INTRODUCED
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HOUSE COMMITTEE
SUBSTITUTE
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SECTION 1. APPROPRIATION
REDUCTION: PUBLIC FINANCE AUTHORITY. The unencumbered appropriations from
the general revenue fund to the Public Finance Authority made by Chapter
1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015 (the
General Appropriations Act), for use during the state fiscal biennium
ending August 31, 2017, for bond debt service payments, including
appropriations subject to Rider 2, page I-47, Chapter 1281 (H.B. 1), Acts
of the 84th Legislature, Regular Session, 2015 (the General Appropriations
Act), to the bill pattern of the appropriations to the authority, are
reduced by a total aggregate of $39,856,983.
The Public Finance Authority shall identify the strategies and objectives
to which the reduction is to be allocated and the amount of the reduction
for each of those strategies and objectives.
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SECTION 1. APPROPRIATION
REDUCTION: PUBLIC FINANCE AUTHORITY. The unencumbered appropriations from
the general revenue fund to the Public Finance Authority made by Chapter
1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015 (the
General Appropriations Act), for use during the state fiscal biennium
ending August 31, 2017, for bond debt service payments, including
appropriations subject to Rider 2, page I-47, Chapter 1281 (H.B. 1), Acts
of the 84th Legislature, Regular Session, 2015 (the General Appropriations
Act), to the bill pattern of the appropriations to the authority, are
reduced by a total aggregate of $53,636,997.
The Public Finance Authority shall identify the strategies and objectives
to which the reduction is to be allocated and the amount of the reduction
for each of those strategies and objectives.
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SECTION 2. HEALTH AND HUMAN
SERVICES COMMISSION: MEDICAID SHORTFALL. (a) In addition to amounts
previously appropriated for the state fiscal biennium ending August 31,
2017, $930,733,818 is appropriated from the economic
stabilization fund, and $1,705,243,901 is appropriated from federal
funds, to the Health and Human Services Commission for the state fiscal
year ending August 31, 2017, for Medicaid services under Goal B, Medicaid,
as listed in Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular
Session, 2015 (the General Appropriations Act).
(b) The expenditure or
emergency transfer of money appropriated under Subsection (a) of this
section is subject to the prior written approval of the Legislative Budget
Board in accordance with Section 69, Article XVI, Texas Constitution.
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SECTION 2. HEALTH AND HUMAN
SERVICES COMMISSION: MEDICAID SHORTFALL. (a) In addition to amounts
previously appropriated for the state fiscal biennium ending August 31,
2017, $930,733,818 is appropriated from the general
revenue fund, and $1,705,243,901 is appropriated from federal funds,
to the Health and Human Services Commission for the state fiscal year
ending August 31, 2017, for Medicaid services under Goal B, Medicaid, as
listed in Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular
Session, 2015 (the General Appropriations Act).
(b) The expenditure or
emergency transfer of money appropriated under Subsection (a) of this
section is subject to the prior written approval of the Legislative Budget
Board in accordance with Section 69, Article XVI, Texas Constitution.
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SECTION 3. HEALTH AND HUMAN
SERVICES COMMISSION: MEDICAID ACUTE CARE THERAPY SERVICES. In addition to
amounts previously appropriated for the state fiscal biennium ending August
31, 2017, $21,500,000 is appropriated from the economic stabilization fund, and $29,800,000 is
appropriated from federal funds, to the Health and Human Services
Commission for the state fiscal year ending August 31, 2017, for Medicaid
acute care therapy services, to be allocated among provider types and
procedure codes for those services to preserve access to care.
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SECTION 3. HEALTH AND HUMAN
SERVICES COMMISSION: MEDICAID ACUTE CARE THERAPY SERVICES. In addition to
amounts previously appropriated for the state fiscal biennium ending August
31, 2017, $21,500,000 is appropriated from the general revenue fund, and $29,800,000 is appropriated
from federal funds, to the Health and Human Services Commission for the
state fiscal year ending August 31, 2017, for Medicaid acute care therapy
services, to be allocated among provider types and procedure codes for
those services to preserve access to care.
