89R8734 AB-F     By: Johnson H.B. No. 5030       A BILL TO BE ENTITLED   AN ACT   relating to the provision of certain mental and behavioral health   services under Medicaid, Medicaid coverage and reimbursement for   those services, and the regulation of psychiatric residential   treatment facilities; requiring an occupational license.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 540.0703(a), Government Code, as   effective April 1, 2025, is amended to read as follows:          (a)  In this section:                (1)  "Behavioral [, "behavioral] health services"   means mental health and substance use disorder services.  The term   includes crisis services, intensive outpatient services, and   partial hospitalization services.                (2)  "Crisis services" means mental health community   services or other necessary interventions provided to an individual   in crisis.  The term includes:                      (A)  crisis respite services, including mobile   and facility-based services;                      (B)  crisis stabilization services, including   mobile crisis stabilization services and services provided in an   extended observation unit or crisis stabilization unit; and                      (C)  other crisis services as the commission   determines.                (3)  "Intensive outpatient services" means outpatient   treatment services, including treatment services for substance use   disorders, depression, eating disorders, and other mental health   conditions that do not require detoxification or 24-hour   supervision, provided to patients who require a time-limited,   multifaceted array of services, structures, and supports by a team   of clinical staff capable of providing, at a minimum, the following   services:                      (A)  individual counseling;                      (B)  group counseling;                      (C)  family counseling;                      (D)  motivational enhancement training; and                      (E)  relapse prevention, drug refusal, and coping   skills training.                (4)  "Partial hospitalization services" means distinct   and organized intensive ambulatory treatment services provided for   periods of not more than 24 hours at a location other than a   patient's home or in an inpatient or a residential care setting.   The term includes the services described by 42 C.F.R. Section   410.43(a)(4).          SECTION 2.  The heading to Chapter 577A, Health and Safety   Code, is amended to read as follows:   CHAPTER 577A. PSYCHIATRIC RESIDENTIAL [YOUTH] TREATMENT   FACILITIES          SECTION 3.  Section 577A.001(3), Health and Safety Code, is   amended to read as follows:                (3)  "Psychiatric residential [youth] treatment   facility" means a private facility that provides psychiatric health   treatments and services in a residential, nonhospital setting   exclusively to individuals who are 21 years of age or younger [and   is licensed as a general residential operation under Chapter 42,   Human Resources Code]. The term includes a facility that provides   room and board.          SECTION 4.  The heading to Subchapter B, Chapter 577A,   Health and Safety Code, is amended to read as follows:   SUBCHAPTER B. LICENSURE [CERTIFICATION], FEES, AND INSPECTIONS          SECTION 5.  Section 577A.051, Health and Safety Code, is   amended to read as follows:          Sec. 577A.051.  LICENSE REQUIRED [VOLUNTARY QUALITY   STANDARDS CERTIFICATION]. A person may not operate a psychiatric   residential treatment facility unless the person holds a license   issued by the commission [The commission shall, using existing   resources to the extent feasible, develop and implement a voluntary   quality standards certification process to certify a psychiatric   residential youth treatment facility that meets standards for   certification] under this chapter.          SECTION 6.  The heading to Section 577A.052, Health and   Safety Code, is amended to read as follows:          Sec. 577A.052.  LICENSE [CERTIFICATE] APPLICATION.          SECTION 7.  Section 577A.052(a), Health and Safety Code, is   amended to read as follows:          (a)  To obtain a license [certificate] under this chapter, an   applicant must submit to the commission an application in the form   and manner prescribed by the commission.          SECTION 8.  Section 577A.053, Health and Safety Code, is   amended to read as follows:          Sec. 577A.053.  FEES. The executive commissioner by rule   shall establish a nonrefundable license [certificate] application   fee and a nonrefundable license [certificate] renewal fee in   amounts necessary to cover the costs of administering this chapter.          SECTION 9.  Section 577A.054, Health and Safety Code, is   amended to read as follows:          Sec. 577A.054.  ISSUANCE AND RENEWAL OF LICENSE   [CERTIFICATE]. (a) The commission shall issue a license   [certificate] to an applicant if on inspection and investigation   the commission determines the applicant meets the requirements of   this chapter and commission rules. [The commission may not issue to   an applicant a certificate under this chapter unless the applicant   is licensed as a general residential operation under Chapter 42,   Human Resources Code.]          (b)  A license [certificate] issued under this chapter   expires on the second anniversary of the date the license   [certificate] is issued or renewed.          (c)  The commission shall renew a license [certificate] if:                (1)  the license [certificate] holder submits to the   commission a fee established by the executive commissioner under   Section 577A.053; and                (2)  on inspection and investigation the commission   determines the license [certificate] holder meets the requirements   of this chapter and commission rules.          SECTION 10.  Section 577A.055, Health and Safety Code, is   amended to read as follows:          Sec. 577A.055.  INSPECTIONS. In addition to the inspections   required under Section 577A.054, the commission shall conduct an   inspection not later than the first anniversary of the date a   license [certificate] is issued or renewed to ensure the license   [certificate] holder remains in compliance with the requirements of   this chapter and commission rules.          SECTION 11.  The heading to Subchapter C, Chapter 577A,   Health and Safety Code, is amended to read as follows:   SUBCHAPTER C. REGULATION OF LICENSED [CERTIFIED] PSYCHIATRIC   RESIDENTIAL [YOUTH] TREATMENT FACILITIES          SECTION 12.  Section 577A.101, Health and Safety Code, is   amended to read as follows:          Sec. 577A.101.  MINIMUM STANDARDS. The executive   commissioner by rule shall establish minimum standards for the   licensing [certification] of psychiatric residential [youth]   treatment facilities under this chapter. The minimum standards   must require a facility to:                (1)  obtain accreditation by The Joint Commission, the   Commission on Accreditation of Rehabilitation Facilities, the   Council on Accreditation, or another accrediting organization   approved by the commission; [and]                (2)  provide and prescribe guidelines for the provision   of the following activities, treatments, and services:                      (A)  development and implementation of individual   plans of care, including the provision of services provided by a   licensed psychiatrist or physician to develop individual plans of   care;                      (B)  individual therapy;                      (C)  family engagement activities;                      (D)  consultation services with qualified   professionals, including case managers, primary care   professionals, community-based mental health providers, school   staff, and other support planners;                      (E)  24-hour nursing services; and                      (F)  direct care and supervision services,   supportive services for daily living and safety, and positive   behavior management services;                (3)  satisfy federal requirements for a psychiatric   residential treatment facility under 42 C.F.R. Section 441.151 et   seq. and 42 C.F.R. Section 483.350 et seq.; and                (4)  satisfy all requirements for licensure as a   general residential operation under Chapter 42, Human Resources   Code, and comply with rules adopted under that chapter.          SECTION 13.  Section 577A.102, Health and Safety Code, is   amended to read as follows:          Sec. 577A.102.  ADMISSION CRITERIA. A facility licensed   [certified] under this chapter may not admit or provide treatments   or services to an individual unless the individual:                (1)  is 21 years of age or younger;                (2)  has been diagnosed with a severe emotional   disturbance by a licensed mental health professional;                (3)  requires residential psychiatric treatment under   the direction of a licensed physician to improve the individual's   condition; and                (4)  was referred for treatments or services in a   psychiatric residential [youth] treatment facility by a licensed   mental health professional.          SECTION 14.  Section 577A.151, Health and Safety Code, is   amended to read as follows:          Sec. 577A.151.  PENALTIES. A facility licensed [certified]   under this chapter is subject to a civil penalty under Section   571.023 or an administrative penalty under Section 571.025, as   applicable, for a violation of this chapter or a rule adopted under   this chapter.          SECTION 15.  Section 32.024, Human Resources Code, is   amended by adding Subsections (oo-1) and (ss) to read as follows:          (oo-1)  The commission shall provide medical assistance   reimbursement to a health care provider who delivers to a recipient   under the medical assistance program services classified as   multisystemic therapy by the Healthcare Common Procedure Coding   System (HCPCS) code.  The executive commissioner shall establish a   separate provider type for multisystemic therapy providers for   purposes of enrollment as a provider for and reimbursement under   the medical assistance program.          (ss) The commission in the commission's rules and standards   governing the scope of services provided under the medical   assistance program shall include psychiatric treatment and related   services provided by a psychiatric residential treatment facility   licensed under Chapter 577A, Health and Safety Code, to the extent   permitted by federal law.          SECTION 16.  Section 32.027, Human Resources Code, is   amended by amending Subsection (l) and adding Subsection (m) to   read as follows:          (l)  Subject to appropriations, the commission shall assure   that a recipient of medical assistance under this chapter may   select a licensed psychologist, a licensed marriage and family   therapist, as defined by Section 502.002, Occupations Code, a   licensed professional counselor, as defined by Section 503.002,   Occupations Code, or a licensed clinical [master] social worker, as   defined by Section 505.002, Occupations Code, to perform any health   care service or procedure covered under the medical assistance   program if the selected person is authorized by law to perform the   service or procedure. This subsection shall be liberally   construed.          (m)  The commission shall assure that a recipient of medical   assistance under this chapter may select the following to perform   any health care service or procedure covered under the medical   assistance program if the selected person is licensed and   authorized by law to perform the service or procedure:                (1)  a licensed marriage and family therapist   associate, as defined by Section 502.002, Occupations Code, who is   working toward fulfilling the supervised practice requirements to   be licensed as a licensed marriage and family therapist, as defined   by that section;                (2)  a licensed master social worker, as defined by   Section 505.002, Occupations Code, who is actively pursuing the   education and training required to be licensed as a licensed   clinical social worker, as defined by that section; or                (3)  a licensed professional counselor associate, as   described by 22 T.A.C. Chapter 681, who is working toward   fulfilling the supervised practice requirements to be licensed as a   licensed professional counselor, as defined by Section 503.002,   Occupations Code.          SECTION 17.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Section 32.04261 to read as follows:          Sec. 32.04261.  REIMBURSEMENT FOR FUNCTIONAL FAMILY THERAPY   SERVICES. (a)  In this section:                (1)  "At-risk youth" means children who are at risk of   involvement with the child welfare system, the criminal justice   system, or the juvenile justice system.                (2)  "Functional family therapy" means an intensive,   short-term, family-based therapeutic treatment program for at-risk   youth designed to improve family dynamics, communication, and   support by:                      (A)  addressing core causes of dysfunctional   behavior patterns;                      (B)  decreasing negativity in the household; and                      (C)  providing tools to improve parental skills   and relationships.          (b)  The commission shall ensure that medical assistance   reimbursement is provided to a provider who provides functional   family therapy services to a recipient under the medical assistance   program.          SECTION 18.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Section 32.079 to read as follows:          Sec. 32.079.  REIMBURSEMENT FOR CERTAIN COUNSELING   SERVICES. (a)  The commission shall provide reimbursement under   the medical assistance program to a provider described by Section   32.027(l) who is a licensed marriage and family therapist, licensed   professional counselor, or licensed clinical social worker, is   selected by a recipient of medical assistance, and provides   counseling services covered under the medical assistance program   that the provider is authorized by law to perform. The commission   shall ensure that the provider is reimbursed at a rate equal to the   reimbursement rate established for a licensed psychiatrist or   licensed psychologist for providing similar services.          (b)  The commission shall provide reimbursement under the   medical assistance program to a provider described by Section   32.027(m) who is selected by a recipient of medical assistance and   who provides counseling services covered under the medical   assistance program that the provider is authorized by law to   perform. The commission shall ensure that the provider is   reimbursed at a rate equal to 70 percent of the reimbursement rate   established for a licensed psychiatrist or licensed psychologist   for providing similar services.          (c)  This section shall be liberally construed.          SECTION 19.  Section 42.041(b), Human Resources Code, is   amended to read as follows:          (b)  This section does not apply to:                (1)  a state-operated facility;                (2)  an agency foster home;                (3)  a facility that is operated in connection with a   shopping center, business, religious organization, or   establishment where children are cared for during short periods   while parents or persons responsible for the children are attending   religious services, shopping, or engaging in other activities,   including retreats or classes for religious instruction, on or near   the premises, that does not advertise as a child-care facility or   day-care center, and that informs parents that it is not licensed by   the state;                (4)  a school or class for religious instruction that   does not last longer than two weeks and is conducted by a religious   organization during the summer months;                (5)  a youth camp licensed by the Department of State   Health Services;                (6)  a facility licensed, operated, certified, or   registered by another state agency;                (7)  an educational facility that is accredited by the   Texas Education Agency, the Southern Association of Colleges and   Schools, or an accreditation body that is a member of the Texas   Private School Accreditation Commission and that operates   primarily for educational purposes for prekindergarten and above, a   before-school or after-school program operated directly by an   accredited educational facility, or a before-school or   after-school program operated by another entity under contract with   the educational facility, if the Texas Education Agency, the   Southern Association of Colleges and Schools, or the other   accreditation body, as applicable, has approved the curriculum   content of the before-school or after-school program operated under   the contract;                (8)  an educational facility that operates solely for   educational purposes for prekindergarten through at least grade   two, that does not provide custodial care for more than one hour   during the hours before or after the customary school day, and that   is a member of an organization that promulgates, publishes, and   requires compliance with health, safety, fire, and sanitation   standards equal to standards required by state, municipal, and   county codes;                (9)  a kindergarten or preschool educational program   that is operated as part of a public school or a private school   accredited by the Texas Education Agency, that offers educational   programs through grade six, and that does not provide custodial   care during the hours before or after the customary school day;                (10)  a family home, whether registered or listed;                (11)  an educational facility that is integral to and   inseparable from its sponsoring religious organization or an   educational facility both of which do not provide custodial care   for more than two hours maximum per day, and that offers an   educational program in one or more of the   following:  prekindergarten through at least grade three,   elementary grades, or secondary grades;                (12)  an emergency shelter facility, other than a   facility that would otherwise require a license as a child-care   facility under this section, that provides shelter or care to a   minor and the minor's child or children, if any, under Section   32.201, Family Code, if the facility:                      (A)  is currently under a contract with a state or   federal agency; or                      (B)  meets the requirements listed under Section   51.005(b)(3);                (13)  a juvenile detention facility certified under   Section 51.12, Family Code, a juvenile correctional facility   certified under Section 51.125, Family Code, a juvenile facility   providing services solely for the Texas Juvenile Justice   Department, or any other correctional facility for children   operated or regulated by another state agency or by a political   subdivision of the state;                (14)  an elementary-age (ages 5-13) recreation program   operated by a municipality provided the governing body of the   municipality annually adopts standards of care by ordinance after a   public hearing for such programs, that such standards are provided   to the parents of each program participant, and that the ordinances   shall include, at a minimum, staffing ratios, minimum staff   qualifications, minimum facility, health, and safety standards,   and mechanisms for monitoring and enforcing the adopted local   standards; and further provided that parents be informed that the   program is not licensed by the state and the program may not be   advertised as a child-care facility;                (15)  an annual youth camp held in a municipality with a   population of more than 1.5 million that operates for not more than   three months and that has been operated for at least 10 years by a   nonprofit organization that provides care for the homeless;                (16)  a food distribution program that:                      (A)  serves an evening meal to children two years   of age or older; and                      (B)  is operated by a nonprofit food bank in a   nonprofit, religious, or educational facility for not more than two   hours a day on regular business days;                (17)  a child-care facility that operates for less than   three consecutive weeks and less than 40 days in a period of 12   months;                (18)  a program:                      (A)  in which a child receives direct instruction   in a single skill, talent, ability, expertise, or proficiency;                      (B)  that does not provide services or offerings   that are not directly related to the single talent, ability,   expertise, or proficiency;                      (C)  that does not advertise or otherwise   represent that the program is a child-care facility, day-care   center, or licensed before-school or after-school program or that   the program offers child-care services;                      (D)  that informs the parent or guardian:                            (i)  that the program is not licensed by the   state; and                            (ii)  about the physical risks a child may   face while participating in the program; and                      (E)  that conducts background checks for all   program employees and volunteers who work with children in the   program using information that is obtained from the Department of   Public Safety;                (19)  an elementary-age (ages 5-13) recreation program   that:                      (A)  