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.