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INTRODUCED
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HOUSE COMMITTEE
SUBSTITUTE
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SECTION 1. Section
533.00251(g), Government Code, is amended.
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SECTION 1. Same as introduced
version.
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SECTION 2. Section 534.053,
Government Code, is amended.
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SECTION 2. Same as introduced
version.
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SECTION 3. Section 534.054,
Government Code, is amended to read as follows:
Sec. 534.054. ANNUAL REPORT
ON IMPLEMENTATION. (a) Not later than September 30 of each year, the
commission, in consultation and collaboration with the advisory
committee, shall prepare and submit a report to the legislature that
must include [regarding]:
(1) an assessment of
the implementation of the system required by this chapter, including
appropriate information regarding the provision of acute care services and
long-term services and supports to individuals with intellectual and
developmental disabilities under the Medicaid program as described by
this chapter; [and]
(2) recommendations regarding
implementation of and improvements to the system redesign, including
recommendations regarding appropriate statutory changes to facilitate the
implementation; and
(3) an evaluation of the effect of the system on
the following:
(A) access to long-term
services and supports;
(B) the quality of acute
care services and long-term services and supports;
(C) meaningful outcomes
for program recipients using person-centered planning, individualized
budgeting, and self-determination, including a person's inclusion in the
community;
(D) the integration of
service coordination of acute care services and long-term services and
supports;
(E) the placement of
individuals in housing that is the least restrictive setting appropriate to
an individual's needs;
(F) employment assistance
and customized, integrated, competitive employment options; and
(G) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law.
(b) This section expires
January 1, 2026 [2024].
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SECTION 3. Section 534.054,
Government Code, as amended by S.B. No. 219, Acts of the 84th Legislature,
Regular Session, 2015, is amended to read as follows:
Sec. 534.054. ANNUAL REPORT
ON IMPLEMENTATION. (a) Not later than September 30 of each year, the
commission, in consultation and collaboration with the advisory
committee, shall prepare and submit a report to the legislature that
must include [regarding]:
(1) an assessment of
the implementation of the system required by this chapter, including
appropriate information regarding the provision of acute care services and
long-term services and supports to individuals with an intellectual or
developmental disability under Medicaid as described by this chapter;
[and]
(2) recommendations regarding
implementation of and improvements to the system redesign, including
recommendations regarding appropriate statutory changes to facilitate the
implementation; and
(3) an assessment of the effect of the system on
the following:
(A) access to long-term
services and supports;
(B) the quality of acute
care services and long-term services and supports;
(C) meaningful outcomes
for Medicaid recipients using person-centered planning, individualized
budgeting, and self-determination, including a person's inclusion in the
community;
(D) the integration of service
coordination of acute care services and long-term services and supports;
(E) the placement of
individuals in housing that is the least restrictive setting appropriate to
an individual's needs;
(F) employment assistance
and customized, integrated, competitive employment options; and
(G) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law.
(b) This section expires
January 1, 2026 [2024].
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SECTION 4. Section 534.104,
Government Code, is amended by amending Subsections (a), (b), (c), (d),
(e), and (g) and adding Subsection (h) to read as follows:
(a) The department, in
consultation and collaboration with the advisory committee, shall
identify [private] services
providers that are good candidates to develop a service delivery model
involving a managed care strategy based on capitation and to test the model
in the provision of long-term services and supports under the Medicaid
program to individuals with intellectual and developmental disabilities through
a pilot program established under this subchapter.
(b)
The department shall solicit managed care strategy proposals from the [private]
services providers identified under Subsection (a). In addition, the
department may accept and approve a managed care strategy proposal from any
qualified entity that is a [private] services provider if the
proposal provides for a comprehensive array of long-term services and
supports, including case management and service coordination.
