81R7422 KFF-F

By: Nelson S.B. No. 805

A BILL TO BE ENTITLED

AN ACT

relating to incentive payments for certain nursing facilities providing services under the medical assistance program.

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

SECTION 1. Section 32.021(f), Human Resources Code, is amended to read as follows:

(f) To encourage nursing facilities to provide the best possible care, the department shall operate [develop] an incentive payment program as provided by Section 32.0283 to recognize facilities providing the highest quality care to Medicaid residents.

SECTION 2. Subchapter B, Chapter 32, Human Resources Code, is amended by adding Section 32.0283 to read as follows:

Sec. 32.0283. PERFORMANCE-BASED INCENTIVES FOR CERTAIN NURSING FACILITIES. (a) In this section:

(1) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(2) "Nursing facility" means a convalescent or nursing home or related institution licensed under Chapter 242, Health and Safety Code, that provides long-term care services, as defined by Section 22.0011, to medical assistance recipients.

(b) The executive commissioner by rule shall establish an incentive payment program for nursing facilities that is designed to motivate continuing improvement in the quality of care provided to medical assistance recipients. The program must:

(1) specify that participation in the program by facilities is voluntary;

(2) provide incentive payments in accordance with this section to the facilities that meet or exceed performance thresholds established by the executive commissioner, as provided by Subsection (f); and

(3) offer incentives that are distinct from those offered under Section 32.028(g).

(c) In establishing an incentive payment program under this section, the executive commissioner shall adopt independent and objective performance measures on which to award incentive payments. The performance measures must include measures of:

(1) quality of care;

(2) quality of life;

(3) direct-care staff stability;

(4) recipient and family satisfaction;

(5) employee satisfaction;

(6) regulatory compliance;

(7) level of person-centered care, which must be based on recognized measures of the degree to which a nursing facility respects the needs and desires of the facility's residents and their families; and

(8) the number of occupied Medicaid beds in the nursing facility and the facility's total occupancy.

(d) The executive commissioner shall:

(1) for each performance measure adopted under Subsection (c), establish a performance threshold for purposes of determining eligibility for an incentive payment under the program;

(2) allocate points or payment values to each performance measure adopted under Subsection (c) as the executive commissioner determines appropriate, and award incentive payments based on those allocations; and

(3) on a quarterly basis, determine the facilities eligible for an incentive payment under this section and the amounts of those payments.

(e) The department shall evaluate participating nursing facilities' performances with respect to the performance measures adopted under Subsection (c) at least quarterly, except that the department shall evaluate those facilities' performances with respect to the performance measures adopted under Subsections (c)(4), (5), (6), and (7) either semiannually or annually, as determined by the department.

(f) To be eligible for an incentive payment under the program, a nursing facility must meet or exceed applicable performance thresholds in at least two of the performance measures adopted under Subsection (c), at least one of which must be quality of care or quality of life.

(g) To the extent the executive commissioner determines that appropriated funds are available after accounting for funds necessary to pay nursing facility base rate reimbursement payments and incentive payments under Section 32.028(g)(1), an incentive paid during a period under this section must be at least one percent but not more than five percent of the average medical assistance nursing facility base rate reimbursement for that period, determined without regard to:

(1) previous incentive payments made under this section; or

(2) payments made under Section 32.028(g)(1).

(h) If the executive commissioner determines that it is cost-effective and feasible, the executive commissioner shall enter into a contract with a person who meets the requirements specified by Subsection (i) to provide the following services related to the program:

(1) data collection;

(2) data analysis; and

(3) reporting of nursing facility performance with respect to adopted performance measures and the amounts of incentive payments paid to facilities under this section.

(i) A person with whom the executive commissioner contracts under Subsection (h) must have:

(1) previous successful and cost-effective experience, as determined by the executive commissioner, supporting state Medicaid programs that offer performance incentive payments in connection with providing nursing facility services;

(2) demonstrated ability to collect from public and private sources, analyze, and report the information required under Subsection (h) through the efficient use of Internet-based technology and dedicated electronic databases;

(3) experience providing statistically valid national and regional comparative benchmarking of nursing facilities' performance with respect to one or more of the performance measures under Subsection (c);

(4) recognized experience in providing actionable performance data to nursing facilities that enables the facilities to engage in continuing evidence-based quality improvement;

(5) successful experience, as determined by the executive commissioner, in creating or populating public Internet websites that:

(A) inform consumers of the relative performance of nursing facilities; and

(B) assist consumers in choosing a nursing facility to provide services; and

(6) relevant research experience, as determined by the executive commissioner, that would enable the person to assist with:

(A) evaluations of the program under this section; and

(B) evidence-based modifications of performance measurements and reward strategies used in the program.

(j) The executive commissioner shall, through the department's Internet website and other means, use the performance data collected through the incentive payment program to inform consumers of the actual and comparative performance of each nursing facility participating in the program. The executive commissioner shall develop, with the assistance of any contractor under Subsection (h), a performance rating index or comparable methodology to provide consumers with valid and understandable information. That information must be updated at least quarterly.

(k) The executive commissioner shall consult with other state agencies, nursing facilities, and consumer representatives that the executive commissioner determines appropriate to assist in developing the incentive payment program under this section.

SECTION 3. Section 32.060(a), Human Resources Code, as added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th Legislature, Regular Session, 2003, is amended to read as follows:

(a) The following are not admissible as evidence in a civil action:

(1) any finding by the department that an institution licensed under Chapter 242, Health and Safety Code, has violated a standard for participation in the medical assistance program under this chapter; [or]

(2) the fact of the assessment of a monetary penalty against an institution under Section 32.021 or the payment of the penalty by an institution; or

(3) any information obtained or used by the department to determine the eligibility of a nursing facility for an incentive payment, or to determine the facility's performance rating, under Section 32.028(g) or 32.0283(f).

SECTION 4. (a) Not later than February 1, 2010, the executive commissioner of the Health and Human Services Commission shall establish the performance thresholds required under Section 32.0283(d)(1), Human Resources Code, as added by this Act.

(b) Not later than January 1, 2011, the executive commissioner of the Health and Human Services Commission, if the executive commissioner determines it cost-effective and feasible, shall enter into the contract required by Section 32.0283(h), Human Resources Code, as added by this Act.

(c) Not later than April 1, 2011, the Health and Human Services Commission shall publish on the commission's Internet website the information required under Section 32.0283(j), Human Resources Code, as added by this Act.

SECTION 5. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 6. This Act takes effect September 1, 2009.