Bill Text: TX SB222 | 2011-2012 | 82nd Legislature | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to access to certain long-term care services and supports under the medical assistance program.

Spectrum: Bipartisan Bill

Status: (Passed) 2011-06-17 - Effective on 9/1/11 [SB222 Detail]

Download: Texas-2011-SB222-Engrossed.html

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By: Nelson S.B. No. 222

A BILL TO BE ENTITLED
AN ACT
relating to access to certain long-term care services and supports
under the medical assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02181 to read as follows:
Sec. 531.02181. PROVISION AND COORDINATION OF CERTAIN
ATTENDANT CARE SERVICES. (a) The commission shall ensure that
recipients who are eligible to receive attendant care services
under the community-based alternatives program are first provided
those services, if available, under a Medicaid state plan program,
including the primary home care and community attendant services
programs. The commission may allow a recipient to receive
attendant care services under the community-based alternatives
program only if:
(1) the recipient requires services beyond those that
are available under a Medicaid state plan program; or
(2) the services are not otherwise provided under a
Medicaid state plan program.
(b) The executive commissioner shall adopt rules and
procedures necessary to implement this section, including rules and
procedures for:
(1) the coordination of services between Medicaid
state plan programs and the community-based alternatives program to
ensure that recipients' needs are being met and to prevent
duplication of services;
(2) an automated authorization system through which
case managers authorize the provision of attendant care services
through the Medicaid state plan program or the community-based
alternatives program, as appropriate, and register the number of
hours authorized through each program; and
(3) billing procedures for attendant care services
provided through the Medicaid state plan program or the
community-based alternatives program, as appropriate.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0515 to read as follows:
Sec. 531.0515. RISK MANAGEMENT CRITERIA FOR CERTAIN WAIVER
PROGRAMS. (a) In this section, "legally authorized
representative" has the meaning assigned by Section 531.051.
(b) The commission shall consider developing risk
management criteria under home and community-based services waiver
programs designed to allow individuals eligible to receive services
under the programs to assume greater choice and responsibility over
the services and supports the individuals receive.
(c) The commission shall ensure that any risk management
criteria developed under this section include:
(1) a requirement that if an individual to whom
services and supports are to be provided has a legally authorized
representative, the representative be involved in determining
which services and supports the individual will receive; and
(2) a requirement that if services or supports are
declined, the decision to decline is clearly documented.
SECTION 3. Section 533.0355, Health and Safety Code, is
amended by adding Subsection (h) to read as follows:
(h) The Department of Aging and Disability Services shall
ensure that local mental retardation authorities are informing and
counseling individuals and their legally authorized
representatives, if applicable, about all program and service
options for which the individuals are eligible in accordance with
Section 533.038(d), including options such as the availability and
types of ICF-MR placements for which an individual may be eligible
while the individual is on a department interest list or other
waiting list for other services.
SECTION 4. Subchapter D, Chapter 161, Human Resources Code,
is amended by adding Sections 161.084 and 161.085 to read as
follows:
Sec. 161.084. MEDICAID SERVICE OPTIONS PUBLIC EDUCATION
INITIATIVE. (a) In this section, "Section 1915(c) waiver program"
has the meaning assigned by Section 531.001, Government Code.
(b) The department, in cooperation with the commission,
shall educate the public on:
(1) the availability of home and community-based
services under a Medicaid state plan program, including the primary
home care and community attendant services programs, and under a
Section 1915(c) waiver program; and
(2) the various service delivery options available
under the Medicaid program, including the consumer direction models
available to recipients under Section 531.051, Government Code.
(c) The department may coordinate the activities under this
section with any other related activity.
Sec. 161.085. INTEREST LIST REPORTING. The department
shall post on the department's Internet website historical data,
categorized by state fiscal year, on the percentages of individuals
who elect to receive services under a program for which the
department maintains an interest list once their names reach the
top of the list.
SECTION 5. (a) In this section:
(1) "Long-term care services" has the meaning assigned
by Section 22.0011, Human Resources Code.
(2) "Medical assistance program" means the medical
assistance program administered under Chapter 32, Human Resources
Code.
(3) "Nursing facility" means a convalescent or nursing
home or related institution licensed under Chapter 242, Health and
Safety Code.
(b) The Health and Human Services Commission, in
cooperation with the Department of Aging and Disability Services,
shall prepare a written report regarding individuals who receive
long-term care services in nursing facilities under the medical
assistance program. The report should use existing data and
information to identify:
(1) the reasons medical assistance recipients of
long-term care services are placed in nursing facilities as opposed
to being provided long-term care services in home or
community-based settings;
(2) the types of medical assistance services
recipients residing in nursing facilities typically receive and
where and from whom those services are typically provided;
(3) community-based services and supports available
under a Medicaid state plan program, including the primary home
care and community attendant services programs, or under a medical
assistance waiver granted in accordance with Section 1915(c) of the
federal Social Security Act (42 U.S.C. Section 1396n(c)) for which
recipients residing in nursing facilities may be eligible; and
(4) ways to expedite recipients' access to
community-based services and supports identified under Subdivision
(3) of this subsection for which interest lists or other waiting
lists exist.
(c) Not later than September 1, 2012, the Health and Human
Services Commission shall submit the report described by Subsection
(b) of this section together with the commission's recommendations
to the governor, the Legislative Budget Board, the Senate Committee
on Finance, the Senate Committee on Health and Human Services, the
House Appropriations Committee, and the House Human Services
Committee. The recommendations must address options for expediting
access to community-based services and supports by recipients
described by Subsection (b)(3) of this section.
SECTION 6. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall apply for and actively pursue amendments
from the federal Centers for Medicare and Medicaid Services, or any
other appropriate federal agency, to the community living
assistance and support services waiver and the home and
community-based services program waiver granted under Section
1915(c) of the federal Social Security Act (42 U.S.C. Section
1396n(c)) to authorize the provision of personal attendant services
through the programs operated under those waivers.
SECTION 7. 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 8. This Act takes effect September 1, 2011.