Bill Text: TX HB4561 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the system redesign for delivery of Medicaid acute care services and long term services and supports to persons with an intellectual or developmental disability and a pilot for certain populations with similar functional needs receiving services in managed care.

Spectrum: Bipartisan Bill

Status: (Introduced) 2019-03-26 - Referred to Human Services [HB4561 Detail]

Download: Texas-2019-HB4561-Introduced.html
 
 
  By: Klick H.B. No. 4561
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the system redesign for delivery of Medicaid acute care
  services and long term services and supports to persons with an
  intellectual or developmental disability and a pilot for certain
  populations with similar functional needs receiving services in
  managed care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 534.001, Subchapter A, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.001.  DEFINITIONS. In this chapter:
               (3)  ["Department" means the Department of Aging and
  Disability Services.] "Commission" means the Health and Human
  Services Commission or an agency operating part of the state
  Medicaid managed care program, as appropriate.
               (4)  "Comprehensive long term services and supports
  provider" is defined as a provider of long term services and
  supports specified under this chapter that ensures the coordinated,
  seamless provision of the full range of services as approved in
  participants' program plans as described under Section 534.1045
  (b), (b-2),(c), and (d). A comprehensive service provider includes:
                     (A)  an ICF/IID program provider who is authorized
  to deliver services in the program defined under Section 534.001
  (8), and
                     (B)  a Medicaid waiver program provider who is
  authorized to deliver services in the programs specified under
  Section 534.001 (12) and certified in accordance with 534.301 (b).
               [(4)(5)  "Functional need" means the measurement of
  an individual's services and supports needs, including the
  individual's intellectual, psychiatric, medical, and physical
  support needs.
               [(5)(6)  "Habilitation services" includes assistance
  provided to an individual with acquiring, retaining, or improving:
                     (A)  skills related to the activities of daily
  living; and
                     (B)  the social and adaptive skills necessary to
  enable the individual to live and fully participate in the
  community.
               [(6)(7)  "ICF-IID" means the program under Medicaid
  serving individuals with an intellectual or developmental
  disability who receive care in intermediate care facilities other
  than a state supported living center.
               [(7)(8)  "ICF-IID program" means a program under
  Medicaid serving individuals with an intellectual or developmental
  disability who reside in and receive care from:
                     (A)  intermediate care facilities licensed under
  Chapter 252, Health and Safety Code; or
                     (B)  community-based intermediate care facilities
  operated by local intellectual and developmental disability
  authorities.
               [(8)(9)  "Local intellectual and developmental
  disability authority" has the meaning assigned by Section 531.002,
  Health and Safety Code.
               [(9)(11)  "Managed care organization," "managed care
  plan," and "potentially preventable event" have the meanings
  assigned under Section 536.001.
               (10)  Repealed by Acts 2015, 84th Leg., R.S., Ch. 1,
  Sec. 2.287(17), eff. April 2, 2015.
               [(11)(12)  "Medicaid waiver program" means only the
  following programs that are authorized under Section 1915(c) of the
  federal Social Security Act (42 U.S.C. Section 1396n(c)) for the
  provision of services to persons with an intellectual or
  developmental disability:
                     (A)  the community living assistance and support
  services (CLASS) waiver program;
                     (B)  the home and community-based services (HCS)
  waiver program;
                     (C)  the deaf-blind with multiple disabilities
  (DBMD) waiver program; and
                     (D)  the Texas home living (TxHmL) waiver program.
               (13)  "Residential Services" means services provided
  for an individual with intellectual or developmental disability in
  a community-based ICF/IID, a three or four persons home and host
  home/companion service offered through the 1915(c) home and
  community-based waiver services program, or a group home in the
  Deaf Blind Multiple Disabilities program.
               [(12)(14)  "State supported living center" has the
  meaning assigned by Section 531.002, Health and Safety Code.
         SECTION 2.  Section 534.051, Subchapter B, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.051.  ACUTE CARE SERVICES AND LONG-TERM SERVICES
  AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR
  DEVELOPMENTAL DISABILITY. In accordance with this chapter, the
  commission [and the department] shall [jointly] design and
  implement an acute care services and long-term services and
  supports system for individuals with an intellectual or
  developmental disability that supports the following goals:
               (1)  provide Medicaid services to more individuals in a
  cost-efficient manner by providing the type and amount of services
  most appropriate to the individuals' needs and preferences in the
  most integrated and least restrictive setting;
         SECTION 3.  Section 534.052, Subchapter B, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.052.  IMPLEMENTATION OF SYSTEM REDESIGN. The
  commission [and department] shall, in consultation and
  collaboration with the advisory committee, [jointly] implement the
  acute care services and long-term services and supports system for
  individuals with an intellectual or developmental disability in the
  manner and in the stages described in this chapter.
         SECTION 4.  Section 534.053, Subchapter B, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.053.  INTELLECTUAL AND DEVELOPMENTAL DISABILITY
  SYSTEM REDESIGN ADVISORY COMMITTEE. (a) The Intellectual and
  Developmental Disability System Redesign Advisory Committee shall
  advise the commission [and the department] on the implementation of
  the acute care services and long-term services and supports system
  redesign under this chapter. Subject to Subsection (b), the
  executive commissioner [and the commissioner of aging and
  disability services] shall [jointly] appoint members of the
  advisory committee who are stakeholders from the intellectual and
  developmental disabilities community, including:
         (b)  To the greatest extent possible, the executive
  commissioner [and the commissioner of aging and disability
  services] shall appoint members of the advisory committee who
  reflect the geographic diversity of the state and include members
  who represent rural Medicaid recipients.
         (e-1)  The advisory committee may establish work groups that
  meet at other times for purposes of studying and making
  recommendations on issues the committee considers appropriate.
         [(g)  On January 1, 2026:
               (1)  the advisory committee is abolished ; and
               (2)  this section expires].
         (g)  On the [one year] two-year anniversary of the date the
  commission completes implementation of the transition required
  under Section 534.202:
               (1)  the advisory committee is abolished; and
               (2)  this section expires.
         SECTION 5.  Section 534.054, Subchapter B, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.054.  ANNUAL REPORT ON IMPLEMENTATION.
