Tex.
Gov't Code Section 542.0151
Delivery of Acute Care Services to Individuals with an Intellectual or Developmental Disability
(a)
Subject to Sections 540.0701 (Acute Care Service Delivery Through Most Cost-effective Model; Managed Care Service Delivery Areas) and 540.0753 (Delivery of Basic Attendant and Habilitation Services), the commission shall:(1)
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(2)
monitor the provision of those benefits.(b)
The commission, in 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 described by Subsection (a). The analysis must:(1)
include an assessment of the effects of the delivery model 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 federal law;(2)
be incorporated into the annual report to the legislature required under Section 542.0054 (Annual Report on Implementation); and(3)
include recommendations for delivery model improvements and implementation for the legislature’s consideration, including recommendations for needed statutory changes.(1)
implement the option for the delivery of basic attendant and habilitation services to individuals with an intellectual or developmental disability under the STAR+PLUS Medicaid managed care program that:(A)
is the most cost-effective; and(B)
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 a personal attendant providing basic attendant and habilitation services under the program.(b)
The commission shall require each managed care organization that contracts with the commission to provide basic attendant and habilitation services under the STAR+PLUS Medicaid managed care program in accordance with this section to:(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 commission 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 commission 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 provided to individuals with an intellectual or developmental disability.(c)
The commission shall contract with and make contract payments to local intellectual and developmental disability authorities to:(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 individuals who are eligible to receive services in a community-based setting, including individuals transitioning to a community-based setting;(2)
provide to the appropriate managed care organization, based on the functional need, risk factors, and desired outcomes of an individual with an intellectual or developmental disability, an assessment of whether the individual needs attendant or habilitation services;(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 commission 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)
annually provide to the appropriate managed care organization and the commission 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)
A local intellectual and developmental disability authority with which the commission contracts under Subsection (c) may subcontract with an eligible person, including a nonprofit entity, to coordinate the delivery of services to 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.(f)
The commission 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 to individuals as described by Subsection (a). The commission has regulatory and oversight authority over the providers with which the commission contracts for the delivery of those services.
Source:
Section 542.0151 — Delivery of Acute Care Services to Individuals with an Intellectual or Developmental Disability, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.542.htm#542.0151 (accessed May 18, 2024).
