By: Van de Putte  S.B. No. 1648
         (In the Senate - Filed March 10, 2009; March 20, 2009, read
  first time and referred to Committee on Veteran Affairs and
  Military Installations; April 29, 2009, reported adversely, with
  favorable Committee Substitute by the following vote:  Yeas 5,
  Nays 0; April 29, 2009, sent to printer.)
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 1648 By:  Van de Putte
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to providing outreach services, behavioral health
  services, and certain health care services related to mental health
  to certain members and veterans of the armed forces and their
  families and providing for the creation of related clinical
  practice guidelines.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Title 12, Health and Safety Code, is amended by
  designating Chapter 1001, Health and Safety Code, as Subtitle A and
  adding a heading for Subtitle A to read as follows:
  SUBTITLE A. ADMINISTRATION BY DEPARTMENT
         SECTION 2.  Title 12, Health and Safety Code, is amended by
  adding Subtitle B to read as follows:
  SUBTITLE B. DEPARTMENT OF STATE HEALTH SERVICES PROGRAMS
  CHAPTER 1022.  SERVICES FOR SERVICEMEMBERS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 1022.001.  DEFINITIONS. In this chapter:
               (1)  "Department" means the Department of State Health
  Services.
               (2)  "Post-traumatic stress disorder" means a
  psychiatric disorder that can occur in people who have experienced
  or witnessed life-threatening events, including natural disasters,
  serious accidents, terrorist incidents, war, or violent personal
  assaults.
               (3)  "Program" means the program established under this
  chapter.
               (4)  "Servicemember" has the meaning assigned by
  Section 161.551.
               (5)  "Traumatic brain injury" means an acquired injury
  to the brain, including brain injuries caused by anoxia due to near
  drowning.  The term does not include brain dysfunction caused by
  congenital or degenerative disorders or birth trauma.
         Sec. 1022.002.  RULES. The executive commissioner of the
  Health and Human Services Commission shall adopt rules to implement
  this chapter.
         Sec. 1022.003.  CREATION AND PURPOSE.  The department shall
  establish a program under this chapter to promote the wellness of
  servicemembers and their families through the development,
  maintenance, and dissemination of clinical practice guidelines and
  other information for the effective treatment of psychological
  trauma and the reintegration of servicemembers into their
  communities, families, and workplaces, with emphasis on the trauma
  of war, including post-traumatic stress disorder, traumatic brain
  injury, and sexual trauma that occurs in military settings.
  [Sections 1022.004-1022.050 reserved for expansion]
  SUBCHAPTER B. CLINICAL PRACTICE GUIDELINES FOR TRAUMA
         Sec. 1022.051.  CLINICAL GUIDELINES.  (a)  The department
  shall develop evidence-based clinical practice guidelines
  containing recommendations to clinicians and other providers of
  mental health services for the management of trauma, including
  post-traumatic stress disorder, traumatic brain injury, and other
  trauma impacting behavioral health.
         (b)  In developing clinical practice guidelines, the
  department shall consider the recommendations and research of the
  National Center for Posttraumatic Stress Disorder of the federal
  Veterans Health Administration, the trauma registry and research
  database of the United States Army Institute of Surgical Research,
  and other appropriate and reputable sources of clinical research
  and information as determined by the department.
         (c)  The department shall provide for the ongoing
  maintenance and updating of the clinical practice guidelines in a
  manner that reflects current diagnostic and treatment best
  practices.
         (d)  Clinical practice guidelines established under this
  subchapter do not constitute the sole source of guidance in the
  management of trauma.  Guidelines are intended to assist clinicians
  by providing a framework for clinical decision making.  These
  guidelines do not provide the only appropriate approach to the
  management of trauma or replace other clinical judgment.
         Sec. 1022.052.  DISSEMINATION OF GUIDELINES.  (a)  The
  department shall make the clinical practice guidelines and other
  information developed under this subchapter available to providers
  of physical and behavioral health services.
         (b)  The department shall provide the clinical practice
  guidelines and information to the appropriate professional
  associations to be used in continuing education and shall, to the
  extent feasible, enter into agreements or take other action to
  promote the use of the materials for continuing education purposes.
         (c)  The department or its designees shall provide training
  and continuing education to clinicians and shall recognize through
  certificates or other means the health care providers that have
  demonstrated knowledge and mastery of the clinical practice
  guidelines and other materials developed by the department for the
  program.
