CHAPTER 531. HEALTH AND HUMAN SERVICES COMMISSION
GOVERNMENT CODE
TITLE 4. EXECUTIVE BRANCH
SUBTITLE I. HEALTH AND HUMAN SERVICES
CHAPTER 531. HEALTH AND HUMAN SERVICES COMMISSION
SUBCHAPTER A. GENERAL PROVISIONS; ORGANIZATION OF COMMISSION
Sec. 531.001. DEFINITIONS. In this subtitle:
(1) "Caseload standards" means the minimum and maximum number of
cases that an employee can reasonably be expected to perform in a
normal work month based on the number of cases handled by or the
number of different job functions performed by the employee.
(1-a) "Child health plan program" means the child health plan
program established under Chapters 62 and 63, Health and Safety
Code.
(2) "Commission" means the Health and Human Services Commission.
(3) "Executive commissioner" means the executive commissioner of
the Health and Human Services Commission.
(4) "Health and human services agencies" includes the:
(A) Department of Aging and Disability Services;
(B) Department of State Health Services;
(C) Department of Assistive and Rehabilitative Services; and
(D) Department of Family and Protective Services.
(5) "Professional caseload standards" means caseload standards
that are established or are recommended for establishment for
employees of health and human services agencies by management
studies conducted for health and human services agencies or by an
authority or association, including the Child Welfare League of
America, the National Eligibility Workers Association, the
National Association of Social Workers, and associations of state
health and human services agencies.
(6) "Section 1915(c) waiver program" means a federally funded
Medicaid program of the state that is authorized under Section
1915(c) of the federal Social Security Act (42 U.S.C. Section
1396n(c)).
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 1997, 75th Leg., ch. 165, Sec. 14.01,
eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 97, eff.
Sept. 1, 1997; Acts 1999, 76th Leg., ch. 7, Sec. 2, eff. Sept. 1,
1999; Acts 1999, 76th Leg., ch. 899, Sec. 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1460, Sec. 8.01, eff. Sept. 1, 1999;
Acts 2001, 77th Leg., ch. 53, Sec. 1, eff. Sept. 1, 2001; Acts
2001, 77th Leg., ch. 957, Sec. 6, eff. Sept. 1, 2001; Acts 2001,
77th Leg., ch. 1429, Sec. 9.007, eff. Sept. 1, 2001; Acts 2003,
78th Leg., ch. 198, Sec. 1.01(a) to 1.01(c), 2.01, eff. Sept. 1,
2003; Acts 2003, 78th Leg., ch. 1276, Sec. 9.009, eff. Sept. 1,
2003.
Sec. 531.002. HEALTH AND HUMAN SERVICES COMMISSION;
RESPONSIBILITY. (a) The Health and Human Services Commission is
an agency of the state.
(b) The commission is the state agency with primary
responsibility for ensuring the delivery of state health and
human services in a manner that:
(1) uses an integrated system to determine client eligibility;
(2) maximizes the use of federal, state, and local funds; and
(3) emphasizes coordination, flexibility, and decision-making at
the local level.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.003. GOALS. The commission's goals are to:
(1) maximize federal funds through the efficient use of
available state and local resources;
(2) provide a system that delivers prompt, comprehensive,
effective services to the people of this state by:
(A) improving access to health and human services at the local
level; and
(B) eliminating architectural, communications, programmatic, and
transportation barriers;
(3) promote the health of the people of this state by:
(A) reducing the incidence of disease and disabling conditions;
(B) increasing the availability of health care services;
(C) improving the quality of health care services;
(D) addressing the high incidence of certain illnesses and
conditions of minority populations;
(E) increasing the availability of trained health care
professionals;
(F) improving knowledge of health care needs;
(G) reducing infant death and disease;
(H) reducing the impact of mental disorders in adults;
(I) reducing the impact of emotional disturbances in children;
(J) increasing participation in nutrition programs;
(K) increasing nutritional education; and
(L) reducing substance abuse;
(4) foster the development of responsible, productive, and
self-sufficient citizens by:
(A) improving workforce skills;
(B) increasing employment, earnings, and benefits;
(C) increasing housing opportunities;
(D) increasing child-care and other dependent-care services;
(E) improving education and vocational training to meet specific
career goals;
(F) reducing school dropouts;
(G) reducing teen pregnancy;
(H) improving parental effectiveness;
(I) increasing support services for people with disabilities;
(J) increasing services to help people with disabilities
maintain or increase their independence;
(K) improving access to work sites, accommodations,
transportation, and other public places and activities covered by
the federal Americans with Disabilities Act of 1990 (42 U.S.C.
Section 12101 et seq.); and
(L) improving services to juvenile offenders;
(5) provide needed resources and services to the people of this
state when they cannot provide or care for themselves by:
(A) increasing support services for adults and their families
during periods of unemployment, financial need, or homelessness;
(B) reducing extended dependency on basic support services; and
(C) increasing the availability and diversity of long-term care
provided to support people with chronic conditions in settings
that focus on community-based services with options ranging from
their own homes to total-care facilities;
(6) protect the physical and emotional safety of all the people
of this state by:
(A) reducing abuse, neglect, and exploitation of elderly people
and adults with disabilities;
(B) reducing child abuse and neglect;
(C) reducing family violence;
(D) increasing services to truants and runaways, children at
risk of truancy or running away, and their families;
(E) reducing crime and juvenile delinquency;
(F) reducing community health risks; and
(G) improving regulation of human services providers; and
(7) improve the coordination and delivery of children's
services.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.004. SUNSET PROVISION. The Health and Human Services
Commission is subject to Chapter 325 (Texas Sunset Act). Unless
continued in existence as provided by that chapter, the
commission is abolished and this chapter expires September 1,
2013.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 1999, 76th Leg., ch. 1460, Sec. 1.01,
eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch. 198, Sec. 1.02,
eff. Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
928, Sec. 3.01, eff. June 15, 2007.
