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  H.B. No. 3523
 
 
 
 
AN ACT
  relating to improving the delivery and quality of Medicaid acute
  care services and long-term care services and supports.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 533.00251, Government Code, is amended
  by amending Subsection (c), as amended by S.B. No. 219, Acts of the
  84th Legislature, Regular Session, 2015, and amending Subsection
  (g) to read as follows:
         (c)  Subject to Section 533.0025 and notwithstanding any
  other law, the commission, in consultation with the advisory
  committee, shall provide benefits under Medicaid to recipients who
  reside in nursing facilities through the STAR + PLUS Medicaid
  managed care program. In implementing this subsection, the
  commission shall ensure:
               (1)  that the commission is responsible for setting the
  minimum reimbursement rate paid to a nursing facility under the
  managed care program[, including the staff rate enhancement paid to
  a nursing facility that qualifies for the enhancement];
               (2)  that a nursing facility is paid not later than the
  10th day after the date the facility submits a clean claim;
               (3)  the appropriate utilization of services
  consistent with criteria established by the commission;
               (4)  a reduction in the incidence of potentially
  preventable events and unnecessary institutionalizations;
               (5)  that a managed care organization providing
  services under the managed care program provides discharge
  planning, transitional care, and other education programs to
  physicians and hospitals regarding all available long-term care
  settings;
               (6)  that a managed care organization providing
  services under the managed care program:
                     (A)  assists in collecting applied income from
  recipients; and
                     (B)  provides payment incentives to nursing
  facility providers that reward reductions in preventable acute care
  costs and encourage transformative efforts in the delivery of
  nursing facility services, including efforts to promote a
  resident-centered care culture through facility design and
  services provided;
               (7)  the establishment of a portal that is in
  compliance with state and federal regulations, including standard
  coding requirements, through which nursing facility providers
  participating in the STAR + PLUS Medicaid managed care program may
  submit claims to any participating managed care organization;
               (8)  that rules and procedures relating to the
  certification and decertification of nursing facility beds under
  Medicaid are not affected; [and]
               (9)  that a managed care organization providing
  services under the managed care program, to the greatest extent
  possible, offers nursing facility providers access to:
                     (A)  acute care professionals; and
                     (B)  telemedicine, when feasible and in
  accordance with state law, including rules adopted by the Texas
  Medical Board; and
               (10)  that the commission approves the staff rate
  enhancement methodology for the staff rate enhancement paid to a
  nursing facility that qualifies for the enhancement under the
  managed care program.
         (g)  Subsection [Subsections (c),] (d)[, (e), and (f)] and
  this subsection expire September 1, 2021 [2019].
         SECTION 2.  Effective September 1, 2021, Section
  533.00251(c), Government Code, as amended by S.B. No. 219, Acts of
  the 84th Legislature, Regular Session, 2015, is amended to read as
  follows:
         (c)  Subject to Section 533.0025 and notwithstanding any
  other law, the commission, in consultation with the advisory
  committee, shall provide benefits under Medicaid to recipients who
  reside in nursing facilities through the STAR + PLUS Medicaid
  managed care program. In implementing this subsection, the
  commission shall ensure:
               (1)  [that the commission is responsible for setting
  the minimum reimbursement rate paid to a nursing facility under the
  managed care program, including the staff rate enhancement paid to
  a nursing facility that qualifies for the enhancement;
               [(2)]  that a nursing facility is paid not later than
  the 10th day after the date the facility submits a clean claim;
               (2) [(3)]  the appropriate utilization of services
  consistent with criteria established by the commission;
               (3) [(4)]  a reduction in the incidence of potentially
  preventable events and unnecessary institutionalizations;
               (4) [(5)]  that a managed care organization providing
  services under the managed care program provides discharge
  planning, transitional care, and other education programs to
  physicians and hospitals regarding all available long-term care
  settings;
               (5) [(6)]  that a managed care organization providing
  services under the managed care program:
                     (A)  assists in collecting applied income from
  recipients; and
                     (B)  provides payment incentives to nursing
  facility providers that reward reductions in preventable acute care
  costs and encourage transformative efforts in the delivery of
  nursing facility services, including efforts to promote a
  resident-centered care culture through facility design and
  services provided;
               (6) [(7)]  the establishment of a portal that is in
  compliance with state and federal regulations, including standard
  coding requirements, through which nursing facility providers
  participating in the STAR + PLUS Medicaid managed care program may
  submit claims to any participating managed care organization;
               (7) [(8)]  that rules and procedures relating to the
  certification and decertification of nursing facility beds under
  Medicaid are not affected; [and]
               (8) [(9)]  that a managed care organization providing
  services under the managed care program, to the greatest extent
  possible, offers nursing facility providers access to:
                     (A)  acute care professionals; and
                     (B)  telemedicine, when feasible and in
  accordance with state law, including rules adopted by the Texas
  Medical Board; and
               (9)  that the commission approves the staff rate
  enhancement methodology for the staff rate enhancement paid to a
  nursing facility that qualifies for the enhancement under the
  managed care program.