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SECTION 4. HEALTH AND HUMAN
SERVICES COMMISSION: CERTAIN RIDERS. Subsection (c), Rider 50, page II-97,
Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015
(the General Appropriations Act), to the bill pattern of the appropriations
to the Health and Human Services Commission is amended to read as follows:
c. HHSC shall reform
reimbursement methodology to be in line with industry standards, policies, and utilization for acute
care therapy services (including physical, occupational, and speech
therapies) while considering stakeholder input and access to care.
In state fiscal year 2017,
$28,500,000 [Out of the amount in subsection (a), in each fiscal
year at least $50,000,000] in General Revenue Funds savings should be
achieved through rate reductions and
$25,000,000 in General Revenue Funds savings may be achieved through
various medical policy initiatives listed in items (1)-(10), below. [If
$25,000,000 in savings is not achieved through various medical policy
initiatives in fiscal year 2016, the amount of unrealized savings (the
difference between $25,000,000 in General Revenue Funds and savings
actually achieved in fiscal year 2016) should be achieved through
additional rate reductions in fiscal year 2017 while continuing any
initiatives implemented in fiscal year 2016 that have been found to produce
savings.] HHSC may achieve savings
through various medical policy initiatives, taking into consideration the
following:
(1)
Clarifying policy language regarding co-therapy definition, documentation,
and billing requirements,
(2)
Clarifying who can participate in therapy sessions in policy that interns,
aides, students, orderlies and technicians can participate in therapy
sessions when they are directly and appropriately supervised according to
provider licensure requirements, but they are not eligible to enroll as
providers and bill Texas Medicaid for services,
(3)
Consolidate Traditional, Comprehensive Care Program and Home Health Agency
therapy policies into one policy,
(4)
Require a primary care or treating physician to initiate a signed order or
referral prior to an initial therapy evaluation. The initial evaluation may
require prior authorization and the signed order or referral must be dated
prior to the evaluation,
(5)
Require a primary care or treating physician to order the therapy services
based on the outcomes of the evaluation,
(6)
Clarify medical necessity for therapy services to ensure prior
authorization staff who are reviewing requests are using guidelines based
on the nationally recognized standards of care,
(7)
Require licensed Medicaid enrolled therapists to document and support
decisions for continued therapy based on professional assessment of a
client's progress relative to their individual treatment plan and in
concert with the client's primary care physician and the individual and/or
family,
(8)
Ensure appropriate duration of services by aligning authorization periods
with national standards,
(9)
Streamline prior authorization processes, and
(10)
Implement policies that ensure services are provided in the most
cost-efficient and medically appropriate setting, and implementation of
other medical or billing policy changes.
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SECTION 4. HEALTH AND HUMAN
SERVICES COMMISSION: CERTAIN RIDERS. Subsection (c), Rider 50, page II-97,
Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015
(the General Appropriations Act), to the bill pattern of the appropriations
to the Health and Human Services Commission is amended to read as follows:
c. HHSC shall reform
reimbursement methodology to be in line with industry standards[, policies,] and utilization
for acute care therapy services (including physical, occupational, and
speech therapies) while considering stakeholder input and access to care. In
state fiscal year 2017, $28,500,000 [Out of the amount in subsection
(a), in each fiscal year at least $50,000,000] in General Revenue Funds
savings should be achieved through rate reductions [and $25,000,000 in General Revenue Funds savings may be
achieved through various medical policy initiatives listed in items
(1)-(10), below. If $25,000,000 in savings is not achieved
through various medical policy initiatives in fiscal year 2016, the amount
of unrealized savings (the difference between $25,000,000 in General
Revenue Funds and savings actually achieved in fiscal year 2016) should be
achieved through additional rate reductions in fiscal year 2017 while
continuing any initiatives implemented in fiscal year 2016 that have been
found to produce savings. HHSC may
achieve savings through various medical policy initiatives, taking into
consideration the following:
[(1)
Clarifying policy language regarding co-therapy definition, documentation,
and billing requirements,
[(2)
Clarifying who can participate in therapy sessions in policy that interns,
