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Amend HB 1218 (Senate committee printing) as follows:
(1) Add the following appropriately numbered SECTIONS to
the bill and renumber subsequent SECTIONS of the bill accordingly:
SECTION ____. CHILD HEALTH PLAN AND MEDICAID PILOT
PROGRAMS. Subchapter B, Chapter 531, Government Code, is amended
by adding Sections 531.0993 and 531.0994 to read as follows:
Sec. 531.0993. OBESITY PREVENTION PILOT PROGRAM. (a) The
commission and the Department of State Health Services shall
coordinate to establish a pilot program designed to:
(1) decrease the rate of obesity in child health plan
program enrollees and Medicaid recipients;
(2) improve the nutritional choices and increase
physical activity levels of child health plan program enrollees and
Medicaid recipients; and
(3) achieve long-term reductions in child health plan
and Medicaid program costs incurred by the state as a result of
obesity.
(b) The commission and the Department of State Health
Services shall implement the pilot program for a period of at least
24 months in one or more health care service regions in this state,
as selected by the commission. In selecting the regions for
participation, the commission shall consider the degree to which
child health plan program enrollees and Medicaid recipients in the
region are at higher than average risk of obesity.
(c) In developing the pilot program, the commission and the
Department of State Health Services in consultation with the Health
Care Quality Advisory Committee established under Section 531.0995
shall identify measurable goals and specific strategies for
achieving those goals. The specific strategies may be
evidence-based to the extent evidence-based strategies are
available for the purposes of the program.
(d) The commission shall submit a report on or before each
November 1 that occurs during the period the pilot program is
operated to the standing committees of the senate and house of
representatives having primary jurisdiction over the child health
plan and Medicaid programs regarding the results of the program. In
addition, the commission shall submit a final report to the
committees regarding those results not later than three months
after the conclusion of the program. Each report must include:
(1) a summary of the identified goals for the program
and the strategies used to achieve those goals;
(2) an analysis of all data collected in the program as
of the end of the period covered by the report and the capability of
the data to measure achievement of the identified goals;
(3) a recommendation regarding the continued
operation of the program; and
(4) a recommendation regarding whether the program
should be implemented statewide.
(e) The executive commissioner may adopt rules to implement
this section.
Sec. 531.0994. MEDICAL HOME FOR CHILD HEALTH PLAN PROGRAM
ENROLLEES AND MEDICAID RECIPIENTS. (a) In this section, "medical
home" means a primary care provider who provides preventive and
primary care to a patient on an ongoing basis and coordinates with
specialists when health care services provided by a specialist are
needed.
(b) The commission shall establish and operate for a period
of at least 24 months a pilot program in one or more health care
service regions in this state designed to establish a medical home
for each child health plan program enrollee and Medicaid recipient
participating in the pilot program. A primary care provider
participating in the program may designate a care coordinator to
support the medical home concept.
(c) The commission shall develop in consultation with the
Health Care Quality Advisory Committee established under Section
531.0995 the pilot program in a manner that:
(1) bases payments made, or incentives provided, to a
participant's medical home on factors that include measurable
wellness and prevention criteria, use of best practices, and
outcomes; and
(2) allows for the examination of measurable wellness
and prevention criteria, use of best practices, and outcomes based
on type of primary care provider.
(d) The commission shall submit a report on or before each
January 1 that occurs during the period the pilot program is
operated to the standing committees of the senate and house of
representatives having primary jurisdiction over the child health
plan and Medicaid programs regarding the status of the pilot
program. Each report must include:
(1) preliminary recommendations regarding the
continued operation of the program or whether the program should be
implemented statewide; or
(2) if the commission cannot make the recommendations
described by Subdivision (1) due to an insufficient amount of data
having been collected at the time of the report, statements
regarding the time frames within which the commission anticipates
collecting sufficient data and making those recommendations.