(c) A managed care strategy
based on capitation developed for implementation through a pilot program
under this subchapter must be designed to:
(1) increase access to
long-term services and supports;
(2) improve quality of acute
care services and long-term services and supports;
(3) promote meaningful
outcomes by using person-centered planning, individualized budgeting, and
self-determination, and promote community inclusion [and customized,
integrated, competitive employment];
(4) promote integrated
service coordination of acute care services and long-term services and
supports;
(5) promote [efficiency
and the best use of funding;
[(6) promote] the
placement of an individual in housing that is the least restrictive setting
appropriate to the individual's needs;
(6) [(7)]
promote employment assistance and customized, integrated, and
competitive [supported] employment;
(7) [(8)]
provide fair hearing and appeals processes in accordance with applicable
federal law; and
(8) [(9)]
promote sufficient flexibility to achieve the goals listed in this section
through the pilot program.
(d) The department, in
consultation and collaboration with the advisory committee, shall
evaluate each submitted managed care strategy proposal and determine
whether:
(1) the proposed strategy
satisfies the requirements of this section; and
(2) the [private]
services provider that submitted the proposal has a demonstrated ability to
provide the long-term services and supports appropriate to the individuals
who will receive services through the pilot program based on the proposed
strategy, if implemented.
(e) Based on the evaluation
performed under Subsection (d), the department may select as pilot program
service providers one or more [private] services providers with
whom the commission will contract.
(g) The department, in
consultation and collaboration with the advisory committee, shall
analyze information provided by the pilot program service providers and any
information collected by the department during the operation of the pilot
programs for purposes of making a recommendation about a system of programs
and services for implementation through future state legislation or rules.
(h) The analysis under
Subsection (g) must include an evaluation
of the effect of the managed care strategies implemented in the pilot
programs on:
(1) access to long-term
services and supports;
(2) the quality of acute
care services and long-term services and supports;
(3) meaningful outcomes
using person-centered planning, individualized budgeting, and
self-determination, including a person's inclusion in the community;
(4) the integration of
service coordination of acute care services and long-term services and
supports;
(5) the placement of
individuals in housing that is the least restrictive setting appropriate to
an individual's needs;
(6) employment assistance
and customized, integrated, competitive employment options; and
(7) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law.
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SECTION 4. Section 534.104,
Government Code, is amended by amending Subsection (a), as amended by S.B.
No. 219, Acts of the 84th Legislature, Regular Session, 2015, amending
Subsections (c), (d), (e), and (g), and adding Subsection (h) to read as
follows:
(a) The department, in
consultation and collaboration with the advisory committee, shall
identify private services providers
that are good candidates to develop a service delivery model involving a
managed care strategy based on capitation and to test the model in the
provision of long-term services and supports under Medicaid to individuals
with an intellectual or developmental disability through a pilot program
established under this subchapter.
(c) A managed care strategy
based on capitation developed for implementation through a pilot program
under this subchapter must be designed to:
(1) increase access to
long-term services and supports;
(2) improve quality of acute
care services and long-term services and supports;
(3) promote meaningful
outcomes by using person-centered planning, individualized budgeting, and
self-determination, and promote community inclusion [and customized,
integrated, competitive employment];
(4) promote integrated
service coordination of acute care services and long-term services and
supports;
(5) promote [efficiency
and the best use of funding;
[(6) promote] the
placement of an individual in housing that is the least restrictive setting
appropriate to the individual's needs;
(6) [(7)]
promote employment assistance and customized, integrated, and
competitive [supported] employment;
(7) [(8)]
provide fair hearing and appeals processes in accordance with applicable
federal law; and
(8) [(9)]
promote sufficient flexibility to achieve the goals listed in this section
through the pilot program.
(d) The department, in
consultation and collaboration with the advisory committee, shall
evaluate each submitted managed care strategy proposal and determine
whether:
(1) the proposed strategy
satisfies the requirements of this section; and
(2) the private services
provider that submitted the proposal has a demonstrated ability to provide
the long-term services and supports appropriate to the individuals who will
receive services through the pilot program based on the proposed strategy,
if implemented.
