Bill Text: TX SB2225 | 2019-2020 | 86th Legislature | Introduced

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Bill Title: Relating to early childhood intervention and rehabilitative and habilitative services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2019-03-21 - Referred to Health & Human Services [SB2225 Detail]

Download: Texas-2019-SB2225-Introduced.html

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86R11984 KFF-D
By: Zaffirini S.B. No. 2225

A BILL TO BE ENTITLED
AN ACT
relating to early childhood intervention and rehabilitative and
habilitative services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.00521 to read as follows:
Sec. 533.00521. PRIOR AUTHORIZATION NOT REQUIRED FOR
CERTAIN EARLY CHILDHOOD INTERVENTION SERVICES. (a) A managed care
organization that contracts with the commission to provide health
care services to recipients under the STAR Health program or the
STAR Kids managed care program may not require prior authorization
for the provision of early childhood intervention program services
under Chapter 73, Human Resources Code, to a child eligible for the
program, including services specified in the child's
individualized family service plan issued by the commission under
the program.
(b) A contract between a managed care organization and the
commission for the organization to provide health care services to
recipients under the STAR Health program or the STAR Kids managed
care program must contain a requirement that the organization:
(1) proactively review and monitor recipient access
and utilization of early childhood intervention services under
Chapter 73, Human Resources Code; and
(2) demonstrate to the commission that the
organization is in compliance with Subsection (a), including a
requirement that the organization submit quarterly reports to the
commission that verify that the organization did not include a
prior authorization request for early childhood intervention
services under Chapter 73, Human Resources Code, as part of a
medical necessity determination.
SECTION 2. Section 73.009(a), Human Resources Code, is
amended to read as follows:
(a) The commission [department] shall develop and the
executive commissioner shall establish policies concerning
services described by this section. A child under three years of
age and the child's parent, guardian, or other legally authorized
representative [family] may be referred for services described by
this section if the child is:
(1) identified as having a developmental delay;
(2) suspected of having a developmental delay; or
(3) considered at risk of developmental delay.
SECTION 3. Chapter 73, Human Resources Code, is amended by
adding Sections 73.0111 and 73.012 to read as follows:
Sec. 73.0111. PROVIDER OMBUDSMAN. (a) In this section,
"ombudsman" means the individual designated as the ombudsman for
providers of services authorized under this chapter.
(b) The executive commissioner shall designate an ombudsman
for providers of services authorized under this chapter.
(c) The ombudsman's office is administratively attached to
the office of the ombudsman of the commission.
(d) The commission may use an alternate title for the
ombudsman in provider-directed materials if the commission
determines that the alternate title would benefit providers'
understanding of or access to ombudsman services.
(e) The ombudsman serves as a neutral party to assist
providers of services authorized under this chapter in resolving
issues related to providing early childhood intervention services
under this chapter, including through the STAR Kids managed care
program.
(f) The ombudsman shall:
(1) provide dispute and complaint resolution
services;
(2) perform provider protection and advocacy
functions;
(3) collect inquiry and complaint data; and
(4) at least annually, submit a report to the
commission relating to the inquiry and complaint data collected
under Subdivision (3) and make recommendations to the commission on
how to improve the provision of early childhood intervention
services under this chapter.
(g) The executive commissioner by rule shall adopt and
ensure the use of procedures for the reporting, monitoring, and
resolution of disputes and complaints described by Subsection (f)
that are consistent with the procedures adopted and used under
Medicaid.
Sec. 73.012. GUIDANCE ON REIMBURSEMENT METHODOLOGY FOR CASE
MANAGEMENT SERVICES. (a) The executive commissioner shall request
clear direction and guidance from the federal Centers for Medicare
and Medicaid Services on the reimbursement methodology that may be
used for the provision of case management services under this
chapter, including direction on allowable and unallowable costs.
(b) This section expires September 1, 2021.
SECTION 4. Subtitle B, Title 3, Human Resources Code, is
amended by adding Chapter 74 to read as follows:
CHAPTER 74. TELE-CONNECTIVE PILOT PROGRAM
Sec. 74.0001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Eligible child" means a child who is eligible for
early childhood intervention services under Chapter 73.
(3) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(4) "Tele-connective pilot program" means the program
developed and implemented under Section 74.0002.