(e) The commission shall submit a final report to the
committees specified by Subsection (d) regarding the results of the
pilot program not later than three months after the conclusion of
the program. The final report must include:
(1) an analysis of all data collected in the program;
and
(2) a final recommendation regarding whether the
program should be implemented statewide.
SECTION ____. HEALTH CARE QUALITY ADVISORY COMMITTEE.
(a) Subchapter B, Chapter 531, Government Code, is amended by
adding Section 531.0995 to read as follows:
Sec. 531.0995. HEALTH CARE QUALITY ADVISORY COMMITTEE.
(a) The commission shall establish the Health Care Quality
Advisory Committee to assist the commission as specified by
Subsection (e) with defining best practices and quality performance
with respect to health care services and setting standards for
quality performance by health care providers and facilities for
purposes of programs administered by the commission or a health and
human services agency.
(b) The executive commissioner shall appoint the members of
the advisory committee. The committee must consist of:
(1) the following types of health care providers:
(A) a physician from an urban area who has
clinical practice expertise and who may be a pediatrician;
(B) a physician from a rural area who has
clinical practice expertise and who may be a pediatrician; and
(C) a nurse practitioner;
(2) a representative of each of the following types of
health care facilities:
(A) a general acute care hospital; and
(B) a children's hospital;
(3) a representative from a care management
organization;
(4) a member of the Advisory Panel on Health
Care-Associated Infections and Preventable Adverse Events who
meets the qualifications prescribed by Section 98.052(a)(4),
Health and Safety Code; and
(5) a representative of health care consumers.
(c) The credentials of a single member of the advisory
committee may satisfy more than one of the criteria required of the
advisory committee members under Subsection (b).
(d) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(e) The advisory committee shall advise the commission on:
(1) measurable goals for the obesity prevention pilot
program under Section 531.0993;
(2) measurable wellness and prevention criteria and
best practices for the medical home pilot program under Section
531.0994;
(3) quality of care standards, evidence-based
protocols, and measurable goals for quality-based payment
initiatives pilot programs implemented under Subchapter W; and
(4) any other quality of care standards,
evidence-based protocols, measurable goals, or other related
issues with respect to which a law or the executive commissioner
specifies that the committee shall advise.
(b) The executive commissioner of the Health and Human
Services Commission shall appoint the members of the Health Care
Quality Advisory Committee not later than November 1, 2009.
SECTION ____. UNCOMPENSATED HOSPITAL CARE DATA. (a) The
heading to Section 531.551, Government Code, is amended to read as
follows:
Sec. 531.551. UNCOMPENSATED HOSPITAL CARE REPORTING AND
ANALYSIS; HOSPITAL AUDIT FEE.
(b) Section 531.551, Government Code, is amended by
amending Subsections (a) and (d) and adding Subsections (a-1),
(a-2), and (m) to read as follows:
(a) Using data submitted to the Department of State Health
Services under Subsection (a-1), the [The] executive commissioner
shall adopt rules providing for:
(1) a standard definition of "uncompensated hospital
care" that reflects unpaid costs incurred by hospitals and accounts
for actual hospital costs and hospital charges and revenue sources;
(2) a methodology to be used by hospitals in this state
to compute the cost of that care that incorporates the standard set
of adjustments described by Section 531.552(g)(4); and
(3) procedures to be used by those hospitals to report
the cost of that care to the commission and to analyze that cost.
(a-1) To assist the executive commissioner in adopting and
amending the rules required by Subsection (a), the Department of
State Health Services shall require each hospital in this state to
provide to the department, not later than a date specified by the
department, uncompensated hospital care data prescribed by the
commission. Each hospital must submit complete and adequate data,
as determined by the department, not later than the specified date.
(a-2) The Department of State Health Services shall notify
the commission of each hospital in this state that fails to submit
complete and adequate data required by the department under
Subsection (a-1) on or before the date specified by the department.
Notwithstanding any other law and to the extent allowed by federal
law, the commission may withhold Medicaid program reimbursements
owed to the hospital until the hospital complies with the
requirement.
(d) If the commission determines through the procedures
adopted under Subsection (b) that a hospital submitted a report
described by Subsection (a)(3) with incomplete or inaccurate
information, the commission shall notify the hospital of the
specific information the hospital must submit and prescribe a date
by which the hospital must provide that information. If the
hospital fails to submit the specified information on or before the
date prescribed by the commission, the commission shall notify the
attorney general of that failure. On receipt of the notice, the
attorney general shall impose an administrative penalty on the
hospital in an amount not to exceed $10,000. In determining the
amount of the penalty to be imposed, the attorney general shall
consider:
(1) the seriousness of the violation;
(2) whether the hospital had previously committed a
violation; and
(3) the amount necessary to deter the hospital from
committing future violations.
(m) The commission may require each hospital that is
required under 42 C.F.R. Section 455.304 to be audited to pay a fee
to offset the cost of the audit in an amount determined by the
commission. The total amount of fees imposed on hospitals as
authorized by this subsection may not exceed the total cost
incurred by the commission in conducting the required audits of the
hospitals.
(c) As soon as possible after the date the Department of
State Health Services requires each hospital in this state to
initially submit uncompensated hospital care data under Subsection
(a-1), Section 531.551, Government Code, as added by this section,
the executive commissioner of the Health and Human Services
Commission shall adopt rules or amendments to existing rules that
conform to the requirements of Subsection (a), Section 531.551,
Government Code, as amended by this section.
SECTION ____. QUALITY-BASED PAYMENT INITIATIVES.
(a) Chapter 531, Government Code, is amended by adding Subchapter
W to read as follows:
SUBCHAPTER W. QUALITY-BASED PAYMENT INITIATIVES PILOT PROGRAMS FOR
PROVISION OF HEALTH CARE SERVICES
Sec. 531.951. DEFINITIONS. In this subchapter:
(1) "Pay-for-performance payment system" means a
system for compensating a health care provider or facility for
arranging for or providing health care services to child health
plan program enrollees or Medicaid recipients, or both, that is
based on the provider or facility meeting or exceeding certain
defined performance measures. The compensation system may include
sharing realized cost savings with the provider or facility.
(2) "Pilot program" means a quality-based payment
initiatives pilot program established under this subchapter.
Sec. 531.952. PILOT PROGRAM PROPOSALS; DETERMINATION OF
BENEFIT TO STATE. (a) Health care providers and facilities and
disease or care management organizations may submit proposals to
the commission for the implementation through pilot programs of
quality-based payment initiatives that provide incentives to the
providers and facilities, as applicable, to develop health care
interventions for child health plan program enrollees or Medicaid
recipients, or both, that are cost-effective to this state and will
improve the quality of health care provided to the enrollees or
recipients.
(b) The commission shall determine whether it is feasible
and cost-effective to implement one or more of the proposed pilot
programs. In addition, the commission shall examine alternative
payment methodologies used in the Medicare program and consider
whether implementing one or more of the methodologies, modified as
necessary to account for programmatic differences, through a pilot
program under this subchapter would achieve cost savings in the
Medicaid program while ensuring the use of best practices.
Sec. 531.953. PURPOSE AND IMPLEMENTATION OF PILOT PROGRAMS.
(a) If the commission determines under Section 531.952 that
implementation of one or more quality-based payment initiatives
pilot programs is feasible and cost-effective for this state, the
commission shall establish one or more programs as provided by this
subchapter to test pay-for-performance payment system alternatives
to traditional fee-for-service or other payments made to health
care providers or facilities participating in the child health plan
or Medicaid program, as applicable, that are based on best
practices, outcomes, and efficiency, but ensure high-quality,
effective health care services.
(b) The commission shall administer any pilot program
established under this subchapter. The executive commissioner may
adopt rules, plans, and procedures and enter into contracts and
other agreements as the executive commissioner considers
appropriate and necessary to administer this subchapter.
