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A BILL TO BE ENTITLED
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AN ACT
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relating to the administration, powers, and duties of the Texas |
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Health Services Authority. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 182.001, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 182.001. PURPOSE. This chapter establishes the Texas |
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Health Services Authority as a public-private collaborative to: |
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(1) implement the state-level health information |
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technology functions identified by the Texas Health Information |
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Technology Advisory Committee by serving as a catalyst for the |
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development of a seamless electronic health information |
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infrastructure to support the health care system in the state and to |
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improve patient safety and quality of care; and |
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(2) make recommendations to improve the quality of |
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health care funded by both public and private payors and to increase |
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accountability and transparency. |
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SECTION 2. Section 182.002, Health and Safety Code, is |
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amended by amending Subdivision (5) and adding Subdivisions (1-a), |
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(3-a), (3-b), and (3-c) to read as follows: |
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(1-a) "Clinical integration" means a network of health |
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care practitioners implementing an active and ongoing program to |
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evaluate and modify practice patterns by the network's participants |
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and create a high degree of interdependence and cooperation to |
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control costs and ensure quality. |
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(3-a) "Global payments" means compensation paid to a |
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health care practitioner or a health care facility for providing or |
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arranging a defined set of covered health care services to |
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participating persons for a specific period. The amount of |
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compensation is based on a predetermined payment for each person |
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for that period regardless of the specific services actually |
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provided to persons in that period. |
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(3-b) "Health care facility" means a hospital, |
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emergency clinic, outpatient clinic, birthing center, ambulatory |
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surgical center, or other facility providing health care services. |
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(3-c) "Health care practitioner" means an individual |
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who is licensed or otherwise authorized to provide health care |
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services in this state. |
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(5) "Payor" ["Physician"] means: |
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(A) an insurer that writes health insurance |
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policies [an individual licensed to practice medicine in this state
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under the authority of Subtitle B, Title 3, Occupations Code]; |
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(B) a preferred provider organization, health |
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maintenance organization, or self-insurance plan [a professional
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entity organized in conformity with Title 7, Business Organizations
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Code, and permitted to practice medicine under Subtitle B, Title 3,
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Occupations Code]; or |
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(C) any other person that provides, offers to |
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provide, or administers hospital, outpatient, medical, or other |
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health benefits to a person treated by a health care practitioner |
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under a policy, plan, or contract [a partnership organized in
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conformity with Title 4, Business Organizations Code, composed
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entirely of individuals licensed to practice medicine under
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Subtitle B, Title 3, Occupations Code;
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[(D)
an approved nonprofit health corporation
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certified under Chapter 162, Occupations Code;
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[(E)
a medical school or medical and dental unit,
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as defined or described by Section 61.003, 61.501, or 74.601,
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Education Code, that employs or contracts with physicians to teach
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or provide medical services or employs physicians and contracts
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with physicians in a practice plan; or
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[(F)
an entity wholly owned by individuals
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licensed to practice medicine under Subtitle B, Title 3,
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Occupations Code]. |
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SECTION 3. Section 182.051(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) The corporation is established to: |
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(1) promote, implement, and facilitate the voluntary |
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and secure electronic exchange of health information[;] and |
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[(2)] create incentives to promote, implement, and |
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facilitate the voluntary and secure electronic exchange of health |
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information; and |
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(2) research, develop, support, and promote |
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recommended strategies to improve the quality of health care in |
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this state and to increase accountability and transparency through |
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voluntary implementation of the recommendations by health care |
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practitioners, health care facilities, and payors, including |
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recommendations for: |
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(A) best practice standards for health care |
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facilities and health care practitioners; |
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(B) performance measures for health care |
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practitioners; |
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(C) improved payment methodologies for payors; |
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and |
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(D) streamlined administrative processes. |
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SECTION 4. Sections 182.053(a), (b), and (c), Health and |
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Safety Code, are amended to read as follows: |
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(a) The corporation is governed by a board of 15 [11] |
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directors appointed as follows: |
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(1) five members appointed by the governor; |
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(2) five members appointed by the governor from a list |
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of candidates prepared by the speaker of the house of |
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representatives; and |
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(3) five members appointed by the lieutenant governor |
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[, with the advice and consent of the senate]. |
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(b) The following [governor shall also appoint at least two] |
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ex officio, nonvoting members also serve on the board: |
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(1) at least two persons representing the Department |
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of State Health Services, appointed by the governor; |
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(2) the executive commissioner of the Health and Human |
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Services Commission; |
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(3) the commissioner of insurance; |
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(4) the executive director of the Employees Retirement |