         Sec. 1022.053.  TRAINING AND EDUCATIONAL MATERIALS.  In
  addition to clinical practice guidelines, the department shall
  develop, with the advice of and in consultation with the Texas
  Veterans Commission, training and educational materials for the use
  of the Texas Veterans Commission, veterans county service officers,
  and other service providers.  The materials must promote the
  understanding and effective treatment of trauma affecting
  behavioral health and other health-related information pertaining
  to the reintegration of servicemembers into their communities,
  families, and workplaces.
  [Sections 1022.054-1022.100 reserved for expansion]
  SUBCHAPTER C.  BEHAVIORAL HEALTH SERVICES AND SERVICE COORDINATION
         Sec. 1022.101.  SERVICE COORDINATION.  (a)  The department,
  in consultation with the United States Department of Veterans
  Affairs, the Texas military forces, the Texas Information and
  Referral Network, the Texas Veterans Commission, and the General
  Land Office, shall provide service coordination for servicemembers
  and their families in all geographic regions of the state to connect
  them to behavioral health services that may be available through
  the United States Department of Veterans Affairs or available under
  this chapter.
         (b)  In geographic areas in this state in which services are
  not yet available or accessible through the United States
  Department of Veterans Affairs, the department shall provide
  service coordination for veterans to connect them to behavioral
  health services that may be available through community mental
  health centers or other community resources with which the
  department contracts until federal services are available.
         (c)  The department shall provide servicemembers and their
  families current, accurate, and complete information about
  behavioral health services and resources through existing
  Internet-based resource programs and through:
               (1)  the directory of services for military personnel
  and their families disseminated through the Texas Information and
  Referral Network under Subchapter U, Chapter 161; and
               (2)  the service referral program under Section
  431.0291, Government Code, as added by Chapter 1381 (S.B. 1058),
  Acts of the 80th Legislature, Regular Session, 2007.
         Sec. 1022.102.  ELIGIBILITY.  (a)  To qualify for behavioral
  health services under Section 1022.103, a servicemember must:
               (1)  reside in this state;
               (2)  be younger than 65 years of age;
               (3)  have served for at least 180 days of duty after the
  servicemember's initial training;
               (4)  not be an inmate of a public institution;
               (5)  not be a resident of a nursing facility;
               (6)  not have health care coverage that provides
  diagnostic review and treatment for post-traumatic stress
  disorder, traumatic brain injury, or other trauma occurring in a
  military setting that impacts behavioral health; and
               (7)  be ineligible for services from the United States
  Department of Veterans Affairs or be unable to access those
  services because:
                     (A)  the servicemember resides more than 50 miles
  from the nearest service provider;
                     (B)  the servicemember does not have
  transportation to a service provider; or
                     (C)  the servicemember must wait more than 45 days
  for an appointment with a service provider.
         (b)  A servicemember who does not meet the eligibility
  requirements for services under this section shall be referred to
  an appropriate service provider for follow-up care.
         (c)  To receive behavioral health services under Section
  1022.103, an eligible servicemember must enroll in the program.  
  Following expiration of the term of a servicemember's enrollment in
  the program, the servicemember may reenroll for services under the
  program if the department or its designee determines that the
  servicemember continues to qualify for treatment for
  post-traumatic stress disorder, traumatic brain injury, or other
  trauma occurring in a military setting that impacts behavioral
  health.
         (d)  A family member of an enrolled servicemember may receive
  behavioral health services under the program as described by
  Section 1022.103.
         Sec. 1022.103.  BEHAVIORAL HEALTH SERVICES PROGRAM.  
  (a)  The department shall establish a program to provide behavioral
  health services in accordance with this section for eligible
  servicemembers under Section 1022.102. The behavioral health
  services provided under this section may include:
               (1)  crisis services in all geographic regions of the
  state; and
               (2)  behavioral health services in areas of the state
  in which existing federal and state behavioral health services are
  determined by the department to be inadequate or inaccessible.
         (b)  The behavioral health services provided under
  Subsection (a)(2) must to the greatest extent possible be provided
  in a peer-based treatment environment and may include:
               (1)  screening assessments;
               (2)  individual, family, and group therapy;
               (3)  substance abuse early intervention and
  detoxification services; and
               (4)  substance abuse medication-assisted treatment.
         (c)  The provision of services by the department under this
  section must be based on medical necessity criteria established by
  department rule.
