HBA-CCH H.B. 967 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 967 By: Naishtat Human Services 3/9/2001 Introduced BACKGROUND AND PURPOSE In L.C. and E.W. v. Olmstead (1999), the U.S. Supreme Court ruled that states must provide communitybased services for persons with a disability when it is medically appropriate and desired by the persons with a disability. In response to the ruling, the governor issued an executive order affirming that Texas is committed to providing community-based alternatives for persons with disabilities. House Bill 967 sets forth Texas's comprehensive response to the Olmstead ruling by clarifying the state's responsibilities to provide meaningful community alternatives for persons with disabilities, assigning responsibilities to relevant agencies, authorizing contracts with community-based organizations, establishing agency workgroups, an advisory committee, and a housing assistance program, setting agency reporting and implementation requirements, and developing a pilot program to assess the delivery of long-term care. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of health and human services in SECTION 2 (Section 531.042, Government Code) and SECTION 5, The Health and Human Services Commission in SECTION 2 (Section 531.042, Government Code), the Texas Department of Human Services in SECTION 4 (Sections 22.037 and 22.038, Human Resources Code), and the Texas Department of Mental Health and Mental Retardation in SECTION 4 (Section 22.038, Human Resources Code) of this bill. ANALYSIS House Bill 967 amends the Government and Human Resources codes to require the Health and Human Services Commission (HHSC) and appropriate health and human services agencies to implement a plan that fosters independence, productivity, and meaningful opportunities for a person with a disability to live in an appropriate setting in the community. The bill provides that the plan require appropriate health and human services agencies to inform a person living in an institution of the care and support options available to the person in the community, facilitate a timely and appropriate transfer to a community setting, and develop strategies to prevent the unnecessary placement in an institution of a person who is at risk of institutionalization because of a lack of community services (Sec. 531.0244, Government Code). The bill requires the Department of Human Services (DHS) in cooperation with the Texas Department of Mental Health and Mental Retardation (MHMR) to develop and implement a pilot program in at least five sites, no later than September 1, 2003. The bill requires the program subject to the availability of funds to include: _a comprehensive system of improved policies and procedures to avoid inappropriately placing a person with a disability in an institution; _a program under which physicians and hospital discharge staff are trained, required to inform a person with a disability of all care and support options available to the person, and required to contact and offer the assistance of a permanency planning specialist regarding community-based alternatives to institutionalization; _a program to provide a transition case manager to assist a person with a disability in making a transition to a community-based alternative; _a program to provide grants to community-based organizations to conduct outreach initiatives to identify persons who may be inappropriately residing in an institution and; _a program under which a person with a disability is presumed eligible for community-based care (Sec. 22.037, Human Resources Code and SECTIONS 6 and 7). The bill also requires DHS and MHMR to adopt a memorandum of understanding, no later than December 1, 2002 to implement the pilot program that defines each agency's responsibilities and provides for interagency coordination. No later than September 1 of each year, DHS and MHMR are required to review and update the memorandum. Each agency is required to adopt, by rule, the memorandum of understanding and all revisions of the memorandum (Sec. 22.038, Human Resources Code and SECTION 8). DHS is required, by rule, to establish qualifications for a person not affiliated with DHS, MHMR, or a state school who implements a component of the pilot program by providing outreach services to a resident of a state school. The bill provides that DHS shall require that the person meet those qualifications and ensure that the resident's guardian is present during each contact between that person and the resident. DHS is required to implement each component of the pilot program if and only if the legislature appropriates sufficient money (Sec. 22.037, Human Resources Code). H.B. 967 requires the commissioner of health and human services (commissioner) to establish an interagency work group and an advisory committee to assist and advise HHSC and appropriate agencies in developing a plan to ensure an appropriate care setting for persons with disabilities no later than December 1, 2001. The bill sets forth provisions regarding the membership and the administration of the work group and the advisory committee. The work group is required to study and make various recommendations to HHSC on developing the plan and identifying appropriate components of the pilot program for coordination and integration between DHS and MHMR. The bill requires the advisory committee to advise the commission and appropriate agencies with respect to implementing the plan (Secs. 531.02441 and 531.02442, Government Code and SECTION 5). The bill requires the commissioner to adopt rules no later than December 1, 2001 to require each health and human services agency to provide each patient or client of the agency with information regarding all long-term care and support options before the agency allows the patient or client to be placed in a care setting. Agencies are required to provide, no later than March 1, 2002, the information to each patient or client in a care setting on September 1, 2001. The bill authorizes an agency to obtain the assistance of a private provider, including a community-based organization, in providing patients, clients, or guardians with information as provided by HHSC rules. An agency that provides a patient, client, or guardian with information regarding care and support options available to the patient or client is required to assist the person in taking advantage of an option selected (Sec. 531.042, Government Code, and SECTIONS 5 and 6). The bill requires HHSC to coordinate with DHS, the Texas Department of Housing and Community Affairs (TDHCA), and MHMR to develop a housing assistance program (program) to assist persons with disabilities in transferring from an institution to an integrated housing setting. HHSC shall require DHS to implement and administer the program, and authorizes DHS to coordinate with TDHCA in this process. DHS is required to provide information to HHSC as necessary to facilitate the programs' development and implementation (Sec. 531.055, Government Code). The bill sets forth deadlines and content and distribution requirements for reports that agencies and the workgroup are required to submit about the implementation of these provisions (Secs. 531.0244, 531.02441, and 531.042, Government Code, Sec. 22.037, Human Resources Code and SECTIONS 7 and 8). EFFECTIVE DATE September 1, 2001.