         (b)  On the two-year anniversary of the date the commission
  completes implementation of the transition required under Section
  534.202 this [This] section expires [January 1, 2026].
         SECTION 6.  Section 534.101, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.101.  Pilot Program Workgroup [DEFINITIONS]. In
  accordance with Section 534.053 (e-1), for puposes of [In] this
  subchapter the advisory committee shall establish a h Workgroup
  that includes representatives from the advisory committee,
  stakeholders representing individuals with an intellectual and
  developmental disability, individuals with similar functional
  needs, and the STAR+PLUS managed care organizations. [:]
               [(1)     "Capitation" means a method of compensating a
  provider on a monthly basis for providing or coordinating the
  provision of a defined set of services and supports that is based on
  a predetermined payment per services recipient.]
               [(2)     "Provider" means a person with whom the
  commission contracts for the provision of long-term services and
  supports under Medicaid to a specific population based on
  capitation.]
         SECTION 7.  Section 534.102, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.102.  PILOT PROGRAM [S] TO TEST PERSON-CENTERED
  MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. The
  commission [and the department may] ,in consultation and
  collaboration with the advisory committee and Pilot Program
  Workgroup, shall develop and implement a pilot program[s] in
  accordance with this subchapter to test, through the STAR+PLUS
  Medicaid managed care program, the delivery of [one or more service
  delivery models involving] long term services and supports [a
  managed care strategy based on capitation to deliver long-term
  services and supports under Medicaid] to individuals [with an
  intellectual or developmental disability]specified under Section
  534.1065.
         SECTION 8.  Section 534.103, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.103.  STAKEHOLDER INPUT. As part of developing and
  implementing a pilot program under this subchapter, the
  [department] commission, in consultation and collaboration with
  the advisory committee and Pilot Program Workgroup, shall develop a
  process to receive and evaluate input from statewide stakeholders
  and stakeholders from the STAR+PLUS service area [region] of the
  state in which the pilot program will be implemented and other
  evaluations and data.
         SECTION 9.  Chaoter 534, Government Code is amended to add
  new Section 534.1035, SELECTION OF MANAGED CARE ORGANIZATION
  VENDORS, to read as follows:
         Sec.534.1035.  SELECTON OF MANAGED CARE ORGANIZATION PILOT
  VENDORS. (a) The commission shall select and contract with no more
  than two managed care organizations contracted to provide services
  under the STAR+PLUS Medicaid managed care program to participate in
  the pilot.
         (b)  The commission, in consultation and collaboration with
  the advisory committee and Pilot Program Workgroup, shall develop
  criteria regarding the selection of managed care organizations to
  conduct the pilot program.
         SECTION 10.  Section 534.104, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.104.  PILOT DESIGN [MANAGED CARE STRATEGY
  PROPOSALS; PILOT PROGRAM SERVICE PROVIDERS].
         [(a)     The department, in consultation and collaboration with
  the advisory committee, shall identify private services providers
  or managed care organizations that are good candidates to develop a
  service delivery model involving a managed care strategy based on
  capitation and to test the model in the provision of long-term
  services and supports under Medicaid to individuals with an
  intellectual or developmental disability through a pilot program
  established under this subchapter].
         [(b)     The department shall solicit managed care strategy
  proposals from the private services providers and managed care
  organizations identified under Subsection (a). In addition, the
  department may accept and approve a managed care strategy proposal
  from any qualified entity that is a private services provider or
  managed care organization if the proposal provides for a
  comprehensive array of long-term services and supports, including
  case management and service coordination.]
         [(c)(a)  [A managed care strategy based on capitation
  developed for implementation through a] The pilot program under
  this subchapter must be designed to:
               (1)  increase access to long-term services and
  supports;
               (2)  improve quality of acute care services and
  long-term services and supports;
               (3)  promote informed choice and meaningful outcomes by
  using person-centered planning, flexible consumer directed
  services, individualized budgeting, and self-determination, and
  promote community inclusion and engagement;
               (4)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (5)  promote efficiency and the best use of funding
  based on the individual's needs and preferences;
               (6)  promote [the placement of an individual in]
  housing stability through housing supports and navigation services
  that is the most integrated and least restrictive setting
  appropriate to the individual's needs and preferences;
               (7)  promote employment assistance and customized,
  integrated, and competitive employment;
               (8)  provide fair hearing and appeals processes in
  accordance with applicable federal and state law; and
               (9)  promote sufficient flexibility to achieve the
  goals listed in this section through the pilot program [.] ;
               (10)  promote the use of innovative technology and
  benefits, including telemonitoring and testing of remote
  monitoring for individuals participating in the pilot. The remote
  monitoring and telemonitoring is voluntary and shall ensure an
  individual's privacy and health and welfare and allow access to
  housing in the most integrated and least restrictive environment.
  Innovations may include transportation and other innovations that
  support community integration. If a pilot participant voluntarily
  decides to use telemonitoring or remote monitoring or other
  innovative technologies, the managed care organization providing
  the pilot services shall deliver the telemonitoring, remote
  monitoring and/or innovative technology services in a way that:
                     (A)  assesses individual needs and preferences in
  a manner that promotes autonomy, self-determination, consumer
  directed services, privacy and increases personal independence;
                     (B)  determines the extent in which remote
  monitoring, telemedicine and other innovative technologies will be
  used, including but not limited to, times of day, where the
  equipment can be used, what types of telemonitoring and/or remote
  monitoring, for what tasks;
                     (C)  is identified and agreed to through the
  person centered planning process;
                     (D)  ensures the staff overseeing remote
  monitoring, telemedicine and other innovative technologies review
  person-centered plans and implementation plans of each individual
  they are monitoring prior to monitoring that individual and
  demonstrate competency regarding the support needs of each
  individual they are monitoring; and
                     (E)  ensures an individual can request to remove
  the remote monitoring and other innovative technology equipment at
  any point during the IDD pilot and the managed care organizations
  must remove the equipment immediately.
                     (F)  ensures individuals can choose not to use
  telemedicine at any point during participation in the pilot and
  that the pilot participating managed care organization must arrange
  for services that do not require the use of telemedicine.
