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A BILL TO BE ENTITLED
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AN ACT
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relating to a pilot project to evaluate the use of self-directed |
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mental health services in the integrated Medicaid managed care |
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system. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 1001, Health and Safety |
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Code, is amended by adding Section 1001.085 to read as follows: |
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Sec. 1001.085. SELF-DIRECTED MENTAL HEALTH SERVICES PILOT |
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PROJECT. (a) The commission and the department jointly shall |
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develop and implement a four-year pilot project for self-directed |
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mental health services in the integrated Medicaid managed care |
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system to maximize patient choice and encourage personal |
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responsibility for achieving recovery. |
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(b) To be eligible to participate in the pilot project, an |
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individual must: |
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(1) be at least 18 years of age; |
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(2) have a serious mental illness, as defined by |
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Section 1355.001, Insurance Code; and |
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(3) be receiving Medicaid rehabilitative services |
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through a local mental health authority. |
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(c) Participation in the pilot project by an individual is |
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voluntary, and the decision whether to participate may be made only |
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by the individual or the individual's legally authorized |
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representative. |
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(d) The commission and the department shall develop the |
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pilot project with input from relevant stakeholders, including |
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patients, advocates, Medicaid managed care organizations, |
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providers, and local mental health authorities. |
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(e) The pilot project as implemented must include: |
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(1) person-centered planning to assist each |
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participant in identifying recovery goals and the specific services |
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and supports needed to accomplish those goals; |
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(2) the development of an individualized budget for |
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each participant that is based on the goals identified in |
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Subdivision (1) and of which some percentage less than 50 may be |
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spent on nontraditional goods and services that the participant |
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generally would not receive as part of a package of outpatient |
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mental health services delivered through a local mental health |
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authority; |
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(3) guidelines for nontraditional goods and services |
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that may be purchased with a participant's individualized budget to |
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ensure that nontraditional goods and services purchased are |
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directly related to the participant's recovery goals; |
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(4) the option for a participant to use a life coach to |
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assist with: |
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(A) person-centered planning; |
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(B) budgeting; |
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(C) identifying and navigating community |
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services; |
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(D) recruiting, hiring, and releasing service |
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providers; |
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(E) crisis planning; and |
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(F) interactions with the fiscal intermediary |
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designated in accordance with Subdivision (7) and billing for goods |
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and services; |
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(5) specific qualifications for a life coach to be |
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eligible to provide services to a participant; |
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(6) the option for a participant to receive services |
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from a certified peer specialist; |
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(7) the designation of a fiscal intermediary who |
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provides financial management and billing support for the project; |
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and |
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(8) a plan for budget neutrality by the end of the |
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second year of the project. |
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(f) The commission and the department shall select the pilot |
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project site based on a competitive application process among the |
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local mental health authorities. Applications must include |
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evidence of significant patient and certified peer specialist |
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participation in the preparation of the application. The |
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commission and the department shall select as the pilot project |
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site an area of this state where the local mental health authority |
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and Medicaid managed care providers have a strong partnership and |
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where there is a high commitment to the success of the project. |
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(g) The commission and the department shall collect |
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information relating to the pilot project, including information |
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relating to recovery-focused outcome metrics and to the costs of |
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the project. |
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(h) Not later than one year after the date the pilot project |
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concludes, the commission and the department shall submit to the |
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legislature a report evaluating the pilot project, particularly |
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with regard to cost-effectiveness and recovery-focused outcomes. |
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In developing the report, the commission and the department shall |
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seek private funding and support to assist with the evaluation |
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process. |
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(i) The executive commissioner, with input from patients |
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receiving mental health services, certified peer specialists, and |
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other interested stakeholders, shall adopt rules necessary to |
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implement the pilot project developed under this section. |
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SECTION 2. As soon as practicable after the effective date |
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of this Act, the Health and Human Services Commission and the |
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Department of State Health Services shall begin developing and |
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implementing the pilot project under Section 1001.085, Health and |
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Safety Code, as added by this Act. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |