parents could become “complex care aides” for STAR Kids

The text as introduced · 1,084 words

By: Harris Davila
H.B. No. 4371

A BILL TO BE ENTITLED

AN ACT

relating to the provision of services by certain persons in the

private duty nursing program.

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

SECTION 1. Chapter 531, Government Code, is amended by

adding Subchapter T to read as follows:

SUBCHAPTER T. COMPLEX CARE AIDE

Sec. 531.801. DEFINITIONS. (a) In this subchapter:

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

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

(2) "Certified complex care aide" means a person who

is:

(A) the parent, legal guardian, or family member

of a recipient participating in the program;

(B) certified under the program to assist in

providing certain private duty nursing services; and

(C) employed by the home and community support

services agency providing services to the recipient.

(3) "Private duty nursing services" means nursing

services provided under the Texas Health Steps comprehensive care

program to a recipient enrolled in the STAR Kids Medicaid managed

care program.

Sec. 531.802. CERTIFIED COMPLEX CARE AIDE. The commission

shall develop policies to enable a parent, legal guardian, or

family member of a recipient receiving private duty nursing

services in a home setting to assist in providing those services as

a complex care aide.

Sec. 531.803. ELIGIBILITY. (a) An individual is eligible

to receive services from a certified complex care aide if:

(1) the recipient is:

(A) enrolled in the STAR Kids Medicaid managed

care program; and

(B) eligible to receive private duty nursing

services under the Texas Health Steps comprehensive care program;

(2) the recipient's parent, legal guardian, or family

member, as defined by commission rule, elects to become a certified

complex care aide;

(3) The recipient's parent, legal guardian, or family

member, completes all required training necessary to be certified

as a complex care aide; and

(4) the home and community support services agency

that employs the professional registered nurses providing private

duty nursing services to the recipient agrees to employ the

recipient's parent, legal guardian, or family member.

Sec. 531.804. RECIPIENT SCREENING AND NOTIFICATION. (a)

The commission shall:

(1) add criteria to any screening tool or other

instrument used to conduct an assessment or reassessment of a

recipient under the STAR Kids Medicaid managed care program to

identify recipients who are eligible to participate in the program;

and

(2) notify the parent or legally authorized

representative of the recipient of the potential availability of

the service option.

(b) The parent or legally authorized representative of

the recipient has the sole choice of whether to utilize the service

option.

Sec. 531.805. COMPLEX CARE AIDE CERTIFICATION REQUIRED.

(a) To assist in providing private duty nursing services to a

recipient under the program, a parent, legal guardian, or other

family member of the recipient must be certified as a complex care

aide. A person seeking certification as a complex care aide must

satisfy all training, testing, and other minimum qualification

standards the commission establishes.

Sec. 531.806. TRAINING PROGRAM. (a) The commission shall

approve family health aide training programs that meet all of the

requirements under 42 CFR 484.80. The training program must

include instruction on:

(1) transferring;

(2) positioning;

(3) ambulation;

(4) feeding;

(5) personal care;

(6) catheter care;

(7) range of motion;

(8) vital signs;

(9) blood pressure;

(10) medication administration;

(11) enteral care and therapy;

(12) administering enteral feedings;

(13) formula types and preparation; and

(14) other tasks the commission approves except for

tracheostomy care.

(b) The home and community support services agency

must also provide ten hours of training in addition to the training

required under (a) regarding tasks and skills specific to the needs

of the recipient.

(c) The home and community support services agency may not

impose a fee on an applicant for the training required by this

subchapter.

Sec. 531.807. CERTIFICATION RESTRICTED; LIMITED SCOPE OF

PRACTICE. (a) A certified complex care aide under this subchapter:

(1) may only provide complex care services to a

recipient who is:

(A) related to the license holder; and

(B) enrolled in the program; and

(2) must be employed by the home and community support

services agency that employs the nurse providing private duty

nursing services to the recipient.

(b) A certified complex care aide may only provide health

services to a recipient if the services are:

(1) delegated to the certified complex care aide by

the professional registered nurse providing private duty nursing

services to the recipient;

(2) performed under the supervision of that nurse;

(3) consistent with Texas Board of Nursing rules

governing the delegation of nursing tasks by a registered

professional nurse and federal law and regulations governing the

provision of private duty nursing services under Medicaid,

including 42 C.F.R. Section 440.80 except for tracheostomy care;

(4) consistent with the recipient's plan of care; and

(5) authorized by commission rules.

Sec. 531.808. HOME AND COMMUNITY SUPPORT SERVICES AGENCIES

OUTREACH. The commission shall:

(1) provide information about the program to home and

community support services agencies that provide private duty

nursing services under the STAR Kids Medicaid managed care program;

and

(2) encourage agencies to employ certified complex

care aides that are qualified to provide services under this

subchapter.

Sec. 531.809. REIMBURSEMENT FOR CERTIFIED COMPLEX CARE AIDE

SERVICES. (a) The commission shall reimburse a home and community

support services agency for services provided to a recipient by a

certified complex care aide under this subchapter at a rate that is

no less than ninety percent of the licensed vocational nurse rate

for private duty nursing services. The commission shall administer

reimbursement based on billing units.

(b) A recipient's parent, legal guardian, or family member

is not eligible for reimbursement as a certified complex care aide

if they:

(1) do not meet all of the requirements under 531.806;

(2) provide more than 40 hours per week of services to an

eligible recipient.

Sec. 531.811. RULES. The executive commissioner shall

adopt rules necessary to implement this subchapter.

SECTION 2. The commission shall allow the provision of

services by certified complex care aides established under

Subchapter T, Chapter 531, Government Code, as added by this Act,

not later than September 1, 2026.

SECTION 3. 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 4. This Act takes effect September 1, 2025.