AI-assisted research summary: The commission must create and run a pilot program for STAR+PLUS Medicaid managed care to test long-term services and supports, and participating managed care organizations must provide those services to certain individuals.
Sec. 542.0102. PILOT PROGRAM TO TEST PERSON-CENTERED MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. (a) The commission, in collaboration with the advisory committee and pilot program work group, shall develop and implement a pilot program to test the delivery of long-term services and supports to pilot program participants through the STAR+PLUS Medicaid managed care program. (b) A managed care organization participating in the pilot program shall provide Medicaid long-term services and supports to individuals with an intellectual or developmental disability and individuals with similar functional needs to test the organization's managed care strategy based on capitation. (c) The pilot program must be designed to: (1) increase access to long-term services and supports; (2) improve the quality of acute care services and long-term services and supports; (3) promote: (A) informed choice and meaningful outcomes by using person-centered planning, flexible consumer-directed services, individualized budgeting, and self-determination; and (B) community inclusion and engagement; (4) promote integrated service coordination of acute care services and long-term services and supports; (5) promote efficiency and best funding use based on a pilot program participant's needs and preferences; (6) promote, through housing supports and navigation services, stability in housing that is the most integrated and least restrictive based on a pilot program participant's needs and preferences; (7) promote employment assistance and customized, integrated, competitive employment; (8) provide fair hearing and appeals processes in accordance with federal and state law; (9) promote the use of innovative technologies and benefits, including telemedicine, telemonitoring, the testing of remote monitoring, transportation services, and other innovations that support community integration; (10) ensure a provider network that is adequate and includes comprehensive long-term services and supports providers and ensure that pilot program participants have a choice among those providers; (11) ensure the timely initiation and consistent provision of long-term services and supports in accordance with a pilot program participant's person-centered plan; (12) ensure that pilot program participants with complex behavioral, medical, and physical needs are assessed and receive appropriate services in the most integrated and least restrictive setting based on the participants' needs and preferences; (13) increase access to, expand flexibility of, and promote the use of the consumer direction model; (14) promote independence, self-determination, the use of the consumer direction model, and decision making by pilot program participants by using alternatives to guardianship, including a supported decision-making agreement as defined by Section 1357.002, Estates Code; and (15) promote sufficient flexibility to achieve, through the pilot program, the goals listed in: (A) this subsection; (B) Subsection (b); and (C) Sections 542.0103, 542.0110(a), 542.0113, and 542.0116(c). Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.