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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of services to individuals with mental |
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retardation. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subsection (a), Section 531.02442, Government |
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Code, is amended by amending Subdivision (1) and adding Subdivision |
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(4) to read as follows: |
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(1) "Institution" means: |
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(A) a residential care facility operated or |
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maintained by the department [Texas Department of Mental Health and
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Mental Retardation] to provide 24-hour services, including |
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residential services, to persons with mental retardation; or |
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(B) an ICF-MR, as defined by Section 531.002, |
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Health and Safety Code. |
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(4) "Department" means the Department of Aging and |
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Disability Services. |
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SECTION 2. Section 531.02442, Government Code, is amended |
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by amending Subsection (b) and adding Subsections (f), (g), and (h) |
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to read as follows: |
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(b) In addition to providing information regarding care and |
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support options as required by Section 531.042, the department |
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[Texas Department of Mental Health and Mental Retardation] shall |
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implement a community living options information process in each |
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institution to inform persons with mental retardation who reside in |
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the institution and their legally authorized representatives of |
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alternative community living options. If a person with mental |
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retardation residing in an institution and the person's legally |
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authorized representative would like to participate in the |
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community living options information process, the department and |
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the local mental retardation authority must provide information |
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regarding the process. |
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(f) The department shall contract with local mental |
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retardation authorities to implement the community living options |
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information process for residents of institutions who are at least |
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22 years of age. The local mental retardation authorities shall |
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provide and implement the process for institutions under Subsection |
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(a)(1)(A) as provided by Section 531.02443. |
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(g) A contract with a local mental retardation authority to |
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implement the community living options information process for an |
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institution other than an institution under Subsection (a)(1)(A) |
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must: |
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(1) delegate to the local mental retardation authority |
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the department's duties under this section with regard to the |
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implementation of the process at the institution; |
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(2) include performance measures designed to assist |
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the department in evaluating the effectiveness of the local mental |
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retardation authority in implementing the community living options |
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information process; and |
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(3) ensure that the local mental retardation authority |
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provides service coordination and relocation services to a resident |
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who is at least 22 years of age and who chooses, is eligible for, and |
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is recommended by an interdisciplinary team for a community living |
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option to facilitate a timely, appropriate, and successful |
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transition from the institution to the community living program. |
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(h) Each year the department shall: |
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(1) review and make necessary updates to materials |
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used during the community living options information process; and |
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(2) provide training regarding the community living |
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options information process to staff members involved with the |
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process at each institution and each local mental retardation |
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authority. |
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SECTION 3. Section 531.02443, Government Code, is amended |
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by amending Subsection (d) and adding Subsection (g) to read as |
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follows: |
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(d) The contract with the local mental retardation |
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authority must: |
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(1) delegate to the local mental retardation authority |
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the department's duties under Section 531.02442 with regard to the |
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implementation of the community living options information process |
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at a state school; |
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(2) include performance measures designed to assist |
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the department in evaluating the effectiveness of a local mental |
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retardation authority in implementing the community living options |
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information process; [and] |
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(3) ensure that the local mental retardation authority |
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provides service coordination and relocation services to an adult |
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resident who chooses, is eligible for, and is recommended by the |
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interdisciplinary team for a community living option to facilitate |
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a timely, appropriate, and successful transition from the state |
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school to the community living option; and |
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(4) require the local mental retardation authority, in |
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coordination with the department and within existing resources, to |
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coordinate tours and visits to community living options for an |
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adult resident or an adult resident's legally authorized |
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representative, as appropriate based on the resident's behavioral |
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needs. |
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(g) The department, in coordination with local mental |
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retardation authorities that perform duties required by the |
