By: Klick, Raymond H.B. No. 4533
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the system redesign for delivery of Medicaid acute care
  services and long-term services and supports to persons with an
  intellectual or developmental disability or with similar
  functional needs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 534.001, Government Code, is amended by
  amending Subdivision (3) and adding Subdivisions (3-a) and (11-a)
  to read as follows:
               (3)  "Comprehensive long-term services and supports
  provider" means a provider of long-term services and supports under
  this chapter that ensures the coordinated, seamless delivery of the
  full range of services in a recipient's program plan. The term
  includes:
                     (A)  a provider under the ICF-IID program; and
                     (B)  a provider under a Medicaid waiver program
  ["Department"   means the Department of Aging and Disability
  Services].
               (3-a)  "Consumer direction model" has the meaning
  assigned by Section 531.051.
               (11-a)  "Residential services" means services provided
  to an individual with an intellectual or developmental disability
  through a community-based ICF-IID, three- or four-person home or
  host home setting under the home and community-based services (HCS)
  waiver program, or a group home under the deaf-blind with multiple
  disabilities (DBMD) waiver program.
         SECTION 2.  Sections 534.051 and 534.052, Government Code,
  are amended to read as follows:
         Sec. 534.051.  ACUTE CARE SERVICES AND LONG-TERM SERVICES
  AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR
  DEVELOPMENTAL DISABILITY. In accordance with this chapter, the
  commission [and the department] shall [jointly] design and
  implement an acute care services and long-term services and
  supports system for individuals with an intellectual or
  developmental disability that supports the following goals:
               (1)  provide Medicaid services to more individuals in a
  cost-efficient manner by providing the type and amount of services
  most appropriate to the individuals' needs and preferences in the
  most integrated and least restrictive setting;
               (2)  improve individuals' access to services and
  supports by ensuring that the individuals receive information about
  all available programs and services, including employment and least
  restrictive housing assistance, and how to apply for the programs
  and services;
               (3)  improve the assessment of individuals' needs and
  available supports, including the assessment of individuals'
  functional needs;
               (4)  promote person-centered planning, self-direction,
  self-determination, community inclusion, and customized,
  integrated, competitive employment;
               (5)  promote individualized budgeting based on an
  assessment of an individual's needs and person-centered planning;
               (6)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (7)  improve acute care and long-term services and
  supports outcomes, including reducing unnecessary
  institutionalization and potentially preventable events;
               (8)  promote high-quality care;
               (9)  provide fair hearing and appeals processes in
  accordance with applicable federal law;
               (10)  ensure the availability of a local safety net
  provider and local safety net services;
               (11)  promote independent service coordination and
  independent ombudsmen services; and
               (12)  ensure that individuals with the most significant
  needs are appropriately served in the community and that processes
  are in place to prevent inappropriate institutionalization of
  individuals.
         Sec. 534.052.  IMPLEMENTATION OF SYSTEM REDESIGN. The
  commission [and department] shall, in consultation and
  collaboration with the advisory committee, [jointly] implement the
  acute care services and long-term services and supports system for
  individuals with an intellectual or developmental disability in the
  manner and in the stages described in this chapter.
         SECTION 3.  Sections 534.053(a) and (b), Government Code,
  are amended to read as follows:
         (a)  The Intellectual and Developmental Disability System
  Redesign Advisory Committee shall advise the commission [and the
  department] on the implementation of the acute care services and
  long-term services and supports system redesign under this
  chapter.  Subject to Subsection (b), the executive commissioner
  [and the commissioner of aging and disability services] shall
  [jointly] appoint members of the advisory committee who are
  stakeholders from the intellectual and developmental disabilities
  community, including:
               (1)  individuals with an intellectual or developmental
  disability who are recipients of services under the Medicaid waiver
  programs, individuals with an intellectual or developmental
  disability who are recipients of services under the ICF-IID
  program, and individuals who are advocates of those recipients,
  including at least three representatives from intellectual and
  developmental disability advocacy organizations;
               (2)  representatives of Medicaid managed care and
  nonmanaged care health care providers, including:
                     (A)  physicians who are primary care providers and
  physicians who are specialty care providers;
                     (B)  nonphysician mental health professionals;
  and
                     (C)  providers of long-term services and
  supports, including direct service workers;
               (3)  representatives of entities with responsibilities
  for the delivery of Medicaid long-term services and supports or
  other Medicaid service delivery, including:
                     (A)  representatives of aging and disability
  resource centers established under the Aging and Disability
  Resource Center initiative funded in part by the federal
  Administration on Aging and the Centers for Medicare and Medicaid
  Services;
                     (B)  representatives of community mental health
  and intellectual disability centers;
                     (C)  representatives of and service coordinators
  or case managers from private and public home and community-based
  services providers that serve individuals with an intellectual or
  developmental disability; and
                     (D)  representatives of private and public
  ICF-IID providers; and
               (4)  representatives of managed care organizations
  contracting with the state to provide services to individuals with
  an intellectual or developmental disability.
         (b)  To the greatest extent possible, the executive
  commissioner [and the commissioner of aging and disability
  services] shall appoint members of the advisory committee who
  reflect the geographic diversity of the state and include members
  who represent rural Medicaid recipients.
         SECTION 4.  Section 534.053(g), Government Code, as amended
  by Chapters 837 (S.B. 200), 946 (S.B. 277), and 1117 (H.B. 3523),
  Acts of the 84th Legislature, Regular Session, 2015, is reenacted
  and amended to read as follows:
         (g)  On the second [one-year] anniversary of the date the
  commission completes implementation of the transition required
  under Section 534.202:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         SECTION 5.  Section 534.054(b), Government Code, is amended
  to read as follows:
         (b)  This section expires on the second anniversary of the
  date the commission completes implementation of the transition
  required under Section 534.202 [January 1, 2026].