Acts 2009, 81st Leg., 1st C.S., Ch.
2, Sec. 2.05, eff. July 10, 2009.
Sec. 531.005. EXECUTIVE COMMISSIONER. (a) The commission is
governed by an executive commissioner appointed by the governor
with the advice and consent of the senate.
(b) The executive commissioner shall be appointed without regard
to race, color, disability, sex, religion, age, or national
origin.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 1.02A,
eff. Sept. 1, 2003.
Sec. 531.0055. EXECUTIVE COMMISSIONER: GENERAL RESPONSIBILITY
FOR HEALTH AND HUMAN SERVICES AGENCIES. (a) In this section and
in Section 531.0056, "agency director" means the commissioner of
a health and human services agency.
(b) The commission shall:
(1) supervise the administration and operation of the Medicaid
program, including the administration and operation of the
Medicaid managed care system in accordance with Section 531.021;
(2) perform information systems planning and management for
health and human services agencies under Section 531.0273, with:
(A) the provision of information technology services at health
and human services agencies considered to be a centralized
administrative support service either performed by commission
personnel or performed under a contract with the commission; and
(B) an emphasis on research and implementation on a
demonstration or pilot basis of appropriate and efficient uses of
new and existing technology to improve the operation of health
and human services agencies and delivery of health and human
services;
(3) monitor and ensure the effective use of all federal funds
received by a health and human services agency in accordance with
Section 531.028 and the General Appropriations Act;
(4) implement Texas Integrated Enrollment Services as required
by Subchapter F, except that notwithstanding Subchapter F,
determining eligibility for benefits under the following programs
is the responsibility of and must be centralized by the
commission:
(A) the child health plan program;
(B) the financial assistance program under Chapter 31, Human
Resources Code;
(C) the medical assistance program under Chapter 32, Human
Resources Code;
(D) the nutritional assistance programs under Chapter 33, Human
Resources Code;
(E) long-term care services, as defined by Section 22.0011,
Human Resources Code;
(F) community-based support services identified or provided in
accordance with Section 531.02481; and
(G) other health and human services programs, as appropriate;
and
(5) implement programs intended to prevent family violence and
provide services to victims of family violence.
(c) The commission shall implement the powers and duties given
to the commission under Sections 531.0246, 531.0247, 2155.144,
and 2167.004.
(d) After implementation of the commission's duties under
Subsections (b) and (c), the commission shall implement the
powers and duties given to the commission under Section 531.0248.
Nothing in the priorities established by this section is intended
to limit the authority of the commission to work simultaneously
to achieve the multiple tasks assigned to the commission in this
section, when such an approach is beneficial in the judgment of
the commission. The commission shall plan and implement an
efficient and effective centralized system of administrative
support services for health and human services agencies. The
performance of administrative support services for health and
human services agencies is the responsibility of the commission.
The term "administrative support services" includes, but is not
limited to, strategic planning and evaluation, audit, legal,
human resources, information resources, purchasing, contract
management, financial management, and accounting services.
(e) Notwithstanding any other law, the executive commissioner
shall adopt rules and policies for the operation of and provision
of health and human services by the health and human services
agencies. In addition, the executive commissioner, as necessary
to perform the functions described by Subsections (b), (c), and
(d) in implementation of applicable policies established for an
agency by the executive commissioner, shall:
(1) manage and direct the operations of each health and human
services agency;
(2) supervise and direct the activities of each agency director;
and
(3) be responsible for the administrative supervision of the
internal audit program for all health and human services
agencies, including:
(A) selecting the director of internal audit;
(B) ensuring that the director of internal audit reports
directly to the executive commissioner; and
(C) ensuring the independence of the internal audit function.
(f) The operational authority and responsibility of the
executive commissioner for purposes of Subsection (e) at each
health and human services agency includes authority over and
responsibility for the:
(1) management of the daily operations of the agency, including
the organization and management of the agency and agency
operating procedures;
(2) allocation of resources within the agency, including use of
federal funds received by the agency;
(3) personnel and employment policies;
(4) contracting, purchasing, and related policies, subject to
this chapter and other laws relating to contracting and
purchasing by a state agency;
(5) information resources systems used by the agency;
(6) location of agency facilities; and
(7) coordination of agency activities with activities of other
state agencies, including other health and human services
agencies.
(g) Notwithstanding any other law, the operational authority and
responsibility of the executive commissioner for purposes of
Subsection (e) at each health and human services agency includes
the authority and responsibility to adopt or approve, subject to
applicable limitations, any rate of payment or similar provision
required by law to be adopted or approved by the agency.
(h) For each health and human services agency, the executive
commissioner shall implement a program to evaluate and supervise
the daily operations of the agency. The program must include
measurable performance objectives for each agency director and
adequate reporting requirements to permit the executive
commissioner to perform the duties assigned to the executive
commissioner under this section.
(i) To facilitate the operations of a health and human services
agency in accordance with this section, the executive
commissioner may delegate a specific power or duty given under
Subsection (f) or (g) to an agency director. The agency director
shall, at the request of the executive commissioner, assist in
the development of rules and policies for the operation and
provision of health and human services by the agency. The agency
director acts on behalf of the executive commissioner in
performing the delegated function and reports to the executive
commissioner regarding the delegated function and any matter
affecting agency programs and operations.
(j) The executive commissioner shall adopt rules to implement
the executive commissioner's authority under this section.
(k) The executive commissioner and each agency director shall
enter into a memorandum of understanding in the manner prescribed
by Section 531.0163 that:
(1) clearly defines the responsibilities of the agency director
and the executive commissioner, including:
(A) the responsibility of the agency director to report to the
governor and to report to and implement policies of the executive
commissioner; and
(B) the extent to which the agency director acts as a liaison
between the agency and the commission;
(2) establishes the program of evaluation and supervision of
daily operations required by Subsection (h); and
(3) describes each delegation of a power or duty made under
Subsection (i) or other law.
(l) Notwithstanding any other law, the executive commissioner
has the authority to adopt policies and rules governing the
delivery of services to persons who are served by each health and
human services agency and the rights and duties of persons who
are served or regulated by each agency.
(m) The executive commissioner shall establish standards for the
use of electronic signatures in accordance with the Uniform
Electronic Transactions Act (Chapter 322, Business & Commerce
Code), with respect to any transaction, as defined by Section
322.002, Business & Commerce Code, in connection with the
administration of health and human services programs.
Added by Acts 1999, 76th Leg., ch. 1460, Sec. 2.01, eff. Sept. 1,
1999. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 1.03, eff.
Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
755, Sec. 2, eff. September 1, 2007.
Acts 2009, 81st Leg., R.S., Ch.
87, Sec. 11.009, eff. September 1, 2009.
Sec. 531.0056. APPOINTMENT OF AGENCY DIRECTOR BY EXECUTIVE
COMMISSIONER. (a) The executive commissioner shall appoint an
agency director for each health and human services agency with
the approval of the governor.
(b) An agency director appointed by the executive commissioner
serves at the pleasure of the executive commissioner.
(c) In addition to the requirements of Section 531.0055(k)(1),
the memorandum of understanding required by that section must
clearly define the responsibilities of the agency director.
(d) The terms of the memorandum of understanding shall outline
specific performance objectives, as defined by the executive
commissioner, to be fulfilled by the agency director, including
the performance objectives outlined in Section 531.0055(h).
(e) Based upon the performance objectives outlined in the
memorandum of understanding, the executive commissioner shall
perform an employment evaluation of the agency director.
(f) The executive commissioner shall submit the evaluation to
the governor not later than January 1 of each even-numbered year.
Added by Acts 1999, 76th Leg., ch. 1460, Sec. 2.01, eff. Sept. 1,
1999. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 1.04, eff.
Sept. 1, 2003.
Sec. 531.0057. MEDICAL TRANSPORTATION SERVICES. (a) The
commission shall provide medical transportation services for
clients of eligible health and human services programs.
(b) The commission may contract with any public or private
transportation provider or with any regional transportation
broker for the provision of public transportation services.
Added by Acts 2007, 80th Leg., R.S., Ch.
268, Sec. 3(b), eff. September 1, 2007.
Sec. 531.006. ELIGIBILITY. (a) A person is not eligible for
appointment as commissioner if the person or the person's spouse
is an employee, officer, or paid consultant of a trade
association in a field under the commission's jurisdiction.
(b) A person who is required to register as a lobbyist under
Chapter 305 because of the person's activities for compensation
in or on behalf of a profession related to a field under the
commission's jurisdiction may not serve as commissioner.
(c) A person is not eligible for appointment as commissioner if
the person has a financial interest in a corporation,
organization, or association under contract with the Texas
Department of Mental Health and Mental Retardation, a local
mental health or mental retardation authority, or a community
center.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.007. TERM. The commissioner serves a two-year term
expiring February 1 of each odd-numbered year.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.008. DIVISIONS OF COMMISSION. (a) Subject to
Subsection (c), the executive commissioner may establish
divisions within the commission as necessary for effective
administration and for the discharge of the commission's
functions.
(b) Subject to Subsection (c), the executive commissioner may
allocate and reallocate functions among the commission's
divisions.
(c) The executive commissioner shall establish the following
divisions and offices within the commission:
(1) the eligibility services division to make eligibility
determinations for services provided through the commission or a
health and human services agency related to:
(A) the child health plan program;
(B) the financial assistance program under Chapter 31, Human
Resources Code;
(C) the medical assistance program under Chapter 32, Human
Resources Code;
(D) the nutritional assistance programs under Chapter 33, Human
Resources Code;
(E) long-term care services, as defined by Section 22.0011,
Human Resources Code;
(F) community-based support services identified or provided in
accordance with Section 531.02481; and
(G) other health and human services programs, as appropriate;
(2) the office of inspector general to perform fraud and abuse
investigation and enforcement functions as provided by Subchapter
C and other law;
(3) the office of the ombudsman to:
(A) provide dispute resolution services for the commission and
the health and human services agencies; and
(B) perform consumer protection functions related to health and
human services;
(4) a purchasing division as provided by Section 531.017; and
(5) an internal audit division to conduct a program of internal
auditing in accordance with Government Code, Chapter 2102.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 1.05,
eff. Sept. 1, 2003.
Sec. 531.0081. OFFICE OF MEDICAL TECHNOLOGY. (a) In this
section, "office" means the office of medical technology.
(b) The commission shall establish the office of medical
technology within the commission. The office shall explore and
evaluate new developments in medical technology and propose
implementing the technology in the medical assistance program
under Chapter 32, Human Resources Code, if appropriate and
cost-effective.
(c) Office staff must have skills and experience in research
regarding health care technology.
Added by Acts 2005, 79th Leg., Ch.
349, Sec. 10, eff. September 1, 2005.
Sec. 531.009. PERSONNEL. (a) The commissioner shall employ a
medical director to provide medical expertise to the commissioner
and the commission and may employ other personnel necessary to
administer the commission's duties.
(b) The commissioner or the commissioner's designated
representative shall develop an intra-agency career ladder
program, one part of which must require the intra-agency posting
of all non-entry-level positions concurrently with any public
posting.
(c) The commissioner or the commissioner's designated
representative shall develop a system of annual performance
evaluations based on measurable job tasks. All merit pay for
commission employees must be based on the system established
under this subsection.
(d) The commissioner shall provide to commission employees as
often as is necessary information regarding their qualifications
under this chapter and their responsibilities under applicable
laws relating to standards of conduct for state employees.
(e) The commissioner or the commissioner's designated
representative shall prepare and maintain a written policy
statement that implements a program of equal employment
opportunity to ensure that all personnel transactions are made
without regard to race, color, disability, sex, religion, age, or
national origin.
(f) The policy statement described by Subsection (e) must
include:
(1) personnel policies, including policies relating to
recruitment, evaluation, selection, training, and promotion of
personnel, that show the intent of the commission to avoid the
unlawful employment practices described by Chapter 21, Labor
Code; and
(2) an analysis of the extent to which the composition of the
commission's personnel is in accordance with state and federal
law and a description of reasonable methods to achieve compliance
with state and federal law.
(g) The policy statement described by Subsection (e) must:
(1) be updated annually;
(2) be reviewed by the state Commission on Human Rights for
compliance with Subsection (f)(1); and
(3) be filed with the governor's office.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 1997, 75th Leg., ch. 165, Sec. 14.18,
eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1460, Sec. 1.02,
eff. Sept. 1, 1999.
Sec. 531.010. MERIT SYSTEM. (a) The commission may establish a
merit system for its employees.
(b) The merit system may be maintained in conjunction with other
state agencies that are required by federal law to operate under
a merit system.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.011. PUBLIC INPUT INFORMATION AND COMPLAINTS. (a) The
commission shall develop and implement policies that provide the
public a reasonable opportunity to appear before the commission
and to speak on any issue under the commission's jurisdiction.
(b) The commission shall develop and implement routine and
ongoing mechanisms, in accessible formats, to:
(1) receive consumer input;
(2) involve consumers in planning, delivery, and evaluation of
programs and services under the jurisdiction of the commission;
and
(3) communicate to the public regarding the input received by
the commission under this section and actions taken in response
to that input.
(c) The commission shall prepare information of public interest
describing the functions of the commission and the commission's
procedures by which complaints are filed with and resolved by the
commission. The commission shall make the information available
to the public and appropriate state agencies.
(d) The commissioner by rule shall establish methods by which
the public, consumers, and service recipients can be notified of
the mailing addresses and telephone numbers of appropriate agency
personnel for the purpose of directing complaints to the
commission. The commission may provide for that notification:
(1) on each registration form, application, or written contract
for services of a person regulated by the commission;
(2) on a sign prominently displayed in the place of business of
each person regulated by the commission; or
(3) in a bill for service provided by a person regulated by the
commission.
(e) The commission shall keep an information file about each
complaint filed with the commission relating to:
(1) a license holder or entity regulated by the commission; or
(2) a service delivered by the commission.
(f) If a written complaint is filed with the commission relating
to a license holder or entity regulated by the commission or a
service delivered by the commission, the commission, at least
quarterly and until final disposition of the complaint, shall
notify the parties to the complaint of the status of the
complaint unless notice would jeopardize an undercover
investigation.
(g) In addition to the information file maintained under
Subsection (e), the commission shall maintain an information file
on a complaint received by the commission relating to any matter
or agency under the jurisdiction of the commission.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 1997, 75th Leg., ch. 165, Sec. 14.02(a),
eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1460, Sec. 1.03,
eff. Sept. 1, 1999.
Sec. 531.012. ADVISORY COMMITTEES. The commissioner may appoint
advisory committees as needed.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995.
Sec. 531.013. ELECTRONIC AVAILABILITY OF TECHNICAL ASSISTANCE.
(a) Health and human services agencies shall, in conjunction
with the Department of Information Resources, coordinate and
enhance their existing Internet sites to provide technical
assistance for human services providers. The commission shall
take the lead and ensure involvement of agencies with the
greatest potential for cost savings.
(b) Assistance under this section may include information in the
following subjects:
(1) case management;
(2) contract management;
(3) financial management;
(4) performance measurement and evaluation;
(5) research; and
(6) other matters the commission considers appropriate.
(c) Assistance under this section must include information on
the impact of federal and state welfare reform changes on human
services providers.
(d) Assistance under this section may not include any
confidential information regarding a client of a human services
provider.
(e) Expired.
Added by Acts 1997, 75th Leg., ch. 147, Sec. 1, eff. Sept. 1,
1997.
Sec. 531.014. CONSOLIDATION OF REPORTS. The commission may
consolidate any annual or biennial reports required to be made
under this chapter or another law if:
(1) the consolidated report is submitted not later than the
earliest deadline for the submission of any component of the
consolidated report; and
(2) each person required to receive a component of the
consolidated report receives the consolidated report and the
consolidated report identifies the component of the report the
person was required to receive.
Added by Acts 1999, 76th Leg., ch. 1460, Sec. 1.04, eff. Sept. 1,
1999.
Sec. 531.0141. REPORT TO SECRETARY OF STATE. (a) In this
section, "colonia" means a geographic area that:
(1) is an economically distressed area as defined by Section
17.921, Water Code;
(2) is located in a county any part of which is within 62 miles
of an international border; and
(3) consists of 11 or more dwellings that are located in close
proximity to each other in an area that may be described as a
community or neighborhood.
(b) To assist the secretary of state in preparing the report
required under Section 405.021, the commission on a quarterly
basis shall provide a report to the secretary of state detailing
any projects funded by the commission that provide assistance to
colonias.
(c) The report must include:
(1) a description of any relevant projects;
(2) the location of each project;
(3) the number of colonia residents served by each project;
(4) the exact amount spent or the anticipated amount to be spent
on each colonia served by each project;
(5) a statement of whether each project is completed and, if
not, the expected completion date of the project; and
(6) any other information, as determined appropriate by the
secretary of state.
(d) The commission shall require an applicant for funds
administered by the commission to submit to the commission a
colonia classification number, if one exists, for each colonia
that may be served by the project proposed in the application.
If a colonia does not have a classification number, the
commission may contact the secretary of state or the secretary of
state's representative to obtain the classification number. On
request of the commission, the secretary of state or the
secretary of state's representative shall assign a classification
number to the colonia.
