85R9622 LED-D

By: Longoria H.B. No. 4115

A BILL TO BE ENTITLED

AN ACT

relating to the establishment of a home and community support services improvement pilot program under the Medicaid managed care program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 533, Government Code, is amended by adding Subchapter F to read as follows:

SUBCHAPTER F. HOME AND COMMUNITY SUPPORT SERVICES IMPROVEMENT

PILOT PROGRAM

Sec. 533.101. DEFINITIONS. In this subchapter:

(1) "Electronic visit verification device" means a device that is installed in an individual's residence and is used by a provider agency to verify that a personal care attendant arrives at the individual's residence to provide services.

(2) "Health service region" means a public health region designated under Section 121.007, Health and Safety Code.

(3) "Participating provider agency" means a provider agency participating in the pilot program established under this subchapter.

(4) "Personal care attendant" means an individual employed by a provider agency to provide personal care services. The term does not include an individual described by Section 142.003(a)(1) or (2), Health and Safety Code.

(5) "Personal care services" means nonmedical services that enable an individual to engage in the activities of daily living or to perform the physical functions required for independent living, including:

(A) bathing, dressing, grooming, feeding, exercising, toileting, positioning, assisting with self-administered medications, routine hair and skin care, and transfer or ambulation; and

(B) light housekeeping, grocery shopping, meal preparation, and laundry.

(6) "Pilot program" means the program established under this subchapter.

(7) "Provider agency" means an agency that contracts with a managed care organization that contracts with the commission to provide health care services to recipients for the provision of personal care services by the agency. The term includes a home and community support services agency licensed under Chapter 142, Health and Safety Code, and a continuing care facility licensed under Chapter 246, Health and Safety Code.

Sec. 533.102. PILOT PROGRAM. (a) The commission shall establish a pilot program in the health service region designated as Region 11 to:

(1) improve the delivery of home and community support services by provider agencies under the Medicaid managed care program;

(2) reduce recipient rehospitalization and unplanned doctor visits;

(3) achieve cost savings; and

(4) reduce fraud, abuse, and waste.

(b) The commission, with the assistance of interested parties, including participating provider agencies, managed care organizations, researchers, and persons who provide funding for the program, shall develop the pilot program. The program must:

(1) provide services to at least 15,000 and not more than 20,000 recipients by its final year of operation; and

(2) include the components described by this subchapter.

(c) The commission shall contract with an independent or university-based health research organization, such as a university group, to assist with the pilot program, by conducting research for and evaluating the effectiveness of the program. The research organization may:

(1) determine data that will be reported and performance measures that will be used under the program;

(2) provide feedback throughout the operation of the program to adjust data reporting;

(3) evaluate the relationship between changes implemented by the program and recipient health outcomes;

(4) compare recipient health outcomes with those of recipients not receiving services in the program; and

(5) prepare a final report that analyzes the effectiveness of the program and makes recommendations about whether to continue the program or any part of the program.

Sec. 533.103. PERSONAL CARE ATTENDANT TRAINING. The commission, in consultation with participating provider agencies and a local community college or health care training organization, shall develop as a component of the pilot program a training program for personal care attendants. The program's curriculum must focus on helping a personal care attendant avoid recipient rehospitalization and must include instruction about:

(1) recognition of potential adverse health care conditions;

(2) trip and fall avoidance;

(3) basic nutrition and cooking;

(4) medication prompting; and

(5) mobility and activity enhancement.

Sec. 533.104. INCREASED SUPERVISION AND COMPLIANCE. As a component of the pilot program, the commission shall require a participating provider agency to:

(1) increase supervision of the agency's personal care attendants;

(2) implement stricter compliance protocols for attendants; and

(3) at least quarterly conduct scheduled and unscheduled visits to a recipient's home to confer with the recipient about the personal care services the recipient is receiving.

Sec. 533.105. FRAUD, WASTE, AND ABUSE PREVENTION PROTOCOLS. As a component of the pilot program, the commission shall require a participating provider agency to:

(1) develop enhanced fraud, waste, and abuse prevention protocols that address collusion and fraud among recipients, personal care attendants, and other provider agency staff; and

(2) implement the protocols during a recipient's enrollment, an agency's hiring process and employment reviews, and other critical points in the delivery of personal care services.

