Sec. 531.051. CONSUMER DIRECTION OF CERTAIN SERVICES FOR PERSONS WITH DISABILITIES AND ELDERLY PERSONS. (a) In this section:
(1) "Consumer" means a person who receives services through a consumer direction model established by the commission under this section.
(2) "Consumer direction" or "consumer direction model" means a service delivery model under which a consumer or the consumer's legally authorized representative exercises control over the development and implementation of the consumer's individual service plan or over the persons delivering the services directly to the consumer. The term includes the consumer-directed service option, the service responsibility option, and other types of service delivery models developed by the commission under this section.
(3) "Consumer-directed service option" means a type of consumer direction model in which:
(A) a consumer or the consumer's legally authorized representative, as the employer, exercises control over:
(i) the recruitment, hiring, management, or dismissal of persons providing services directly to the consumer; or
(ii) the retention of contractors or vendors for other authorized program services; and
(B) the consumer-directed services agency serves as fiscal agent and performs employer-related administrative functions for the consumer or the consumer's legally authorized representative, including payroll and the filing of tax and related reports.
(4) "Designated representative" means an adult volunteer appointed by a consumer or the consumer's legally authorized representative, as an employer, to perform all or part of the consumer's or the representative's duties as employer as approved by the consumer or the representative.
(5) "Legally authorized representative":
(A) means:
(i) a parent or legal guardian if the person is a minor;
(ii) a legal guardian if the person has been adjudicated as incapacitated to manage the person's personal affairs; or
(iii) any other person authorized or required by law to act on behalf of the person with regard to the person's care; and
(B) does not include a designated representative.
(6) "Service responsibility option" means a type of consumer direction model in which:
(A) a consumer or the consumer's legally authorized representative participates in the selection of, trains, and manages persons providing services directly to the consumer; and
(B) the provider agency, as the employer, performs employer-related administrative functions for the consumer or the consumer's legally authorized representative, including the hiring and dismissal of persons providing services directly to the consumer.
(b) The commission shall develop and oversee the implementation of consumer direction models under which a person with a disability or an elderly person who is receiving certain state-funded or Medicaid-funded services, or the person's legally authorized representative, exercises control over the development and implementation of the person's individual service plan or over the persons who directly deliver the services.
(c) In adopting rules for the consumer direction models, the executive commissioner shall:
(1) determine which services are appropriate and suitable for delivery through consumer direction;
(2) ensure that each consumer direction model is designed to comply with applicable federal and state laws;
(3) maintain procedures to ensure that a potential consumer or the consumer's legally authorized representative has adequate and appropriate information, including the responsibilities of a consumer or representative under each service delivery option, to make an informed choice among the types of consumer direction models;
(4) require each consumer or the consumer's legally authorized representative to sign a statement acknowledging receipt of the information required by Subdivision (3);
(5) maintain procedures to monitor delivery of services through consumer direction to ensure:
(A) adherence to existing applicable program standards;
(B) appropriate use of funds; and
(C) consumer satisfaction with the delivery of services;
(6) ensure that authorized program services that are not being delivered to a consumer through consumer direction are provided by a provider agency chosen by the consumer or the consumer's legally authorized representative; and
(7) set a timetable to complete the implementation of the consumer direction models.
(d) The consumer direction models established under this section may be implemented in appropriate and suitable programs of the commission or a health and human services agency.
(e) Section 301.251(a), Occupations Code, does not apply to delivery of a service for which payment is provided under the consumer-directed service option developed under this section if:
(1) the person who delivers the service:
(A) has not been denied a license under Chapter 301, Occupations Code;
(B) has not been issued a license under Chapter 301, Occupations Code, that is revoked or suspended; and
(C) performs a service that is not expressly prohibited from delegation by the Texas Board of Nursing; and
(2) the consumer who receives the service:
(A) has a disability and the service would have been performed by the consumer or the consumer's legally authorized representative except for that disability; and
(B) if:
(i) the consumer is capable of training the person in the proper performance of the service, the consumer directs the person to deliver the service; or
(ii) the consumer is not capable of training the person in the proper performance of the service, the consumer's legally authorized representative is capable of training the person in the proper performance of the service and directs the person to deliver the service.