(c) The commission may limit a pilot program to:
(1) one or more regions in this state;
(2) one or more organized networks of health care
facilities and providers; or
(3) specified types of services provided under the
child health plan or Medicaid program, or specified types of
enrollees or recipients under those programs.
(d) A pilot program implemented under this subchapter must
be operated for at least one state fiscal year.
Sec. 531.954. STANDARDS; PROTOCOLS. (a) In consultation
with the Health Care Quality Advisory Committee established under
Section 531.0995, the executive commissioner shall approve quality
of care standards, evidence-based protocols, and measurable goals
for a pilot program to ensure high-quality and effective health
care services.
(b) In addition to the standards approved under Subsection
(a), the executive commissioner may approve efficiency performance
standards that may include the sharing of realized cost savings
with health care providers and facilities that provide health care
services that exceed the efficiency performance standards. The
efficiency performance standards may not create any financial
incentive for or involve making a payment to a health care provider
that directly or indirectly induces the limitation of medically
necessary services.
Sec. 531.955. QUALITY-BASED PAYMENT INITIATIVES. (a) The
executive commissioner may contract with appropriate entities,
including qualified actuaries, to assist in determining
appropriate payment rates for a pilot program implemented under
this subchapter.
(b) The executive commissioner may increase a payment rate,
including a capitation rate, adopted under this section as
necessary to adjust the rate for inflation.
(c) The executive commissioner shall ensure that services
provided to a child health plan program enrollee or Medicaid
recipient, as applicable, meet the quality of care standards
required under this subchapter and are at least equivalent to the
services provided under the child health plan or Medicaid program,
as applicable, for which the enrollee or recipient is eligible.
Sec. 531.956. TERMINATION OF PILOT PROGRAM; EXPIRATION OF
SUBCHAPTER. The pilot program terminates and this subchapter
expires September 2, 2013.
(b) Not later than November 1, 2012, the Health and Human
Services Commission shall present a report to the governor, the
lieutenant governor, the speaker of the house of representatives,
and the members of each legislative committee having jurisdiction
over the child health plan and Medicaid programs. For each pilot
program implemented under Subchapter W, Chapter 531, Government
Code, as added by this section, the report must:
(1) describe the operation of the pilot program;
(2) analyze the quality of health care provided to
patients under the pilot program;
(3) compare the per-patient cost under the pilot
program to the per-patient cost of the traditional fee-for-service
or other payments made under the child health plan and Medicaid
programs; and
(4) make recommendations regarding the continuation
or expansion of the pilot program.
SECTION ____. QUALITY-BASED HOSPITAL PAYMENTS. Chapter
531, Government Code, is amended by adding Subchapter X to read as
follows:
SUBCHAPTER X. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
Sec. 531.981. DEFINITIONS. In this subchapter:
(1) "DRG methodology" means a diagnoses-related
groups methodology.
(2) "Potentially preventable complication" means a
harmful event or negative outcome with respect to a person,
including an infection or surgical complication, that:
(A) occurs after the person's admission to a
hospital;
(B) results from the care or treatment provided
during the hospital stay rather than from a natural progression of
an underlying disease; and
(C) could reasonably have been prevented if care
and treatment had been provided in accordance with accepted
standards of care.
(3) "Potentially preventable readmission" means a
return hospitalization of a person within a period specified by the
commission that results from deficiencies in the care or treatment
provided to the person during a previous hospital stay or from
deficiencies in post-hospital discharge follow-up. The term does
not include a hospital readmission necessitated by the occurrence
of unrelated events after the discharge. The term includes the
readmission of a person to a hospital for:
(A) the same condition or procedure for which the
person was previously admitted;
(B) an infection or other complication resulting
from care previously provided;
(C) a condition or procedure that indicates that
a surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
(D) another condition or procedure of a similar
nature, as determined by the executive commissioner.
Sec. 531.982. DEVELOPMENT OF QUALITY-BASED HOSPITAL
REIMBURSEMENT SYSTEM. (a) Subject to Subsection (b), the
commission shall develop a quality-based hospital reimbursement
system for paying Medicaid reimbursements to hospitals. The system
is intended to align Medicaid provider payment incentives with
improved quality of care, promote coordination of health care, and
reduce potentially preventable complications and readmissions.
(b) The commission shall develop the quality-based hospital
reimbursement system in phases as provided by this subchapter. To
the extent possible, the commission shall coordinate the timeline
for the development and implementation with the implementation of
the Medicaid Information Technology Architecture (MITA) initiative
of the Center for Medicaid and State Operations and the ICD-10 code
sets initiative and with the ongoing Enterprise Data Warehouse
(EDW) planning process to maximize receipt of federal funds.
Sec. 531.983. PHASE ONE: COLLECTION AND REPORTING OF
CERTAIN INFORMATION. (a) The first phase of the development of
the quality-based hospital reimbursement system consists of the
elements described by this section.
(b) The executive commissioner shall adopt rules for
identifying potentially preventable readmissions of Medicaid
recipients and the commission shall collect data on
present-on-admission indicators for purposes of this section.
(c) The commission shall establish a program to provide a
confidential report to each hospital in this state regarding the
hospital's performance with respect to potentially preventable
readmissions. A hospital shall provide the information contained
in the report provided to the hospital to health care providers
providing services at the hospital.
(d) After the commission provides the reports to hospitals
as provided by Subsection (c), each hospital will be afforded a
period of two years during which the hospital may adjust its
practices in an attempt to reduce its potentially preventable
readmissions. During this period, reimbursements paid to the
hospital may not be adjusted on the basis of potentially
preventable readmissions.
(e) The commission shall convert hospitals that are
reimbursed using a DRG methodology to a DRG methodology that will
allow the commission to more accurately classify specific patient
populations and account for severity of patient illness and
mortality risk. For purposes of hospitals that are not reimbursed
using a DRG methodology, the commission may modify data collection
requirements to allow the commission to more accurately classify
specific patient populations and account for severity of patient
illness and mortality risk.
Sec. 531.984. PHASE TWO: REIMBURSEMENT ADJUSTMENTS. (a)
The second phase of the development of the quality-based hospital
reimbursement system consists of the elements described by this
section and must be based on the information reported, data
collected, and DRG methodology implemented during phase one of the
development.
(b) Using the information reported by hospitals that are not
reimbursed using a DRG methodology during phase one of the
development of the quality-based hospital reimbursement system,
and using the DRG methodology for hospitals that are reimbursed
using the DRG methodology implemented during that phase, the
commission shall adjust Medicaid reimbursements to hospitals based
on performance in reducing potentially preventable readmissions.
An adjustment:
(1) may not be applied to a hospital if the patient's
readmission to that hospital is classified as a potentially
preventable readmission, but that hospital is not the same hospital
to which the person was previously admitted; and
(2) must be focused on addressing potentially
preventable readmissions that are continuing, significant
problems, as determined by the commission.
Sec. 531.985. PHASE THREE: STUDY OF POTENTIALLY
PREVENTABLE COMPLICATIONS. (a) In phase three of the development
of the quality-based hospital reimbursement system, the executive
commissioner shall adopt rules for identifying potentially
preventable complications and the commission shall study the
feasibility of:
(1) collecting data from hospitals concerning
potentially preventable complications;
(2) adjusting Medicaid reimbursements based on
performance in reducing those complications; and
(3) developing reconsideration review processes that
provide basic due process in challenging a reimbursement adjustment
described by Subdivision (2).
(b) The commission shall provide a report to the standing
committees of the senate and house of representatives having
primary jurisdiction over the Medicaid program concerning the
results of the study conducted under this section when the study is
completed.
(c) Rules adopted by the executive commissioner regarding
potentially preventable complications are not admissible in a civil
action for purposes of establishing a standard of care applicable
to a physician.
