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  S.B. No. 26
 
 
 
 
AN ACT
  relating to local mental health authority and local behavioral
  health authority audits and mental and behavioral health reporting,
  services, and programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 8.151, Education Code, is amended to
  read as follows:
         Sec. 8.151.  DEFINITIONS. In this subchapter:
               (1)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (2)  "Local[, "local] mental health authority" and
  "non-physician mental health professional" have the meanings
  assigned by Section 571.003, Health and Safety Code.
         SECTION 2.  Section 8.152, Education Code, is amended by
  adding Subsections (c) and (d) to read as follows:
         (c)  If a local mental health authority is unable to employ a
  professional who qualifies as a non-physician mental health
  professional, the authority may request a waiver from the executive
  commissioner for approval to employ, for purposes of performing the
  functions and duties of a non-physician mental health professional
  under this subchapter, a person who:
               (1)  is a licensed master social worker, as defined by
  Section 505.002, Occupations Code; or
               (2)  has been issued a licensed professional counselor
  associate license by the Texas State Board of Examiners of
  Professional Counselors.
         (d)  A person approved under a waiver under Subsection (c)
  shall carry out the functions and duties required of a
  non-physician mental health professional under this subchapter in
  the same manner as a non-physician mental health professional
  employed under Subsection (a) or (b).
         SECTION 3.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.09915 to read as follows:
         Sec. 531.09915.  INNOVATION MATCHING GRANT PROGRAM FOR
  MENTAL HEALTH EARLY INTERVENTION AND TREATMENT. (a) In this
  section:
               (1)  "Inpatient mental health facility" has the meaning
  assigned by Section 571.003, Health and Safety Code.
               (2)  "Program" means the grant program established
  under this section.
               (3)  "State hospital" has the meaning assigned by
  Section 552.0011, Health and Safety Code.
         (b)  To the extent money is appropriated to the commission
  for that purpose, the commission shall establish a matching grant
  program to provide support to eligible entities for community-based
  initiatives that promote identification of mental health issues and
  improve access to early intervention and treatment for children and
  families.  The initiatives may:
               (1)  be evidence-based or otherwise demonstrate
  positive outcomes, including:
                     (A)  improved relationship skills;
                     (B)  improved self-esteem;
                     (C)  reduced involvement in the juvenile justice
  system;
                     (D)  participation in the relinquishment
  avoidance program under Subchapter E, Chapter 262, Family Code; and
                     (E)  avoidance of emergency room use; and
               (2)  include:
                     (A)  training; and
                     (B)  services and supports for:
                           (i)  community-based initiatives;
                           (ii)  agencies that provide services to
  children and families;
                           (iii)  individuals who work with children or
  caregivers of children showing atypical social or emotional
  development or other challenging behaviors; and
                           (iv)  children in or at risk of placement in
  foster care or the juvenile justice system.
         (c)  The commission may award a grant under the program only
  in accordance with a contract between the commission and a grant
  recipient. The contract must include provisions under which the
  commission is given sufficient control to ensure the public purpose
  of providing mental health prevention services to children and
  families is accomplished and the state receives the return benefit.
         (d)  The executive commissioner by rule shall establish
  application and eligibility requirements for an entity to be
  awarded a grant under the program.
         (e)  The following entities are eligible for a grant awarded
  under the program:
               (1)  a hospital licensed under Chapter 241, Health and
  Safety Code;
               (2)  a mental hospital licensed under Chapter 577,
  Health and Safety Code;
               (3)  a hospital district;
               (4)  a local mental health authority;
               (5)  a child-care facility, as defined by Chapter 42,
  Human Resources Code;
               (6)  a county or municipality; and
               (7)  a nonprofit organization that is exempt from
  federal income taxation under Section 501(a), Internal Revenue Code
  of 1986, by being listed as an exempt entity under Section 501(c)(3)
  of that code.
         (f)  In awarding grants under the program, the commission
  shall prioritize entities that work with children and family
  members of children with a high risk of experiencing a crisis or
  developing a mental health condition to reduce:
               (1)  the need for future intensive mental health
  services;
               (2)  the number of children at risk of placement in
  foster care or the juvenile justice system; or
               (3)  the demand for placement in state hospitals,
  inpatient mental health facilities, and residential behavioral
  health facilities.
         (g)  The commission shall condition each grant awarded under
  the program on the grant recipient providing matching money in an
  amount that is equal to at least 10 percent of the grant amount.
         (h)  A grant recipient may only use grant money awarded under
  the program and matching money provided by the recipient to develop
  innovative strategies that provide:
               (1)  resiliency;
               (2)  coping and social skills;
               (3)  healthy social and familial relationships; and
               (4)  parenting skills and behaviors.