(5) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
Sec. 74.0002. TELE-CONNECTIVE PILOT PROGRAM. (a) The
commission shall develop and implement a pilot program to provide
early childhood intervention services under Chapter 73 to eligible
children through the provision of telehealth and telemedicine
medical services delivered using access points established in
schools and in school districts selected to participate in the
program.
(b) In developing and implementing the tele-connective
pilot program, the commission shall ensure the program aligns with
the provision of existing telemedicine medical services.
Sec. 74.0003. SCHOOL DISTRICT SELECTION. The commission in
cooperation with the Texas Education Agency shall select the school
districts in which to implement the tele-connective pilot program.
In determining the school districts in which to implement the
program, the commission and the Texas Education Agency shall:
(1) consider each school district in which there is:
(A) a low or inadequate number of service
providers authorized under Chapter 73; or
(B) a significant risk of losing service
providers authorized under Chapter 73; and
(2) implement the program only in school districts in
which the implementation is reasonable and feasible.
Sec. 74.0004. PROVIDER PARTICIPATION. (a) The commission
shall ensure that providers of services under Chapter 73 other than
school districts are allowed to participate as providers in the
tele-connective pilot program and provide services both inside and
outside a school-based setting.
(b) The commission shall collaborate with the Texas
Education Agency to establish any school-based provider access
points for the program.
(c) The commission shall track the service hours of
providers participating in the tele-connective pilot program.
Sec. 74.0005. ADEQUATE NETWORK OF ACCESS POINTS. (a) The
commission, in consultation with the Texas Education Agency, shall
ensure that an adequate number of school-based and non-school-based
tele-connective pilot program access points are established in a
school district participating in the program. Access points may be
established at schools, regional education service centers, and
other entities, locations, and modes the commission determines
appropriate.
(b) When selecting access points in which to implement the
tele-connective pilot program, the commission and the Texas
Education Agency shall consider the availability of existing
infrastructure.
Sec. 74.0006. AUTOMATIC AND VOLUNTARY PARTICIPATION OF
CERTAIN ELIGIBLE CHILDREN. (a) Subject to Subsection (b), the
executive commissioner shall, after receiving recommendations from
the advisory committee established under Section 73.004, by rule
establish which eligible children will be automatically enrolled in
the tele-connective pilot program.
(b) The parent, guardian, or other legally authorized
representative of an eligible child may, at any time, elect to opt
the child out of the tele-connective pilot program.
(c) A child who is enrolled in the tele-connective pilot
program may receive early childhood intervention services through
the program only to the extent the services are available and
suitable. Enrollment in the tele-connective pilot program does not
prevent a child from receiving early childhood intervention
services in the child's home or other natural environment.
Sec. 74.0007. SCHOOL DISTRICT EMPLOYEE TRAINING. The Texas
Education Agency shall develop a training course on the
tele-connective pilot program to be given to appropriate school
district employees.
Sec. 74.0008. INITIAL SCREENING AND EVALUATION. (a) The
parent, guardian, or other legally authorized representative of an
eligible child must be:
(1) present during an initial screening or evaluation
under the tele-connective pilot program; and
(2) given the opportunity to opt the child out of the
tele-connective pilot program at the time of the child's initial
screening or evaluation.
(b) Notwithstanding any other law, after a child is enrolled
in the tele-connective pilot program, early childhood intervention
services, including any initial treatment or prescription, that are
delivered or issued by a physician or by a health care provider
acting under the delegation or supervision of the physician or
under the health care provider's license may be provided using
telecommunications or other information technology.
Sec. 74.0009. PROVIDER REIMBURSEMENT. The executive
commissioner in adopting rules governing the tele-connective pilot
program shall ensure that provider reimbursement for a telehealth
or telemedicine medical service is made at a rate that is comparable
to the rate paid under Medicaid for the provision of the same or
substantially similar services.
Sec. 74.0010. CONFIDENTIALITY OF INFORMATION. The
commission shall ensure that the tele-connective pilot program
complies with federal and state law regarding confidentiality of
medical information, including the Health Insurance Portability
and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.
Section 1232g).
Sec. 74.0011. ACCESS POINT EVALUATION. Not later than
September 1, 2020, the commission shall conduct an evaluation of
the tele-connective pilot program to ensure that an adequate number
of access points have been established in each school district
participating in the program. This section expires January 1,
2021.
Sec. 74.0012. REPORT. Not later than January 1, 2021, the
commission shall submit an initial report to the governor, the
lieutenant governor, the speaker of the house of representatives,
and the presiding officers of the standing committees of the senate
and house of representatives having primary jurisdiction over the
early childhood intervention program authorized by Chapter 73. The
report must evaluate the operation of the tele-connective pilot
program and make recommendations regarding the continuation or
expansion of the program.
