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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 acute nursing |
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services and certain other services provided under the Medicaid |
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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 and 531.024171 to read as |
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follows: |
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Sec. 531.02417. MEDICAID NURSING SERVICES ASSESSMENTS. (a) |
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In this section, "acute nursing services" means home health skilled |
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nursing services, home health aide services, and private duty |
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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 by a state employee or |
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contractor who is not the person who will deliver any necessary |
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services to the recipient and is not affiliated with the person who |
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will deliver those services; 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; and |
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(B) 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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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 a comparable |
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process with respect to assessing the needs of a Medicaid recipient |
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for therapy services would be 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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SECTION 2. 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 3. This Act takes effect September 1, 2011. |