Bill Text: TX HB4115 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to the establishment of a home and community support services improvement pilot program under the Medicaid managed care program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-03-31 - Referred to Public Health [HB4115 Detail]
Download: Texas-2017-HB4115-Introduced.html
85R9622 LED-D | ||
By: Longoria | H.B. No. 4115 |
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relating to the establishment of a home and community support | ||
services improvement pilot program under the Medicaid managed care | ||
program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 533, Government Code, is amended by | ||
adding Subchapter F to read as follows: | ||
SUBCHAPTER F. HOME AND COMMUNITY SUPPORT SERVICES IMPROVEMENT | ||
PILOT PROGRAM | ||
Sec. 533.101. DEFINITIONS. In this subchapter: | ||
(1) "Electronic visit verification device" means a | ||
device that is installed in an individual's residence and is used by | ||
a provider agency to verify that a personal care attendant arrives | ||
at the individual's residence to provide services. | ||
(2) "Health service region" means a public health | ||
region designated under Section 121.007, Health and Safety Code. | ||
(3) "Participating provider agency" means a provider | ||
agency participating in the pilot program established under this | ||
subchapter. | ||
(4) "Personal care attendant" means an individual | ||
employed by a provider agency to provide personal care services. | ||
The term does not include an individual described by Section | ||
142.003(a)(1) or (2), Health and Safety Code. | ||
(5) "Personal care services" means nonmedical | ||
services that enable an individual to engage in the activities of | ||
daily living or to perform the physical functions required for | ||
independent living, including: | ||
(A) bathing, dressing, grooming, feeding, | ||
exercising, toileting, positioning, assisting with | ||
self-administered medications, routine hair and skin care, and | ||
transfer or ambulation; and | ||
(B) light housekeeping, grocery shopping, meal | ||
preparation, and laundry. | ||
(6) "Pilot program" means the program established | ||
under this subchapter. | ||
(7) "Provider agency" means an agency that contracts | ||
with a managed care organization that contracts with the commission | ||
to provide health care services to recipients for the provision of | ||
personal care services by the agency. The term includes a home and | ||
community support services agency licensed under Chapter 142, | ||
Health and Safety Code, and a continuing care facility licensed | ||
under Chapter 246, Health and Safety Code. | ||
Sec. 533.102. PILOT PROGRAM. (a) The commission shall | ||
establish a pilot program in the health service region designated | ||
as Region 11 to: | ||
(1) improve the delivery of home and community support | ||
services by provider agencies under the Medicaid managed care | ||
program; | ||
(2) reduce recipient rehospitalization and unplanned | ||
doctor visits; | ||
(3) achieve cost savings; and | ||
(4) reduce fraud, abuse, and waste. | ||
(b) The commission, with the assistance of interested | ||
parties, including participating provider agencies, managed care | ||
organizations, researchers, and persons who provide funding for the | ||
program, shall develop the pilot program. The program must: | ||
(1) provide services to at least 15,000 and not more | ||
than 20,000 recipients by its final year of operation; and | ||
(2) include the components described by this | ||
subchapter. | ||
(c) The commission shall contract with an independent or | ||
university-based health research organization, such as a | ||
university group, to assist with the pilot program, by conducting | ||
research for and evaluating the effectiveness of the program. The | ||
research organization may: | ||
(1) determine data that will be reported and | ||
performance measures that will be used under the program; | ||
(2) provide feedback throughout the operation of the | ||
program to adjust data reporting; | ||
(3) evaluate the relationship between changes | ||
implemented by the program and recipient health outcomes; | ||
(4) compare recipient health outcomes with those of | ||
recipients not receiving services in the program; and | ||
(5) prepare a final report that analyzes the | ||
effectiveness of the program and makes recommendations about | ||
whether to continue the program or any part of the program. | ||
Sec. 533.103. PERSONAL CARE ATTENDANT TRAINING. The | ||
commission, in consultation with participating provider agencies | ||
and a local community college or health care training organization, | ||
shall develop as a component of the pilot program a training program | ||
for personal care attendants. The program's curriculum must focus | ||
on helping a personal care attendant avoid recipient | ||
rehospitalization and must include instruction about: | ||
(1) recognition of potential adverse health care | ||
conditions; | ||
(2) trip and fall avoidance; | ||
(3) basic nutrition and cooking; | ||
(4) medication prompting; and | ||
(5) mobility and activity enhancement. | ||
Sec. 533.104. INCREASED SUPERVISION AND COMPLIANCE. As a | ||
component of the pilot program, the commission shall require a | ||
participating provider agency to: | ||
(1) increase supervision of the agency's personal care | ||
attendants; | ||
(2) implement stricter compliance protocols for | ||
attendants; and | ||
(3) at least quarterly conduct scheduled and | ||
unscheduled visits to a recipient's home to confer with the | ||
recipient about the personal care services the recipient is | ||
receiving. | ||
Sec. 533.105. FRAUD, WASTE, AND ABUSE PREVENTION PROTOCOLS. | ||
As a component of the pilot program, the commission shall require a | ||
participating provider agency to: | ||
(1) develop enhanced fraud, waste, and abuse | ||
