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A BILL TO BE ENTITLED
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AN ACT
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relating to the amelioration and informal dispute resolution |
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processes for providers participating in certain Medicaid waiver |
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programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 161, Human Resources Code, |
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is amended by adding Sections 161.0891 and 161.0892 to read as |
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follows: |
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Sec. 161.0891. AMELIORATION PROCESS. (a) In lieu of |
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demanding payment of an administrative penalty assessed under |
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Section 161.089, the commission may, in accordance with this |
|
section, allow the provider subject to the penalty to use, under the |
|
supervision of the commission, any portion of the amount of the |
|
penalty to ameliorate the violation or to improve services in the |
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waiver program in which the provider participates. |
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(b) The commission shall offer amelioration to a provider |
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under this section not later than the 10th day after the date the |
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provider receives from the commission a final notification of the |
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assessment of an administrative penalty that is sent to the |
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provider after an informal dispute resolution process but before an |
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administrative hearing. |
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(c) A provider to whom amelioration has been offered must |
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file a plan for amelioration not later than the 45th day after the |
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date the provider receives the offer of amelioration from the |
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commission. In submitting the plan, the provider must agree to |
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waive the provider's right to an administrative hearing if the |
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commission approves the plan. |
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(d) At a minimum, a plan for amelioration must: |
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(1) propose changes to the management or operation of |
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the waiver program in which the provider participates that will |
|
improve services to or quality of care for clients in the program; |
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(2) identify, through measurable outcomes, the ways in |
|
which and the extent to which the proposed changes will improve |
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services to or quality of care for clients in the waiver program; |
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(3) establish clear goals to be achieved through the |
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proposed changes; |
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(4) establish a timeline for implementing the proposed |
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changes; and |
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(5) identify specific actions necessary to implement |
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the proposed changes. |
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(e) The commission may require that an amelioration plan |
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propose changes that would result in conditions that exceed the |
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requirements of a law or rule relating to the waiver program in |
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which the provider participates. |
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(f) The commission shall approve or deny an amelioration |
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plan not later than the 45th day after the date the commission |
|
receives the plan. On approval of a provider's plan, the commission |
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or the State Office of Administrative Hearings, as appropriate, |
|
shall deny a pending request for a hearing submitted by the |
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provider. |
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(g) The commission may not offer amelioration to a provider: |
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(1) more than three times in a two-year period; or |
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(2) more than one time in a two-year period for the |
|
same or similar violation. |
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Sec. 161.0892. INFORMAL DISPUTE RESOLUTION. (a) The |
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executive commissioner by rule shall establish an informal dispute |
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resolution process in accordance with this section. The process |
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must provide for adjudication by an appropriate disinterested |
|
person of disputes relating to a proposed enforcement action or |
|
related proceeding of the commission against a provider |
|
participating in a waiver program described by Section 161.089. |
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The informal dispute resolution process must require: |
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(1) a provider participating in a waiver program |
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described by Section 161.089 to request informal dispute resolution |
|
not later than the 10th calendar day after the date of notification |
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by the commission of the violation of a law or rule relating to the |
|
program; and |
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(2) the commission to complete the process not later |
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than the 30th calendar day after the date of receipt of a request |
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from a provider for informal dispute resolution. |
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(b) As part of the informal dispute resolution process |
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established under this section, the commission shall contract with |
|
an appropriate disinterested person who is a nonprofit organization |
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to adjudicate disputes between a provider participating in a |
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program described by Section 161.089 and the commission concerning |
|
a statement of violations prepared by the commission. Section |
|
2009.053, Government Code, does not apply to the selection of an |
|
appropriate disinterested person under this subsection. The person |
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with whom the commission contracts shall adjudicate all disputes |
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described by this subsection. |
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(c) The executive commissioner shall adopt rules to |
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adjudicate claims in contested cases. |
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(d) The commission may not delegate its responsibility to |
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administer the informal dispute resolution process established by |
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this section to another state agency. |
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SECTION 2. Subchapter D, Chapter 161, Human Resources Code, |
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is amended by adding Sections 161.0881 and 161.0882 to read as |
|
follows: |
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Sec. 161.0881. AMELIORATION PROCESS. (a) In lieu of |
|
demanding payment of an administrative penalty assessed under |
|
Section 161.088, the commission may, in accordance with this |
|
section, allow the provider subject to the penalty to use, under the |
|
supervision of the commission, any portion of the amount of the |
|
penalty to ameliorate the violation or to improve services in the |
|
waiver program in which the provider participates. |
|
(b) The commission shall offer amelioration to a provider |
|
under this section not later than the 10th day after the date the |
|
provider receives from the commission a final notification of the |
|
assessment of an administrative penalty that is sent to the |
|
provider after an informal dispute resolution process but before an |
|
administrative hearing. |
|
(c) A provider to whom amelioration has been offered must |
|
file a plan for amelioration not later than the 45th day after the |
|
date the provider receives the offer of amelioration from the |
|
commission. In submitting the plan, the provider must agree to |
|
waive the provider's right to an administrative hearing if the |
|
commission approves the plan. |
|
(d) At a minimum, a plan for amelioration must: |
|
(1) propose changes to the management or operation of |
|
the waiver program in which the provider participates that will |
|
improve services to or quality of care for clients in the program; |
|
(2) identify, through measurable outcomes, the ways in |
|
which and the extent to which the proposed changes will improve |
|
services to or quality of care for clients in the waiver program; |
|
(3) establish clear goals to be achieved through the |
|
proposed changes; |
|
(4) establish a timeline for implementing the proposed |
|
changes; and |
|
(5) identify specific actions necessary to implement |
|
the proposed changes. |
|
(e) The commission may require that an amelioration plan |
|
propose changes that would result in conditions that exceed the |
|
requirements of a law or rule relating to the waiver program in |
|
which the provider participates. |
|
(f) The commission shall approve or deny an amelioration |
|
plan not later than the 45th day after the date the commission |
|
receives the plan. On approval of a provider's plan, the commission |
|
or the State Office of Administrative Hearings, as appropriate, |
|
shall deny a pending request for a hearing submitted by the |
|
provider. |
|
(g) The commission may not offer amelioration to a provider: |
|
(1) more than three times in a two-year period; or |
|
(2) more than one time in a two-year period for the |
|
same or similar violation. |
|
Sec. 161.0882. INFORMAL DISPUTE RESOLUTION. (a) The |
|
executive commissioner by rule shall establish an informal dispute |
|
resolution process in accordance with this section. The process |
|
must provide for adjudication by an appropriate disinterested |
|
person of disputes relating to a proposed enforcement action or |
|
related proceeding of the commission against a provider |
|
participating in a waiver program described by Section 161.088. |
|
The informal dispute resolution process must require: |
|
(1) a provider participating in a waiver program |
|
described by Section 161.088 to request informal dispute resolution |
|
not later than the 10th calendar day after the date of notification |
|
by the commission of the violation of a law or rule relating to the |
|
program; and |
|
(2) the commission to complete the process not later |
|
than the 30th calendar day after the date of receipt of a request |
|
from a provider for informal dispute resolution. |
|
(b) As part of the informal dispute resolution process |
|
established under this section, the commission shall contract with |
|
an appropriate disinterested person who is a nonprofit organization |
|
to adjudicate disputes between a provider participating in a |
|
program described by Section 161.088 and the commission concerning |
|
a statement of violations prepared by the commission. Section |
|
2009.053, Government Code, does not apply to the selection of an |
|
appropriate disinterested person under this subsection. The person |
|
with whom the commission contracts shall adjudicate all disputes |
|
described by this subsection. |
|
(c) The executive commissioner shall adopt rules to |
|
adjudicate claims in contested cases. |
|
(d) The commission may not delegate its responsibility to |
|
administer the informal dispute resolution process established by |
|
this section to another state agency. |
|
SECTION 3. (a) Section 1 of this Act takes effect only if |
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the Act of the 85th Legislature, Regular Session, 2017, relating to |
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nonsubstantive additions to and corrections in enacted codes |
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becomes law. |
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(b) Section 2 of this Act takes effect only if the Act of the |
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85th Legislature, Regular Session, 2017, relating to |
|
nonsubstantive additions to and corrections in enacted codes does |
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not become law. |
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SECTION 4. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
|
Services Commission shall adopt the rules necessary to implement |
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the changes in law made by this Act. |
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SECTION 5. This Act takes effect September 1, 2017. |