88R30348 EAS-D     By: Kolkhorst, et al. S.B. No. 26     (Jetton)     Substitute the following for S.B. No. 26:  No.       A BILL TO BE ENTITLED   AN ACT   relating to local mental health authority and local behavioral   health authority audits and mental and behavioral health reporting,   services, and programs.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter B, Chapter 531, Government Code, is   amended by adding Section 531.09915 to read as follows:          Sec. 531.09915.  INNOVATION MATCHING GRANT PROGRAM FOR   MENTAL HEALTH EARLY INTERVENTION AND TREATMENT. (a) In this   section:                (1)  "Inpatient mental health facility" has the meaning   assigned by Section 571.003, Health and Safety Code.                (2)  "Program" means the grant program established   under this section.                (3)  "State hospital" has the meaning assigned by   Section 552.0011, Health and Safety Code.          (b)  To the extent money is appropriated to the commission   for that purpose, the commission shall establish a matching grant   program to provide support to eligible entities for community-based   initiatives that promote identification of mental health issues and   improve access to early intervention and treatment for children and   families.  The initiatives may:                (1)  be evidence-based or otherwise demonstrate   positive outcomes, including:                      (A)  improved relationship skills;                      (B)  improved self-esteem;                      (C)  reduced involvement in the juvenile justice   system;                      (D)  participation in the relinquishment   avoidance program under Subchapter E, Chapter 262, Family Code; and                      (E)  avoidance of emergency room use; and                (2)  include:                      (A)  training; and                      (B)  services and supports for:                            (i)  community-based initiatives;                            (ii)  agencies that provide services to   children and families;                            (iii)  individuals who work with children or   caregivers of children showing atypical social or emotional   development or other challenging behaviors; and                            (iv)  children in or at risk of placement in   foster care or the juvenile justice system.          (c)  The commission may award a grant under the program only   in accordance with a contract between the commission and a grant   recipient. The contract must include provisions under which the   commission is given sufficient control to ensure the public purpose   of providing mental health prevention services to children and   families is accomplished and the state receives the return benefit.          (d)  The executive commissioner by rule shall establish   application and eligibility requirements for an entity to be   awarded a grant under the program.          (e)  The following entities are eligible for a grant awarded   under the program:                (1)  a hospital licensed under Chapter 241, Health and   Safety Code;                (2)  a mental hospital licensed under Chapter 577,   Health and Safety Code;                (3)  a hospital district;                (4)  a local mental health authority;                (5)  a child-care facility, as defined by Chapter 42,   Human Resources Code;                (6)  a county or municipality; and                (7)  a nonprofit organization that is exempt from   federal income taxation under Section 501(a), Internal Revenue Code   of 1986, by being listed as an exempt entity under Section 501(c)(3)   of that code.          (f)  In awarding grants under the program, the commission   shall prioritize entities that work with children and family   members of children with a high risk of experiencing a crisis or   developing a mental health condition to reduce:                (1)  the need for future intensive mental health   services;                (2)  the number of children at risk of placement in   foster care or the juvenile justice system; or                (3)  the demand for placement in state hospitals,   inpatient mental health facilities, and residential behavioral   health facilities.          (g)  The commission shall condition each grant awarded under   the program on the grant recipient providing matching money in an   amount that is equal to at least 10 percent of the grant amount.          (h)  A grant recipient may only use grant money awarded under   the program and matching money provided by the recipient to develop   innovative strategies that provide:                (1)  resiliency;                (2)  coping and social skills;                (3)  healthy social and familial relationships; and                (4)  parenting skills and behaviors.          (i)  A grant recipient may not use grant money awarded under   the program or matching money provided by the recipient to:                (1)  reimburse an expense or pay a cost that another   source, including the Medicaid program, is obligated to reimburse   or pay by law or under a contract; or                (2)  supplant or be a substitute for money awarded to   the recipient from a non-Medicaid federal funding source, including   federal grant funding.           (j)  A Medicaid provider's receipt of a grant under the   program does not affect any legal or contractual duty of the   provider to comply with requirements under the Medicaid program.          (k)  The commission may use a reasonable amount of the money   appropriated by the legislature for the purposes of the program,   not to exceed five percent, to pay the administrative costs of   implementing and administering the program.          SECTION 2.  Subchapter B, Chapter 531, Government Code, is   amended by adding Section 531.09991 to read as follows:          Sec. 531.09991.  PLAN FOR THE TRANSITION OF CARE OF CERTAIN   INDIVIDUALS. (a)  Not later than January 1, 2025, the commission   shall, in consultation with nursing facilities licensed under   Chapter 242, Health and Safety Code, develop a plan for   transitioning from a hospital that primarily provides behavioral   health services to a nursing facility individuals who require:                (1)  a level of care provided by nursing facilities;   and                (2)  a high level of behavioral health supports and   services.          (b)  The plan must include:                (1)  recommendations for providing incentives to   providers for the provision of services to individuals described by   Subsection (a), including an assessment of the feasibility of   including incentive payments under the Quality Incentive Payment   Program (QIPP) for those providers;                (2)  recommendations for methods to create bed   capacity, including reserving specific beds; and                (3)  a fiscal estimate, including estimated costs to   nursing facilities and savings to hospitals that will result from   transitioning individuals under Subsection (a).          (c)  The commission may implement the plan, including   recommendations under the plan, only if the commission determines   that implementing the plan would increase the amount of available   state general revenue.          (d)  This section expires September 1, 2025.          SECTION 3.  Section 531.1025, Government Code, is amended by   adding Subsection (c) to read as follows:          (c)  The commission's office of inspector general shall   conduct performance audits and require financial audits to be   conducted of each local behavioral health authority designated   under Section 533.0356, Health and Safety Code, and local mental   health authority, as defined by Section 531.002, Health and Safety   Code. The office shall:                (1)  establish a performance audit schedule that   ensures the office audits each authority described by this   subsection at least once every five years;                (2)  establish a financial audit schedule that ensures   each authority described by this subsection:                      (A)  undergoes a financial audit conducted by an   independent auditor at least once every three years; and                      (B)  submits to the office the results of the   financial audit; and                (3)  require additional audits to be conducted as   necessary based on adverse findings in a previous audit or as   requested by the commission.          SECTION 4.  Section 534.0535, Health and Safety Code, is   amended to read as follows:          Sec. 534.0535.  JOINT DISCHARGE PLANNING.  (a)  The   executive commissioner shall adopt or amend, and the department   shall enforce, rules that require continuity of services and   planning for patient care between department facilities and local   mental health authorities.          (b)  At a minimum, the rules must:                (1)  specify the local mental health authority's   responsibility for ensuring the successful transition of patients   who are determined by the facility to be medically appropriate for   discharge; and                (2)  require participation by a department facility in    joint discharge planning with [between a department facility and] a   local mental health authority before the [a] facility discharges a   patient or places the patient on an extended furlough with an intent   to discharge.          (c)  The local mental health authority shall plan with the   department facility to [and] determine the appropriate community   services for the patient.          (d)  The local mental health authority shall arrange for the   provision of the services upon discharge [if department funds are   to be used and may subcontract with or make a referral to a local   agency or entity].          (e)  The commission shall require each facility to designate   at least one employee to provide transition support services for   patients who are determined medically appropriate for discharge   from the facility.          (f)  Transition support services provided by the local   mental health authority must be designed to complement joint   discharge planning efforts and may include:                (1)  enhanced services and supports for complex or   high-need patients, including services and supports necessary to   create viable discharge or outpatient management plans; and                (2)  post-discharge monitoring for up to one year after   the discharge date to reduce the likelihood of readmission.          (g)  The commission shall ensure that each department   facility concentrates the provision of transition support services   for patients who have been:                (1)  admitted to and discharged from a facility   multiple times during a 30-day period; or                (2)  in the facility for longer than 365 consecutive   days.          SECTION 5.  Chapter 572, Health and Safety Code, is amended   by adding Section 572.0026 to read as follows:          Sec. 572.0026.  VOLUNTARY ADMISSION RESTRICTIONS.  The   facility administrator of an inpatient mental health facility or   the administrator's designee may only approve the admission of a   person for whom a proper request for voluntary inpatient services   is filed if, at the time the request is filed, there is available   space at the inpatient mental health facility.          SECTION 6.  Section 1001.084, Health and Safety Code, as   redesignated by Chapter 1236 (S.B. 1296), Acts of the 84th   Legislature, Regular Session, 2015, is amended by amending   Subsections (a), (b), (c), and (d) and adding Subsections (d-1),   (d-2), and (g) to read as follows:          (a)  The department, in collaboration with the commission,   shall establish and maintain a public reporting system of   performance and outcome measures relating to mental health and   substance use [abuse] services established by the [Legislative   Budget Board, the department, and the] commission. The system must   allow external users to view and compare the performance[,   outputs,] and outcomes of:                (1)  local mental health authorities [community   centers established under Subchapter A, Chapter 534, that provide   mental health services];                (2)  local behavioral health authorities [Medicaid   managed care pilot programs that provide mental health services];   and                (3)  local intellectual and developmental disability   authorities [agencies, organizations, and persons that contract   with the state to provide substance abuse services].          (b)  The public reporting system must allow external users to   view and compare the performance[, outputs,] and outcomes of the   Medicaid managed care programs that provide mental health services.          (c)  The department shall post the performance[, output,]   and outcome measures on the department's Internet website so that   the information is accessible to the public. The department shall   post the measures monthly, or as frequently as possible [quarterly   or semiannually in accordance with when the measures are reported   to the department].          (d)  The [department shall consider public input in   determining the appropriate outcome measures to collect in the]   public reporting system must[.  To the extent possible, the   department shall] include outcome measures that capture:                (1)  inpatient psychiatric care diversion;                (2)  [,] avoidance of emergency room use;                (3)  [,] criminal justice diversion;                (4)  [, and] the numbers of people who are homeless   served;                (5)  access to timely and adequate screening and rapid   crisis stabilization services;                (6)  timely access to and appropriate treatment from   community-based crisis residential services and hospitalization;                (7)  improved functioning as a result of   medication-related and psychosocial rehabilitation services;                (8)  information related to the number of people   referred to a state hospital, state supported living center, or   community-based hospital, the length of time between referral and   admission, the length of stay, and the length of time between the   date a person is determined ready for discharge or transition and   the date of discharge or transition;                (9)  the rate of denial of services or requests for   assistance from jails and other entities and the reason for denial;                (10)  quality of care in community-based mental health   services and state facilities;                (11)  the average number of hours of service provided   to individuals in a full level of care compared to the recommended   number of hours of service for each level of care; and                (12)  any other relevant information to determine the   quality of services provided during the reporting period.          (d-1)  A local intellectual and developmental disability   authority is only required to report information described by   Subsection (d)(8) that is related to a state supported living   center.          (d-2)  This subsection and Subsections (d) and (d-1) expire   September 1, 2025.          (g)  In this section:                (1)  "Local behavioral health authority" means an   authority designated by the commission under Section 533.0356.                (2)  "Local intellectual and developmental disability   authority" and "local mental health authority" have the meanings   assigned by Section 531.002.                (3)  "State hospital" has the meaning assigned by   Section 552.0011.                (4)  "State supported living center" has the meaning   assigned by Section 531.002.          SECTION 7.  Section 1001.084(e), Health and Safety Code, as   redesignated by Chapter 1236 (S.B. 1296), Acts of the 84th   Legislature, Regular Session, 2015, is repealed.          SECTION 8.  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 9.  This Act takes effect September 1, 2023.