         SECTION 3.  Section 534.053, Government Code, is amended by
  adding Subsection (e-1) and amending Subsection (g) to read as
  follows:
         (e-1)  The advisory committee may establish work groups that
  meet at other times for purposes of studying and making
  recommendations on issues the committee considers appropriate.
         (g)  On January 1, 2026 [2024]:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         SECTION 4.  Section 534.054, Government Code, as amended by
  S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015,
  is amended to read as follows:
         Sec. 534.054.  ANNUAL REPORT ON IMPLEMENTATION. (a)  Not
  later than September 30 of each year, the commission, in
  consultation and collaboration with the advisory committee, shall
  prepare and submit a report to the legislature that must include 
  [regarding]:
               (1)  an assessment of the implementation of the system
  required by this chapter, including appropriate information
  regarding the provision of acute care services and long-term
  services and supports to individuals with an intellectual or
  developmental disability under Medicaid as described by this
  chapter; [and]
               (2)  recommendations regarding implementation of and
  improvements to the system redesign, including recommendations
  regarding appropriate statutory changes to facilitate the
  implementation; and
               (3)  an assessment of the effect of the system on the
  following:
                     (A)  access to long-term services and supports;
                     (B)  the quality of acute care services and
  long-term services and supports;
                     (C)  meaningful outcomes for Medicaid recipients
  using person-centered planning, individualized budgeting, and
  self-determination, including a person's inclusion in the
  community;
                     (D)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (E)  the efficiency and use of funding;
                     (F)  the placement of individuals in housing that
  is the least restrictive setting appropriate to an individual's
  needs;
                     (G)  employment assistance and customized,
  integrated, competitive employment options; and
                     (H)  the number and types of fair hearing and
  appeals processes in accordance with applicable federal law.
         (b)  This section expires January 1, 2026 [2024].
         SECTION 5.  Section 534.104, Government Code, is amended by
  amending Subsection (a), as amended by S.B. No. 219, Acts of the
  84th Legislature, Regular Session, 2015, amending Subsections (b),
  (c), (d), (e), and (g), and adding Subsection (h) to read as
  follows:
         (a)  The department, in consultation and collaboration with
  the advisory committee, shall identify private services providers
  or managed care organizations that are good candidates to develop a
  service delivery model involving a managed care strategy based on
  capitation and to test the model in the provision of long-term
  services and supports under Medicaid to individuals with an
  intellectual or developmental disability through a pilot program
  established under this subchapter.
         (b)  The department shall solicit managed care strategy
  proposals from the private services providers and managed care
  organizations identified under Subsection (a). In addition, the
  department may accept and approve a managed care strategy proposal
  from any qualified entity that is a private services provider or
  managed care organization if the proposal provides for a
  comprehensive array of long-term services and supports, including
  case management and service coordination.
         (c)  A managed care strategy based on capitation developed
  for implementation through a pilot program under this subchapter
  must be designed to:
               (1)  increase access to long-term services and
  supports;
               (2)  improve quality of acute care services and
  long-term services and supports;
               (3)  promote meaningful outcomes by using
  person-centered planning, individualized budgeting, and
  self-determination, and promote community inclusion [and
  customized, integrated, competitive employment];
               (4)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (5)  promote efficiency and the best use of funding;
               (6)  promote the placement of an individual in housing
  that is the least restrictive setting appropriate to the
  individual's needs;
               (7)  promote employment assistance and customized,
  integrated, and competitive [supported] employment;
               (8)  provide fair hearing and appeals processes in
  accordance with applicable federal law; and
               (9)  promote sufficient flexibility to achieve the
  goals listed in this section through the pilot program.