prevention protocols that address collusion and fraud among | ||
recipients, personal care attendants, and other provider agency | ||
staff; and | ||
(2) implement the protocols during a recipient's | ||
enrollment, an agency's hiring process and employment reviews, and | ||
other critical points in the delivery of personal care services. | ||
Sec. 533.106. PERSONAL CARE ATTENDANT REGISTRY. The | ||
commission, in consultation with participating provider agencies | ||
and managed care organizations that contract with the commission to | ||
provide health care services to recipients, shall establish as a | ||
component of the pilot program a personal care attendant registry | ||
that allows the commission to: | ||
(1) track personal care attendant performance by | ||
measuring recipient health outcomes; and | ||
(2) identify each personal care attendant who fails to | ||
meet certain standards, including following a participating | ||
provider agency's implementation of progressive work improvement | ||
efforts for the attendant. | ||
Sec. 533.107. RECIPIENT TRANSFER PROTOCOLS. (a) As a | ||
component of the pilot program, the commission shall require a | ||
participating provider agency to develop and implement enhanced | ||
recipient transfer protocols to: | ||
(1) prevent a recipient and personal care attendant | ||
from moving to a different provider agency in an effort to avoid | ||
disciplinary action against or unfairly leverage a raise for the | ||
personal care attendant; | ||
(2) prevent fraud, waste, and abuse; and | ||
(3) identify a poorly performing personal care | ||
attendant. | ||
(b) An enhanced recipient transfer protocol developed under | ||
this section must allow a recipient to choose a provider agency. | ||
Sec. 533.108. ENHANCED ELECTRONIC VISIT VERIFICATION | ||
DEVICE COMPLIANCE. (a) As a component of the pilot program, the | ||
commission shall require a participating provider agency to develop | ||
and implement enhanced electronic visit verification device | ||
compliance protocols to prevent fraud and waste due to an | ||
attendant's reporting of hours that the attendant did not work. | ||
(b) The commission shall meet with developers or providers | ||
of electronic visit verification devices used by provider agencies | ||
to explore additional options to counter fraud using the systems. | ||
Sec. 533.109. ANTI-SOLICITATION AND ANTI-KICKBACK RULES. | ||
The commission, in consultation with participating provider | ||
agencies, shall determine as a component of the pilot program | ||
strategies to strengthen anti-solicitation and anti-kickback rules | ||
in order to prevent fraud and waste and improve the continuity of | ||
care for recipients. | ||
Sec. 533.110. ENHANCED PROVIDER AGENCY STANDARDS. The | ||
commission, in consultation with participating provider agencies, | ||
shall develop as a component of the pilot program stricter provider | ||
agency standards to continually improve the delivery of home and | ||
community support services. The standards must be outcome-based | ||
and measured by recipient health outcomes or satisfaction. | ||
Sec. 533.111. INCREASED ENFORCEMENT. (a) The commission, | ||
in consultation with the commission's office of inspector general | ||
and participating provider agencies, shall develop and implement: | ||
(1) strengthened enforcement strategies for the pilot | ||
program components; and | ||
(2) effective strategies for provider agency | ||
self-regulation with respect to the pilot program components and | ||
other applicable requirements. | ||
(b) The strategies must focus on: | ||
(1) preventing fraud, waste, and abuse; | ||
(2) eliminating from the Medicaid managed care program | ||
the provider agencies and personal care attendants who have the | ||
poorest performance; | ||
(3) improving health care outcomes for recipients; and | ||
(4) increasing savings for the state. | ||
Sec. 533.112. MANAGED CARE ORGANIZATION PARTNERSHIPS. The | ||
commission shall coordinate as a component of the pilot program | ||
partnerships between participating provider agencies and managed | ||
care organizations that contract with the commission to provide | ||
health care services to recipients to improve the delivery of home | ||
and community support services under the Medicaid managed care | ||
program. | ||
Sec. 533.113. REPORT. (a) Not later than September 1, | ||
2021, the commission shall submit to the legislature a report | ||
concerning the pilot program that includes: | ||
(1) the results of any research related to the | ||
program; | ||
(2) the effectiveness of each component of the | ||
program; | ||
(3) any reports made by a participant or research | ||
organization during the course of the program; | ||
(4) other relevant information concerning the | ||
program; and | ||
(5) a recommendation about whether the pilot program | ||
should be continued in whole or in part, expanded, or terminated. | ||
(b) The commission shall provide the report prepared under | ||
Subsection (a) to participating provider agencies and managed care | ||
organizations. | ||
Sec. 533.114. GIFTS, GRANTS, AND DONATIONS. The commission | ||
may solicit and accept gifts, grants, and donations of any kind and | ||
from any source for purposes of implementing this subchapter. | ||
Sec. 533.115. RULES. The executive commissioner may adopt | ||
rules necessary to implement this subchapter. | ||
Sec. 533.116. EXPIRATION. This subchapter expires | ||
September 1, 2023. | ||
SECTION 2. Not later than January 1, 2018, the Health and | ||
Human Services Commission shall establish the home and community | ||
support services improvement pilot program as required by | ||
Subchapter F, Chapter 533, Government Code, as added by this Act. | ||
SECTION 3. 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 4. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2017. |