By: Davis of Harris H.B. No. 3520       A BILL TO BE ENTITLED   AN ACT   relating to state fiscal matters related to health and human   services and state agencies administering health and human services   programs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1.  REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES AND   COST-SAVING MEASURES GENERALLY          SECTION 1.01.  This article applies to any state agency that   receives an appropriation under Article II of the General   Appropriations Act and to any program administered by any of those   agencies.          SECTION 1.02.  Notwithstanding any other statute of this   state, each state agency to which this article applies is   authorized to reduce or recover expenditures by:                (1)  consolidating any reports or publications the   agency is required to make and filing or delivering any of those   reports or publications exclusively by electronic means;                (2)  extending the effective period of any license,   permit, or registration the agency grants or administers;                (3)  entering into a contract with another governmental   entity or with a private vendor to carry out any of the agency's   duties;                (4)  adopting additional eligibility requirements   consistent with federal law for persons who receive benefits under   any law the agency administers to ensure that those benefits are   received by the most deserving persons consistent with the purposes   for which the benefits are provided, including under the following   laws:                      (A)  Chapter 62, Health and Safety Code (child   health plan program);                      (B)  Chapter 31, Human Resources Code (Temporary   Assistance for Needy Families program);                      (C)  Chapter 32, Human Resources Code (Medicaid   program);                      (D)  Chapter 33, Human Resources Code   (supplemental nutrition assistance and other nutritional   assistance programs); and                      (E)  Chapter 533, Government Code (Medicaid   managed care);                (5)  providing that any communication between the   agency and another person and any document required to be delivered   to or by the agency, including any application, notice, billing   statement, receipt, or certificate, may be made or delivered by   e-mail or through the Internet;                (6)  adopting and collecting fees or charges to cover   any costs the agency incurs in performing its lawful functions; and                (7)  modifying and streamlining processes used in:                      (A)  the conduct of eligibility determinations   for programs listed in Subdivision (4) of this subsection by or   under the direction of the Health and Human Services Commission;                      (B)  the provision of child and adult protective   services by the Department of Family and Protective Services;                      (C)  the provision of community health services,   consumer protection services, and mental health services by the   Department of State Health Services; and                      (D)  the provision or administration of other   services provided or programs operated by the Health and Human   Services Commission or a health and human services agency, as   defined by Section 531.001, Government Code.   ARTICLE 2.  MEDICAID PROGRAM          SECTION 2.01.  Subchapter A, Chapter 533, Government Code,   is amended by adding Sections 533.00291, 533.00292, and 533.00293   to read as follows:          Sec. 533.00291.  CARE COORDINATION BENEFITS.  (a)  In this   section, "care coordination" means assisting recipients to develop   a plan of care, including a service plan, that meets the recipient's   needs and coordinating the provision of Medicaid benefits in a   manner that is consistent with the plan of care. The term is   synonymous with "case management," "service coordination," and   "service management."          (b)  The commission shall streamline and clarify the   provision of care coordination benefits across Medicaid programs   and services for recipients receiving benefits under a managed care   delivery model. In streamlining and clarifying the provision of   care coordination benefits under this section, the commission shall   at a minimum:                (1)  subject to Subsection (c), establish a process for   determining and designating a single entity as the primary entity   responsible for a recipient's care coordination;                (2)  evaluate and eliminate duplicative services   intended to achieve recipient care coordination, including care   coordination or related benefits provided:                      (A)  by a Medicaid managed care organization;                      (B)  by a recipient's medical or health home;                      (C)  through a disease management program   provided by a Medicaid managed care organization;                       (D)  by a provider of targeted case management and   psychiatric rehabilitation services; and                      (E)  through a program of case management for   high-risk pregnant women and high-risk children established under   Section 22.0031, Human Resources Code;                 (3)  evaluate and, if the commission determines it   appropriate, modify the capitation rate paid to Medicaid managed   care organizations to account for the provision of care   coordination benefits by a person not affiliated with the   organization; and                (4)  establish and use a consistent set of terms for   care coordination provided under a managed care delivery model.          (c)  In establishing a process under Subsection (b)(1), the   commission shall ensure that:                (1)  for a recipient who receives targeted case   management and psychiatric rehabilitation services, the default   entity to act as the primary entity responsible for the recipient's   care coordination under Subsection (b)(1) is the provider of   targeted case management and psychiatric rehabilitation services;   and                (2)  for recipients other than those described by   Subdivision (1), the process includes an evaluation process   designed to identify the provider that would best meet the care   coordination needs of a recipient and that the commission   incorporates into Medicaid managed care program contracts.          Sec. 533.00292.  CARE COORDINATOR CASELOAD STANDARDS. (a)   In this section:                (1)  "Care coordination" has the meaning assigned by   Section 533.00291.                (2)  "Care coordinator" means a person, including a   case manager, engaged by a Medicaid managed care organization to   provide care coordination benefits.          (b)  The executive commissioner by rule shall establish   caseload standards for care coordinators providing care   coordination under the STAR+PLUS home and community-based services   supports (HCBS) program.          (c)  The executive commissioner by rule may, if the executive   commissioner determines it appropriate, establish caseload   standards for care coordinators providing care coordination under   Medicaid programs other than the STAR+PLUS home and community-based   services supports (HCBS) program.          (d)  In determining whether to establish caseload standards   for a Medicaid program under Subsection (c), the executive   commissioner shall consider whether implementing the standards   would improve:                (1)  Medicaid managed care organization contract   compliance;                (2)  the quality of care coordination provided under   the program;                (3)  recipient health outcomes; and                (4)  transparency regarding the availability of care   coordination benefits to recipients and interested stakeholders.          Sec. 533.00293.  INFORMATION SHARING. (a) In this section:                (1)  "Care coordination" has the meaning assigned by   Section 533.00291.                (2)  "Care coordinator" has the meaning assigned by   Section 533.00292.          (b)  To the extent permitted under applicable federal and   state law enacted to protect the confidentiality and privacy of   patients' health information, managed care organizations under   contract with the commission to provide health care services to   recipients shall ensure the sharing of information, including   recipient medical records, among care coordinators and health care   providers as appropriate to provide care coordination benefits.   For purposes of implementing this section, a managed care   organization may allow a care coordinator to share a recipient's   service plan with health care providers, subject to the limitations   of this section.          SECTION 2.02.  Section 533.0061, Government Code, as added   by Chapter 1272 (S.B. 760), Acts of the 84th Legislature, Regular   Session, 2015, is amended by amending Subsections (a) and (c) and   adding Subsection (d) to read as follows:          (a)  The commission shall establish minimum provider access   standards for the provider network of a managed care organization   that contracts with the commission to provide health care services   to recipients.  The access standards must ensure that a managed   care organization provides recipients sufficient access to:                (1)  preventive care;                (2)  primary care;                (3)  specialty care;                (4)  [after-hours] urgent care;                (5)  chronic care;                (6)  long-term services and supports;                (7)  nursing services;                (8)  therapy services, including services provided in a   clinical setting or in a home or community-based setting; and                (9)  any other services identified by the commission.          (c)  The commission shall biennially submit to the   legislature and make available to the public a report containing   information and statistics about recipient access to providers   through the provider networks of the managed care organizations and   managed care organization compliance with contractual obligations   related to provider access standards established under this   section. The report must contain:                (1)  a compilation and analysis of information   submitted to the commission under Section 533.005(a)(20)(D);                (2)  for both primary care providers and specialty   providers, information on provider-to-recipient ratios in an   organization's provider network, as well as benchmark ratios to   indicate whether deficiencies exist in a given network; [and]                (3)  a description of, and analysis of the results   from, the commission's monitoring process established under   Section 533.007(l); and                (4)  a detailed analysis of recipient access to urgent   care providers, including:                      (A)  an analysis of the implementation of any   distance standard adopted under Section 32.0248(b)(1), Human   Resources Code;                      (B)  information on urgent care   provider-to-recipient ratios; and                      (C)  information and statistics about   organization compliance with contractual obligations related to   urgent care access standards, including standards established   under Section 32.0248, Human Resources Code, and any other   applicable standards.          (d)  In this section, "urgent care provider" has the meaning   assigned by Section 32.0248, Human Resources Code.          SECTION 2.03.  Subchapter B, Chapter 32, Human Resources   Code, is amended by adding Section 32.0248 to read as follows:          Sec. 32.0248.  INCREASING ACCESS TO URGENT CARE PROVIDERS.     (a)  In this section, "urgent care provider" means a health care   provider that:                (1)  provides episodic ambulatory medical care to   individuals outside of a hospital emergency room setting;                (2)  does not require an individual to make an   appointment;                (3)  provides some services typically provided in a   primary care physician's office; and                (4)  treats individuals requiring treatment of an   illness or injury that requires immediate care but is not   life-threatening.          (b)  The executive commissioner shall adopt rules and   policies to increase recipient access to urgent care providers   under the medical assistance program.  In adopting the rules and   policies under this subsection, the executive commissioner shall   consider:                (1)  whether to establish a distance standard to ensure   that all recipients have access to at least one urgent care provider   within a specified distance of the recipient's residence;                (2)  requiring that the medical assistance program   provider database established under Section 32.102 accurately   identify urgent care providers;                (3)  requiring each managed care organization that   contracts with the commission under Chapter 533, Government Code,   to provide health care services to medical assistance recipients   to:                      (A)  improve the accuracy and accessibility of   information regarding urgent care providers in the managed care   organization's provider network directory required under Section   533.0063, Government Code; and                      (B)  if the organization maintains a nurse   telephone hotline for its enrolled recipients, provide information   to recipients, if appropriate, on the availability of services   through in-network urgent care providers; and                (4)  encouraging primary care physicians participating   in the medical assistance program to maintain a relationship with   urgent care providers for purposes of referring recipients in need   of urgent care.          (c)  In addition to adopting rules and policies under   Subsection (b), to increase medical assistance recipients' access   to urgent care providers, the commission shall consider whether to   amend the Medicaid state plan to permit urgent care providers to   enroll as facility providers under the medical assistance program.          (d)  The commission shall consider implementing a process to   streamline provider enrollment and credentialing for urgent care   providers, including applying the requirements of Sections   533.0055 and 533.0064, Government Code, to those providers.          SECTION 2.04.  As soon as practicable after the effective   date of this article, the executive commissioner of the Health and   Human Services Commission shall adopt the rules required by Section   32.0248, Human Resources Code, as added by this article.          SECTION 2.05.  This article takes effect immediately if this   Act 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 this article to   have immediate effect, this article takes effect September 1, 2017.   ARTICLE 3. MENTAL HEALTH SERVICES          SECTION 3.01.  Subchapter B, Chapter 531, Government Code,   is amended by adding Section 531.0993 to read as follows:          Sec. 531.0993.  GRANT PROGRAM TO REDUCE RECIDIVISM, ARREST,   AND INCARCERATION AMONG INDIVIDUALS WITH MENTAL ILLNESS AND TO   REDUCE WAIT TIME FOR FORENSIC COMMITMENT. (a)  For purposes of this   section, "low-income household" means a household with a total   income at or below 200 percent of the federal poverty guideline.          (b)  Using money appropriated to the commission for that   purpose, the commission shall make grants to county-based community   collaboratives for the purposes of reducing:                (1)  recidivism by, the frequency of arrests of, and   incarceration of persons with mental illness; and                (2)  the total waiting time for forensic commitment of   persons with mental illness to a state hospital.          (c)  A community collaborative is eligible to receive a grant   under this section only if the collaborative includes a county, a   local mental health authority that operates in the county, and each   hospital district, if any, located in the county.  