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A BILL TO BE ENTITLED
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AN ACT
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relating to establishing a participant-directed Medicaid waiver |
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pilot program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0511 to read as follows: |
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Sec. 531.0511. PARTICIPANT-DIRECTED MEDICAID WAIVER PILOT |
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PROGRAM. (a) The commission, in consultation with the consumer |
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direction work group created under Section 531.052, shall develop |
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and implement a pilot program that allows Medicaid recipients who |
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participate in any Section 1915(c) waiver program to have greater |
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choice, direction, and control over the Medicaid benefits they |
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receive than is available under the consumer direction models |
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offered under Section 531.051. The pilot program must: |
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(1) be operated in one rural area and one urban area of |
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the state; |
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(2) be operated for a period of at least four years; |
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(3) in addition to offering consumer-directed service |
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options, as defined by Section 531.051, allow a program participant |
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to: |
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(A) purchase participant-directed goods and |
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services that address the needs identified in the participant's |
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individual service plan using money that: |
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(i) is allocated to the participant through |
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an individual budget; and |
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(ii) represents amounts that would be spent |
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providing Medicaid services to the participant in the absence of |
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the pilot program; and |
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(B) employ, as the participant determines is |
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appropriate, a household member, including the participant's |
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spouse, to provide direct services to the participant under the |
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participant's individual service plan, provided the household |
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member is 18 years of age or older; |
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(4) make available to each program participant a |
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support advisor for purposes of: |
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(A) verifying the participant's allocated |
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budget; |
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(B) assisting the participant in developing the |
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participant's individual service plan based on the participant's |
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allocated budget; and |
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(C) coordinating the service and support |
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providers and goods selected by the participant as part of the |
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participant's individual service plan; and |
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(5) employ strategies designed to achieve the |
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following goals: |
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(A) improving the health outcomes of program |
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participants; |
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(B) improving program participant access to |
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services; |
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(C) achieving cost containment and efficiency; |
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and |
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(D) reducing the administrative complexity of |
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delivering benefits under the Medicaid program. |
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(b) Not later than September 1, 2016, the commission shall |
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submit to the legislature a report regarding the results of the |
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pilot program. The report must include: |
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(1) a summary of the strategies employed to achieve |
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the program goals described by Subsection (a)(5); |
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(2) an analysis of data collected during the operation |
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of the program and the capability of the data to measure achievement |
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of the program goals; |
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(3) a recommendation regarding the continued |
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operation of the program; and |
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(4) a recommendation regarding whether the program |
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should be implemented statewide. |
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(c) This section expires September 1, 2017. |
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SECTION 2. The Health and Human Services Commission shall |
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apply for and actively pursue a waiver or other authorization to the |
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state Medicaid plan from the federal Centers for Medicare and |
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Medicaid Services or any other federal agency as necessary to |
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implement the participant-directed Medicaid waiver pilot program |
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under Section 531.0511, Government Code, as added by this Act, and |
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may delay implementing that provision until the waiver or other |
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authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2011. |