Relating to the provision of services by certain persons in the private duty nursing program.
HB 4371 creates a new “complex care aide” category within Chapter 531 of the Government Code for certain family members of children or other recipients receiving private duty nursing services through the STAR Kids Medicaid managed care program. The bill allows a parent, legal guardian, or family member of an eligible recipient to be trained, certified, and employed by the home and community support services agency so they can help provide specified nursing-related tasks in the home under the supervision and delegation of a registered nurse. The bill is aimed at recipients who qualify for private duty nursing under the Texas Health Steps comprehensive care program and gives the family member the option to participate, but does not require it.
To participate, the recipient must be enrolled in STAR Kids and eligible for private duty nursing, the family member must complete required training and certification, and the agency employing the nurse must agree to employ the family member as well. The bill directs HHSC to identify potentially eligible recipients during assessments, notify families about the option, approve training programs, and adopt rules to implement the new subchapter. It also requires agencies to provide additional recipient-specific training, prohibits charging applicants for the required training, and limits the scope of services that certified complex care aides may perform, including excluding tracheostomy care.
The bill also establishes reimbursement rules. HHSC must reimburse agencies for certified complex care aide services at a rate no less than 90 percent of the licensed vocational nurse rate for private duty nursing services, with billing based on units. A family member cannot be reimbursed if they do not meet the training and certification requirements or if they provide more than 40 hours per week of services to the recipient. The bill delays implementation until September 1, 2026, and allows state agencies to seek any necessary federal waiver or authorization before implementation.
The overall sentiment reflected in the bill’s progress is favorable, as it was reported favorably as substituted by the House Human Services Committee. The bill appears designed to expand home-based care options and support families caring for medically complex children, while preserving nurse supervision and Medicaid program controls. No committee transcript or recorded vote details were provided, so there is no evidence in the available materials of significant opposition or debate.
The main policy issues likely to draw attention are the scope of tasks family members may perform, the training and certification requirements, reimbursement levels, and the administrative burden on agencies and HHSC. The bill also raises implementation questions tied to federal Medicaid rules and whether the state can secure any needed federal approval for the new service model.
HB 4371 would amend Texas Government Code Chapter 531 by adding a new subchapter authorizing HHSC to establish and regulate certified complex care aides in the STAR Kids Medicaid managed care program. It affects Medicaid administration, home and community support services agencies licensed under Chapter 142 of the Health and Safety Code, and families of recipients who receive private duty nursing services. The bill would require agency employment, nurse delegation and supervision, training standards, screening and notification procedures, and a reimbursement framework for these family-provided services.
The available legislative history suggests a generally positive reception. The bill was reported favorably as substituted by the House Human Services Committee, indicating committee support for the concept. Because there are no transcript excerpts or recorded floor votes in the provided materials, the record does not show specific dissent, but the structure of the bill suggests an effort to balance expanded family caregiving with regulatory safeguards and Medicaid compliance.
The likely points of contention are the extent to which family members should be allowed to perform nursing-related tasks, whether the training and certification requirements are sufficient, and whether reimbursement at 90 percent of the LVN rate is appropriate. Another possible concern is the exclusion of tracheostomy care and the 40-hour weekly limit on reimbursable family services, which may affect families with the highest care needs. Agencies may also be concerned about the need for federal approval, implementation timing, and the operational burden of employing and training family caregivers.