BILL ANALYSIS

C.S.H.B. 329

By: Guillen

Human Services

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Currently, there are a variety of programs in Texas designed to help the elderly and those with disabilities. Interested parties have commented that navigating the available services and learning how to access those services can be confusing and time-consuming. Because information about long-term care services is available through a variety of sources, a person may have to obtain information from several different agencies to determine eligibility and enroll for various services. C.S.H.B. 329 seeks to authorize a pilot project to institute a comprehensive, single-point-of-entry system to simplify and expedite the process of accessing long-term care services.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 329 amends the Government Code to add a temporary provision, set to expire September 1, 2015, to require the Health and Human Services Commission (HHSC), subject to availability of funds appropriated by the legislature for such a purpose, to develop and implement a pilot project to establish a comprehensive access point system for long-term services and supports in which colocated long-term services and supports staff members work in collaboration to provide all necessary services in connection with long-term services and supports from the intake process to the start of service delivery.  The bill requires the pilot project to require that, at a minimum, the staff members work collaboratively to inform and educate older persons, persons with physical disabilities, and their family members and other caregivers about long-term services and supports for which they may qualify; screen older persons and persons with physical disabilities requesting long-term services and supports; provide a tentative assessment of functional and financial eligibility for older persons and persons with physical disabilities requesting long-term services and supports for which there are no interest lists; and make final determinations of eligibility for long-term services and supports.

C.S.H.B. 329 requires HHSC, in developing and implementing the pilot project, to ensure that the pilot project site has colocated long-term services and supports staff members who are located in the same physical office, the pilot project site serves as a comprehensive access point for older persons and persons with physical disabilities to obtain information about long-term services and supports for which they may qualify and access long-term services and supports in the site's service area, and the pilot project site is designed and operated in accordance with best practices adopted by the executive commissioner of HHSC after HHSC reviews best practices for similar initiatives in other states and professional policy-based research describing best practices for successful initiatives. 

C.S.H.B. 329 requires HHSC to ensure that the colocated long-term services and supports staff members supporting the pilot project site include one full-time HHSC staff member who determines eligibility for the Medicaid program and who has full access to the Texas Integrated Eligibility Redesign System (TIERS), has previously made Medicaid long-term care eligibility determinations, and is dedicated primarily to making eligibility determinations for incoming clients at the site. The bill requires HHSC to ensure that colocated long-term services and supports staff members of a project site include sufficient Department of Aging and Disability Services staff members to carry out the tentative functional and financial eligibility and screening functions at the site; sufficient area agency on aging staff members to assist with the performance of screening functions and service coordination for services under the federal Older Americans Act of 1965, such as meals programs, and identify other locally funded and supported services that will enable older persons and persons with physical disabilities to continue to reside in the community to the extent reasonable; and any available staff members from local service agencies. The bill requires HHSC to ensure that the colocated long-term services and supports staff members of a pilot project site process intakes for long-term services and supports in person or by telephone or through the Internet; use a standardized screening tool to tentatively assess both functional and financial eligibility with the goal of initiating services within seven business days; closely coordinate with local hospital discharge planners and staff members of extended rehabilitation units of local hospitals and nursing homes; and inform persons about community-based services available in the area served by the pilot project.

C.S.H.B. 329 requires the pilot project to be implemented in a single county or a multicounty area, as determined by HHSC.  The bill requires the pilot project site to be located within an aging and disability resource center service area and authorizes the pilot program site to be located at another appropriate location if HHSC finds there is no aging and disability resource center willing or able to accommodate a pilot project site on the date the pilot project is to be implemented.

C.S.H.B. 329 requires HHSC, not later than January 31, 2013, to submit a report concerning the pilot project to the presiding officers of the standing committees of the senate and house of representatives having primary jurisdiction over health and human services.  The bill requires the report to contain an evaluation of the operation of the pilot project; to contain an evaluation of the pilot project's benefits for persons who received services; to contain a calculation of the costs and cost savings that can be attributed to implementation of the pilot project; to include a recommendation regarding adopting improved policies and procedures concerning long-term services and supports with statewide applicability, as determined from information obtained in operating the pilot project; to include a recommendation regarding the feasibility of expanding the pilot project to other areas of Texas or statewide; and to contain the perspectives of service providers participating in the pilot project.

C.S.H.B. 329 requires HHSC, not later than December 31, 2011, to ensure that the pilot project site is in operation under the pilot project.  The bill requires a state agency that is affected by a provision of the bill to request a federal waiver or authorization if the agency determines that a waiver or authorization is necessary for the implementation of the provision, and it authorizes the agency to delay implementation until the federal waiver or authorization is obtained.

C.S.H.B. 329 defines "aging and disability resource center," "colocated long-term services and supports staff members," "Department of Aging and Disability Services staff members," "long-term services and supports," "long-term services and supports staff," "pilot project site," and "tentative assessment of functional and financial eligibility."

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2011.

COMPARISON OF ORIGINAL AND SUBSTITUTE

C.S.H.B. 329 differs from the original by including community services staff members of the Department of Aging and Disability Services (DADS) in the definition of "Department of Aging and Disability Services staff members," whereas the original includes the access and intake staff members and the community care for the aged and disabled staff members of DADS in that definition.  The substitute omits a provision in the original defining "expedited service authorization."  The substitute omits a provision in the original including assistance or care provided through the program of all-inclusive care for the elderly (PACE), if the program is available in the area served by the pilot project, in the definition of "long-term services and supports."  The substitute differs from the original by defining "pilot project site" as a location in an area served by the pilot project where colocated long-term services and supports staff members work collaboratively to provide information and tentatively assess functional and financial eligibility to initiate long-term services and supports, whereas in the original such colocated long-term services and supports staff members work collaboratively to provide information and authorize and initiate long-term services and supports.  The bill contains a provision not in the original defining "tentative assessment of functional and financial eligibility" and omits a provision included in the original defining "tentative eligibility."

C.S.H.B. 329 contains a provision not in the original making the requirement for the Health and Human Services Commission (HHSC) to develop and implement the pilot program subject to the availability of funds appropriated by the legislature for such a purpose.  The substitute differs from the original by requiring HHSC to develop and implement a pilot project, whereas the original requires HHSC to develop and implement a pilot project in not more than three geographic areas of Texas.  The substitute differs from the original by requiring staff members of the pilot project to work collaboratively to provide a tentative assessment of functional and financial eligibility for older persons and persons with physical disabilities requesting long-term services and supports for which there are no interest lists, whereas the original requires staff members of the pilot project to work collaboratively to establish tentative eligibility for long-term services and supports and to support and provide expedited service authorization for such persons requesting long-term services and supports for which there are no interest lists.  The substitute differs from the original by requiring staff members of the pilot project to work collaboratively to make a final determination of eligibility for long-term services and supports, whereas the original requires staff members to work collaboratively to make final determinations of financial eligibility for long-term services and supports after a period of tentative eligibility for receipt of those services. The substitute differs from the original by requiring the colocated long-term services and supports staff members supporting the pilot project site to include one full-time HHSC staff member who determines eligibility for the Medicaid program and who has full access to the Texas Integrated Eligibility Redesign System (TIERS), whereas the original requires one or more such full-time HHSC staff members who have full access to TIERS or the System of Application, Verification, Eligibility, Referral, and Reporting (SAVERR).   

C.S.H.B. 329 differs from the original by specifying that the standardized screening tool used by colocated long-term services and supports staff members that assesses both functional and financial program eligibility assess such eligibility with the goal of initiating services within seven business days, whereas the original requires the tool to provide sufficient information to make a tentative eligibility determination for receipt of services. The substitute differs from the original by requiring such staff members to process intakes for long-term services and supports, whereas the original requires such staff to process requests.  The substitute omits provisions in the original requiring such staff members to perform all screening and assessment, eligibility determination, and service authorization functions necessary to promptly initiate appropriate service delivery and to give first priority to persons who urgently need services. 

C.S.H.B. 329 differs from the original by requiring the pilot project to be implemented in a single county or a multicounty area and located within an aging and disability resource center service area, whereas the original authorizes an area in which the pilot program will be implemented to consist of a single county or multicounty region and requires at least one of the areas to have a pilot project site located within an aging and disability resource center. The substitute omits a provision in the original authorizing HHSC to locate a pilot project site at a local DADS office or an area agency on aging office under certain conditions.

C.S.H.B. 329 omits a provision in the original requiring the report concerning the pilot project required to be presented to the presiding officers of the standing committees of the senate and house of representatives having primary jurisdiction over health and human services to be prepared by a person not associated with the pilot project or HHSC.  The substitute differs from the original by requiring that report to contain the perspectives of service providers participating in the pilot project, whereas the original requires the report to contain the perspectives of certain specified service providers who are operating in the area served by a pilot project site. 

C.S.H.B. 329 differs from the original in conforming ways and by making a technical correction.