(e) Based on the evaluation
performed under Subsection (d), the department may select as pilot program
service providers one or more private services providers with whom the
commission will contract.
(g) The department, in
consultation and collaboration with the advisory committee, shall
analyze information provided by the pilot program service providers and any
information collected by the department during the operation of the pilot
programs for purposes of making a recommendation about a system of programs
and services for implementation through future state legislation or rules.
(h) The analysis under
Subsection (g) must include an assessment
of the effect of the managed care strategies implemented in the pilot
programs on:
(1) access to long-term
services and supports;
(2) the quality of acute
care services and long-term services and supports;
(3) meaningful outcomes
using person-centered planning, individualized budgeting, and
self-determination, including a person's inclusion in the community;
(4) the integration of
service coordination of acute care services and long-term services and
supports;
(5) the placement of
individuals in housing that is the least restrictive setting appropriate to
an individual's needs;
(6) employment assistance
and customized, integrated, competitive employment options; and
(7) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law.
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No
equivalent provision.
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SECTION 5. Sections
534.106(a) and (b), Government Code, are amended to read as follows:
(a) The commission and the
department shall implement any pilot programs established under this
subchapter not later than September 1, 2017 [2016].
(b) A pilot program
established under this subchapter may [must] operate for up
to [not less than] 24 months. A[, except that a]
pilot program may cease operation [before the expiration of 24 months]
if the pilot program service provider terminates the contract with the
commission before the agreed-to termination date.
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No
equivalent provision.
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SECTION 6. Section
534.108(d), Government Code, is amended to read as follows:
(d) The [On or
before December 1, 2016, and December 1, 2017, the] commission and the
department, in consultation and collaboration with the advisory
committee, shall review and evaluate the progress and outcomes of each
pilot program implemented under this subchapter and submit, as part of
the annual report to the legislature required by Section 534.054, a
report to the legislature during the operation of the pilot programs. Each
report must include recommendations for program improvement and continued
implementation.
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SECTION 5. Section 534.110,
Government Code, is amended to read as follows:
Sec. 534.110. TRANSITION
BETWEEN PROGRAMS. (a) The commission shall ensure that there is a
comprehensive plan for transitioning the provision of Medicaid program
benefits between a Medicaid waiver program or an ICF-IID program and a
pilot program under this subchapter to protect continuity of care.
(b) The transition plan
shall be developed in consultation and collaboration with the advisory
committee and with stakeholder input as described by Section 534.103.
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SECTION 7. Section 534.110,
Government Code, as amended by S.B. No. 219, Acts of the 84th Legislature,
Regular Session, 2015, is amended to read as follows:
Sec. 534.110. TRANSITION
BETWEEN PROGRAMS. (a) The commission shall ensure that there is a
comprehensive plan for transitioning the provision of Medicaid benefits
between a Medicaid waiver program or an ICF-IID program and a pilot program
under this subchapter to protect continuity of care.
(b) The transition plan
shall be developed in consultation and collaboration with the advisory
committee and with stakeholder input as described by Section 534.103.
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SECTION 6. Section 534.151,
Government Code, is amended to read as follows:
Sec. 534.151. DELIVERY OF
ACUTE CARE SERVICES FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL
DISABILITIES. (a) Subject to Section 533.0025, the commission shall
provide acute care Medicaid program benefits to individuals with
intellectual and developmental disabilities through the STAR + PLUS
Medicaid managed care program or the most appropriate integrated capitated
managed care program delivery model and monitor the provision of those
benefits.
(b) The commission and
the department, in consultation and collaboration with the advisory
committee, shall analyze the outcomes of providing acute care Medicaid
program benefits to individuals with an intellectual or developmental disability
under a model specified in Subsection (a). The analysis must:
(1) include an evaluation of the effects on:
(A) access to and quality
of acute care services; and
(B) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law;
(2) be incorporated into
the annual report to the legislature required under Section 534.054; and
(3) include
recommendations for delivery model improvements and implementation for
consideration by the legislature, including recommendations for needed
statutory changes.
