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AN ACT
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relating to the functions of local mental health and mental |
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retardation authorities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.031, Health and Safety Code, is |
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amended by adding Subdivisions (4), (5), (6), (7), and (8) to read |
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as follows: |
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(4) "Commission" means the Health and Human Services |
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Commission. |
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(5) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(6) "ICF-MR and related waiver programs" includes |
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ICF-MR Section 1915(c) waiver programs, home and community-based |
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services, Texas home living waiver services, or another Medicaid |
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program serving persons with mental retardation. |
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(7) "Section 1915(c) waiver program" means a federally |
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funded Medicaid program of the state that is authorized under |
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Section 1915(c) of the federal Social Security Act (42 U.S.C. |
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Section 1396n(c)). |
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(8) "Qualified service provider" means an entity that |
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meets requirements for service providers established by the |
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executive commissioner. |
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SECTION 2. Section 533.035, Health and Safety Code, is |
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amended by amending Subsections (a), (c), and (e) and adding |
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Subsections (b-1) and (e-1) to read as follows: |
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(a) The executive commissioner shall designate a local |
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mental health authority and a local mental retardation authority in |
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one or more local service areas. The executive commissioner |
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[board] may delegate to the local authorities the [board's] |
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authority and responsibility of the executive commissioner, the |
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commission, or a department of the commission related to [for the] |
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planning, policy development, coordination, including coordination |
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with criminal justice entities, resource allocation, and resource |
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development for and oversight of mental health and mental |
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retardation services in the most appropriate and available setting |
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to meet individual needs in that service area. The executive |
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commissioner may designate a single entity as the local mental |
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health authority and the local mental retardation authority for a |
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service area. |
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(b-1) This subsection expires September 1, 2009, and |
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applies only to the determination of payment methodologies for |
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mental health services and not to rate setting or the payment rates |
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for intermediate care facilities for the mentally retarded, Section |
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1915(c) waiver programs, mental retardation service coordination, |
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and other Medicaid services. Before the Department of State Health |
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Services institutes a change in payment methodology for mental |
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health services, the department shall: |
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(1) evaluate various forms of payment for services, |
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including fee-for-service, case rate, capitation, and other |
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appropriate payment methods to determine the most cost-effective |
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and efficient form of payment for services; |
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(2) evaluate the effect of each proposed payment |
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methodology on: |
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(A) the availability of services in urban and |
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rural service areas; |
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(B) the availability of services for persons who |
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are indigent; |
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(C) the cost certainty of the delivery of |
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Medicaid rehabilitation mental health services; and |
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(D) the ability of the local mental health |
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authority to meet unique local needs and develop and manage a |
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network of providers; |
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(3) determine the implementation and ongoing |
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operational costs for the state and local mental health authorities |
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associated with each proposed payment methodology; |
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(4) develop an implementation plan, with the advice |
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and assistance of the local authority network advisory committee, |
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for any new payment methodology for mental health services that |
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integrates the department's findings under Subdivisions (1), (2), |
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and (3); and |
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(5) report the department's findings and the |
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implementation plan for any new payment methodology for mental |
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health services to the executive commissioner and the legislature |
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not later than January 1, 2009. |
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(c) A local mental health and mental retardation authority, |
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with the [department's] approval of the Department of State Health |
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Services or the Department of Aging and Disability Services, or |
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both, as applicable, shall use the funds received under Subsection |
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(b) to ensure mental health, mental retardation, and chemical |
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dependency services are provided in the local service area. The |
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local authority shall consider public input, ultimate |
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cost-benefit, and client care issues to ensure consumer choice and |
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the best use of public money in: |
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(1) assembling a network of service providers; [and] |
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(2) making recommendations relating to the most |
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appropriate and available treatment alternatives for individuals |
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in need of mental health or mental retardation services; and |
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(3) procuring services for a local service area, |
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including a request for proposal or open-enrollment procurement |
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method. |
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(e) Subject to Section 533.0358, in [In] assembling a |
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network of service providers, a local mental health [and mental
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retardation] authority may serve as a provider of services only as a |
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provider of last resort and only if the local authority |
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demonstrates to the department in the local authority's local |
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network development plan that: |
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(1) the local authority has made every reasonable |
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attempt to solicit the development of an available and appropriate |
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provider base that is sufficient to meet the needs of consumers in |
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its service area; and |
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(2) there is not a willing provider of the relevant |
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services in the local authority's service area or in the county |
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where the provision of the services is needed. |
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(e-1) A local mental retardation authority may serve as a |
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provider of ICF-MR and related waiver programs only if: |
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(1) the local authority complies with the limitations |
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prescribed by Section 533.0355(d); or |
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(2) the ICF-MR and related waiver programs are |
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necessary to ensure the availability of services and the local |
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authority demonstrates to the commission that there is not a |
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willing ICF-MR and related waiver program qualified service |
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provider in the local authority's service area where the service is |
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needed. |
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SECTION 3. Section 533.0351, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 533.0351. LOCAL AUTHORITY NETWORK [TECHNICAL] |
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ADVISORY COMMITTEE. (a) [In this section, "local authority" means
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a local mental health or mental retardation authority.