Sec. 74.0013. FUNDING. The commission shall actively seek
and apply for any available federal money to support the
tele-connective pilot program, including federal money made
available by the:
(1) Federal Communications Commission, including
money available under the federal Rural Health Care Program;
(2) United States Health Resources and Services
Administration's Office for the Advancement of Telehealth; and
(3) United States Department of Agriculture,
including the Distance Learning and Telemedicine Grant Program
established under 7 C.F.R. Part 1734.
Sec. 74.0014. EXPIRATION. This chapter expires September
1, 2023.
SECTION 5. The heading to Subchapter E, Chapter 1367,
Insurance Code, is amended to read as follows:
SUBCHAPTER E. EARLY CHILDHOOD INTERVENTION SERVICES AND
DEVELOPMENTAL DELAYS
SECTION 6. Section 1367.201, Insurance Code, is amended to
read as follows:
Sec. 1367.201. DEFINITION. In this subchapter,
rehabilitative and habilitative therapies and related services
include:
(1) occupational therapy evaluations and services;
(2) physical therapy evaluations and services;
(3) speech therapy evaluations and services; [and]
(4) dietary or nutritional evaluations;
(5) specialized skills training by a person certified
as an early intervention specialist; and
(6) case management provided by a person certified as
an early intervention specialist.
SECTION 7. Section 1367.202, Insurance Code, is amended to
read as follows:
Sec. 1367.202. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or an individual or group evidence of coverage that is offered by:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a fraternal benefit society operating under
Chapter 885;
(D) a stipulated premium company operating under
Chapter 884;
(E) a health maintenance organization operating
under Chapter 843; or
(F) a multiple employer welfare arrangement
subject to regulation under Chapter 846;
(2) is offered by an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844; or
(3) provides health and accident coverage through a
risk pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code, or any
other law.
(b) Notwithstanding any other law, this subchapter also
applies to a standard health benefit plan provided under Chapter
1507.
(c) Notwithstanding any provision in Chapter 1575 or 1579 or
any other law, this subchapter applies to:
(1) a basic plan under Chapter 1575; and
(2) a primary care coverage plan under Chapter 1579.
SECTION 8. Section 1367.203, Insurance Code, is amended to
read as follows:
Sec. 1367.203. EXCEPTION. (a) This subchapter does not
apply to:
(1) a plan that provides coverage:
(A) only for a specified disease or for another
limited benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) only for dental or vision care; or
(G) only for indemnity for hospital confinement;
(2) a small employer health benefit plan written under
Chapter 1501;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Section 1367.202.
(b) This subchapter does not apply to a qualified health
plan to the extent that a determination is made under 45 C.F.R.
Section 155.170 that:
(1) this subchapter requires the plan to offer
benefits in addition to the essential health benefits required
under 42 U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this subchapter.
SECTION 9. Section 1367.204, Insurance Code, is amended to
read as follows:
Sec. 1367.204. PROVISION [OFFER] OF COVERAGE REQUIRED.
[(a)] A health benefit plan issuer must provide [offer] coverage
that complies with this subchapter.
[(b) The individual or group policy or contract holder may
reject coverage required to be offered under this section.]
SECTION 10. Section 1367.205, Insurance Code, is amended by
amending Subsections (a) and (b) and adding Subsection (d) to read
as follows:
(a) A health benefit plan required to provide [that
provides] coverage for rehabilitative and habilitative therapies
and related services under this subchapter may not prohibit or
restrict payment for covered services provided to a child and
determined to be necessary to and provided in accordance with an
individualized family service plan issued by the Health and Human
Services Commission [Interagency Council on Early Childhood
Intervention] under Chapter 73, Human Resources Code.
(b) Rehabilitative and habilitative therapies and related
services described by Subsection (a) must be covered in the amount,
duration, scope, and service setting established in the child's
individualized family service plan.
(d) A health benefit plan prior authorization requirement,
or another requirement that a service be authorized, otherwise
applicable to a covered rehabilitative or habilitative therapy
service or a related service is satisfied if the service is
specified in a child's individualized family service plan.