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SECTION 8. Section 534.151,
Government Code, as amended by S.B. No. 219, Acts of the 84th Legislature,
Regular Session, 2015, is amended to read as follows:
Sec. 534.151. DELIVERY OF
ACUTE CARE SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL
DISABILITY. (a) Subject to Section 533.0025, the commission shall
provide acute care Medicaid benefits to individuals with an intellectual or
developmental disability through the STAR + PLUS Medicaid managed care program
or the most appropriate integrated capitated managed care program delivery
model and monitor the provision of those benefits.
(b) The commission and
the department, in consultation and collaboration with the advisory
committee, shall analyze the outcomes of providing acute care Medicaid
benefits to individuals with an intellectual or developmental disability
under a model specified in Subsection (a). The analysis must:
(1) include an assessment of the effects on:
(A) access to and quality
of acute care services; and
(B) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law;
(2) be incorporated into
the annual report to the legislature required under Section 534.054; and
(3) include
recommendations for delivery model improvements and implementation for
consideration by the legislature, including recommendations for needed
statutory changes.
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No
equivalent provision.
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SECTION 9. The heading to
Section 534.152, Government Code, is amended to read as follows:
Sec. 534.152. DELIVERY OF
CERTAIN OTHER SERVICES UNDER STAR + PLUS MEDICAID MANAGED CARE PROGRAM AND
BY WAIVER PROGRAM PROVIDERS.
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No
equivalent provision.
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SECTION 10. Section 534.152,
Government Code, is amended by adding Subsection (g) to read as follows:
(g) The department may
contract with providers participating in the home and community-based
services (HCS) waiver program, the Texas home living (TxHmL) waiver
program, the community living assistance and support services (CLASS)
waiver program, or the deaf-blind with multiple disabilities (DBMD) waiver
program for the delivery of basic attendant and habilitation services
described in Subsection (a) for individuals to which that subsection
applies. The department has regulatory and oversight authority over the
providers with which the department contracts for the delivery of those
services.
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SECTION 7. Section 534.201,
Government Code, is amended by amending Subsections (b), (d), and (e) and
adding Subsection (g) to read as follows:
(b) On or after [Not
later than] September 1, 2018 [2017], the commission may
[shall] transition the provision of Medicaid program benefits to
individuals to whom this section applies to the STAR + PLUS Medicaid
managed care program delivery model or the most appropriate integrated
capitated managed care program delivery model, as determined by the
commission based on cost-effectiveness and the experience of the STAR +
PLUS Medicaid managed care program in providing basic attendant and
habilitation services and of the pilot programs established under
Subchapter C, subject to Subsection (c)(1).
(d) In implementing the
transition described by Subsection (b), the commission, in consultation
and collaboration with the advisory committee, shall develop a process
to receive and evaluate input from interested statewide stakeholders [that
is in addition to the input provided by the advisory committee].
(e) The commission, in
consultation and collaboration with the advisory committee, shall
ensure that there is a comprehensive plan for transitioning the provision
of Medicaid program benefits under this section that protects the
continuity of care provided to individuals to whom this section applies.
(g) The commission, in
consultation and collaboration with the advisory committee, shall analyze
the outcomes of the transition of the long-term services and supports under
the Texas home living (TxHmL) Medicaid waiver program to a managed care
program delivery model. The analysis must:
(1) include an evaluation of the effect of the transition
on:
(A) access to long-term
services and supports;
(B) meaningful outcomes
using person-centered planning, individualized budgeting, and
self-determination, including a person's inclusion in the community;
(C) the integration of service
coordination of acute care services and long-term services and supports;
(D) employment assistance
and customized, integrated, competitive employment options; and
(E) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law;
(2) be incorporated into
the annual report to the legislature required under Section 534.054; and
(3) include
recommendations for improvements to the transition implementation for
consideration by the legislature, including recommendations for needed
statutory changes.
