79R6893 UM-D

By:  Truitt                                                       H.B. No. 2572


A BILL TO BE ENTITLED
AN ACT
relating to the functions of local mental health and mental retardation authorities. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 533.031, Health and Safety Code, is amended by adding Subdivisions (4), (5), (6), and (7) to read as follows: (4) "Commission" means the Health and Human Services Commission. (5) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission. (6) "ICF-MR and related waiver programs" includes ICF-MR programs, home and community based services, Texas home living waiver services or another Medicaid program serving persons with mental retardation. (7) "Qualified service provider" means an entity that meets requirements for service providers established by the executive commissioner. SECTION 2. Section 533.035, Health and Safety Code, is amended by amending Subsections (a), (c), and (e) and adding Subsection (e-1) to read as follows: (a) The executive commissioner shall designate a local mental health authority and a local mental retardation authority in one or more local service areas. The executive commissioner [board] may delegate to the local authorities the [board's] authority and responsibility of the executive commissioner, the commission, or a department of the commission related to [for the] planning, policy development, coordination, including coordination with criminal justice entities, resource allocation, and resource development for and oversight of mental health and mental retardation services in the most appropriate and available setting to meet individual needs in that service area. The executive commissioner may designate a single entity as the local mental health authority and the local mental retardation authority for a service area. (c) A local mental health and mental retardation authority, with the department's approval, shall use the funds received under Subsection (b) to ensure mental health, mental retardation, and chemical dependency services are provided in the local service area. The local authority shall consider public input, ultimate cost-benefit, and client care issues to ensure consumer choice and the best use of public money in: (1) assembling a network of service providers; [and] (2) making recommendations relating to the most appropriate and available treatment alternatives for individuals in need of mental health or mental retardation services; and (3) determining whether the authority will provide the service or contract with another organization to provide the service. (e) In assembling a network of service providers, a local mental health [and mental retardation] authority may serve as a provider of services only as a provider of last resort and only if the authority demonstrates to the department that: (1) the authority has made every reasonable attempt to solicit the development of an available and appropriate provider base that is sufficient to meet the needs of consumers in its service area; and (2) there is not a willing provider of the relevant services in the authority's service area or in the county where the provision of the services is needed. (e-1) A local mental retardation authority may serve as a provider of ICF-MR and related waiver services only if: (1) the authority complies with the limitations prescribed by Section 533.0355(c); or (2) the ICF-MR and related waiver services are necessary to ensure the availability of services and the authority demonstrates to the commission that there is not a willing ICF-MR and related waiver service qualified service provider in the authority's service area where the service is needed. SECTION 3. Section 533.0355, Health and Safety Code, is amended to read as follows: Sec. 533.0355. LOCAL MENTAL RETARDATION AUTHORITY RESPONSIBILITIES [ALLOCATION OF DUTIES] UNDER CERTAIN MEDICAID WAIVER PROGRAMS. (a) The executive commissioner shall adopt rules establishing the roles and responsibilities of local mental retardation authorities [In this section, "waiver program" means the local mental retardation authority waiver program established under the state Medicaid program]. (b) In adopting rules under this section, the executive commissioner must include rules regarding: (1) access; (2) intake; (3) eligibility functions; (4) enrollment, initial assessment, and service authorization; (5) utilization management; (6) safety net functions, including crisis management services and assistance in accessing facility–based care; (7) service coordination functions; (8) provision and oversight of state general revenue services; (9) local planning functions, including stakeholder involvement, technical assistance and training, and provider complaint and resolution processes; and (10) processes to assure accountability in performance, compliance, and monitoring. [A provider of services under the waiver program shall: [(1) develop a person-directed plan and an individual program plan for each person who receives services from the provider under the waiver program; [(2) perform justification and implementation functions for the plans described by Subdivision (1); [(3) conduct case management under the waiver program, other than case management under Subsection (c)(3), in accordance with applicable state and federal laws; and [(4) plan, coordinate, and review the provision of