81R10180 KFF-D

By: Davis of Harris H.B. No. 2197

A BILL TO BE ENTITLED

AN ACT

relating to the implementation of a quality improvement initiative in the Medicaid program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 32, Human Resources Code, is amended by adding Section 32.077 to read as follows:

Sec. 32.077. IMPLEMENTATION OF QUALITY IMPROVEMENT INITIATIVE. (a) In this section, "commission" means the Health and Human Services Commission.

(b) The commission may implement a quality improvement initiative in the medical assistance program designed to improve the quality of care provided to medical assistance recipients. Subject to Subsections (c) and (d), the initiative may consist of one or more of the following quality improvement strategies not implemented under other law:

(1) establishing a disease management outcomes measurement system that measures improvements in outcomes experienced by recipients with chronic diseases specified by the commission, including diabetes and asthma;

(2) establishing a pay-for-performance reimbursement system for acute care services and long-term care services provided by nursing facilities under the program, provided that the system complies with Subsection (e);

(3) expanding the use of evidence-based standards of care in the program; and

(4) developing the use of a medical home through which a primary care physician provides preventive and primary care services on an ongoing basis to a recipient and coordinates with specialists when health care services provided by a specialist are needed.

(c) Before implementing a quality improvement strategy under Subsection (b), the commission shall:

(1) study the cost-effectiveness of implementing that strategy;

(2) assess whether the implementation is anticipated to have a positive effect on the quality of care provided to medical assistance recipients; and

(3) determine whether the implementation would:

(A) be consistent with federal law; and

(B) require a waiver or authorization from a federal agency.

(d) A quality improvement strategy may not be implemented under Subsection (b) unless:

(1) based on the study and assessment conducted under Subsection (c), the commission anticipates that the strategy will be cost-effective and positively affect quality of care; and

(2) the commission obtains any necessary waiver or authorization identified under Subsection (c)(3) from a federal agency.

(e) A pay-for-performance reimbursement system implemented under Subsection (b)(2) must be based on a pilot project developed by the federal Centers for Medicare and Medicaid Services and use alternative reimbursement methods that are designed to reward the provision of efficient, quality services resulting in successful health outcomes. The system must be data-driven, recipient-centered, and transparent, but may not impose significant additional administrative burdens on medical assistance providers.

(f) To develop evidence-based standards of care for implementation under Subsection (b)(3), the commission shall study the use of performance measures in other states and determine whether adopting similar standards, and corresponding incentives for meeting or exceeding those standards, will improve health care outcomes under the medical assistance program.

(g) To develop a medical home model for implementation under Subsection (b)(4), the commission shall examine policies and practices in other states relating to the use of a medical home under those states' medical assistance programs and determine whether similar policies and practices could be effectively implemented in this state.

SECTION 2. This Act takes effect September 1, 2009.