SB 7, Sen 2nd Rdg, Amnd #F1

(1) In SECTION 1.01 of the bill, between added Sections 534.001(3) and (4), Government Code (page 1, between lines 44 and 45), insert the following subdivision and renumber subsequent subdivisions of the section accordingly:

(4) "Functional need" means the measurement of an individual's services and supports needs, including the individual's intellectual, psychiatric, medical, and physical support needs.

(2) In SECTION 1.01 of the bill, strike added Section 534.001(7), Government Code (page 2, lines 4 through 6), and substitute the following:

(7) "Local intellectual and developmental disability authority" means an authority defined by Section 531.002(11), Health and Safety Code.

(3) In SECTION 1.01 of the bill, in added Section 534.051(3), Government Code (page 2, line 47), between "supports" and the underlined semicolon, insert ", including the assessment of individuals' functional needs".

(4) In SECTION 1.01 of the bill, in added Section 534.051(9), Government Code (page 2, line 60), strike "and".

(5) In SECTION 1.01 of the bill, in added Section 534.051(10), Government Code (page 2, line 62), between "services" and the underlined period, insert the following:

(11) promote independent service coordination and independent ombudsmen services; and

(12) ensure that individuals with the most significant needs are appropriately served in the community and that processes are in place to prevent inappropriate institutionalization of individuals

(6) In SECTION 1.01 of the bill, in added Section 534.053(a)(1), Government Code (page 3, line 12), between "recipients" and the underlined semicolon, insert ", including at least three representatives from intellectual and developmental disability advocacy organizations".

(7) In SECTION 1.01 of the bill, in added Section 534.053(a)(2), Government Code, on page 3, strike lines 13 and 14 and substitute the following:

(2) representatives of Medicaid managed care and non-managed care health care providers, including:

(8) In SECTION 1.01 of the bill, strike added Sections 534.053(a)(3)(A) through (E), Government Code (page 3, lines 24 through 33), and substitute the following:

(A) representatives of aging and disability resource centers established under the Aging and Disability Resource Center initiative funded in part by the federal Administration on Aging and the Centers for Medicare and Medicaid Services;

(B) representatives of community mental health and intellectual disability centers; and

(C) representatives of and service coordinators or case managers from private and public home and community-based services providers that serve individuals with intellectual and developmental disabilities; and

(9) In SECTION 1.01 of the bill, in added Section 534.054(a), Government Code (page 3, line 60), strike "December 1" and substitute "September 30".

(10) In SECTION 1.01 of the bill, between added Sections 534.106 and 534.107, Government Code (page 5, between lines 38 and 39), insert the following:

Sec. 534.1065. RECIPIENT PARTICIPATION IN PROGRAM VOLUNTARY. Participation in a pilot program established under this subchapter by an individual with an intellectual or developmental disability is voluntary, and the decision whether to participate in a program and receive long-term services and supports from a provider through that program may be made only by the individual or the individual's legally authorized representative.

(11) In SECTION 1.01 of the bill, strike added Section 534.152, Government Code (page 7, lines 18 through 25), and substitute the following:

Sec. 534.152. DELIVERY OF CERTAIN OTHER SERVICES UNDER STAR + PLUS AND STAR KIDS MEDICAID MANAGED CARE PROGRAMS. (a) The commission shall:

(1) implement the most cost-effective option for the delivery of basic attendant and habilitation services for individuals with intellectual and developmental disabilities under the STAR + PLUS and STAR Kids Medicaid managed care programs that maximizes federal funding for the delivery of services across those and other similar programs; and

(2) provide voluntary training to individuals receiving services under the STAR + PLUS and STAR Kids Medicaid managed care programs or their legally authorized representatives regarding how to select, manage, and dismiss personal attendants providing basic attendant and habilitation services under the programs.

(b) The commission shall require that each managed care organization that contracts with the commission for the provision of basic attendant and habilitation services under the STAR + PLUS or STAR Kids Medicaid managed care program in accordance with this section include in the organization's provider network for the provision of those services only:

(1) home and community support services agencies licensed under Chapter 142, Health and Safety Code, with which the commission has a contract to provide services under the community living assistance and support services (CLASS) waiver program; and

(2) persons exempted from licensing under Section 142.003(a)(19), Health and Safety Code, with which the commission has a contract to provide services under:

(A) the home and community-based services (HCS) waiver program; or

(B) the Texas home living (TxHmL) waiver program.

(c) The Department of Aging and Disability Services shall contract with local intellectual and developmental disability authorities to provide service coordination to individuals with intellectual and developmental disabilities under the STAR + PLUS and STAR Kids Medicaid managed care programs in accordance with this section. Local intellectual and developmental disability authorities providing service coordination under this section may not also provide attendant and habilitation services under this section.

(d) During the first three years basic attendant and habilitation services are provided to individuals with intellectual and developmental disabilities under the STAR + PLUS or STAR Kids Medicaid managed care program in accordance with this section, providers eligible to participate in the home and community-based services (HCS) waiver program, the Texas home living (TxHmL) waiver program, or the community living assistance and support services (CLASS) waiver program on September 1, 2013, are considered significant traditional providers.

(12) In SECTION 1.01 of the bill, in added Section 534.202(b), Government Code (page 8, line 11), strike "Subsection (c)(1)" and substitute "Subsections (c)(1) and (g)".

(13) In SECTION 1.01 of the bill, strike added Section 534.202(c)(1), Government Code (page 8, lines 14 through 17), and substitute the following:

(1) continue operation of the Medicaid waiver programs or Medicaid ICF-IID program only for purposes of providing, if applicable:

(A) supplemental long-term services and supports not available under the managed care program delivery model selected by the commission; or

(B) long-term services and supports to Medicaid waiver program recipients who choose to continue receiving benefits under the waiver program as provided by Subsection (g); or

(14) In SECTION 1.01 of the bill, in added Section 534.202(c)(2), Government Code (page 8, line 18), between "(2)" and "provide", insert "subject to Subsection (g),".

(15) In SECTION 1.01 of the bill, in added Section 534.202(c)(2), Government Code (page 8, line 19), between "available" and "under", insert "only".

(16) In SECTION 1.01 of the bill, immediately following added Section 534.202(f), Government Code (page 8, between lines 36 and 37), insert the following:

(g) If the commission determines that all or a portion of the long-term services and supports previously available only under the Medicaid waiver programs should be provided through a managed care program delivery model under Subsection (c)(2), the commission shall, at the time of the transition, allow each recipient receiving long-term services and supports under a Medicaid waiver program the option of:

(1) continuing to receive the services and supports under the Medicaid waiver program; or

(2) receiving the services and supports through the managed care program delivery model selected by the commission.

(h) A recipient who chooses to receive long-term services and supports through a managed care program delivery model under Subsection (g) may not, at a later time, choose to receive the services and supports under a Medicaid waiver program.

(17) In SECTION 1.03(1) of the bill (page 8, line 49), strike "December 1, 2014" and substitute "September 30, 2014".

(18) In SECTION 1.03(2) of the bill (page 8, line 51), strike "December 1, 2023" and substitute "September 30, 2023".

(19) In SECTION 1.06(a)(2) of the bill (page 9, line 13), strike "December 1" and substitute "September 30".

(20) In ARTICLE 1 of the bill, add the following appropriately numbered SECTIONS and renumber subsequent SECTIONS of the ARTICLE accordingly:

SECTION 1.__. Section 142.003(a), Health and Safety Code, is amended to read as follows:

(a) The following persons need not be licensed under this chapter:

(1) a physician, dentist, registered nurse, occupational therapist, or physical therapist licensed under the laws of this state who provides home health services to a client only as a part of and incidental to that person's private office practice;

(2) a registered nurse, licensed vocational nurse, physical therapist, occupational therapist, speech therapist, medical social worker, or any other health care professional as determined by the department who provides home health services as a sole practitioner;