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[(b)] The executive commissioner shall establish a |
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[nine-member] local authority network advisory committee to advise |
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the executive commissioner and the Department of State Health |
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Services on technical and administrative issues that directly |
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affect local mental health authority responsibilities. |
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(b) [(c)] The committee is composed of equal numbers of |
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representatives of local mental health authorities, community |
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mental health service providers, private mental health service |
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providers, local government officials, advocates for individuals |
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with mental health needs, consumers of mental health services, |
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family members of individuals with mental health needs, and other |
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individuals with expertise in the field of mental health [and one
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member representing the public] appointed by the executive |
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commissioner. In addition, the executive commissioner may appoint |
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facilitators to the committee as necessary. In appointing the |
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members, the executive commissioner shall also ensure a balanced |
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representation of: |
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(1) different regions of this state; |
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(2) rural and urban counties; and |
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(3) single-county and multicounty local mental health |
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authorities. |
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(c) Members [(d)
Except for the member representing the
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public, members] appointed to the advisory committee must have some |
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knowledge of, familiarity with, or understanding of [expertise in] |
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the day-to-day operations of a local mental health authority. |
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(d) [(e)] The advisory committee shall: |
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(1) review rules and proposed rules and participate in |
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any negotiated rulemaking process related to local mental health |
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authority operations; |
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(2) advise the executive commissioner and the |
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Department of State Health Services regarding evaluation and |
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coordination of initiatives related to local mental health |
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authority operations; |
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(3) advise the executive commissioner and the |
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Department of State Health Services [and assist the department] in |
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developing a method of contracting with local mental health |
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authorities that will result in contracts that are flexible and |
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responsive to: |
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(A) the needs and services of local communities; |
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and |
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(B) the department's performance expectations; |
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(4) coordinate with [and monitor the activities of] |
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work groups whose actions may affect local mental health authority |
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operations; |
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(5) report to the executive commissioner and the |
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Department of State Health Services [board] on the committee's |
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activities and recommendations at least once each fiscal quarter; |
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and |
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(6) work with the executive commissioner or the |
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Department of State Health Services as the executive commissioner |
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directs. |
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(e) [(f)] For any written recommendation the committee |
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makes to the Department of State Health Services [department], the |
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department shall provide to the committee a written response |
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regarding any action taken on the recommendation or the reasons for |
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the department's inaction on the subject of the recommendation. |
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(f) The [(g) Except as provided by this subsection, the] |
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committee is subject to Chapter 2110, Government Code, except that |
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the committee is not subject to Section 2110.004 or 2110.008, |
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Government Code. The committee is abolished [automatically] on |
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September 1, 2017 [2007], unless the executive commissioner [board] |
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adopts a rule continuing the committee in existence beyond that |
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date. |
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(g) The Department of State Health Services may reimburse |
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consumers of mental health services and family members of |
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individuals with mental health needs appointed to the committee for |
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travel costs incurred in performing their duties as provided in the |
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General Appropriations Act. |
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SECTION 4. Subchapter B, Chapter 533, Health and Safety |
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Code, is amended by adding Section 533.03521 to read as follows: |
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Sec. 533.03521. LOCAL NETWORK DEVELOPMENT PLAN CREATION AND |
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APPROVAL. (a) A local mental health authority shall develop a |
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local network development plan regarding the configuration and |
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development of the local mental health authority's provider |
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network. The plan must reflect local needs and priorities and |
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maximize consumer choice and access to qualified service providers. |
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(b) The local mental health authority shall submit the local |
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network development plan to the Department of State Health Services |
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for approval. |
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(c) On receipt of a local network development plan under |
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this section, the department shall review the plan to ensure that |
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the plan: |
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(1) complies with the criteria established by Section |
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533.0358 if the local mental health authority is providing services |
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under that section; and |
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(2) indicates that the local mental health authority |
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is reasonably attempting to solicit the development of a provider |
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base that is: |
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(A) available and appropriate; and |
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(B) sufficient to meet the needs of consumers in |
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the local authority's local service area. |
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(d) If the department determines that the local network |
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development plan complies with Subsection (c), the department shall |
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approve the plan. |
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(e) At least biennially, the department shall review a local |
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mental health authority's local network development plan and |
