psychiatric residential treatment facilities need a license now

The text as introduced · 3,784 words

89R8734 AB-F

By: Johnson
H.B. No. 5030

A BILL TO BE ENTITLED

AN ACT

relating to the provision of certain mental and behavioral health

services under Medicaid, Medicaid coverage and reimbursement for

those services, and the regulation of psychiatric residential

treatment facilities; requiring an occupational license.

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

SECTION 1. Section 540.0703(a), Government Code, as

effective April 1, 2025, is amended to read as follows:

(a) In this section :

(1) "Behavioral [ , "behavioral ] health services"

means mental health and substance use disorder services. The term

includes crisis services, intensive outpatient services, and

partial hospitalization services.

(2) "Crisis services" means mental health community

services or other necessary interventions provided to an individual

in crisis. The term includes:

(A) crisis respite services, including mobile

and facility-based services;

(B) crisis stabilization services, including

mobile crisis stabilization services and services provided in an

extended observation unit or crisis stabilization unit; and

(C) other crisis services as the commission

determines.

(3) "Intensive outpatient services" means outpatient

treatment services, including treatment services for substance use

disorders, depression, eating disorders, and other mental health

conditions that do not require detoxification or 24-hour

supervision, provided to patients who require a time-limited,

multifaceted array of services, structures, and supports by a team

of clinical staff capable of providing, at a minimum, the following

services:

(A) individual counseling;

(B) group counseling;

(C) family counseling;

(D) motivational enhancement training; and

(E) relapse prevention, drug refusal, and coping

skills training.

(4) "Partial hospitalization services" means distinct

and organized intensive ambulatory treatment services provided for

periods of not more than 24 hours at a location other than a

patient's home or in an inpatient or a residential care setting.

The term includes the services described by 42 C.F.R. Section

410.43(a)(4).

SECTION 2. The heading to Chapter 577A, Health and Safety

Code, is amended to read as follows:

CHAPTER 577A. PSYCHIATRIC RESIDENTIAL [ YOUTH ] TREATMENT

FACILITIES

SECTION 3. Section 577A.001(3), Health and Safety Code, is

amended to read as follows:

(3) "Psychiatric residential [ youth ] treatment

facility" means a private facility that provides psychiatric health

treatments and services in a residential, nonhospital setting

exclusively to individuals who are 21 years of age or younger [ and

is licensed as a general residential operation under Chapter 42,

Human Resources Code ]. The term includes a facility that provides

room and board.

SECTION 4. The heading to Subchapter B, Chapter 577A,

Health and Safety Code, is amended to read as follows:

SUBCHAPTER B. LICENSURE [ CERTIFICATION ], FEES, AND INSPECTIONS

SECTION 5. Section 577A.051, Health and Safety Code, is

amended to read as follows:

Sec. 577A.051. LICENSE REQUIRED [ VOLUNTARY QUALITY

STANDARDS CERTIFICATION ]. A person may not operate a psychiatric

residential treatment facility unless the person holds a license

issued by the commission [ The commission shall, using existing

resources to the extent feasible, develop and implement a voluntary

quality standards certification process to certify a psychiatric

residential youth treatment facility that meets standards for

certification ] under this chapter.

SECTION 6. The heading to Section 577A.052, Health and

Safety Code, is amended to read as follows:

Sec. 577A.052. LICENSE [ CERTIFICATE ] APPLICATION.

SECTION 7. Section 577A.052(a), Health and Safety Code, is

amended to read as follows:

(a) To obtain a license [ certificate ] under this chapter, an

applicant must submit to the commission an application in the form

and manner prescribed by the commission.

SECTION 8. Section 577A.053, Health and Safety Code, is

amended to read as follows:

Sec. 577A.053. FEES. The executive commissioner by rule

shall establish a nonrefundable license [ certificate ] application

fee and a nonrefundable license [ certificate ] renewal fee in

amounts necessary to cover the costs of administering this chapter.

