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A BILL TO BE ENTITLED
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AN ACT
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relating to streamlining of and utilization management in Medicaid |
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long-term care waiver programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 161.077, Human Resources Code, as added |
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by Chapter 759 (S.B. 705), Acts of the 81st Legislature, Regular |
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Session, 2009, is redesignated as Section 161.081, Human Resources |
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Code, and amended to read as follows: |
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Sec. 161.081 [161.077]. LONG-TERM CARE MEDICAID WAIVER |
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PROGRAMS: STREAMLINING AND UNIFORMITY. (a) In this section, |
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"Section 1915(c) waiver program" has the meaning assigned by |
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Section 531.001, Government Code. |
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(b) The department, in consultation with the commission, |
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shall streamline the administration of and delivery of services |
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through Section 1915(c) waiver programs. In implementing this |
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subsection, the department, subject to Subsection (c), may consider |
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implementing the following streamlining initiatives: |
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(1) reducing the number of forms used in administering |
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the programs; |
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(2) revising program provider manuals and training |
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curricula; |
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(3) consolidating service authorization systems; |
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(4) eliminating any physician signature requirements |
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the department considers unnecessary; |
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(5) standardizing individual service plan processes |
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across the programs; [and] |
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(6) if feasible: |
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(A) concurrently conducting program |
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certification and billing audit and review processes and other |
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related audit and review processes; |
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(B) streamlining other billing and auditing |
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requirements; |
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(C) eliminating duplicative responsibilities |
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with respect to the coordination and oversight of individual care |
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plans for persons receiving waiver services; and |
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(D) streamlining cost reports and other cost |
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reporting processes; and |
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(7) any other initiatives that will increase |
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efficiencies in the programs. |
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(c) The department shall ensure that actions taken under |
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Subsection (b) [this section] do not conflict with any requirements |
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of the commission under Section 531.0218, Government Code. |
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(d) The department and the commission shall jointly explore |
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the development of uniform licensing and contracting standards that |
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would: |
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(1) apply to all contracts for the delivery of Section |
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1915(c) waiver program services; |
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(2) promote competition among providers of those |
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program services; and |
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(3) integrate with other department and commission |
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efforts to streamline and unify the administration and delivery of |
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the program services, including those required by this section or |
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Section 531.0218, Government Code. |
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SECTION 2. Subchapter D, Chapter 161, Human Resources Code, |
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is amended by adding Section 161.082 to read as follows: |
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Sec. 161.082. LONG-TERM CARE MEDICAID WAIVER PROGRAMS: |
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UTILIZATION REVIEW. (a) In this section, "Section 1915(c) waiver |
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program" has the meaning assigned by Section 531.001, Government |
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Code. |
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(b) The department shall perform utilization review of |
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services in all Section 1915(c) waiver programs. The utilization |
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review must include reviewing program recipients' levels of care |
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and any plans of care for those recipients that exceed service level |
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thresholds established in the applicable waiver program |
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guidelines. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect September 1, 2011. |