79R6893 UM-D
By: Truitt H.B. No. 2572
A BILL TO BE ENTITLED
AN ACT
relating to the functions of local mental health and mental
retardation authorities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.031, Health and Safety Code, is
amended by adding Subdivisions (4), (5), (6), and (7) to read as
follows:
(4) "Commission" means the Health and Human Services
Commission.
(5) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(6) "ICF-MR and related waiver programs" includes
ICF-MR programs, home and community based services, Texas home
living waiver services or another Medicaid program serving persons
with mental retardation.
(7) "Qualified service provider" means an entity that
meets requirements for service providers established by the
executive commissioner.
SECTION 2. Section 533.035, Health and Safety Code, is
amended by amending Subsections (a), (c), and (e) and adding
Subsection (e-1) to read as follows:
(a) The executive commissioner shall designate a local
mental health authority and a local mental retardation authority in
one or more local service areas. The executive commissioner
[board] may delegate to the local authorities the [board's]
authority and responsibility of the executive commissioner, the
commission, or a department of the commission related to [for the]
planning, policy development, coordination, including coordination
with criminal justice entities, resource allocation, and resource
development for and oversight of mental health and mental
retardation services in the most appropriate and available setting
to meet individual needs in that service area. The executive
commissioner may designate a single entity as the local mental
health authority and the local mental retardation authority for a
service area.
(c) A local mental health and mental retardation authority,
with the department's approval, shall use the funds received under
Subsection (b) to ensure mental health, mental retardation, and
chemical dependency services are provided in the local service
area. The local authority shall consider public input, ultimate
cost-benefit, and client care issues to ensure consumer choice and
the best use of public money in:
(1) assembling a network of service providers; [and]
(2) making recommendations relating to the most
appropriate and available treatment alternatives for individuals
in need of mental health or mental retardation services; and
(3) determining whether the authority will provide the
service or contract with another organization to provide the
service.
(e) In assembling a network of service providers, a local
mental health [and mental retardation] authority may serve as a
provider of services only as a provider of last resort and only if
the authority demonstrates to the department that:
(1) the authority has made every reasonable attempt to
solicit the development of an available and appropriate provider
base that is sufficient to meet the needs of consumers in its
service area; and
(2) there is not a willing provider of the relevant
services in the authority's service area or in the county where the
provision of the services is needed.
(e-1) A local mental retardation authority may serve as a
provider of ICF-MR and related waiver services only if:
(1) the authority complies with the limitations
prescribed by Section 533.0355(c); or
(2) the ICF-MR and related waiver services are
necessary to ensure the availability of services and the authority
demonstrates to the commission that there is not a willing ICF-MR
and related waiver service qualified service provider in the
authority's service area where the service is needed.
SECTION 3. Section 533.0355, Health and Safety Code, is
amended to read as follows:
Sec. 533.0355. LOCAL MENTAL RETARDATION AUTHORITY
RESPONSIBILITIES [ALLOCATION OF DUTIES] UNDER CERTAIN MEDICAID
WAIVER PROGRAMS. (a) The executive commissioner shall adopt rules
establishing the roles and responsibilities of local mental
retardation authorities [In this section, "waiver program" means
the local mental retardation authority waiver program established
under the state Medicaid program].
(b) In adopting rules under this section, the executive
commissioner must include rules regarding:
(1) access;
(2) intake;
(3) eligibility functions;
(4) enrollment, initial assessment, and service
authorization;
(5) utilization management;
(6) safety net functions, including crisis management
services and assistance in accessing facility–based care;
(7) service coordination functions;
(8) provision and oversight of state general revenue
services;
(9) local planning functions, including stakeholder
involvement, technical assistance and training, and provider
complaint and resolution processes; and
(10) processes to assure accountability in
performance, compliance, and monitoring. [A provider of services
under the waiver program shall:
[(1) develop a person-directed plan and an individual
program plan for each person who receives services from the
provider under the waiver program;
[(2) perform justification and implementation
functions for the plans described by Subdivision (1);
[(3) conduct case management under the waiver program,
other than case management under Subsection (c)(3), in accordance
with applicable state and federal laws; and
[(4) plan, coordinate, and review the provision of
services to all persons who receive services from the service
provider under the waiver program.]
