• The department (TDHS) shall set a personal needs allowance of not less than $60 a month for a resident of a nursing home, personal care home, ICF/MR or similar long term care facility.
• The department shall develop an early warning system to detect fraud in the handling of the personal needs allowance and other funds of residents for long term care facilities.
• The HHSC shall ensure that the rules governing the determination of rates paid for nursing home services provide for the rate component derived from reported liability insurance costs to be paid only to those homes that purchase liability insurance acceptable to the commission.

HB482

Author: Naishtat
Passed and Signed by Governor
Retaliation protection for certain persons who filed claims of abuse or neglect against nursing homes or ICFs/MR

• Requires nursing homes and ICF’s to display the following information in public areas: License, Complaint procedures, Notice for access to cited deficiencies reports with a toll free number, Summary of the most recent inspection, Notice for access to summary reports of facility history pertaining to quality/access to care and Notice of protection from discrimination/retaliation for employees, other staff, resident, family members/guardians and volunteers.
• Facilities cannot retaliate or discriminate against those who: make complaints, file grievances, report violations or cooperate in investigations concerning the services provided in the facility.
• Allows certain persons to sue if facilities retaliate or discriminate.

HB966

Author: Naishtat
Passed and Signed by Governor
Requires HHSC to study ways of allowing appropriated money to follow an individual leaving institutional care into community-based services

• Study how health and human services:

1)      Quantify the amount of money appropriated by legislature that is spent to care for a person receiving institutional care in an institution operated by the state or funded at least in part by appropriated money.

2)      Redirect all or part of that amount to one or more community- based services for those leaving the institution to live in the community

• Study alternatives for redirecting money under existing laws, with general law changes or changes in the General Appropriations Act.

HB1154

Author: Raymond
Passed and Signed by Governor
Grants to organizations providing community-based support for long-term care services

• Allows Health and Human Services Commission (HHSC), Texas Department of Human Services and Texas Department of Aging to provide grants to community-based organizations that support/provide community-based support and service delivery systems for long-term care services.
• HHSC will 1)  Evaluate proposals for grants based on merit and demonstrated need, and 2)  Adopt guidelines for grants and give priority to proposals utilizing internet and related information technology that will provide clients referral services and needs assessments.

HB1179

Author: Wohlegemuth
Passed and Signed by Governor
Protective services for the elderly and disabled.

• Requires TDPRS to notify certain agencies after an investigation of reported abuse of an elderly or disabled person in a facility licensed under HCSSA and to allow the agencies access to its records.  States that TDMHMR is responsible for providing services to a person receiving HCS services as necessary to alleviate abuse, neglect, or exploitation if TDPRS determines that the person needs the services because of the failure of a provider to furnish contracted services.

HB2258

Author: Maxey
Passed and Signed by the Governor
Relating to assessment of certain nursing home residents for MH or MR

• Requires DHS to assess residents of nursing homes before transferring to a community program to determine whether the person has MH or MR.
• The assessment process used must be as effective as the PASSAR assessment.
• If the person has MH or MR, DHS must share the information with MHMR.
• MHMR must use the information to determine the need for and funding levels of MH/MR services for persons moving from the nursing home to the community, provide MH/MR services to the person once moved, and refer the person to the local MHMRA or private provider for additional MH/MR services.

SB38

Author: Zaffirini
Passed and Signed by Governor
Authorizes conduct of architectural review before construction or remodeling a long term care facility

• Establishes early compliance review for all construction or remodeling of a care or long-term facility.
• The department will review building plans and results within 30 days for compliance with department architectural requirements and apply review charges if necessary.
• After complying with review requirements, changes to architectural requirements applicable to the project will be made only if change is required by federal law or the project is not completed in reasonable time.
• Review does not include review of building plans for compliance with the Texas Accessibility Standards.

SB83

Author: Madla
Passed and Signed by Governor
Regulation of ICFs/MR

• Stipulates TDHS must adopt rules that require:
  *  TDHS and TDMHMR to work cooperatively in developing any rules for the program.
  *  TDMHMR Commissioner review of and comment on any rules considered by TDHS prior to adoption.  The comment must address the impact of the rule on the program.
  *  Specialized staff to conduct surveys and investigations.
  TDHS and TDMHMR to work cooperatively to ensure any facility closure or transition plans for closure.

SB367

Author: Zaffirini
Passed and Signed Governor
Relates to an appropriate care setting for a person with a disability, addressing recommendations in the Promoting Independence Report and requiring HHSC and related health and human service agencies to implement a plan to provide a system of services that fosters independence for a person who lives in an institution to live in the community.  This includes:
-  Giving them information about various, appropriate living options.
-  If chosen, provide the service in a timely manner.
-  Developing strategies to prevent persons living in the community from unnecessary placement in an institution.
-  Establish a workgroup to develop the plan.
-  Establish an advisory committee to advise HHSC on appropriate care settings and oversee implementation of the plan.
-  Specifies state agency requirements re:  sharing information about all available living options.
-  Requires HHSC, TDMHMR, and TDHCS (Housing and Community Affairs) to develop a housing assistance program to assist persons in moving from an institution to a housing setting.
-  Upon availability of funding, requires TDHS and TDMHMR to establish a pilot program in at least 5 sites that addresses the plan developed to implement this bill and specifies the components of the pilot to include an analysis of the costs, benefits, and effectiveness of placing the person in a community setting.  An evaluation of the pilot is required as well as the establishment of an MOU outlining each agencies responsibilities re: the implementation of the pilot.

SB368

Author: Zaffirini
Passed and Signed by Governor
Permanency planning procedures for children in state institutions

• The Commission and other appropriate health and human services agencies shall develop to the extent possible uniform procedures that promote efficiency for agencies and stability for each child who is the subject of a permanency plan.
• Community resources coordinating group will establish a permanency plan for each child with a developmental disability who is placed in an institution, including a nursing facility licensed under the Chapter 242, Health and Safety Code.
• TDHS/TDMHMR shall designate a volunteer advocate for a child placed in an institution.

SB1245

Author: Moncrief
Passed and Signed by Governor
Relating to the Employee Misconduct Registry, revising Chapter 48, Human Resources Code, specifically to include agencies licensed under Chapter 142 of the Health and Safety Code (HCSSA’s).

• Defines “reportable conduct.”
• Requires the Texas Department of Protective and Regulatory (TDPRS) to investigate and  report findings of misconduct to the TDHS to record the reportable conduct in the registry.
• If a governmental agency of another state or federal government finds that an employee has committed an act that constitutes reportable conduct, the TDPRS may send the report to the TDHS for recording in the registry.
• Specifies when and how an employee requests a hearing and/or a judicial review.
• Before a facility or an agency licensed under Chapter 142 (HCSSA) may hire an employee, the agency shall search the employee misconduct registry and the nurse aid registry to determine whether the person is designated in either registry as having abused, neglected or exploited a consumer of a facility or an individual receiving services form an agency licensed under Chapter 142. The facility and/or agency may not employ a person who is listed in either registry.
• The TDHS may remove a person from the registry if, after receiving written request from the person, the department finds that the person does not meet the requirements for inclusion in the employee misconduct registry.

SB1376

Author: Moncrief
Passed and Signed by Governor
Relating to the amelioration of ICF/MR Violations and Waiving the right to an Administrative Hearing.  (Applies to Nursing Facilities also.)

• In lieu of demanding payment of an administrative penalty, the department (TDHS) may allow a provider to use, under the supervision of the department, all or part of the amount of the penalty to ameliorate the violation to improve services, other than administrative services.
• The department shall offer amelioration if the violation does not constitute immediate jeopardy to the health and safety of the residents.
• The department shall offer amelioration not later than the 10th day after the facility receives final notification of the assessment of an administrative penalty after the informal dispute resolution process but before an administrative hearing.
• A facility to which amelioration has been offered must file a plan not later than the 45th day after the facility receives the offer .  In submitting the plan, the facility waives its right to an administrative hearing, if the department approves the plan.
• At a minimum, the plan must :  propose changes to the management or operation of the facility that will improve services to or quality of care; identify the ways in which the changes will improve services; establish clear goals to be achieved and timelines for implementing the changes; and identify specific actions necessary to implement the changes.
• A plan may include changes to: improve staff recruitment and retention; offer  or improve dental services; and improve the overall quality of life for the residents.
• The department may require that a plan propose changes that exceed the requirements of this Chapter or the rules adopted under this Chapter.
• The department may not offer amelioration to a facility: more that three times in a two year period or more than one time in a two year period for the same or similar violation.
• This act would take effect September 1, 2001 and applies only to a violation that occurs on or after that date.

SB1386

Author: Armbrister
Passed and Signed by Governor
Provision of MHMR services

Outlines the responsibilities of the local authority in making recommendations re: the most appropriate treatment alternatives for persons in need of MHMR services and in transferring persons with MR to a MH facility.  Emphasis of the bill is on MH related services.

SB1536

Author: Madla
Passed and Signed by Governor
Relating to the creation of pilot projects for demonstrating the application of technology to the  provision of long-term care, community care, and certain other medical assistance.

• HHSC may establish one or  more pilot projects allowing for reimbursement under Chapter 32,  Human Resources Code, to demonstrate the application of technology in the provision of services.  A pilot project may relate to long-term care, community care and support, rehabilitation, care for the aged or disabled, other forms of medical assistance.
• The commission by rule shall establish policies that permit reimbursement under the state Medicaid and CHIP for services provided through telemedicine medical services and telehealth services to children with special health care needs, and the piloting of such programs.
• The commission shall establish an advisory committee to assist in: evaluating policies for telemedical consultations; ensure the efficient and consistent  development and use of telecommunication technology for consultations; monitoring the types of programs receiving reimbursement; and coordinating the activities of state agencies concerned with the use of telemedical consultations.

SB1839

Author:  Moncrief
Passed and signed by Governor
Relates to certain long term care providers; establishes quality assurance fee applicable to both public and private ICF/MR providers and both new and revised rules governing surveyor training and experience, review of survey process, informal dispute resolutions, quality assurances warning system, and amelioration of violation.

  Quality Assurance Fee:

• The fee, to be paid monthly by providers, will be combined with federal matching funds to support or maintain an increase in reimbursement rates for community-based ICF/MR providers.  The bill specifies that once rates have been adjusted for ICF/MR providers, excess revenues can be used to augment rates for HCS and MRLA providers.  The effective date of the bill is September 1, 2001. Unless reauthorized by the Legislature, the bill expires September 1, 2005.  Concerning implementation of the fee, the bill specifies the following:

• HHSC or the department (TDHS) shall set the fee for each day in the amount necessary to produce annual revenues equal to an amount that is not more than six percent of the facility’s total annual gross receipts.  The fee, which is payable monthly, is subject to a prospective adjustment as necessary, must be determined using patient days and gross receipts reported to the department and covering a period of at least 6 months, and is an allowable cost for reimbursement under Medicaid.
• HHSC or TDHS shall collect the fee in accordance with criteria regarding timeframes for collecting as specified in the bill.

• HHSC is directed to adopt rules governing the administration and imposition of the fee and may not adopt rules granting any exceptions from the fee.  An administrative penalty assessed under this subchapter may not exceed one-half of the amount of the outstanding quality assurance fee or $20,000.00, whichever is greater.
• Money deposited in the quality assurance fund remains the property of the fund and may not be used for any other purpose other than what is specified in this chapter.
• The fee combined with federal matching funds will support or maintain an increase in Medicaid reimbursement for facilities.  After reimbursement rates have been established for the biennium and money is allocated from the fund for that purpose, HHSC may allocate any money remaining in the fund to HCS/MRLA.
• HHSC shall use the money in the fund, together with any federal match to:  offset allowable expenses to administer the fee; or to increase rates paid under the Medicaid program to facilities subject to Section 252.206 (d).
• HHSC shall by rule adopt the formula by which amounts received under this section increase the reimbursement rates paid to facilities and HCS/MRLA programs and ensure that the formula devised provides incentives to increase direct care staffing and direct care wages and benefits.
• The provisions of this section of the bill expire September 1, 2005 unless renewed by the 79^th Texas Legislature.  Note:  The quality assurance fee imposed under this Subchapter of Chapter 252 of the Health and Safety Code that is effective for the first month following the effective date of this Act is equal to $5.25 multiplied by the number of patient days as determined under that subchapter.
• SPECIAL NOTE:  Section 10.80.  Contingency Appropriation for Senate Bill 1839, Related to Long Term Care Facilities of SB 1, Other Appropriations and Adjustments states that…  Contingent upon enactment of Senate Bill 1839, or similar legislation of the 77^th Legislature relating to a Quality Assurance Fee on state-licensed ICFs/MR, TDMHMR is hereby appropriated $17,854,395.00 in GR and $26.972,106.00 in Federal Funds for FY 2002 and $19,173,011.00 in GR and $28,843,546.00 in Federal Funds for FY 2003 contingent upon the collection and deposit of $44,826,501.00 in revenues generated under the provisions of the bill for the biennium.  All of these GR and Federal Funds are to be utilized to provide rate increases to non-state operated public ICF/MR providers and to private ICF/MR providers.

Other provisions of the bill which impact ICF/MR providers:

• Surveyor Training:  Requires 1) surveyors to complete a basic training program before they can survey facilities which includes monitoring of a program unrelated to the survey process for a minimum of 10 working days within a 14 day period,  2)  TDHS to provide semi-annual training for surveyors and providers that address at least one of the 10 most common violations by facilities, and 3)  the minimum CEU requirements for certain health care professionals who are surveyors.
• Survey Review Process:  Establishes procedures to review the survey process, requiring HHSC to adopt rules and procedures for reviewing 1) citations or penalties assessed for a violation of a rule taking into consideration the number of violations by geographic region, the pattern of violations in each region, and the outcomes following the assessment of a penalty, and 2)  the performance of duties by employees and agents of the TDHS or any other state agency charged with the licensing or surveying of such a facility as such performance relates to complaints received by HHSC or any standards or rules violated by an employee or agent of the state agency.
• Informal Dispute Resolution:  Requires HHSC to establish an informal dispute resolution process which provides for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action.  The process must require:  1)  the facility to request the resolution not later than the 10^th calendar day after notification of a violation, 2)  HHSC to complete the process not later than the 30^th day after receipt of a request; and 3) a person representing a facility in a dispute resolution to register with HHSC to include disclosing certain personal and professional information as specified in the bill.  HHSC may not delegate this responsibility to any other state agency.
• Quality Assurance Early Warning System:  TDHS must establish an early warning system to detect conditions that could be detrimental to the health, safety, and welfare of residents as follows:  1)  The system must include an analysis of financial and quality-of-care indicators that would predict the need for the department to take action,  2)  TDHS must establish regional offices with one or more quality-of-care monitors to monitor the facilities on a regular, unannounced, periodic basis that must include weekends, holidays, nights, and evenings,  3)  Visits shall be based on a facility’s history of deficiencies,  4)  Monitors will assess the overall quality of life and conditions related to consumer care, observe care being given, and be allowed to interview consumers, staff, family members, volunteers, etc.,  5)  Findings will be reported to the facility orally and in writing and recommendations for improving care will be developed as appropriate, and  6)  Situations that create an immediate threat to the health and safety of a resident must be reported immediately to the regional office supervisor for appropriate action.  In addition to the quality-of-care monitors, TDHS must further create rapid    response teams that can visit facilities identified through the early warning system.  The facility may ask for a team to visit, but may not ask for a team’s help in preparing for a survey.

• Amelioration of Violation:  The provisions specified in this section of the bill are parallel to those specified in SB 1376 (Moncrief).  Refer to SB 1376 for details.  Note: Current statute and TDHS rule governing amelioration only extend authority for the application of the provision.  SB1376 and SB1839 maintain the authority, but specify the criteria for the application of the authority.