88R19564 KKR-F     By: Noble H.B. No. 3462     Substitute the following for H.B. No. 3462:     By:  Hull C.S.H.B. No. 3462       A BILL TO BE ENTITLED   AN ACT   relating to the consolidation of ombudsman programs administered by   the Health and Human Services Commission.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  The heading to Subchapter Y, Chapter 531,   Government Code, is amended to read as follows:   SUBCHAPTER Y. COMMISSION OMBUDSMAN PROGRAMS [FOR THE DEPARTMENT OF   FAMILY AND PROTECTIVE SERVICES]          SECTION 2.  Section 531.991(2), Government Code, as amended   by Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular   Session, 2017, is reenacted and amended to read as follows:                (2)  "Ombudsman" means the individual appointed as the   ombudsman for an ombudsman program [the Department of Family and   Protective Services].          SECTION 3.  Section 531.991, Government Code, is amended by   adding Subdivision (3) to read as follows:                (3)  "Ombudsman program" means an ombudsman program   administered by the commission under this subchapter.           SECTION 4.  Subchapter Y, Chapter 531, Government Code, is   amended by adding Section 531.9912 to read as follows:          Sec. 531.9912.  ESTABLISHMENT OF OMBUDSMAN PROGRAMS. The   executive commissioner shall establish the following ombudsman   programs:                (1)  the health and human services office of the   ombudsman in accordance with Section 531.9915;                (2)  the ombudsman for children and youth in foster   care in accordance with Section 531.9931;                 (3)  the ombudsman for managed care assistance in   accordance with Section 531.9932;                (4)  the ombudsman for behavioral health access to care   in accordance with Section 531.9933; and                (5)  the ombudsman for individuals with an intellectual   or developmental disability in accordance with Section 531.9934.          SECTION 5.  Section 531.0171, Government Code, is   transferred to Subchapter Y, Chapter 531, Government Code, and   redesignated as Section 531.9915, Government Code, to read as   follows:          Sec. 531.9915 [531.0171].  OFFICE OF OMBUDSMAN. (a) The   executive commissioner shall establish the commission's office of   the ombudsman with authority and responsibility over the health and   human services system in performing the following functions:                (1)  providing dispute resolution services for the   health and human services system;                (2)  performing consumer protection and advocacy   functions related to health and human services, including assisting   a consumer or other interested person with:                      (A)  raising a matter within the health and human   services system that the person feels is being ignored; and                      (B)  obtaining information regarding a filed   complaint; and                (3)  collecting inquiry and complaint data related to   the health and human services system.          (b)  The office of the ombudsman does not have the authority   to provide a separate process for resolving complaints or appeals.          (c)  The executive commissioner shall develop a standard   process for tracking and reporting received inquiries and   complaints within the health and human services system.  The   process must provide for the centralized tracking of inquiries and   complaints submitted to field, regional, or other local health and   human services system offices.          (d)  Using the process developed under Subsection (c), the   office of the ombudsman shall collect inquiry and complaint data   from all offices, agencies, divisions, and other entities within   the health and human services system.  To assist with the   collection of data under this subsection, the office may access any   system or process for recording inquiries and complaints used or   maintained within the health and human services system.          SECTION 6.  Section 531.992, Government Code, as amended by   Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular   Session, 2017, is reenacted and amended to read as follows:          Sec. 531.992.  APPOINTMENT OF OMBUDSMAN [FOR THE DEPARTMENT   OF FAMILY AND PROTECTIVE SERVICES]. [(a)] The executive   commissioner [governor] shall appoint an ombudsman for each   ombudsman program [the Department of Family and Protective   Services] to serve at the will of the executive commissioner   [governor].          [(b)  The ombudsman is administratively attached to the   office of the ombudsman for the commission.          [(c)  Subject to the appropriation of money for that purpose,   the ombudsman may employ staff to assist the ombudsman in   performing the ombudsman's duties under this subchapter.          [(d)  The ombudsman may not use the name or any logo of the   department on any forms or other materials produced and distributed   by the ombudsman.]          SECTION 7.  Section 531.9921, Government Code, as added by   Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular   Session, 2017, is reenacted and amended to read as follows:          Sec. 531.9921.  CONFLICT OF INTEREST. A person may not serve   as ombudsman in an ombudsman program if the person or the person's   spouse:                (1)  is employed by or participates in the management   of a business entity or other organization receiving funds from the   commission [department];                (2)  owns or controls, directly or indirectly, any   interest in a business entity or other organization receiving funds   from the commission [department]; or                (3)  is required to register as a lobbyist under   Chapter 305 because of the person's activities for compensation on   behalf of a profession related to the operation of the commission   [department].          