(f) If the person delivers the service under Subsection (e)(2)(B)(ii), the legally authorized representative must be present when the service is performed or be immediately accessible to the person who delivers the service. If the person will perform the service when the representative is not present, the representative must observe the person performing the service at least once to assure the representative that the person performing the service can competently perform that service.
(g) Repealed by Acts 2007, 80th Leg., R.S., Ch. 576, Sec. 5, eff. September 1, 2007.
(h) Repealed by Acts 2007, 80th Leg., R.S., Ch. 576, Sec. 5, eff. September 1, 2007.
Added by Acts 1999, 76th Leg., ch. 1288, Sec. 1, eff. June 18, 1999. Amended by Acts 2001, 77th Leg., ch. 1508, Sec. 1, eff. June 17, 2001; Acts 2003, 78th Leg., ch. 553, Sec. 2.006, eff. Feb. 1, 2004.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 576 (S.B. 1766), Sec. 1, eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 576 (S.B. 1766), Sec. 2, eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 576 (S.B. 1766), Sec. 5, eff. September 1, 2007.
Acts 2009, 81st Leg., R.S., Ch. 229 (S.B. 1484), Sec. 1, eff. May 27, 2009.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.091, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.06, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.06, eff. January 1, 2016.
Structure Texas Statutes
Subtitle I - Health and Human Services
Chapter 531 - Health and Human Services Commission
Subchapter B. Powers and Duties
Section 531.021. Administration of Medicaid
Section 531.0211. Managed Care Medicaid Program: Rules; Education Programs
Section 531.02111. Biennial Medicaid Financial Report
Section 531.02113. Optimization of Medicaid Financing
Section 531.02114. Dental Director
Section 531.02118. Streamlining Medicaid Provider Enrollment and Credentialing Processes
Section 531.021182. Use of National Provider Identifier Number
Section 531.021191. Medicaid Enrollment of Certain Eye Health Care Providers
Section 531.0212. Medicaid Bill of Rights and Bill of Responsibilities
Section 531.0213. Support Services for Medicaid Recipients
Section 531.02131. Grievances Related to Medicaid
Section 531.0214. Medicaid Data Collection System
Section 531.02141. Medicaid Information Collection and Analysis
Section 531.02142. Public Access to Certain Medicaid Data
Section 531.02143. Data Regarding Postnatal Alcohol and Controlled Substance Treatment
Section 531.0215. Compilation of Statistics Relating to Fraud
Section 531.02164. Medicaid Services Provided Through Home Telemonitoring Services
Section 531.0217. Reimbursement for Certain Medical Consultations
Section 531.02171. Reimbursement for Certain Telehealth Services
Section 531.02172. Reimbursement for Teledentistry Dental Services
Section 531.02174. Additional Authority Regarding Telemedicine Medical Services
Section 531.02175. Reimbursement for Online Medical Consultations
Section 531.0218. Long-Term Care Medicaid Programs
Section 531.02191. Public Input
Section 531.02192. Federally Qualified Health Center and Rural Health Clinic Services
Section 531.02193. Certain Conditions on Medicaid Reimbursement of Rural Health Clinics Prohibited
Section 531.02194. Reimbursement Methodology for Rural Hospitals
Section 531.022. Coordinated Strategic Plan for Health and Human Services
Section 531.0222. Local Mental Health Authority Group Regional Planning
Section 531.0224. Planning and Policy Direction of Temporary Assistance for Needy Families Program
Section 531.0225. Mental Health and Substance Abuse Services
Section 531.02251. Ombudsman for Behavioral Health Access to Care
Section 531.02253. Telehealth Treatment for Substance Use Disorders
Section 531.0226. Chronic Health Conditions Services Medicaid Waiver Program
Section 531.0227. Person First Respectful Language Promotion
Section 531.023. Submission of Plans and Updates by Agencies
Section 531.024. Planning and Delivery of Health and Human Services; Data Sharing
Section 531.0241. Streamlining Delivery of Services
Section 531.02411. Streamlining Administrative Processes
Section 531.024115. Service Delivery Area Alignment
Section 531.02412. Service Delivery Audit Mechanisms
Section 531.02413. Billing Coordination System
Section 531.024131. Expansion of Billing Coordination and Information Collection Activities
Section 531.02414. Nonemergency Transportation Services Under Medical Transportation Program
Section 531.02415. Electronic Eligibility Information Pilot Project
Section 531.024163. Accessibility of Information Regarding Medicaid Prior Authorization Requirements
Section 531.024164. External Medical Review
Section 531.024165. Medical Review of Medicaid Service Denials for Foster Care Youth
Section 531.02417. Medicaid Nursing Services Assessments
Section 531.024171. Therapy Services Assessments
Section 531.024172. Electronic Visit Verification System
Section 531.0242. Use of Agency Staff
Section 531.0244. Ensuring Appropriate Care Setting for Persons With Disabilities
Section 531.02444. Medicaid Buy-in Programs for Certain Persons With Disabilities
Section 531.02445. Transition Services for Youth With Disabilities
Section 531.02447. Employment-First Policy
Section 531.02448. Competitive and Integrated Employment Initiative for Certain Medicaid Recipients
Section 531.0245. Permanency Planning for Certain Children
Section 531.0246. Regional Management of Health and Human Services Agencies
Section 531.0247. Annual Business Plan
Section 531.0248. Community-Based Support Systems
Section 531.02481. Community-Based Support and Service Delivery Systems for Long-Term Care Services
Section 531.02491. Joint Training for Certain Caseworkers
Section 531.02492. Delivery of Health and Human Services to Young Texans
Section 531.025. Statewide Needs Appraisal Project
Section 531.027. Appropriations Request by Agencies
Section 531.0271. Health and Human Services Agencies Operating Budgets
Section 531.0273. Information Resources Planning and Management
Section 531.02731. Report of Information Resources Manager to Commission
Section 531.0274. Coordination and Approval of Caseload Estimates
Section 531.028. Monitoring and Effective Management of Funds
Section 531.031. Management Information and Cost Accounting System
Section 531.0312. Texas Information and Referral Network
Section 531.0313. Electronic Access to Health and Human Services Referral Information
Section 531.03131. Electronic Access to Child-Care and Education Services Referral Information
Section 531.0317. Health and Human Services Information Made Available Through the Internet
Section 531.0318. Long-Term Care Consumer Information Made Available Through the Internet
Section 531.0319. Outreach Campaigns for Aging Adults With Visual Impairments
Section 531.032. Application of Other Laws
Section 531.0335. Prohibition on Punitive Action for Failure to Immunize
Section 531.035. Dispute Arbitration
Section 531.036. Public Hearings
Section 531.037. Notice of Public Hearings
Section 531.038. Gifts and Grants
Section 531.0381. Certain Gifts and Grants to Health and Human Services Agencies
Section 531.0391. Subrogation and Third-Party Reimbursement Collection Contract
Section 531.0392. Recovery of Certain Third-Party Reimbursements Under Medicaid
Section 531.040. Reference Guide; Dictionary
Section 531.041. General Powers and Duties
Section 531.0411. Rules Regarding Refugee Resettlement
Section 531.042. Information and Assistance Regarding Care and Support Options
Section 531.043. Long-Term Care Vision
Section 531.044. Financial Assistance Recipients Eligible for Federal Programs
Section 531.047. Substitute Care Provider Outcome Standards
Section 531.048. Caseload Standards
Section 531.050. Minimum Collection Goal
Section 531.0501. Medicaid Waiver Programs: Interest List Management
Section 531.0511. Medically Dependent Children Waiver Program: Consumer Direction of Services
Section 531.0512. Notification Regarding Consumer Direction Model
Section 531.0515. Risk Management Criteria for Certain Waiver Programs