Sec. 533.106. PERSONAL CARE ATTENDANT REGISTRY. The commission, in consultation with participating provider agencies and managed care organizations that contract with the commission to provide health care services to recipients, shall establish as a component of the pilot program a personal care attendant registry that allows the commission to:

(1) track personal care attendant performance by measuring recipient health outcomes; and

(2) identify each personal care attendant who fails to meet certain standards, including following a participating provider agency's implementation of progressive work improvement efforts for the attendant.

Sec. 533.107. RECIPIENT TRANSFER PROTOCOLS. (a) As a component of the pilot program, the commission shall require a participating provider agency to develop and implement enhanced recipient transfer protocols to:

(1) prevent a recipient and personal care attendant from moving to a different provider agency in an effort to avoid disciplinary action against or unfairly leverage a raise for the personal care attendant;

(2) prevent fraud, waste, and abuse; and

(3) identify a poorly performing personal care attendant.

(b) An enhanced recipient transfer protocol developed under this section must allow a recipient to choose a provider agency.

Sec. 533.108. ENHANCED ELECTRONIC VISIT VERIFICATION DEVICE COMPLIANCE. (a) As a component of the pilot program, the commission shall require a participating provider agency to develop and implement enhanced electronic visit verification device compliance protocols to prevent fraud and waste due to an attendant's reporting of hours that the attendant did not work.

(b) The commission shall meet with developers or providers of electronic visit verification devices used by provider agencies to explore additional options to counter fraud using the systems.

Sec. 533.109. ANTI-SOLICITATION AND ANTI-KICKBACK RULES. The commission, in consultation with participating provider agencies, shall determine as a component of the pilot program strategies to strengthen anti-solicitation and anti-kickback rules in order to prevent fraud and waste and improve the continuity of care for recipients.

Sec. 533.110. ENHANCED PROVIDER AGENCY STANDARDS. The commission, in consultation with participating provider agencies, shall develop as a component of the pilot program stricter provider agency standards to continually improve the delivery of home and community support services. The standards must be outcome-based and measured by recipient health outcomes or satisfaction.

Sec. 533.111. INCREASED ENFORCEMENT. (a) The commission, in consultation with the commission's office of inspector general and participating provider agencies, shall develop and implement:

(1) strengthened enforcement strategies for the pilot program components; and

(2) effective strategies for provider agency self-regulation with respect to the pilot program components and other applicable requirements.

(b) The strategies must focus on:

(1) preventing fraud, waste, and abuse;

(2) eliminating from the Medicaid managed care program the provider agencies and personal care attendants who have the poorest performance;

(3) improving health care outcomes for recipients; and

(4) increasing savings for the state.

Sec. 533.112. MANAGED CARE ORGANIZATION PARTNERSHIPS. The commission shall coordinate as a component of the pilot program partnerships between participating provider agencies and managed care organizations that contract with the commission to provide health care services to recipients to improve the delivery of home and community support services under the Medicaid managed care program.

Sec. 533.113. REPORT. (a) Not later than September 1, 2021, the commission shall submit to the legislature a report concerning the pilot program that includes:

(1) the results of any research related to the program;

(2) the effectiveness of each component of the program;

(3) any reports made by a participant or research organization during the course of the program;

(4) other relevant information concerning the program; and

(5) a recommendation about whether the pilot program should be continued in whole or in part, expanded, or terminated.

(b) The commission shall provide the report prepared under Subsection (a) to participating provider agencies and managed care organizations.

Sec. 533.114. GIFTS, GRANTS, AND DONATIONS. The commission may solicit and accept gifts, grants, and donations of any kind and from any source for purposes of implementing this subchapter.

Sec. 533.115. RULES. The executive commissioner may adopt rules necessary to implement this subchapter.

Sec. 533.116. EXPIRATION. This subchapter expires September 1, 2023.

SECTION 2. Not later than January 1, 2018, the Health and Human Services Commission shall establish the home and community support services improvement pilot program as required by Subchapter F, Chapter 533, Government Code, as added by this Act.

SECTION 3. 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 4. This Act takes effect immediately if it 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 immediate effect, this Act takes effect September 1, 2017.