state by direct contract.
(c) An innovative project must use innovative financing
arrangements, innovative service delivery models, innovative
business practices, or other innovative methods to improve the
delivery of behavioral health services or aging and disability
services in furtherance of the goals of this chapter.
Sec. 531.457. ROLE OF DEPARTMENT OF AGING AND DISABILITY
SERVICES. (a) The Department of Aging and Disability Services, in
conjunction with the commission, is responsible for ensuring the
provision of aging and disability services and for coordinating the
provision of those services locally.
(b) The department shall manage contracts with local aging
and disability authorities for ensuring the provision of local
services.
(c) The department, in coordination with the commission,
may determine financing options for payment of costs of services to
be provided locally and for reimbursement of local service
providers.
(d) The department is responsible for approving:
(1) the creation and operations of local aging and
disability authorities in their respective local service regions;
and
(2) the local service delivery plan for each local
service region.
(e) The department shall ensure that contracts involving
aging services comply with requirements of the federal Older
Americans Act of 1965 (42 U.S.C. Section 3001 et seq.).
(f) The department shall operate in accordance with state
permanency planning laws.
(g) The department shall ensure that area agencies on aging
comply with the state's requirements regarding Title II of the
Americans with Disabilities Act (42 U.S.C. Section 12131 et seq.).
(h) The department shall maintain the area agencies on aging
and their current designated planning and service areas in
accordance with commission rules.
(i) The department, in coordination with the commission,
shall continue to manage Medicaid contracts with Medicaid
providers.
Sec. 531.458. ROLE OF DEPARTMENT OF STATE HEALTH SERVICES.
(a) The Department of State Health Services, in conjunction with
the commission, is responsible for ensuring the provision of
behavioral health services and for coordinating the provision of
those services locally.
(b) The department shall manage contracts with local
behavioral health authorities for ensuring the provision of local
services.
(c) The department, in coordination with the commission,
may determine financing options for payment of costs of services to
be provided locally and for reimbursement of local service
providers.
(d) The department is responsible for approving:
(1) the creation and operations of local behavioral
health authorities in their respective local service regions; and
(2) the local service delivery plan for each local
service region.
(e) The department shall ensure that local behavioral
health service delivery systems further the following goals:
(1) making the behavioral health care system one that
is family-driven and consumer-driven by:
(A) requiring individualized plans of care for
every adult with a serious mental illness or a substance abuse
problem and for every child with a serious emotional disturbance or
a substance abuse problem;
(B) involving consumers, families, and
stakeholders fully in the development of a system that is oriented
toward resiliency, disease management, and recovery; and
(C) protecting and enhancing the rights of people
with mental illness or substance abuse problems;
(2) reducing disparities in behavioral health
services by improving access to:
(A) culturally competent quality care; and
(B) quality care in rural and remote areas;
(3) enhancing the implementation of the resiliency and
disease management model for mental health services; and
(4) screening for co-occurring mental and substance
abuse disorders and treating persons with integrated treatment
strategies.
(f) The department shall implement a fee-for-service
payment model for regions that select noncapitated fiscal
arrangements.
Sec. 531.459. ROLES AND DUTIES OF LOCAL SERVICE
AUTHORITIES. (a) A local service authority, as a contractor of the
Department of Aging and Disability Services or the Department of
State Health Services, shall:
(1) provide for public access to the intake and
assessment process for aging, disability, or behavioral health
services needs and for those appropriate activities delegated
locally by the state as they relate to eligibility for services; and
(2) ensure and authorize the development of service
delivery plans for eligible clients of the authority.
(b) A local service authority shall endeavor to improve the
capacities of the communities by fostering partnerships among
service providers and other resources and shall raise community
awareness of the available services and service needs of the local
service region.
(c) A local service authority shall ensure the development
and maintenance of:
(1) a network of providers of services for the
authority's local service region; and
(2) other needed resources to support the delivery of
services in the authority's local service region.
(d) A local service authority may not provide a service
directly except as provided by Section 531.460.
(e) A local service authority is responsible for
coordinating the use of state facilities.
(f) A local service authority shall have a continuing
quality assurance and quality improvement program to ensure that
services delivered are adequate and appropriate.
(g) A local service authority shall have an ombudsman
program to assist clients of the region and other interested
persons in resolving complaints and in making appeals regarding
eligibility or regarding services delivered or denied.
Sec. 531.460. PROVISION OF MENTAL RETARDATION SERVICES BY
COMMUNITY CENTERS THROUGH AUTHORITIES. (a) In this section,
"ICF-MR" has the meaning assigned by Section 531.002, Health and
Safety Code.
(b) A community center may perform assessment and service
coordination functions for mental retardation services on behalf of
a local service authority for a period to be determined by
commission rule.
(c) The Department of Aging and Disability Services, in
consultation with the commission, shall establish limits on the
number of individuals who may be enrolled in waiver and ICF-MR
services provided by a community center that also is providing
assessment and service coordination functions for mental
retardation services on behalf of a local service authority.
(d) Rules adopted under this section shall establish a
process to allow community centers to provide waiver and ICF-MR
services above the enrollment limits established under Subsection
(c) under extenuating circumstances.
(e) A community center that does not provide assessment and
service coordination functions for mental retardation services on
behalf of an authority is not subject to the enrollment limits
established by the commission in accordance with Subsection (c).
Sec. 531.461. PREFERRED PROVIDER STATUS. (a) For a
transitional term that expires September 1, 2010, each local
service authority shall contract, as appropriate, with community
centers and chemical dependency and substance abuse service
providers in the local service region that are:
(1) providing services on September 1, 2005; and
(2) determined to be in good standing.
(b) The executive commissioner by rule shall require a local
service authority that provides jail diversion services to provide
the right of first refusal to community centers to provide those
services, if the community center provides those services on
September 1, 2005.