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SECTION 11. Section 534.201,
Government Code, is amended by amending Subsections (b) and (e), as amended
by S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015,
amending Subsection (d), and adding Subsection (g) to read as follows:
(b) On or after [Not
later than] September 1, 2018 [2017], the commission may
[shall] transition the provision of Medicaid benefits to individuals
to whom this section applies to the STAR + PLUS Medicaid managed care
program delivery model or the most appropriate integrated capitated managed
care program delivery model, as determined by the commission based on
cost-effectiveness and the experience of the STAR + PLUS Medicaid managed
care program in providing basic attendant and habilitation services and of
the pilot programs established under Subchapter C, subject to Subsection
(c)(1).
(d) In implementing the
transition described by Subsection (b), the commission, in consultation
and collaboration with the advisory committee, shall develop a process
to receive and evaluate input from interested statewide stakeholders [that
is in addition to the input provided by the advisory committee].
(e) The commission, in
consultation and collaboration with the advisory committee, shall ensure
that there is a comprehensive plan for transitioning the provision of
Medicaid benefits under this section that protects the continuity of care
provided to individuals to whom this section applies.
(g) The commission, in
consultation and collaboration with the advisory committee, shall analyze
the outcomes of the transition of the long-term services and supports under
the Texas home living (TxHmL) Medicaid waiver program to a managed care
program delivery model. The analysis must:
(1) include an assessment of the effect of the transition
on:
(A) access to long-term
services and supports;
(B) meaningful outcomes
using person-centered planning, individualized budgeting, and
self-determination, including a person's inclusion in the community;
(C) the integration of
service coordination of acute care services and long-term services and
supports;
(D) employment assistance
and customized, integrated, competitive employment options; and
(E) the number and types
of fair hearing and appeals processes in accordance with applicable federal
law;
(2) be incorporated into
the annual report to the legislature required under Section 534.054; and
(3) include
recommendations for improvements to the transition implementation for
consideration by the legislature, including recommendations for needed
statutory changes.
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SECTION 8. Section
534.202(b), Government Code, is amended to read as follows:
(b) After implementing the
transition required by Section 534.201, if that transition is
implemented [but not later than September 1, 2020], the
commission may, on or after September 1, 2021, [shall]
transition the provision of Medicaid program benefits to individuals to
whom this section applies to the STAR + PLUS Medicaid managed care program
delivery model or the most appropriate integrated capitated managed care
program delivery model, as determined by the commission based on
cost-effectiveness and the experience of the transition of Texas home
living (TxHmL) waiver program recipients to a managed care program delivery
model under Section 534.201, subject to Subsections (c)(1) and (g).
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SECTION 12. Section
534.202(b), Government Code, as amended by S.B. No. 219, Acts of the 84th
Legislature, Regular Session, 2015, is amended to read as follows:
(b) After implementing the
transition required by Section 534.201, if that transition is
implemented [but not later than September 1, 2020], the
commission may, on or after September 1, 2021, [shall]
transition the provision of Medicaid benefits to individuals to whom this
section applies to the STAR + PLUS Medicaid managed care program delivery
model or the most appropriate integrated capitated managed care program
delivery model, as determined by the commission based on cost-effectiveness
and the experience of the transition of Texas home living (TxHmL) waiver
program recipients to a managed care program delivery model under Section
534.201, subject to Subsections (c)(1) and (g).
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SECTION 9. 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.
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SECTION 13. Same as
introduced version.
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SECTION 10. This Act takes
effect immediately if it receives a vote of two-thirds of all the members
elected to each house, as provided by Section 39, Article III, Texas
Constitution. If this Act does not receive the vote necessary for
immediate effect, this Act takes effect September 1, 2015.
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SECTION 14. Same as
introduced version.
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