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A BILL TO BE ENTITLED
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AN ACT
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relating to improving the delivery and quality of Medicaid acute |
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care services and long-term care services and supports. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.00251(g), Government Code, is |
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amended to read as follows: |
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(g) Subsection [Subsections (c),] (d)[, (e), and (f)] and |
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this subsection expire September 1, 2019. |
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SECTION 2. Section 534.053, Government Code, is amended by |
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adding Subsection (e-1) and amending Subsection (g) to read as |
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follows: |
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(e-1) The advisory committee may establish work groups that |
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meet at other times for purposes of studying and making |
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recommendations on issues the committee considers appropriate. |
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(g) On January 1, 2026 [2024]: |
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(1) the advisory committee is abolished; and |
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(2) this section expires. |
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SECTION 3. Section 534.054, Government Code, as amended by |
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S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, |
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is amended to read as follows: |
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Sec. 534.054. ANNUAL REPORT ON IMPLEMENTATION. (a) Not |
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later than September 30 of each year, the commission, in |
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consultation and collaboration with the advisory committee, shall |
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prepare and submit a report to the legislature that must include |
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[regarding]: |
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(1) an assessment of the implementation of the system |
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required by this chapter, including appropriate information |
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regarding the provision of acute care services and long-term |
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services and supports to individuals with an intellectual or |
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developmental disability under Medicaid as described by this |
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chapter; [and] |
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(2) recommendations regarding implementation of and |
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improvements to the system redesign, including recommendations |
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regarding appropriate statutory changes to facilitate the |
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implementation; and |
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(3) an assessment of the effect of the system on the |
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following: |
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(A) access to long-term services and supports; |
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(B) the quality of acute care services and |
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long-term services and supports; |
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(C) meaningful outcomes for Medicaid recipients |
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using person-centered planning, individualized budgeting, and |
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self-determination, including a person's inclusion in the |
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community; |
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(D) the integration of service coordination of |
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acute care services and long-term services and supports; |
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(E) the placement of individuals in housing that |
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is the least restrictive setting appropriate to an individual's |
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needs; |
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(F) employment assistance and customized, |
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integrated, competitive employment options; and |
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(G) the number and types of fair hearing and |
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appeals processes in accordance with applicable federal law. |
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(b) This section expires January 1, 2026 [2024]. |
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SECTION 4. Section 534.104, Government Code, is amended by |
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amending Subsection (a), as amended by S.B. No. 219, Acts of the |
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84th Legislature, Regular Session, 2015, amending Subsections (c), |
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(d), (e), and (g), and adding Subsection (h) to read as follows: |
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(a) The department, in consultation and collaboration with |
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the advisory committee, shall identify private services providers |
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that are good candidates to develop a service delivery model |
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involving a managed care strategy based on capitation and to test |
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the model in the provision of long-term services and supports under |
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Medicaid to individuals with an intellectual or developmental |
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disability through a pilot program established under this |
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subchapter. |
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(c) A managed care strategy based on capitation developed |
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for implementation through a pilot program under this subchapter |
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must be designed to: |
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(1) increase access to long-term services and |
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supports; |
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(2) improve quality of acute care services and |
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long-term services and supports; |
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(3) promote meaningful outcomes by using |
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person-centered planning, individualized budgeting, and |
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self-determination, and promote community inclusion [and
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customized, integrated, competitive employment]; |
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(4) promote integrated service coordination of acute |
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care services and long-term services and supports; |
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(5) promote [efficiency and the best use of funding;
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[(6) promote] the placement of an individual in |
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housing that is the least restrictive setting appropriate to the |
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individual's needs; |
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(6) [(7)] promote employment assistance and |
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customized, integrated, and competitive [supported] employment; |
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(7) [(8)] provide fair hearing and appeals processes |
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in accordance with applicable federal law; and |
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(8) [(9)] promote sufficient flexibility to achieve |
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the goals listed in this section through the pilot program. |
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(d) The department, in consultation and collaboration with |
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the advisory committee, shall evaluate each submitted managed care |
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strategy proposal and determine whether: |