SECTION 9. Section 577A.054, Health and Safety Code, is

amended to read as follows:

Sec. 577A.054. ISSUANCE AND RENEWAL OF LICENSE

[ CERTIFICATE ]. (a) The commission shall issue a license

[ certificate ] to an applicant if on inspection and investigation

the commission determines the applicant meets the requirements of

this chapter and commission rules. [ The commission may not issue to

an applicant a certificate under this chapter unless the applicant

is licensed as a general residential operation under Chapter 42,

Human Resources Code. ]

(b) A license [ certificate ] issued under this chapter

expires on the second anniversary of the date the license

[ certificate ] is issued or renewed.

(c) The commission shall renew a license [ certificate ] if:

(1) the license [ certificate ] holder submits to the

commission a fee established by the executive commissioner under

Section 577A.053; and

(2) on inspection and investigation the commission

determines the license [ certificate ] holder meets the requirements

of this chapter and commission rules.

SECTION 10. Section 577A.055, Health and Safety Code, is

amended to read as follows:

Sec. 577A.055. INSPECTIONS. In addition to the inspections

required under Section 577A.054, the commission shall conduct an

inspection not later than the first anniversary of the date a

license [ certificate ] is issued or renewed to ensure the license

[ certificate ] holder remains in compliance with the requirements of

this chapter and commission rules.

SECTION 11. The heading to Subchapter C, Chapter 577A,

Health and Safety Code, is amended to read as follows:

SUBCHAPTER C. REGULATION OF LICENSED [ CERTIFIED ] PSYCHIATRIC

RESIDENTIAL [ YOUTH ] TREATMENT FACILITIES

SECTION 12. Section 577A.101, Health and Safety Code, is

amended to read as follows:

Sec. 577A.101. MINIMUM STANDARDS. The executive

commissioner by rule shall establish minimum standards for the

licensing [ certification ] of psychiatric residential [ youth ]

treatment facilities under this chapter. The minimum standards

must require a facility to:

(1) obtain accreditation by The Joint Commission, the

Commission on Accreditation of Rehabilitation Facilities, the

Council on Accreditation, or another accrediting organization

approved by the commission; [ and ]

(2) provide and prescribe guidelines for the provision

of the following activities, treatments, and services:

(A) development and implementation of individual

plans of care, including the provision of services provided by a

licensed psychiatrist or physician to develop individual plans of

care;

(B) individual therapy;

(C) family engagement activities;

(D) consultation services with qualified

professionals, including case managers, primary care

professionals, community-based mental health providers, school

staff, and other support planners;

(E) 24-hour nursing services; and

(F) direct care and supervision services,

supportive services for daily living and safety, and positive

behavior management services ;

(3) satisfy federal requirements for a psychiatric

residential treatment facility under 42 C.F.R. Section 441.151 et

seq. and 42 C.F.R. Section 483.350 et seq.; and

(4) satisfy all requirements for licensure as a

general residential operation under Chapter 42, Human Resources

Code, and comply with rules adopted under that chapter .

SECTION 13. Section 577A.102, Health and Safety Code, is

amended to read as follows:

Sec. 577A.102. ADMISSION CRITERIA. A facility licensed

[ certified ] under this chapter may not admit or provide treatments

or services to an individual unless the individual:

(1) is 21 years of age or younger;

(2) has been diagnosed with a severe emotional

disturbance by a licensed mental health professional;

(3) requires residential psychiatric treatment under

the direction of a licensed physician to improve the individual's

condition; and

(4) was referred for treatments or services in a

psychiatric residential [ youth ] treatment facility by a licensed

mental health professional.

SECTION 14. Section 577A.151, Health and Safety Code, is

amended to read as follows:

Sec. 577A.151. PENALTIES. A facility licensed [ certified ]

under this chapter is subject to a civil penalty under Section

571.023 or an administrative penalty under Section 571.025, as

applicable, for a violation of this chapter or a rule adopted under

this chapter.

SECTION 15. Section 32.024, Human Resources Code, is

amended by adding Subsections (oo-1) and (ss) to read as follows:

(oo-1) The commission shall provide medical assistance

reimbursement to a health care provider who delivers to a recipient

under the medical assistance program services classified as

multisystemic therapy by the Healthcare Common Procedure Coding

System (HCPCS) code. The executive commissioner shall establish a

separate provider type for multisystemic therapy providers for

purposes of enrollment as a provider for and reimbursement under

the medical assistance program.

(ss) The commission in the commission's rules and standards

governing the scope of services provided under the medical

assistance program shall include psychiatric treatment and related

services provided by a psychiatric residential treatment facility

licensed under Chapter 577A, Health and Safety Code, to the extent

permitted by federal law.

SECTION 16. Section 32.027, Human Resources Code, is

amended by amending Subsection (l) and adding Subsection (m) to

read as follows:

(l) Subject to appropriations, the commission shall assure

that a recipient of medical assistance under this chapter may

select a licensed psychologist, a licensed marriage and family

therapist, as defined by Section 502.002, Occupations Code, a

licensed professional counselor, as defined by Section 503.002,

Occupations Code, or a licensed clinical [ master ] social worker, as

defined by Section 505.002, Occupations Code, to perform any health

care service or procedure covered under the medical assistance

program if the selected person is authorized by law to perform the

service or procedure. This subsection shall be liberally

construed.

(m) The commission shall assure that a recipient of medical

assistance under this chapter may select the following to perform

any health care service or procedure covered under the medical

assistance program if the selected person is licensed and

authorized by law to perform the service or procedure:

(1) a licensed marriage and family therapist

associate, as defined by Section 502.002, Occupations Code, who is

working toward fulfilling the supervised practice requirements to

be licensed as a licensed marriage and family therapist, as defined

by that section;

(2) a licensed master social worker, as defined by

Section 505.002, Occupations Code, who is actively pursuing the

education and training required to be licensed as a licensed

clinical social worker, as defined by that section; or

(3) a licensed professional counselor associate, as

described by 22 T.A.C. Chapter 681, who is working toward

fulfilling the supervised practice requirements to be licensed as a

licensed professional counselor, as defined by Section 503.002,

Occupations Code.

SECTION 17. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.04261 to read as follows:

Sec. 32.04261. REIMBURSEMENT FOR FUNCTIONAL FAMILY THERAPY

SERVICES. (a) In this section:

(1) "At-risk youth" means children who are at risk of

involvement with the child welfare system, the criminal justice

system, or the juvenile justice system.

(2) "Functional family therapy" means an intensive,

short-term, family-based therapeutic treatment program for at-risk

youth designed to improve family dynamics, communication, and

support by:

(A) addressing core causes of dysfunctional

behavior patterns;

(B) decreasing negativity in the household; and

(C) providing tools to improve parental skills

and relationships.

(b) The commission shall ensure that medical assistance

reimbursement is provided to a provider who provides functional

family therapy services to a recipient under the medical assistance

program.

SECTION 18. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.079 to read as follows:

Sec. 32.079. REIMBURSEMENT FOR CERTAIN COUNSELING

SERVICES. (a) The commission shall provide reimbursement under

the medical assistance program to a provider described by Section

32.027(l) who is a licensed marriage and family therapist, licensed

professional counselor, or licensed clinical social worker, is

selected by a recipient of medical assistance, and provides

counseling services covered under the medical assistance program

that the provider is authorized by law to perform. The commission

shall ensure that the provider is reimbursed at a rate equal to the

reimbursement rate established for a licensed psychiatrist or

licensed psychologist for providing similar services.

(b) The commission shall provide reimbursement under the

medical assistance program to a provider described by Section

32.027(m) who is selected by a recipient of medical assistance and

who provides counseling services covered under the medical

assistance program that the provider is authorized by law to

perform. The commission shall ensure that the provider is

reimbursed at a rate equal to 70 percent of the reimbursement rate

established for a licensed psychiatrist or licensed psychologist

for providing similar services.

(c) This section shall be liberally construed.

SECTION 19. Section 42.041(b), Human Resources Code, is

amended to read as follows:

(b) This section does not apply to:

(1) a state-operated facility;

(2) an agency foster home;

(3) a facility that is operated in connection with a

shopping center, business, religious organization, or

establishment where children are cared for during short periods

while parents or persons responsible for the children are attending

religious services, shopping, or engaging in other activities,

including retreats or classes for religious instruction, on or near

the premises, that does not advertise as a child-care facility or

day-care center, and that informs parents that it is not licensed by

the state;

(4) a school or class for religious instruction that

does not last longer than two weeks and is conducted by a religious

organization during the summer months;

(5) a youth camp licensed by the Department of State

Health Services;

(6) a facility licensed, operated, certified, or

registered by another state agency;

(7) an educational facility that is accredited by the

Texas Education Agency, the Southern Association of Colleges and

Schools, or an accreditation body that is a member of the Texas

Private School Accreditation Commission and that operates

primarily for educational purposes for prekindergarten and above, a

before-school or after-school program operated directly by an

accredited educational facility, or a before-school or

after-school program operated by another entity under contract with

the educational facility, if the Texas Education Agency, the

Southern Association of Colleges and Schools, or the other

accreditation body, as applicable, has approved the curriculum

content of the before-school or after-school program operated under

the contract;

(8) an educational facility that operates solely for

educational purposes for prekindergarten through at least grade

two, that does not provide custodial care for more than one hour

during the hours before or after the customary school day, and that

is a member of an organization that promulgates, publishes, and

requires compliance with health, safety, fire, and sanitation

standards equal to standards required by state, municipal, and

county codes;

(9) a kindergarten or preschool educational program

that is operated as part of a public school or a private school

accredited by the Texas Education Agency, that offers educational

programs through grade six, and that does not provide custodial

care during the hours before or after the customary school day;

(10) a family home, whether registered or listed;

(11) an educational facility that is integral to and

inseparable from its sponsoring religious organization or an

educational facility both of which do not provide custodial care

for more than two hours maximum per day, and that offers an

educational program in one or more of the

following: prekindergarten through at least grade three,

elementary grades, or secondary grades;

(12) an emergency shelter facility, other than a

facility that would otherwise require a license as a child-care

facility under this section, that provides shelter or care to a

minor and the minor's child or children, if any, under Section

32.201, Family Code, if the facility:

(A) is currently under a contract with a state or

federal agency; or

(B) meets the requirements listed under Section

51.005(b)(3);

(13) a juvenile detention facility certified under

Section 51.12, Family Code, a juvenile correctional facility

certified under Section 51.125, Family Code, a juvenile facility

providing services solely for the Texas Juvenile Justice

Department, or any other correctional facility for children

operated or regulated by another state agency or by a political

subdivision of the state;

(14) an elementary-age (ages 5-13) recreation program

operated by a municipality provided the governing body of the

municipality annually adopts standards of care by ordinance after a

public hearing for such programs, that such standards are provided

to the parents of each program participant, and that the ordinances

shall include, at a minimum, staffing ratios, minimum staff

qualifications, minimum facility, health, and safety standards,

and mechanisms for monitoring and enforcing the adopted local

standards; and further provided that parents be informed that the

program is not licensed by the state and the program may not be

advertised as a child-care facility;

(15) an annual youth camp held in a municipality with a

population of more than 1.5 million that operates for not more than

three months and that has been operated for at least 10 years by a

nonprofit organization that provides care for the homeless;

(16) a food distribution program that:

(A) serves an evening meal to children two years

of age or older; and

(B) is operated by a nonprofit food bank in a

nonprofit, religious, or educational facility for not more than two

hours a day on regular business days;

(17) a child-care facility that operates for less than

three consecutive weeks and less than 40 days in a period of 12

months;

(18) a program:

(A) in which a child receives direct instruction

in a single skill, talent, ability, expertise, or proficiency;

(B) that does not provide services or offerings

that are not directly related to the single talent, ability,

expertise, or proficiency;

(C) that does not advertise or otherwise

represent that the program is a child-care facility, day-care

center, or licensed before-school or after-school program or that

the program offers child-care services;

(D) that informs the parent or guardian:

(i) that the program is not licensed by the

state; and

(ii) about the physical risks a child may

face while participating in the program; and

(E) that conducts background checks for all

program employees and volunteers who work with children in the

program using information that is obtained from the Department of

Public Safety;

(19) an elementary-age (ages 5-13) recreation program

that:

(A) adopts standards of care, including

standards relating to staff ratios, staff training, health, and

safety;

(B) provides a mechanism for monitoring and

enforcing the standards and receiving complaints from parents of

enrolled children;

(C) does not advertise as or otherwise represent

the program as a child-care facility, day-care center, or licensed

before-school or after-school program or that the program offers

child-care services;

(D) informs parents that the program is not

licensed by the state;

(E) is organized as a nonprofit organization or

is located on the premises of a participant's residence;

(F) does not accept any remuneration other than a

nominal annual membership fee;

(G) does not solicit donations as compensation or

payment for any good or service provided as part of the program; and

(H) conducts background checks for all program

employees and volunteers who work with children in the program

using information that is obtained from the Department of Public

Safety;

(20) a living arrangement in a caretaker's home

involving one or more children or a sibling group, excluding

children who are related to the caretaker, in which the caretaker:

(A) had a prior relationship with the child or

sibling group or other family members of the child or sibling group;

(B) does not care for more than one unrelated

child or sibling group;

(C) does not receive compensation or solicit

donations for the care of the child or sibling group; and

(D) has a written agreement with the parent to

care for the child or sibling group;

(21) a living arrangement in a caretaker's home

involving one or more children or a sibling group, excluding

children who are related to the caretaker, in which:

(A) the department is the managing conservator of

the child or sibling group;

(B) the department placed the child or sibling

group in the caretaker's home; and

(C) the caretaker had a long-standing and

significant relationship with the child or sibling group, or the

family of the child or sibling group, before the child or sibling

group was placed with the caretaker;

(22) a living arrangement in a caretaker's home

involving one or more children or a sibling group, excluding

children who are related to the caretaker, in which the child is in

the United States on a time-limited visa under the sponsorship of

the caretaker or of a sponsoring organization;

(23) a facility operated by a nonprofit organization

that:

(A) does not otherwise operate as a child-care

facility that is required to be licensed under this section;

(B) provides emergency shelter and care for not

more than 15 days to children 13 years of age or older but younger

than 18 years of age who are victims of human trafficking alleged

under Section 20A.02, Penal Code;

(C) is located in a municipality with a

population of at least 600,000 that is in a county on an

international border; and

(D) meets one of the following criteria:

(i) is licensed by, or operates under an

agreement with, a state or federal agency to provide shelter and

care to children; or

(ii) meets the eligibility requirements for

a contract under Section 51.005(b)(3);

(24) a facility that provides respite care exclusively

for a local mental health authority under a contract with the local

mental health authority; [ or ]

(25) a living arrangement in a caretaker's home

involving one or more children or a sibling group in which the

caretaker:

(A) has a written authorization agreement under

Chapter 34, Family Code, with the parent of each child or sibling

group to care for each child or sibling group;

(B) does not care for more than six children,

excluding children who are related to the caretaker; and

(C) does not receive compensation for caring for

any child or sibling group ; or

(26) a psychiatric residential treatment facility

licensed under Chapter 577A, Health and Safety Code .

SECTION 20. Section 577A.003, Health and Safety Code, is

repealed.

SECTION 21. As soon as practicable after the effective date

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

Services Commission shall adopt rules as necessary to implement the

changes in law made by this Act.

SECTION 22. 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 23. Notwithstanding the changes in law made by this

Act to Chapter 577A, Health and Safety Code, a psychiatric

residential treatment facility that is licensed under Chapter 42,

Human Resources Code, on the effective date of this Act is not

required to be licensed under Chapter 577A, Health and Safety Code,

until the expiration of the facility's license under Chapter 42,

Human Resources Code.

SECTION 24. This Act takes effect September 1, 2025.