SECTION ____. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
Subchapter B, Chapter 32, Human Resources Code, is amended by
adding Section 32.0424 to read as follows:
Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
(a) A third-party health insurer is required to provide to the
department, on the department's request, information in a form
prescribed by the department necessary to determine:
(1) the period during which an individual entitled to
medical assistance, the individual's spouse, or the individual's
dependents may be, or may have been, covered by coverage issued by
the health insurer;
(2) the nature of the coverage; and
(3) the name, address, and identifying number of the
health plan under which the person may be, or may have been,
covered.
(b) A third-party health insurer shall accept the state's
right of recovery and the assignment under Section 32.033 to the
state of any right of an individual or other entity to payment from
the third-party health insurer for an item or service for which
payment was made under the medical assistance program.
(c) A third-party health insurer shall respond to any
inquiry by the department regarding a claim for payment for any
health care item or service reimbursed by the department under the
medical assistance program not later than the third anniversary of
the date the health care item or service was provided.
(d) A third-party health insurer may not deny a claim
submitted by the department or the department's designee for which
payment was made under the medical assistance program solely on the
basis of the date of submission of the claim, the type or format of
the claim form, or a failure to present proper documentation at the
point of service that is the basis of the claim, if:
(1) the claim is submitted by the department or the
department's designee not later than the third anniversary of the
date the item or service was provided; and
(2) any action by the department or the department's
designee to enforce the state's rights with respect to the claim is
commenced not later than the sixth anniversary of the date the
department or the department's designee submits the claim.
(e) This section does not limit the scope or amount of
information required by Section 32.042.
SECTION ____. PREVENTABLE ADVERSE EVENT REPORTING.
(a) The heading to Chapter 98, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
PREVENTABLE ADVERSE EVENTS
(b) Subdivisions (1) and (11), Section 98.001, Health and
Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, are amended to read as follows:
(1) "Advisory panel" means the Advisory Panel on
Health Care-Associated Infections and Preventable Adverse Events.
(11) "Reporting system" means the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System.
(c) Section 98.051, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.051. ESTABLISHMENT. The commissioner shall
establish the Advisory Panel on Health Care-Associated Infections
and Preventable Adverse Events within [the infectious disease
surveillance and epidemiology branch of] the department to guide
the implementation, development, maintenance, and evaluation of
the reporting system. The commissioner may establish one or more
subcommittees to assist the advisory panel in addressing health
care-associated infections and preventable adverse events relating
to hospital care provided to children or other special patient
populations.
(d) Subsection (a), Section 98.052, Health and Safety Code,
as added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, is amended to read as follows:
(a) The advisory panel is composed of 18 [16] members as
follows:
(1) two infection control professionals who:
(A) are certified by the Certification Board of
Infection Control and Epidemiology; and
(B) are practicing in hospitals in this state, at
least one of which must be a rural hospital;
(2) two infection control professionals who:
(A) are certified by the Certification Board of
Infection Control and Epidemiology; and
(B) are nurses licensed to engage in professional
nursing under Chapter 301, Occupations Code;
(3) three board-certified or board-eligible
physicians who:
(A) are licensed to practice medicine in this
state under Chapter 155, Occupations Code, at least two of whom have
active medical staff privileges at a hospital in this state and at
least one of whom is a pediatric infectious disease physician with
expertise and experience in pediatric health care epidemiology;
(B) are active members of the Society for
Healthcare Epidemiology of America; and
(C) have demonstrated expertise in quality
assessment and performance improvement or infection control in
health care facilities;
(4) four additional [two] professionals in quality
assessment and performance improvement[, one of whom is employed by
a general hospital and one of whom is employed by an ambulatory
surgical center];
(5) one officer of a general hospital;
(6) one officer of an ambulatory surgical center;
(7) three nonvoting members who are department
employees representing the department in epidemiology and the
licensing of hospitals or ambulatory surgical centers; and
(8) two members who represent the public as consumers.
