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A BILL TO BE ENTITLED
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AN ACT
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relating to improving the quality of health care services provided |
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under certain state programs through certain initiatives, |
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including payment strategies and medication history review |
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requirements. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Sections 531.0961 and 531.0995 to read as |
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follows: |
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Sec. 531.0961. MEDICAID PROVIDER REVIEW OF ELECTRONIC |
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MEDICATION HISTORY. The commission, as part of a quality-based |
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payment initiatives pilot program developed under Subchapter W, may |
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require a health care provider providing acute care services under |
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the state Medicaid program to review, before providing an acute |
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care service or procedure to a Medicaid recipient, the recipient's |
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prescription and nonprescription medication history included in: |
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(1) a health passport provided to the recipient under |
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Section 266.006, Family Code, or any other law; or |
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(2) any other electronic health records maintained |
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under the program with respect to the recipient and to which the |
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provider has access. |
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Sec. 531.0995. HEALTH CARE QUALITY ADVISORY COMMITTEE. |
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(a) The commission shall establish the Health Care Quality |
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Advisory Committee to assist the commission as specified by |
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Subsection (d) with defining best practices and quality performance |
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with respect to health care services and setting standards for |
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quality performance by health care providers and facilities for |
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purposes of programs administered by the commission or a health and |
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human services agency. |
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(b) The executive commissioner shall appoint the members of |
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the advisory committee. The committee must consist of health care |
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providers, representatives of health care facilities, and other |
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stakeholders interested in health care services provided in this |
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state. At least one member must be a physician who has clinical |
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practice expertise, and at least one member must be a member of the |
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advisory panel established as provided by Section 98.051, Health |
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and Safety Code, who meets the qualifications prescribed by Section |
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98.052(a)(4), Health and Safety Code. |
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(c) The executive commissioner shall appoint the presiding |
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officer of the advisory committee. |
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(d) The advisory committee shall advise the commission on: |
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(1) quality of care standards, evidence-based |
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protocols, and measurable goals for quality-based payment |
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initiatives pilot programs implemented under Subchapter W; and |
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(2) any other quality of care standards, |
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evidence-based protocols, measurable goals, or other related |
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issues with respect to which a law or the executive commissioner |
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specifies that the committee shall advise. |
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SECTION 2. Chapter 531, Government Code, is amended by |
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adding Subchapter W to read as follows: |
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SUBCHAPTER W. QUALITY-BASED PAYMENT INITIATIVES PILOT PROGRAMS FOR |
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PROVISION OF HEALTH CARE SERVICES |
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Sec. 531.951. DEFINITIONS. In this subchapter: |
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(1) "Pay-for-performance payment system" means a |
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system for compensating a health care provider or facility for |
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arranging for or providing health care services to child health |
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plan program enrollees or Medicaid recipients, or both, that is |
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based on the provider or facility meeting or exceeding certain |
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defined performance measures. The compensation system may include |
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sharing realized cost savings with the provider or facility. |
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(2) "Pilot program" means a quality-based payment |
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initiatives pilot program established under this subchapter. |
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Sec. 531.952. PILOT PROGRAM PROPOSALS; DETERMINATION OF |
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BENEFIT TO STATE. (a) Health care providers and facilities may |
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submit proposals to the commission for the implementation through |
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pilot programs of quality-based payment initiatives that provide |
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incentives to the providers and facilities, as applicable, to |
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develop health care interventions for child health plan program |
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enrollees or Medicaid recipients, or both, that are cost-effective |
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to this state and will improve the quality of health care provided |
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to the enrollees or recipients. |
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(b) The commission shall determine whether it is feasible |
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and cost-effective to implement one or more of the proposed pilot |
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programs. In addition, the commission shall examine alternative |
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payment methodologies used in the Medicare program and consider |
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whether implementing one or more of the methodologies, modified as |
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necessary to account for programmatic differences, through a pilot |
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program under this subchapter would achieve cost savings in the |
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Medicaid program while ensuring the use of best practices. |
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Sec. 531.953. PURPOSE AND IMPLEMENTATION OF PILOT PROGRAMS. |
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(a) If the commission determines under Section 531.952 that |
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implementation of one or more quality-based payment initiatives |
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pilot programs is feasible and cost-effective for this state, the |
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commission shall establish one or more programs as provided by this |
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subchapter to test pay-for-performance payment system alternatives |
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to traditional fee-for-service or other payments made to health |
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care providers or facilities participating in the child health plan |
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or Medicaid program, as applicable, that are based on best |
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practices, outcomes, and efficiency, but ensure high-quality, |
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effective health care services. |
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(b) The commission shall administer any pilot program |
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established under this subchapter. The executive commissioner may |
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adopt rules, plans, and procedures and enter into contracts and |
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other agreements as the executive commissioner considers |
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appropriate and necessary to administer this subchapter. |
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(c) The commission may limit a pilot program to: |
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(1) one or more regions in this state; |
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(2) one or more organized networks of health care |
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facilities and providers; or |
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(3) specified types of services provided under the |
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child health plan or Medicaid program, or specified types of |
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enrollees or recipients under those programs. |
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(d) A pilot program implemented under this subchapter must |
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be operated for at least one state fiscal year. |
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Sec. 531.954. STANDARDS; PROTOCOLS. (a) In consultation |
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with the Health Care Quality Advisory Committee established under |
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Section 531.0995, the executive commissioner shall approve quality |
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of care standards, evidence-based protocols, and measurable goals |
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for a pilot program to ensure high-quality and effective health |
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care services. |
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(b) In addition to the standards approved under Subsection |
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(a), the executive commissioner may approve efficiency performance |
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standards that may include the sharing of realized cost savings |
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with health care providers and facilities that provide health care |
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services that exceed the efficiency performance standards. |
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Sec. 531.955. QUALITY-BASED PAYMENT INITIATIVES. (a) The |
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executive commissioner may contract with appropriate entities, |
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including qualified actuaries, to assist in determining |
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appropriate payment rates for a pilot program implemented under |
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this subchapter. |
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(b) The executive commissioner may increase a payment rate, |
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including a capitation rate, adopted under this section as |
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necessary to adjust the rate for inflation. |
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(c) The executive commissioner shall ensure that services |
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provided to a child health plan program enrollee or Medicaid |
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recipient, as applicable, meet the quality of care standards |
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required under this subchapter and are at least equivalent to the |
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services provided under the child health plan or Medicaid program, |
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as applicable, for which the enrollee or recipient is eligible. |
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Sec. 531.956. TERMINATION OF PILOT PROGRAM; EXPIRATION OF |
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SUBCHAPTER. The pilot program terminates and this subchapter |
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expires September 2, 2013. |
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SECTION 3. The executive commissioner of the Health and |
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Human Services Commission shall appoint the members of the Health |
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Care Quality Advisory Committee not later than November 1, 2009. |
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SECTION 4. Not later than November 1, 2012, the Health and |
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Human Services Commission shall present a report to the governor, |
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the lieutenant governor, the speaker of the house of |
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representatives, and the members of each legislative committee |
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having jurisdiction over the child health plan and Medicaid |
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programs. For each pilot program implemented under Subchapter W, |
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Chapter 531, Government Code, as added by this Act, the report must: |
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(1) describe the operation of the pilot program; |
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(2) analyze the quality of health care provided to |
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patients under the pilot program; |
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(3) compare the per-patient cost under the pilot |
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program to the per-patient cost of the traditional fee-for-service |
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or other payments made under the child health plan and Medicaid |
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programs; and |
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(4) make recommendations regarding the continuation |
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or expansion of the pilot program. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. This Act takes effect September 1, 2009. |