services to all persons who receive services from the service provider under the waiver program.] (c) In establishing a local mental retardation authority's role as a qualified service provider of ICF-MR and related waiver programs under Section 533.035(e-1), the executive commissioner by rule shall require the local mental retardation authority to: (1) base the authority's provider capacity on the authority's August 2004 enrollment levels for the waiver programs the authority operates and, if the authority's enrollment levels exceed those levels, to reduce the levels by voluntary attrition; and (2) base any increase in the authority's provider capacity on: (A) the authority's state-mandated conversion from one Medicaid program to another Medicaid program allowing for a permanent increase in the authority's provider capacity in accordance with the number of persons who choose the authority as their provider; (B) the authority's voluntary conversion from one Medicaid program to another Medicaid program allowing for a temporary increase in the authority's provider capacity in accordance with the number of persons who choose the authority as their provider; or (C) other extenuating circumstances that: (i) are clearly defined in rules adopted by the executive commissioner; (ii) are monitored and approved by the department; and (iii) do not include increases resulting from refinancing and do not include increases that unnecessarily promote the authority's provider role over its role as a local mental retardation authority. [A local mental retardation authority shall: [(1) manage any waiting lists for services under the waiver program; [(2) perform functions relating to consumer choice and enrollment for persons who receive services under the waiver program; and [(3) conduct case management under the waiver program relating to funding disputes between a service provider and the local mental retardation authority.] (d) In adopting a rule under this section, the executive commissioner shall seek the participation of and comments from local mental health and mental retardation authorities, providers, advocates, and other interested stakeholders. [The department shall perform all administrative functions under the waiver program that are not assigned to a service provider under Subsection (b) or to a local mental retardation authority under Subsection (c). Administrative functions performed by the department include: [(1) any surveying, certification, and utilization review functions required under the waiver program; and [(2) managing an appeals process relating to decisions that affect a person receiving services under the waiver program.] (e) Any increase based on extenuating circumstances under Subsection (c)(2)(C) is considered a temporary increase in the local mental retardation authority's provider capacity. [The department shall review: [(1) screening and assessment of levels of care; [(2) case management fees paid under the waiver program to a community center; and [(3) administrative fees paid under the waiver program to a service provider.] (f) At least biennially, the department shall review and determine the local mental retardation authority's status as a qualified service provider in accordance with criteria that includes the consideration of the authority's ability to assure the availability of services in its area, including: (1) program stability and viability; (2) the number of other qualified service providers in the area; and (3) the geographical area in which the authority is located. [The department shall perform any function relating to inventory for persons who receive services under the waiver program and agency planning assessments. [(g) The review required under Subsection (e) must include a comparison of fees paid before the implementation of this section with fees paid after the implementation of this section. The department may adjust fees paid based on that review. [(h) The department shall allocate the portion of the gross reimbursement funds paid to a local authority and a service provider for client services for the case management function in accordance with this section and to the extent allowed by law. [(i) The department may adopt rules governing the functions of a local mental retardation authority or service provider under this section.] SECTION 4. Section 535.002(b), Health and Safety Code, is amended to read as follows: (b) If feasible and economical, the commission shall [department may] use local mental health and mental retardation authorities to implement this chapter. [However, the department may not designate those local mental health and mental retardation authorities as the sole providers of services if other providers are available.] SECTION 5. (a) Sections 533.035(f) and (g), Health and Safety Code, are repealed. (b) Section 2.82A, Chapter 198, Acts of the 78th Legislature, Regular Session, 2003, is repealed. SECTION 6. Not later than January 1, 2007, the Health and Human Services Commission shall submit a report to the governor, lieutenant governor, and speaker of the house of representatives that includes any information the commission finds relevant regarding the implementation of Sections 535.035 and 535.0355, Health and Safety Code, as amended by this Act, by local mental retardation authorities. SECTION 7. This Act takes effect September 1, 2005.