         (d)  The department shall seek reimbursement for the costs of
  services provided under this section from the United States
  Department of Veterans Affairs and from other governmental agencies
  that may provide behavioral health services or payments for such
  services to servicemembers and their families.
         (e)  In order to enhance service coordination and assess the
  needs of servicemembers and their families, the department shall
  provide an opportunity for servicemembers to disclose military
  status when accessing local behavioral health services that receive
  funding from the department.
  [Sections 1022.104-1022.150 reserved for expansion]
  SUBCHAPTER D.  BEHAVIORAL HEALTH OUTREACH
         Sec. 1022.151.  OUTREACH ACTIVITIES.  (a)  Through a public
  outreach program, the department shall provide to servicemembers
  and their families information on accessing services through the
  Texas Information and Referral Network and through other
  organizations participating in memoranda of understanding
  maintained by the Texas military forces.
         (b)  The department's outreach activities must describe
  programs administered by health and human services agencies that
  could be of interest to servicemembers and their families,
  including early childhood intervention services, state vocational
  rehabilitation services, and higher education benefits and support
  services.
         (c)  The department's outreach efforts must be:
               (1)  conducted on a statewide basis;
               (2)  conducted through a contract or contracts with
  statewide or local community-based organizations with experience
  in statewide outreach to the military; and
               (3)  staffed by individuals with demonstrated
  experience in working with the military and military service
  organizations.
         (d)  Outreach methods must include direct personal contacts
  with servicemembers and outreach using communications media and
  printed materials.  As a component of the department's outreach
  activities, the department shall maintain or support an existing
  interactive Internet-based resource program that:
               (1)  allows individuals to access comprehensive
  information, advocacy resources, and other resources regarding
  public and private behavioral health services, crisis and emergency
  services, and early intervention and prevention programs; and
               (2)  enables the public and private health care
  communities to work together to address the problems related to
  obtaining access to behavioral health services and other
  reintegration services for servicemembers and their families.
         (e)  The interactive Internet-based program established
  under Subsection (d) shall be developed or maintained by the
  department with the advice of and in consultation with the Texas
  military forces. The department shall collaborate with state
  agencies and the Texas military forces to develop strategies to use
  existing interactive Internet-based resources that serve
  servicemembers and their families.
         SECTION 3.  Subchapter A, Chapter 431, Government Code, is
  amended by adding Section 431.0186 to read as follows:
         Sec. 431.0186.  SCREENING FOR TRAUMATIC BRAIN INJURY.  
  (a)  The adjutant general shall require each member of the Texas
  National Guard who served during Operation Enduring Freedom or
  Operation Iraqi Freedom to be screened for traumatic brain injury.
         (b)  The adjutant general shall assist a member of the Texas
  National Guard who tests positive for traumatic brain injury in
  obtaining appropriate medical care.
         SECTION 4.  Section 434.007, Government Code, is amended to
  read as follows:
         Sec. 434.007.  DUTIES.  (a)  The commission shall:
               (1)  compile federal, state, and local laws enacted to
  benefit members of the armed forces, veterans, and their families
  and dependents;
               (2)  collect information relating to services and
  facilities available to veterans;
               (3)  cooperate with veterans service agencies in the
  state;
               (4)  inform members and veterans of the armed forces,
  their families and dependents, and military and civilian
  authorities about the existence or availability of:
                     (A)  educational training and retraining
  facilities;
                     (B)  health, medical, rehabilitation, and housing
  services and facilities;
                     (C)  employment and reemployment services;
                     (D)  provisions of federal, state, and local law
  affording rights, privileges, and benefits to members and veterans
  of the armed forces and their families and dependents; and
                     (E)  other similar, related, or appropriate
  matters;
               (5)  assist veterans and their families and dependents
  in presenting, proving, and establishing claims, privileges,
  rights, and benefits they may have under federal, state, or local
  law, including establishing eligibility for health care services
  and treatments from the federal Veterans Health Administration and
  for services provided through the Department of State Health
  Services;
               (6)  cooperate with all government and private agencies
  securing services or benefits to veterans and their families and
  dependents;
               (7)  investigate, and if possible correct, abuses or
  exploitation of veterans or their families or dependents, and
  recommend necessary legislation for full correction;
               (8)  coordinate the services and activities of state
  departments and divisions having services and resources affecting
  veterans or their families or dependents;
               (9)  provide training and certification of veterans
  county service officers and assistant veterans county service
  officers in accordance with Section 434.038; and
               (10)  through surveys or other reasonable and accurate
  methods of estimation, collect and maintain for each county in the
  state the number of servicemembers and veterans residing in the
  county and annually update and publish the information on the
  commission's website.