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(1) the proposed strategy satisfies the requirements |
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of this section; and |
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(2) the private services provider that submitted the |
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proposal has a demonstrated ability to provide the long-term |
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services and supports appropriate to the individuals who will |
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receive services through the pilot program based on the proposed |
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strategy, if implemented. |
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(e) Based on the evaluation performed under Subsection (d), |
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the department may select as pilot program service providers one or |
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more private services providers with whom the commission will |
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contract. |
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(g) The department, in consultation and collaboration with |
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the advisory committee, shall analyze information provided by the |
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pilot program service providers and any information collected by |
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the department during the operation of the pilot programs for |
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purposes of making a recommendation about a system of programs and |
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services for implementation through future state legislation or |
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rules. |
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(h) The analysis under Subsection (g) must include an |
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assessment of the effect of the managed care strategies implemented |
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in the pilot programs on: |
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(1) access to long-term services and supports; |
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(2) the quality of acute care services and long-term |
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services and supports; |
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(3) meaningful outcomes using person-centered |
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planning, individualized budgeting, and self-determination, |
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including a person's inclusion in the community; |
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(4) the integration of service coordination of acute |
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care services and long-term services and supports; |
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(5) the placement of individuals in housing that is |
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the least restrictive setting appropriate to an individual's needs; |
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(6) employment assistance and customized, integrated, |
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competitive employment options; and |
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(7) the number and types of fair hearing and appeals |
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processes in accordance with applicable federal law. |
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SECTION 5. Sections 534.106(a) and (b), Government Code, |
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are amended to read as follows: |
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(a) The commission and the department shall implement any |
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pilot programs established under this subchapter not later than |
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September 1, 2017 [2016]. |
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(b) A pilot program established under this subchapter may |
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[must] operate for up to [not less than] 24 months. A[, except that
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a] pilot program may cease operation [before the expiration of 24
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months] if the pilot program service provider terminates the |
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contract with the commission before the agreed-to termination date. |
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SECTION 6. Section 534.108(d), Government Code, is amended |
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to read as follows: |
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(d) The [On or before December 1, 2016, and December 1,
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2017, the] commission and the department, in consultation and |
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collaboration with the advisory committee, shall review and |
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evaluate the progress and outcomes of each pilot program |
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implemented under this subchapter and submit, as part of the annual |
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report to the legislature required by Section 534.054, a report to |
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the legislature during the operation of the pilot programs. Each |
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report must include recommendations for program improvement and |
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continued implementation. |
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SECTION 7. Section 534.110, Government Code, as amended by |
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S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, |
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is amended to read as follows: |
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Sec. 534.110. TRANSITION BETWEEN PROGRAMS. (a) The |
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commission shall ensure that there is a comprehensive plan for |
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transitioning the provision of Medicaid benefits between a Medicaid |
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waiver program or an ICF-IID program and a pilot program under this |
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subchapter to protect continuity of care. |
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(b) The transition plan shall be developed in consultation |
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and collaboration with the advisory committee and with stakeholder |
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input as described by Section 534.103. |
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SECTION 8. Section 534.151, Government Code, as amended by |
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S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015, |
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is amended to read as follows: |
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Sec. 534.151. DELIVERY OF ACUTE CARE SERVICES FOR |
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INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY. (a) |
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Subject to Section 533.0025, the commission shall provide acute |
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care Medicaid benefits to individuals with an intellectual or |
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developmental disability through the STAR + PLUS Medicaid managed |
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care program or the most appropriate integrated capitated managed |
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care program delivery model and monitor the provision of those |
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benefits. |
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(b) The commission and the department, in consultation and |
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collaboration with the advisory committee, shall analyze the |
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outcomes of providing acute care Medicaid benefits to individuals |
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with an intellectual or developmental disability under a model |
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specified in Subsection (a). The analysis must: |
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(1) include an assessment of the effects on: |
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(A) access to and quality of acute care services; |
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and |
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(B) the number and types of fair hearing and |
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appeals processes in accordance with applicable federal law; |
