ENGROSSED HOUSE
BILL NO. 1363	By:	Peters, McDaniel (Jeanie), Newell and Cockroft of the House

				and

		Jolley and Allen of the Senate

An Act relating to poor persons; creating the Oklahoma Choices for Long-Term Care Act; stating purpose; making legislative findings; stating eligibility for the ADvantage Waiver Program; directing Oklahoma Health Care Authority to create a system of eligibility for home- and community-based services; directing Department of Human Services to make certain changes in regulations; directing Authority to submit applications for waivers by certain date; providing that copies of waivers be provided to certain individuals; requiring authority to implement waivers within certain time period; requiring Authority to include certain information in annual report; directing the Long-Term Care Management Authority (LTCA) to lead efforts to address long-term supports and service needs; providing for certain duties; directing certain state agencies to cooperate and collaborate; directing LTCA to assume administrative agent responsibilities for ADvantage Waiver Program; providing certain duties; providing for codification; and declaring an emergency.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.1 of Title 56, unless there is created a duplication in numbering, reads as follows:  
A.  Sections 1 through 7 of this act shall be known and may be cited as the “Oklahoma Choices for Long-Term Care Act”.
B.  The purpose of the Oklahoma Choices for Long-Term Care Act is to make long-term services and supports for citizens easily accessible, cost-effective and of high quality and to provide a comprehensive and systematic approach to addressing these needs.  The Oklahoma Choices for Long-Term Care Act shall provide older Oklahomans and adults with physical disabilities the opportunity to choose where they live and receive their services, and provide efficient administration of the ADvantage Waiver Program.
SECTION 2.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.2 of Title 56, unless there is created a duplication in numbering, reads as follows:
The Legislature finds that:
1.  Oklahoma has a successful home- and community-based services program known as the ADvantage Waiver Program for the frail, elderly and adults with physical disabilities age twenty-one (21) and over who do not have mental retardation nor a cognitive impairment.  The ADvantage Waiver Program provides the following services:  case management, transitional case management, advantage personal care, advanced supportive/restorative, skilled nursing - home health setting, RN assessment evaluation, occupational therapy, physical therapy, respiratory therapy, speech/language therapy, adult day health, personal care in adult day health, therapy in adult day health, home-delivered meals, NF extended respite, in-home respite, in-home extended respite, environmental modifications, hospice, and specialized medical equipment and supplies;  
2.  Many Oklahomans who could safely stay at home with cost-effective home- and community-based services go into nursing facilities the day assistance is needed because their eligibility for nursing facility supports is “presumed” by the nursing facility, while eligibility for home and community supports can take weeks or months.  If their circumstances are such that they need immediate or urgent care, they lose their choice to live and receive their services at home.  Once they are in a nursing facility, they may lose their home or the supports they need to stay at home; and
3.  The cost of serving Oklahomans who are in nursing facilities when they could be living and receiving services at home is significantly higher than the cost of serving them with home- and community-based services.
SECTION 3.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.3 of Title 56, unless there is created a duplication in numbering, reads as follows:
To be eligible for the ADvantage Waiver Program, a person shall:
1.  Qualify financially for Medicaid;
2.  Be sixty-five (65) years of age or older or be a physically disabled adult as determined by the Social Security Administration, age twenty-one (21) years or older without mental retardation or cognitive impairment;
3.  Be determined to meet the nursing facility institutional level of care by the Aging Services Division of the Department of Human Services; 
4.  Reside in his or her own home or a family member’s home; and
5.  Have needs that can be safely met with waiver services and family or community supports.  
SECTION 4.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.4 of Title 56, unless there is created a duplication in numbering, reads as follows:
A.  The Oklahoma Health Care Authority is directed to create a system of eligibility for home- and community-based services provided by the ADvantage 1915C Waiver Program that provides for presumptive eligibility.
B.  The Department of Human Services is directed to make such changes in its regulations, policies and procedures as are necessary to implement the eligibility requirements established pursuant to subsection A of this section.