(3) a registry that operates solely as a clearinghouse to put consumers in contact with persons who provide home health, hospice, or personal assistance services and that does not maintain official client records, direct client services, or compensate the person who is providing the service;

(4) an individual whose permanent residence is in the client's residence;

(5) an employee of a person licensed under this chapter who provides home health, hospice, or personal assistance services only as an employee of the license holder and who receives no benefit for providing the services, other than wages from the license holder;

(6) a home, nursing home, convalescent home, assisted living facility, special care facility, or other institution for individuals who are elderly or who have disabilities that provides home health or personal assistance services only to residents of the home or institution;

(7) a person who provides one health service through a contract with a person licensed under this chapter;

(8) a durable medical equipment supply company;

(9) a pharmacy or wholesale medical supply company that does not furnish services, other than supplies, to a person at the person's house;

(10) a hospital or other licensed health care facility that provides home health or personal assistance services only to inpatient residents of the hospital or facility;

(11) a person providing home health or personal assistance services to an injured employee under Title 5, Labor Code;

(12) a visiting nurse service that:

(A) is conducted by and for the adherents of a well-recognized church or religious denomination; and

(B) provides nursing services by a person exempt from licensing by Section 301.004, Occupations Code, because the person furnishes nursing care in which treatment is only by prayer or spiritual means;

(13) an individual hired and paid directly by the client or the client's family or legal guardian to provide home health or personal assistance services;

(14) a business, school, camp, or other organization that provides home health or personal assistance services, incidental to the organization's primary purpose, to individuals employed by or participating in programs offered by the business, school, or camp that enable the individual to participate fully in the business's, school's, or camp's programs;

(15) a person or organization providing sitter-companion services or chore or household services that do not involve personal care, health, or health-related services;

(16) a licensed health care facility that provides hospice services under a contract with a hospice;

(17) a person delivering residential acquired immune deficiency syndrome hospice care who is licensed and designated as a residential AIDS hospice under Chapter 248;

(18) the Texas Department of Criminal Justice;

(19) a person that provides home health, hospice, or personal assistance services only to persons receiving benefits under:

(A) the home and community-based services (HCS) waiver program;

(B) the Texas home living (TxHmL) waiver program; or

(C) Section 534.152, Government Code [enrolled in a program funded wholly or partly by the Texas Department of Mental Health and Mental Retardation and monitored by the Texas Department of Mental Health and Mental Retardation or its designated local authority in accordance with standards set by the Texas Department of Mental Health and Mental Retardation]; or

(20) an individual who provides home health or personal assistance services as the employee of a consumer or an entity or employee of an entity acting as a consumer's fiscal agent under Section 531.051, Government Code.

SECTION 1.__. (a) In this section, "health and human services agencies" has the meaning assigned by Section 531.001, Government Code.

(b) The Health and Human Services Commission and any other health and human services agency implementing a provision of this Act that affects individuals with intellectual and developmental disabilities shall consult with the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 534.053, Government Code, as added by this article, regarding implementation of the provision.

(21) In SECTION 2.01 of the bill, in amended Section 533.0025(a), Government Code (page 9, lines 24 and 25), strike "and 533.00253" and substitute "533.00253, and 533.00254".

(22) In the recital to SECTION 2.02 of the bill (page 9, line 62), strike "and 533.00253" and substitute "533.00253, and 533.00254".

(23) In SECTION 2.02 of the bill, in added Section 533.00253(a), Government Code (page 11, between lines 31 and 32), add the following appropriately numbered subdivision and renumber existing subdivisions accordingly:

( ) "Advisory committee" means the STAR Kids Managed Care Advisory Committee established under Section 533.00254.

(24) In SECTION 2.02 of the bill, in added Section 533.00253(b), Government Code (page 11, line 41), between "shall" and "establish", insert ", in consultation with the advisory committee and the Children's Policy Council established under Section 22.035, Human Resources Code,".

(25) In SECTION 2.02 of the bill, in added Section 533.00253(c), Government Code (page 12, lines 3 and 4), strike "or a portion".