         SECTION 6.  The heading to Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
  SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING [PROGRAMS TO
  IMPROVE] SERVICE DELIVERY MODELS
         SECTION 7.  Section 534.101, Government Code, is amended by
  amending Subdivision (2) and adding Subdivision (3) to read as
  follows:
               (2)  "Pilot program" means the pilot program
  established under this subchapter ["Provider" means a person with
  whom the commission contracts for the provision of long-term
  services and supports under Medicaid to a specific population based
  on capitation].
               (3)  "Pilot program workgroup" means the pilot program
  workgroup established under Section 534.1015.
         SECTION 8.  Subchapter C, Chapter 534, Government Code, is
  amended by adding Section 534.1015 to read as follows:
         Sec. 534.1015.  PILOT PROGRAM WORKGROUP. (a)  The executive
  commissioner, in consultation with the advisory committee, shall
  establish a pilot program workgroup to provide assistance in
  developing and advice concerning the operation of the pilot
  program.
         (b)  The pilot program workgroup is composed of:
               (1)  representatives of the advisory committee;
               (2)  stakeholders representing individuals with an
  intellectual or developmental disability;
               (3)  stakeholders representing individuals with
  similar functional needs as those individuals described by
  Subdivision (2); and
               (4)  representatives of managed care organizations
  that contract with the commission to provide services under the
  STAR+PLUS Medicaid managed care program.
         (c)  Chapter 2110 applies to the pilot program workgroup.
         SECTION 9.  Sections 534.102 and 534.103, Government Code,
  are amended to read as follows:
         Sec. 534.102.  PILOT PROGRAM [PROGRAMS] TO TEST
  PERSON-CENTERED MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON
  CAPITATION. The commission, in consultation and collaboration with
  the advisory committee and pilot program workgroup, shall [and the
  department may] develop and implement a pilot program [programs] in
  accordance with this subchapter to test, through the STAR+PLUS
  Medicaid managed care program, the delivery of [one or more service
  delivery models involving a managed care strategy based on
  capitation to deliver] long-term services and supports [under
  Medicaid] to individuals participating in the pilot program [with
  an intellectual or developmental disability].
         Sec. 534.103.  STAKEHOLDER INPUT. As part of developing and
  implementing the [a] pilot program [under this subchapter], the
  commission, in consultation and collaboration with the advisory
  committee and pilot program workgroup, [department] shall develop a
  process to receive and evaluate:
               (1)  input from statewide stakeholders and
  stakeholders from a STAR+PLUS Medicaid managed care service area
  [the region of the state] in which the pilot program will be
  implemented; and
               (2)  other evaluations and data.
         SECTION 10.  Subchapter C, Chapter 534, Government Code, is
  amended by adding Section 534.1035 to read as follows:
         Sec. 534.1035.  MANAGED CARE ORGANIZATION SELECTION. (a)
  The commission, in consultation and collaboration with the advisory
  committee and pilot program workgroup, shall develop criteria
  regarding the selection of a managed care organization to
  participate in the pilot program.
         (b)  The commission shall select and contract with not more
  than two managed care organizations that contract with the
  commission to provide services under the STAR+PLUS Medicaid managed
  care program to participate in the pilot program.
         SECTION 11.  Section 534.104, Government Code, is amended to
  read as follows:
         Sec. 534.104.  [MANAGED CARE STRATEGY PROPOSALS;] PILOT
  PROGRAM DESIGN [SERVICE PROVIDERS]. (a) The [department, in
  consultation and collaboration with the advisory committee, shall
  identify private services providers or managed care organizations
  that are good candidates to develop a service delivery model
  involving a managed care strategy based on capitation and to test
  the model in the provision of long-term services and supports under
  Medicaid to individuals with an intellectual or developmental
  disability through a pilot program established under this
  subchapter.
         [(b)     The department shall solicit managed care strategy
  proposals from the private services providers and managed care
  organizations identified under Subsection (a). In addition, the
  department may accept and approve a managed care strategy proposal
  from any qualified entity that is a private services provider or
  managed care organization if the proposal provides for a
  comprehensive array of long-term services and supports, including
  case management and service coordination.
         [(c)     A managed care strategy based on capitation developed
  for implementation through a] pilot program [under this subchapter]
  must be designed to:
               (1)  increase access to long-term services and
  supports;
               (2)  improve quality of acute care services and
  long-term services and supports;
               (3)  promote:
                     (A)  informed choice and meaningful outcomes by
  using person-centered planning, flexible consumer-directed
  services, individualized budgeting, and self-determination;[,] and
                     (B)  [promote] community inclusion and
  engagement;
               (4)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (5)  promote efficiency and the best use of funding
  based on an individual's needs and preferences;
               (6)  promote through housing supports and navigation
  services stability [the placement of an individual] in housing that
  is the most integrated and least restrictive based on [setting
  appropriate to] the individual's needs and preferences;
               (7)  promote employment assistance and customized,
  integrated, and competitive employment;
               (8)  provide fair hearing and appeals processes in
  accordance with applicable federal and state law; [and]
               (9)  promote sufficient flexibility to achieve the
  goals listed in this section through the pilot program;
               (10)  promote the use of innovative technologies and
  benefits, including telemedicine, telemonitoring, the testing of
  remote monitoring, transportation services, and other innovations
  that support community integration;
               (11)  ensure an adequate provider network that includes
  comprehensive long-term services and supports providers and ensure
  that pilot program participants have a choice among those
  providers;
               (12)  ensure the timely initiation and consistent
  provision of long-term services and supports in accordance with an
  individual's person-centered plan;
               (13)  ensure that individuals with complex behavioral,
  medical, and physical needs are assessed and receive appropriate
  services in the most integrated and least restrictive setting based
  on the individuals' needs and preferences;
               (14)  increase access to, expand flexibility of, and
  promote the use of the consumer direction model; and
               (15)  promote independence, self-determination, the
  use of the consumer direction model, and decision making by
  individuals participating in the pilot program by using
  alternatives to guardianship, including a supported
  decision-making agreement as defined by Section 1357.002, Estates
  Code.