         (d)  The department, in consultation and collaboration with
  the advisory committee, shall evaluate each submitted managed care
  strategy proposal and determine whether:
               (1)  the proposed strategy satisfies the requirements
  of this section; and
               (2)  the private services provider or managed care
  organization that submitted the proposal has a demonstrated ability
  to provide the long-term services and supports appropriate to the
  individuals who will receive services through the pilot program
  based on the proposed strategy, if implemented.
         (e)  Based on the evaluation performed under Subsection (d),
  the department may select as pilot program service providers one or
  more private services providers or managed care organizations with
  whom the commission will contract.
         (g)  The department, in consultation and collaboration with
  the advisory committee, shall analyze information provided by the
  pilot program service providers and any information collected by
  the department during the operation of the pilot programs for
  purposes of making a recommendation about a system of programs and
  services for implementation through future state legislation or
  rules.
         (h)  The analysis under Subsection (g) must include an
  assessment of the effect of the managed care strategies implemented
  in the pilot programs on:
               (1)  access to long-term services and supports;
               (2)  the quality of acute care services and long-term
  services and supports;
               (3)  meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
               (4)  the integration of service coordination of acute
  care services and long-term services and supports;
               (5)  the efficiency and use of funding;
               (6)  the placement of individuals in housing that is
  the least restrictive setting appropriate to an individual's needs;
               (7)  employment assistance and customized, integrated,
  competitive employment options; and
               (8)  the number and types of fair hearing and appeals
  processes in accordance with applicable federal law.
         SECTION 6.  Sections 534.106(a) and (b), Government Code,
  are amended to read as follows:
         (a)  The commission and the department shall implement any
  pilot programs established under this subchapter not later than
  September 1, 2017 [2016].
         (b)  A pilot program established under this subchapter may 
  [must] operate for up to [not less than] 24 months. A[, except that
  a] pilot program may cease operation [before the expiration of 24
  months] if the pilot program service provider terminates the
  contract with the commission before the agreed-to termination date.
         SECTION 7.  Section 534.108(d), Government Code, is amended
  to read as follows:
         (d)  The [On or before December 1, 2016, and December 1,
  2017, the] commission and the department, in consultation and
  collaboration with the advisory committee, shall review and
  evaluate the progress and outcomes of each pilot program
  implemented under this subchapter and submit, as part of the annual
  report to the legislature required by Section 534.054, a report to
  the legislature during the operation of the pilot programs.  Each
  report must include recommendations for program improvement and
  continued implementation.
         SECTION 8.  Section 534.110, Government Code, as amended by
  S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015,
  is amended to read as follows:
         Sec. 534.110.  TRANSITION BETWEEN PROGRAMS. (a) The
  commission shall ensure that there is a comprehensive plan for
  transitioning the provision of Medicaid benefits between a Medicaid
  waiver program or an ICF-IID program and a pilot program under this
  subchapter to protect continuity of care.
         (b)  The transition plan shall be developed in consultation
  and collaboration with the advisory committee and with stakeholder
  input as described by Section 534.103.
         SECTION 9.  Section 534.151, Government Code, as amended by
  S.B. No. 219, Acts of the 84th Legislature, Regular Session, 2015,
  is amended to read as follows:
         Sec. 534.151.  DELIVERY OF ACUTE CARE SERVICES FOR
  INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY. (a) 
  Subject to Section 533.0025, the commission shall provide acute
  care Medicaid benefits to individuals with an intellectual or
  developmental disability through the STAR + PLUS Medicaid managed
  care program or the most appropriate integrated capitated managed
  care program delivery model and monitor the provision of those
  benefits.
         (b)  The commission and the department, in consultation and
  collaboration with the advisory committee, shall analyze the
  outcomes of providing acute care Medicaid benefits to individuals
  with an intellectual or developmental disability under a model
  specified in Subsection (a). The analysis must:
               (1)  include an assessment of the effects on:
                     (A)  access to and quality of acute care services;
  and
                     (B)  the number and types of fair hearing and
  appeals processes in accordance with applicable federal law;
               (2)  be incorporated into the annual report to the
  legislature required under Section 534.054; and
               (3)  include recommendations for delivery model
  improvements and implementation for consideration by the
  legislature, including recommendations for needed statutory
  changes.