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System of Texas; |
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(5) the executive director of the Teacher Retirement |
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System of Texas; and |
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(6) the state Medicaid director of the Health and |
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Human Services Commission. |
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(c) The governor and lieutenant governor shall appoint as |
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voting board members individuals who represent consumers, clinical |
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laboratories, health benefit plans, hospitals, regional health |
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information exchange initiatives, pharmacies, physicians, or rural |
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health providers, or who possess expertise in any other area the |
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governor or lieutenant governor finds necessary for the successful |
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operation of the corporation. |
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SECTION 5. Section 182.054, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 182.054. TERMS OF OFFICE. Appointed members of the |
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board serve two-year terms and may continue to serve until a |
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successor has been appointed by the appropriate appointing |
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authority [governor]. |
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SECTION 6. Section 182.101, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 182.101. GENERAL POWERS AND DUTIES. (a) The |
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corporation may: |
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(1) establish statewide health information exchange |
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capabilities, including capabilities for electronic laboratory |
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results, diagnostic studies, and medication history delivery, and, |
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where applicable, promote definitions and standards for electronic |
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interactions statewide; |
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(2) seek funding to: |
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(A) implement, promote, and facilitate the |
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voluntary exchange of secure electronic health information between |
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and among individuals and entities that are providing or paying for |
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health care services or procedures; and |
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(B) create incentives to implement, promote, and |
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facilitate the voluntary exchange of secure electronic health |
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information between and among individuals and entities that are |
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providing or paying for health care services or procedures; |
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(3) establish statewide health information exchange |
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capabilities for streamlining health care administrative functions |
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including: |
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(A) communicating point of care services, |
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including laboratory results, diagnostic imaging, and prescription |
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histories; |
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(B) communicating patient identification and |
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emergency room required information in conformity with state and |
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federal privacy laws; |
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(C) real-time communication of enrollee status |
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in relation to health plan coverage, including enrollee |
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cost-sharing responsibilities; and |
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(D) current census and status of health plan |
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contracted providers; |
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(4) support regional health information exchange |
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initiatives by: |
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(A) identifying data and messaging standards for |
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health information exchange; |
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(B) administering programs providing financial |
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incentives, including grants and loans for the creation and support |
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of regional health information networks, subject to available |
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funds; |
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(C) providing technical expertise where |
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appropriate; |
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(D) sharing intellectual property developed |
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under Section 182.105; |
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(E) waiving the corporation's fees associated |
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with intellectual property, data, expertise, and other services or |
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materials provided to regional health information exchanges |
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operated on a nonprofit basis; and |
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(F) applying operational and technical standards |
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developed by the corporation to existing health information |
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exchanges only on a voluntary basis, except for standards related |
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to ensuring effective privacy and security of individually |
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identifiable health information; and |
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(5) [identify standards for streamlining health care
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administrative functions across payors and providers, including
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electronic patient registration, communication of enrollment in
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health plans, and information at the point of care regarding
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services covered by health plans; and
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[(6)] support the secure, electronic exchange of |
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health information through other strategies identified by the |
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board. |
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(b) The corporation shall research, develop, support, and |
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promote: |
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(1) best practice standards for health care |
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practitioners and health care facilities; |
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(2) strategies to require or encourage adherence to |
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best practice standards, including providing health care |
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practitioners and health care facilities with the support tools and |
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information necessary to promote adherence to best practice |
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standards; |
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(3) performance measures that may be used to evaluate |
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the quality of care that a patient receives from a health care |
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practitioner or at a health care facility; |
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(4) standards for reporting the results of performance |
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measures under Subdivision (3), comparing health care |
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practitioners and health care facilities based on the performance |
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measures, and sharing this information among health care |
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practitioners, health care facilities, and payors; |
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(5) recommendations for disseminating the results of |
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the performance measures under Subdivision (3) to the public; |
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(6) standards for technology to collect information to |
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measure medical outcomes, quality of care, and adherence to best |
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practice standards; |
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(7) strategies for use of existing resources that are |
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available for the exchange of health care information; |
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(8) strategies for use by the state to facilitate the |
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exchange of health care information, the interoperability of |
