79R365 JJT-D
By: Nelson S.B. No. 194
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. SERVICE DELIVERY THROUGH LOCAL SERVICE AUTHORITIES
BY REGION
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 disabled services" includes:
(A) aging services;
(B) mental retardation services;
(C) community care services for elderly persons
or persons with disabilities; and
(D) nursing home services.
(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) "Local service authority" means a local aging and
disabled authority or a local behavioral health authority.
(5) "Mental health services" has the meaning assigned
by Section 531.002, Health and Safety Code.
(6) "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 disabled 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 disabled 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 assessment and eligibility for and
the provision of services in local service 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 commission shall coordinate Medicaid services
provided through the service provider resources of local service
authorities.
Sec. 531.454. 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 disabled services and for coordinating the
provision of those services locally.
(b) The department shall manage contracts with local aging
and disabled 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
disabled 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 ensure that the local service
delivery systems are in accord with the "Enterprise" vision and
mission of the commission to:
(1) ensure a comprehensive and cost-effective service
delivery system that is easily accessed and aimed at developing and
improving service options responsive to individual needs and
preferences;
(2) promote individual well-being, dignity, and
choice;
(3) work in partnership with consumers, caregivers,
service providers, and local stakeholders; and
(4) ensure and protect consumers' self-determination,
rights, and safety.
Sec. 531.455. 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 of State Health Services 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) developing 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 and families fully in
orienting the behavioral health system toward recovery; and
(C) protecting and enhancing the rights of people
with mental illness or substance abuse problems;
(2) eliminating disparities in behavioral health
services by:
(A) improving access to culturally competent
quality care; and
(B) improving access to quality care in rural and
remote areas; and
(3) making early behavioral health screening,
assessment, and referral to services a common practice by:
(A) promoting the behavioral health of young
children;
(B) improving public school system behavioral
health programs; and
(C) screening for co-occurring mental and
substance abuse disorders and treating persons with integrated
treatment strategies.
Sec. 531.456. LOCAL SERVICE REGIONS. (a) The executive
commissioner shall establish local service regions for delivery of
services by local service delivery systems coordinated by local
behavioral health authorities and local service regions for
delivery of services by local service delivery systems coordinated
by local aging and disabled authorities. Local service regions for
behavioral health authorities must be the same as those for local
service regions for aging and disabled authorities.
(b) In developing the local service regions, the executive
commissioner shall:
(1) ensure that each local service region includes
communities with common or similar needs for relevant services;
(2) consider the services referral and delivery
systems available for use in the proposed local service regions;
and
(3) design the local service regions so that:
(A) each county in this state is included in a
region; and
(B) each region includes:
(i) only adjacent counties; and
(ii) more than one county.
(c) The executive commissioner may revise the local service
regions in response to changing needs or information. Before
revising the regions, the executive commissioner must give public
notice and an opportunity for comment in accordance with rules
adopted by the executive commissioner. The rules governing notice
and comment must be designed to allow the public, local service
authorities, representatives of communities, and interested
persons and organizations to appeal or comment on any community's
inclusion in or exclusion from a local service region and to allow
those persons, representatives, and organizations to comment on the
inclusion in or exclusion from a local service region of any
resource available for service referral or delivery.
Sec. 531.457. 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) provide for the development of service delivery
plans for eligible clients of the authority.
(b) A local service authority may not provide services
directly. 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.
(c) 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.
(d) A local service authority shall provide for local
service delivery planning and shall ensure that interested local
persons, providers, and organizations are encouraged to comment on
planning issues and participate in planning. A local service
authority shall define the local service region's service delivery
goals and priorities in the local service delivery plan. The local
service authority may not implement a local service delivery plan
until the plan is approved by the department that contracts with the
local service authority. The local service delivery plan must be
designed to:
(1) ensure access to various kinds of available
services through a single entity with coordinated service access
points; and
(2) maximize the receipt of federal matching money
available for services by using different and advantageous service
delivery models and facilities.