               (11)  ensure an adequate provider network that includes
  comprehensive long term services and supports providers as
  described in Section 534.001 (4) and Section 534.107 (a)(2) and
  choice from among these providers;
               (12)  ensure timely initiation and consistent
  provision of long term services and supports in accordance with an
  individual's person centered care plan;
               (13)  ensure individuals with complex behavioral,
  medical and physical needs receive services based on assessed needs
  and in the most integrated, least restrictive setting according to
  the each individual's needs and preferences;
               (14)  increase, expand flexibility and promote use of
  the consumer directed services model ; and
               (15)  promote independence, self-determination,
  consumer directed services and decision making by using
  alternatives to guardianship, including supported decision-making
  agreements under Chapter 1357, Estates Code.
         (b)  The pilot program shall be designed to test innovations
  and payment models for the provision of long-term services and
  supports to achieve the goals outlined in subsection (a) utilizing
  methods such as:
               (1)  payment of a bundled amount without downside risk
  to a long term services and supports provider for some or all
  services delivered as part of a comprehensive array of long term
  services and supports;
               (2)  enhanced incentive payments to providers of long
  term services and supports based on meeting pre-determined outcome
  or quality metrics; and
               (3)  any other payment models approved by the
  commission.
         (c)  The alternative payment rates or methodologies tested
  under subsection (b) must be agreed to in writing by the managed
  care organization and participating long term services and supports
  provider. In developing the alternative payment rates or
  methodologies, the parties must utilize:
               (1)  the historical costs of long term services and
  supports, including Medicaid fee-for-service rates; and
               (2)  reasonable cost estimates for new pilot program
  services; and
               (3)  whether alternative payment rates or
  methodologies are sufficient to ensure the provider's continued
  participation in the pilot program and promote quality outcomes.
         (d)  For long term services and supports delivered under the
  pilot, the alternative payment models tested under subsection (b)
  shall not reduce the minimum payment to providers below the current
  fee for service reimbursement rates.
         (e)  The pilot program must allow existing providers of
  long-term services and supports for persons with intellectual and
  developmental disabilities, as defined in Section 534.001 (4), and
  providers of long term services and supports for persons with
  similar functional needs to voluntarily participate in one or more
  pilot projects. Failure to participate in a pilot project does not
  affect the contracting status of any provider as a significant
  traditional provider.
         [(d)     The department, in consultation and collaboration with
  the advisory committee, shall evaluate each submitted managed care
  strategy proposal and determine whether:
               (1)     the proposed strategy satisfies the requirements
  of this section; and
               (2)     the private services provider or managed care
  organization that submitted the proposal has a demonstrated ability
  to provide the long-term services and supports appropriate to the
  individuals who will receive services through the pilot program
  based on the proposed strategy, if implemented.]
         [(e)     Based on the evaluation performed under Subsection
  (d), the department may select as pilot program service providers
  one or more private services providers or managed care
  organizations with whom the commission will contract.]
         (f)  [For each pilot program service provider, the
  department__shall develop and implement a pilot program.] Under a
  pilot program, the [pilot program service provider] the
  participating managed care organizations shall provide long-term
  services and supports under Medicaid to persons with an
  intellectual or developmental disability, and other individuals
  with disabilities with similar functional needs, to test its
  managed care strategy based on capitation.
         (g)  The [department] commission, in consultation and
  collaboration with the advisory committee and Pilot Program
  Workgroup, shall analyze information provided by the [pilot program
  service providers] participating managed care organizations and
  any information collected by the [department] commission during the
  operation of the pilot program[s] for purposes of making a
  recommendation about a system of programs and services for
  implementation through future state legislation or rules.
         (h)  The analysis under Subsection (g) must include an
  assessment of the effect of the managed care strategies implemented
  in the pilot program[s] on the goals specified under Subsections
  (a), (b), (c) and (d). [:]
               [(1)  access to long-term services and supports;
               (2)     the quality of acute care services and long-term
  services and supports;
               (3)     meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
               (4)     the integration of service coordination of acute
  care services and long-term services and supports;
               (5)  the efficiency and use of funding;
               (6)     the placement of individuals in housing that is
  the least restrictive setting appropriate to an individual's needs;
               (7)     employment assistance and customized, integrated,
  competitive employment options; and
               (8)     the number and types of fair hearing and appeals
  processes in accordance with applicable federal law.]
         (i)  Prior to implementation of the pilot program, the
  commission, in consultation and collaboration with the advisory
  committee and Pilot Program Workgroup, shall develop a process to
  ensure 12 months continuous Medicaid eligibility for pilot
  participants.
         SECTION 11.  Chapter 534, Government Code is amended to add
  new section 534.1045, PILOT BENEFITS AND PROVIDER QUALIFICATIONS as
  follows:
         Sec. 534.1045.  PILOT BENEFITS AND PROVIDER QUALIFICATIONS.
  (a) The pilot program must ensure that participating managed care
  organizations provide:
               (1)  all Medicaid state plan acute care benefits
  available under the STAR+PLUS program;
               (2)  long term services and supports in the Medicaid
  state plan, including:
                     (A)  Community First Choice services;
                     (B)  Personal Assistant services;
                     (C)  Day Activity Health Services;
                     (D)  Habilitation services defined under Section
  534/001 (6);
               (3)  long term services and supports in the STAR+PLUS
  home and community-based services waiver, including:
                     (A)  assisted living
                     (B)  personal assistance services;
                     (C)  employment assistance;
                     (D)  supported employment;
                     (E)  adult foster care;
                     (F)  dental care;
                     (G)  nursing care;
                     (H)  respite care;
                     (I)  home-delivered meals;
                     (J)  cogniticve rehabilitative therapy;
                     (K)  physical therapy;
                     (L)  occupational therapy;
                     (M)  speech-language pathology;
                     (N)  medical supplies;
                     (O)  minor home modifcations;
                     (P)  adaptive aids;
               (4)  long term services and supports available in the
  Medicaid waiver programs defined in Section 534.001 (12),
  including:
                     (A)  enhanced behavioral health services;
                     (B)  behavioral supports;
                     (C)  day habilitation;
                     (D)  community support transporation;
               (5)  additional long term services and supports,
  including:
                     (A)  housing supports;
                     (B)  behavioral health crisis intervention;
                     (C)  high medical needs services; and
               (6)  Other non-residential long term services and
  supports the commission, in consultation and coordination with the
  advisory committee and Pilot Program Workgroup, determines
  appropriate and consistent with the regulations governing the 1915
  (c) waiver programs defined in Section 534.001 (12),
  person-centered approaches, home and community-based settings
  requirements, and the most integrated and least restrictive setting
  according to an individual's needs and preferences.
         (b)  A comprehensive long term services and supports
  provider is authorized to deliver services listed under under
  subsections (a)(2)(A), (a)(2)(D), (a)(3)(B), (a)(3)(C), (a)(3)(D),
  (a)(3)(G), (a)(3)(H), (a)(3)(J), (a)(3)(K), (a)(3)(L), (a)(3)(M),
  and (a)(3)(4),if they also deliver the service in a Medicaid waiver
  defined under Section 534.001 (12).
         (b-2)  A comprehensive long term services and supports
  provider may deliver services under subsections (a)(5) and (a)(6)
  if agreed to under contract with the pilot participating managed
  care organization.
         (c)  Day habilitation services under (a)(4)(c) may be
  delivered by a provider who is contracted or subcontracted under a
  1915 (c) Medicaid waiver as defined under Section 534.001 (12) or an
  ICF/IID program as defined under Section 534.001 (8).
         (d)  A comprehensive long term services and supports
  provider works in consultation with the pilot participating managed
  care organization's care coordinators to ensure the seamless
  delivery of acute care and long term services and supports on a
  day-to-day basis in accordance with an individual's plan of care
  and may be reimbursed by the managed care organization for this
  coordination.
         (e)  Prior to implementation of the pilot program, the
  commission, in consultation and collaboration with the advisory
  committee and Pilot Program Workgroup, shall:
               (1)  develop recommendations to modify, for the pilot
  program only, the Adult Foster Care, Supported Employment and
  Employment Assistance benefits to ensure increased access to and
  availability of this service, and
               (2)  as needed, definitions for services described
  under subsection (a)(4) and (5), and any services added under
  subsection (6).
         SECTION 12.  Section 534.105, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.105.  PILOT PROGRAM: MEASURABLE GOALS. (a) The
  [department] commission, in consultation and collaboration with
  the advisory committee and Pilot Program Workgroup, shall identify
  measurable goals using National Core Indicators, National Quality
  Forum LTSS measures and other appropriate CAHPS measures to be
  achieved by [each] the pilot program implemented under this
  subchapter. [The identified goals must:
               (1)     align with information that will be collected
  under Section 534.108(a); and
               (2)     be designed to improve the quality of outcomes for
  individuals receiving services through the pilot program.]
         (b)  The [department] commission, in consultation and
  collaboration with the advisory committee and Pilot Program
  Workgroup, shall [propose] develop specific strategies and
  performance measures for achieving the identified goals. A proposed
  strategy may be evidence-based if there is an evidence-based
  strategy available for meeting the pilot program's goals.
         (c)  The commission, in consultation and collaboration with
  the advisory committee and Pilot Program Workgroup, shall ensure
  that the mechanisms to report, track and assess the specific
  strategies and performance measures for achieving the identified
  goals are established prior to implementation of the pilot program.
         SECTION 13.  Section 534.106, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.106.  IMPLEMENTATION, LOCATION, AND DURATION. (a)
  The commission [and the department] shall implement [any] the pilot
  program[s] established under this subchapter [not later than] on
  September 1, [2017] 2023.
         (b)  A pilot program established under this subchapter [may]
  shall operate for at least [up to] 24 months. [A pilot program may
  cease operation if the pilot program service provider terminates
  the contract with the commission before the agreed-to termination
  date.]
         (c)  A pilot program established under this subchapter shall
  be conducted in [one or more] the STAR+PLUS service area [regions]
  selected by the [department] commission.
         SECTION 14.  Section 534.1065, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.1065.  RECIPIENT ENROLLMENT, PARTICIPATION AND
  ELIGIBILITY [IN PROGRAM VOLUNTARY]. (a) Enrollment
  [Participation]in a pilot program established under this
  subchapter by an individual [with an intellectual or developmental
  disability] shall occur using an opt-out process [is voluntary,
  and] with the decision whether to participate in a program and
  receive long-term services and supports from a provider through
  that program [may] to be made only by the individual or the
  individual's legally authorized representative.
               (1)  The commission, in consultation and collaboration
  with the advisory committee and Pilot Program Workgroup, shall
  develop a timeline and process for and informational materials
  related to educating pilot participants about the pilot including
  its benefits, impact on current services and other related
  information to ensure prospective pilot participants are able to
  make an informed decision regarding participation. The process must
  ensure:
                     (A)  the timeline for development and
  distribution of the pilot informational materials allows for
  sufficient advance notification to and education of individuals
  eligible for pilot participation, their families and other
  individuals actively involved in their lives;
                     (B)  individuals eligible for pilot
  participation, including new and current STAR+PLUS enrollees and
  other individuals specified in subsection (a) (1) (A), receive oral
  and written information about the pilot prior to participation,
                     (C)  the information provided is written in clear,
  simple language and presented in a manner individuals are able to
  understand and, at a minimum, explains that:
                           (i)  upon conclusion of the pilot,
  individuals will be requested to provide input on their pilot
  participation experience, including whether the pilot was able to
  meet their unique support needs;
                           (ii)  participation in the pilot does not
  remove individuals from any Interest List or, in accordance with
  Section 534.1065 (c), the right to select an enrollment, transition
  or diversion offer; and
                           (iii)  individuals have choice among acute
  care and long term services providers, including the consumer
  directed services model and the comprehensive services model.
         (b)  The commission, in consultation and coordination with
  the advisory committee and Pilot Program Workgroup, shall develop
  pilot program participant eligibility criteria. The criteria must
  ensure pilot participants include:
               (1)  individuals with an intellectual and
  developmental disability including autism and individuals with
  significant complex behavioral, medical and physical needs
  receiving home and community-based services through STAR+PLUS or a
  STAR+PLUS member who is also on a Medicaid Waiver Interest List or
  is a STAR+PLUS member meeting criteria for intellectual
  disabilities. It does not include individuals who are receiving
  only acute care services under STAR+PLUS and enrolled in the
  community-based ICF/IID program or one of the Medicaid waiver
  programs defined under Section 534.001 (12).