         (i)  A grant recipient may not use grant money awarded under
  the program or matching money provided by the recipient to:
               (1)  reimburse an expense or pay a cost that another
  source, including the Medicaid program, is obligated to reimburse
  or pay by law or under a contract; or
               (2)  supplant or be a substitute for money awarded to
  the recipient from a non-Medicaid federal funding source, including
  federal grant funding. 
         (j)  A Medicaid provider's receipt of a grant under the
  program does not affect any legal or contractual duty of the
  provider to comply with requirements under the Medicaid program.
         (k)  The commission may use a reasonable amount of the money
  appropriated by the legislature for the purposes of the program,
  not to exceed five percent, to pay the administrative costs of
  implementing and administering the program.
         SECTION 4.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.09991 to read as follows:
         Sec. 531.09991.  PLAN FOR THE TRANSITION OF CARE OF CERTAIN
  INDIVIDUALS. (a)  Not later than January 1, 2025, the commission
  shall, in consultation with nursing facilities licensed under
  Chapter 242, Health and Safety Code, develop a plan for
  transitioning from a hospital that primarily provides behavioral
  health services to a nursing facility individuals who require:
               (1)  a level of care provided by nursing facilities;
  and
               (2)  a high level of behavioral health supports and
  services.
         (b)  The plan must include:
               (1)  recommendations for providing incentives to
  providers for the provision of services to individuals described by
  Subsection (a), including an assessment of the feasibility of
  including incentive payments under the Quality Incentive Payment
  Program (QIPP) for those providers;
               (2)  recommendations for methods to create bed
  capacity, including reserving specific beds; and
               (3)  a fiscal estimate, including estimated costs to
  nursing facilities and savings to hospitals that will result from
  transitioning individuals under Subsection (a).
         (c)  The commission may implement the plan, including
  recommendations under the plan, only if the commission determines
  that implementing the plan would increase the amount of available
  state general revenue.
         (d)  This section expires September 1, 2025.
         SECTION 5.  Section 531.1025, Government Code, is amended by
  adding Subsection (c) to read as follows:
         (c)  The commission's office of inspector general shall
  conduct performance audits and require financial audits to be
  conducted of each local behavioral health authority designated
  under Section 533.0356, Health and Safety Code, and local mental
  health authority, as defined by Section 531.002, Health and Safety
  Code. The office shall:
               (1)  establish a performance audit schedule that
  ensures the office audits each authority described by this
  subsection at least once every five years;
               (2)  establish a financial audit schedule that ensures
  each authority described by this subsection:
                     (A)  undergoes a financial audit conducted by an
  independent auditor at least once every three years; and
                     (B)  submits to the office the results of the
  financial audit; and
               (3)  require additional audits to be conducted as
  necessary based on adverse findings in a previous audit or as
  requested by the commission.
         SECTION 6.  Section 534.0535, Health and Safety Code, is
  amended to read as follows:
         Sec. 534.0535.  JOINT DISCHARGE PLANNING.  (a)  The
  executive commissioner shall adopt or amend, and the department
  shall enforce, rules that require continuity of services and
  planning for patient care between department facilities and local
  mental health authorities.
         (b)  At a minimum, the rules must:
               (1)  specify the local mental health authority's
  responsibility for ensuring the successful transition of patients
  who are determined by the facility to be medically appropriate for
  discharge; and
               (2)  require participation by a department facility in 
  joint discharge planning with [between a department facility and] a
  local mental health authority before the [a] facility discharges a
  patient or places the patient on an extended furlough with an intent
  to discharge.
         (c)  The local mental health authority shall plan with the
  department facility to [and] determine the appropriate community
  services for the patient.
         (d)  The local mental health authority shall arrange for the
  provision of the services upon discharge [if department funds are
  to be used and may subcontract with or make a referral to a local
  agency or entity].
         (e)  The commission shall require each facility to designate
  at least one employee to provide transition support services for
  patients who are determined medically appropriate for discharge
  from the facility.
         (f)  Transition support services provided by the local
  mental health authority must be designed to complement joint
  discharge planning efforts and may include:
               (1)  enhanced services and supports for complex or
  high-need patients, including services and supports necessary to
  create viable discharge or outpatient management plans; and
               (2)  post-discharge monitoring for up to one year after
  the discharge date to reduce the likelihood of readmission.
         (g)  The commission shall ensure that each department
  facility concentrates the provision of transition support services
  for patients who have been:
               (1)  admitted to and discharged from a facility
  multiple times during a 30-day period; or
               (2)  in the facility for longer than 365 consecutive
  days.
