Howard Medicaid Bill Delivers A Plan Before Any New Rates

The text as introduced · 1,072 words

89R8738 AB-F

By: Howard
H.B. No. 4117

A BILL TO BE ENTITLED

AN ACT

relating to the development of a strategic plan for home and

community-based services provided under Medicaid and the child

health plan program and the establishment of an advisory committee

on home and community-based services.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 526, Government Code, as effective April

1, 2025, is amended by adding Subchapter R to read as follows:

SUBCHAPTER R. HOME AND COMMUNITY-BASED SERVICES

Sec. 526.0851. DEFINITIONS. In this subchapter:

(1) "Home and community-based services" means

person-centered care that addresses the needs of an individual with

functional limitations who needs assistance with daily living, is

delivered to the individual in the individual's home or community,

and enables the individual to remain in the individual's home or

community, including:

(A) acute care and long-term services and

supports;

(B) services and supports for an individual's

physical, emotional, mental, social, and vocational needs; and

(C) any other services necessary to enable an

individual to remain in the individual's home or community.

(2) "Home and community support services agency" means

a person licensed under Chapter 142, Health and Safety Code, who

provides for pay or other consideration home health, hospice, or

personal assistance services as those terms are defined by Section

142.001, Health and Safety Code, in a client's residence, an

independent living environment, or another appropriate location.

Sec. 526.0852. STRATEGIC PLAN; REPORT. (a) The commission

shall develop and, subject to Subsection (c), implement a strategic

plan to ensure that Medicaid recipients and child health plan

program enrollees in this state have access to home and

community-based services provided by a home and community support

services agency.

(b) The strategic plan must include:

(1) a proposal for developing a viable rate

methodology for each home and community-based service provided by a

home and community support services agency that will ensure access

to the service;

(2) an assessment of the unmet needs for home and

community-based services of Medicaid recipients and child health

plan program enrollees;

(3) access to care standards for services provided by

a home and community support services agency specific to each home

and community-based services program under Medicaid and the child

health plan program, which may include standards based on:

(A) the amount of delivered units of service as a

percentage of authorized units of service;

(B) the number of in-network home and community

support services agencies;

(C) the types of services provided;

(D) the geographic areas served;

(E) vacancy rates; and

(F) the capacity to provide services;

(4) an assessment of the potential costs, including

costs to the state, associated with the lack of adequate access to

home and community-based services in this state, including an

analysis of:

(A) any projected long-term savings from

providing timely access to home and community-based services;

(B) the costs associated with providing services

in an institutional or hospital setting, as compared to providing

services in a home or community-based setting; and

(C) the potential immediate and long-term costs

associated with a lack of access to services in a timely manner; and

(5) set dates for achieving the goals identified in

the strategic plan.

(b-1) Not later than January 1, 2026, the commission shall

submit the strategic plan developed under Subsection (b) to the

Legislative Budget Board for approval. The board must review and

provide the commission with comments on the plan before determining

whether to approve the plan. This subsection expires September 1,

2027.

(c) The commission may not implement the proposal described

by Subsection (b)(1) until the Legislative Budget Board approves

the strategic plan.

(d) Not later than November 1 of each even-numbered year,

the commission shall submit a report on the commission's

development and implementation of the strategic plan to:

(1) the legislature;

(2) the governor; and

(3) the Legislative Budget Board.

Sec. 526.0853. ADVISORY COMMITTEE. (a) In this section,

"advisory committee" means the home and community-based services

advisory committee established under this section.

(b) The commission shall establish the home and

community-based services advisory committee as an advisory

committee or a subcommittee of the medical care advisory committee

established under Section 32.022, Human Resources Code, to:

(1) advise the commission on:

(A) developing a viable long-term payment

methodology for services provided by home and community support

services agencies; and

(B) addressing issues relating to home and

community-based services;

(2) develop a sustainable strategy to support home and

community-based services;

(3) make recommendations for cost savings in program

areas, including:

(A) program integrity;

(B) reductions in hospitalizations;

(C) prior authorization of services; and

(D) care coordination efforts; and

(4) review and offer comments on the strategic plan

described by Section 526.0852.

(c) The advisory committee is composed of the following

members appointed by the executive commissioner:

(1) one member who is an ex officio nonvoting

representative of the commission; and

(2) an odd number, not to exceed 15, of voting members

as follows:

(A) representatives of:

(i) at least one association representing

managed care organizations;

(ii) at least one association representing

home and community support services agencies;

(iii) at least two associations or

coalitions representing Medicaid recipients who receive home and

community-based services in this state;

(iv) at least one rural home and community

support services agency providing services to Medicaid recipients

who receive home and community-based services;

(v) at least one statewide home and

community support services agency providing services to Medicaid

recipients who receive home and community-based services; and

(vi) another discipline involving

expertise in financing Medicaid home and community-based services;

(B) at least one person who is the parent of and

caregiver to a child who receives home and community-based services

as a Medicaid recipient or child health plan program enrollee;

(C) at least one person who is a recipient of home

and community-based services under Medicaid;

(D) at least one person who provides financial

management services; and

(E) at least one person who provides electronic

visit verification services.

(d) A member of the advisory committee serves without

compensation.

(e) The advisory committee is abolished and this section

expires September 1, 2029.

SECTION 2. As soon as practicable after the effective date

of this Act, the executive commissioner of the Health and Human

Services Commission shall appoint the members of the home and

community-based services advisory committee established under

Subchapter R, Chapter 526, Government Code, as added by this Act.

SECTION 3. This Act takes effect September 1, 2025.