Added by Acts 2007, 80th Leg., R.S., Ch.
341, Sec. 3, eff. June 15, 2007.
Sec. 531.015. NEW FACILITIES IN CERTAIN COUNTIES. A health and
human services agency is prohibited from establishing a new
facility in a county with a population of less than 200,000 until
the agency provides notification about the facility, its
location, and its purpose to each state representative and state
senator that represents all or part of the county, the county
judge that represents the county, and the mayor of any
municipality in which the facility would be located.
Added by Acts 1999, 76th Leg., ch. 1460, Sec. 1.05, eff. Sept. 1,
1999.
For expiration of this section, see Subsection (g).
Sec. 531.016. EQUAL ACCESS TO FACILITIES, SERVICES, AND
TREATMENT. (a) The commission, the Texas Youth Commission, and
the Texas Juvenile Probation Commission shall periodically
review, document, and compare the accessibility and funding of
facilities, services, and treatment provided to females under 18
years of age to the accessibility and funding of facilities,
services, and treatment provided to males in the same age group.
(b) The commission shall coordinate the review, documentation,
and comparison required by Subsection (a).
(c) The areas of review required by Subsection (a) must include:
(1) the nature, extent, and effectiveness of services offered
for females under 18 years of age within the areas of teen
pregnancy, physical and sexual abuse, and alcohol and drug abuse,
services for runaway and homeless females, and services for
females involved in gangs or other delinquent activity; and
(2) the equity of services offered to persons under 18 years of
age with respect to gender within the areas of physical and
sexual abuse, alcohol and drug abuse, and services offered to
runaway and homeless youth.
(d) Each health and human services agency or other state agency
that provides facilities, services, treatment, or funding subject
to the review required by Subsection (a) shall identify existing
differences within the agency in the allocation and expenditures
of money and services for males under 18 years of age in
comparison to females in the same age group. Each agency shall
submit a report to the commission describing any differences
identified.
(e) Each agency described by Subsection (d) shall:
(1) develop a plan to address any lack of services for females
under 18 years of age reported by the agency; and
(2) submit a report to the commission on the progress made under
the plan.
(f) The commission shall assemble the agency reports submitted
under Subsections (d) and (e) and prepare an executive summary to
be delivered to the members of the legislature not later than
July 1 of each even-numbered year.
(g) This section expires September 1, 2011.
Added by Acts 2007, 80th Leg., R.S., Ch.
263, Sec. 20, eff. June 8, 2007.
Sec. 531.0161. NEGOTIATED RULEMAKING AND ALTERNATIVE DISPUTE
PROCEDURES. (a) The commission shall develop and implement a
policy, for the commission and each health and human services
agency, to encourage the use of:
(1) negotiated rulemaking procedures under Chapter 2008 for the
adoption of rules for the commission and each agency; and
(2) appropriate alternative dispute resolution procedures under
Chapter 2009 to assist in the resolution of internal and external
disputes under the commission's or agency's jurisdiction.
(b) The procedures relating to alternative dispute resolution
must conform, to the extent possible, to any model guidelines
issued by the State Office of Administrative Hearings for the use
of alternative dispute resolution by state agencies.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.06, eff. Sept. 1,
2003.
Sec. 531.0162. USE OF TECHNOLOGY. (a) The commission shall
develop and implement a policy requiring the agency commissioner
and employees of each health and human services agency to
research and propose appropriate technological solutions to
improve the agency's ability to perform its functions. The
technological solutions must:
(1) ensure that the public is able to easily find information
about a health and human services agency on the Internet;
(2) ensure that persons who want to use a health and human
services agency's services are able to:
(A) interact with the agency through the Internet; and
(B) access any service that can be provided effectively through
the Internet;
(3) be cost-effective and developed through the commission's
planning process; and
(4) meet federal accessibility standards for persons with
disabilities.
(b) The commission shall develop and implement a policy
described by Subsection (a) in relation to the commission's
functions.
(c) Subject to available appropriations, the commission shall
use technology whenever possible in connection with the adult
protective services program of the Department of Family and
Protective Services to:
(1) provide for automated collection of information necessary to
evaluate program effectiveness using systems that integrate
collection of necessary information with other routine duties of
caseworkers and other service providers; and
(2) consequently reduce the time that caseworkers and other
service providers are required to use in gathering and reporting
information necessary for program evaluation.
(d) The commission shall include representatives of the private
sector in the technology planning process used to determine
appropriate technology for the adult protective services program
of the Department of Family and Protective Services.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.06, eff. Sept. 1,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
268, Sec. 2.17, eff. September 1, 2005.
Sec. 531.0163. MEMORANDUM OF UNDERSTANDING. (a) The memorandum
of understanding under Section 531.0055(k) must be adopted by the
executive commissioner by rule in accordance with the procedures
prescribed by Subchapter B, Chapter 2001, for adopting rules,
except that the requirements of Section 2001.033(a)(1)(A) or (C)
do not apply with respect to any part of the memorandum of
understanding that:
(1) concerns only internal management or organization within or
among health and human services agencies and does not affect
private rights or procedures; or
(2) relates solely to the internal personnel practices of health
and human services agencies.
(b) The memorandum of understanding may be amended only by
following the procedures prescribed under Subsection (a).
Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.06, eff. Sept. 1,
2003.
Sec. 531.017. PURCHASING DIVISION. (a) The commission shall
establish a purchasing division for the management of
administrative activities related to the purchasing functions of
the commission and the health and human services agencies.
(b) The purchasing division shall:
(1) seek to achieve targeted cost reductions, increase process
efficiencies, improve technological support and customer
services, and enhance purchasing support for each health and
human services agency; and
(2) if cost-effective, contract with private entities to perform
purchasing functions for the commission and the health and human
services agencies.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.02(a), eff. Sept.
1, 2003.
Sec. 531.018. CERTAIN CONTRACTS FOR HEALTH CARE PURPOSES; REVIEW
BY ATTORNEY GENERAL. (a) This section applies to any contract
with a contract amount of $250 million or more:
(1) under which a person provides goods or services in
connection with the provision of medical or health care services,
coverage, or benefits; and
(2) entered into by the person and:
(A) the commission;
(B) a health and human services agency; or
(C) any other state agency under the jurisdiction of the
commission.
(b) Notwithstanding any other law, before a contract described
by Subsection (a) may be entered into by the agency, a
representative of the office of the attorney general shall review
the form and terms of the contract and may make recommendations
to the agency for changes to the contract if the attorney general
determines that the office of the attorney general has sufficient
subject matter expertise and resources available to provide this
service.
(c) An agency described by Subsection (a)(2) must notify the
office of the attorney general at the time the agency initiates
the planning phase of the contracting process. A representative
of the office of the attorney general or another attorney
advising the agency under Subsection (d) may participate in
negotiations or discussions with proposed contractors and may be
physically present during those negotiations or discussions.
(d) If the attorney general determines that the office of the
attorney general does not have sufficient subject matter
expertise or resources available to provide the services
described by this section, the office of the attorney general may
require the state agency to enter into an interagency agreement
or to obtain outside legal services under Section 402.0212 for
the provision of services described by this section.
(e) The state agency shall provide to the office of the attorney
general any information the office of the attorney general
determines is necessary to administer this section.
Added by Acts 2005, 79th Leg., Ch.
1011, Sec. 1, eff. September 1, 2005.
Sec. 531.019. ADMINISTRATIVE AND JUDICIAL REVIEW OF CERTAIN
DECISIONS. (a) In this section, "public assistance benefits"
means benefits provided under a public assistance program under
Chapter 31, 32, or 33, Human Resources Code.
(b) The proceedings of a hearing related to a decision regarding
public assistance benefits contested by an applicant for or
recipient of the benefits that is conducted by the commission or
a health and human services agency to which the commission
delegates a function related to the benefits must be recorded
electronically. Notwithstanding Section 2001.177, the cost of
preparing the record and transcript required to be sent to a
reviewing court may not be charged to the applicant for or
recipient of the benefits.
(c) Before an applicant for or recipient of public assistance
benefits may appeal a decision of a hearing officer for the
commission or a health and human services agency related to those
benefits, the applicant or recipient must request an
administrative review by an appropriate attorney of the
commission or a health and human services agency, as applicable,
in accordance with rules of the executive commissioner. Not
later than the 15th business day after the date the attorney
receives the request for administrative review, the attorney
shall complete an administrative review of the decision and
notify the applicant or recipient in writing of the results of
that review.
(d) Except as provided by this section, Subchapters G and H,
Chapter 2001, govern an appeal of a decision made by a hearing
officer for the commission or a health and human services agency
related to public assistance benefits brought by an applicant for
or recipient of the benefits.
(e) For purposes of Section 2001.171, an applicant for or
recipient of public assistance benefits has exhausted all
available administrative remedies and a decision, including a
decision under Section 31.034 or 32.035, Human Resources Code, is
final and appealable on the date that, after a hearing:
(1) the hearing officer for the commission or a health and human
services agency reaches a final decision related to the benefits;
and
(2) the appropriate attorney completes an administrative review
of the decision and notifies the applicant or recipient in
writing of the results of that review.
(f) For purposes of Section 2001.171, an applicant for or
recipient of public assistance benefits is not required to file a
motion for rehearing with the commission or a health and human
services agency, as applicable.
(g) Judicial review of a decision made by a hearing officer for
the commission or a health and human services agency related to
public assistance benefits is under the substantial evidence rule
and is instituted by filing a petition with a district court in
Travis County, as provided by Subchapter G, Chapter 2001.
(h) An appeal described by Subsection (d) takes precedence over
all civil cases except workers' compensation and unemployment
compensation cases.
(i) The appellee is the commission.
Added by Acts 2007, 80th Leg., R.S., Ch.
1161, Sec. 1, eff. September 1, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
1351, Sec. 10(a), eff. September 1, 2009.
Sec. 531.0191. SERVICES PROVIDED BY CONTRACTOR TO PERSONS WITH
LIMITED ENGLISH PROFICIENCY. (a) Each contract with the
commission or a health and human services agency that requires
the provision of call center services or written communications
related to call center services must include performance
standards that measure the effectiveness, promptness, and
accuracy of the contractor's oral and written communications with
persons with limited English proficiency. Each person who seeks
to enter into a contract described by this subsection shall
include in the bid or other applicable expression of interest for
the contract a proposal for providing call center services or
written communications related to call center services to persons
with limited English proficiency.
(b) The proposal required under Subsection (a) must include a
language access plan that describes how the contractor will
achieve any performance standards described in the request for
bids, proposals, or other applicable expressions of interest.
The plan must also describe how the contractor will:
(1) identify persons who need language assistance;
(2) provide language assistance measures, including the
translation of forms into languages other than English and the
provision of translators and interpreters;
(3) inform persons with limited English proficiency of the
language services available to them and how to obtain them;
(4) develop and implement qualifications for bilingual staff;
and
(5) monitor compliance with the language access plan.
(c) In determining which bid or other applicable expression of
interest offers the best value, the commission or a health and
human services agency, as applicable, shall evaluate the extent
to which the proposal for providing call center services or
written communications related to call center services in
languages other than English will provide meaningful access to
the services for persons with limited English proficiency.
(d) In determining the extent to which a proposal will provide
meaningful access under Subsection (c), the agency shall
consider:
(1) the language access plan developed under Subsection (b);
(2) the number or proportion of persons with limited English
proficiency in the agency's eligible service population;
(3) the frequency with which persons with limited English
proficiency seek information regarding the agency's programs;
(4) the importance of the services provided by the agency's
programs; and
(5) the resources available to the agency.
(e) The agency must avoid selecting a contractor that the agency
reasonably believes will:
(1) provide information in languages other than English that is
limited in scope;
(2) unreasonably delay the provision of information in languages
other than English; or
(3) provide program information, including forms, notices, and
correspondence, in English only.
(f) This section does not apply to 2-1-1 services provided by
the Texas Information and Referral Network.
Added by Acts 2007, 80th Leg., R.S., Ch.
1110, Sec. 1, eff. June 15, 2007.
Renumbered from Government Code, Section 531.019 by Acts 2009,
81st Leg., R.S., Ch.
87, Sec. 27.001(35), eff. September 1, 2009.
Sec. 531.020. OFFICE OF COMMUNITY COLLABORATION. The executive
commissioner shall establish within the commission an office of
community collaboration. The office is responsible for:
(1) collaborating with community, state, and federal
stakeholders to improve the elements of the health care system
that are involved in the delivery of Medicaid services; and
(2) sharing with Medicaid providers, including hospitals, any
best practices, resources, or other information regarding
improvements to the health care system.
Added by Acts 2005, 79th Leg., Ch.
349, Sec. 1, eff. September 1, 2005.
SUBCHAPTER B. POWERS AND DUTIES
Sec. 531.021. ADMINISTRATION OF MEDICAID PROGRAM. (a) The
commission is the state agency designated to administer federal
medical assistance funds.
(b) The commission shall:
(1) plan and direct the Medicaid program in each agency that
operates a portion of the Medicaid program, including the
management of the Medicaid managed care system and the
development, procurement, management, and monitoring of contracts
necessary to implement the Medicaid managed care system;
(2) adopt reasonable rules and standards governing the
determination of fees, charges, and rates for medical assistance
payments under Chapter 32, Human Resources Code, in consultation
with the agencies that operate the Medicaid program; and
(3) establish requirements for and define the scope of the
ongoing evaluation of the Medicaid managed care system conducted
in conjunction with the Texas Health Care Information Council
under Section 108.0065, Health and Safety Code.
(c) The commission in its adoption of reasonable rules and
standards under Subsection (b)(2) shall include financial
performance standards that, in the event of a proposed rate
reduction, provide private ICF-MR facilities and home and
community-based services providers with flexibility in
determining how to use medical assistance payments to provide
services in the most cost-effective manner while continuing to
meet the state and federal requirements of the Medicaid program.
(d) In adopting rules and standards required by Subsection
(b)(2), the commission may provide for payment of fees, charges,
and rates in accordance with:
(1) formulas, procedures, or methodologies prescribed by the
commission's rules;
(2) applicable state or federal law, policies, rules,
regulations, or guidelines;
(3) economic conditions that substantially and materially affect
provider participation in the Medicaid program, as determined by
the commissioner; or
(4) available levels of appropriated state and federal funds.
(e) Notwithstanding any other provision of Chapter 32, Human
Resources Code, Chapter 533, or this chapter, the commission may
adjust the fees, charges, and rates paid to Medicaid providers as
necessary to achieve the objectives of the Medicaid program in a
manner consistent with the considerations described by Subsection
(d).
(f) In adopting rates for medical assistance payments under
Subsection (b)(2), the executive commissioner may adopt
reimbursement rates for appropriate nursing services provided to
recipients with certain health conditions if those services are
determined to provide a cost-effective alternative to
hospitalization. A physician must certify that the nursing
services are medically appropriate for the recipient for those
services to qualify for reimbursement under this subsection.
(g) In adopting rates for medical assistance payments under
Subsection (b)(2), the executive commissioner may adopt
cost-effective reimbursement rates for group appointments with
medical assistance providers for certain diseases and medical
conditions specified by rules of the executive commissioner.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept.
1, 1995. Amended by Acts 1997, 75th Leg., ch. 1262, Sec. 1, eff.
Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1460, Sec. 3.01, eff.
Sept. 1, 1999; Acts 2003, 78th Leg., ch. 198, Sec. 2.03, eff.
Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
349, Sec. 11(a), eff. September 1, 2005.
Sec. 531.0211. MANAGED CARE MEDICAID PROGRAM: RULES; EDUCATION
PROGRAMS. (a) In adopting rules to implement a managed care
Medicaid program, the commission shall establish guidelines for,
and require managed care organizations to provide, education
programs for providers and clients using a variety of techniques
and mediums.
(b) A provider education program must include information on:
(1) Medicaid policies, procedures, eligibility standards, and
benefits;
(2) the specific problems and needs of Medicaid clients; and
(3) the rights and responsibilities of Medicaid clients under
the bill of rights and the bill of responsibilities prescribed by
Section 531.0212.
(c) A client education program must present information in a
manner that is easy to understand. A program must include
information on:
(1) a client's rights and responsibilities under the bill of
rights and the bill of responsibilities prescribed by Section
531.0212;
(2) how to access health care services;
(3) how to access complaint procedures and the client's right to
bypass the managed care organization's internal complaint system
and use the notice and appeal procedures otherwise required by
the Medicaid program;
(4) Medicaid policies, procedures, eligibility standards, and
benefits;
(5) the policies and procedures of the managed care
organization; and
(6) the importance of prevention, early intervention, and
appropriate use of services.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.03(a), eff. Sept.
1, 1997.
Sec. 531.02111. BIENNIAL MEDICAID FINANCIAL REPORT. (a) The
commission shall prepare a biennial Medicaid financial report
covering each state agency that administers any part of the state
Medicaid program and each of the Medicaid programs operated or
administered by those agencies.
(b) The report must include:
(1) for each state agency described by Subsection (a):
(A) a description of each of the Medicaid programs administered
or operated by the agency; and
(B) an accounting of all funds related to the state Medicaid
program received and disbursed by the agency during the period
covered by the report, including:
(i) the amount of any federal medical assistance funds allocated
to the agency for the support of each of the Medicaid programs
operated or administered by the agency;
(ii) the amount of any funds appropriated by the legislature to
the agency for each of those programs; and
(iii) the amount of medical assistance payments and related
expenditures made by or in connection with each of those
programs; and
(2) for each Medicaid program identified in the report:
(A) the amount and source of funds or other revenue received by
or made available to the agency for the program; and
(B) the information required by Section 531.02112(b).
(c) The report must cover the three-year period ending on the
last day of the previous fiscal year.
(d) The commission may request from any appropriate state agency
information necessary to complete the report. Each agency shall
cooperate with the commission in providing information for the
report.
(e) Not later than December 1 of each even-numbered year, the
commission shall submit the report to the governor, the
lieutenant governor, the speaker of the house of representatives,
the presiding officer of each standing committee of the senate
and house of representatives having jurisdiction over health and
human services issues, the state auditor, and the comptroller.
Added by Acts 2001, 77th Leg., ch. 209, Sec. 1, eff. May 21,
2001.
Sec. 531.02112. QUARTERLY REPORT OF MEDICAID EXPENDITURES. (a)
The commission shall prepare a report, on a quarterly basis,
regarding the Medicaid expenditures of each state agency that
administers or operates a Medicaid program.
(b) The report must identify each agency's expenditures by
Medicaid program and must include for each program:
(1) the amount spent on each type of service or benefit provided
by or under the program;
(2) the amount spent on program operations, including
eligibility determination, claims processing, and case
management; and
(3) the amount spent on any other administrative costs.
(c) The commission shall submit the report to the governor,
legislature, state auditor, and comptroller.
Added by Acts 2001, 77th Leg., ch. 209, Sec. 1, eff. May 21,
2001.
Sec. 531.02113. OPTIMIZATION OF MEDICAID FINANCING. The
commission shall ensure that the Medicaid finance system is
optimized to:
(1) maximize the state's receipt of federal funds;
(2) create incentives for providers to use preventive care;
(3) increase and retain providers in the system to maintain an
adequate provider network;
(4) more accurately reflect the costs borne by providers; and
(5) encourage the improvement of the quality of care.
Added by Acts 2005, 79th Leg., Ch.
349, Sec. 2(a), eff. September 1, 2005.
For expiration of this section, see Subsection (g).
Sec. 531.02114. PILOT PROJECT TO SIMPLIFY, STREAMLINE, AND REDUCE
COSTS ASSOCIATED WITH MEDICAID COST REPORTING AND AUDITING
PROCESS FOR CERTAIN PROVIDERS. (a) In this section:
(1) "Pilot project" means the pilot project to simplify,
streamline, and reduce costs associated with the Medicaid cost
reporting and auditing process for providers implemented by the
commission under this section.
(2) "Provider" means a private ICF-MR facility or home and
community-based services waiver program provider.
(b) The commission shall develop and implement a pilot project
to simplify, streamline, and reduce costs associated with the
Medicaid cost reporting and auditing process for private ICF-MR
facilities and home and community-based services waiver program
providers.
(c) The executive commissioner by rule shall, with the
assistance of the work group established under Subsection (d),
adopt cost reporting and auditing processes and guidelines
similar to standard business financial reporting processes and
guidelines. The rules must:
(1) require that cost report forms:
(A) not exceed 20 letter-size pages in length, including any
appendices; and
(B) be distributed to providers at least one month before the
beginning of the applicable reporting period;
(2) require that a provider summarize information regarding
program revenue, administrative costs, central office costs,
facility costs, and direct-care costs, including the hourly wage
detail of direct-care staff;
(3) allow a provider to electronically submit cost reports;
(4) require the filing of cost reports in alternating years as
follows:
(A) in even-numbered years, private ICF-MR facility providers;
and
(B) in odd-numbered years, home and community-based services
waiver program providers;
(5) allow a provider to request and receive from the commission
information, including reports, relating to the services provided
by the provider that is maintained by the commission in a
database or under another program or system to facilitate the
cost reporting process; and
(6) require that each provider receive a full audit by the
commission's office of inspector general at least once during the
period the pilot project is in operation.
(d) In developing the pilot project, the commission shall
establish a work group that reports to the executive commissioner
and is responsible for:
(1) developing and proposing cost report forms and processes,
audit processes, and rules necessary to implement the pilot
project;
(2) developing:
(A) a plan for monitoring the pilot project's implementation;
and
(B) recommendations for improving and expanding the pilot
project to other Medicaid programs;
(3) establishing an implementation date for the pilot project
that allows the commission to have sufficient information related
to the pilot project for purposes of preparing the commission's
legislative appropriations request for the state fiscal biennium
beginning September 1, 2009;
(4) monitoring wage levels of the direct-care staff of providers
to assess the value and need for minimum spending levels; and
(5) submitting a quarterly report to the lieutenant governor,
the speaker of the house of representatives, the senate finance
committee, and the house appropriations committee regarding the
status of the pilot project.
(e) The executive commissioner shall determine the number of
members of the work group described by Subsection (d). The
executive commissioner shall ensure that the work group includes
members who represent:
(1) public and private providers of ICF-MR services and home and
community-based waiver program services;
(2) experienced cost report preparers who have received cost
report training from the commission;
(3) accounting firms licensed under Chapter 901, Occupations
Code, that are familiar with the provision of program services
described by Subdivision (1);
(4) commission staff; and
(5) other interested stakeholders, as determined by the
executive commissioner.
(f) Not later than September 1, 2012, the commission shall
submit a report to the legislature that:
(1) evaluates the operation of the pilot project; and
(2) makes recommendations regarding the continuation or
expansion of the pilot project.
(g) This section expires September 1, 2013.
Added by Acts 2007, 80th Leg., R.S., Ch.
894, Sec. 1, eff. September 1, 2007.
Sec. 531.0212. MEDICAID BILL OF RIGHTS AND BILL OF
RESPONSIBILITIES.