82R1323 KFF-D

By: Nelson S.B. No. 222

A BILL TO BE ENTITLED

AN ACT

relating to access to certain long-term care services and supports under the medical assistance program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.02181 to read as follows:

Sec. 531.02181. PROVISION AND COORDINATION OF ATTENDANT CARE SERVICES. (a) The commission shall ensure that recipients who are eligible to receive attendant care services under a Section 1915(c) waiver program are first provided those services, if available, under a Medicaid state plan program, including the primary home care, community attendant services, and personal care services programs. The commission may allow a recipient to receive attendant care services under a waiver program only if:

(1) the recipient requires services beyond those that are available under a Medicaid state plan program; or

(2) the services are not otherwise provided under a Medicaid state plan program.

(b) The executive commissioner shall adopt rules and procedures necessary to implement this section, including rules and procedures for:

(1) the coordination of services between Medicaid state plan programs and Section 1915(c) waiver programs to ensure that recipients' needs are being met and to prevent duplication of services;

(2) an automated authorization system through which case managers authorize the provision of attendant care services through the appropriate Medicaid state plan program or Section 1915(c) waiver program and register the number of hours authorized through each program;

(3) billing procedures for attendant care services provided through each Medicaid state plan program or Section 1915(c) waiver program; and

(4) determinations by case managers and service providers regarding whether provided services are personal care services or habilitation/supported home living services, if that determination is necessary.

SECTION 2. Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.0515 to read as follows:

Sec. 531.0515. RISK MANAGEMENT CRITERIA FOR CERTAIN WAIVER PROGRAMS. (a) In this section, "legally authorized representative" has the meaning assigned by Section 531.051.

(b) The commission shall consider developing risk management criteria under home and community-based services waiver programs designed to allow individuals eligible to receive services under the programs to assume greater choice and responsibility over the services and supports the individuals receive.

(c) The commission shall ensure that any risk management criteria developed under this section include:

(1) a requirement that if an individual to whom services and supports are to be provided has a legally authorized representative, the representative be involved in determining which services and supports the individual will receive; and

(2) a requirement that if services or supports are declined, the decision to decline is clearly documented.

SECTION 3. Section 533.0355, Health and Safety Code, is amended by adding Subsection (h) to read as follows:

(h) The Department of Aging and Disability Services shall ensure that local mental retardation authorities are informing and counseling individuals and their legally authorized representatives, if applicable, about all program and service options for which the individuals are eligible in accordance with Section 533.038(d), including options such as the availability and types of temporary ICF-MR placements for which an individual may be eligible while the individual is on a department interest list or other waiting list for other services.

SECTION 4. Subchapter D, Chapter 161, Human Resources Code, is amended by adding Sections 161.084 and 161.085 to read as follows:

Sec. 161.084. ALTERNATIVE OPTIONS IN MEDICAID PUBLIC AWARENESS AND EDUCATION CAMPAIGN. (a) In this section, "Section 1915(c) waiver program" has the meaning assigned by Section 531.001, Government Code.

(b) The department in cooperation with the commission shall develop and implement a public awareness and education campaign designed to educate the public on the availability of:

(1) home and community-based services under Section 1915(c) waiver programs; and

(2) the various service delivery options available under the Medicaid program, including the consumer direction models available to recipients under Section 531.051, Government Code.

(c) The department may coordinate the implementation of the campaign under this section with any other related campaign or activity.

Sec. 161.085. INTEREST LIST REPORTING. The department shall post on the department's Internet website historical data, categorized by state fiscal year, on the percentages of individuals who elect to receive services under a program for which the department maintains an interest list once their names reach the top of the list.

SECTION 5. (a) In this section:

(1) "Long-term care services" has the meaning assigned by Section 22.0011, Human Resources Code.

(2) "Medical assistance program" means the medical assistance program administered under Chapter 32, Human Resources Code.

(3) "Nursing facility" means a convalescent or nursing home or related institution licensed under Chapter 242, Health and Safety Code.

(b) The Health and Human Services Commission in cooperation with the Department of Aging and Disability Services shall conduct a study of individuals who receive long-term care services in nursing facilities under the medical assistance program. The study must identify:

(1) the reasons medical assistance recipients of long-term care services are placed in nursing facilities as opposed to being provided long-term care services in home or community-based settings;

(2) the types of medical assistance services recipients residing in nursing facilities typically receive and where and from whom those services are typically provided;

(3) community-based services and supports available under a medical assistance waiver granted in accordance with Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)), for which recipients residing in nursing facilities would be eligible; and

(4) ways to expedite recipients' access to community-based services and supports identified under Subdivision (3) of this subsection for which interest lists or other waiting lists exist.

(c) Not later than September 1, 2012, the Health and Human Services Commission shall submit a written report containing the findings of the study conducted under Subsection (b) of this section together with the commission's recommendations to the governor, the Legislative Budget Board, the Senate Finance Committee, the Senate Health and Human Services Committee, the House Appropriations Committee, and the House Human Services Committee.

SECTION 6. The Health and Human Services Commission shall seek an amendment to the home and community-based services program waiver obtained in accordance with Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)) to allow for the provision of residential care and services under the waiver program by six-bed group home providers. The amendment sought under this section must allow for the conversion of three-bed and four-bed group home providers under the waiver program to six-bed group home providers.

SECTION 7. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 8. This Act takes effect September 1, 2011.