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(2) be incorporated into the annual report to the |
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legislature required under Section 534.054; and |
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(3) include recommendations for delivery model |
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improvements and implementation for consideration by the |
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legislature, including recommendations for needed statutory |
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changes. |
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SECTION 9. The heading to Section 534.152, Government Code, |
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is amended to read as follows: |
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Sec. 534.152. DELIVERY OF CERTAIN OTHER SERVICES UNDER STAR |
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+ PLUS MEDICAID MANAGED CARE PROGRAM AND BY WAIVER PROGRAM |
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PROVIDERS. |
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SECTION 10. Section 534.152, Government Code, is amended by |
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adding Subsection (g) to read as follows: |
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(g) The department may contract with providers |
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participating in the home and community-based services (HCS) waiver |
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program, the Texas home living (TxHmL) waiver program, the |
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community living assistance and support services (CLASS) waiver |
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program, or the deaf-blind with multiple disabilities (DBMD) waiver |
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program for the delivery of basic attendant and habilitation |
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services described in Subsection (a) for individuals to which that |
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subsection applies. The department has regulatory and oversight |
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authority over the providers with which the department contracts |
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for the delivery of those services. |
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SECTION 11. Section 534.201, Government Code, is amended by |
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amending Subsections (b) and (e), as amended by S.B. No. 219, Acts |
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of the 84th Legislature, Regular Session, 2015, amending Subsection |
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(d), and adding Subsection (g) to read as follows: |
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(b) On or after [Not later than] September 1, 2018 [2017], |
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the commission may [shall] transition the provision of Medicaid |
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benefits to individuals to whom this section applies to the STAR + |
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PLUS Medicaid managed care program delivery model or the most |
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appropriate integrated capitated managed care program delivery |
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model, as determined by the commission based on cost-effectiveness |
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and the experience of the STAR + PLUS Medicaid managed care program |
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in providing basic attendant and habilitation services and of the |
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pilot programs established under Subchapter C, subject to |
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Subsection (c)(1). |
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(d) In implementing the transition described by Subsection |
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(b), the commission, in consultation and collaboration with the |
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advisory committee, shall develop a process to receive and evaluate |
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input from interested statewide stakeholders [that is in addition
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to the input provided by the advisory committee]. |
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(e) The commission, in consultation and collaboration with |
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the advisory committee, shall ensure that there is a comprehensive |
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plan for transitioning the provision of Medicaid benefits under |
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this section that protects the continuity of care provided to |
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individuals to whom this section applies. |
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(g) The commission, in consultation and collaboration with |
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the advisory committee, shall analyze the outcomes of the |
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transition of the long-term services and supports under the Texas |
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home living (TxHmL) Medicaid waiver program to a managed care |
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program delivery model. The analysis must: |
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(1) include an assessment of the effect of the |
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transition on: |
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(A) access to long-term services and supports; |
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(B) meaningful outcomes using person-centered |
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planning, individualized budgeting, and self-determination, |
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including a person's inclusion in the community; |
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(C) the integration of service coordination of |
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acute care services and long-term services and supports; |
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(D) employment assistance and customized, |
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integrated, competitive employment options; and |
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(E) the number and types of fair hearing and |
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appeals processes in accordance with applicable federal law; |
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(2) be incorporated into the annual report to the |
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legislature required under Section 534.054; and |
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(3) include recommendations for improvements to the |
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transition implementation for consideration by the legislature, |
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including recommendations for needed statutory changes. |
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SECTION 12. Section 534.202(b), Government Code, as amended |
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by S.B. No. 219, Acts of the 84th Legislature, Regular Session, |
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2015, is amended to read as follows: |
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(b) After implementing the transition required by Section |
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534.201, if that transition is implemented [but not later than
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September 1, 2020], the commission may, on or after September 1, |
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2021, [shall] transition the provision of Medicaid benefits to |
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individuals to whom this section applies to the STAR + PLUS Medicaid |
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managed care program delivery model or the most appropriate |
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integrated capitated managed care program delivery model, as |
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determined by the commission based on cost-effectiveness and the |
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experience of the transition of Texas home living (TxHmL) waiver |
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program recipients to a managed care program delivery model under |
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Section 534.201, subject to Subsections (c)(1) and (g). |
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SECTION 13. If before implementing any provision of this |
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Act 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 14. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, this Act takes effect September 1, 2015. |