(e) Subsections (a) and (c), Section 98.102, Health and
Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, are amended to read as follows:
(a) The department shall establish the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System within the [infectious disease surveillance and
epidemiology branch of the] department. The purpose of the
reporting system is to provide for:
(1) the reporting of health care-associated
infections by health care facilities to the department;
(2) the reporting of health care-associated
preventable adverse events by health care facilities to the
department;
(3) the public reporting of information regarding the
health care-associated infections by the department;
(4) the public reporting of information regarding
health care-associated preventable adverse events by the
department; and
(5) [(3)] the education and training of health care
facility staff by the department regarding this chapter.
(c) The data reported by health care facilities to the
department must contain sufficient patient identifying information
to:
(1) avoid duplicate submission of records;
(2) allow the department to verify the accuracy and
completeness of the data reported; and
(3) for data reported under Section 98.103 or 98.104,
allow the department to risk adjust the facilities' infection
rates.
(f) Subchapter C, Chapter 98, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, is amended by adding Section 98.1045 to read
as follows:
Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS.
(a) Each health care facility shall report to the department the
occurrence of any of the following preventable adverse events
involving the facility's patient:
(1) a health care-associated adverse condition or
event for which the Medicare program will not provide additional
payment to the facility under a policy adopted by the federal
Centers for Medicare and Medicaid Services; and
(2) subject to Subsection (b), an event included in
the list of adverse events identified by the National Quality Forum
that is not included under Subdivision (1).
(b) The executive commissioner may exclude an adverse event
described by Subsection (a)(2) from the reporting requirement of
Subsection (a) if the executive commissioner, in consultation with
the advisory panel, determines that the adverse event is not an
appropriate indicator of a preventable adverse event.
(g) Subsections (a), (b), and (g), Section 98.106, Health
and Safety Code, as added by Chapter 359 (S.B. 288), Acts of the
80th Legislature, Regular Session, 2007, are amended to read as
follows:
(a) The department shall compile and make available to the
public a summary, by health care facility, of:
(1) the infections reported by facilities under
Sections 98.103 and 98.104; and
(2) the preventable adverse events reported by
facilities under Section 98.1045.
(b) Information included in the [The] departmental summary
with respect to infections reported by facilities under Sections
98.103 and 98.104 must be risk adjusted and include a comparison of
the risk-adjusted infection rates for each health care facility in
this state that is required to submit a report under Sections 98.103
and 98.104.
(g) The department shall make the departmental summary
available on an Internet website administered by the department and
may make the summary available through other formats accessible to
the public. The website must contain a statement informing the
public of the option to report suspected health care-associated
infections and preventable adverse events to the department.
(h) Section 98.108, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.108. FREQUENCY OF REPORTING. In consultation with
the advisory panel, the executive commissioner by rule shall
establish the frequency of reporting by health care facilities
required under Sections 98.103, [and] 98.104, and 98.1045.
Facilities may not be required to report more frequently than
quarterly.
(i) Section 98.109, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended by adding Subsection (b-1) and amending
Subsection (e) to read as follows:
(b-1) A state employee or officer may not be examined in a
civil, criminal, or special proceeding, or any other proceeding,
regarding the existence or contents of information or materials
obtained, compiled, or reported by the department under this
chapter.
(e) A department summary or disclosure may not contain
information identifying a [facility] patient, employee,
contractor, volunteer, consultant, health care professional,
student, or trainee in connection with a specific [infection]
incident.
(j) Sections 98.110 and 98.111, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, are amended to read as follows:
Sec. 98.110. DISCLOSURE AMONG CERTAIN AGENCIES [WITHIN
DEPARTMENT]. Notwithstanding any other law, the department may
disclose information reported by health care facilities under
Section 98.103, [or] 98.104, or 98.1045 to other programs within
the department, to the Health and Human Services Commission, and to
other health and human services agencies, as defined by Section
531.001, Government Code, for public health research or analysis
purposes only, provided that the research or analysis relates to
health care-associated infections or preventable adverse events.
The privilege and confidentiality provisions contained in this
chapter apply to such disclosures.
Sec. 98.111. CIVIL ACTION. Published infection rates or
preventable adverse events may not be used in a civil action to
establish a standard of care applicable to a health care facility.
(k) As soon as possible after the effective date of this
Act, the commissioner of state health services shall appoint two
additional members to the advisory panel who meet the
qualifications prescribed by Subdivision (4), Subsection (a),
Section 98.052, Health and Safety Code, as amended by this section.
(l) Not later than February 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt rules and procedures necessary to implement the reporting of
health care-associated preventable adverse events as required
under Chapter 98, Health and Safety Code, as amended by this
section.
SECTION ____. PREVENTABLE ADVERSE EVENT REIMBURSEMENT.
(a) Subchapter B, Chapter 32, Human Resources Code, is amended by
adding Section 32.0312 to read as follows:
Sec. 32.0312. REIMBURSEMENT FOR SERVICES ASSOCIATED WITH
PREVENTABLE ADVERSE EVENTS. The executive commissioner of the
Health and Human Services Commission shall adopt rules regarding
the denial or reduction of reimbursement under the medical
assistance program for preventable adverse events that occur in a
hospital setting. In adopting the rules, the executive
commissioner:
(1) shall ensure that the commission imposes the same
reimbursement denials or reductions for preventable adverse events
as the Medicare program imposes for the same types of health
care-associated adverse conditions and the same types of health
care providers and facilities under a policy adopted by the federal
Centers for Medicare and Medicaid Services;
(2) shall consult with the Health Care Quality
Advisory Committee established under Section 531.0995, Government
Code, to obtain the advice of that committee regarding denial or
reduction of reimbursement claims for any other preventable adverse
events that cause patient death or serious disability in health
care settings, including events on the list of adverse events
identified by the National Quality Forum; and
(3) may allow the commission to impose reimbursement
denials or reductions for preventable adverse events described by
Subdivision (2).
(b) Not later than September 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt the rules required by Section 32.0312, Human Resources Code,
as added by this section.
(c) Rules adopted by the executive commissioner of the
Health and Human Services Commission under Section 32.0312, Human
Resources Code, as added by this section, may apply only to a
preventable adverse event occurring on or after the effective date
of the rules.
SECTION ____. PATIENT RISK IDENTIFICATION SYSTEM.
Subchapter A, Chapter 311, Health and Safety Code, is amended by
adding Section 311.004 to read as follows:
Sec. 311.004. STANDARDIZED PATIENT RISK IDENTIFICATION
SYSTEM. (a) In this section:
(1) "Department" means the Department of State Health
Services.
(2) "Hospital" means a general or special hospital as
defined by Section 241.003. The term includes a hospital
maintained or operated by this state.
(b) The department shall coordinate with hospitals to
develop a statewide standardized patient risk identification
system under which a patient with a specific medical risk may be
readily identified through the use of a system that communicates to
hospital personnel the existence of that risk. The executive
commissioner of the Health and Human Services Commission shall
appoint an ad hoc committee of hospital representatives to assist
the department in developing the statewide system.
(c) The department shall require each hospital to implement
and enforce the statewide standardized patient risk identification
system developed under Subsection (b) unless the department
authorizes an exemption for the reason stated in Subsection (d).
(d) The department may exempt from the statewide
standardized patient risk identification system a hospital that
seeks to adopt another patient risk identification methodology
supported by evidence-based protocols for the practice of medicine.
(e) The department shall modify the statewide standardized
patient risk identification system in accordance with
evidence-based medicine as necessary.
(f) The executive commissioner of the Health and Human
Services Commission may adopt rules to implement this section.
(2) Strike SECTION 5 of the bill (page 2, lines 18 through
22) and substitute the following appropriately numbered SECTION:
SECTION ____. This Act takes effect September 1, 2009.