         (b)  An individual is not required to use an innovative
  technology described by Subsection (a)(10). If an individual
  chooses to use an innovative technology described by that
  subdivision, the commission shall ensure that services associated
  with the technology are delivered in a manner that:
               (1)  ensures the individual's privacy, health, and
  well-being;
               (2)  provides access to housing in the most integrated
  and least restrictive environment;
               (3)  assesses individual needs and preferences to
  promote autonomy, self-determination, the use of the consumer
  direction model, and privacy;
               (4)  increases personal independence;
               (5)  specifies the extent to which the innovative
  technology will be used, including:
                     (A)  the times of day during which the technology
  will be used;
                     (B)  the place in which the technology may be
  used;
                     (C)  the types of telemonitoring or remote
  monitoring that will be used; and
                     (D)  for what purposes the technology will be
  used;
               (6)  is consistent with and agreed on during the
  person-centered planning process;
               (7)  ensures that staff overseeing the use of an
  innovative technology:
                     (A)  review the person-centered and
  implementation plans for each individual before overseeing the use
  of the innovative technology; and
                     (B)  demonstrate competency regarding the support
  needs of each individual using the innovative technology;
               (8)  ensures that an individual using an innovative
  technology is able to request the removal of equipment relating to
  the technology and, on receipt of a request for the removal, the
  equipment is immediately removed; and
               (9)  ensures that an individual is not required to use
  telemedicine at any point during the pilot program and, in the event
  the individual refuses to use telemedicine, the managed care
  organization providing health care services to the individual under
  the pilot program arranges for services that do not include
  telemedicine.
         (c)  The pilot program must be designed to test innovative
  payment rates and methodologies for the provision of long-term
  services and supports to achieve the goals of the pilot program by
  using payment methodologies that include:
               (1)  the payment of a bundled amount without downside
  risk to a comprehensive long-term services and supports provider
  for some or all services delivered as part of a comprehensive array
  of long-term services and supports;
               (2)  enhanced incentive payments to comprehensive
  long-term services and supports providers based on the completion
  of predetermined outcomes or quality metrics; and
               (3)  any other payment models approved by the
  commission.
         (d)  An alternative payment rate or methodology described by
  Subsection (c) may be used for a managed care organization and
  comprehensive long-term services and supports provider only if the
  organization and provider agree in advance and in writing to use the
  rate or methodology [The department, in consultation and
  collaboration with the advisory committee, shall evaluate each
  submitted managed care strategy proposal and determine whether:
               [(1)     the proposed strategy satisfies the requirements
  of this section; and
               [(2)     the private services provider or managed care
  organization that submitted the proposal has a demonstrated ability
  to provide the long-term services and supports appropriate to the
  individuals who will receive services through the pilot program
  based on the proposed strategy, if implemented].
         (e)  In developing an alternative payment rate or
  methodology described by Subsection (c), the commission, managed
  care organizations, and comprehensive long-term services and
  supports providers shall consider:
               (1)  the historical costs of long-term services and
  supports, including Medicaid fee-for-service rates;
               (2)  reasonable cost estimates for new services under
  the pilot program; and
               (3)  whether an alternative payment rate or methodology
  is sufficient to promote quality outcomes and ensure a provider's
  continued participation in the pilot program [Based on the
  evaluation performed under Subsection (d), the department may
  select as pilot program service providers one or more private
  services providers or managed care organizations with whom the
  commission will contract].
         (f)  An alternative payment rate or methodology described by
  Subsection (c) may not reduce the minimum payment received by a
  provider for the delivery of long-term services and supports under
  the pilot program below the fee-for-service reimbursement rate
  received by the provider for the delivery of those services before
  participating in the pilot program.
         (g)  The pilot program must allow a comprehensive long-term
  services and supports provider for individuals with an intellectual
  or developmental disability or similar functional needs that
  contracts with the commission to provide services under Medicaid
  before the implementation date of the pilot program to voluntarily
  participate in the pilot program. A provider's choice not to
  participate in the pilot program does not affect the provider's
  status as a significant traditional provider.
         (h)  [(f)     For each pilot program service provider, the
  department shall develop and implement a pilot program.] Under the
  [a] pilot program, a participating managed care organization [the
  pilot program service provider] shall provide long-term services
  and supports under Medicaid to persons with an intellectual or
  developmental disability and persons with similar functional needs
  to test its managed care strategy based on capitation.
         (i) [(g)]  The commission [department], in consultation and
  collaboration with the advisory committee and pilot program
  workgroup, shall analyze information provided by the managed care
  organizations participating in the pilot program [service
  providers] and any information collected by the commission
  [department] during the operation of the pilot program [programs]
  for purposes of making a recommendation about a system of programs
  and services for implementation through future state legislation or
  rules.
         (j) [(h)]  The analysis under Subsection (i) [(g)] must
  include an assessment of the effect of the managed care strategies
  implemented in the pilot program [programs] on the goals described
  by this section [:
               [(1)  access to long-term services and supports;
               [(2)     the quality of acute care services and long-term
  services and supports;
               [(3)     meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
               [(4)     the integration of service coordination of acute
  care services and long-term services and supports;
               [(5)  the efficiency and use of funding;
               [(6)     the placement of individuals in housing that is
  the least restrictive setting appropriate to an individual's needs;
               [(7)     employment assistance and customized,
  integrated, competitive employment options; and
               [(8)     the number and types of fair hearing and appeals
  processes in accordance with applicable federal law].
         (k)  Before implementing the pilot program, the commission,
  in consultation and collaboration with the advisory committee and
  pilot program workgroup, shall develop and implement a process to
  ensure pilot program participants remain eligible for Medicaid
  benefits for 12 consecutive months during the pilot program.
         SECTION 12.  Subchapter C, Chapter 534, Government Code, is
  amended by adding Section 534.1045 to read as follows:
         Sec. 534.1045.  PILOT PROGRAM BENEFITS AND PROVIDER
  QUALIFICATIONS. (a) Subject to Subsection (b), the commission
  shall ensure that a managed care organization participating in the
  pilot program provides:
               (1)  all Medicaid state plan acute care benefits
  available under the STAR+PLUS Medicaid managed care program;
               (2)  long-term services and supports under the Medicaid
  state plan, including:
                     (A)  Community First Choice services;
                     (B)  personal assistance services;
                     (C)  day activity health services; and
                     (D)  habilitation services;
               (3)  long-term services and supports under the
  STAR+PLUS home and community-based services (HCBS) waiver program,
  including:
                     (A)  assisted living services;
                     (B)  personal assistance services;
                     (C)  employment assistance;
                     (D)  supported employment;
                     (E)  adult foster care;
                     (F)  dental care;
                     (G)  nursing care;
                     (H)  respite care;
                     (I)  home-delivered meals;
                     (J)  cognitive rehabilitative therapy;
                     (K)  physical therapy;
                     (L)  occupational therapy;
                     (M)  speech-language pathology;
                     (N)  medical supplies;
                     (O)  minor home modifications; and
                     (P)  adaptive aids;
               (4)  the following long-term services and supports
  under a Medicaid waiver program:
                     (A)  enhanced behavioral health services;
                     (B)  behavioral supports;
                     (C)  day habilitation; and
                     (D)  community support transportation;
               (5)  the following additional long-term services and
  supports:
                     (A)  housing supports;
                     (B)  behavioral health crisis intervention
  services; and
                     (C)  high medical needs services; and
               (6)  other nonresidential long-term services and
  supports that the commission, in consultation and collaboration
  with the advisory committee and pilot program workgroup, determines
  are appropriate and consistent with applicable requirements
  governing the Medicaid waiver programs, person-centered
  approaches, home and community-based setting requirements, and
  achieving the most integrated and least restrictive setting based
  on an individual's needs and preferences.
         (b)  A comprehensive long-term services and supports
  provider may deliver services listed under the following provisions
  only if the provider also delivers the services under a Medicaid
  waiver program:
               (1)  Subsections (a)(2)(A) and (D);
               (2)  Subsections (a)(3)(B), (C), (D), (G), (H), (J),
  (K), (L), and (M); and
               (3)  Subsection (a)(4).
         (c)  A comprehensive long-term services and supports
  provider may deliver services listed under Subsections (a)(5) and
  (6) only if the managed care organization in the network of which
  the provider participates agrees to, in a contract with the
  provider, the provision of those services.
         (d)  Day habilitation services listed under Subsection
  (a)(4)(C) may be delivered by a provider who contracts or
  subcontracts with the commission to provide day habilitation
  services under the home and community-based services (HCS) waiver
  program or the ICF-IID program.
         (e)  A comprehensive long-term services and supports
  provider participating in the pilot program shall work in
  coordination with the care coordinators of a managed care
  organization participating in the pilot program to ensure the
  seamless delivery of acute care and long-term services and supports
  on a daily basis in accordance with an individual's plan of care. A
  comprehensive long-term services and supports provider may be
  reimbursed by a managed care organization for coordinating with
  care coordinators under this subsection.
         (f)  Before implementing the pilot program, the commission,
  in consultation and collaboration with the advisory committee and
  pilot program workgroup, shall:
               (1)  for purposes of the pilot program only, develop
  recommendations to modify adult foster care and supported
  employment and employment assistance benefits to increase access to
  and availability of those services; and
               (2)  as necessary, define services listed under
  Subsections (a)(4) and (5) and any other services determined to be
  appropriate under Subsection (a)(6).
         SECTION 13.  Sections 534.105, 534.106, 534.1065, 534.107,
  534.108, and 534.109, Government Code, are amended to read as
  follows:
         Sec. 534.105.  PILOT PROGRAM: MEASURABLE GOALS. (a) The
  commission [department], in consultation and collaboration with
  the advisory committee and pilot program workgroup and using
  national core indicators, the National Quality Forum long-term
  services and supports measures, and other appropriate Consumer
  Assessment of Healthcare Providers and Systems measures, shall
  identify measurable goals to be achieved by the [each] pilot
  program [implemented under this subchapter. The identified goals
  must:
               [(1)     align with information that will be collected
  under Section 534.108(a); and
               [(2)     be designed to improve the quality of outcomes
  for individuals receiving services through the pilot program].
         (b)  The commission [department], in consultation and
  collaboration with the advisory committee and pilot program
  workgroup, shall develop [propose] specific strategies and
  performance measures for achieving the identified goals. A
  proposed strategy may be evidence-based if there is an
  evidence-based strategy available for meeting the pilot program's
  goals.
         (c)  The commission, in consultation and collaboration with
  the advisory committee and pilot program workgroup, shall ensure
  that mechanisms to report, track, and assess specific strategies
  and performance measures for achieving the identified goals are
  established before implementing the pilot program.
         Sec. 534.106.  IMPLEMENTATION, LOCATION, AND DURATION. (a)
  The commission [and the department] shall implement the [any] pilot
  program on [programs established under this subchapter not later
  than] September 1, 2023 [2017].
         (b)  The [A] pilot program [established under this
  subchapter] shall [may] operate for at least [up to] 24 months. [A
  pilot program may cease operation if the pilot program service
  provider terminates the contract with the commission before the
  agreed-to termination date.]
         (c)  The [A] pilot program [established under this
  subchapter] shall be conducted in a STAR+PLUS Medicaid managed care
  service area [one or more regions] selected by the commission
  [department].
         Sec. 534.1065.  RECIPIENT ENROLLMENT, PARTICIPATION, AND
  ELIGIBILITY [IN PROGRAM VOLUNTARY]. (a) An individual who is
  eligible for the pilot program will be enrolled automatically
  [Participation in a pilot program established under this subchapter
  by an individual with an intellectual or developmental disability
  is voluntary], and the decision whether to opt out of participation
  [participate] in the pilot [a] program and not receive long-term
  services and supports under the pilot [from a provider through
  that] program may be made only by the individual or the individual's
  legally authorized representative.
         (b)  To ensure prospective pilot program participants are
  able to make an informed decision on whether to participate in the
  pilot program, the commission, in consultation and collaboration
  with the advisory committee and pilot program workgroup, shall
  develop and distribute informational materials on the pilot program
  that describe the pilot program's benefits, the pilot program's
  impact on current services, and other related information. The
  commission shall establish a timeline and process for the
  development and distribution of the materials and shall ensure:
               (1)  the materials are developed and distributed to
  individuals eligible to participate in the pilot program with
  sufficient time to educate the individuals, their families, and
  other persons actively involved in their lives regarding the pilot
  program;
               (2)  individuals eligible to participate in the pilot
  program, including individuals enrolled in the STAR+PLUS Medicaid
  managed care program, their families, and other persons actively
  involved in their lives, receive the materials and oral information
  on the pilot program;
               (3)  the materials contain clear, simple language
  presented in a manner that is easy to understand; and
               (4)  the materials explain, at a minimum, that:
                     (A)  on conclusion of the pilot program, pilot
  program participants will be asked to provide feedback on their
  experience, including feedback on whether the pilot program was
  able to meet their unique support needs;
                     (B)  participation in the pilot program does not
  remove individuals from any Medicaid waiver program interest list;
                     (C)  individuals who choose to participate in the
  pilot program and who, during the pilot program's operation, are
  offered enrollment in a Medicaid waiver program may accept the
  enrollment, transition, or diversion offer; and
                     (D)  pilot program participants have a choice
  among acute care and comprehensive long-term services and supports
  providers and service delivery options, including the consumer
  direction model and comprehensive services model.
         (c)  The commission, in consultation and collaboration with
  the advisory committee and pilot program workgroup, shall develop
  pilot program participant eligibility criteria. The criteria must
  ensure pilot program participants:
               (1)  include individuals with an intellectual or
  developmental disability or a cognitive disability, including:
                     (A)  individuals with autism;
                     (B)  individuals with significant complex
  behavioral, medical, and physical needs who are receiving home and
  community-based services through the STAR+PLUS Medicaid managed
  care program;
                     (C)  individuals enrolled in the STAR+PLUS
  Medicaid managed care program who:
                           (i)  are on a Medicaid waiver program
  interest list;
                           (ii)  meet the criteria for an intellectual
  or developmental disability; or
                           (iii)  have a traumatic brain injury that
  occurred after the age of 21; and
                     (D)  other individuals with disabilities who have
  similar functional needs without regard to the age of onset or
  diagnosis; and
               (2)  do not include individuals who are receiving only
  acute care services under the STAR+PLUS Medicaid managed care
  program and are enrolled in the community-based ICF-IID program or
  another Medicaid waiver program.
         Sec. 534.107.  COMMISSION RESPONSIBILITIES [COORDINATING
  SERVICES]. (a) The commission [In providing long-term services
  and supports under Medicaid to individuals with an intellectual or
  developmental disability, a pilot program service provider] shall
  require that a managed care organization participating in the pilot
  program:
               (1)  ensures that individuals participating in the
  pilot program have a choice among acute care and comprehensive
  long-term services and supports providers and service delivery
  options, including the consumer direction model [coordinate
  through the pilot program institutional and community-based
  services available to the individuals, including services provided
  through:
                     [(A)     a facility licensed under Chapter 252,
  Health and Safety Code;
                     [(B)  a Medicaid waiver program; or
                     [(C)     a community-based ICF-IID operated by local
  authorities];
               (2)  demonstrates to the commission's satisfaction that
  the organization's network of acute care, long-term services and
  supports, and comprehensive long-term services and supports
  providers have experience and expertise in providing services for
  individuals with an intellectual or developmental disability and
  individuals with similar functional needs [collaborate with
  managed care organizations to provide integrated coordination of
  acute care services and long-term services and supports, including
  discharge planning from acute care services to community-based
  long-term services and supports];
               (3)  has [have] a process for preventing inappropriate
  institutionalizations of individuals; and
               (4)  ensures the timely initiation and consistent
  provision of services in accordance with an individual's
  person-centered plan [accept the risk of inappropriate
  institutionalizations of individuals previously residing in
  community settings].
         (b)  For the duration of the pilot program, the commission
  shall ensure that comprehensive long-term services and supports
  providers are considered significant traditional providers and
  included in the provider network of a managed care organization
  participating in the pilot program.
         Sec. 534.108.  PILOT PROGRAM INFORMATION. (a) The
  commission, in consultation and collaboration with the advisory
  committee and pilot program workgroup, [and the department] shall
  determine which information will be collected from a managed care
  organization participating in the pilot program to use in
  conducting the evaluation and preparing the report under Section
  534.112 [collect and compute the following information with respect
  to each pilot program implemented under this subchapter to the
  extent it is available:
               [(1)     the difference between the average monthly cost
  per person for all acute care services and long-term services and
  supports received by individuals participating in the pilot program
  while the program is operating, including services provided through
  the pilot program and other services with which pilot program
  services are coordinated as described by Section 534.107, and the
  average monthly cost per person for all services received by the
  individuals before the operation of the pilot program;
               [(2)     the percentage of individuals receiving services
  through the pilot program who begin receiving services in a
  nonresidential setting instead of from a facility licensed under
  Chapter 252, Health and Safety Code, or any other residential
  setting;
               [(3)     the difference between the percentage of
  individuals receiving services through the pilot program who live
  in non-provider-owned housing during the operation of the pilot
  program and the percentage of individuals receiving services
  through the pilot program who lived in non-provider-owned housing
  before the operation of the pilot program;
               [(4)     the difference between the average total Medicaid
  cost, by level of need, for individuals in various residential
  settings receiving services through the pilot program during the
  operation of the program and the average total Medicaid cost, by
  level of need, for those individuals before the operation of the
  program;
               [(5)     the difference between the percentage of
  individuals receiving services through the pilot program who obtain
  and maintain employment in meaningful, integrated settings during
  the operation of the program and the percentage of individuals
  receiving services through the program who obtained and maintained
  employment in meaningful, integrated settings before the operation
  of the program;
               [(6)     the difference between the percentage of
  individuals receiving services through the pilot program whose
  behavioral, medical, life-activity, and other personal outcomes
  have improved since the beginning of the program and the percentage
  of individuals receiving services through the program whose
  behavioral, medical, life-activity, and other personal outcomes
  improved before the operation of the program, as measured over a
  comparable period; and
               [(7)     a comparison of the overall client satisfaction
  with services received through the pilot program, including for
  individuals who leave the program after a determination is made in
  the individuals' cases at hearings or on appeal, and the overall
  client satisfaction with services received before the individuals
  entered the pilot program].
         (b)  For the duration of the pilot program, a managed care
  organization participating in the pilot program shall submit to the
  commission and the advisory committee quarterly reports on the
  services provided to each pilot program participant that include
  information on:
               (1)  the level of each requested service and the
  authorization and utilization rates for those services;
               (2)  timelines of:
                     (A)  the delivery of each requested service;
                     (B)  authorization of each requested service;
                     (C)  the initiation of each requested service; and
                     (D)  each unplanned break in the delivery of
  requested services and the duration of the break;
               (3)  the number of pilot program participants using
  employment assistance and supported employment services;
               (4)  the number of service denials and fair hearings
  and the dispositions of fair hearings;
               (5)  the number of complaints and inquiries received by
  the managed care organization and the outcome of each complaint;
  and
               (6)  the number of pilot program participants who
  choose the consumer direction model and the reasons why other
  participants did not choose the consumer direction model [The pilot
  program service provider shall collect any information described by
  Subsection (a) that is available to the provider and provide the
  information to the department and the commission not later than the
  30th day before the date the program's operation concludes].
         (c)  The commission shall ensure that the mechanisms to
  report and track the information and data required by this section
  are established before implementing the pilot program [In addition
  to the information described by Subsection (a), the pilot program
  service provider shall collect any information specified by the
  department for use by the department in making an evaluation under
  Section 534.104(g).
         [(d)     The commission and the department, in consultation and
  collaboration with the advisory committee, shall review and
  evaluate the progress and outcomes of each pilot program
  implemented under this subchapter and submit, as part of the annual
  report to the legislature required by Section 534.054, a report to
  the legislature during the operation of the pilot programs. Each
  report must include recommendations for program improvement and
  continued implementation].
         Sec. 534.109.  PERSON-CENTERED PLANNING. The commission, in
  consultation and collaboration [cooperation] with the advisory
  committee and pilot program workgroup [department], shall ensure
  that each individual [with an intellectual or developmental
  disability] who receives services and supports under Medicaid
  through the [a] pilot program [established under this subchapter],
  or the individual's legally authorized representative, has access
  to a comprehensive, facilitated, person-centered plan that
  identifies outcomes for the individual and drives the development
  of the individualized budget. The consumer direction model must be
  an available option for individuals to achieve self-determination,
  choice, and control[, as defined by Section 531.051, may be an
  outcome of the plan].
         SECTION 14.  Section 534.110, Government Code, is amended to
  read as follows:
         Sec. 534.110.  TRANSITION BETWEEN PROGRAMS; CONTINUITY OF
  SERVICES. (a) During the evaluation of the pilot program required
  under Section 534.112, the [The] commission may continue the pilot
  program to ensure continuity of care for pilot program
  participants. If the commission does not continue the pilot
  program following the evaluation, the commission shall ensure that
  there is a comprehensive plan for transitioning the provision of
  Medicaid benefits for pilot program participants to the benefits
  provided before participating in the pilot program [between a
  Medicaid waiver program or an ICF-IID program and a pilot program
  under this subchapter to protect continuity of care].
         (b)  A [The] transition plan under Subsection (a) shall be
  developed in consultation and collaboration with the advisory
  committee and pilot program workgroup and with stakeholder input as
  described by Section 534.103.
         SECTION 15.  Section 534.111, Government Code, is amended to
  read as follows:
         Sec. 534.111.  CONCLUSION OF PILOT PROGRAM [PROGRAMS;
  EXPIRATION]. (a) On September 1, 2025, the pilot program is
  concluded unless the commission continues the pilot program under
  Section 534.110 [2019:
               [(1)     each pilot program established under this
  subchapter that is still in operation must conclude; and
               [(2)  this subchapter expires].
         (b)  If the commission continues the pilot program under
  Section 534.110, the commission shall publish notice of the pilot
  program's continuance in the Texas Register not later than
  September 1, 2025.
         SECTION 16.  Subchapter C, Chapter 534, Government Code, is
  amended by adding Section 534.112 to read as follows:
         Sec. 534.112.  PILOT PROGRAM EVALUATIONS AND REPORTS. (a)
  The commission, in consultation and collaboration with the advisory
  committee and pilot program workgroup, shall review and evaluate
  the progress and outcomes of the pilot program and submit, as part
  of the annual report required under Section 534.054, a report on the
  pilot program's status that includes recommendations for improving
  the program.