(e) A local service authority shall have a continuing
quality assurance and quality improvement program to ensure that
services delivered are adequate and appropriate.
(f) 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.
(g) A local service authority is responsible for
coordinating the use of facilities and services.
Sec. 531.458. COMPOSITION OF BOARDS OF DIRECTORS OF LOCAL
SERVICE AUTHORITIES. (a) The chief elected officials of each local
service region for aging and disabled services shall appoint the
board of directors of the region's local aging and disabled
authority and the chief elected officials of each local service
region for behavioral health services shall appoint the board of
directors of the region's local behavioral health authority. The
composition of the board of directors for a local service authority
must reflect the ethnic and geographic diversity of the authority's
local service region.
(b) The board of directors for a local aging and disabled
authority should include as members:
(1) an elderly resident of the region;
(2) a consumer of services for the person's
disability;
(3) a person with mental retardation; and
(4) members of the general public.
(c) The board of directors for a local behavioral health
authority should include as members:
(1) an adult with a mental illness;
(2) a parent of a child with a serious emotional
disturbance;
(3) a person with a substance abuse problem;
(4) a person with, or a person advocating for a person
with, co-occurring behavioral health disorders; and
(5) members of the general public.
Sec. 531.459. SERVICE COORDINATION BY LOCAL AGING AND
DISABLED AUTHORITIES. (a) A local aging and disabled authority
shall coordinate services for persons in the authority's local
service region and shall provide assistance to persons seeking
services for themselves or for others in accessing appropriate
information, treatment resources, and supports to assist a person
to achieve a level of independence, quality of life, and
participation in the community that is acceptable to the person and
the person's legally authorized representative, family member, or
caregiver.
(b) The Department of Aging and Disability Services shall
ensure that an aging and disabled authority's service delivery
system is designed to:
(1) create a support system for a family that chooses
to keep a family member who is aging or who has a disability at the
family's home;
(2) ensure a continuum of care for all persons with
disabilities;
(3) make preparations in consideration of the
anticipated increase in the population of aged residents of this
state who may be in need of services;
(4) foster partnerships among state agency programs,
local health departments, hospital districts, and other parties;
and
(5) allow for innovative or new models of service
delivery.
(c) An authority's service coordination activities may
include, to the extent they are consistent with the terms of the
authority's contracts with the Department of Aging and Disability
Services:
(1) providing information, assistance, and referrals
for services;
(2) providing benefits counseling;
(3) assessing persons seeking services;
(4) planning and coordinating various available
services across programs;
(5) monitoring services;
(6) providing relocation services and transition
services;
(7) determining eligibility for services; and
(8) engaging in crisis prevention and crisis
management activities.
Sec. 531.460. SERVICE COORDINATION BY LOCAL BEHAVIORAL
HEALTH AUTHORITIES. (a) A local behavioral health authority shall
coordinate services for clients in the authority's local service
region and shall provide assistance to persons seeking services for
themselves or for others in accessing appropriate information,
treatment resources, and supports to assist in identifying a
person's illness or condition and to develop a plan for the
provision of services.
(b) The Department of State Health Services shall ensure
that a local behavioral health authority's service delivery system
is designed to:
(1) encourage integration of behavioral health and
primary care services;
(2) decrease the stigma associated with mental health
services;
(3) more effectively treat persons with multiple
diagnoses or with behavioral health issues and physical health
issues;
(4) foster partnerships among state agency programs,
local health departments, hospital districts, and other parties;
(5) allow for innovative or new models of service
delivery;
(6) maximize to the extent practicable federal
matching money; and
(7) improve services for children with serious
emotional disturbances by linking programs and resources related to
children's mental health into a more integrated system.
(c) An authority's service coordination activities may
include, to the extent they are consistent with the terms of the
authority's contracts with the Department of State Health Services:
(1) providing information, assistance, and referrals
for services;
(2) providing benefits counseling;
(3) assessing persons seeking services;
(4) planning and coordinating various available
services across programs;
(5) monitoring services;
(6) authorizing services;
(7) planning for discharge of clients and
postdischarge treatment, services, or supports as needed; and
(8) determining eligibility for services.