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different information storage and transmission systems, and the |
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standardization of health care information in the system; |
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(9) recommendations to encourage clinical integration |
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and collaboration of health care practitioners to control costs and |
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improve quality; |
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(10) alternative payment methodologies for payors of |
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health care practitioners and health care facilities that improve |
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efficiency and promote a higher quality of patient care and the use |
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of best practices, including: |
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(A) bundling payments for episodes of care and |
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using global payments to health care practitioners and health care |
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facilities; |
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(B) replacing payment methodologies that are |
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based on number of patients seen or procedures performed; and |
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(C) promoting the use of new payment |
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methodologies by both public and private payors; |
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(11) standards for streamlining health care |
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administrative functions across payors, health care practitioners, |
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and health care facilities, including electronic patient |
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registration, communication of enrollment in health plans, and |
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information at the point of care regarding services covered by |
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health plans; and |
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(12) recommendations for streamlining health care |
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administrative functions, including: |
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(A) communicating point of care services, |
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including laboratory results, diagnostic imaging, and prescription |
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histories; |
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(B) communicating patient identification and |
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emergency room required information in conformity with state and |
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federal privacy laws; |
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(C) real-time communication of enrollee status |
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in relation to health plan coverage, including enrollee |
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cost-sharing responsibilities; and |
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(D) current census and status of health plan |
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contracted health care practitioners and health care facilities. |
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SECTION 7. Subchapter C, Chapter 182, Health and Safety |
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Code, is amended by adding Section 182.1015 to read as follows: |
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Sec. 182.1015. STUDIES ON PAYMENT METHODOLOGIES. (a) The |
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corporation shall conduct a study or contract for a study to be |
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conducted to develop payment incentives to increase access to |
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primary care. The study must evaluate proposals for changes to |
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payment methodologies for implementation by multiple public and |
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private payors and must consider payment methodologies that: |
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(1) reward primary health care practitioners for |
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patient retention; |
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(2) encourage primary health care practitioners to |
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spend an appropriate amount of time with each patient; |
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(3) reward primary health care practitioners for |
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monitoring patients, including reminders to obtain follow-up care; |
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(4) provide incentives for having 24-hour |
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availability of a primary health care practitioner in the practice |
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and taking other action to reduce unnecessary emergency room |
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visits; and |
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(5) improve access to primary care. |
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(b) The corporation shall conduct a study or contract for a |
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study to be conducted to develop payment methodologies based on |
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risk-adjusted episodes of care, including global payments, that |
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create incentives for higher quality of services and reduce |
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unnecessary services. The study must: |
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(1) evaluate payment methodologies that: |
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(A) align incentives for health care |
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practitioners and health care facilities; |
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(B) bundle payments based on episodes of care or |
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provide global payments to address variation in cost while |
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providing incentives for higher quality care; |
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(C) allow for the adjustment of costs based on |
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the risk factors of the patient, including age; and |
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(D) may be adopted by private and public payors; |
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and |
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(2) identify standard medical procedures and |
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determine a standard cost for each procedure that may be used in |
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recommended payment methodologies. |
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(c) The corporation shall submit to the legislature not |
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later than January 1, 2011: |
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(1) a summary of the results of the studies conducted |
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under this section; and |
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(2) legislative recommendations regarding the |
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studies' findings, including methods to require or encourage as |
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many payors as possible to use the payment methodologies |
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recommended by the studies. |
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(d) This section expires September 1, 2011. |
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SECTION 8. Section 182.102(b), Health and Safety Code, is |
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amended to read as follows: |
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(b) The corporation has no authority and may [shall] not |
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disseminate information[, in any manner,] to the public that |
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compares, rates, tiers, classifies, measures, or ranks a health |
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care practitioner's or health care facility's [physician's] |
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performance, efficiency, or quality of practice. |
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SECTION 9. Section 182.102(a), Health and Safety Code, is |
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repealed. |
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SECTION 10. (a) The term of a voting member of the board of |
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directors of the Texas Health Services Authority serving |
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immediately before the effective date of this Act expires on that |
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date. |
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(b) The governor and lieutenant governor shall appoint |
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voting members of the board of directors under Section 182.053(a), |
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Health and Safety Code, as amended by this Act, as soon as possible |
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after the effective date of this Act. A person who is a voting |
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member of the board of directors immediately before the effective |
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date of this Act may be reappointed to the board. |
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SECTION 11. This Act takes effect September 1, 2009. |