(26) In SECTION 2.02 of the bill, immediately following added Section 533.00253(d), Government Code (page 12, between lines 12 and 13), insert the following:

(e) The commission shall seek ongoing input from the Children's Policy Council regarding the establishment and implementation of the STAR Kids managed care program.

Sec. 533.00254. STAR KIDS MANAGED CARE ADVISORY COMMITTEE. (a) The STAR Kids Managed Care Advisory Committee is established to advise the commission on the establishment and implementation of the STAR Kids managed care program under Section 533.00253.

(b) The executive commissioner shall appoint the members of the advisory committee. The committee must consist of:

(1) families whose children will receive private-duty nursing under the program;

(2) health care providers;

(3) providers of home and community-based services; and

(4) other stakeholders as the executive commissioner determines appropriate.

(d) A member of the advisory committee serves without compensation.

(e) The advisory committee is subject to the requirements of Chapter 551.

(f) On September 1, 2016:

(1) the advisory committee is abolished; and

(2) this section expires.

(27) In ARTICLE 2 of the bill, add the following appropriately numbered SECTIONS and renumber subsequent SECTIONS of the ARTICLE accordingly:

SECTION 2.__. Section 533.041, Government Code, is amended by amending Subsection (a) and adding Subsections (c) and (d) to read as follows:

(a) The executive commissioner [~~commission~~] shall appoint a state Medicaid managed care advisory committee. The advisory committee consists of representatives of:

(2) managed care organizations and participating health care providers;

(3) primary care providers and specialty care providers;

(5) low-income recipients or consumer advocates representing low-income recipients;

(6) recipients with disabilities, including recipients with intellectual and developmental disabilities or physical disabilities, or consumer advocates representing those recipients [~~with a disability~~];

(7) parents of children who are recipients;

(8) rural providers;

(9) advocates for children with special health care needs;

(10) pediatric health care providers, including specialty providers;

(11) long-term services and supports [~~care~~] providers, including nursing facility [~~home~~] providers and direct service workers;

(12) obstetrical care providers;

(13) community-based organizations serving low-income children and their families; [~~and~~]

(14) community-based organizations engaged in perinatal services and outreach;

(15) recipients who are 65 years of age or older;

(16) recipients with mental illness;

(17) nonphysician mental health providers participating in the Medicaid managed care program; and

(18) entities with responsibilities for the delivery of long-term services and supports or other Medicaid program service delivery, including:

(A) independent living centers;

(B) area agencies on aging;

(C) aging and disability resource centers established under the Aging and Disability Resource Center initiative funded in part by the federal Administration on Aging and the Centers for Medicare and Medicaid Services;

(D) community mental health and intellectual disability centers; and

(E) the NorthSTAR Behavioral Health Program provided under Chapter 534, Health and Safety Code.

(d) To the greatest extent possible, the executive commissioner shall appoint members of the advisory committee who reflect the geographic diversity of the state and include members who represent rural Medicaid program recipients.

SECTION 2.__. Section 533.042, Government Code, is amended to read as follows:

Sec. 533.042. MEETINGS. (a) The advisory committee shall meet at the call of the presiding officer at least semiannually, but no more frequently than quarterly.

(b) The advisory committee:

(1) [,] shall develop procedures that provide the public with reasonable opportunity to appear before the committee [~~committtee~~] and speak on any issue under the jurisdiction of the committee;[,] and

(2) is subject to Chapter 551.

SECTION 2.__. Section 533.043, Government Code, is amended to read as follows:

Sec. 533.043. POWERS AND DUTIES. (a) The advisory committee shall:

(1) provide recommendations and ongoing advisory input to the commission on the statewide implementation and operation of Medicaid managed care, including:

(A) program design and benefits;

(B) systemic concerns from consumers and providers;

(D) contract requirements for Medicaid managed care organizations;

(E) Medicaid managed care provider network adequacy; and

(F) other issues as requested by the executive commissioner;

(2) assist the commission with issues relevant to Medicaid managed care to improve the policies established for and programs operating under Medicaid managed care, including the early and periodic screening, diagnosis, and treatment program, provider and patient education issues, and patient eligibility issues; and

(3) disseminate or make available to each regional advisory committee appointed under Subchapter B information on best practices with respect to Medicaid managed care that is obtained from a regional advisory committee.

