Tex.
Gov't Code Section 534.151
Delivery of Acute Care Services for Individuals with an Intellectual or Developmental Disability
(a)
Subject to Section 533.0025 (Delivery of Services), the commission shall provide acute care Medicaid benefits to individuals with an intellectual or developmental disability through the STAR + PLUS Medicaid managed care program or the most appropriate integrated capitated managed care program delivery model and monitor the provision of those benefits.(b)
The commission and the department, in consultation and collaboration with the advisory committee, shall analyze the outcomes of providing acute care Medicaid benefits to individuals with an intellectual or developmental disability under a model specified in Subsection (a). The analysis must:(1)
include an assessment of the effects on:(A)
access to and quality of acute care services; and(B)
the number and types of fair hearing and appeals processes in accordance with applicable federal law;(2)
be incorporated into the annual report to the legislature required under Section 534.054 (Annual Report on Implementation); and(3)
include recommendations for delivery model improvements and implementation for consideration by the legislature, including recommendations for needed statutory changes.(1)
implement the most cost-effective option for the delivery of basic attendant and habilitation services for individuals with an intellectual or developmental disability under the STAR + PLUS Medicaid managed care program that maximizes federal funding for the delivery of services for that program and other similar programs; and(2)
provide voluntary training to individuals receiving services under the STAR + PLUS Medicaid managed care program or their legally authorized representatives regarding how to select, manage, and dismiss personal attendants providing basic attendant and habilitation services under the program.(b)
The commission shall require that each managed care organization that contracts with the commission for the provision of basic attendant and habilitation services under the STAR + PLUS Medicaid managed care program in accordance with this section:(1)
include in the organization’s provider network for the provision of those services:(A)
home and community support services agencies licensed under Chapter 142 (Home and Community Support Services), Health and Safety Code, with which the department has a contract to provide services under the community living assistance and support services (CLASS) waiver program; and(B)
persons exempted from licensing under Section 142.003 (Exemptions from Licensing Requirement)(a)(19), Health and Safety Code, with which the department has a contract to provide services under:(i)
the home and community-based services (HCS) waiver program; or(ii)
the Texas home living (TxHmL) waiver program;(2)
review and consider any assessment conducted by a local intellectual and developmental disability authority providing intellectual and developmental disability service coordination under Subsection (c); and(3)
enter into a written agreement with each local intellectual and developmental disability authority in the service area regarding the processes the organization and the authority will use to coordinate the services of individuals with an intellectual or developmental disability.(c)
The department shall contract with and make contract payments to local intellectual and developmental disability authorities to conduct the following activities under this section:(1)
provide intellectual and developmental disability service coordination to individuals with an intellectual or developmental disability under the STAR + PLUS Medicaid managed care program by assisting those individuals who are eligible to receive services in a community-based setting, including individuals transitioning to a community-based setting;(2)
provide an assessment to the appropriate managed care organization regarding whether an individual with an intellectual or developmental disability needs attendant or habilitation services, based on the individual’s functional need, risk factors, and desired outcomes;(3)
assist individuals with an intellectual or developmental disability with developing the individuals’ plans of care under the STAR + PLUS Medicaid managed care program, including with making any changes resulting from periodic reassessments of the plans;(4)
provide to the appropriate managed care organization and the department information regarding the recommended plans of care with which the authorities provide assistance as provided by Subdivision (3), including documentation necessary to demonstrate the need for care described by a plan; and(5)
on an annual basis, provide to the appropriate managed care organization and the department a description of outcomes based on an individual’s plan of care.(d)
Local intellectual and developmental disability authorities providing service coordination under this section may not also provide attendant and habilitation services under this section.(e)
During the first three years basic attendant and habilitation services are provided to individuals with an intellectual or developmental disability under the STAR + PLUS Medicaid managed care program in accordance with this section, providers eligible to participate in the home and community-based services (HCS) waiver program, the Texas home living (TxHmL) waiver program, or the community living assistance and support services (CLASS) waiver program on September 1, 2013, are considered significant traditional providers.(f)
A local intellectual and developmental disability authority with which the department contracts under Subsection (c) may subcontract with an eligible person, including a nonprofit entity, to coordinate the services of individuals with an intellectual or developmental disability under this section. The executive commissioner by rule shall establish minimum qualifications a person must meet to be considered an “eligible person” under this subsection.(g)
The department may contract with providers participating in the home and community-based services (HCS) waiver program, the Texas home living (TxHmL) waiver program, the community living assistance and support services (CLASS) waiver program, or the deaf-blind with multiple disabilities (DBMD) waiver program for the delivery of basic attendant and habilitation services described in Subsection (a) for individuals to which that subsection applies. The department has regulatory and oversight authority over the providers with which the department contracts for the delivery of those services.
Source:
Section 534.151 — Delivery of Acute Care Services for Individuals with an Intellectual or Developmental Disability, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.534.htm#534.151 (accessed Jun. 5, 2024).