Sec. 531.462. LOCAL FUNDING. A local service authority
that receives money from a local governmental entity shall use the
money in accordance with an agreement between the authority and the
local governmental entity.
Sec. 531.463. LOCAL PLANNING PROCESS. (a) The executive
commissioner by rule shall establish a procedure for the chief
elected officials of each local service region to convene and
establish a governing structure for the region's local behavioral
health authority or local aging and disability authority. The
rules must provide guidelines for the officials to follow in
establishing the responsibilities and functions of each authority
and the requirements for approval of a local authority plan.
(b) In developing plans for the local service delivery
structure, the chief elected officials shall:
(1) solicit information, guidance, and comments from
interested persons and organizations in the local service region,
including persons and organizations who may receive or provide
services;
(2) evaluate the needs in the local service region for
services to be coordinated through the local service authority;
(3) evaluate the need for and use of locally provided
funding resources;
(4) develop methods to improve coordination of local
services;
(5) consider and encourage the use of innovative
service delivery models;
(6) address the coordination of programs for those
children in the local service delivery plan;
(7) consider the use of 16-bed inpatient mental health
facilities to maximize the receipt of available federal matching
money for mental health services; and
(8) develop a mechanism for reporting information to
local governmental entities that provide funding to the authority
and to chief elected officials who want feedback regarding the
activity of the authority.
(c) The commission shall make available to the chief elected
officials the recommendations of the mental health working group of
the Texas State Strategic Health Partnership regarding behavioral
health services reform.
(d) The commission, the Department of Aging and Disability
Services, and the Department of State Health Services shall provide
the chief elected officials with needed technical assistance and
advice in their efforts to establish the governing structure of a
local service authority under this section.
(e) The chief elected officials of each local service
region, in conjunction with the commission and the appropriate
department, shall develop a transition plan for the local service
region to transition from the existing authority structure to the
regional authority structure established under this subchapter.
Each existing local mental health and mental retardation authority
with jurisdiction in the local service region shall participate in
the development of the transition plan in accordance with rules
adopted under this subchapter. The transition plan must provide
for services to be delivered without disruption.
(f) The chief elected officials shall submit the service
delivery and transition plans to the Department of Aging and
Disibility Services and the Department of State Health Services for
approval.
(g) The commission and the Department of Aging and
Disability Services and the Department of State Health Services
jointly shall establish timeframes for the implementation of this
section.
(h) In developing the local service delivery system under
this subchapter, the commission shall endeavor to maximize to the
extent practicable federal matching money.
Sec. 531.464. COMPOSITION OF BOARDS OF DIRECTORS OF LOCAL
SERVICE AUTHORITIES. (a) The chief elected officials of each local
service region shall appoint the board of directors of the region's
local aging and disability authority and local behavioral health
authority.
(b) The board of directors for a local service authority
must have at least nine members and must reflect the ethnic and
geographic diversity of the authority's local service region.
(c) The chief elected officials of a local service region
are encouraged to include on the board of directors for a local
aging and disability authority one or more:
(1) older residents of the local service region;
(2) individuals with a disability who are receiving
services;
(3) persons with mental retardation;
(4) individuals knowledgeable of children's needs and
supports; and
(5) members of the general public.
(d) The chief elected officials of a local service region
are encouraged to include on the board of directors for a local
behavioral health authority one or more:
(1) adults with mental illness;
(2) parents of children with serious emotional
disturbances or histories of substance abuse disorders;
(3) persons with histories of chemical dependency;
(4) persons with, or persons advocating for persons
with, co-occurring behavioral health disorders;
(5) retired behavioral health professionals or
behavioral health professionals who are licensed but not
practicing; and
(6) members of the general public.
Sec. 531.465. COORDINATION OF STATE FACILITIES. The
Department of Aging and Disability Services or the Department of
State Health Services, as appropriate, shall coordinate with local
service authorities regarding the use of state mental health and
mental retardation facilities, services, and buildings by eligible
individuals.
Sec. 531.466. LOCAL BEHAVIORAL HEALTH AUTHORITY RESOURCES
FOR CHILDREN. (a) A local behavioral health authority shall design
system of care resources for children with serious emotional
disturbances that recognize:
(1) the unique needs of such children;
(2) the various programs in this state through which a
child may be directed to the authority for services; and
(3) the various programs available to the child, the
child's family, and the authority through which the child and the
child's family may receive behavioral health services or other
services.
(b) A local behavioral health authority shall develop
formal partnerships and coordinate with entities in the authority's
local service region to ensure that a child with a serious emotional
disturbance receives the most appropriate and effective care and
services to the extent possible.
(c) As appropriate, the authority shall use teams composed
of representatives of public and private service providers and
members of the child's family to develop individual and family
service plans that encompass to the extent possible all appropriate
services and direct interagency and provider cooperation as
necessary to further the plans.
(d) A local behavioral health authority shall establish a
system for integrating funding for a child's services to meet the
needs of a child and the child's family. In establishing the system
the authority shall consider the criteria and expansion plans
developed for the Texas Integrated Funding Initiative under
Subchapter G-1.
SECTION 2. Sections 533.035 and 533.0356, Health and Safety
Code, are repealed.
SECTION 3. This Act does not authorize the expansion of
Medicaid managed care programs, unless the chief elected officials
of a local service region established under Subchapter M, Chapter
531, Government Code, as added by this Act, choose to implement a
managed behavioral health care program.
SECTION 4. The executive commissioner of the Health and
Human Services Commission shall adopt rules necessary to implement
Subchapter M, Chapter 531, Government Code, as added by this Act, on
or before December 31, 2006.
SECTION 5. This Act takes effect September 1, 2005.