         (b)  Not later than September 1, 2026, the commission, in
  consultation and collaboration with the advisory committee and
  pilot program workgroup, shall prepare and submit to the
  legislature a written report that evaluates the pilot program based
  on a comprehensive analysis. The analysis must:
               (1)  assess the effect of the pilot program on:
                     (A)  access to and quality of long-term services
  and supports;
                     (B)  informed choice and meaningful outcomes
  using person-centered planning, flexible consumer-directed
  services, individualized budgeting, and self-determination,
  including a pilot program participant's inclusion in the community;
                     (C)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (D)  employment assistance and customized,
  integrated, competitive employment options;
                     (E)  the number, types, and dispositions of fair
  hearings and appeals in accordance with applicable federal and
  state law;
                     (F)  increasing the use and flexibility of the
  consumer direction model;
                     (G)  increasing the use of alternatives to
  guardianship, including supported decision-making agreements as
  defined by Section 1357.002, Estates Code;
                     (H)  achieving the best and most cost-effective
  use of funding based on a pilot program participant's needs and
  preferences; and
                     (I)  attendant recruitment and retention;
               (2)  analyze the experiences and outcomes of the
  following systems changes:
                     (A)  the comprehensive assessment instrument
  described by Section 533A.0335, Health and Safety Code;
                     (B)  the 21st Century Cures Act (Pub. L. No.
  114-255);
                     (C)  implementation of the federal rule adopted by
  the Centers for Medicare and Medicaid Services and published at 79
  Fed. Reg. 2948 (January 16, 2014) related to the provision of
  long-term services and supports through a home and community-based
  services (HCS) waiver program under Section 1915(c), 1915(i), or
  1915(k) of the federal Social Security Act (42 U.S.C. Section
  1396n(c), (i), or (k));
                     (D)  the provision of basic attendant and
  habilitation services under Section 534.152; and
                     (E)  the benefits of providing STAR+PLUS Medicaid
  managed care services to persons based on functional needs;
               (3)  include feedback on the pilot program based on the
  personal experiences of:
                     (A)  individuals with an intellectual or
  developmental disability and individuals with similar functional
  needs who participated in the pilot program;
                     (B)  families of and other persons actively
  involved in the lives of individuals described by Paragraph (A);
  and
                     (C)  comprehensive long-term services and
  supports providers who delivered services under the pilot program;
               (4)  be incorporated in the annual report required
  under Section 534.054; and
               (5)  include recommendations on:
                     (A)  a system of programs and services for
  consideration by the legislature;
                     (B)  necessary statutory changes; and
                     (C)  whether to implement the pilot program
  statewide under the STAR+PLUS Medicaid managed care program for
  eligible individuals.
         SECTION 17.  The heading to Subchapter E, Chapter 534,
  Government Code, is amended to read as follows:
  SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS
  AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED
  MANAGED CARE SYSTEM
         SECTION 18.  The heading to Section 534.202, Government
  Code, is amended to read as follows:
         Sec. 534.202.  DETERMINATION TO TRANSITION [OF] ICF-IID
  PROGRAM RECIPIENTS AND CERTAIN OTHER MEDICAID WAIVER PROGRAM
  RECIPIENTS TO MANAGED CARE PROGRAM.
         SECTION 19.  Sections 534.202(a), (b), (c), (e), and (i),
  Government Code, are amended to read as follows:
         (a)  This section applies to individuals with an
  intellectual or developmental disability who[, on the date the
  commission implements the transition described by Subsection (b),]
  are receiving long-term services and supports under:
               (1)  a Medicaid waiver program [other than the Texas
  home living (TxHmL) waiver program]; or
               (2)  an ICF-IID program.
         (b)  Subject to Subsection (g), after [After] implementing
  the pilot program under Subchapter C and completing the evaluation
  under Section 534.112 [transition required by Section 534.201, on
  September 1, 2021], the commission, in consultation and
  collaboration with the advisory committee, shall develop a plan for
  the transition of all or a portion of the services provided through
  an ICF-IID program or a Medicaid waiver program to a Medicaid
  managed care model. The plan must include:
               (1)  a process for transitioning the services in phases
  as follows:
                     (A)  beginning September 1, 2027, the Texas home
  living (TxHmL) waiver program services;
                     (B)  beginning September 1, 2029, the community
  living assistance and support services (CLASS) waiver program
  services;
                     (C)  beginning September 1, 2031, nonresidential
  services provided under the home and community-based services (HCS)
  waiver program and the deaf-blind with multiple disabilities (DBMD)
  waiver program; and
                     (D)  subject to Subdivision (2), the residential
  services provided under an ICF-IID program, the home and
  community-based services (HCS) waiver program, and the deaf-blind
  with multiple disabilities (DBMD) waiver program; and
               (2)  a process for evaluating and determining the
  feasibility and cost efficiency of transitioning residential
  services described by Subdivision (1)(D) to a Medicaid managed care
  model that is based on an evaluation of a separate pilot program
  conducted by the commission, in consultation and collaboration with
  the advisory committee, that operates after the transition process
  described by Subdivision (1) [transition the provision of Medicaid
  benefits to individuals to whom this section applies to the STAR +
  PLUS Medicaid managed care program delivery model or the most
  appropriate integrated capitated managed care program delivery
  model, as determined by the commission based on cost-effectiveness
  and the experience of the transition of Texas home living (TxHmL)
  waiver program recipients to a managed care program delivery model
  under Section 534.201, subject to Subsections (c)(1) and (g)].
         (c)  Before implementing the [At the time of the] transition
  described by Subsection (b), the commission shall, subject to
  Subsection (g), determine whether to:
               (1)  continue operation of the Medicaid waiver programs
  or ICF-IID program only for purposes of providing, if applicable:
                     (A)  supplemental long-term services and supports
  not available under the managed care program delivery model
  selected by the commission; or
                     (B)  long-term services and supports to Medicaid
  waiver program recipients who choose to continue receiving benefits
  under the waiver programs [program] as provided by Subsection (g);
  or
               (2)  [subject to Subsection (g),] provide all or a
  portion of the long-term services and supports previously available
  under the Medicaid waiver programs or ICF-IID program through the
  managed care program delivery model selected by the commission.
         (e)  The commission shall ensure that there is a
  comprehensive plan for transitioning the provision of Medicaid
  benefits under this section that protects the continuity of care
  provided to individuals to whom this section applies and ensures
  individuals have a choice among acute care and comprehensive
  long-term services and supports providers and service delivery
  options, including the consumer direction model.
         (i)  In addition to the requirements of Section 533.005, a
  contract between a managed care organization and the commission for
  the organization to provide Medicaid benefits under this section
  must contain a requirement that the organization implement a
  process for individuals with an intellectual or developmental
  disability that:
               (1)  ensures that the individuals have a choice among
  acute care and comprehensive long-term services and supports
  providers and service delivery options, including the consumer
  direction model;
               (2)  to the greatest extent possible, protects those
  individuals' continuity of care with respect to access to primary
  care providers, including the use of single-case agreements with
  out-of-network providers; and
               (3)  provides access to a member services phone line
  for individuals or their legally authorized representatives to
  obtain information on and assistance with accessing services
  through network providers, including providers of primary,
  specialty, and other long-term services and supports.
         SECTION 20.  Section 534.203, Government Code, is amended to
  read as follows:
         Sec. 534.203.  RESPONSIBILITIES OF COMMISSION UNDER
  SUBCHAPTER. In administering this subchapter, the commission shall
  ensure, on making a determination to transition services under
  Section 534.202:
               (1)  that the commission is responsible for setting the
  minimum reimbursement rate paid to a provider of ICF-IID services
  or a group home provider under the integrated managed care system,
  including the staff rate enhancement paid to a provider of ICF-IID
  services or a group home provider;
               (2)  that an ICF-IID service provider or a group home
  provider is paid not later than the 10th day after the date the
  provider submits a clean claim in accordance with the criteria used
  by the commission [department] for the reimbursement of ICF-IID
  service providers or a group home provider, as applicable; [and]
               (3)  the establishment of an electronic portal through
  which a provider of ICF-IID services or a group home provider
  participating in the STAR+PLUS [STAR + PLUS] Medicaid managed care
  program delivery model or the most appropriate integrated capitated
  managed care program delivery model, as appropriate, may submit
  long-term services and supports claims to any participating managed
  care organization; and
               (4)  that the consumer direction model is an available
  option for each individual with an intellectual or developmental
  disability who receives Medicaid benefits in accordance with this
  subchapter to achieve self-determination, choice, and control, and
  that the individual or the individual's legally authorized
  representative has access to a comprehensive, facilitated,
  person-centered plan that identifies outcomes for the individual.
         SECTION 21.  Chapter 534, Government Code, is amended by
  adding Subchapter F to read as follows:
  SUBCHAPTER F. OTHER IMPLEMENTATION REQUIREMENTS AND
  RESPONSIBILITIES
         Sec. 534.251.  DELAYED IMPLEMENTATION AUTHORIZED.
  Notwithstanding any other law, the commission may delay
  implementation of a provision of this chapter without further
  investigation, adjustments, or legislative action if the
  commission determines the provision adversely affects the system of
  services and supports to persons and programs to which this chapter
  applies.
         Sec. 534.252.  REQUIREMENTS REGARDING TRANSITION OF
  SERVICES. (a) For purposes of implementing the pilot program under
  Subchapter C and transitioning the provision of services provided
  to recipients under certain Medicaid waiver programs to a Medicaid
  managed care delivery model following completion of the pilot
  program, the commission shall:
               (1)  implement and maintain a certification process for
  and maintain regulatory oversight over providers under the Texas
  home living (TxHmL) and home and community-based services (HCS)
  waiver programs; and
               (2)  require managed care organizations to include in
  the organizations' provider networks providers who are certified in
  accordance with the certification process described by Subdivision
  (1).
         (b)  For purposes of implementing the pilot program under
  Subchapter C and transitioning the provision of services described
  by Section 534.202 to the STAR+PLUS Medicaid managed care program,
  a comprehensive long-term services and supports provider:
               (1)  must report to the managed care organization in
  the network of which the provider participates each encounter of
  any directly contracted service;
               (2)  must provide to the managed care organization
  quarterly reports on:
                     (A)  coordinated services and time frames for the
  delivery of those services; and
                     (B)  the goals and objectives outlined in an
  individual's person-centered plan and progress made toward meeting
  those goals and objectives; and
               (3)  may not be held accountable for the provision of
  services specified in an individual's service plan that are not
  authorized or subsequently denied by the managed care organization.
         (c)  On transitioning services under a Medicaid waiver
  program to a Medicaid managed care delivery model, the commission
  shall ensure that individuals do not lose benefits they receive
  under the Medicaid waiver program.
         SECTION 22.  Section 534.201, Government Code, is repealed.
         SECTION 23.  Not later than September 1, 2020, and only if
  the Health and Human Services Commission determines it would be
  cost effective, the executive commissioner of the Health and Human
  Services Commission shall seek a waiver or authorization from the
  appropriate federal agency
  to provide Medicaid benefits to
  medically fragile individuals:
               (1)  who are 21 years of age or older; and
               (2)  whose health care costs exceed cost limits under
  appropriate Medicaid waiver programs, as defined by Section
  534.001, Government Code.
         SECTION 24.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules as necessary to implement the
  changes in law made by this Act.
         SECTION 25.  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 26.  This Act takes effect September 1, 2019.