C.  The Oklahoma Health Care Authority shall develop and submit for approval no later than November 1, 2011, applications for waivers or amendments to waivers of applicable federal laws and regulations as necessary to implement the provisions of the Oklahoma Choices for Long-Term Care Act.  Copies of all waivers submitted to the United States Centers for Medicare and Medicaid Services shall be provided to the Governor, the Speaker of the Oklahoma House of Representatives and the President Pro Tempore of the Oklahoma State Senate within ten (10) days of their submissions.  Waivers and amendments to waivers approved by the United States Centers for Medicare and Medicaid Services as provided in this section shall be provided to the Governor, the Speaker of the Oklahoma House of Representatives and the President Pro Tempore of the Oklahoma State Senate within ten (10) days of their approval.  The Oklahoma Health Care Authority shall implement any waivers and amendments to waivers approved by the United States Centers for Medicare and Medicaid Services no later than January 1, 2012, or within sixty (60) days of their approval.  The Oklahoma Health Care Authority shall report the savings as the result of the Oklahoma Choices for Long-Term Care Act each year in its annual report.   
SECTION 5.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.5 of Title 63, unless there is created a duplication in numbering, reads as follows:
The Long-Term Care Management Authority (LTCA) shall be directed to lead the state’s efforts to address the long-term supports and service needs of its citizens.  With this responsibility, the LTCA shall:
1.  Serve as a catalyst and change agent to lead the state’s efforts to enhance and sustain home- and community-based long-term services and supports;
2.  Collaborate with the Legislature to apply for both public and private funding opportunities in conjunction with other state agencies and receive designated appropriations for funding of long-term services and supports initiatives;
3.  Initiate joint planning, development, implementation, evaluation and management of home- and community-based long-term supports and services in this state;
4.  Streamline the existing, sustainable private sector of experienced home- and community-based providers to deliver critical services to citizens at a lower cost, higher quality and in a timely manner; and
5.  Provide accountability for performance, transparency and responsiveness to state agencies, private sector providers, the Legislature, and other stakeholders through monthly, quarterly and annual reports based on measurable goals, benchmarks and best practices through ongoing information-sharing.
SECTION 6.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.6 of Title 63, unless there is created a duplication in numbering, reads as follows:
The Oklahoma Health Care Authority and the Department of Human Services are directed to cooperate and collaborate with the Long-Term Care Management Authority to address the long-term supports and service needs to the citizens of this state.
SECTION 7.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1017.7 of Title 63, unless there is created a duplication in numbering, reads as follows:
The Long-Term Care Management Authority (LTCA) is directed to assume administrative agent responsibilities for the ADvantage Waiver Program.  The LTCA shall:
1.  Prepare for transition by developing a comprehensive plan for assuming administrative agent responsibilities that outlines the key objectives, activities and timelines involved in the transition of the operation and administrative responsibilities for the ADvantage Waiver Program currently under the administration of the  Department of Human Services;
2.  Implement the transition plan by assuming management responsibilities for ADvantage Waiver Program operations;
3.  Focus immediate efforts on the following areas to diminish the increasing negative impact to members and service providers:
a.	assess the current backlog of service plan authorization and implement a plan to return service authorizations to a best-practice timeline (no more than five (5) days),
b.	evaluate challenges with the current service authentication technology, AuthentiCare, and recommend a plan for resolution, 
c.	investigate problems related to assessor subjectivity involved in denied medical eligibility, voluntary withdrawals, and nursing home placement and recommend a plan for resolution, and 
d.	assess the extent of unpaid claims related to delayed service plan authorizations and challenges with the AuthentiCare system, and recommend a plan to return claims payment to a best-practice timeline;
4.  Evaluate and identify other areas of concern based on the following Centers for Medicare and Medicaid Services Waiver Assurances: level of care, service plans, qualified providers, health and welfare, administrative authority, and financial accountability;
5.  Provide a status report of immediate efforts to the Legislature by August 1, 2011;
6.  Develop an improvement plan with performance measures to the Legislature by September 1, 2011; and
7.  Establish a monthly report to the Legislature on the progress of ADvantage Waiver Program administration.
SECTION 8.  It being immediately necessary for the preservation of the public peace, health and safety, an emergency is hereby declared to exist, by reason whereof this act shall take effect and be in full force from and after its passage and approval.
Passed the House of Representatives the 1st day of March, 2011.

	
Presiding Officer of the House of
	Representatives

Passed the Senate the ____ day of __________, 2011.

	
Presiding Officer of the Senate