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A BILL TO BE ENTITLED
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AN ACT
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relating to the implementation of a quality improvement initiative |
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in the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.077 to read as follows: |
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Sec. 32.077. IMPLEMENTATION OF QUALITY IMPROVEMENT |
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INITIATIVE. (a) In this section, "commission" means the Health and |
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Human Services Commission. |
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(b) The commission may implement a quality improvement |
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initiative in the medical assistance program designed to improve |
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the quality of care provided to medical assistance recipients. |
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Subject to Subsections (c) and (d), the initiative may consist of |
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one or more of the following quality improvement strategies not |
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implemented under other law: |
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(1) establishing a disease management outcomes |
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measurement system that measures improvements in outcomes |
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experienced by recipients with chronic diseases specified by the |
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commission, including diabetes and asthma; |
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(2) establishing a pay-for-performance reimbursement |
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system for acute care services and long-term care services provided |
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by nursing facilities under the program, provided that the system |
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complies with Subsection (e); |
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(3) expanding the use of evidence-based standards of |
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care in the program; and |
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(4) developing the use of a medical home through which |
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a primary care physician provides preventive and primary care |
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services on an ongoing basis to a recipient and coordinates with |
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specialists when health care services provided by a specialist are |
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needed. |
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(c) Before implementing a quality improvement strategy |
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under Subsection (b), the commission shall: |
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(1) study the cost-effectiveness of implementing that |
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strategy; |
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(2) assess whether the implementation is anticipated |
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to have a positive effect on the quality of care provided to medical |
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assistance recipients; and |
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(3) determine whether the implementation would: |
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(A) be consistent with federal law; and |
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(B) require a waiver or authorization from a |
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federal agency. |
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(d) A quality improvement strategy may not be implemented |
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under Subsection (b) unless: |
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(1) based on the study and assessment conducted under |
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Subsection (c), the commission anticipates that the strategy will |
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be cost-effective and positively affect quality of care; and |
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(2) the commission obtains any necessary waiver or |
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authorization identified under Subsection (c)(3) from a federal |
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agency. |
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(e) A pay-for-performance reimbursement system implemented |
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under Subsection (b)(2) must be based on a pilot project developed |
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by the federal Centers for Medicare and Medicaid Services and use |
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alternative reimbursement methods that are designed to reward the |
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provision of efficient, quality services resulting in successful |
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health outcomes. The system must be data-driven, |
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recipient-centered, and transparent, but may not impose |
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significant additional administrative burdens on medical |
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assistance providers. |
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(f) To develop evidence-based standards of care for |
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implementation under Subsection (b)(3), the commission shall study |
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the use of performance measures in other states and determine |
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whether adopting similar standards, and corresponding incentives |
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for meeting or exceeding those standards, will improve health care |
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outcomes under the medical assistance program. |
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(g) To develop a medical home model for implementation under |
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Subsection (b)(4), the commission shall examine policies and |
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practices in other states relating to the use of a medical home |
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under those states' medical assistance programs and determine |
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whether similar policies and practices could be effectively |
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implemented in this state. |
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SECTION 2. This Act takes effect September 1, 2009. |