Amend CSSB 1188 (House Committee Printing) by adding the
following appropriately numbered SECTIONS to the bill and
renumbering subsequent SECTIONS of the bill accordingly:
SECTION ____. OFFICE OF MEDICAL TECHNOLOGY. Subchapter A,
Chapter 531, Government Code, is amended by adding Section 531.0081
to read as follows:
Sec. 531.0081. OFFICE OF MEDICAL TECHNOLOGY. (a) In this
section, "office" means the office of medical technology.
(b) The commission shall establish the office of medical
technology within the commission. The office shall explore and
evaluate new developments in medical technology and propose
implementing the technology in the medical assistance program under
Chapter 32, Human Resources Code, if appropriate and
cost-effective.
(c) Office staff must have skills and experience in research
regarding health care technology.
SECTION ____. MEDICAID REIMBURSEMENT RATES. (a) Section
531.021, Government Code, is amended by adding Subsections (f) and
(g) to read as follows:
(f) In adopting rates for medical assistance payments under
Subsection (b)(2), the executive commissioner may adopt
reimbursement rates for appropriate nursing services provided to
recipients with certain health conditions if those services are
determined to provide a cost-effective alternative to
hospitalization. A physician must certify that the nursing
services are medically appropriate for the recipient for those
services to qualify for reimbursement under this subsection.
(g) In adopting rates for medical assistance payments under
Subsection (b)(2), the executive commissioner may adopt
cost-effective reimbursement rates for group appointments with
medical assistance providers for certain diseases and medical
conditions specified by rules of the executive commissioner.
(b) Subchapter B, Chapter 531, Government Code, is amended
by adding Section 531.02175 to read as follows:
Sec. 531.02175. REIMBURSEMENT FOR ONLINE MEDICAL
CONSULTATIONS. (a) In this section, "physician" means a person
licensed to practice medicine in this state under Subtitle B, Title
3, Occupations Code.
(b) Subject to the requirements of this subsection, the
executive commissioner by rule may require the commission and each
health and human services agency that administers a part of the
Medicaid program to provide Medicaid reimbursement for a medical
consultation that is provided by a physician or other health care
professional using the Internet as a cost-effective alternative to
an in-person consultation. The executive commissioner may require
the commission or a health and human services agency to provide the
reimbursement described by this subsection only if the Centers for
Medicare and Medicaid Services develop an appropriate Current
Procedural Terminology code for medical services provided using the
Internet.
(c) The executive commissioner may develop and implement a
pilot program in one or more sites chosen by the executive
commissioner under which Medicaid reimbursements are paid for
medical consultations provided by physicians or other health care
professionals using the Internet. The pilot program must be
designed to test whether an Internet medical consultation is a
cost-effective alternative to an in-person consultation under the
Medicaid program. The executive commissioner may modify the pilot
program as necessary throughout its implementation to maximize the
potential cost-effectiveness of Internet medical consultations.
If the executive commissioner determines from the pilot program
that Internet medical consultations are cost-effective, the
executive commissioner may expand the pilot program to additional
sites or may implement Medicaid reimbursements for Internet medical
consultations statewide.
(d) The executive commissioner is not required to implement
the pilot program authorized under Subsection (c) as a prerequisite
to providing Medicaid reimbursement authorized by Subsection (b) on
a statewide basis.
SECTION ____. HOSPITAL EMERGENCY ROOM USE REDUCTION. (a)
Subchapter B, Chapter 531, Government Code, is amended by adding
Section 531.085 to read as follows:
Sec. 531.085. HOSPITAL EMERGENCY ROOM USE REDUCTION
INITIATIVES. The commission shall develop and implement a
comprehensive plan to reduce the use of hospital emergency room
services by recipients under the medical assistance program. The
plan may include:
(1) a pilot program designed to facilitate program
participants in accessing an appropriate level of health care,
which may include as components:
(A) providing program participants access to
bilingual health services providers; and
(B) giving program participants information on
how to access primary care physicians, advanced practice nurses,
and local health clinics;
(2) a pilot program under which health care providers,
other than hospitals, are given financial incentives for treating
recipients outside of normal business hours to divert those
recipients from hospital emergency rooms;
(3) payment of a nominal referral fee to hospital
emergency rooms that perform an initial medical evaluation of a
recipient and subsequently refer the recipient, if medically
stable, to an appropriate level of health care, such as care
provided by a primary care physician, advanced practice nurse, or
local clinic;
(4) a program under which the commission or a managed
care organization that enters into a contract with the commission
under Chapter 533 contacts, by telephone or mail, a recipient who
accesses a hospital emergency room three times during a six-month
period and provides the recipient with information on ways the
recipient may secure a medical home to avoid unnecessary treatment
at hospital emergency rooms;
(5) a health care literacy program under which the
commission develops partnerships with other state agencies and
private entities to:
(A) assist the commission in developing
materials that:
(i) contain basic health care information
for parents of young children who are recipients under the medical
assistance program and who are participating in public or private
child-care or prekindergarten programs, including federal Head
Start programs; and
(ii) are written in a language
understandable to those parents and specifically tailored to be
applicable to the needs of those parents;
(B) distribute the materials developed under
Paragraph (A) to those parents; and
(C) otherwise teach those parents about the
health care needs of their children and ways to address those needs;
and
(6) other initiatives developed and implemented in
other states that have shown success in reducing the incidence of
unnecessary treatment in hospital emergency rooms.
(b) The Health and Human Services Commission may develop the
health care literacy component of the comprehensive plan to reduce
the use of hospital emergency room services required by Section
531.085(5), Government Code, as added by this section, so that the
health care literacy component operates in a manner similar to the
manner in which the Johnson & Johnson/UCLA Health Care Institute
operates its health care training program that is designed to teach
parents to better address the health care needs of their children.
SECTION ____. PERFORMANCE BONUS PILOT PROGRAM. Subchapter
B, Chapter 531, Government Code, is amended by adding Section
531.086 to read as follows:
Sec. 531.086. PERFORMANCE BONUS PILOT PROGRAM. (a) The
commission shall develop a proposal for providing higher
reimbursement rates to primary care case management providers under
the Medicaid program who treat program recipients with chronic
health conditions in accordance with evidence-based, nationally
accepted best practices and standards of care.
(b) The commission shall define the parameters of the
proposed program, including:
(1) the types of chronic health conditions the program
would target;
(2) the best practices and standards of care that must
be followed for a provider to obtain a higher reimbursement rate
under the proposed program; and
(3) the types of providers to whom the higher
reimbursement rate would be offered under the proposed program.
(c) Not later than December 1, 2006, the Health and Human
Services Commission shall report to the standing committees of the
senate and the house of representatives having primary jurisdiction
over welfare programs regarding the proposed program under this
section. The report must include:
(1) the anticipated effect of the higher reimbursement
rates to be offered under the program on the quality of care
provided and the health outcomes for program recipients;
(2) a determination of whether the program would be
cost-effective; and
(3) a recommendation regarding implementation of the
program.
(d) This section expires September 1, 2007.
SECTION ____. RETURN OF UNUSED DRUGS. Section 562.1085,
Occupations Code, is amended by amending Subsection (a) and adding
Subsection (f) to read as follows:
(a) A pharmacist who practices in or serves as a consultant
for a health care facility in this state may return to a pharmacy
certain unused drugs, other than a controlled substance as defined
by Chapter 481, Health and Safety Code, purchased from the pharmacy
as provided by board rule. The unused drugs must:
(1) be approved by the federal Food and Drug
Administration and be:
(A) sealed in [the manufacturer's original]
unopened tamper-evident packaging and either individually packaged
or packaged in unit-dose packaging;
(B) oral or parenteral medication in sealed
single-dose containers approved by the federal Food and Drug
Administration;
(C) topical or inhalant drugs in sealed
units-of-use containers approved by the federal Food and Drug
Administration; or
(D) parenteral medications in sealed
multiple-dose containers approved by the federal Food and Drug
Administration from which doses have not been withdrawn; and
(2) not be the subject of a mandatory recall by a state
or federal agency or a voluntary recall by a drug seller or
manufacturer.
(f) The tamper-evident packaging required under Subsection
(a)(1) for the return of unused drugs is not required to be the
manufacturer's original packaging unless that packaging is
required by federal law.
SECTION ____. MEDICAID COVERAGE FOR HEALTH INSURANCE
PREMIUMS AND LONG-TERM CARE NEEDS. (a) The Health and Human
Services Commission shall explore the commission's authority under
federal law to offer, and the cost and feasibility of offering:
(1) a stipend paid by the Medicaid program to a person
to cover the cost of a private health insurance plan as an
alternative to providing traditional Medicaid services for the
person;
(2) premium payment assistance through the Medicaid
program for long-term care insurance for a person with a health
condition that increases the likelihood that the person will need
long-term care in the future; and
(3) a long-term care partnership between the Medicaid
program and a person under which the person pays the premiums for
long-term care insurance and the Medicaid program provides
continued coverage after benefits under that insurance are
exhausted.
(b) In exploring the feasibility of the options described by
Subsection (a) of this section, the Health and Human Services
Commission shall consider whether other state incentives that could
encourage persons to purchase health insurance plans or long-term
care insurance are feasible. The incentives may include offering
tax credits to businesses to increase the availability of
affordable insurance.
(c) If the Health and Human Services Commission determines
that any of the options described by Subsection (a) of this section
are feasible and cost-effective, the commission shall make efforts
to implement those options to the extent they are authorized by
federal law. The commission shall request any necessary waivers
from the Centers for Medicare and Medicaid Services as soon as
possible after determining that an option is feasible and
cost-effective. If the commission determines that legislative
changes are necessary to implement an option, the commission shall
report to the 80th Legislature and specify the changes that are
needed.