               (2)  individuals receiving services under the
  STAR+PLUS Medicaid managed care program who have a traumatic brain
  injury that occurred after the age of 22; and
               (3)  other individuals with disabilities who have
  similar functional needs independent of age of onset or diagnosis.
         (c)  Individuals participating in the pilot who, during the
  pilot's implementation, are offered enrollment in one of the 1915
  (c) Medicaid waiver programs defined under Section 534.001 (12)
  shall be eligible to accept the enrollment, transition or diversion
  offer.
         SECTION 15.  Section 534.107, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.107.  [COORDINATING SERVICES] COMMISSION
  RESPONSIBILTIES. (a) [In providing long-term services and supports
  under Medicaid to individuals with an intellectual or developmental
  disability,] The commission [a pilot program service provider]
  shall require managed care organizations participating in the pilot
  program to:
               (1)  ensure individuals participating in the pilot have
  choice among acute care and comprehensive long term services and
  supports providers and service delivery options including the
  consumer directed services model as specified under Section
  534.109. [coordinate through the pilot program institutional and
  community-based services available to the individuals, including
  services provided through:
                     (A)     a facility licensed under Chapter 252, Health
  and Safety Code;
                     (B)  a Medicaid waiver program; or
                     (C)     a community-based ICF-IID operated by local
  authorities] ;
               (2)  demonstrate to the satisfaction of the commission
  that their network of acute care, long term services and supports
  and comprehensive service providers have experience and expertise
  providing services for individuals with an intellectual or
  developmental disability and individuals with similar functional
  needs;
               [collaborate with managed care organizations to provide
  integrated coordination of acute care services and long-term
  services and supports, including discharge planning from acute care
  services to community-based long-term services and supports];
               (3)  have a process for preventing inappropriate
  institutionalizations of individuals; and
               (4)  ensure timely initiation and consistent provision
  of services in accordance with an individual's person-centered plan
  [accept the risk of inappropriate institutionalizations of
  individuals previously residing in community settings].
         (b)  For the duration of the pilot the commission must ensure
  that comprehensive long term services and supports providers as
  defined under Section 534.001(4) are deemed significant
  traditional providers and included in the provider network of the
  managed care organizations participating in the pilot.
         SECTION 16.  Section 534.108, Subchapter C., Chapter 534,
  Government Code, is amended to read as follows:
         Section 534.108.  Pilot Program Information. (a) The
  commission [and the department, in consultation and coordination
  with the advisory committee and Pilot Program Workgroup, shall
  determine the information to be collected from each managed care
  organization participating in the pilot for use in the evaluation
  and reports required under Section 534.121. [collect and compute
  the following information with respect to each pilot program
  implemented under this subchapter to the extent it is available:]
         (b)  For the duration of the pilot each managed care
  organization participating in the pilot shall submit to the
  commission and the advisory committee a quarterly report on the
  services provided to each pilot participant that includes the
  following information:
                     (A)  the level of services requested, and the
  authorization and utilization rates of services for each pilot
  service;
                     (B)  timeliness of services requested,
  authorized, initiated, and number and duration of unplanned service
  breaks;
                     (C)  number of pilot participants using
  employment assistance and supported employment services;
                     (D)  number of service denials and fair hearings,
  and disposition of fair hearings;
                     (E)  number of complaints and inquiries received
  by the commission and managed care organizations participating in
  the pilot and the outcome of the complaints; and
                     (F)  number of participants who select the
  consumer directed services model and reasons participants did not
  select the service model.
         (c)  The commission shall ensure that the mechanisms to
  report and track the information and data required in subsections
  (a) and (b) are established prior to implementation of the pilot
  program.
               [(1)     the difference between the average monthly cost
  per person for all acute care services and long-term services and
  supports received by individuals participating in the pilot program
  while the program is operating, including services provided through
  the pilot program and other services with which pilot program
  services are coordinated as described by Section 534.107, and the
  average monthly cost per person for all services received by the
  individuals before the operation of the pilot program;
               (2)     the percentage of individuals receiving services
  through the pilot program who begin receiving services in a
  nonresidential setting instead of from a facility licensed under
  Chapter 252, Health and Safety Code, or any other residential
  setting;
               (3)     the difference between the percentage of
  individuals receiving services through the pilot program who live
  in non-provider-owned housing during the operation of the pilot
  program and the percentage of individuals receiving services
  through the pilot program who lived in non-provider-owned housing
  before the operation of the pilot program;
               (4)     the difference between the average total Medicaid
  cost, by level of need, for individuals in various residential
  settings receiving services through the pilot program during the
  operation of the program and the average total Medicaid cost, by
  level of need, for those individuals before the operation of the
  program;
               (5)     the difference between the percentage of
  individuals receiving services through the pilot program who obtain
  and maintain employment in meaningful, integrated settings during
  the operation of the program and the percentage of individuals
  receiving services through the program who obtained and maintained
  employment in meaningful, integrated settings before the operation
  of the program;
               (6)     the difference between the percentage of
  individuals receiving services through the pilot program whose
  behavioral, medical, life-activity, and other personal outcomes
  have improved since the beginning of the program and the percentage
  of individuals receiving services through the program whose
  behavioral, medical, life-activity, and other personal outcomes
  improved before the operation of the program, as measured over a
  comparable period; and
               (7)     a comparison of the overall client satisfaction
  with services received through the pilot program, including for
  individuals who leave the program after a determination is made in
  the individuals' cases at hearings or on appeal, and the overall
  client satisfaction with services received before the individuals
  entered the pilot program.
         (b)     The pilot program service provider shall collect any
  information described by Subsection (a) that is available to the
  provider and provide the information to the department and the
  commission not later than the 30th day before the date the program's
  operation concludes.
         (c)     In addition to the information described by Subsection
  (a), the pilot program service provider shall collect any
  information specified by the department for use by the department
  in making an evaluation under Section 534.104(g).
         (d)     The commission and the department, in consultation and
  collaboration with the advisory committee, shall review and
  evaluate the progress and outcomes of each pilot program
  implemented under this subchapter and submit, as part of the annual
  report to the legislature required by Section 534.054, a report to
  the legislature during the operation of the pilot programs. Each
  report must include recommendations for program improvement and
  continued implementation.]
         SECTION 17.  Section 534.109, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.109.  PERSON-CENTERED PLANNING. The commission, in
  consultation and collaboration [cooperation] with the [department]
  advisory committee and Pilot Program Workgroup, shall ensure that
  each individual[with an intellectual or developmental disability]
  who receives services and supports under Medicaid through a pilot
  program established under this subchapter, or the individual's
  legally authorized representative, has access to a comprehensive
  facilitated, person-centered plan that identifies outcomes for the
  individual and drives the development of the individualized budget.
  The consumer directed services[direction] model, as defined by
  Section 531.051, [may be an outcome of the plan] must be an
  available option for individuals to achieve self-determination,
  choice and control.
         SECTION 18.  Section 534.110, Subchapter C., Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.110.  TRANSITION BETWEEN PROGRAMS; CONTINUITY OF
  SERVICES. (a) During the evaluation of the pilot required under
  Section 534.121,[The] the commission may continue the pilot to
  protect continuity of care. If the commission determines not to
  continue the pilot during the evaluation, the commission, in
  consultation and collaboration with the advisory committee and
  Pilot Program Workgroup, shall ensure that there is a comprehensive
  plan for transitioning the provision of Medicaid benefits provided
  to pilot participants to the services provided before the pilot.
  [between a Medicaid waiver program or an ICF-IID program and a pilot
  program under this subchapter to protect continuity of care.]
         (b)  The transition plan shall be developed in consultation
  and collaboration with the advisory committee and with stakeholder
  input as described by Section 534.103.
         SECTION 19.  Section 534.111, Subchapter C, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.111.  CONCLUSION OF PILOT PROGRAM[S]; EXPIRATION.
  Contingent on the decision made under Section 534.110, [On] on
  September 1, [2019] 2025:
               (1)  [each] the pilot program established under this
  subchapter [that is still in operation] either continues or must
  conclude. [; and
               (2)  this subchapter expires.]
         SECTION 21.  Chapter 534, Government Code,is amended to add
  new Subchapter C-1 to read as follows: SUBCHAPTER C-1. PILOT
  EVALUATION AND REPORT
         Section 534.121.  EVALUATION OF AND REPORT ON PILOT PROGRAM.
  (a) The commission, in consultation and collaboration with the
  advisory committee and Pilot Program Workgroup, shall review and
  evaluate the progress and outcomes of the pilot program implemented
  under Subchapter C of this Chapter and submit, as part of the annual
  report required by Section 534.054, a report on the status of the
  pilot program. The report must include recommendations for program
  improvement.
         (b)  Upon conclusion of the pilot program required under
  Subchapter C, the commission, in consultation and collaboration
  with the advisory committee and Pilot Program Workgroup, shall
  evaluate the pilot program and prepare and submit a report to the
  legislature based on a comprehensive analysis of the pilot.
         (c)  The comprehensive analysis must:
               (1)  include an assessment of the effect of the pilot
  on:
                     (A)  access to and improved quality of long-term
  services and supports;
                     (B)  informed choice and meaningful outcomes
  using person-centered planning, flexible consumer directed
  services, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
                     (C)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (D)  employment assistance and customized,
  integrated, competitive employment options;
                     (E)  the number, types and dispositions of fair
  hearing and appeals processes in accordance with applicable federal
  and state law;
                     (F)  increasing use and flexibility of the
  consumer directed service model;
                     (G)  increasing use of alternatives to
  guardianship, including supported decision-making agreements under
  Chapter 1357, Estates Code;
                     (H)  achieving cost effectiveness and best use of
  funding based on individuals' needs and preferences; and
                     (I)  attendant recruitment and retention;
               (2)  provide an analysis of the experience and outcome
  of the following systems changes:
                     (A)  the IDD assessment tool required under
  Chapter 533, Subchapter B, Section 533.0335, Health and Safety
  Code;
                     (B)  the 21st Century Cures Act;
                     (C)  implementation of the federal HCBS Settings
  regulations; and
                     (D)  the provision of basic attendant and
  habilitation services required under Section 534.152 of this
  Chapter, and
                     (E)  the benefits of providing STAR+PLUS services
  to persons based on functional needs;
               (3)  include input from the individuals with
  intellectual and developmental disabilities and participants of
  similar functional needs, families and other individuals actively
  involved in the lives of the individuals; and providers of long term
  services and supports programs defined under Section 534.001 (8)
  and (12) who participated in the pilot about their experiences;
               (4)  be incorporated into the annual report to the
  legislature required under Section 534.054; and
               (5)  include recommendations about a system of programs
  and services for consideration by the legislature, including
  recommendations for needed statutory changes and whether to
  transition the pilot to a statewide program under the STAR+PLUS
  program for individuals who meet the eligibility criteria specified
  in Section 534.1065.
         SECTION 22.  The heading to Subchapter E, Chapter 534,
  Government Code, is amended to read as follows: SUBCHAPTER E. STAGE
  TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS AND LONG-TERM CARE
  MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED MANAGED CARE
  SYSTEM
         SECTION 23.  Section 534.201, Subchapter E, Chapter 534,
  Government Code, is repealed:
         [Sec. 534.201. TRANSITION OF RECIPIENTS UNDER TEXAS HOME
  LIVING (TxHmL) WAIVER PROGRAM TO MANAGED CARE PROGRAM.] [(a)[This
  section applies to individuals with an intellectual or
  developmental disability who are receiving long-term services and
  supports under the Texas home living (TxHmL) waiver program on the
  date the commission implements the transition described by
  Subsection (b).]
         [(b)     On September 1, 2020, the commission shall transition
  the provision of Medicaid benefits to individuals to whom this
  section applies to the STAR + PLUS Medicaid managed care program
  delivery model or the most appropriate integrated capitated managed
  care program delivery model, as determined by the commission based
  on cost-effectiveness and the experience of the STAR + PLUS
  Medicaid managed care program in providing basic attendant and
  habilitation services and of the pilot programs established under
  Subchapter C, subject to Subsection (c)(1).]