         SECTION 7.  Chapter 572, Health and Safety Code, is amended
  by adding Section 572.0026 to read as follows:
         Sec. 572.0026.  VOLUNTARY ADMISSION RESTRICTIONS.  The
  facility administrator of an inpatient mental health facility or
  the administrator's designee may only approve the admission of a
  person for whom a proper request for voluntary inpatient services
  is filed if, at the time the request is filed, there is available
  space at the inpatient mental health facility.
         SECTION 8.  Section 1001.084, Health and Safety Code, as
  redesignated by Chapter 1236 (S.B. 1296), Acts of the 84th
  Legislature, Regular Session, 2015, is amended by amending
  Subsections (a), (b), (c), and (d) and adding Subsections (d-1),
  (d-2), and (g) to read as follows:
         (a)  The department, in collaboration with the commission,
  shall establish and maintain a public reporting system of
  performance and outcome measures relating to mental health and
  substance use [abuse] services established by the [Legislative
  Budget Board, the department, and the] commission. The system must
  allow external users to view and compare the performance[,
  outputs,] and outcomes of:
               (1)  local mental health authorities [community
  centers established under Subchapter A, Chapter 534, that provide
  mental health services];
               (2)  local behavioral health authorities [Medicaid
  managed care pilot programs that provide mental health services];
  and
               (3)  local intellectual and developmental disability
  authorities [agencies, organizations, and persons that contract
  with the state to provide substance abuse services].
         (b)  The public reporting system must allow external users to
  view and compare the performance[, outputs,] and outcomes of the
  Medicaid managed care programs that provide mental health services.
         (c)  The department shall post the performance[, output,]
  and outcome measures on the department's Internet website so that
  the information is accessible to the public. The department shall
  post the measures monthly, or as frequently as possible [quarterly
  or semiannually in accordance with when the measures are reported
  to the department].
         (d)  The [department shall consider public input in
  determining the appropriate outcome measures to collect in the]
  public reporting system must[.  To the extent possible, the
  department shall] include outcome measures that capture:
               (1)  inpatient psychiatric care diversion;
               (2)  [,] avoidance of emergency room use;
               (3)  [,] criminal justice diversion;
               (4)  [, and] the numbers of people who are homeless
  served;
               (5)  access to timely and adequate screening and rapid
  crisis stabilization services;
               (6)  timely access to and appropriate treatment from
  community-based crisis residential services and hospitalization;
               (7)  improved functioning as a result of
  medication-related and psychosocial rehabilitation services;
               (8)  information related to the number of people
  referred to a state hospital, state supported living center, or
  community-based hospital, the length of time between referral and
  admission, the length of stay, and the length of time between the
  date a person is determined ready for discharge or transition and
  the date of discharge or transition;
               (9)  the rate of denial of services or requests for
  assistance from jails and other entities and the reason for denial;
               (10)  quality of care in community-based mental health
  services and state facilities;
               (11)  the average number of hours of service provided
  to individuals in a full level of care compared to the recommended
  number of hours of service for each level of care; and
               (12)  any other relevant information to determine the
  quality of services provided during the reporting period.
         (d-1)  A local intellectual and developmental disability
  authority is only required to report information described by
  Subsection (d)(8) that is related to a state supported living
  center.
         (d-2)  This subsection and Subsections (d) and (d-1) expire
  September 1, 2025.
         (g)  In this section:
               (1)  "Local behavioral health authority" means an
  authority designated by the commission under Section 533.0356.
               (2)  "Local intellectual and developmental disability
  authority" and "local mental health authority" have the meanings
  assigned by Section 531.002.
               (3)  "State hospital" has the meaning assigned by
  Section 552.0011.
               (4)  "State supported living center" has the meaning
  assigned by Section 531.002.
         SECTION 9.  Not later than November 1, 2024, the executive
  commissioner of the Health and Human Services Commission shall by
  rule establish the process for requesting a waiver under Section
  8.152(c), Education Code, as added by this Act.
         SECTION 10.  Section 1001.084(e), Health and Safety Code, as
  redesignated by Chapter 1236 (S.B. 1296), Acts of the 84th
  Legislature, Regular Session, 2015, is repealed.
         SECTION 11.  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 12.  This Act takes effect September 1, 2023.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 26 passed the Senate on
  April 13, 2023, by the following vote: Yeas 30, Nays 0; and that
  the Senate concurred in House amendments on May 26, 2023, by the
  following vote: Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 26 passed the House, with
  amendments, on May 23, 2023, by the following vote: Yeas 143,
  Nays 0, two present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor