By: Harris Davila H.B. No. 4371       A BILL TO BE ENTITLED   AN ACT   relating to the provision of services by certain persons in the   private duty nursing program.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 531, Government Code, is amended by   adding Subchapter T to read as follows:   SUBCHAPTER T.  COMPLEX CARE AIDE          Sec. 531.801.  DEFINITIONS. (a) In this subchapter:                (1)  "Home and community support services agency" means   a person licensed under Chapter 142, Health and Safety Code.                (2)  "Certified complex care aide" means a person who   is:                      (A)  the parent, legal guardian, or family member   of a recipient participating in the program;                      (B)  certified under the program to assist in   providing certain private duty nursing services; and                      (C)  employed by the home and community support   services agency providing services to the recipient.                (3)  "Private duty nursing services" means nursing   services provided under the Texas Health Steps comprehensive care   program to a recipient enrolled in the STAR Kids Medicaid managed   care program.          Sec. 531.802.  CERTIFIED COMPLEX CARE AIDE. The commission   shall develop policies to enable a parent, legal guardian, or   family member of a recipient receiving private duty nursing   services in a home setting to assist in providing those services as   a complex care aide.          Sec. 531.803.  ELIGIBILITY. (a) An individual is eligible   to receive services from a certified complex care aide if:                (1)  the recipient is:                      (A)  enrolled in the STAR Kids Medicaid managed   care program; and                      (B)  eligible to receive private duty nursing   services under the Texas Health Steps comprehensive care program;                (2)  the recipient's parent, legal guardian, or family   member, as defined by commission rule, elects to become a certified   complex care aide;                (3)  The recipient's parent, legal guardian, or family   member, completes all required training necessary to be certified   as a complex care aide; and                (4)  the home and community support services agency   that employs the professional registered nurses providing private   duty nursing services to the recipient agrees to employ the   recipient's parent, legal guardian, or family member.          Sec. 531.804.  RECIPIENT SCREENING AND NOTIFICATION. (a)   The commission shall:                (1)  add criteria to any screening tool or other   instrument used to conduct an assessment or reassessment of a   recipient under the STAR Kids Medicaid managed care program to   identify recipients who are eligible to participate in the program;   and                (2)  notify the parent or legally authorized   representative of the recipient of the potential availability of   the service option.                (b)  The parent or legally authorized representative of   the recipient has the sole choice of whether to utilize the service   option.          Sec. 531.805.  COMPLEX CARE AIDE CERTIFICATION REQUIRED.   (a) To assist in providing private duty nursing services to a   recipient under the program, a parent, legal guardian, or other   family member of the recipient must be certified as a complex care   aide. A person seeking certification as a complex care aide must   satisfy all training, testing, and other minimum qualification   standards the commission establishes.          Sec. 531.806.  TRAINING PROGRAM. (a) The commission shall   approve family health aide training programs that meet all of the   requirements under 42 CFR 484.80.  The training program must   include instruction on:                (1)  transferring;                (2)  positioning;                (3)  ambulation;                (4)  feeding;                (5)  personal care;                (6)  catheter care;                (7)  range of motion;                (8)  vital signs;                (9)  blood pressure;                (10)  medication administration;                (11)  enteral care and therapy;                (12)  administering enteral feedings;                (13)  formula types and preparation; and                (14)  other tasks the commission approves except for   tracheostomy care.                (b)  The home and community support services agency   must also provide ten hours of training in addition to the training   required under (a) regarding tasks and skills specific to the needs   of the recipient.          (c)  The home and community support services agency may not   impose a fee on an applicant for the training required by this   subchapter.          Sec. 531.807.  CERTIFICATION RESTRICTED; LIMITED SCOPE OF   PRACTICE. (a) A certified complex care aide under this subchapter:                (1)  may only provide complex care services to a   recipient who is:                      (A)  related to the license holder; and                      (B)  enrolled in the program; and                (2)  must be employed by the home and community support   services agency that employs the nurse providing private duty   nursing services to the recipient.          (b)  A certified complex care aide may only provide health   services to a recipient if the services are:                (1)  delegated to the certified complex care aide by   the professional registered nurse providing private duty nursing   services to the recipient;                (2)  performed under the supervision of that nurse;                (3)  consistent with Texas Board of Nursing rules   governing the delegation of nursing tasks by a registered   professional nurse and federal law and regulations governing the   provision of private duty nursing services under Medicaid,   including 42 C.F.R. Section 440.80 except for tracheostomy care;                (4)  consistent with the recipient's plan of care; and                (5)  authorized by commission rules.          Sec. 531.808.  HOME AND COMMUNITY SUPPORT SERVICES AGENCIES   OUTREACH. The commission shall:                (1)  provide information about the program to home and   community support services agencies that provide private duty   nursing services under the STAR Kids Medicaid managed care program;   and                (2)  encourage agencies to employ certified complex   care aides that are qualified to provide services under this   subchapter.          Sec. 531.809.  REIMBURSEMENT FOR CERTIFIED COMPLEX CARE AIDE   SERVICES.  (a)  The commission shall reimburse a home and community   support services agency for services provided to a recipient by a   certified complex care aide under this subchapter at a rate that is   no less than ninety percent of the licensed vocational nurse rate   for private duty nursing services.  The commission shall administer   reimbursement based on billing units.          (b)  A recipient's parent, legal guardian, or family member   is not eligible for reimbursement as a certified complex care aide   if they:          (1)  do not meet all of the requirements under 531.806;          (2)  provide more than 40 hours per week of services to an   eligible recipient.          Sec. 531.811.  RULES. The executive commissioner shall   adopt rules necessary to implement this subchapter.          SECTION 2.  The commission shall allow the provision of   services by certified complex care aides established under   Subchapter T, Chapter 531, Government Code, as added by this Act,   not later than September 1, 2026.          SECTION 3.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 4.  This Act takes effect September 1, 2025.