         [(c)     At the time of the transition described by Subsection
  (b), the commission shall determine whether to:
               (1)     continue operation of the Texas home living
  (TxHmL) waiver program for purposes of providing supplemental
  long-term services and supports not available under the managed
  care program delivery model selected by the commission; or
               (2)     provide all or a portion of the long-term services
  and supports previously available under the Texas home living
  (TxHmL) waiver program through the managed care program delivery
  model selected by the commission.]
         [(d)     In implementing the transition described by Subsection
  (b), the commission, in consultation and collaboration with the
  advisory committee, shall develop a process to receive and evaluate
  input from interested statewide stakeholders.]
         [(e)     The commission, in consultation and collaboration with
  the advisory committee, shall ensure that there is a comprehensive
  plan for transitioning the provision of Medicaid benefits under
  this section that protects the continuity of care provided to
  individuals to whom this section applies.]
         [(f)     In addition to the requirements of Section 533.005, a
  contract between a managed care organization and the commission for
  the organization to provide Medicaid benefits under this section
  must contain a requirement that the organization implement a
  process for individuals with an intellectual or developmental
  disability that:
               (1)     ensures that the individuals have a choice of
  providers;
               (2)     to the greatest extent possible, protects those
  individuals' continuity of care with respect to access to primary
  care providers, including the use of single-case agreements with
  out-of-network providers; and
               (3)     provides access to a member services phone line
  for individuals or their legally authorized representatives to
  obtain information on and assistance with accessing services
  through network providers, including providers of primary,
  specialty, and other long-term services and supports].
         [(g)]     [The commission, in consultation and collaboration
  with the advisory committee, shall analyze the outcomes of the
  transition of the long-term services and supports under the Texas
  home living (TxHmL) Medicaid waiver program to a managed care
  program delivery model.]  [The analysis must:]
               [(1)     include an assessment of the effect of the
  transition on:]
                     [(A)  access to long-term services and supports;]
                     [(B)     meaningful outcomes using person-centered
  planning, individualized budgeting, and self-determination,
  including a person's inclusion in the community;
                     [(C)     the integration of service coordination of
  acute care services and long-term services and supports;]
                     [(D)     employment assistance and customized,
  integrated, competitive employment options; and]
                     [(E)     the number and types of fair hearing and
  appeals processes in accordance with applicable federal law;]
         [(2)     be incorporated into the annual report to the
  legislature required under Section 534.054; and]
               (3)     include recommendations for improvements to the
  transition implementation for consideration by the legislature,
  including recommendations for needed statutory changes.]
         SECTION 24.  Section 534.202, Subchapter E, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.202.  DETERMINATION TO TRANSITION [OF] ICF-IID
  PROGRAM RECIPIENTS AND CERTAIN [OTHER] MEDICAID WAIVER PROGRAM
  RECIPIENTS TO MANAGED CARE PROGRAM. (a) This section applies to
  individuals with an intellectual or developmental disability who
         [ , on the date the commission implements the transition
  described by Subsection (b), ] are receiving long-term services and
  supports under:
               (1)  a Medicaid waiver program as defined under Section
  534.001 (12) [other than the Texas home living (TxHmL) waiver
  program]; or
               (2)  an ICF-IID program.
         (b)  After implementing the pilot [transition] required by
  Subchapter C of this Chapter, completing the evaluation required
  under Section 534.121, and subject to subsection (g)[on September
  1, 2021], the commission, in consultation and collaboration with
  the advisory committee, shall develop a plan for the transition of
  all or a portion of the services provided through the programs
  defined in Sections 534.001 (8) and (12) which were not included in
  the pilot under Subchapter C. The plan must include:
               (1)  The process for transitioning the services in the
  programs defined in Sections 534.001 (8) and (12) in a phased-in
  manner as follows:
                     (A)  Texas Home Living;
                     (B)  CLASS;
                     (C)  non-residential services provided through
  the 1915 (c) Home and Community-based Services and DBMD waivers;
  and
                     (D)  subject to subsection (b) (3), the
  residential services offered through the ICF/IID program and the
  HCS and DBMD waiver programs.
               (2)  With the exception of the residential services
  provided through the programs specified in subsection (b) (1)(D),
  the schedule for transitioning the services and individuals into
  managed care must occur in the order specified under subsection
  (b)(1)beginning with TxHmL on September 1, 2027; CLASS on September
  1, 2029,; and the non-residential services provided through the
  Home and Community-based services and DBMD waivers on September 1,
  2031.
               (3)  The process for evaluating the feasibility and
  cost efficiency of transitioning the residential services offered
  through the ICF/IID program and the HCS and DBMD waiver programs,
  and, as appropriate, transitioning to the managed care program.
                     (A)  The process for determining the transition of
  the residential services must be based on an evaluation of a two
  year pilot.
  [transition the provision of Medicaid benefits to individuals to
  whom this section applies to the STAR + PLUS Medicaid managed care
  program delivery model or the most appropriate integrated capitated
  managed care program delivery model, as determined by the
  commission based on cost-effectiveness and the experience of the
  transition of Texas home living (TxHmL) waiver program recipients
  to a managed care program delivery model under Section 534.201
  subject to Subsections (c)(1) and (g).]
         (c)  [At the time of] Prior to the transition [described by]
  dates specified under Subsection (b) (2) and subject to subsection
  (g), the commission shall determine whether to:
               (1)  continue operation of the Medicaid waiver programs
  only for purposes of providing, if applicable:
                     (A)  supplemental long-term services and supports
  not available under the managed care program delivery model
  selected by the commission; or
                     (B)  long term services and supports to Medicaid
  waiver program recipients who choose to continue receiving benefits
  under the waiver programs who choose to continue receiving benefits
  under the waiver program as provided by Subsection (g); or
               (2)  subject to Subsection (g), provide all or a
  portion of the long-term services and supports previously available
  under the Medicaid waiver programs through the managed care program
  delivery model selected by the commission.
         (d)  In implementing the transition described by Subsection
  (b)(2), the commission shall develop a process to receive and
  evaluate input from interested statewide stakeholders that is in
  addition to the input provided by the advisory committee.
         (e)  The commission shall ensure that there is a
  comprehensive plan for transitioning the provision of Medicaid
  benefits under this section that protects the continuity of care
  provided to individuals to whom this section applies and ensures
  individuals have a choice among acute care and comprehensive long
  term services and supports providers and service delivery options
  including the consumer directed services model as specified under
  Subsection (i).
