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A BILL TO BE ENTITLED
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AN ACT
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relating to incentive payments for certain nursing facilities |
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providing services under the medical assistance program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 32.021(f), Human Resources Code, is |
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amended to read as follows: |
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(f) To encourage nursing facilities to provide the best |
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possible care, the department shall operate [develop] an incentive |
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payment program as provided by Section 32.0283 to recognize |
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facilities providing the highest quality care to Medicaid |
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residents. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0283 to read as follows: |
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Sec. 32.0283. PERFORMANCE-BASED INCENTIVES FOR CERTAIN |
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NURSING FACILITIES. (a) In this section: |
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(1) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(2) "Nursing facility" means a convalescent or nursing |
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home or related institution licensed under Chapter 242, Health and |
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Safety Code, that provides long-term care services, as defined by |
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Section 22.0011, to medical assistance recipients. |
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(b) The executive commissioner by rule shall establish an |
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incentive payment program for nursing facilities that is designed |
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to motivate continuing improvement in the quality of care provided |
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to medical assistance recipients. The program must: |
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(1) specify that participation in the program by |
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facilities is voluntary; |
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(2) provide incentive payments in accordance with this |
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section to the facilities that meet or exceed performance |
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thresholds established by the executive commissioner, as provided |
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by Subsection (f); and |
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(3) offer incentives that are distinct from those |
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offered under Section 32.028(g). |
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(c) In establishing an incentive payment program under this |
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section, the executive commissioner shall adopt independent and |
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objective performance measures on which to award incentive |
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payments. The performance measures must include measures of: |
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(1) quality of care; |
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(2) quality of life; |
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(3) direct-care staff stability; |
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(4) recipient and family satisfaction; |
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(5) employee satisfaction; |
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(6) regulatory compliance; |
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(7) level of person-centered care, which must be based |
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on recognized measures of the degree to which a nursing facility |
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respects the needs and desires of the facility's residents and |
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their families; and |
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(8) the number of occupied Medicaid beds in the |
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nursing facility and the facility's total occupancy. |
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(d) The executive commissioner shall: |
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(1) for each performance measure adopted under |
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Subsection (c), establish a performance threshold for purposes of |
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determining eligibility for an incentive payment under the program; |
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(2) allocate points or payment values to each |
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performance measure adopted under Subsection (c) as the executive |
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commissioner determines appropriate, and award incentive payments |
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based on those allocations; and |
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(3) on a quarterly basis, determine the facilities |
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eligible for an incentive payment under this section and the |
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amounts of those payments. |
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(e) The department shall evaluate participating nursing |
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facilities' performances with respect to the performance measures |
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adopted under Subsection (c) at least quarterly, except that the |
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department shall evaluate those facilities' performances with |
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respect to the performance measures adopted under Subsections |
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(c)(4), (5), (6), and (7) either semiannually or annually, as |
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determined by the department. |
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(f) To be eligible for an incentive payment under the |
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program, a nursing facility must meet or exceed applicable |
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performance thresholds in at least two of the performance measures |
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adopted under Subsection (c), at least one of which must be quality |
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of care or quality of life. |
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(g) To the extent the executive commissioner determines |
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that appropriated funds are available after accounting for funds |
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necessary to pay nursing facility base rate reimbursement payments |
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and incentive payments under Section 32.028(g)(1), an incentive |
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paid during a period under this section must be at least one percent |
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but not more than five percent of the average medical assistance |
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nursing facility base rate reimbursement for that period, |
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determined without regard to: |
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(1) previous incentive payments made under this |
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section; or |
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(2) payments made under Section 32.028(g)(1). |
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(h) If the executive commissioner determines that it is |
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cost-effective and feasible, the executive commissioner shall |
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enter into a contract with a person who meets the requirements |
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specified by Subsection (i) to provide the following services |
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related to the program: |
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(1) data collection; |
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(2) data analysis; and |
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(3) reporting of nursing facility performance with |
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respect to adopted performance measures and the amounts of |
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incentive payments paid to facilities under this section. |
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(i) A person with whom the executive commissioner contracts |
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under Subsection (h) must have: |
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(1) previous successful and cost-effective |
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experience, as determined by the executive commissioner, |
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supporting state Medicaid programs that offer performance |
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incentive payments in connection with providing nursing facility |
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services; |
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(2) demonstrated ability to collect from public and |
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private sources, analyze, and report the information required under |
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Subsection (h) through the efficient use of Internet-based |
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technology and dedicated electronic databases; |
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(3) experience providing statistically valid national |
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and regional comparative benchmarking of nursing facilities' |
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performance with respect to one or more of the performance measures |
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under Subsection (c); |
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(4) recognized experience in providing actionable |
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performance data to nursing facilities that enables the facilities |
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to engage in continuing evidence-based quality improvement; |
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(5) successful experience, as determined by the |
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executive commissioner, in creating or populating public Internet |
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websites that: |
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(A) inform consumers of the relative performance |
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of nursing facilities; and |
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(B) assist consumers in choosing a nursing |
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facility to provide services; and |
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(6) relevant research experience, as determined by the |
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executive commissioner, that would enable the person to assist |
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with: |
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(A) evaluations of the program under this |
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section; and |
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(B) evidence-based modifications of performance |
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measurements and reward strategies used in the program. |
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(j) The executive commissioner shall, through the |
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department's Internet website and other means, use the performance |
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data collected through the incentive payment program to inform |
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consumers of the actual and comparative performance of each nursing |
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facility participating in the program. The executive commissioner |
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shall develop, with the assistance of any contractor under |
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Subsection (h), a performance rating index or comparable |
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methodology to provide consumers with valid and understandable |
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information. That information must be updated at least quarterly. |
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(k) The executive commissioner shall consult with other |
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state agencies, nursing facilities, and consumer representatives |
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that the executive commissioner determines appropriate to assist in |
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developing the incentive payment program under this section. |
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SECTION 3. Section 32.060(a), Human Resources Code, as |
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added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th |
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Legislature, Regular Session, 2003, is amended to read as follows: |
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(a) The following are not admissible as evidence in a civil |
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action: |
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(1) any finding by the department that an institution |
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licensed under Chapter 242, Health and Safety Code, has violated a |
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standard for participation in the medical assistance program under |
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this chapter; [or] |
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(2) the fact of the assessment of a monetary penalty |
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against an institution under Section 32.021 or the payment of the |
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penalty by an institution; or |
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(3) any information obtained or used by the department |
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to determine the eligibility of a nursing facility for an incentive |
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payment, or to determine the facility's performance rating, under |
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Section 32.028(g) or 32.0283(f). |
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SECTION 4. (a) Not later than February 1, 2010, the |
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executive commissioner of the Health and Human Services Commission |
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shall establish the performance thresholds required under Section |
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32.0283(d)(1), Human Resources Code, as added by this Act. |
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(b) Not later than January 1, 2011, the executive |
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commissioner of the Health and Human Services Commission, if the |
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executive commissioner determines it cost-effective and feasible, |
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shall enter into the contract required by Section 32.0283(h), Human |
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Resources Code, as added by this Act. |
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(c) Not later than April 1, 2011, the Health and Human |
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Services Commission shall publish on the commission's Internet |
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website the information required under Section 32.0283(j), Human |
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Resources Code, as added by this Act. |
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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. |