HBA-MPM C.S.H.B. 2873 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2873 By: Maxey Public Health 4/6/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Many Texas children with disabilities require long term care. Texas has developed and provided Medicaid waivers for those children who would otherwise be forced to enter an institution. The waivers allow individuals with significant support needs to obtain comprehensive services in their communities, including the families of children younger than 23 years of age with disabilities or special health care needs who require a flexible service array to ensure that basic needs for safety, security, and stability are met. These waivers may need to be modified to ensure that services are structured and provided in a manner supportive of families. C.S.H.B. 2873 requires the Health and Human Services Commission or an agency operating part of the medical assistance program, as appropriate, in developing and providing services subject to this section, to adopt a specific protocol in the identification of children with disabilities or special needs and methods of providing support services to children and their families. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter B, Chapter 32, Human Resources Code, by adding Section 32.052, as follows: Sec. 32.052. WAIVER PROGRAMS FOR CHILDREN WITH DISABILITIES OR SPECIAL HEALTH CARE NEEDS. (a) Makes this section applicable to services under the medical assistance program (program) provided to children younger than 23 years of age with disabilities or special health care needs under a waiver granted under 42 U.S.C., Section 1396n(c) (Section 1915(c), Social Security Act) (Waiver Respecting Medical Assistance Requirement in State Plan: Scope, etc.). (b) Defines "permanency planning" for purposes of this section as a philosophy and planning process designed to achieve family support through the facilitation of a permanent living arrangement that has as its primary feature an enduring and nurturing parental relationship. (c) Requires the Health and Human Services Commission or an agency operating part of the medical assistance program (department), as appropriate, in developing and providing services subject to this section, to: (1) assess a child at the time the child applies for assistance to determine all appropriate services for the child under the program, including both waiver and nonwaiver services; (2) ensure permanency planning implementation to identify and establish the family support necessary to maintain a child's permanent living arrangement with a family; (3) implement a transition and referral process to prevent breaks in services when a child is leaving a medical assistance waiver program or moving between service delivery systems due to a change in the child's disability status or needs, aging out of the current delivery system, or moving between geographic areas within the state. (4) identify and provide core services addressing a child's developmental needs and the needs of the child's family; (5) provide for comprehensive coordination and use of available services and resources in a manner that ensures support for families in keeping their families at home. (6) ensure that eligibility requirements, assessments for service needs, and other components of service delivery are fair and equitable for all families; and (7) provide for certain service options and a reasonable choice of service providers. (d) Requires the department to coordinate the provision of services subject to this section with services provided under the Texas Health Steps Comprehensive Care Program (THSCCP) to ensure that the services are cost neutral and that they are not duplicated within the program. (e) Requires the department to establish an advisory committee (committee) to provide recommendations on the delivery of services subject to this section. Provides that the committee must meet regularly and include the parents of children receiving services subject to this section and representatives of appropriate advocacy organizations. Requires the committee to provide recommendations relating to: (1) administration of services subject to this section in a manner that eliminates duplication of assessment, evaluation, and services provided under the Texas Health Steps Comprehensive Care Program; (2) coordination of services in a manner that provides accessibility to comprehensive services without gaps in service delivery; (3) procedures for obtaining authorization for services subject to this section and other nonwaiver services under the medical assistance program, including procedures for appealing denials of service; (4) encouragement of the use of waivers under 42 U.S.C. Section 1396n(c) (Section 1915(c), Social Security Act), to provide the state with the flexibility to provide services outside the scope, amount, or duration of nonwaiver services available under the medical assistance program; (5) determination of policies that ensure a child receiving services subject to this section has access to comprehensive waiver services for adults when the child ages and loses eligibility for children's services; (6) ensuring that the medical assistance waiver programs serve the interest of the child and support families; (7) encouraging medical assistance waiver services to have flexibility to provide services that are outside of the scope, amount, or duration of state plan services; and (8) evaluation of the quality and effectiveness of services subject to this section. (f) Entitles a member of the committee established under Subsection (e) who is the parent of a child receiving services subject to this section to reimbursement of travel expenses incurred while conducting committee business in the manner provided by the General Appropriations Act. SECTION 2. Requires a state agency to request a waiver or authorization and authorizes it to delay implementing a provision until the waiver or authorization is granted, should the agency determine that a waiver or authorization from a federal agency is necessary before implementing any provision of this Act. SECTION 3.Emergency clause. Effective date: upon passage. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. modifies the original bill in SECTION 1 to specify that proposed Section 32.052 (a), Human Resources Code, is applicable to children younger than 23 years of age. The substitute modifies proposed Subsection (c) to modify certain functions required by the Health and Human Services Commission or an agency operating part of the medical assistance program (department), as appropriate, in developing and providing services subject to this section, as follows: (1) (makes no change); (2) (makes no change); (3) implement a transition and referral process to prevent breaks, rather than gaps, in service when a child is leaving a medical assistance waiver program or moving between service delivery systems due to a change in the child's disability status or needs, aging out of the current delivery system, or moving between geographic areas within the state. The original text of this subdivision qualified the services as those which could otherwise result from changes in the delivery system serving the child, changes in the child's needs and eligibility status, or changes in the child's residence. (4) (makes no change); (5) provide for comprehensive coordination and use of available services and resources in a manner that ensures support for families in keeping their families at home, rather than in a manner that ensures that a child's family is aware of all service options; (6) (makes no change); and (7) (makes no change). The substitute differs from proposed Subsection (e) in the original in that it expands and modifies the requirements the advisory committee is required to provide, as follows: (1) administration of services subject to this section in a manner that eliminates duplication of assessment and evaluation, as well as services, provided under the Texas Health Steps Comprehensive Care Program; (2) coordination of services in a manner that provides accessibility to comprehensive services without gaps in service delivery, rather than "coordination of services;" (3) procedures for obtaining authorization for services subject to this section and other nonwaiver services under the medical assistance program, including procedures for appealing denials of service, rather than elimination of gaps in service delivery; (4) encouragement of the use of waivers under 42 U.S.C. Section 1396n(c) (Section 1915(c), Social Security Act), to provide the state with the flexibility to provide services outside the scope, amount, or duration of nonwaiver services available under the medical assistance program, rather than policy development in a manner demonstrating sensitivity to the needs of children with disabilities and special health needs and their families to the goals of legislation relating to services for those children and their families; (5) determination of policies that ensure a child receiving services subject to this section has access to comprehensive waiver services for adults when the child ages and loses eligibility for children's services (redesignates Subdivision (5) in the original to Subdivision (8) in the substitute); (6) ensuring that the medical assistance waiver programs serve the interest of the child and support families; (7) encouraging medical assistance waiver services to have flexibility to provide services that are outside of the scope, amount, or duration of state plan services; and (8) (redesignated from Subdivision (5)).