         SECTION 10.  The heading to Section 534.152, Government
  Code, is amended to read as follows:
         Sec. 534.152.  DELIVERY OF CERTAIN OTHER SERVICES UNDER STAR
  + PLUS MEDICAID MANAGED CARE PROGRAM AND BY WAIVER PROGRAM
  PROVIDERS.
         SECTION 11.  Section 534.152, Government Code, is amended by
  adding Subsection (g) to read as follows:
         (g)  The department may contract with providers
  participating in the home and community-based services (HCS) waiver
  program, the Texas home living (TxHmL) waiver program, the
  community living assistance and support services (CLASS) waiver
  program, or the deaf-blind with multiple disabilities (DBMD) waiver
  program for the delivery of basic attendant and habilitation
  services described in Subsection (a) for individuals to which that
  subsection applies. The department has regulatory and oversight
  authority over the providers with which the department contracts
  for the delivery of those services.
         SECTION 12.  Section 534.201, Government Code, is amended by
  amending Subsections (b) and (e), as amended by S.B. No. 219, Acts
  of the 84th Legislature, Regular Session, 2015, amending Subsection
  (d), and adding Subsection (g) to read as follows:
         (b)  On [Not later than] September 1, 2018 [2017], the
  commission shall transition the provision of Medicaid benefits to
  individuals to whom this section applies to the STAR + PLUS Medicaid
  managed care program delivery model or the most appropriate
  integrated capitated managed care program delivery model, as
  determined by the commission based on cost-effectiveness and the
  experience of the STAR + PLUS Medicaid managed care program in
  providing basic attendant and habilitation services and of the
  pilot programs established under Subchapter C, subject to
  Subsection (c)(1).
         (d)  In implementing the transition described by Subsection
  (b), the commission, in consultation and collaboration with the
  advisory committee, shall develop a process to receive and evaluate
  input from interested statewide stakeholders [that is in addition
  to the input provided by the advisory committee].
         (e)  The commission, in consultation and collaboration with
  the advisory committee, shall ensure that there is a comprehensive
  plan for transitioning the provision of Medicaid benefits under
  this section that protects the continuity of care provided to
  individuals to whom this section applies.
         (g)  The commission, in consultation and collaboration with
  the advisory committee, shall analyze the outcomes of the
  transition of the long-term services and supports under the Texas
  home living (TxHmL) Medicaid waiver program to a managed care
  program delivery model. The analysis must:
               (1)  include an assessment of the effect of the
  transition on:
                     (A)  access to long-term services and supports;
                     (B)  meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
                     (C)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (D)  employment assistance and customized,
  integrated, competitive employment options; and
                     (E)  the number and types of fair hearing and
  appeals processes in accordance with applicable federal law;
               (2)  be incorporated into the annual report to the
  legislature required under Section 534.054; and
               (3)  include recommendations for improvements to the
  transition implementation for consideration by the legislature,
  including recommendations for needed statutory changes.
         SECTION 13.  Section 534.202(b), Government Code, as amended
  by S.B. No. 219, Acts of the 84th Legislature, Regular Session,
  2015, is amended to read as follows:
         (b)  After implementing the transition required by Section
  534.201, on [but not later than] September 1, 2021 [2020], the
  commission shall transition the provision of Medicaid benefits to
  individuals to whom this section applies to the STAR + PLUS Medicaid
  managed care program delivery model or the most appropriate
  integrated capitated managed care program delivery model, as
  determined by the commission based on cost-effectiveness and the
  experience of the transition of Texas home living (TxHmL) waiver
  program recipients to a managed care program delivery model under
  Section 534.201, subject to Subsections (c)(1) and (g).
         SECTION 14.  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 15.  Except as otherwise provided by this Act:
               (1)  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; and
               (2)  if this Act does not receive the vote necessary for
  immediate effect, this Act takes effect September 1, 2015.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 3523 was passed by the House on May 4,
  2015, by the following vote:  Yeas 138, Nays 0, 2 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 3523 on May 28, 2015, by the following vote:  Yeas 142, Nays 1,
  2 present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 3523 was passed by the Senate, with
  amendments, on May 26, 2015, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor