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A BILL TO BE ENTITLED
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AN ACT
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relating to including certain performance measures and incentives |
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in certain Medicaid managed care contracts. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0051 to read as follows: |
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Sec. 533.0051. PERFORMANCE MEASURES AND INCENTIVES FOR |
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VALUE-BASED CONTRACTS. (a) The commission shall establish |
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outcome-based performance measures and incentives to include in |
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each contract between a health maintenance organization and the |
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commission for the provision of health care services to recipients |
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that is procured and managed under a value-based purchasing model. |
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The performance measures and incentives must be designed to |
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facilitate and increase recipients' access to appropriate health |
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care services. |
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(b) Subject to Subsection (c), the commission shall include |
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the performance measures and incentives established under |
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Subsection (a) in each contract described by that subsection in |
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addition to all other contract provisions required by this chapter. |
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(c) The commission may use a graduated approach to including |
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the performance measures and incentives established under |
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Subsection (a) in contracts described by that subsection to ensure |
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incremental and continued improvements over time. |
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(d) The commission shall assess the feasibility and |
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cost-effectiveness of including provisions in a contract described |
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by Subsection (a) that require the health maintenance organization |
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to provide to the providers in the organization's provider network |
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pay-for-performance opportunities that support quality |
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improvements in the care of Medicaid recipients. If the commission |
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determines that the provisions are feasible and may be |
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cost-effective, the commission shall develop and implement a pilot |
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program in at least one health care service region under which the |
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commission will include the provisions in contracts with health |
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maintenance organizations offering managed care plans in the |
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region. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2007. |