Sec. 531.461. 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, including school districts, state and local
agencies, and service providers, to ensure that a child with a
serious emotional disturbance receives the most appropriate and
effective care and services to the extent possible. 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.
(c) The authority shall establish a system for integrating
funding for a child's services from various available sources to
provide a spectrum of 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. Section 533.035(g), Health and Safety Code, is
repealed.
SECTION 3. (a) To implement Section 531.456, Government
Code, as added by this Act, the executive commissioner of the Health
and Human Services Commission shall issue for public comment a
draft proposal for dividing this state into local service regions
for delivery of behavioral health services, including mental health
and chemical dependency services, by local behavioral health
authorities and for delivery of services for aging persons and
persons with disabilities by local aging and disabled authorities.
(b) In developing the proposed local service regions, the
executive commissioner shall:
(1) analyze aging, disability, and behavioral health
services needs in, and service delivery to, urban and rural areas to
determine whether urban and rural service delivery in a local
service region may be more effectively provided jointly or
separately and consider the results of that analysis in combining
communities into local service regions; and
(2) otherwise comply with the requirements and
procedures prescribed by Section 531.456, Government Code, as added
by this Act.
SECTION 4. (a) The executive commissioner of the Health and
Human Services Commission by rule shall establish a procedure for
the chief elected officials of each local service region
established under Section 531.456, Government Code, as added by
this Act, to convene and establish a governing structure for the
region's local behavioral health authority or local aging and
disabled authority. The rules must provide guidelines for the
officials to follow in establishing the responsibilities and
functions of each authority.
(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 of persons 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 private service
providers and of innovative service delivery models;
(6) consider the variety of programs for and services
provided to children and address children's programs and services
and the coordination of those programs and services in the local
service delivery plan; and
(7) consider the use of 16-bed inpatient mental health
facilities to maximize the receipt of available federal matching
money for mental health services.
(c) The Health and Human Services 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 Health and Human Services 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) An entity is eligible for designation as a local service
authority only if the entity will not provide services after its
designation. Entities eligible for designation as a local service
authority include:
(1) a local mental health or mental retardation
authority;
(2) a hospital district or health services district;
(3) a local health department or public health
district;
(4) a city or county government;
(5) an area agency on aging;
(6) a council of government;
(7) a provider of services;
(8) a new entity created by the chief elected
officials or others;
(9) a state-operated entity; and
(10) a private entity.
(f) The chief elected officials of each local service
region, in conjunction with the Health and Human Services
Commission, the Department of Aging and Disability Services, the
Department of State Health Services, the existing local mental
health and mental retardation authorities with jurisdiction in the
local service region, and the board of directors of the region's
local behavioral health authority or local aging and disabled
authority, as appropriate, shall develop a transition plan to
manage the replacement of local mental health and mental
retardation authority responsibilities and services with those of
the new local behavioral health authority or local aging and
disabled authority and to manage the transition from the provision
of services under the law immediately preceding the effective date
of this Act to the provision of services by local service
authorities under Subchapter M, Chapter 531, Government Code, as
added by this Act, in accordance with rules adopted under that
subchapter. The transition plan must provide for services to be
delivered without disruption.
SECTION 5. (a) The Department of State Health Services
shall assist the chief elected officials of each local service
region in designing service delivery systems and resources for
behavioral health care to be coordinated through their local
behavioral health authorities.
(b) In providing assistance under Subsection (a) of this
section, the Department of State Health Services shall examine and
promote the solutions to challenges in the mental health care
system that are identified by the President's New Freedom
Commission on Mental Health in its July 2003 final report.
SECTION 6. The executive commissioner of the Health and
Human Services Commission shall adopt rules necessary to implement
this Act and the changes in law made by this Act not later than
December 31, 2006.
SECTION 7. This Act takes effect September 1, 2005.