81R3822 UM-D
 
  By: Ellis S.B. No. 1060
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the creation of a strategic plan to reform long-term
  services and supports for individuals with disabilities.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 536 to read as follows:
  CHAPTER 536. STRATEGIC PLAN REGARDING LONG-TERM SERVICES AND
  SUPPORTS FOR INDIVIDUALS WITH DISABILITIES
         Sec. 536.001.  PURPOSE; INTENT. (a)  The purpose of this
  chapter is to develop a comprehensive plan to reform and rebalance
  Texas' system of long-term services and supports for people with
  disabilities, including individuals who are eligible for ICF-MR
  services.
         (b)  It is the intent of the legislature that the system
  analysis and planning effort prescribed by this chapter encompass
  services for individuals with disabilities across different
  programs and settings.
         (c)  It is the intent of the legislature that the reformed
  system:
               (1)  be based on principles of self-determination;
               (2)  include person-centered planning and maximize
  opportunities for consumer direction for all eligible individuals;
               (3)  provide and expand timely access to services in
  the consumer's setting of choice, whether in the community or in an
  institution;
               (4)  base service provision on functional need;
               (5)  simplify and streamline community-based services
  to ensure that, to the extent possible, individuals have access to
  the same array of services regardless of an individual's
  disability;
               (6)  improve the quality of services delivered across
  programs and settings, with particular attention given to services
  delivered to consumers in state schools and state centers;
               (7)  strengthen oversight of community-based services;
  and
               (8)  increase the cost-effectiveness and
  sustainability of long-term care services and supports.
         Sec. 536.002.  PRINCIPLES OF SELF-DETERMINATION.  For
  purposes of this chapter, "self-determination" includes the
  following principles:
               (1)  freedom, the opportunity to choose where and with
  whom one lives and how one organizes all important aspects of one's
  life with freely chosen assistance as needed;
               (2)  authority, the ability to control some targeted
  amount of public dollars;
               (3)  support, the ability to organize support in ways
  that are unique to the individual;
               (4)  responsibility, the obligation to use public
  dollars wisely and to contribute to one's community; and
               (5)  confirmation, the recognition that individuals
  with disabilities must be a major part of the redesign of the human
  services system of long-term care.
         Sec. 536.003.  CREATION OF STRATEGIC PLAN.  The commission
  shall create a strategic plan for reform of the services and
  supports available for persons with disabilities, including
  individuals eligible for ICF-MR services. The commission shall
  develop the plan using a clearly defined process that allows
  ongoing and meaningful statewide public involvement.
         Sec. 536.004.  CONTENTS OF STRATEGIC PLAN.  (a)  The
  strategic plan required by this chapter must:
               (1)  assess the need for services and supports based on
  current interest lists, national trends, best practices, consumer
  satisfaction surveys, and any other relevant data;
               (2)  prescribe methods to expand timely access to
  community-based services by:
                     (A)  eliminating wait times for services of
  greater than two years;
                     (B)  transferring funds from institutional to
  community-based strategies where appropriate;
                     (C)  developing community-based provider
  capacity;
                     (D)  providing incentives for ICF-MR providers to
  transition to serving consumers in the most integrated setting;
                     (E)  improving and expanding behavioral supports
  in the community for adults and children; and
                     (F)  applying "Money Follows the Person" methods
  of financing for persons residing in state schools, state centers,
  or public or private ICF-MRs;
               (3)  analyze current utilization management methods
  for community-based services and determine necessary modifications
  to ensure more timely access to services;
               (4)  examine local access issues for community-based
  services and identify appropriate solutions;
               (5)  examine the current functional eligibility
  criteria, functional assessment tools, and service planning
  reimbursement methodology for the home and community-based
  services waiver system and determine appropriate methods to modify
  those protocols so individuals can access needed services,
  regardless of the program in which the individual is enrolled;
               (6)  prescribe methods to redesign the home and
  community-based services waiver system across all programs by:
                     (A)  simplifying and streamlining the
  administrative, policy, and regulatory processes to the extent
  possible;
                     (B)  ensuring that person-centered plans and
  philosophy match utilization review and utilization management
  methods and philosophy;
                     (C)  permitting, to the extent allowed by federal
  law, flexibility in the development of a consumer's individualized
  service plan based on the needs of the consumer rather than the
  consumer's disability label or diagnosis;
                     (D)  ensuring that a consumer's individualized
  service plan can be modified when the consumer's support needs
  change; and
                     (E)  implementing other strategies to streamline
  services for consumers with a disability who are eligible for
  waiver services;
               (7)  prescribe methods to improve services delivered to
  consumers in state schools and state centers;
               (8)  prescribe methods to reduce reliance on
  institutional placements of consumers;
               (9)  prescribe methods to end institutional placements
  of individuals who are younger than 22 years of age;
               (10)  prescribe methods to consolidate and close state
  schools and state centers in accordance with Subsection (b);
               (11)  prescribe methods to downsize large and
  medium-sized public and private ICF-MRs;
               (12)  prescribe methods to improve the quality of
  services provided to consumers by:
                     (A)  examining current methods and processes
  related to the quality of services and identifying which methods or
  processes:
                           (i)  need further enhancements;
                           (ii)  need to be developed; or
                           (iii)  are effective and should be
  considered for implementation across all services;
                     (B)  increasing oversight and accountability in
  community-based settings;
                     (C)  developing an appropriate population of
  qualified direct services workers in the community;
                     (D)  developing and making available alternatives
  to guardianship for consumers who need support in their
  decision-making; and
                     (E)  identifying quality measures, including
  timeliness of service delivery, number of consumers served, and
  types of services being received, and providing a process by which
  this information is reported to the legislature on an annual basis;
  and
               (13)  identify barriers to system reform and make
  recommendations to eliminate or address barriers to system reform,
  including any necessary statutory amendment.
