85R5422 JG-F     By: Raymond H.B. No. 2590       A BILL TO BE ENTITLED   AN ACT   relating to the amelioration and informal dispute resolution   processes for providers participating in certain Medicaid waiver   programs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter D, Chapter 161, Human Resources Code,   is amended by adding Sections 161.0891 and 161.0892 to read as   follows:          Sec. 161.0891.  AMELIORATION PROCESS. (a) In lieu of   demanding payment of an administrative penalty assessed under   Section 161.089, the commission may, in accordance with this   section, allow the provider subject to the penalty to use, under the   supervision of the commission, any portion of the amount of the   penalty to ameliorate the violation or to improve services in the   waiver program in which the provider participates.          (b)  The commission shall offer amelioration to a provider   under this section not later than the 10th day after the date the   provider receives from the commission a final notification of the   assessment of an administrative penalty that is sent to the   provider after an informal dispute resolution process but before an   administrative hearing.          (c)  A provider to whom amelioration has been offered must   file a plan for amelioration not later than the 45th day after the   date the provider receives the offer of amelioration from the   commission.  In submitting the plan, the provider must agree to   waive the provider's right to an administrative hearing if the   commission approves the plan.          (d)  At a minimum, a plan for amelioration must:                (1)  propose changes to the management or operation of   the waiver program in which the provider participates that will   improve services to or quality of care for clients in the program;                (2)  identify, through measurable outcomes, the ways in   which and the extent to which the proposed changes will improve   services to or quality of care for clients in the waiver program;                (3)  establish clear goals to be achieved through the   proposed changes;                (4)  establish a timeline for implementing the proposed   changes; and                (5)  identify specific actions necessary to implement   the proposed changes.          (e)  The commission may require that an amelioration plan   propose changes that would result in conditions that exceed the   requirements of a law or rule relating to the waiver program in   which the provider participates.          (f)  The commission shall approve or deny an amelioration   plan not later than the 45th day after the date the commission   receives the plan.  On approval of a provider's plan, the commission   or the State Office of Administrative Hearings, as appropriate,   shall deny a pending request for a hearing submitted by the   provider.          (g)  The commission may not offer amelioration to a provider:                (1)  more than three times in a two-year period; or                (2)  more than one time in a two-year period for the   same or similar violation.          Sec. 161.0892.  INFORMAL DISPUTE RESOLUTION. (a) The   executive commissioner by rule shall establish an informal dispute   resolution process in accordance with this section.  The process   must provide for adjudication by an appropriate disinterested   person of disputes relating to a proposed enforcement action or   related proceeding of the commission against a provider   participating in a waiver program described by Section 161.089.     The informal dispute resolution process must require:                (1)  a provider participating in a waiver program   described by Section 161.089 to request informal dispute resolution   not later than the 10th calendar day after the date of notification   by the commission of the violation of a law or rule relating to the   program; and                (2)  the commission to complete the process not later   than the 30th calendar day after the date of receipt of a request   from a provider for informal dispute resolution.          (b)  As part of the informal dispute resolution process   established under this section, the commission shall contract with   an appropriate disinterested person who is a nonprofit organization   to adjudicate disputes between a provider participating in a   program described by Section 161.089 and the commission concerning   a statement of violations prepared by the commission.  Section   2009.053, Government Code, does not apply to the selection of an   appropriate disinterested person under this subsection.  The person   with whom the commission contracts shall adjudicate all disputes   described by this subsection.          (c)  The executive commissioner shall adopt rules to   adjudicate claims in contested cases.          (d)  The commission may not delegate its responsibility to   administer the informal dispute resolution process established by   this section to another state agency.          SECTION 2.  Subchapter D, Chapter 161, Human Resources Code,   is amended by adding Sections 161.0881 and 161.0882 to read as   follows:          Sec. 161.0881.  AMELIORATION PROCESS. (a) In lieu of   demanding payment of an administrative penalty assessed under   Section 161.088, the commission may, in accordance with this   section, allow the provider subject to the penalty to use, under the   supervision of the commission, any portion of the amount of the   penalty to ameliorate the violation or to improve services in the   waiver program in which the provider participates.          (b)  The commission shall offer amelioration to a provider   under this section not later than the 10th day after the date the   provider receives from the commission a final notification of the   assessment of an administrative penalty that is sent to the   provider after an informal dispute resolution process but before an   administrative hearing.          (c)  A provider to whom amelioration has been offered must   file a plan for amelioration not later than the 45th day after the   date the provider receives the offer of amelioration from the   commission.  In submitting the plan, the provider must agree to   waive the provider's right to an administrative hearing if the   commission approves the plan.          (d)  At a minimum, a plan for amelioration must:                (1)  propose changes to the management or operation of   the waiver program in which the provider participates that will   improve services to or quality of care for clients in the program;                (2)  identify, through measurable outcomes, the ways in   which and the extent to which the proposed changes will improve   services to or quality of care for clients in the waiver program;                (3)  establish clear goals to be achieved through the   proposed changes;                (4)  establish a timeline for implementing the proposed   changes; and                (5)  identify specific actions necessary to implement   the proposed changes.          (e)  The commission may require that an amelioration plan   propose changes that would result in conditions that exceed the   requirements of a law or rule relating to the waiver program in   which the provider participates.          (f)  The commission shall approve or deny an amelioration   plan not later than the 45th day after the date the commission   receives the plan.  On approval of a provider's plan, the commission   or the State Office of Administrative Hearings, as appropriate,   shall deny a pending request for a hearing submitted by the   provider.          (g)  The commission may not offer amelioration to a provider:                (1)  more than three times in a two-year period; or                (2)  more than one time in a two-year period for the   same or similar violation.          Sec. 161.0882.  INFORMAL DISPUTE RESOLUTION. (a) The   executive commissioner by rule shall establish an informal dispute   resolution process in accordance with this section.  The process   must provide for adjudication by an appropriate disinterested   person of disputes relating to a proposed enforcement action or   related proceeding of the commission against a provider   participating in a waiver program described by Section 161.088.     The informal dispute resolution process must require:                (1)  a provider participating in a waiver program   described by Section 161.088 to request informal dispute resolution   not later than the 10th calendar day after the date of notification   by the commission of the violation of a law or rule relating to the   program; and                (2)  the commission to complete the process not later   than the 30th calendar day after the date of receipt of a request   from a provider for informal dispute resolution.          (b)  As part of the informal dispute resolution process   established under this section, the commission shall contract with   an appropriate disinterested person who is a nonprofit organization   to adjudicate disputes between a provider participating in a   program described by Section 161.088 and the commission concerning   a statement of violations prepared by the commission.  Section   2009.053, Government Code, does not apply to the selection of an   appropriate disinterested person under this subsection.  The person   with whom the commission contracts shall adjudicate all disputes   described by this subsection.          (c)  The executive commissioner shall adopt rules to   adjudicate claims in contested cases.          (d)  The commission may not delegate its responsibility to   administer the informal dispute resolution process established by   this section to another state agency.          SECTION 3.  (a) Section 1 of this Act takes effect only if   the Act of the 85th Legislature, Regular Session, 2017, relating to   nonsubstantive additions to and corrections in enacted codes   becomes law.          (b)  Section 2 of this Act takes effect only if the Act of the   85th Legislature, Regular Session, 2017, relating to   nonsubstantive additions to and corrections in enacted codes does   not become law.          SECTION 4.  As soon as practicable after the effective date   of this Act, the executive commissioner of the Health and Human   Services Commission shall adopt the rules necessary to implement   the changes in law made by this Act.          SECTION 5.  This Act takes effect September 1, 2017.