88R19564 KKR-F
 
  By: Noble H.B. No. 3462
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the consolidation of ombudsman programs administered by
  the Health and Human Services Commission.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Subchapter Y, Chapter 531,
  Government Code, is amended to read as follows:
  SUBCHAPTER Y. COMMISSION OMBUDSMAN PROGRAMS [FOR THE DEPARTMENT OF
  FAMILY AND PROTECTIVE SERVICES]
         SECTION 2.  Section 531.991(2), Government Code, as amended
  by Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular
  Session, 2017, is reenacted and amended to read as follows:
               (2)  "Ombudsman" means the individual appointed as the
  ombudsman for an ombudsman program [the Department of Family and
  Protective Services].
         SECTION 3.  Section 531.991, Government Code, is amended by
  adding Subdivision (3) to read as follows:
               (3)  "Ombudsman program" means an ombudsman program
  administered by the commission under this subchapter. 
         SECTION 4.  Subchapter Y, Chapter 531, Government Code, is
  amended by adding Section 531.9912 to read as follows:
         Sec. 531.9912.  ESTABLISHMENT OF OMBUDSMAN PROGRAMS. The
  executive commissioner shall establish the following ombudsman
  programs:
               (1)  the health and human services office of the
  ombudsman in accordance with Section 531.9915;
               (2)  the ombudsman for children and youth in foster
  care in accordance with Section 531.9931; 
               (3)  the ombudsman for managed care assistance in
  accordance with Section 531.9932;
               (4)  the ombudsman for behavioral health access to care
  in accordance with Section 531.9933; and
               (5)  the ombudsman for individuals with an intellectual
  or developmental disability in accordance with Section 531.9934.
         SECTION 5.  Section 531.0171, Government Code, is
  transferred to Subchapter Y, Chapter 531, Government Code, and
  redesignated as Section 531.9915, Government Code, to read as
  follows:
         Sec. 531.9915 [531.0171].  OFFICE OF OMBUDSMAN. (a) The
  executive commissioner shall establish the commission's office of
  the ombudsman with authority and responsibility over the health and
  human services system in performing the following functions:
               (1)  providing dispute resolution services for the
  health and human services system;
               (2)  performing consumer protection and advocacy
  functions related to health and human services, including assisting
  a consumer or other interested person with:
                     (A)  raising a matter within the health and human
  services system that the person feels is being ignored; and
                     (B)  obtaining information regarding a filed
  complaint; and
               (3)  collecting inquiry and complaint data related to
  the health and human services system.
         (b)  The office of the ombudsman does not have the authority
  to provide a separate process for resolving complaints or appeals.
         (c)  The executive commissioner shall develop a standard
  process for tracking and reporting received inquiries and
  complaints within the health and human services system.  The
  process must provide for the centralized tracking of inquiries and
  complaints submitted to field, regional, or other local health and
  human services system offices.
         (d)  Using the process developed under Subsection (c), the
  office of the ombudsman shall collect inquiry and complaint data
  from all offices, agencies, divisions, and other entities within
  the health and human services system.  To assist with the
  collection of data under this subsection, the office may access any
  system or process for recording inquiries and complaints used or
  maintained within the health and human services system.
         SECTION 6.  Section 531.992, Government Code, as amended by
  Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular
  Session, 2017, is reenacted and amended to read as follows:
         Sec. 531.992.  APPOINTMENT OF OMBUDSMAN [FOR THE DEPARTMENT
  OF FAMILY AND PROTECTIVE SERVICES]. [(a)] The executive
  commissioner [governor] shall appoint an ombudsman for each
  ombudsman program [the Department of Family and Protective
  Services] to serve at the will of the executive commissioner
  [governor].
         [(b)  The ombudsman is administratively attached to the
  office of the ombudsman for the commission.
         [(c)  Subject to the appropriation of money for that purpose,
  the ombudsman may employ staff to assist the ombudsman in
  performing the ombudsman's duties under this subchapter.
         [(d)  The ombudsman may not use the name or any logo of the
  department on any forms or other materials produced and distributed
  by the ombudsman.]
         SECTION 7.  Section 531.9921, Government Code, as added by
  Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular
  Session, 2017, is reenacted and amended to read as follows:
         Sec. 531.9921.  CONFLICT OF INTEREST. A person may not serve
  as ombudsman in an ombudsman program if the person or the person's
  spouse:
               (1)  is employed by or participates in the management
  of a business entity or other organization receiving funds from the
  commission [department];
               (2)  owns or controls, directly or indirectly, any
  interest in a business entity or other organization receiving funds
  from the commission [department]; or
               (3)  is required to register as a lobbyist under
  Chapter 305 because of the person's activities for compensation on
  behalf of a profession related to the operation of the commission
  [department].
         SECTION 8.  Section 531.993, Government Code, as amended by
  Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular
  Session, 2017, is reenacted and amended to read as follows:
         Sec. 531.993.  DUTIES OF OMBUDSMAN. (a) An [The] ombudsman
  serves as an impartial [a neutral] party in assisting:
               (1)  children and youth in the conservatorship of the
  department with complaints regarding issues within the authority of
  the commission or department, as applicable [or another health and
  human services agency]; and
               (2)  persons with a complaint against the commission
  [department] regarding case-specific activities of the programs
  within the health and human services system [of the department,
  including adult protective services, child protective services,
  child-care licensing, and statewide intake].
         (b)  An [The] ombudsman shall:
               (1)  develop and implement statewide procedures to:
                     (A)  receive complaints from:
                           (i)  children and youth in the
  conservatorship of the department; and
                           (ii)  other persons with a complaint against
  a program within the health and human services system [the
  department];
                     (B)  review complaints filed with an [the]
  ombudsman and take appropriate action, including:
                           (i)  conducting an investigation into
  individual complaints that allege violations of commission
  procedures or policies [department or agency procedure or policy]
  or other violations; and
                           (ii)  referring to the commission
  [department or agency management] for resolution any trends or
  systemic issues identified in complaints;
                     (C)  provide any necessary assistance to:
                           (i)  children and youth in the
  conservatorship of the department in making complaints and
  reporting allegations of abuse, [or] neglect, or exploitation under
  Chapter 48, Human Resources Code [to the department]; and
                           (ii)  any other person in making complaints
  against a program within the health and human services system or
  reporting allegations of abuse, neglect, or exploitation under
  Chapter 48, Human Resources Code;
                     (D)  maintain the confidentiality of:
                           (i)  an [the] ombudsman's communications and
  records;
                           (ii)  records of another person that have
  been provided to an [the] ombudsman; and
                           (iii)  communications of another person with
  an [the] ombudsman; and
                     (E)  ensure that [the department and] any person
  [or a child or youth in the conservatorship of the department] who
  files a complaint with an [the] ombudsman is [are] informed of the
  results of the ombudsman's investigation of the complaint,
  including whether the ombudsman was able to substantiate the
  [person's, child's, or youth's] complaint;
               (2)  collaborate with the commission [department] to
  develop and implement an annual outreach plan to promote awareness
  of the ombudsman programs among the public[, children] and
  stakeholders [youth in the conservatorship of the department,
  family members and caretakers of those children, and facilities
  licensed by the department and] that includes:
                     (A)  how an ombudsman [the office] may be
  contacted;
                     (B)  the purpose of an ombudsman [the office]; and
                     (C)  the services an ombudsman [the office]
  provides;
               (3)  issue and file with the commission [department and
  any applicable health and human services agency] a report that
  contains an [the] ombudsman's final determination regarding a
  complaint and any recommended corrective actions to be taken as a
  result of the complaint;
               (4)  establish a secure form of communication with any
  individual who files a complaint with an [the] ombudsman;
               (5)  collaborate with the commission [department] to
  identify consequences for any retaliatory action related to a
  complaint filed with an [the] ombudsman, in accordance with Section
  531.997 [40.0041(g), Human Resources Code]; and
               (6)  monitor and evaluate the [department's] corrective
  actions taken in response to a recommendation by an [the]
  ombudsman.
         (c)  An [The] ombudsman's final determination in a report
  described by Subsection (b)(3) must include a determination of
  whether there was wrongdoing or negligence by the commission or
  department or an agent of the commission or department or whether
  the complaint was frivolous or [and] without merit. If the
  ombudsman determines there was wrongdoing or negligence, the
  ombudsman shall recommend corrective actions to be taken by the
  commission or department.
         (c-1)  The department and the commission shall provide
  written notice to an ombudsman on whether the department or
  commission adopted or rejected the ombudsman's recommended
  corrective action. If the department or commission rejects a
  recommended corrective action, the department or commission shall
  include in the notice the reason for the rejection.