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community living options information process under Section |
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531.02442 or this section, shall annually submit a report to the |
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commission and the interagency task force on ensuring appropriate |
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care settings for persons with disabilities regarding the outcomes |
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of the community living options information process as performed by |
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the local mental retardation authority. A report required by this |
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section must include: |
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(1) the number of individuals in a state school who |
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indicated a desire to pursue an alternative community living option |
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and the status of the individual's transition to the community; |
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(2) the number of times the local mental retardation |
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authority performed duties under Section 531.02442 or this section |
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for individuals and the number of individuals for whom the |
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authority performed this function; |
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(3) the number of individuals transitioned to an |
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alternative community living option after the local mental |
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retardation authority performed the community living options |
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information process for the individual; |
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(4) the responses to satisfaction survey questions; |
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and |
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(5) any other relevant information as determined by |
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the department. |
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SECTION 4. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02446 to read as follows: |
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Sec. 531.02446. DIVERSION PROTOCOLS TO PREVENT COMMITMENT |
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TO CERTAIN INSTITUTIONS. (a) The executive commissioner by rule |
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shall develop protocols to divert adults and children with mental |
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retardation at imminent risk of commitment to a state school from |
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commitment to a state school. |
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(b) The executive commissioner shall ensure that the |
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diversion protocols are designed to: |
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(1) reduce the commitment to state schools of |
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individuals younger than 22 years of age; and |
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(2) provide options to adults and children with mental |
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retardation at imminent risk of commitment to a state school to |
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ensure that they have access to the least restrictive living |
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environment appropriate for the person. |
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(c) The department shall develop the diversion protocols |
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with the advice and assistance of the interagency task force on |
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ensuring appropriate care settings for persons with disabilities |
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and representatives of family members or legally authorized |
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representatives of adult residents of state schools, persons with |
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mental retardation, state schools, and local mental retardation |
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authorities. |
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(d) As part of the diversion protocols, the executive |
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commissioner may contract with an organization for the provision of |
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temporary, emergency living arrangements for children at imminent |
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risk of commitment to a state school. |
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(e) An entity awarded a contract under this section must |
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provide temporary, emergency living arrangements at homes, with no |
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more than six children placed in the home. |
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SECTION 5. Subdivision (2), Section 252.002, Health and |
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Safety Code, is amended to read as follows: |
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(2) "Department" means the [Texas] Department of Aging |
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and Disability [Human] Services. |
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SECTION 6. Subchapter B, Chapter 533, Health and Safety |
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Code, is amended by adding Section 533.03551 to read as follows: |
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Sec. 533.03551. CASE MANAGEMENT BY LOCAL MENTAL RETARDATION |
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AUTHORITIES. (a) The executive commissioner shall designate |
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local mental retardation authorities for the purpose of performing |
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case management functions for certain Section 1915(c) waiver |
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programs, including the home and community-based services waiver |
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program and the Texas home living waiver services waiver program. |
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(b) The executive commissioner shall ensure that a local |
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mental retardation authority performing case management functions |
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for a Section 1915(c) waiver program has an organizational |
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structure that separates local mental retardation authority |
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functions from any service provider functions under the applicable |
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Section 1915(c) waiver programs. |
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(c) The executive commissioner, with the advice and |
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assistance of a work group composed of representatives appointed by |
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the executive commissioner from private and public service |
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providers under the Section 1915(c) waiver programs, advocates for |
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individuals with mental retardation, families of individuals with |
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mental retardation, consumers, and other interested stakeholders, |
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shall develop rules to implement this section. The rules must: |
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(1) clearly delineate the roles and responsibilities |
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of the Department of Aging and Disability Services, a local mental |
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retardation authority, and a service provider under this section |
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and include criteria specifying when a service provider is required |
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to receive approval from a local mental retardation authority |
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before changing an individual plan of care; |
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(2) require a local mental retardation authority, in |
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conducting case management functions for a Section 1915(c) waiver |
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program to: |
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(A) perform consumer screening and assessment; |
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(B) enroll consumers in the home and |
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community-based waiver services or Texas home living waiver |
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services and, as applicable, other Medicaid waiver-related |
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services, in a manner that ensures consumer choice; |
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(C) develop an initial plan of care for a |
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consumer, approve an annual plan of care for a consumer, conduct |
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quarterly reviews of a plan of care for a consumer, and approve |
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changes to a plan of care for a consumer; |
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(D) manage consumer transfers between service |
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providers to ensure consumer choice; |
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(E) facilitate communication of complaints to |
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the appropriate person; |
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(F) at least quarterly, meet with consumers in |
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person; and |
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(G) ensure consumer access to a crisis response |
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system; |
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(3) require a service provider to: |
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(A) implement and manage the plan of care for a |
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consumer for whom the service provider provides services; |
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(B) ensure that services provided to a consumer |
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are provided in accordance with the consumer's approved plan of |
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care; |
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(C) respond to the consumer's or the consumer's |
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family's needs and to crisis situations involving the consumer or |
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the consumer's family; and |
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(D) communicate the need for changes to a |
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consumer's plan of care and coordinate those changes; and |
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(4) require the Department of Aging and Disability |
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Services to: |
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(A) enroll service providers for Section 1915(c) |
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waiver programs, including the home and community-based services |
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waiver program or the Texas home living waiver services waiver |
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program; |
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(B) manage service provider contracts related to |
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Section 1915(c) waiver programs; |
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(C) conduct surveys and certification reviews; |
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(D) perform utilization review, including |
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consumer screening and assessment and final individual plan of care |
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authorizations; |
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(E) conduct other relevant administrative and |
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regulatory functions; |
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(F) ensure the case management functions of a |
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local mental retardation authority are conducted consistently |
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across this state and that a local mental retardation authority's |
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interface with service providers is efficient and effective; |
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(G) establish a protocol for providing consumers |
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with information about service and support options and choice of |
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service providers; and |
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(H) ensure that consumer needs are met in the |
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most efficient and effective manner possible by requiring use of a |
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person-directed planning process to develop an individually |
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tailored plan of care that includes services and supports chosen by |
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and directed by each consumer to the maximum extent possible with |
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periodic review of a consumer's progress toward desired outcomes. |
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SECTION 7. Subsections (a) and (b), Section 593.013, Health |
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and Safety Code, are amended to read as follows: |
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(a) A person may not be admitted or committed to a |
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residential care facility unless an interdisciplinary team from a |
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local mental retardation authority serving the county in which the |
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application was filed recommends that placement. |
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(b) The [An] interdisciplinary team shall: |
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(1) interview the person with mental retardation, the |
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person's parent if the person is a minor, and the person's guardian; |
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(2) review the person's: |
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(A) social and medical history; |
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(B) medical assessment, which must [shall] |
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include an audiological, neurological, and vision screening; |
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(C) psychological and social assessment; and |
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(D) determination of adaptive behavior level; |
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(3) determine the person's need for additional |
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assessments, including educational and vocational assessments; |
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(4) obtain any additional assessment necessary to plan |
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services; |
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(5) identify the person's habilitation and service |
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preferences and needs; and |
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(6) recommend services to address the person's needs |
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that consider the person's preferences. |
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SECTION 8. Subchapter B, Chapter 593, Health and Safety |
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Code, is amended by adding Section 593.0251 to read as follows: |
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Sec. 593.0251. POLICY REGARDING SERVICES IN STATE SCHOOL. |
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It is the policy of this state that a person residing in a |
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residential care facility operated by the Department of Aging and |
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Disability Services that is a state school has the right to continue |
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receiving services in a facility if: |
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(1) the person or, if appropriate, the person's |
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legally authorized representative, indicates a preference for the |
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person continuing to receive services in the facility; and |
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(2) the facility is not required to transfer, furlough |
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to an alternative placement, or discharge the person under Section |
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594.011. |
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SECTION 9. Subchapter B, Chapter 161, Human Resources Code, |
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is amended by adding Section 161.033 to read as follows: |
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Sec. 161.033. STATE SCHOOL REQUIREMENTS FOR LONG-RANGE PLAN |
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AND STATEWIDE CENSUS. (a) In this section, "alleged offender |
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resident" means a resident who: |
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(1) was committed to or transferred to a state school |
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under Chapter 46B or 46C, Code of Criminal Procedure, as a result of |
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being charged with or convicted of a criminal offense; or |
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(2) is a child committed to or transferred to a state |
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school under Chapter 55, Family Code, as a result of being alleged |
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by petition or having been found to have engaged in delinquent |
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conduct constituting a criminal offense. |
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(b) In developing the long-range plan required by Section |
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533.032, Health and Safety Code, the department shall: |
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(1) include strategies for downsizing state schools |
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and transitioning more state school residents to community-based |
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care; |
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(2) describe initiatives for achieving cost |
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efficiencies relating to the strategies required by Subdivision |
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(1); and |
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(3) estimate the fiscal impact of each strategy and |
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initiative, including the impact on department funding and the |
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number of full-time equivalent department employees and the cost |
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implications to other health and human services agencies. |
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(c) Through census management, not closure, the department |
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may reduce the number of state school residents, excluding alleged |
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offender residents, to not more than a total of 3,000 residents, |
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with not more than 350 residents residing at each state school. |
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This section does not require the department to remove a state |
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school resident from a state school against the resident's will or |
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against the will of the resident's legally authorized guardian for |
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the purpose of meeting capacity limits specified by this section. |
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This section does not authorize the department to deny admission to |
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a state school on the basis that the admission would cause the state |
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school to exceed the capacity limits specified by this section. |
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SECTION 10. (a) In implementing Section 533.03551, Health |
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and Safety Code, as added by this Act, the Department of Aging and |
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Disability Services shall: |
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(1) conduct a review of the existing processes and |
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documentation requirements of the home and community-based |
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services waiver program and eliminate complexities or requirements |
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that do not add value or quality to the program; |
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(2) consider information and data from previous and |
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existing projects or programs related to the provision of services |
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through the home and community-based services waiver program or |
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other Section 1915(c) waiver programs designed to achieve |
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efficiencies and improved access to care; and |
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(3) oversee the development and implementation of the |
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new service delivery design to ensure that appropriate state action |
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is taken to identify and resolve barriers to service delivery |
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through that design. |
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(b) The Health and Human Services Commission shall evaluate |
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the reimbursement rates of local mental retardation authorities and |
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service providers for the cost of conducting case management and |
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other functions, as applicable, in accordance with Section |
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533.03551, Health and Safety Code, as added by this Act. |
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(c) The executive commissioner of the Health and Human |
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Services Commission shall: |
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(1) evaluate the consumer benefit and |
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cost-effectiveness of providing case management in the manner |
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provided by Section 533.03551, Health and Safety Code, as added by |
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this Act; and |
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(2) not later than December 1, 2010, submit a report to |
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the lieutenant governor, the speaker of the house of |
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representatives, the Senate Committee on Finance, and the House |
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Appropriations Committee regarding the status of the project during |
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the development and implementation phases of Section 533.03551, |
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Health and Safety Code, as added by this Act. |
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SECTION 11. (a) The Health and Human Services Commission |
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and the Department of Aging and Disability Services shall jointly |
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design a plan to implement a long-term services and supports |
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capitated or noncapitated pilot program to serve individuals with |
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intellectual or developmental disabilities. |
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(b) The Department of Aging and Disability Services may |
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contract with a person to conduct a study and make recommendations |
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regarding the design and implementation of the long-term services |
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and supports capitated or noncapitated pilot program and shall |
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include meaningful input regarding the plan from individuals with |
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intellectual or developmental disabilities who receive services |
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from the department, the families of those individuals, service |
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providers, local mental retardation authorities, entities that |
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advocate for those individuals, and other interested parties. |
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(c) The plan designed under this section must examine |
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managed care models employed by other states for individuals with |
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intellectual or developmental disabilities in determining the most |
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appropriate manner to implement the pilot program. |
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(d) Not later than December 1, 2010, the Health and Human |
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Services Commission and the Department of Aging and Disability |
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Services shall submit a report regarding the plan to the standing |
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committees of the house of representatives and senate having |
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primary jurisdiction over the Medicaid program. The report must |
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include: |
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(1) recommendations for the implementation of the |
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pilot program, including: |
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(A) the area or areas in this state in which the |
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program should be implemented; |
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(B) options for consolidating waiver services; |
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(C) the costs and methods of financing; |
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(D) utilization review; |
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(E) provider network; |
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(F) eligibility criteria; |
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(G) service coordination; |
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(H) quality management; |
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(I) waiver development and federal requirements; |
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and |
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(J) any other relevant issues as determined by |
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the commission or the department; and |
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(2) a consumer-impact analysis that includes a review |
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of the impact of managed care on individuals receiving services. |
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SECTION 12. (a) The Health and Human Services Commission |
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and the Department of Aging and Disability Services shall jointly |
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conduct a study, with meaningful stakeholder input, regarding the |
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effectiveness of the requirements for admission and commitment to a |
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residential care facility provided by Chapter 593, Health and |
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Safety Code, as amended by this Act, and department rules. |
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(b) In conducting the study, the Health and Human Services |
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Commission and the Department of Aging and Disability Services |
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shall consider whether: |
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(1) existing processes ensure that proposed and |
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existing residents of a residential care facility receive supports |
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and services in the least restrictive alternative for the person, |
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including alternatives that become available or are developed after |
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the person is a resident; |
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(2) standards of evidence as required by law are |
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appropriate to support commitment to a residential care facility, |
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including making a determination regarding an operational |
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definition of that evidence; |
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(3) orders for long-term placement in a residential |
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care facility should be reviewed on an ongoing basis; and |
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(4) a process for renewing commitment orders should be |
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required by statute. |
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(c) Not later than November 1, 2010, the Health and Human |
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Services Commission and the Department of Aging and Disability |
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Services shall provide a joint written report to the legislature |
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and the Sunset Advisory Commission regarding the study, including |
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any recommendations for legislation to address proposed changes to |
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the requirements for admission or commitment to a residential care |
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facility. |
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(d) As part of its review of the Department of Aging and |
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Disability Services for the 82nd Legislature, the Sunset Advisory |
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Commission shall consider the report submitted to the commission in |
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accordance with this section. |
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SECTION 13. (a) Not later than January 1, 2010, the |
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executive commissioner of the Health and Human Services Commission |
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shall develop and implement the diversion protocols required under |
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Section 531.02446, Government Code, as added by this Act. |
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(b) Not later than September 1, 2009, the executive |
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commissioner of the Health and Human Services Commission shall |
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appoint the work group as required by Section 533.03551, Health and |
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Safety Code, as added by this Act. |
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(c) Not later than July 1, 2010, the executive commissioner |
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of the Health and Human Services Commission shall ensure that the |
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transfer of case management services is completed as provided by |
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Section 533.03551, Health and Safety Code, as added by this Act. |
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SECTION 14. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission shall apply for and actively pursue a waiver or |
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an amendment to this state's waiver under Section 1915(c) of the |
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federal Social Security Act (42 U.S.C. Section 1396n(c)) or other |
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authorization from the federal Centers for Medicare and Medicaid |
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Services or any other federal agency authorizing the provision of |
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home and community-based services at licensed group homes that |
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choose to participate and in which five or six individuals with |
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mental retardation reside and receive those services. |
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SECTION 15. This Act does not make an appropriation. This |
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Act takes effect only if a specific appropriation for |
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implementation of this Act is provided in a general appropriations |
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act of the 81st Legislature. |
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SECTION 16. This Act takes effect September 1, 2009. |
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* * * * * |