Section 531.053. Leases and Subleases of Certain Office Space
Section 531.055. Memorandum of Understanding on Services for Persons Needing Multiagency Services
Section 531.056. Review of Survey Process in Certain Institutions and Facilities
Section 531.057. Volunteer Advocate Program for the Elderly
Section 531.058. Informal Dispute Resolution for Certain Long-Term Care Facilities
Section 531.0581. Long-Term Care Facilities Council
Section 531.0585. Issuance of Materials to Certain Long-Term Care Facilities
Section 531.059. Voucher Program for Transitional Living Assistance for Persons With Disabilities
Section 531.060. Family-Based Alternatives for Children
Section 531.0601. Long-Term Care Services Waiver Program Interest Lists
Section 531.06011. Certain Medicaid Waiver Programs: Interest List Management
Section 531.0602. Medically Dependent Children (Mdcp) Waiver Program Assessments and Reassessments
Section 531.06021. Medically Dependent Children (Mdcp) Waiver Program Quality Monitoring; Report
Section 531.0605. Advancing Care for Exceptional Kids Pilot Program
Section 531.061. Participation by Fathers
Section 531.062. Pilot Projects Relating to Technology Applications
Section 531.066. Participation of Diagnostic Laboratory Service Providers in Certain Programs
Section 531.069. Periodic Review of Vendor Drug Program
Section 531.0693. Prescription Drug Use and Expenditure Patterns
Section 531.0694. Period of Validity for Prescription
Section 531.0696. Considerations in Awarding Certain Contracts
Section 531.070. Supplemental Rebates
Section 531.0701. Value-Based Arrangements
Section 531.071. Confidentiality of Information Regarding Drug Rebates, Pricing, and Negotiations
Section 531.072. Preferred Drug Lists
Section 531.073. Prior Authorization for Certain Prescription Drugs
Section 531.0735. Medicaid Drug Utilization Review Program: Drug Use Reviews and Annual Report
Section 531.0736. Drug Utilization Review Board
Section 531.0737. Drug Utilization Review Board: Conflicts of Interest
Section 531.075. Prior Authorization for High-Cost Medical Services
Section 531.076. Review of Prior Authorization and Utilization Review Processes
Section 531.077. Recovery of Certain Assistance
Section 531.078. Quality Assurance Fees on Certain Waiver Program Services
Section 531.079. Waiver Program Quality Assurance Fee Account
Section 531.080. Reimbursement of Waiver Programs
Section 531.081. Invalidity; Federal Funds
Section 531.082. Expiration of Quality Assurance Fee on Waiver Programs
Section 531.083. Medicaid Long-Term Care System
Section 531.084. Medicaid Long-Term Care Cost Containment Strategies
Section 531.0841. Long-Term Care Insurance Awareness and Education Campaign
Section 531.0843. Durable Medical Equipment Reuse Program
Section 531.085. Hospital Emergency Room Use Reduction Initiatives
Section 531.087. Distribution of Earned Income Tax Credit Information
Section 531.088. Pooled Funding for Foster Care Preventive Services
Section 531.089. Certain Medication for Sex Offenders Prohibited
Section 531.090. Joint Purchasing of Prescription Drugs and Other Medications
Section 531.091. Integrated Benefits Issuance
Section 531.092. Transfer of Money for Community-Based Services
Section 531.0925. Veteran Suicide Prevention Action Plan
Section 531.093. Services for Military Personnel
Section 531.0941. Medicaid Health Savings Account Pilot Program
Section 531.097. Tailored Benefit Packages for Certain Categories of the Medicaid Population
Section 531.0971. Tailored Benefit Packages for Non-Medicaid Populations
Section 531.0972. Pilot Program to Prevent the Spread of Certain Infectious or Communicable Diseases
Section 531.0981. Wellness Screening Program
Section 531.0991. Grant Program for Mental Health Services
Section 531.0992. Grant Program for Mental Health Services for Veterans and Their Families
Section 531.0994. Study; Annual Report
Section 531.0995. Information for Certain Enrollees in the Healthy Texas Women Program