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  By: Davis of Harris H.B. No. 3520
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to state fiscal matters related to health and human
  services and state agencies administering health and human services
  programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1.  REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES AND
  COST-SAVING MEASURES GENERALLY
         SECTION 1.01.  This article applies to any state agency that
  receives an appropriation under Article II of the General
  Appropriations Act and to any program administered by any of those
  agencies.
         SECTION 1.02.  Notwithstanding any other statute of this
  state, each state agency to which this article applies is
  authorized to reduce or recover expenditures by:
               (1)  consolidating any reports or publications the
  agency is required to make and filing or delivering any of those
  reports or publications exclusively by electronic means;
               (2)  extending the effective period of any license,
  permit, or registration the agency grants or administers;
               (3)  entering into a contract with another governmental
  entity or with a private vendor to carry out any of the agency's
  duties;
               (4)  adopting additional eligibility requirements
  consistent with federal law for persons who receive benefits under
  any law the agency administers to ensure that those benefits are
  received by the most deserving persons consistent with the purposes
  for which the benefits are provided, including under the following
  laws:
                     (A)  Chapter 62, Health and Safety Code (child
  health plan program);
                     (B)  Chapter 31, Human Resources Code (Temporary
  Assistance for Needy Families program);
                     (C)  Chapter 32, Human Resources Code (Medicaid
  program);
                     (D)  Chapter 33, Human Resources Code
  (supplemental nutrition assistance and other nutritional
  assistance programs); and
                     (E)  Chapter 533, Government Code (Medicaid
  managed care);
               (5)  providing that any communication between the
  agency and another person and any document required to be delivered
  to or by the agency, including any application, notice, billing
  statement, receipt, or certificate, may be made or delivered by
  e-mail or through the Internet;
               (6)  adopting and collecting fees or charges to cover
  any costs the agency incurs in performing its lawful functions; and
               (7)  modifying and streamlining processes used in:
                     (A)  the conduct of eligibility determinations
  for programs listed in Subdivision (4) of this subsection by or
  under the direction of the Health and Human Services Commission;
                     (B)  the provision of child and adult protective
  services by the Department of Family and Protective Services;
                     (C)  the provision of community health services,
  consumer protection services, and mental health services by the
  Department of State Health Services; and
                     (D)  the provision or administration of other
  services provided or programs operated by the Health and Human
  Services Commission or a health and human services agency, as
  defined by Section 531.001, Government Code.
  ARTICLE 2.  MEDICAID PROGRAM
         SECTION 2.01.  Subchapter A, Chapter 533, Government Code,
  is amended by adding Sections 533.00291, 533.00292, and 533.00293
  to read as follows:
         Sec. 533.00291.  CARE COORDINATION BENEFITS.  (a)  In this
  section, "care coordination" means assisting recipients to develop
  a plan of care, including a service plan, that meets the recipient's
  needs and coordinating the provision of Medicaid benefits in a
  manner that is consistent with the plan of care. The term is
  synonymous with "case management," "service coordination," and
  "service management."
         (b)  The commission shall streamline and clarify the
  provision of care coordination benefits across Medicaid programs
  and services for recipients receiving benefits under a managed care
  delivery model. In streamlining and clarifying the provision of
  care coordination benefits under this section, the commission shall
  at a minimum:
               (1)  subject to Subsection (c), establish a process for
  determining and designating a single entity as the primary entity
  responsible for a recipient's care coordination;
               (2)  evaluate and eliminate duplicative services
  intended to achieve recipient care coordination, including care
  coordination or related benefits provided:
                     (A)  by a Medicaid managed care organization;
                     (B)  by a recipient's medical or health home;
                     (C)  through a disease management program
  provided by a Medicaid managed care organization; 
                     (D)  by a provider of targeted case management and
  psychiatric rehabilitation services; and
                     (E)  through a program of case management for
  high-risk pregnant women and high-risk children established under
  Section 22.0031, Human Resources Code; 
               (3)  evaluate and, if the commission determines it
  appropriate, modify the capitation rate paid to Medicaid managed
  care organizations to account for the provision of care
  coordination benefits by a person not affiliated with the
  organization; and
               (4)  establish and use a consistent set of terms for
  care coordination provided under a managed care delivery model.
         (c)  In establishing a process under Subsection (b)(1), the
  commission shall ensure that:
               (1)  for a recipient who receives targeted case
  management and psychiatric rehabilitation services, the default
  entity to act as the primary entity responsible for the recipient's
  care coordination under Subsection (b)(1) is the provider of
  targeted case management and psychiatric rehabilitation services;
  and
               (2)  for recipients other than those described by
  Subdivision (1), the process includes an evaluation process
  designed to identify the provider that would best meet the care
  coordination needs of a recipient and that the commission
  incorporates into Medicaid managed care program contracts.
         Sec. 533.00292.  CARE COORDINATOR CASELOAD STANDARDS. (a)
  In this section:
               (1)  "Care coordination" has the meaning assigned by
  Section 533.00291.
               (2)  "Care coordinator" means a person, including a
  case manager, engaged by a Medicaid managed care organization to
  provide care coordination benefits.
         (b)  The executive commissioner by rule shall establish
  caseload standards for care coordinators providing care
  coordination under the STAR+PLUS home and community-based services
  supports (HCBS) program.
         (c)  The executive commissioner by rule may, if the executive
  commissioner determines it appropriate, establish caseload
  standards for care coordinators providing care coordination under
  Medicaid programs other than the STAR+PLUS home and community-based
  services supports (HCBS) program.
         (d)  In determining whether to establish caseload standards
  for a Medicaid program under Subsection (c), the executive
  commissioner shall consider whether implementing the standards
  would improve:
               (1)  Medicaid managed care organization contract
  compliance;
               (2)  the quality of care coordination provided under
  the program;
               (3)  recipient health outcomes; and
               (4)  transparency regarding the availability of care
  coordination benefits to recipients and interested stakeholders.
         Sec. 533.00293.  INFORMATION SHARING. (a) In this section:
               (1)  "Care coordination" has the meaning assigned by
  Section 533.00291.
               (2)  "Care coordinator" has the meaning assigned by
  Section 533.00292.
         (b)  To the extent permitted under applicable federal and
  state law enacted to protect the confidentiality and privacy of
  patients' health information, managed care organizations under
  contract with the commission to provide health care services to
  recipients shall ensure the sharing of information, including
  recipient medical records, among care coordinators and health care
  providers as appropriate to provide care coordination benefits.
  For purposes of implementing this section, a managed care
  organization may allow a care coordinator to share a recipient's
  service plan with health care providers, subject to the limitations
  of this section.
         SECTION 2.02.  Section 533.0061, Government Code, as added
  by Chapter 1272 (S.B. 760), Acts of the 84th Legislature, Regular
  Session, 2015, is amended by amending Subsections (a) and (c) and
  adding Subsection (d) to read as follows:
         (a)  The commission shall establish minimum provider access
  standards for the provider network of a managed care organization
  that contracts with the commission to provide health care services
  to recipients.  The access standards must ensure that a managed
  care organization provides recipients sufficient access to:
               (1)  preventive care;
               (2)  primary care;
               (3)  specialty care;
               (4)  [after-hours] urgent care;
               (5)  chronic care;
               (6)  long-term services and supports;
               (7)  nursing services;
               (8)  therapy services, including services provided in a
  clinical setting or in a home or community-based setting; and
               (9)  any other services identified by the commission.
         (c)  The commission shall biennially submit to the
  legislature and make available to the public a report containing
  information and statistics about recipient access to providers
  through the provider networks of the managed care organizations and
  managed care organization compliance with contractual obligations
  related to provider access standards established under this
  section. The report must contain:
               (1)  a compilation and analysis of information
  submitted to the commission under Section 533.005(a)(20)(D);
               (2)  for both primary care providers and specialty
  providers, information on provider-to-recipient ratios in an
  organization's provider network, as well as benchmark ratios to
  indicate whether deficiencies exist in a given network; [and]
               (3)  a description of, and analysis of the results
  from, the commission's monitoring process established under
  Section 533.007(l); and
               (4)  a detailed analysis of recipient access to urgent
  care providers, including:
                     (A)  an analysis of the implementation of any
  distance standard adopted under Section 32.0248(b)(1), Human
  Resources Code;
                     (B)  information on urgent care
  provider-to-recipient ratios; and
                     (C)  information and statistics about
  organization compliance with contractual obligations related to
  urgent care access standards, including standards established
  under Section 32.0248, Human Resources Code, and any other
  applicable standards.
         (d)  In this section, "urgent care provider" has the meaning
  assigned by Section 32.0248, Human Resources Code.
         SECTION 2.03.  Subchapter B, Chapter 32, Human Resources
  Code, is amended by adding Section 32.0248 to read as follows:
         Sec. 32.0248.  INCREASING ACCESS TO URGENT CARE PROVIDERS.  
  (a)  In this section, "urgent care provider" means a health care
  provider that:
               (1)  provides episodic ambulatory medical care to
  individuals outside of a hospital emergency room setting;
               (2)  does not require an individual to make an
  appointment;
               (3)  provides some services typically provided in a
  primary care physician's office; and
               (4)  treats individuals requiring treatment of an
  illness or injury that requires immediate care but is not
  life-threatening.
         (b)  The executive commissioner shall adopt rules and
  policies to increase recipient access to urgent care providers
  under the medical assistance program.  In adopting the rules and
  policies under this subsection, the executive commissioner shall
  consider:
               (1)  whether to establish a distance standard to ensure
  that all recipients have access to at least one urgent care provider
  within a specified distance of the recipient's residence;
               (2)  requiring that the medical assistance program
  provider database established under Section 32.102 accurately
  identify urgent care providers;
               (3)  requiring each managed care organization that
  contracts with the commission under Chapter 533, Government Code,
  to provide health care services to medical assistance recipients
  to:
                     (A)  improve the accuracy and accessibility of
  information regarding urgent care providers in the managed care
  organization's provider network directory required under Section
  533.0063, Government Code; and
                     (B)  if the organization maintains a nurse
  telephone hotline for its enrolled recipients, provide information
  to recipients, if appropriate, on the availability of services
  through in-network urgent care providers; and
               (4)  encouraging primary care physicians participating
  in the medical assistance program to maintain a relationship with
  urgent care providers for purposes of referring recipients in need
  of urgent care.
         (c)  In addition to adopting rules and policies under
  Subsection (b), to increase medical assistance recipients' access
  to urgent care providers, the commission shall consider whether to
  amend the Medicaid state plan to permit urgent care providers to
  enroll as facility providers under the medical assistance program.
         (d)  The commission shall consider implementing a process to
  streamline provider enrollment and credentialing for urgent care
  providers, including applying the requirements of Sections
  533.0055 and 533.0064, Government Code, to those providers.
         SECTION 2.04.  As soon as practicable after the effective
  date of this article, the executive commissioner of the Health and
  Human Services Commission shall adopt the rules required by Section
  32.0248, Human Resources Code, as added by this article.
         SECTION 2.05.  This article takes effect immediately if this
  Act 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 this article to
  have immediate effect, this article takes effect September 1, 2017.
  ARTICLE 3. MENTAL HEALTH SERVICES
         SECTION 3.01.  Subchapter B, Chapter 531, Government Code,
  is amended by adding Section 531.0993 to read as follows:
         Sec. 531.0993.  GRANT PROGRAM TO REDUCE RECIDIVISM, ARREST,
  AND INCARCERATION AMONG INDIVIDUALS WITH MENTAL ILLNESS AND TO
  REDUCE WAIT TIME FOR FORENSIC COMMITMENT. (a)  For purposes of this
  section, "low-income household" means a household with a total
  income at or below 200 percent of the federal poverty guideline.
         (b)  Using money appropriated to the commission for that
  purpose, the commission shall make grants to county-based community
  collaboratives for the purposes of reducing:
               (1)  recidivism by, the frequency of arrests of, and
  incarceration of persons with mental illness; and
               (2)  the total waiting time for forensic commitment of
  persons with mental illness to a state hospital.
         (c)  A community collaborative is eligible to receive a grant
  under this section only if the collaborative includes a county, a
  local mental health authority that operates in the county, and each
  hospital district, if any, located in the county.  A community
  collaborative may include other local entities designated by the
  collaborative's members.
         (d)  The commission shall condition each grant provided to a
  community collaborative under this section on the collaborative
  providing matching funds from non-state sources in a total amount
  at least equal to the awarded grant amount.  To raise matching
  funds, a collaborative may seek and receive gifts, grants, or
  donations from any person.
         (e)  The commission shall estimate the number of cases of
  serious mental illness in low-income households located in each of
  the 10 most populous counties in this state. For the purposes of
  distributing grants under this section to community collaboratives
  established in those 10 counties, for each fiscal year the
  commission shall determine an amount of grant money available on a
  per-case basis by dividing the total amount of money appropriated
  to the commission for the purpose of making grants under this
  section in that year by the estimated total number of cases of
  serious mental illness in low-income households located in those 10
  counties.
         (f)  The commission shall make available to a community
  collaborative established in each of the 10 most populous counties
  in this state a grant in an amount equal to the lesser of:
               (1)  an amount determined by multiplying the per-case
  amount determined under Subsection (e) by the estimated number of
  cases of serious mental illness in low-income households in that
  county; or
               (2)  an amount equal to the collaborative's available
  matching funds.
         (g)  To the extent appropriated money remains available to
  the commission for that purpose after the commission awards grants
  under Subsection (f), the commission shall make available to
  community collaboratives established in other counties in this
  state grants through a competitive request for proposal process.
  For purposes of awarding a grant under this subsection, a
  collaborative may include adjacent counties if, for each member
  county, the collaborative's members include a local mental health
  authority that operates in the county and each hospital district,
  if any, located in the county. A grant awarded under this
  subsection may not exceed an amount equal to the lesser of:
               (1)  an amount determined by multiplying the per-case
  amount determined under Subsection (e) by the estimated number of
  cases of serious mental illness in low-income households in the
  county or counties; or
               (2)  an amount equal to the collaborative's available
  matching funds.
         (h)  The community collaboratives established in each of the
  10 most populous counties in this state shall submit to the
  commission a plan that:
               (1)  is endorsed by each of the collaborative's member
  entities;
               (2)  identifies a target population;
               (3)  describes how the grant money and matching funds
  will be used;
               (4)  includes outcome measures to evaluate the success
  of the plan, including the plan's effect on reducing state hospital
  admissions of the target population; and
               (5)  describes how the success of the plan in
  accordance with the outcome measures would further the state's
  interest in the grant program's purposes.
         (i)  A community collaborative that applies for a grant under
  Subsection (g) must submit to the commission a plan as described by
  Subsection (h).  The commission shall consider the submitted plan
  together with any other relevant information in awarding a grant
  under Subsection (g).
         (j)  The commission must review and approve plans submitted
  under Subsection (h) or (i) before the commission distributes a
  grant under Subsection (f) or (g).  If the commission determines
  that a plan includes insufficient outcome measures, the commission
  may make the necessary changes to the plan to establish appropriate
  outcome measures.  The commission may not make other changes to a
  plan submitted under Subsection (h) or (i).
         (k)  Acceptable uses for the grant money and matching funds
  include:
               (1)  the continuation of a mental health jail diversion
  program;
               (2)  the establishment or expansion of a mental health
  jail diversion program;
               (3)  the establishment of alternatives to competency
  restoration in a state hospital, including outpatient competency
  restoration, inpatient competency restoration in a setting other
  than a state hospital, or jail-based competency restoration;
               (4)  the provision of assertive community treatment or
  forensic assertive community treatment with an outreach component;
               (5)  the provision of intensive mental health services
  and substance abuse treatment not readily available in the county;
               (6)  the provision of continuity of care services for
  an individual being released from a state hospital;
               (7)  the establishment of interdisciplinary rapid
  response teams to reduce law enforcement's involvement with mental
  health emergencies; and
               (8)  the provision of local community hospital, crisis,
  respite, or residential beds.
         (l)  Not later than December 31 of each year for which the
  commission distributes a grant under this section, each community
  collaborative that receives a grant shall prepare and submit a
  report describing the effect of the grant money and matching funds
  in achieving the standard defined by the outcome measures in the
  plan submitted under Subsection (h) or (i).
         (m)  The commission may make inspections of the operation and
  provision of mental health services provided by a community
  collaborative to ensure state money appropriated for the grant
  program is used effectively.
         (n)  The commission shall enter into an agreement with a
  qualified nonprofit or private entity to serve as the administrator
  of the grant program at no cost to the state. The administrator
  shall assist, support, and advise the commission in fulfilling the
  commission's responsibilities with respect to the grant program.
  The administrator may advise the commission on:
               (1)  design, development, implementation, and
  management of the program;
               (2)  eligibility requirements for grant recipients;
               (3)  design and management of the competitive bidding
  processes for applications or proposals and the evaluation and
  selection of grant recipients;
               (4)  grant requirements and mechanisms;
               (5)  roles and responsibilities of grant recipients;
               (6)  reporting requirements for grant recipients;
               (7)  support and technical capabilities;
               (8)  timelines and deadlines for the program;
               (9)  evaluation of the program and grant recipients;
               (10)  requirements for reporting on the program to
  policy makers; and
               (11)  estimation of the number of cases of serious
  mental illness in low-income households in each county.
  ARTICLE 4. CHILD PROTECTIVE AND PREVENTION AND EARLY INTERVENTION
  SERVICES
         SECTION 4.01.  Subchapter A, Chapter 261, Family Code, is
  amended by adding Section 261.004 to read as follows:
         Sec. 261.004.  TRACKING OF RECURRENCE OF CHILD ABUSE OR
  NEGLECT REPORTS. The department shall collect, compile, and
  monitor data regarding repeated reports of abuse or neglect
  involving the same child or by the same alleged perpetrator.  In
  compiling reports under this section, the department shall group
  together separate reports involving different children residing in
  the same household.
         SECTION 4.02.  Subchapter A, Chapter 265, Family Code, is
  amended by adding Sections 265.0041 and 265.0042 to read as
  follows:
         Sec. 265.0041.  GEOGRAPHIC RISK MAPPING FOR PREVENTION AND
  EARLY INTERVENTION SERVICES. (a) The department shall use
  existing risk terrain modeling systems, predictive analytics, or
  geographic risk assessments to:
               (1)  identify geographic areas that have high risk
  indicators of child maltreatment and child fatalities resulting
  from abuse or neglect; and
               (2)  target the implementation and use of prevention
  and early intervention services to those geographic areas.
         (b)  The department may not use data gathered under this
  section to identify a specific family or individual.
         Sec. 265.0042.  COLLABORATION WITH INSTITUTIONS OF HIGHER
  EDUCATION. (a) The Health and Human Services Commission, on behalf
  of the department, shall enter into agreements with institutions of
  higher education to conduct efficacy reviews of any prevention and
  early intervention programs that have not previously been evaluated
  for effectiveness through a scientific research evaluation
  process.
         (b)  The department shall collaborate with an institution of
  higher education to create and track indicators of child well-being
  to determine the effectiveness of prevention and early intervention
  services.
         SECTION 4.03.  Section 265.005(b), Family Code, is amended
  to read as follows:
         (b)  A strategic plan required under this section must:
               (1)  identify methods to leverage other sources of
  funding or provide support for existing community-based prevention
  efforts;
               (2)  include a needs assessment that identifies
  programs to best target the needs of the highest risk populations
  and geographic areas;
               (3)  identify the goals and priorities for the
  department's overall prevention efforts;
               (4)  report the results of previous prevention efforts
  using available information in the plan;
               (5)  identify additional methods of measuring program
  effectiveness and results or outcomes;
               (6)  identify methods to collaborate with other state
  agencies on prevention efforts; [and]
               (7)  identify specific strategies to implement the plan
  and to develop measures for reporting on the overall progress
  toward the plan's goals; and
               (8)  identify specific strategies to increase local
  capacity for the delivery of prevention and early intervention
  services through collaboration with communities and stakeholders.
  ARTICLE 5.  FEDERAL AUTHORIZATION; EFFECTIVE DATE
         SECTION 5.01.  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.
         SECTION 5.02.  Except as otherwise provided by this Act,
  this Act takes effect September 1, 2017.