HB 4371

relating to the provision of services by certain persons in the
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Chapter 531, Government Code, is amended by
adding Subchapter T to read as follows:
SUBCHAPTER T.  COMPLEX CARE AIDE
Sec. 531.801.  DEFINITIONS.  (a)  In this subchapter:
(1)  "Home and community support services agency" means
a person licensed under Chapter 142, Health and Safety Code.
(2)  "Certified complex care aide" means a person who
(A)  the parent, legal guardian, or family member
of a recipient participating in the program;
(B)  certified under the program to assist in
providing certain private duty nursing services; and
(C)  employed by the home and community support
services agency providing services to the recipient.
(3)  "Private duty nursing services" means nursing
services provided under the Texas Health Steps comprehensive care
program to a recipient enrolled in the STAR Kids Medicaid managed
Sec. 531.802.  CERTIFIED COMPLEX CARE AIDE.  The commission
shall develop policies to enable a parent, legal guardian, or
family member of a recipient receiving private duty nursing
services in a home setting to assist in providing those services as
Sec. 531.803.  ELIGIBILITY.  (a)  An individual is eligible
to receive services from a certified complex care aide if:
(A)  enrolled in the STAR Kids Medicaid managed
(B)  eligible to receive private duty nursing
services under the Texas Health Steps comprehensive care program;
(2)  the recipient's parent, legal guardian, or family
member, as defined by commission rule, elects to become a certified
(3)  The recipient's parent, legal guardian, or family
member, completes all required training necessary to be certified
(4)  the home and community support services agency
that employs the professional registered nurses providing private
duty nursing services to the recipient agrees to employ the
recipient's parent, legal guardian, or family member.
Sec. 531.804.  RECIPIENT SCREENING AND NOTIFICATION.  (a)
(1)  add criteria to any screening tool or other
instrument used to conduct an assessment or reassessment of a
recipient under the STAR Kids Medicaid managed care program to
identify recipients who are eligible to participate in the program;
(2)  notify the parent or legally authorized
representative of the recipient of the potential availability of
(b)  The parent or legally authorized representative of
the recipient has the sole choice of whether to utilize the service
Sec. 531.805.  COMPLEX CARE AIDE CERTIFICATION REQUIRED.
(a)  To assist in providing private duty nursing services to a
recipient under the program, a parent, legal guardian, or other
family member of the recipient must be certified as a complex care
aide.  A person seeking certification as a complex care aide must
satisfy all training, testing, and other minimum qualification
standards the commission establishes.
Sec. 531.806.  TRAINING PROGRAM.  (a)  The commission shall
approve family health aide training programs that meet all of the
requirements under 42 CFR 484.80.  The training program must
(10)  medication administration;
(11)  enteral care and therapy;
(12)  administering enteral feedings;
(13)  formula types and preparation; and
(14)  other tasks the commission approves except for
(b)  The home and community support services agency
must also provide ten hours of training in addition to the training
required under (a) regarding tasks and skills specific to the needs
(c)  The home and community support services agency may not
impose a fee on an applicant for the training required by this
Sec. 531.807.  CERTIFICATION RESTRICTED; LIMITED SCOPE OF
PRACTICE.  (a)  A certified complex care aide under this subchapter:
(1)  may only provide complex care services to a
(A)  related to the license holder; and
(B)  enrolled in the program; and
(2)  must be employed by the home and community support
services agency that employs the nurse providing private duty
nursing services to the recipient.
(b)  A certified complex care aide may only provide health
services to a recipient if the services are:
(1)  delegated to the certified complex care aide by
the professional registered nurse providing private duty nursing
(2)  performed under the supervision of that nurse;
(3)  consistent with Texas Board of Nursing rules
governing the delegation of nursing tasks by a registered
professional nurse and federal law and regulations governing the
provision of private duty nursing services under Medicaid,
including 42 C.F.R. Section 440.80 except for tracheostomy care;
(4)  consistent with the recipient's plan of care; and
(5)  authorized by commission rules.
Sec. 531.808.  HOME AND COMMUNITY SUPPORT SERVICES AGENCIES
OUTREACH.  The commission shall:
(1)  provide information about the program to home and
community support services agencies that provide private duty
nursing services under the STAR Kids Medicaid managed care program;
(2)  encourage agencies to employ certified complex
care aides that are qualified to provide services under this
Sec. 531.809.  REIMBURSEMENT FOR CERTIFIED COMPLEX CARE AIDE
SERVICES.  (a)  The commission shall reimburse a home and community
support services agency for services provided to a recipient by a
certified complex care aide under this subchapter at a rate that is
no less than ninety percent of the licensed vocational nurse rate
for private duty nursing services.  The commission shall administer
reimbursement based on billing units.
(b)  A recipient's parent, legal guardian, or family member
is not eligible for reimbursement as a certified complex care aide
(1)  do not meet all of the requirements under 531.806;
(2)  provide more than 40 hours per week of services to an
Sec. 531.811.  RULES.  The executive commissioner shall
adopt rules necessary to implement this subchapter.
SECTION 2.  The commission shall allow the provision of
services by certified complex care aides established under
Subchapter T, Chapter 531, Government Code, as added by this Act,
not later than September 1, 2026.
SECTION 3.  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 4.  This Act takes effect September 1, 2025.