SECTION 11. Subchapter E, Chapter 1367, Insurance Code, is
amended by adding Section 1367.2055 to read as follows:
Sec. 1367.2055. MEDICAID PAY PARITY. A health benefit plan
issuer shall reimburse a health care provider providing a
rehabilitative and habilitative therapy or related service at a
rate that is at least equal to the reimbursement rate the health
care provider would receive for providing the same or a
substantially similar service under Medicaid.
SECTION 12. Section 1367.206, Insurance Code, is amended to
read as follows:
Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage
required to be provided [offered] under this subchapter, a health
benefit plan issuer may not:
(1) apply the cost of rehabilitative and habilitative
therapies and related services described by Section 1367.205(a) to
an annual or lifetime maximum plan benefit or similar provision
under the plan; or
(2) use the cost of rehabilitative or habilitative
therapies and related services described by Section 1367.205(a) as
the sole justification for:
(A) increasing plan premiums; or
(B) terminating the insured's or enrollee's
participation in the plan.
SECTION 13. Subchapter A, Chapter 302, Labor Code, is
amended by adding Section 302.0061 to read as follows:
Sec. 302.0061. WORKFORCE DEVELOPMENT GRANTS FOR PROVIDERS
UNDER EARLY CHILDHOOD INTERVENTION PROGRAM. (a) In this section,
"early childhood intervention program" means the program
established under Chapter 73, Human Resources Code, to provide
early childhood intervention services in accordance with Part C,
Individuals with Disabilities Education Act (IDEA)(20 U.S.C.
Section 1431 et seq.).
(b) The commission shall actively seek and apply for federal
funding to establish a program designed to provide workforce
development grants to providers participating in the early
childhood intervention program for purposes of improving the
provision of program services by offering providers appropriate
education and training.
SECTION 14. (a) The Health and Human Services Commission
shall request guidance from the federal Centers for Medicare and
Medicaid Services or other appropriate federal agency regarding the
feasibility of receiving a waiver or other authorization necessary
to provide through Medicaid early childhood intervention services
to children who are eligible to receive those services under
Chapter 73, Human Resources Code, as amended by this Act, but who
are not eligible for Medicaid and do not have private health
benefits coverage.
(b) As soon as practicable after receiving guidance under
Subsection (a) of this section, the Health and Human Services
Commission shall prepare a report on how best to provide to children
the coverage described by that subsection. The commission shall
submit the report to the governor, the lieutenant governor, the
speaker of the house of representatives, and the presiding officers
of the standing committees of the senate and house of
representatives having primary jurisdiction over the early
childhood intervention program authorized by Chapter 73, Human
Resources Code, as amended by this Act.
SECTION 15. (a) As soon as practicable after the effective
date of this Act, the Health and Human Services Commission, after
consulting with the Texas Education Agency, other appropriate state
agencies, and the advisory committee established under Section
73.004, Human Resources Code, shall conduct a financial evaluation
of the early childhood intervention services provided under Chapter
73, Human Resources Code, as amended by this Act, and report on that
evaluation. The report must quantify the amount by which providing
early childhood intervention services in this state affects other
budget strategies, including the budget strategies of school
districts, regional education service centers, and other affected
governmental entities.
(b) Not later than September 1, 2020, the Health and Human
Services Commission shall submit the report prepared under
Subsection (a) of this section to the governor, the lieutenant
governor, the speaker of the house of representatives, and the
presiding officers of the standing committees of the senate and
house of representatives having primary jurisdiction over the early
childhood intervention program authorized by Chapter 73, Human
Resources Code, as amended by this Act.
SECTION 16. Not later than December 1, 2019, the Health and
Human Services Commission shall issue guidance to health benefit
plan issuers clarifying that providers of early childhood
intervention services under Chapter 73, Human Resources Code, as
amended by this Act, must file claims using the national provider
identifier number and Texas provider identifier number.
SECTION 17. Section 533.00521(b), Government Code, as added
by this Act, applies to a contract entered into or renewed on or
after the effective date of this Act. A contract entered into or
renewed before that date is governed by the law in effect on the
date the contract was entered into or renewed, and that law is
continued in effect for that purpose.
SECTION 18. Subchapter E, Chapter 1367, Insurance Code, as
amended by this Act, applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2020. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2020, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 19. As soon as practicable after the effective date
of this Act, but not later than January 1, 2020, the Health and
Human Services Commission shall develop and implement the
tele-connective pilot program required by Chapter 74, Human
Resources Code, as added by this Act.
SECTION 20. 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 21. This Act takes effect September 1, 2019.