aides, students, orderlies and technicians can participate in therapy
sessions when they are directly and appropriately supervised according to
provider licensure requirements, but they are not eligible to enroll as
providers and bill Texas Medicaid for services,
[(3)
Consolidate Traditional, Comprehensive Care Program and Home Health Agency
therapy policies into one policy,
[(4)
Require a primary care or treating physician to initiate a signed order or
referral prior to an initial therapy evaluation. The initial evaluation may
require prior authorization and the signed order or referral must be dated
prior to the evaluation,
[(5)
Require a primary care or treating physician to order the therapy services
based on the outcomes of the evaluation,
[(6)
Clarify medical necessity for therapy services to ensure prior
authorization staff who are reviewing requests are using guidelines based
on the nationally recognized standards of care,
[(7)
Require licensed Medicaid enrolled therapists to document and support
decisions for continued therapy based on professional assessment of a
client's progress relative to their individual treatment plan and in
concert with the client's primary care physician and the individual and/or
family,
[(8)
Ensure appropriate duration of services by aligning authorization periods
with national standards,
[(9)
Streamline prior authorization processes, and
[(10)
Implement policies that ensure services are provided in the most
cost-efficient and medically appropriate setting, and implementation of
other medical or billing policy changes].
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SECTION 5. HEALTH AND HUMAN
SERVICES COMMISSION: CRITICAL LIFE AND SAFETY NEEDS. In addition to amounts
previously appropriated for the state fiscal biennium ending August 31,
2017, $188,609,263 is appropriated from the economic stabilization fund to
the Health and Human Services Commission for the two-year period beginning
on the effective date of this Act for critical life and safety needs at
state hospitals and state supported living centers.
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No
equivalent provision.
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SECTION 6. HEALTH AND HUMAN
SERVICES COMMISSION: FORENSIC BED CAPACITY. In addition to amounts
previously appropriated for the state fiscal biennium ending August 31,
2017, $50,000,000 is appropriated from the economic stabilization fund to
the Health and Human Services Commission for the two-year period beginning
on the effective date of this Act to increase bed capacity at state
hospitals and in mental health community hospitals.
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No
equivalent provision.
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SECTION 7. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: ADDITIONAL APPROPRIATIONS. In addition to
amounts previously appropriated for the state fiscal biennium ending August
31, 2017, the following amounts are appropriated from the economic stabilization fund to the
Department of Family and Protective Services for the state fiscal year ending
August 31, 2017, for the following purposes as listed in Chapter 1281 (H.B.
1), Acts of the 84th Legislature, Regular Session, 2015 (the General
Appropriations Act):
(1) $12,740,200 for Strategy
B.1.3., TWC Contracted Day Care;
(2) $31,993,283 for Strategy
B.1.9., Foster Care Payments; and
(3) $1,576,783 for Strategy
B.1.10., Adoption/PCA Payments.
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SECTION 5. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: ADDITIONAL APPROPRIATIONS. In addition to
amounts previously appropriated for the state fiscal biennium ending August
31, 2017, the following amounts are appropriated from the general revenue fund to the Department
of Family and Protective Services for the state fiscal year ending August
31, 2017, for the following purposes as listed in Chapter 1281 (H.B. 1),
Acts of the 84th Legislature, Regular Session, 2015 (the General
Appropriations Act):
(1) $12,740,200 for Strategy
B.1.3., TWC Contracted Day Care;
(2) $31,993,283 for Strategy
B.1.9., Foster Care Payments; and
(3) $1,576,783 for Strategy
B.1.10., Adoption/PCA Payments.
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SECTION 8. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: CERTAIN TRANSFERS. Notwithstanding the
limitations of Rider 32, page II-43, Chapter 1281 (H.B. 1), Acts of the
84th Legislature, Regular Session, 2015 (the General Appropriations Act),
to the bill pattern of the appropriations to the Department of Family and
Protective Services, the department shall transfer $435,475 from Strategy
B.1.11., Relative Caregiver Payments, to Strategy B.1.9., Foster Care
Payments, as listed in Chapter 1281 (H.B. 1), Acts of the 84th Legislature,
Regular Session, 2015 (the General Appropriations Act).
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SECTION 6. Same as introduced
version.
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SECTION 9. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: ADDITIONAL APPROPRIATIONS FOR AGENCY
CRITICAL NEEDS. In addition to amounts previously appropriated for the
state fiscal biennium ending August 31, 2017, the Department of Family and
Protective Services is appropriated for the state fiscal year ending August
31, 2017, the following amounts from the economic
stabilization fund for the following strategies as listed in Chapter
1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015 (the
General Appropriations Act), to address critical needs of the agency with
respect to those strategies:
(1) $75,521,204 for Strategy
B.1.1., CPS Direct Delivery Staff;
(2) $613,174 for Strategy
B.1.2., CPS Program Support;
(3) $21,000,000 for Strategy
B.1.9., Foster Care Payments;
(4) $138,854 for Strategy
D.1.1., APS Direct Delivery Staff;
(5) $6,703 for Strategy D.1.2.,
APS Program Support;
(6) $376,259 for Strategy
F.1.1., Central Administration;
(7) $33,546 for Strategy
F.1.2., Other Support Services;
(8) $3,067,626 for Strategy
F.1.4., IT Program Support; and
(9) $940,108 for Strategy
G.1.1., Agency-Wide Automated Systems.
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SECTION 7. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: ADDITIONAL APPROPRIATIONS FOR AGENCY
CRITICAL NEEDS. In addition to amounts previously appropriated for the
state fiscal biennium ending August 31, 2017, the Department of Family and
Protective Services is appropriated for the state fiscal year ending August
31, 2017, the following amounts from the general
revenue fund for the following strategies as listed in Chapter 1281
(H.B. 1), Acts of the 84th Legislature, Regular Session, 2015 (the General
Appropriations Act), to address critical needs of the agency with respect
to those strategies:
(1) $75,521,204 for Strategy
B.1.1., CPS Direct Delivery Staff;
(2) $613,174 for Strategy
B.1.2., CPS Program Support;
(3) $21,000,000 for Strategy
B.1.9., Foster Care Payments;
(4) $138,854 for Strategy
D.1.1., APS Direct Delivery Staff;
(5) $6,703 for Strategy
D.1.2., APS Program Support;
(6) $376,259 for Strategy
F.1.1., Central Administration;
(7) $33,546 for Strategy
F.1.2., Other Support Services;
(8) $3,067,626 for Strategy
F.1.4., IT Program Support; and
(9) $940,108 for Strategy
G.1.1., Agency-Wide Automated Systems.
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SECTION 10. DEPARTMENT OF
FAMILY AND PROTECTIVE SERVICES: CERTAIN TRANSFERS. (a) Notwithstanding any
transfer limitation specified in Chapter 1281 (H.B. 1), Acts of the 84th
Legislature, Regular Session, 2015 (the General Appropriations Act), the
Department of Family and Protective Services shall transfer to the Health
and Human Services Commission the following amounts:
(1) $29,247,213 of general
revenue funds; and
(2) $72,450,261 of Temporary
Assistance for Needy Families (TANF) program federal funds.
(b) The Health and Human
Services Commission may spend Temporary Assistance for Needy Families
(TANF) program federal funds transferred under Subsection (a)(2) of this
section during the state fiscal year ending August 31, 2017, only with the
prior written approval of the Legislative Budget Board in accordance with
Section 69, Article XVI, Texas Constitution.
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SECTION 8. Same as introduced
version.
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SECTION 11. DEPARTMENT OF
CRIMINAL JUSTICE: CORRECTIONAL MANAGED HEALTH CARE SHORTFALL. In addition
to amounts previously appropriated for the state fiscal biennium ending
August 31, 2017, $80,000,000 is appropriated from the economic stabilization fund to the
Department of Criminal Justice for the state fiscal year ending August 31,
2017, for correctional managed health care under Strategy C.1.9., Hospital
and Clinical Care, as listed in Chapter 1281 (H.B. 1), Acts of the 84th
Legislature, Regular Session, 2015 (the General Appropriations Act).
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SECTION 10. DEPARTMENT OF
CRIMINAL JUSTICE: CORRECTIONAL MANAGED HEALTH CARE SHORTFALL. In addition
to amounts previously appropriated for the state fiscal biennium ending
August 31, 2017, $80,000,000 is appropriated from the general revenue fund to the Department
of Criminal Justice for the state fiscal year ending August 31, 2017, for
correctional managed health care under Strategy C.1.9., Hospital and
Clinical Care, as listed in Chapter 1281 (H.B. 1), Acts of the 84th
Legislature, Regular Session, 2015 (the General Appropriations Act).
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SECTION 12. TEXAS A&M
FOREST SERVICE: APPROPRIATION FOR GENERAL COSTS CAUSED BY VARIOUS EMERGENCY
WEATHER-RELATED RESPONSES. In addition to amounts previously appropriated
for the state fiscal biennium ending August 31, 2017, $5,100,000 is
appropriated from the economic
stabilization fund to the Texas A&M Forest Service for the state
fiscal year ending August 31, 2017, for the purpose of paying for, or reimbursing
payments made for, costs incurred by the forest service associated with
responding to various weather-related emergencies.
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SECTION 9. TEXAS A&M
FOREST SERVICE: APPROPRIATION FOR GENERAL COSTS CAUSED BY VARIOUS EMERGENCY
WEATHER-RELATED RESPONSES. In addition to amounts previously appropriated
for the state fiscal biennium ending August 31, 2017, $5,100,000 is
appropriated from the general revenue
fund to the Texas A&M Forest Service for the state fiscal year
ending August 31, 2017, for the purpose of paying for, or reimbursing
payments made for, costs incurred by the forest service associated with
responding to various weather-related emergencies.
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No
equivalent provision.
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SECTION 11. JUVENILE JUSTICE
DEPARTMENT: OPERATIONAL SHORTFALL. In addition to amounts previously
appropriated for the state fiscal biennium ending August 31, 2017,
$4,469,257 is appropriated from the general revenue fund to the Juvenile
Justice Department for the state fiscal year ending August 31, 2017, for an
operational shortfall.
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SECTION 13. ANIMAL HEALTH
COMMISSION: CATTLE FEVER TICKS. (a) In addition to amounts previously
appropriated for the state fiscal biennium ending August 31, 2017, $649,987
is appropriated from the economic
stabilization fund to the Animal Health Commission for the state
fiscal year ending August 31, 2017, for preparedness for, response to, and
mitigation of cattle fever ticks under Strategy A.1.1., Field Operations,
as listed in Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular
Session, 2015 (the General Appropriations Act).
(b)
The amount of $7,169,791 is appropriated from the economic stabilization
fund to the Animal Health Commission for the state fiscal biennium
beginning September 1, 2017, for preparedness for, response to, and
mitigation of cattle fever ticks.
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SECTION 12. ANIMAL HEALTH
COMMISSION: CATTLE FEVER TICKS. In addition to amounts previously
appropriated for the state fiscal biennium ending August 31, 2017, $649,987
is appropriated from the general revenue
fund to the Animal Health Commission for the state fiscal year
ending August 31, 2017, for preparedness for, response to, and mitigation
of cattle fever ticks under Strategy A.1.1., Field Operations, as listed in
Chapter 1281 (H.B. 1), Acts of the 84th Legislature, Regular Session, 2015
(the General Appropriations Act).
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SECTION 14. EFFECTIVE DATE. (a) Except as provided by Subsection (b) of
this section, this Act takes effect immediately.
(b)
Sections 2, 3, 5, 6, 7, 9, 11, 12, and 13 of this Act take effect only if
this Act receives a vote of two-thirds of the members present in each house
of the legislature, as provided by Section 49-g(m), Article III, Texas
Constitution.
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SECTION 13. EFFECTIVE DATE. This
Act takes effect immediately.
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