SECTION 8.  Section 531.993, Government Code, as amended by   Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular   Session, 2017, is reenacted and amended to read as follows:          Sec. 531.993.  DUTIES OF OMBUDSMAN. (a) An [The] ombudsman   serves as an impartial [a neutral] party in assisting:                (1)  children and youth in the conservatorship of the   department with complaints regarding issues within the authority of   the commission or department, as applicable [or another health and   human services agency]; and                (2)  persons with a complaint against the commission   [department] regarding case-specific activities of the programs   within the health and human services system [of the department,   including adult protective services, child protective services,   child-care licensing, and statewide intake].          (b)  An [The] ombudsman shall:                (1)  develop and implement statewide procedures to:                      (A)  receive complaints from:                            (i)  children and youth in the   conservatorship of the department; and                            (ii)  other persons with a complaint against   a program within the health and human services system [the   department];                      (B)  review complaints filed with an [the]   ombudsman and take appropriate action, including:                            (i)  conducting an investigation into   individual complaints that allege violations of commission   procedures or policies [department or agency procedure or policy]   or other violations; and                            (ii)  referring to the commission   [department or agency management] for resolution any trends or   systemic issues identified in complaints;                      (C)  provide any necessary assistance to:                            (i)  children and youth in the   conservatorship of the department in making complaints and   reporting allegations of abuse, [or] neglect, or exploitation under   Chapter 48, Human Resources Code [to the department]; and                            (ii)  any other person in making complaints   against a program within the health and human services system or   reporting allegations of abuse, neglect, or exploitation under   Chapter 48, Human Resources Code;                      (D)  maintain the confidentiality of:                            (i)  an [the] ombudsman's communications and   records;                            (ii)  records of another person that have   been provided to an [the] ombudsman; and                            (iii)  communications of another person with   an [the] ombudsman; and                      (E)  ensure that [the department and] any person   [or a child or youth in the conservatorship of the department] who   files a complaint with an [the] ombudsman is [are] informed of the   results of the ombudsman's investigation of the complaint,   including whether the ombudsman was able to substantiate the   [person's, child's, or youth's] complaint;                (2)  collaborate with the commission [department] to   develop and implement an annual outreach plan to promote awareness   of the ombudsman programs among the public[, children] and   stakeholders [youth in the conservatorship of the department,   family members and caretakers of those children, and facilities   licensed by the department and] that includes:                      (A)  how an ombudsman [the office] may be   contacted;                      (B)  the purpose of an ombudsman [the office]; and                      (C)  the services an ombudsman [the office]   provides;                (3)  issue and file with the commission [department and   any applicable health and human services agency] a report that   contains an [the] ombudsman's final determination regarding a   complaint and any recommended corrective actions to be taken as a   result of the complaint;                (4)  establish a secure form of communication with any   individual who files a complaint with an [the] ombudsman;                (5)  collaborate with the commission [department] to   identify consequences for any retaliatory action related to a   complaint filed with an [the] ombudsman, in accordance with Section   531.997 [40.0041(g), Human Resources Code]; and                (6)  monitor and evaluate the [department's] corrective   actions taken in response to a recommendation by an [the]   ombudsman.          (c)  An [The] ombudsman's final determination in a report   described by Subsection (b)(3) must include a determination of   whether there was wrongdoing or negligence by the commission or   department or an agent of the commission or department or whether   the complaint was frivolous or [and] without merit. If the   ombudsman determines there was wrongdoing or negligence, the   ombudsman shall recommend corrective actions to be taken by the   commission or department.          (c-1)  The department and the commission shall provide   written notice to an ombudsman on whether the department or   commission adopted or rejected the ombudsman's recommended   corrective action. If the department or commission rejects a   recommended corrective action, the department or commission shall   include in the notice the reason for the rejection.          (d)  An [The] ombudsman may attend any judicial proceeding   related to a complaint filed with the ombudsman program [office].          SECTION 9.  Section 531.9931, Government Code, as added by   Chapter 906 (S.B. 213), Acts of the 85th Legislature, Regular   Session, 2017, is reenacted and amended to read as follows:          Sec. 531.9931.  [DIVISION OF] OMBUDSMAN FOR CHILDREN AND   YOUTH IN FOSTER CARE.  (a)  The commission shall establish an   ombudsman program to provide support and information services to   children and youth in foster care.          (b)  An [The division of the] ombudsman appointed under this   section shall [for children and youth in foster care is created   within the office of the ombudsman for the purpose of]:                (1)  receive [receiving] complaints from children and   youth in the conservatorship of the department as provided under   Section 531.993(b)(1)(A)(i) [531.993(a)(1)];                (2)  inform [informing] children and youth in the   conservatorship of the department who file a complaint under this   subchapter about the result of an [the] ombudsman's investigation   of the complaint, including whether the ombudsman was able to   substantiate the child's or youth's complaint; and                (3)  collaborate [collaborating] with the department   to develop an outreach plan for children and youth in the   conservatorship of the department to promote awareness of the   ombudsman program.          [(b)  If a child or youth in the conservatorship of the   department contacts the ombudsman by telephone call to report a   complaint under this subchapter, the call shall be transferred   directly to a person employed by the division of the ombudsman   created under this section.]          SECTION 10.  Section 531.0213, Government Code, is   transferred to Subchapter Y, Chapter 531, Government Code,   redesignated as Section 531.9932, Government Code, and amended to   read as follows:          Sec. 531.9932  [531.0213]. OMBUDSMAN FOR MANAGED CARE   ASSISTANCE [SUPPORT SERVICES FOR MEDICAID RECIPIENTS]. (a) The   commission shall establish an ombudsman program to provide support   and information services to a person enrolled in or applying for   Medicaid coverage who experiences barriers to receiving health care   services.          (b)  An ombudsman appointed under this section [The   commission] shall give emphasis to assisting a person with an   urgent or immediate medical or support need.          (c) [(b-1)]  The commission shall provide support and   information services required by this section through a network of   entities coordinated by the commission's [office of the] ombudsman   program [or other division of the commission designated by the   executive commissioner] and composed of:                (1)  the commission's [office of the] ombudsman program   or other division of the commission designated by the executive   commissioner to coordinate the network;                (2)  the office of the state long-term care ombudsman   required under Subchapter F, Chapter 101A, Human Resources Code;                (3)  the division within the commission responsible for   oversight of Medicaid managed care contracts;                (4)  area agencies on aging;                (5)  aging and disability resource centers established   under the Aging and Disability Resource Center initiative funded in   part by the federal Administration on Aging and the Centers for   Medicare and Medicaid Services; and                (6)  any other entity the executive commissioner   determines appropriate[, including nonprofit organizations with   which the commission contracts under Subsection (c)].          [(c)  The commission may provide support and information   services by contracting with nonprofit organizations that are not   involved in providing health care, health insurance, or health   benefits.]          (d)  As a part of the support and information services   required by this section, the ombudsman program [commission] shall:                (1)  operate a statewide toll-free assistance   telephone number that includes relay services for persons with   speech or hearing disabilities and assistance for persons who speak   Spanish;                (2)  intervene promptly with the state Medicaid office,   managed care organizations and providers, and any other appropriate   entity on behalf of a person who has an urgent need for medical   services;                (3)  assist a person who is experiencing barriers in   the Medicaid application and enrollment process and refer the   person for further assistance if appropriate;                (4)  educate persons so that they:                      (A)  understand the concept of managed care;                      (B)  understand their rights under Medicaid,   including grievance and appeal procedures; and                      (C)  are able to advocate for themselves;                (5)  [collect and maintain statistical information on a   regional basis regarding calls received by the assistance lines and   publish quarterly reports that:                      [(A)  list the number of calls received by region;                      [(B)  identify trends in delivery and access   problems;                      [(C)  identify recurring barriers in the Medicaid   system; and                      [(D)  indicate other problems identified with   Medicaid managed care;                [(6)]  assist the state Medicaid office and managed   care organizations and providers in identifying and correcting   problems, including site visits to affected regions if necessary;                (6) [(7)]  meet the needs of all current and future   Medicaid managed care recipients, including children receiving   dental benefits [and other recipients receiving benefits, under   the:                      [(A)  STAR Medicaid managed care program;                      [(B)  STAR + PLUS Medicaid managed care program,   including the Texas Dual Eligibles Integrated Care Demonstration   Project provided under that program;                      [(C)  STAR Kids managed care program established   under Section 533.00253; and                      [(D)  STAR Health program];                (7) [(8)]  incorporate support services for children   enrolled in the child health plan established under Chapter 62,   Health and Safety Code; and                (8) [(9)]  ensure that staff providing support and   information services receives sufficient training, including   training in the Medicare program for the purpose of assisting   recipients who are dually eligible for Medicare and Medicaid, and   has sufficient authority to resolve barriers experienced by   recipients to health care and long-term services and supports.          (e)  The [commission's office of the] ombudsman program[, or   other division of the commission designated by the executive   commissioner to coordinate the network of entities responsible for   providing support and information services under this section,]   must be sufficiently independent from other aspects of Medicaid   managed care to represent the best interests of recipients in   problem resolution.          SECTION 11.  Section 531.02251, Government Code, is   transferred to Subchapter Y, Chapter 531, Government Code, and   redesignated as Section 531.9933, Government Code, to read as   follows:          Sec. 531.9933 [531.02251].  OMBUDSMAN FOR BEHAVIORAL HEALTH   ACCESS TO CARE. (a) The commission shall establish an ombudsman   program to provide support and information services to a consumer   enrolled in or applying for a behavioral health program [In this   section, "ombudsman" means the individual designated as the   ombudsman for behavioral health access to care].          (b)  [The executive commissioner shall designate an   ombudsman for behavioral health access to care.          [(c)  The ombudsman is administratively attached to the   office of the ombudsman for the commission.          [(d)]  The commission may use an alternate title for the   ombudsman in consumer-facing materials if the commission   determines that an alternate title would be beneficial to consumer   understanding or access.          (c)  An [(e) The] ombudsman serves as an impartial [a   neutral] party to help consumers, including consumers who are   uninsured or have public or private health benefit coverage, and   behavioral health care providers navigate and resolve issues   related to consumer access to behavioral health care, including   care for mental health conditions and substance use disorders.          (d)  An [(f) The] ombudsman shall:                (1)  interact with consumers and behavioral health care   providers with concerns or complaints to help the consumers and   providers resolve behavioral health care access issues;                (2)  identify, track, and help report potential   violations of state or federal rules, regulations, or statutes   concerning the availability of, and terms and conditions of,   benefits for mental health conditions or substance use disorders,   including potential violations related to quantitative and   nonquantitative treatment limitations;                (3)  report concerns, complaints, and potential   violations described by Subdivision (2) to the appropriate   regulatory or oversight agency;                (4)  receive and report concerns and complaints   relating to inappropriate care or mental health commitment;                (5)  provide appropriate information to help consumers   obtain behavioral health care;                (6)  develop appropriate points of contact for   referrals to other state and federal agencies; and                (7)  provide appropriate information to help consumers   or providers file appeals or complaints with the appropriate   entities, including insurers and other state and federal agencies.          (e) [(h)]  The Texas Department of Insurance shall appoint a   liaison to an [the] ombudsman to receive reports of concerns,   complaints, and potential violations described by Subsection   (d)(2) [(f)(2)] from an [the] ombudsman, consumers, or behavioral   health care providers.          SECTION 12.  Subchapter Y, Chapter 531, Government Code, is   amended by adding Section 531.9934 to read as follows:          Sec. 531.9934.  OMBUDSMAN FOR INDIVIDUALS WITH AN   INTELLECTUAL OR DEVELOPMENTAL DISABILITY.  The executive   commissioner shall appoint an ombudsman to assist a client, or a   person acting on behalf of an individual with an intellectual or   developmental disability or a group of individuals with an   intellectual or developmental disability, with a complaint or   grievance regarding the infringement of the rights of an individual   with an intellectual or developmental disability or the delivery of   intellectual disability services submitted under Section 592.039,   Health and Safety Code.          SECTION 13.  Section 531.994, Government Code, is amended to   read as follows:          Sec. 531.994.  INVESTIGATION OF UNREPORTED COMPLAINTS. If,   during the investigation of a complaint, an [the] ombudsman   discovers unreported violations of the commission's [department's   or a health and human services agency's] rules and policies, the   ombudsman shall open a new investigation for each unreported   violation.          SECTION 14.  Sections 531.995 and 531.996, Government Code,   are amended to read as follows:          Sec. 531.995.  ACCESS TO INFORMATION. The commission   [department and each health and human services agency] shall   provide an [the] ombudsman access to the [department's or agency's]   records that relate to a complaint the ombudsman is reviewing or   investigating.          Sec. 531.996.  COMMUNICATION AND CONFIDENTIALITY. (a) A   person may communicate with an [the] ombudsman relating to a   complaint by telephone, by mail, by electronic mail, or by any other   means the ombudsman determines to be feasible, secure, and   accessible [to children and youth].          (b)  A communication with an [the] ombudsman is confidential   during an investigation or review of a complaint and remains   confidential after the complaint is resolved.          (c)  The records of an [the] ombudsman are confidential and   must be maintained in a manner that preserves the confidentiality   of the records.          (d)  The disclosure of confidential information to an [the]   ombudsman under this subchapter [section or Section 531.995] does   not constitute a waiver of confidentiality. Any information   disclosed to the ombudsman under this subchapter [section or   Section 531.995] remains confidential and privileged following   disclosure.          (e)  An [The] ombudsman is not prohibited from communicating   with the commission [department or another health and human   services agency] regarding confidential information disclosed to   the ombudsman [by the department or agency].          (f)  An [The] ombudsman may make reports relating to an   investigation of a complaint public after the complaint is   resolved. A report may not include information that identifies an   individual complainant, client, parent, or employee or any other   person involved in the complaint.          SECTION 15.  Sections 531.997 and 531.998, Government Code,   as amended by Chapter 906 (S.B. 213), Acts of the 85th Legislature,   Regular Session, 2017, are reenacted and amended to read as   follows:          Sec. 531.997.  RETALIATION PROHIBITED. The commission   [department or another health and human services agency] may not   retaliate against a commission [department] employee[, a child or   youth in the conservatorship of the department,] or any other   person who in good faith makes a complaint to an [the] ombudsman or   against any person who cooperates with the ombudsman in an   investigation.          Sec. 531.998.  REPORT. (a) Each [The] ombudsman shall   prepare an annual report that contains:                (1)  a description of the ombudsman's work;                (2)  any change made by the commission or department   [or another health and human services agency] in response to a   substantiated complaint;                (3)  a description of any trends in the nature of   complaints received by the ombudsman or any systemic issues   identified by the ombudsman in the investigation of individual   complaints, any recommendations related to addressing those trends   and issues, and an evaluation of the feasibility of the ombudsman's   recommendations;                (4)  a glossary of terms used in the report;                (5)  a description of the methods used to promote   awareness of the ombudsman under Section 531.993(b) and the   ombudsman's promotion plan for the next year; and                (6)  any public feedback received by the ombudsman   relating to the ombudsman's previous annual reports.          (b)  Each [The] report must be submitted to the governor, the   lieutenant governor, each standing committee of the legislature   with jurisdiction over matters involving the commission   [department], each member of the legislature, and the executive   commissioner[, and the commissioner of the department] not later   than December 1 of each year. On receipt of the report, the   [department and the] commission shall make the report publicly   available on the [department's and the] commission's Internet   website [websites].          SECTION 16.  Section 592.039, Health and Safety Code, is   amended to read as follows:          Sec. 592.039.  GRIEVANCES. A client, or a person acting on   behalf of a person with an intellectual disability or a group of   persons with an intellectual disability, has the right to submit   complaints or grievances regarding the infringement of the rights   of a person with an intellectual disability or the delivery of   intellectual disability services against a person, group of   persons, organization, or business to the Health and Human Services   Commission's ombudsman for individuals with an intellectual or   developmental disability as provided under Section 531.9934,   Government Code [department's Office of Consumer Rights and   Services for investigation and appropriate action].          SECTION 17.  Section 531.9941, Government Code, is repealed.          SECTION 18.  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 19.  This Act takes effect immediately if it   receives a vote of two-thirds of all the members elected to each   house, as provided by Section 39, Article III, Texas Constitution.     If this Act does not receive the vote necessary for immediate   effect, this Act takes effect September 1, 2023.