         (b)  The strategic plan must prescribe a method that will
  result in the consolidation and closure of state school and state
  center facilities through a reduction in the number of consumers
  placed in those facilities. In determining the method for
  consolidating and closing state school and state center facilities,
  the plan must:
               (1)  establish a goal of reducing, within eight years
  of the submission of the strategic plan, the utilization rate of
  state schools and other facilities with 16 or more beds to not more
  than the average national utilization rate;
               (2)  establish benchmarks that will demonstrate
  measurable progress during the eight-year period following the
  submission of the strategic plan toward the reduction of the
  utilization rate of state schools and other facilities with 16 or
  more beds;
               (3)  reflect the recommendations of a steering
  committee that includes:
                     (A)  as appointed by the speaker of the house of
  representatives:
                           (i)  one member representing a district in
  which a state school or state center is located; and
                           (ii)  one member representing a district in
  which no state school or state center is located;
                     (B)  as appointed by the lieutenant governor:
                           (i)  one senator representing a district in
  which a state school or state center is located; and
                           (ii)  one senator representing a district in
  which no state school or state center is located;
                     (C)  as appointed by the executive commissioner,
  one representative of:
                           (i)  providers of community-based services;
                           (ii)  providers of ICF-MR services;
                           (iii)  state school employees;
                           (iv)  consumers;
                           (v)  advocates for consumers;
                           (vi)  advocates for consumers who are
  children;
                           (vii)  families of residents of a state
  school located in a rural area;
                           (viii)  families of residents of a state
  school located in an urban area; and
                           (ix)  local mental retardation authorities;
  and
                     (D)  for the purpose of providing assistance and
  serving as a resource to the steering committee, representatives of
  relevant agencies, including the Texas Department of Housing and
  Community Affairs and other agencies other than the commission, as
  determined by the other members of the steering committee;
               (4)  require the executive commissioner to appoint or
  hire a person, who is not an employee of the Department of Aging and
  Disability Services, to oversee the closure process;
               (5)  identify the number and location of state schools
  and state centers that will be closed under the plan and the
  timeline for each closure;
               (6)  establish guiding principles for state schools and
  state centers that will be closed under the plan, including
  guidelines for the future use of closed facilities and principles
  addressing the needs of:
                     (A)  residents and their families;
                     (B)  employees; and
                     (C)  affected communities;
               (7)  define transitional supports, including
  employment supports, that will be made available to a state school
  or state center resident who moves from a state school or state
  center; and
               (8)  prescribe methods to provide consumers in state
  schools or state centers who do not have a legally authorized
  representative with access to alternatives to guardianship.
         (c)  The strategic plan must establish a timeline and defined
  benchmarks for measuring progress in implementing the plan. The
  executive commissioner shall ensure that the plan includes an
  ongoing evaluation process that allows the plan to be amended in
  response to needs identified by the process.  The proposed timeline
  and benchmarks must progressively move the state closer to the goal
  of reducing the utilization rate of state schools and other
  facilities with 16 or more beds to a rate that is not more than the
  national utilization rate and to the goal of reducing wait times for
  community-based services. The plan must require the commission to
  inform the governor, the lieutenant governor, the speaker of the
  house of representatives, the Legislative Budget Board, and the
  standing committees of both houses of the legislature with
  appropriate subject matter jurisdiction when significant revisions
  to the strategic plan are made or when a proposed timeline is not
  met.
         (d)  The executive commissioner, in developing the strategic
  plan, shall consider the efforts of other states, Texas' settlement
  of Lelsz v. Kavanagh, and any relevant directives or information
  resulting from the investigation of state school or state center
  facilities by the United States Department of Justice.
         (e)  The executive commissioner may contract with a
  disinterested person with expertise in evaluating and planning
  long-term care services and supports for persons with disabilities,
  self-determination and consumer direction, and facilities
  closures, to aid the commission in developing the plan required by
  this chapter.
         Sec. 536.005.  CLOSURE OR CONSOLIDATION OF CERTAIN
  FACILITIES.  As soon as possible after the commission submits the
  strategic plan required by this chapter, the executive commissioner
  shall begin the facility closure process described by the plan.  The
  commission may begin the implementation of the plan and close or
  consolidate a facility as described by the plan without additional
  or specific legislative action.
         SECTION 2.  Not later than December 1, 2010, the Health and
  Human Services Commission shall submit the strategic plan required
  by Chapter 536, Government Code, as added by this Act, to the
  presiding officers of the Senate Health and Human Services
  Committee and the House Human Services Committee.
         SECTION 3.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2009.