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A BILL TO BE ENTITLED
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AN ACT
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relating to physician incentive programs to reduce hospital |
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emergency room use for non-emergent conditions by Medicaid |
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recipients. |
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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 531.086 and 531.0861 to read as follows: |
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Sec. 531.086. STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS |
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TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. |
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(a) The commission shall conduct a study to evaluate physician |
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incentive programs that attempt to reduce hospital emergency room |
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use for non-emergent conditions by recipients under the medical |
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assistance program. Each physician incentive program evaluated in |
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the study must: |
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(1) be administered by a health maintenance |
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organization participating in the STAR or STAR + PLUS Medicaid |
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managed care program; and |
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(2) provide incentives to primary care providers who |
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attempt to reduce emergency room use for non-emergent conditions by |
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recipients. |
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(b) The study conducted under Subsection (a) must evaluate: |
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(1) the cost-effectiveness of each component included |
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in a physician incentive program; and |
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(2) any change in statute required to implement each |
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component within the Medicaid fee-for-service or primary care case |
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management model. |
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(c) Not later than August 31, 2012, the executive |
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commissioner shall submit to the governor and the Legislative |
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Budget Board a report summarizing the findings of the study |
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required by this section. |
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(d) This section expires September 1, 2013. |
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Sec. 531.0861. PHYSICIAN INCENTIVE PROGRAM TO REDUCE |
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HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) The |
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executive commissioner by rule shall establish a physician |
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incentive program designed to reduce the use of hospital emergency |
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room services for non-emergent conditions by recipients under the |
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medical assistance program. |
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(b) In establishing the physician incentive program under |
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Subsection (a), the executive commissioner may include only the |
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program components identified as cost-effective in the study |
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conducted under Section 531.086. |
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(c) If the physician incentive program includes the payment |
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of an enhanced reimbursement rate for routine after-hours |
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appointments, the executive commissioner shall implement controls |
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to ensure that the after-hours services billed are actually being |
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provided outside of normal business hours. |
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SECTION 2. 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 the implementation of that |
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provision, the agency affected by the provision shall request the |
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waiver or authorization and may delay implementing that provision |
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until the waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2011. |