A community   collaborative may include other local entities designated by the   collaborative's members.          (d)  The commission shall condition each grant provided to a   community collaborative under this section on the collaborative   providing matching funds from non-state sources in a total amount   at least equal to the awarded grant amount.  To raise matching   funds, a collaborative may seek and receive gifts, grants, or   donations from any person.          (e)  The commission shall estimate the number of cases of   serious mental illness in low-income households located in each of   the 10 most populous counties in this state. For the purposes of   distributing grants under this section to community collaboratives   established in those 10 counties, for each fiscal year the   commission shall determine an amount of grant money available on a   per-case basis by dividing the total amount of money appropriated   to the commission for the purpose of making grants under this   section in that year by the estimated total number of cases of   serious mental illness in low-income households located in those 10   counties.          (f)  The commission shall make available to a community   collaborative established in each of the 10 most populous counties   in this state a grant in an amount equal to the lesser of:                (1)  an amount determined by multiplying the per-case   amount determined under Subsection (e) by the estimated number of   cases of serious mental illness in low-income households in that   county; or                (2)  an amount equal to the collaborative's available   matching funds.          (g)  To the extent appropriated money remains available to   the commission for that purpose after the commission awards grants   under Subsection (f), the commission shall make available to   community collaboratives established in other counties in this   state grants through a competitive request for proposal process.   For purposes of awarding a grant under this subsection, a   collaborative may include adjacent counties if, for each member   county, the collaborative's members include a local mental health   authority that operates in the county and each hospital district,   if any, located in the county. A grant awarded under this   subsection may not exceed an amount equal to the lesser of:                (1)  an amount determined by multiplying the per-case   amount determined under Subsection (e) by the estimated number of   cases of serious mental illness in low-income households in the   county or counties; or                (2)  an amount equal to the collaborative's available   matching funds.          (h)  The community collaboratives established in each of the   10 most populous counties in this state shall submit to the   commission a plan that:                (1)  is endorsed by each of the collaborative's member   entities;                (2)  identifies a target population;                (3)  describes how the grant money and matching funds   will be used;                (4)  includes outcome measures to evaluate the success   of the plan, including the plan's effect on reducing state hospital   admissions of the target population; and                (5)  describes how the success of the plan in   accordance with the outcome measures would further the state's   interest in the grant program's purposes.          (i)  A community collaborative that applies for a grant under   Subsection (g) must submit to the commission a plan as described by   Subsection (h).  The commission shall consider the submitted plan   together with any other relevant information in awarding a grant   under Subsection (g).          (j)  The commission must review and approve plans submitted   under Subsection (h) or (i) before the commission distributes a   grant under Subsection (f) or (g).  If the commission determines   that a plan includes insufficient outcome measures, the commission   may make the necessary changes to the plan to establish appropriate   outcome measures.  The commission may not make other changes to a   plan submitted under Subsection (h) or (i).          (k)  Acceptable uses for the grant money and matching funds   include:                (1)  the continuation of a mental health jail diversion   program;                (2)  the establishment or expansion of a mental health   jail diversion program;                (3)  the establishment of alternatives to competency   restoration in a state hospital, including outpatient competency   restoration, inpatient competency restoration in a setting other   than a state hospital, or jail-based competency restoration;                (4)  the provision of assertive community treatment or   forensic assertive community treatment with an outreach component;                (5)  the provision of intensive mental health services   and substance abuse treatment not readily available in the county;                (6)  the provision of continuity of care services for   an individual being released from a state hospital;                (7)  the establishment of interdisciplinary rapid   response teams to reduce law enforcement's involvement with mental   health emergencies; and                (8)  the provision of local community hospital, crisis,   respite, or residential beds.          (l)  Not later than December 31 of each year for which the   commission distributes a grant under this section, each community   collaborative that receives a grant shall prepare and submit a   report describing the effect of the grant money and matching funds   in achieving the standard defined by the outcome measures in the   plan submitted under Subsection (h) or (i).          (m)  The commission may make inspections of the operation and   provision of mental health services provided by a community   collaborative to ensure state money appropriated for the grant   program is used effectively.          (n)  The commission shall enter into an agreement with a   qualified nonprofit or private entity to serve as the administrator   of the grant program at no cost to the state. The administrator   shall assist, support, and advise the commission in fulfilling the   commission's responsibilities with respect to the grant program.   The administrator may advise the commission on:                (1)  design, development, implementation, and   management of the program;                (2)  eligibility requirements for grant recipients;                (3)  design and management of the competitive bidding   processes for applications or proposals and the evaluation and   selection of grant recipients;                (4)  grant requirements and mechanisms;                (5)  roles and responsibilities of grant recipients;                (6)  reporting requirements for grant recipients;                (7)  support and technical capabilities;                (8)  timelines and deadlines for the program;                (9)  evaluation of the program and grant recipients;                (10)  requirements for reporting on the program to   policy makers; and                (11)  estimation of the number of cases of serious   mental illness in low-income households in each county.   ARTICLE 4. CHILD PROTECTIVE AND PREVENTION AND EARLY INTERVENTION   SERVICES          SECTION 4.01.  Subchapter A, Chapter 261, Family Code, is   amended by adding Section 261.004 to read as follows:          Sec. 261.004.  TRACKING OF RECURRENCE OF CHILD ABUSE OR   NEGLECT REPORTS. The department shall collect, compile, and   monitor data regarding repeated reports of abuse or neglect   involving the same child or by the same alleged perpetrator.  In   compiling reports under this section, the department shall group   together separate reports involving different children residing in   the same household.          SECTION 4.02.  Subchapter A, Chapter 265, Family Code, is   amended by adding Sections 265.0041 and 265.0042 to read as   follows:          Sec. 265.0041.  GEOGRAPHIC RISK MAPPING FOR PREVENTION AND   EARLY INTERVENTION SERVICES. (a) The department shall use   existing risk terrain modeling systems, predictive analytics, or   geographic risk assessments to:                (1)  identify geographic areas that have high risk   indicators of child maltreatment and child fatalities resulting   from abuse or neglect; and                (2)  target the implementation and use of prevention   and early intervention services to those geographic areas.          (b)  The department may not use data gathered under this   section to identify a specific family or individual.          Sec. 265.0042.  COLLABORATION WITH INSTITUTIONS OF HIGHER   EDUCATION. (a) The Health and Human Services Commission, on behalf   of the department, shall enter into agreements with institutions of   higher education to conduct efficacy reviews of any prevention and   early intervention programs that have not previously been evaluated   for effectiveness through a scientific research evaluation   process.          (b)  The department shall collaborate with an institution of   higher education to create and track indicators of child well-being   to determine the effectiveness of prevention and early intervention   services.          SECTION 4.03.  Section 265.005(b), Family Code, is amended   to read as follows:          (b)  A strategic plan required under this section must:                (1)  identify methods to leverage other sources of   funding or provide support for existing community-based prevention   efforts;                (2)  include a needs assessment that identifies   programs to best target the needs of the highest risk populations   and geographic areas;                (3)  identify the goals and priorities for the   department's overall prevention efforts;                (4)  report the results of previous prevention efforts   using available information in the plan;                (5)  identify additional methods of measuring program   effectiveness and results or outcomes;                (6)  identify methods to collaborate with other state   agencies on prevention efforts; [and]                (7)  identify specific strategies to implement the plan   and to develop measures for reporting on the overall progress   toward the plan's goals; and                (8)  identify specific strategies to increase local   capacity for the delivery of prevention and early intervention   services through collaboration with communities and stakeholders.   ARTICLE 5.  FEDERAL AUTHORIZATION; EFFECTIVE DATE          SECTION 5.01.  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 5.02.  Except as otherwise provided by this Act,   this Act takes effect September 1, 2017.