adopts standards of care, including   standards relating to staff ratios, staff training, health, and   safety;                      (B)  provides a mechanism for monitoring and   enforcing the standards and receiving complaints from parents of   enrolled children;                      (C)  does not advertise as or otherwise represent   the program as a child-care facility, day-care center, or licensed   before-school or after-school program or that the program offers   child-care services;                      (D)  informs parents that the program is not   licensed by the state;                      (E)  is organized as a nonprofit organization or   is located on the premises of a participant's residence;                      (F)  does not accept any remuneration other than a   nominal annual membership fee;                      (G)  does not solicit donations as compensation or   payment for any good or service provided as part of the program; and                      (H)  conducts background checks for all program   employees and volunteers who work with children in the program   using information that is obtained from the Department of Public   Safety;                (20)  a living arrangement in a caretaker's home   involving one or more children or a sibling group, excluding   children who are related to the caretaker, in which the caretaker:                      (A)  had a prior relationship with the child or   sibling group or other family members of the child or sibling group;                      (B)  does not care for more than one unrelated   child or sibling group;                      (C)  does not receive compensation or solicit   donations for the care of the child or sibling group; and                      (D)  has a written agreement with the parent to   care for the child or sibling group;                (21)  a living arrangement in a caretaker's home   involving one or more children or a sibling group, excluding   children who are related to the caretaker, in which:                      (A)  the department is the managing conservator of   the child or sibling group;                      (B)  the department placed the child or sibling   group in the caretaker's home; and                      (C)  the caretaker had a long-standing and   significant relationship with the child or sibling group, or the   family of the child or sibling group, before the child or sibling   group was placed with the caretaker;                (22)  a living arrangement in a caretaker's home   involving one or more children or a sibling group, excluding   children who are related to the caretaker, in which the child is in   the United States on a time-limited visa under the sponsorship of   the caretaker or of a sponsoring organization;                (23)  a facility operated by a nonprofit organization   that:                      (A)  does not otherwise operate as a child-care   facility that is required to be licensed under this section;                      (B)  provides emergency shelter and care for not   more than 15 days to children 13 years of age or older but younger   than 18 years of age who are victims of human trafficking alleged   under Section 20A.02, Penal Code;                      (C)  is located in a municipality with a   population of at least 600,000 that is in a county on an   international border; and                      (D)  meets one of the following criteria:                            (i)  is licensed by, or operates under an   agreement with, a state or federal agency to provide shelter and   care to children; or                            (ii)  meets the eligibility requirements for   a contract under Section 51.005(b)(3);                (24)  a facility that provides respite care exclusively   for a local mental health authority under a contract with the local   mental health authority; [or]                (25)  a living arrangement in a caretaker's home   involving one or more children or a sibling group in which the   caretaker:                      (A)  has a written authorization agreement under   Chapter 34, Family Code, with the parent of each child or sibling   group to care for each child or sibling group;                      (B)  does not care for more than six children,   excluding children who are related to the caretaker; and                      (C)  does not receive compensation for caring for   any child or sibling group; or                (26)  a psychiatric residential treatment facility   licensed under Chapter 577A, Health and Safety Code.          SECTION 20.  Section 577A.003, Health and Safety Code, is   repealed.          SECTION 21.  As soon as practicable after the effective date   of this Act, the executive commissioner of the Health and Human   Services Commission shall adopt rules as necessary to implement the   changes in law made by this Act.          SECTION 22.  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 23.  Notwithstanding the changes in law made by this   Act to Chapter 577A, Health and Safety Code, a psychiatric   residential treatment facility that is licensed under Chapter 42,   Human Resources Code, on the effective date of this Act is not   required to be licensed under Chapter 577A, Health and Safety Code,   until the expiration of the facility's license under Chapter 42,   Human Resources Code.          SECTION 24.  This Act takes effect September 1, 2025.