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determine whether the plan complies with Subsection (c). |
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(f) As part of a local network development plan, a local |
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mental health authority annually shall post on the local |
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authority's website a list of persons with whom the local authority |
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had a contract or agreement in effect during all or part of the |
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previous year, or on the date the list is posted, related to the |
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provision of mental health services. |
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SECTION 5. Section 533.0355, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 533.0355. LOCAL MENTAL RETARDATION AUTHORITY |
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RESPONSIBILITIES [ALLOCATION OF DUTIES UNDER CERTAIN MEDICAID
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WAIVER PROGRAMS]. (a) The executive commissioner shall adopt |
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rules establishing the roles and responsibilities of local mental |
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retardation authorities [In this section, "waiver program" means
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the local mental retardation authority waiver program established
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under the state Medicaid program]. |
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(b) In adopting rules under this section, the executive |
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commissioner must include rules regarding the following local |
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mental retardation authority responsibilities: |
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(1) access; |
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(2) intake; |
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(3) eligibility functions; |
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(4) enrollment, initial person-centered assessment, |
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and service authorization; |
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(5) utilization management; |
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(6) safety net functions, including crisis management |
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services and assistance in accessing facility-based care; |
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(7) service coordination functions; |
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(8) provision and oversight of state general revenue |
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services; |
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(9) local planning functions, including stakeholder |
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involvement, technical assistance and training, and provider |
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complaint and resolution processes; and |
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(10) processes to assure accountability in |
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performance, compliance, and monitoring. [A provider of services
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under the waiver program shall:
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[(1)
develop a person-directed plan and an individual
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program plan for each person who receives services from the
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provider under the waiver program;
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[(2)
perform justification and implementation
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functions for the plans described by Subdivision (1);
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[(3)
conduct case management under the waiver program,
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other than case management under Subsection (c)(3), in accordance
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with applicable state and federal laws; and
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[(4)
plan, coordinate, and review the provision of
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services to all persons who receive services from the service
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provider under the waiver program.] |
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(c) In determining eligibility under Subsection (b)(3), a |
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local mental retardation authority must offer a state school as an |
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option among the residential services and other community living |
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options available to an individual who is eligible for those |
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services and who meets the department's criteria for state school |
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admission, regardless of whether other residential services are |
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available to the individual. |
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(d) In establishing a local mental retardation authority's |
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role as a qualified service provider of ICF-MR and related waiver |
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programs under Section 533.035(e-1), the executive commissioner |
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shall require the local mental retardation authority to: |
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(1) base the local authority's provider capacity on |
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the local authority's August 2004 enrollment levels for the waiver |
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programs the local authority operates and, if the local authority's |
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enrollment levels exceed those levels, to reduce the levels by |
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attrition; and |
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(2) base any increase in the local authority's |
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provider capacity on: |
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(A) the local authority's state-mandated |
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conversion from an ICF-MR program to a Section 1915(c) waiver |
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program allowing for a permanent increase in the local authority's |
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provider capacity in accordance with the number of persons who |
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choose the local authority as their provider; |
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(B) the local authority's voluntary conversion |
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from an ICF-MR program to a Section 1915(c) waiver program allowing |
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for a temporary increase in the local authority's provider |
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capacity, to be reduced by attrition, in accordance with the number |
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of persons who choose the local authority as their provider; |
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(C) the local authority's refinancing from |
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services funded solely by state general revenue to a Medicaid |
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program allowing for a temporary increase in the local authority's |
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provider capacity, to be reduced by attrition, in accordance with |
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the number of persons who choose the local authority as their |
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provider; or |
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(D) other extenuating circumstances that: |
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(i) are monitored and approved by the |
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Department of Aging and Disability Services; |
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(ii) do not include increases that |
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unnecessarily promote the local authority's provider role over its |
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role as a local mental retardation authority; and |
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(iii) may include increases necessary to |
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accommodate a family-specific or consumer-specific circumstance |
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and choice [A local mental retardation authority shall:
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[(1)
manage any waiting lists for services under the
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waiver program;
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[(2)
perform functions relating to consumer choice and
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enrollment for persons who receive services under the waiver
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program; and
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[(3)
conduct case management under the waiver program
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relating to funding disputes between a service provider and the
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local mental retardation authority.