         (b)  The commission shall enter into a memorandum of
  understanding with the Department of State Health Services to
  develop training materials for veterans county service officers and
  veterans service organizations that promote the understanding and
  effective treatment of trauma affecting behavioral health and other
  health-related information that promotes the reintegration of
  members and veterans of the armed forces into their communities,
  families, and workplaces. The commission shall:
               (1)  disseminate training and educational materials
  for the development of clinical practice guidelines and other
  training and educational materials that it receives from the
  department;
               (2)  enter into a contract or other agreement for the
  development of the training and educational materials with the
  department;
               (3)  reimburse the department for costs of preparing
  the materials from appropriations or other amounts available to the
  commission; and
               (4)  enter into relationships with established
  training programs for the purpose of providing peer support
  training and certification for veterans county service officers.
         SECTION 5.  Subsection (a), Section 434.0078, Government
  Code, is amended to read as follows:
         (a)  The commission shall adopt procedures for administering
  claims assistance services under Section 434.007(5). Claims
  assistance services shall be provided for establishing eligibility
  for health care services and treatments from the federal Veterans
  Health Administration.  The procedures shall include:
               (1)  criteria for determining when a veteran's initial
  claim is substantially complete and basic eligibility requirements
  are met as provided by federal law;
               (2)  a process for expediting a claim based on
  hardship, including whether the veteran:
                     (A)  is in immediate need;
                     (B)  is terminally ill;
                     (C)  has a verifiable financial hardship; or
                     (D)  has a disability that presents an undue
  burden;
               (3)  a procedure for counseling veterans on the
  potential merits or drawbacks of pursuing a claim;
               (4)  a process to ensure adequate documentation and
  development of a claim or appeal, including early client
  involvement, collection of needed evidence and records, and
  analysis of actions necessary to pursue and support a claim or
  appeal;
               (5)  criteria for evaluating whether a decision of the
  United States Department of Veterans Affairs contains sufficient
  cause for filing an appeal;
               (6)  a requirement that a claims counselor report to
  the United States Department of Veterans Affairs if the counselor
  has direct knowledge that a claim contains false or deceptive
  information; and
               (7)  a procedure for prioritizing a claim, when
  appropriate, or providing an alternative source for obtaining
  claims assistance services when it is not appropriate to
  prioritize.
         SECTION 6.  The Department of State Health Services shall
  conduct an immediate analysis of the behavioral health needs of
  servicemembers and their families and submit a preliminary report
  of its findings and recommendations to the legislature and the
  governor on or before December 1, 2009, and a final report of its
  findings and recommendations on or before December 1, 2010.  The
  report shall:
               (1)  identify the gaps in behavioral health services
  available to servicemembers and their families;
               (2)  identify impediments to the ability of
  servicemembers and their families to access the behavioral health
  services that are available, particularly in the state's rural
  areas;
               (3)  evaluate collaboration among organizations and
  entities that provide behavioral health services to servicemembers
  and their families;
               (4)  make recommendations with respect to improving
  outreach to servicemembers and their families in need of behavioral
  health services;
               (5)  include a specific plan of action to promote
  federal and state collaboration to maximize funding and access to
  resources for the behavioral health needs of servicemembers and
  their families;
               (6)  make recommendations with respect to building
  provider capacity and increasing provider training to meet the
  behavioral health needs of servicemembers and their families
  through peer support treatment methodologies; and
               (7)  make recommendations with respect to improving the
  coordination of behavioral health services for servicemembers and
  their families.
         SECTION 7.  Not later than January 1, 2010, the executive
  commissioner of the Health and Human Services Commission shall
  adopt rules as necessary to administer Chapter 1022, Health and
  Safety Code, as added by this Act.
         SECTION 8.  This Act does not make an appropriation.  This
  Act takes effect only if a specific appropriation for the
  implementation of the Act is provided in a general appropriations
  act of the 81st Legislature.
         SECTION 9.  Except as provided by Section 8 of this Act, this
  Act takes effect September 1, 2009.
 
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