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A BILL TO BE ENTITLED
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AN ACT
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relating to objective assessment processes for and appropriate |
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provision of acute nursing services and certain other services |
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provided under the Medicaid 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 Sections 531.02417, 531.024171, and 531.024172 to |
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read as follows: |
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Sec. 531.02417. MEDICAID NURSING SERVICES ASSESSMENTS. |
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(a) In this section, "acute nursing services" means home health |
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skilled nursing services, home health aide services, and private |
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duty nursing services. |
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(b) The commission shall develop an objective assessment |
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process for use in assessing the needs of a Medicaid recipient for |
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acute nursing services. The commission shall require that: |
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(1) the assessment be conducted: |
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(A) by a state employee or contractor who is not |
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the person who will deliver any necessary services to the recipient |
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and is not affiliated with the person who will deliver those |
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services; and |
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(B) in a timely manner so as to protect the health |
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and safety of the recipient by avoiding unnecessary delays in |
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service delivery; and |
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(2) the process include: |
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(A) an assessment of specified criteria and |
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documentation of the assessment results on a standard form; |
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(B) an assessment of whether the recipient should |
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be referred for additional assessments regarding the recipient's |
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needs for therapy services, as defined by Section 531.024171, |
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attendant care services, and durable medical equipment; and |
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(C) completion by the person conducting the |
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assessment of any documents related to obtaining prior |
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authorization for necessary nursing services. |
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(c) The commission shall: |
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(1) implement the objective assessment process |
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developed under Subsection (b) within the Medicaid fee-for-service |
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model and the primary care case management Medicaid managed care |
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model; and |
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(2) take necessary actions, including modifying |
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contracts with managed care organizations under Chapter 533 to the |
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extent allowed by law, to implement the process within the STAR and |
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STAR+PLUS Medicaid managed care programs. |
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(d) The executive commissioner shall adopt rules providing |
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for a process by which a provider of acute nursing services who |
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disagrees with the results of the assessment conducted as provided |
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by Subsection (b) may request and obtain a review of those results. |
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Sec. 531.024171. THERAPY SERVICES ASSESSMENTS. (a) In |
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this section, "therapy services" includes occupational, physical, |
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and speech therapy services. |
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(b) After implementing the objective assessment process for |
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acute nursing services as required by Section 531.02417, the |
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commission shall consider whether implementing an objective |
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assessment process for assessing the needs of a Medicaid recipient |
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for therapy services that is comparable to the process required |
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under Section 531.02417 for acute nursing services would be |
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feasible and beneficial. |
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(c) If the commission determines that implementing a |
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comparable process with respect to one or more types of therapy |
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services is feasible and would be beneficial, the commission may |
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implement the process within: |
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(1) the Medicaid fee-for-service model; |
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(2) the primary care case management Medicaid managed |
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care model; and |
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(3) the STAR and STAR+PLUS Medicaid managed care |
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programs. |
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(d) An objective assessment process implemented under this |
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section must include a process that allows a provider of therapy |
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services to request and obtain a review of the results of an |
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assessment conducted as provided by this section that is comparable |
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to the process implemented under rules adopted under Section |
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531.02417(d). |
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Sec. 531.024172. ELECTRONIC VISIT VERIFICATION SYSTEM. |
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(a) In this section, "acute nursing services" has the meaning |
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assigned by Section 531.02417. |
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(b) If it is cost-effective and feasible, the commission |
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shall implement an Electronic Visit Verification system to |
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electronically verify and document through a telephone or |
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computer-based system basic information relating to the delivery of |
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Medicaid acute nursing services, including: |
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(1) the provider's name; |
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(2) the recipient's name; and |
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(3) the date and time the provider begins and ends each |
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service delivery visit. |
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SECTION 2. Not later than September 1, 2012, the Health and |
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Human Services Commission shall implement the Electronic Visit |
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Verification system required by Section 531.024172, Government |
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Code, as added by this Act, if the commission determines that |
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implementation of that system is cost-effective and feasible. |
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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. |