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[(d)
The department shall perform all administrative
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functions under the waiver program that are not assigned to a
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service provider under Subsection (b) or to a local mental
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retardation authority under Subsection (c). Administrative
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functions performed by the department include:
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[(1)
any surveying, certification, and utilization
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review functions required under the waiver program; and
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[(2)
managing an appeals process relating to decisions
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that affect a person receiving services under the waiver program]. |
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(e) Any increase based on extenuating circumstances under |
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Subsection (d)(2)(D) is considered a temporary increase in the |
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local mental retardation authority's provider capacity, to be |
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reduced by attrition [The department shall review:
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[(1) screening and assessment of levels of care;
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[(2)
case management fees paid under the waiver
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program to a community center; and
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[(3)
administrative fees paid under the waiver program
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to a service provider]. |
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(f) At least biennially, the Department of Aging and |
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Disability Services shall review and determine the local mental |
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retardation authority's status as a qualified service provider in |
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accordance with criteria that includes the consideration of the |
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local authority's ability to assure the availability of services in |
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its area, including: |
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(1) program stability and viability; |
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(2) the number of other qualified service providers in |
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the area; and |
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(3) the geographical area in which the local authority |
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is located [The department shall perform any function relating to
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inventory for persons who receive services under the waiver program
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and agency planning assessments]. |
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(g) The Department of Aging and Disability Services shall |
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ensure that local services delivered further the following goals: |
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(1) to provide individuals with the information, |
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opportunities, and support to make informed decisions regarding the |
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services for which the individual is eligible; |
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(2) to respect the rights, needs, and preferences of |
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an individual receiving services; and |
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(3) to integrate individuals with mental retardation |
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and developmental disabilities into the community in accordance |
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with relevant independence initiatives and permanency planning |
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laws. [The review required under Subsection (e) must include a
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comparison of fees paid before the implementation of this section
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with fees paid after the implementation of this section. The
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department may adjust fees paid based on that review.
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[(h)
The department shall allocate the portion of the gross
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reimbursement funds paid to a local authority and a service
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provider for client services for the case management function in
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accordance with this section and to the extent allowed by law.
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[(i)
The department may adopt rules governing the functions
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of a local mental retardation authority or service provider under
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this section.] |
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SECTION 6. Subchapter B, Chapter 533, Health and Safety |
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Code, is amended by adding Sections 533.0357, 533.0358, and |
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533.0359 to read as follows: |
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Sec. 533.0357. BEST PRACTICES CLEARINGHOUSE FOR LOCAL |
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MENTAL HEALTH AUTHORITIES. (a) In coordination with local mental |
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health authorities, the department shall establish an online |
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clearinghouse of information relating to best practices of local |
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mental health authorities regarding the provision of mental health |
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services, development of a local provider network, and achievement |
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of the best return on public investment in mental health services. |
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(b) The department shall solicit and collect from local |
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mental health authorities that meet established outcome and |
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performance measures, community centers, consumers and advocates |
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with expertise in mental health or in the provision of mental health |
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services, and other local entities concerned with mental health |
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issues examples of best practices related to: |
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(1) developing and implementing a local network |
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development plan; |
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(2) assembling and expanding a local provider network |
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to increase consumer choice; |
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(3) creating and enforcing performance standards for |
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providers; |
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(4) managing limited resources; |
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(5) maximizing available funding; |
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(6) producing the best client outcomes; |
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(7) ensuring consumers of mental health services have |
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control over decisions regarding their health; |
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(8) developing procurement processes to protect |
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public funds; |
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(9) achieving the best mental health consumer outcomes |
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possible; and |
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(10) implementing strategies that effectively |
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incorporate consumer and family involvement to develop and evaluate |
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the provider network. |
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(c) The department may contract for the services of one or |
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more contractors to develop, implement, and maintain a system of |
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collecting and evaluating the best practices of local mental health |
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authorities as provided by this section. |
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(d) The department shall encourage local mental health |
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authorities that successfully implement best practices in |
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accordance with this section to mentor local mental health |
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authorities that have service deficiencies. |
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(e) Before the executive commissioner may remove a local |
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mental health authority's designation under Section 533.035(a) as a |
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local mental health authority, the executive commissioner shall: |
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(1) assist the local mental health authority in |
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attaining training and mentorship in using the best practices |
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established in accordance with this section; and |
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(2) track and document the local mental health |
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authority's improvements in the provision of service or continued |
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service deficiencies. |
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(f) Subsection (e) does not apply to the removal of a local |
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mental health authority's designation initiated at the request of a |
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local government official who has responsibility for the provision |
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of mental health services. |
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(g) The department shall implement this section using only |
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existing resources. |
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(h) The Department of State Health Services shall ensure |
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that a local mental health authority providing best practices |
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information to the department or mentoring another local mental |
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health authority complies with Section 533.03521(f). |
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Sec. 533.0358. LOCAL MENTAL HEALTH AUTHORITY'S PROVISION OF |
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SERVICES AS PROVIDER OF LAST RESORT. (a) A local mental health |
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authority may serve as a provider of services under Section |
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533.035(e) only if, through the local network development plan |
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process, the local authority determines that at least one of the |
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following applies: |
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(1) interested qualified service providers are not |
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available to provide services or no service provider meets the |
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local authority's procurement requirements; |
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(2) the local authority's network of providers does |
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not provide a minimum level of consumer choice by: |
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(A) presenting consumers with two or more |
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qualified service providers in the local authority's network for |
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service packages; and |
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(B) presenting consumers with two or more |
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qualified service providers in the local authority's network for |
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specific services within a service package; |
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(3) the local authority's provider network does not |
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provide consumers in the local service area with access to services |
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at least equal to the level of access provided as of a date the |
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executive commissioner specifies; |
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(4) the combined volume of services delivered by |
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qualified service providers in the local network does not meet all |
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of the local authority's service capacity for each service package |
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identified in the local network development plan; |
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(5) the performance of the services by the local |
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authority is necessary to preserve critical infrastructure and |
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ensure continuous provision of services; or |
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(6) existing contracts or other agreements restrict |
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the local authority from contracting with qualified service |
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providers for services in the local network development plan. |
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(b) If a local mental health authority continues to provide |
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services in accordance with this section, the local authority shall |
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identify in the local authority's local network development plan: |
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(1) the proportion of its local network services that |
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the local authority will provide; and |
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(2) the local authority's basis for its determination |
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that the local authority must continue to provide services. |
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Sec. 533.0359. RULEMAKING FOR LOCAL MENTAL HEALTH |
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AUTHORITIES. (a) In developing rules governing local mental |
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health authorities under Sections 533.035, 533.0351, 533.03521, |
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533.0357, and 533.0358, the executive commissioner shall use |
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rulemaking procedures under Subchapter B, Chapter 2001, Government |
|
Code. |
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(b) The executive commissioner by rule shall prohibit a |
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trustee or employee of a local mental health authority from |
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soliciting or accepting from another person a benefit, including a |
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security or stock, a gift, or another item of value, that is |
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intended to influence the person's conduct of authority business. |
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SECTION 7. Sections 533.035(f) and (g), Health and Safety |
|
Code, are repealed. |
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SECTION 8. 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, |
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the agency affected by the provision shall request the waiver or |
|
authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 9. Not later than January 1, 2008, the Health and |
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Human Services Commission shall submit a report to the governor, |
|
the lieutenant governor, and the speaker of the house of |
|
representatives that includes: |
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(1) whether a waiver from a federal agency is |
|
necessary for implementation of any provision of this Act and, if a |
|
waiver is necessary, the date the commission applied for that |
|
waiver or will apply for the waiver; and |
|
(2) any other information the commission finds |
|
relevant regarding the implementation of Sections 533.035, |
|
533.0351, 533.03521, 533.0355, 533.0357, and 533.0358, Health and |
|
Safety Code, as amended or added by this Act, by local mental health |
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and mental retardation authorities. |
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SECTION 10. Not later than November 1, 2007, the executive |
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commissioner of the Health and Human Services Commission shall |
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re-create and appoint the members of the local authority network |
|
advisory committee under Section 533.0351, Health and Safety Code, |
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as amended by this Act. |
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SECTION 11. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
|
house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
|
effect, this Act takes effect September 1, 2007. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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|
|
I certify that H.B. No. 2439 was passed by the House on April |
|
26, 2007, by the following vote: Yeas 142, Nays 0, 2 present, not |
|
voting; and that the House concurred in Senate amendments to H.B. |
|
No. 2439 on May 17, 2007, by the following vote: Yeas 133, Nays 1, |
|
1 present, not voting. |
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|
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______________________________ |
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Chief Clerk of the House |
|
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I certify that H.B. No. 2439 was passed by the Senate, with |
|
amendments, on May 15, 2007, by the following vote: Yeas 30, Nays |
|
0. |
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|
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |