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.