(c) In establishing a local mental retardation authority's
role as a qualified service provider of ICF-MR and related waiver
programs under Section 533.035(e-1), the executive commissioner by
rule shall require the local mental retardation authority to:
(1) base the authority's provider capacity on the
authority's August 2004 enrollment levels for the waiver programs
the authority operates and, if the authority's enrollment levels
exceed those levels, to reduce the levels by voluntary attrition;
and
(2) base any increase in the authority's provider
capacity on:
(A) the authority's state-mandated conversion
from one Medicaid program to another Medicaid program allowing for
a permanent increase in the authority's provider capacity in
accordance with the number of persons who choose the authority as
their provider;
(B) the authority's voluntary conversion from
one Medicaid program to another Medicaid program allowing for a
temporary increase in the authority's provider capacity in
accordance with the number of persons who choose the authority as
their provider; or
(C) other extenuating circumstances that:
(i) are clearly defined in rules adopted by
the executive commissioner;
(ii) are monitored and approved by the
department; and
(iii) do not include increases resulting
from refinancing and do not include increases that unnecessarily
promote the authority's provider role over its role as a local
mental retardation authority. [A local mental retardation
authority shall:
[(1) manage any waiting lists for services under the
waiver program;
[(2) perform functions relating to consumer choice and
enrollment for persons who receive services under the waiver
program; and
[(3) conduct case management under the waiver program
relating to funding disputes between a service provider and the
local mental retardation authority.]
(d) In adopting a rule under this section, the executive
commissioner shall seek the participation of and comments from
local mental health and mental retardation authorities, providers,
advocates, and other interested stakeholders. [The department
shall perform all administrative functions under the waiver program
that are not assigned to a service provider under Subsection (b) or
to a local mental retardation authority under Subsection (c).
Administrative functions performed by the department include:
[(1) any surveying, certification, and utilization
review functions required under the waiver program; and
[(2) managing an appeals process relating to decisions
that affect a person receiving services under the waiver program.]
(e) Any increase based on extenuating circumstances under
Subsection (c)(2)(C) is considered a temporary increase in the
local mental retardation authority's provider capacity. [The
department shall review:
[(1) screening and assessment of levels of care;
[(2) case management fees paid under the waiver
program to a community center; and
[(3) administrative fees paid under the waiver program
to a service provider.]
(f) At least biennially, the department shall review and
determine the local mental retardation authority's status as a
qualified service provider in accordance with criteria that
includes the consideration of the authority's ability to assure the
availability of services in its area, including:
(1) program stability and viability;
(2) the number of other qualified service providers in
the area; and
(3) the geographical area in which the authority is
located. [The department shall perform any function relating to
inventory for persons who receive services under the waiver program
and agency planning assessments.
[(g) The review required under Subsection (e) must include a
comparison of fees paid before the implementation of this section
with fees paid after the implementation of this section. The
department may adjust fees paid based on that review.
[(h) The department shall allocate the portion of the gross
reimbursement funds paid to a local authority and a service
provider for client services for the case management function in
accordance with this section and to the extent allowed by law.
[(i) The department may adopt rules governing the functions
of a local mental retardation authority or service provider under
this section.]
SECTION 4. Section 535.002(b), Health and Safety Code, is
amended to read as follows:
(b) If feasible and economical, the commission shall
[department may] use local mental health and mental retardation
authorities to implement this chapter. [However, the department
may not designate those local mental health and mental retardation
authorities as the sole providers of services if other providers
are available.]
SECTION 5. (a) Sections 533.035(f) and (g), Health and
Safety Code, are repealed.
(b) Section 2.82A, Chapter 198, Acts of the 78th
Legislature, Regular Session, 2003, is repealed.
SECTION 6. Not later than January 1, 2007, the Health and
Human Services Commission shall submit a report to the governor,
lieutenant governor, and speaker of the house of representatives
that includes any information the commission finds relevant
regarding the implementation of Sections 535.035 and 535.0355,
Health and Safety Code, as amended by this Act, by local mental
retardation authorities.
SECTION 7. This Act takes effect September 1, 2005.