         (f)  Before transitioning the provision of Medicaid benefits
  for children under this section, a managed care organization
  providing services under the managed care program delivery model
  selected by the commission must demonstrate to the satisfaction of
  the commission that the organization's network of providers has
  experience and expertise in the provision of services to children
  with an intellectual or developmental disability. Before
  transitioning the provision of Medicaid benefits for adults with an
  intellectual or developmental disability under this section, a
  managed care organization providing services under the managed care
  program delivery model selected by the commission must demonstrate
  to the satisfaction of the commission that the organization's
  network of providers has experience and expertise in the provision
  of services to adults with an intellectual or developmental
  disability.
         (g)  If the commission determines that all or a portion of
  the long-term services and supports previously available under the
  Medicaid waiver programs should be provided through a managed care
  program delivery model under Subsection (c)(1), the commission
  shall, at the time of the transition, allow each recipient
  receiving long-term services and supports under a Medicaid waiver
  program the option of:
               (1)  continuing to receive the services and supports
  under the Medicaid waiver program; or
               (2)  receiving the services and supports through the
  managed care program delivery model selected by the commission.
         (h)  A recipient who chooses to receive long-term services
  and supports through a managed care program delivery model under
  Subsection (g) may not, at a later time, choose to receive the
  services and supports under a Medicaid waiver program.
         (i)  In addition to the requirements of Section 533.005, a
  contract between a managed care organization and the commission for
  the organization to provide Medicaid benefits under this section
  must contain a requirement that the organization implement a
  process for individuals with an intellectual or developmental
  disability that:
               (1)  ensures that the individuals have a choice among
  acute care and comprehensive long term services and supports
  providers and service delivery options including the consumer
  directed services model;
               (2)  to the greatest extent possible, protects those
  individuals' continuity of care with respect to access to primary
  care providers, including the use of single-case agreements with
  out-of-network providers; and
               (3)  provides access to a member services phone line
  for individuals or their legally authorized representatives to
  obtain information on and assistance with accessing services
  through network providers, including providers of primary,
  specialty, and other long-term services and supports.
         SECTION 25.  Section 534.203, Subchapter E, Chapter 534,
  Government Code, is amended to read as follows:
         Sec. 534.203.  RESPONSIBILITIES OF COMMISSION UNDER
  SUBCHAPTER. In administering this subchapter, the commission shall
  ensure that upon a determination to transition services in the
  programs defined under Sections 534.001 (8) and (12):
               (1)  that the commission is responsible for setting the
  minimum reimbursement rate paid to a provider of ICF-IID services
  or a group home provider under the integrated managed care system,
  including the staff rate enhancement paid to a provider of ICF-IID
  services or a group home provider;
               (2)  that an ICF-IID service provider or a group home
  provider is paid not later than the 10th day after the date the
  provider submits a clean claim in accordance with the criteria used
  by the department for the reimbursement of ICF-IID service
  providers or a group home provider, as applicable; and
               (3)  the establishment of an electronic portal through
  which a provider of ICF-IID services or a group home provider
  participating in the STAR + PLUS Medicaid managed care program
  delivery model or the most appropriate integrated capitated managed
  care program delivery model, as appropriate, may submit long-term
  services and supports claims to any participating managed care
  organization [. ] ; and
               (4)  that each individual with an intellectual or
  developmental disability and the individual's legally authorized
  representative has access to a comprehensive facilitated,
  person-centered plan that identifies outcomes for the individual.
  The consumer directed services model must be promoted as an
  available option for individuals to achieve self-determination,
  choice and control.
         SECTION 26.  Chapter 534, Government Code, is amended to add
  Subchapter F. to read as follows:
  SUBCHAPTER F. OTHER IMPLEMENTATION REQUIREMENTS AND
  RESPONSIBILITIES UNDER THIS CHAPTER
         Sec. 534.301.  IMPLEMENTATION AND RESPONSIBILITIES UNDER
  THIS CHAPTER. (a) The commission is authorized to delay
  implementation of this Chapter or its subchapters without further
  investigation or adjustments or legislative intervention, if it
  determines any provision under the Chapter or other related mandate
  or initiative integral to implementation adversely affects the
  system of services and supports to persons and programs to which the
  Chapter applies.
         (b)  For purpose of the pilot under Subchpater C. of this
  Chapter and any subsequent transition of recipients receiving
  services under certain Medicaid waiver programs defined under
  Section 534.001 (12) to a managed care program as specified under
  Section 534.202 (c), the commission must:
               (1)  maintain a certification process and regulatory
  oversight of Texas Home Living and Home and Community-based
  Services providers; and
               (2)  require managed care organizations include in
  their network of qualified long term services and supports
  providers certified Texas Home Living and Home and Community-based
  Services providers that specialize in services for persons with
  intellectual disabilities.
         (c)  Subject to Section 534.202 (b) and (c), upon a decision
  to transition the long term services and supports under a Medicaid
  waiver program defined under Section 534.001 (12), the commission
  shall ensure individuals do not lose the benefits they are
  receiving through these Medicaid waiver programs.
         (d)  For purposes of the pilot under Subchapter C. and any
  future transition of services specified under Section 534.202 into
  the STAR+PLUS program, the comprehensive long term services and
  supports provider defined in Section 534.001 (4):
               (1)  must report encounters of any directly contracted
  services to the managed care organization; provide quarterly
  reporting of coordinated services and timeframes to the managed
  care organization, and provide quarterly progress on goals and
  objectives set by an individual's person centered plan; and
               (2)  will not be held accountable for the provision of
  services on an individual's service plan for which a managed care
  organization denies or does not authorize access to in a timely
  manner.
         SECTION 27.  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 28.  If the Health and Human Services Commission
  determines that it is cost effective, the commission shall apply
  for and actively seek a waiver or authorization from the
  appropriate federal agency to allow the state to provide medical
  assistance under the waiver or authorization to medically fragile
  individuals;
               (1)  Who are at least 21 years of age; and
               (2)  Whose costs to receive care exceed cost limits
  under existing Medicaid waiver programs.
         SECTION 29.  This act takes effect September 1, 2019.
feedback