         (d)  An [The] ombudsman may attend any judicial proceeding
  related to a complaint filed with the ombudsman program [office].
         SECTION 9.  Section 531.9931, Government Code, as added by
  Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular
  Session, 2017, is reenacted and amended to read as follows:
         Sec. 531.9931.  [DIVISION OF] OMBUDSMAN FOR CHILDREN AND
  YOUTH IN FOSTER CARE.  (a)  The commission shall establish an
  ombudsman program to provide support and information services to
  children and youth in foster care.
         (b)  An [The division of the] ombudsman appointed under this
  section shall [for children and youth in foster care is created
  within the office of the ombudsman for the purpose of]:
               (1)  receive [receiving] complaints from children and
  youth in the conservatorship of the department as provided under
  Section 531.993(b)(1)(A)(i) [531.993(a)(1)];
               (2)  inform [informing] children and youth in the
  conservatorship of the department who file a complaint under this
  subchapter about the result of an [the] ombudsman's investigation
  of the complaint, including whether the ombudsman was able to
  substantiate the child's or youth's complaint; and
               (3)  collaborate [collaborating] with the department
  to develop an outreach plan for children and youth in the
  conservatorship of the department to promote awareness of the
  ombudsman program.
         [(b)  If a child or youth in the conservatorship of the
  department contacts the ombudsman by telephone call to report a
  complaint under this subchapter, the call shall be transferred
  directly to a person employed by the division of the ombudsman
  created under this section.]
         SECTION 10.  Section 531.0213, Government Code, is
  transferred to Subchapter Y, Chapter 531, Government Code,
  redesignated as Section 531.9932, Government Code, and amended to
  read as follows:
         Sec. 531.9932  [531.0213]. OMBUDSMAN FOR MANAGED CARE
  ASSISTANCE [SUPPORT SERVICES FOR MEDICAID RECIPIENTS]. (a) The
  commission shall establish an ombudsman program to provide support
  and information services to a person enrolled in or applying for
  Medicaid coverage who experiences barriers to receiving health care
  services.
         (b)  An ombudsman appointed under this section [The
  commission] shall give emphasis to assisting a person with an
  urgent or immediate medical or support need.
         (c) [(b-1)]  The commission shall provide support and
  information services required by this section through a network of
  entities coordinated by the commission's [office of the] ombudsman
  program [or other division of the commission designated by the
  executive commissioner] and composed of:
               (1)  the commission's [office of the] ombudsman program
  or other division of the commission designated by the executive
  commissioner to coordinate the network;
               (2)  the office of the state long-term care ombudsman
  required under Subchapter F, Chapter 101A, Human Resources Code;
               (3)  the division within the commission responsible for
  oversight of Medicaid managed care contracts;
               (4)  area agencies on aging;
               (5)  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; and
               (6)  any other entity the executive commissioner
  determines appropriate[, including nonprofit organizations with
  which the commission contracts under Subsection (c)].
         [(c)  The commission may provide support and information
  services by contracting with nonprofit organizations that are not
  involved in providing health care, health insurance, or health
  benefits.]
         (d)  As a part of the support and information services
  required by this section, the ombudsman program [commission] shall:
               (1)  operate a statewide toll-free assistance
  telephone number that includes relay services for persons with
  speech or hearing disabilities and assistance for persons who speak
  Spanish;
               (2)  intervene promptly with the state Medicaid office,
  managed care organizations and providers, and any other appropriate
  entity on behalf of a person who has an urgent need for medical
  services;
               (3)  assist a person who is experiencing barriers in
  the Medicaid application and enrollment process and refer the
  person for further assistance if appropriate;
               (4)  educate persons so that they:
                     (A)  understand the concept of managed care;
                     (B)  understand their rights under Medicaid,
  including grievance and appeal procedures; and
                     (C)  are able to advocate for themselves;
               (5)  [collect and maintain statistical information on a
  regional basis regarding calls received by the assistance lines and
  publish quarterly reports that:
                     [(A)  list the number of calls received by region;
                     [(B)  identify trends in delivery and access
  problems;
                     [(C)  identify recurring barriers in the Medicaid
  system; and
                     [(D)  indicate other problems identified with
  Medicaid managed care;
               [(6)]  assist the state Medicaid office and managed
  care organizations and providers in identifying and correcting
  problems, including site visits to affected regions if necessary;
               (6) [(7)]  meet the needs of all current and future
  Medicaid managed care recipients, including children receiving
  dental benefits [and other recipients receiving benefits, under
  the:
                     [(A)  STAR Medicaid managed care program;
                     [(B)  STAR + PLUS Medicaid managed care program,
  including the Texas Dual Eligibles Integrated Care Demonstration
  Project provided under that program;
                     [(C)  STAR Kids managed care program established
  under Section 533.00253; and
                     [(D)  STAR Health program];
               (7) [(8)]  incorporate support services for children
  enrolled in the child health plan established under Chapter 62,
  Health and Safety Code; and
               (8) [(9)]  ensure that staff providing support and
  information services receives sufficient training, including
  training in the Medicare program for the purpose of assisting
  recipients who are dually eligible for Medicare and Medicaid, and
  has sufficient authority to resolve barriers experienced by
  recipients to health care and long-term services and supports.
         (e)  The [commission's office of the] ombudsman program[, or
  other division of the commission designated by the executive
  commissioner to coordinate the network of entities responsible for
  providing support and information services under this section,]
  must be sufficiently independent from other aspects of Medicaid
  managed care to represent the best interests of recipients in
  problem resolution.
         SECTION 11.  Section 531.02251, Government Code, is
  transferred to Subchapter Y, Chapter 531, Government Code, and
  redesignated as Section 531.9933, Government Code, to read as
  follows:
         Sec. 531.9933 [531.02251].  OMBUDSMAN FOR BEHAVIORAL HEALTH
  ACCESS TO CARE. (a) The commission shall establish an ombudsman
  program to provide support and information services to a consumer
  enrolled in or applying for a behavioral health program [In this
  section, "ombudsman" means the individual designated as the
  ombudsman for behavioral health access to care].
         (b)  [The executive commissioner shall designate an
  ombudsman for behavioral health access to care.
         [(c)  The ombudsman is administratively attached to the
  office of the ombudsman for the commission.
         [(d)]  The commission may use an alternate title for the
  ombudsman in consumer-facing materials if the commission
  determines that an alternate title would be beneficial to consumer
  understanding or access.
         (c)  An [(e) The] ombudsman serves as an impartial [a
  neutral] party to help consumers, including consumers who are
  uninsured or have public or private health benefit coverage, and
  behavioral health care providers navigate and resolve issues
  related to consumer access to behavioral health care, including
  care for mental health conditions and substance use disorders.
         (d)  An [(f) The] ombudsman shall:
               (1)  interact with consumers and behavioral health care
  providers with concerns or complaints to help the consumers and
  providers resolve behavioral health care access issues;
               (2)  identify, track, and help report potential
  violations of state or federal rules, regulations, or statutes
  concerning the availability of, and terms and conditions of,
  benefits for mental health conditions or substance use disorders,
  including potential violations related to quantitative and
  nonquantitative treatment limitations;
               (3)  report concerns, complaints, and potential
  violations described by Subdivision (2) to the appropriate
  regulatory or oversight agency;
               (4)  receive and report concerns and complaints
  relating to inappropriate care or mental health commitment;
               (5)  provide appropriate information to help consumers
  obtain behavioral health care;
               (6)  develop appropriate points of contact for
  referrals to other state and federal agencies; and
               (7)  provide appropriate information to help consumers
  or providers file appeals or complaints with the appropriate
  entities, including insurers and other state and federal agencies.
         (e) [(h)]  The Texas Department of Insurance shall appoint a
  liaison to an [the] ombudsman to receive reports of concerns,
  complaints, and potential violations described by Subsection
  (d)(2) [(f)(2)] from an [the] ombudsman, consumers, or behavioral
  health care providers.
         SECTION 12.  Subchapter Y, Chapter 531, Government Code, is
  amended by adding Section 531.9934 to read as follows:
         Sec. 531.9934.  OMBUDSMAN FOR INDIVIDUALS WITH AN
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY.  The executive
  commissioner shall appoint an ombudsman to assist a client, or a
  person acting on behalf of an individual with an intellectual or
  developmental disability or a group of individuals with an
  intellectual or developmental disability, with a complaint or
  grievance regarding the infringement of the rights of an individual
  with an intellectual or developmental disability or the delivery of
  intellectual disability services submitted under Section 592.039,
  Health and Safety Code.
         SECTION 13.  Section 531.994, Government Code, is amended to
  read as follows:
         Sec. 531.994.  INVESTIGATION OF UNREPORTED COMPLAINTS. If,
  during the investigation of a complaint, an [the] ombudsman
  discovers unreported violations of the commission's [department's
  or a health and human services agency's] rules and policies, the
  ombudsman shall open a new investigation for each unreported
  violation.
         SECTION 14.  Sections 531.995 and 531.996, Government Code,
  are amended to read as follows:
         Sec. 531.995.  ACCESS TO INFORMATION. The commission
  [department and each health and human services agency] shall
  provide an [the] ombudsman access to the [department's or agency's]
  records that relate to a complaint the ombudsman is reviewing or
  investigating.
         Sec. 531.996.  COMMUNICATION AND CONFIDENTIALITY. (a) A
  person may communicate with an [the] ombudsman relating to a
  complaint by telephone, by mail, by electronic mail, or by any other
  means the ombudsman determines to be feasible, secure, and
  accessible [to children and youth].
         (b)  A communication with an [the] ombudsman is confidential
  during an investigation or review of a complaint and remains
  confidential after the complaint is resolved.
         (c)  The records of an [the] ombudsman are confidential and
  must be maintained in a manner that preserves the confidentiality
  of the records.
         (d)  The disclosure of confidential information to an [the]
  ombudsman under this subchapter [section or Section 531.995] does
  not constitute a waiver of confidentiality. Any information
  disclosed to the ombudsman under this subchapter [section or
  Section 531.995] remains confidential and privileged following
  disclosure.
         (e)  An [The] ombudsman is not prohibited from communicating
  with the commission [department or another health and human
  services agency] regarding confidential information disclosed to
  the ombudsman [by the department or agency].
         (f)  An [The] ombudsman may make reports relating to an
  investigation of a complaint public after the complaint is
  resolved. A report may not include information that identifies an
  individual complainant, client, parent, or employee or any other
  person involved in the complaint.
         SECTION 15.  Sections 531.997 and 531.998, Government Code,
  as amended by Chapter 906 (S.B. 213), Acts of the 85th Legislature,
  Regular Session, 2017, are reenacted and amended to read as
  follows:
         Sec. 531.997.  RETALIATION PROHIBITED. The commission
  [department or another health and human services agency] may not
  retaliate against a commission [department] employee[, a child or
  youth in the conservatorship of the department,] or any other
  person who in good faith makes a complaint to an [the] ombudsman or
  against any person who cooperates with the ombudsman in an
  investigation.
         Sec. 531.998.  REPORT. (a) Each [The] ombudsman shall
  prepare an annual report that contains:
               (1)  a description of the ombudsman's work;
               (2)  any change made by the commission or department
  [or another health and human services agency] in response to a
  substantiated complaint;
               (3)  a description of any trends in the nature of
  complaints received by the ombudsman or any systemic issues
  identified by the ombudsman in the investigation of individual
  complaints, any recommendations related to addressing those trends
  and issues, and an evaluation of the feasibility of the ombudsman's
  recommendations;
               (4)  a glossary of terms used in the report;
               (5)  a description of the methods used to promote
  awareness of the ombudsman under Section 531.993(b) and the
  ombudsman's promotion plan for the next year; and
               (6)  any public feedback received by the ombudsman
  relating to the ombudsman's previous annual reports.
         (b)  Each [The] report must be submitted to the governor, the
  lieutenant governor, each standing committee of the legislature
  with jurisdiction over matters involving the commission
  [department], each member of the legislature, and the executive
  commissioner[, and the commissioner of the department] not later
  than December 1 of each year. On receipt of the report, the
  [department and the] commission shall make the report publicly
  available on the [department's and the] commission's Internet
  website [websites].
         SECTION 16.  Section 592.039, Health and Safety Code, is
  amended to read as follows:
         Sec. 592.039.  GRIEVANCES. A client, or a person acting on
  behalf of a person with an intellectual disability or a group of
  persons with an intellectual disability, has the right to submit
  complaints or grievances regarding the infringement of the rights
  of a person with an intellectual disability or the delivery of
  intellectual disability services against a person, group of
  persons, organization, or business to the Health and Human Services
  Commission's ombudsman for individuals with an intellectual or
  developmental disability as provided under Section 531.9934,
  Government Code [department's Office of Consumer Rights and
  Services for investigation and appropriate action].
         SECTION 17.  Section 531.9941, Government Code, is repealed.
         SECTION 18.  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 19.  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, 2023.