H.B. No. 3550
  relating to standards for and services provided by prescribed
  pediatric extended care centers, including Medicaid reimbursement
  for those services.
         SECTION 1.  Section 248A.101(b), Health and Safety Code, is
  amended to read as follows:
         (b)  To protect the health and safety of the public and
  ensure the health, safety, and comfort of the minors served by a
  center, the rules must establish minimum center standards,
               (1)  standards relating to the issuance, renewal,
  denial, suspension, probation, and revocation of a license to
  operate a center;
               (2)  standards relating to the provision of
  family-centered basic services that include individualized
  medical, developmental, and family training services;
               (3)  based on the size of the building and the number of
  minors served, building construction and renovation standards,
  including standards for plumbing, electrical, glass, manufactured
  buildings, accessibility for persons with physical disabilities,
  and fire protection;
               (4)  based on the size of the building and the number of
  minors served, building maintenance conditions relating to
  plumbing, heating, lighting, ventilation, adequate space, fire
  protection, and other conditions;
               (5)  standards relating to the minimum number of and
  qualifications required for personnel who provide personal care or
  basic services to the minors served;
               (6)  standards relating to the sanitary conditions
  within a center and its surroundings, including water supply,
  sewage disposal, food handling, and general hygiene;
               (7)  standards relating to the programs offered by the
  center to promote and maintain the health and development of the
  minors served and to meet the training needs of the minors' parents
  or legal guardians;
               (8)  standards relating to physician-prescribed
  supportive services;
               (9)  standards relating to transportation services and
  as required by Section 248A.1015; and
               (10)  standards relating to maintenance of patient
  medical records and program records in accordance with other law
  and with accepted professional standards and practices.
         SECTION 2.  Subchapter C, Chapter 248A, Health and Safety
  Code, is amended by adding Sections 248A.1015 and 248A.105 to read
  as follows:
         Sec. 248A.1015.  TRANSPORTATION STANDARDS. The executive
  commissioner by rule shall establish minimum standards for
  transportation services as required under Section 248A.101(b)(9).
  In adopting rules under this section, the executive commissioner:
               (1)  shall authorize a center to determine:
                     (A)  in coordination with a minor client's parent,
  guardian, or other legally authorized representative, the schedule
  of transportation services; and
                     (B)  in coordination with the client's
  prescribing physician, the necessary type of provider who must be
  present during transportation;
               (2)  shall permit a minor client's parent, guardian, or
  other legally authorized representative to decline a center's
  transportation services entirely or only on a specific date; and
               (3)  may not:
                     (A)  require a plan of care or physician's order
  to document a client's need for transportation services to access a
  center's services; or
                     (B)  consider transportation services as nursing
  services included in a client's plan of care.
  TREATMENT. (a) Except as provided by Subsection (b), any rules the
  executive commissioner adopts under this subchapter may not
  interfere with the authority of a parent, guardian, or legally
  authorized representative of a minor client to make decisions
  regarding the treatment provided to the child.
         (b)  The executive commissioner, by rule, may limit the
  maximum amount of authorized services provided to a client.
         SECTION 3.  Section 248A.158, Health and Safety Code, is
  amended to read as follows:
         Sec. 248A.158.  RELATION TO NURSING SERVICES.  (a) Subject
  to Subsection (b), nursing [Nursing] services provided to a client
  by a center must be a [one-to-one] replacement of private duty
  nursing or other skilled nursing services provided in a setting
  other than a center unless additional nursing services are
  medically necessary.
         (b)  A center may provide nursing services in a group
  setting, consistent with appropriate staffing ratios as the
  executive commissioner determines.
         SECTION 4.  Subchapter D, Chapter 248A, Health and Safety
  Code, is amended by adding Section 248A.159 to read as follows:
         Sec. 248A.159.  ADMISSION FORMS. (a) Before admission to a
  center, the center may obtain all required parent or legal guardian
  signatures for a patient on one consent document.
         (b)  The consent document must illustrate the involvement of
  the parent or legal guardian in developing and establishing the
  care and treatment to be provided to the patient in the center.
         SECTION 5.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.0287 to read as follows:
  REIMBURSEMENT. (a) In this section, "center" means a prescribed
  pediatric extended care center licensed under Chapter 248A, Health
  and Safety Code.
         (b)  In adopting rules governing the reimbursement of a
  center for services provided under the medical assistance program,
  the executive commissioner shall clearly identify the
  documentation a center must obtain and maintain to be eligible for
  reimbursement. The rules may not:
               (1)  authorize a center to combine documentation for
  transportation with documentation for other services provided by
  the center; or
               (2)  condition reimbursement of non-transportation
  services on:
                     (A)  a recipient's decision to use transportation
  services on a specific date or on an ongoing basis; or
                     (B)  a center's obtaining and maintaining
  transportation documentation.
         SECTION 6.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall:
               (1)  adopt the rules necessary to implement the changes
  in law made by this Act; and
               (2)  update any relevant procedure manuals, including
  the Children's Services Handbook, to conform to the changes in law
  made by this Act.
         SECTION 7.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 8.  This Act takes effect September 1, 2023.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I certify that H.B. No. 3550 was passed by the House on April
  28, 2023, by the following vote:  Yeas 109, Nays 33, 2 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 3550 on May 26, 2023, by the following vote:  Yeas 113, Nays 29,
  1 present, not voting.
  Chief Clerk of the House   
         I certify that H.B. No. 3550 was passed by the Senate, with
  amendments, on May 24, 2023, by the following vote:  Yeas 25, Nays
  Secretary of the Senate   
  APPROVED: __________________