(b) The commission and the Department of Aging and Disability Services shall ensure coordination and communication between the advisory committee, regional Medicaid managed care advisory committees appointed by the commission under Subchapter B, and other advisory committees or groups that perform functions related to Medicaid managed care, including the Intellectual and Developmental Disability System Redesign Advisory Committee established under Section 534.053, in a manner that enables the state Medicaid managed care advisory committee to act as a central source of agency information and stakeholder input relevant to the implementation and operation of Medicaid managed care.

(c) The advisory committee may establish work groups that meet at other times for purposes of studying and making recommendations on issues the committee determines appropriate.

SECTION 2.__. Section 533.044, Government Code, is amended to read as follows:

Sec. 533.044. OTHER LAW. (a) Except as provided by Subsection (b) and other provisions of this subchapter, the advisory committee is subject to Chapter 2110.

(b) Section 2110.008 does not apply to the advisory committee.

SECTION 2.__. Subchapter C, Chapter 533, Government Code, is amended by adding Section 533.045 to read as follows:

Sec. 533.045. COMPENSATION; REIMBURSEMENT. (a) Except as provided by Subsection (b), a member of the advisory committee is not entitled to receive compensation or reimbursement for travel expenses.

(b) A member of the advisory committee who is a Medicaid program recipient or the relative of a Medicaid program recipient is entitled to a per diem allowance and reimbursement at rates established in the General Appropriations Act.

SECTION 2.__. (a) Not later than October 1, 2013, the executive commissioner of the Health and Human Services Commission shall appoint additional members to the state Medicaid managed care advisory committee to comply with Section 533.041, Government Code, as amended by this article.

(b) Not later than December 1, 2013, the presiding officer of the state Medicaid managed care advisory committee shall convene the first meeting of the advisory committee following appointment of additional members as required by Subsection (a) of this section.

(28) In SECTION 3.01 of the bill, strike added Sections 533.0335(a)(3) and (4), Health and Safety Code (page 12, line 68, through page 13, line 3), and substitute the following:

(3) "Functional need," "ICF-IID program," and "Medicaid waiver program" have the meanings assigned those terms by Section 534.001, Government Code.

(29) In Section 3.01 of the bill, strike added Section 533.0335(b), Health and Safety Code (page 13, lines 4 through 11), and substitute the following:

(b) Subject to the availability of federal funding, the department shall develop and implement a comprehensive assessment instrument and a resource allocation process for individuals with intellectual and developmental disabilities as needed to ensure that each individual with an intellectual or developmental disability receives the type, intensity, and range of services that are both appropriate and available, based on the functional needs of that individual, if the individual receives services through one of the following:

(1) a Medicaid waiver program;

(2) the ICF-IID program; or

(3) an intermediate care facility operated by the state and providing services for individuals with intellectual and developmental disabilities.

(b-1) In developing a comprehensive assessment instrument for purposes of Subsection (b), the department shall evaluate any assessment instrument in use by the department. In addition, the department may implement an evidence-based, nationally recognized, comprehensive assessment instrument that assesses the functional needs of an individual with intellectual and developmental disabilities as the comprehensive assessment instrument required by Subsection (b). This subsection expires September 1, 2015.

(30) Strike SECTION 5.02 of the bill (page 21, lines 38 through 49).

(31) In ARTICLE 7 of the bill, add the following appropriately numbered SECTION and renumber subsequent SECTIONS of the ARTICLE accordingly:

SECTION 7.__. If the Health and Human Services Commission determines that it is cost-effective, the commission shall apply for and actively seek a waiver or authorization from the appropriate federal agency to allow the state to provide medical assistance under the waiver or authorization to medically fragile individuals: