82R4699 ALB-D
 
  By: Zerwas H.B. No. 2245
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to physician incentive programs to reduce hospital
  emergency room use for non-emergent conditions by Medicaid
  recipients.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Sections 531.086 and 531.0861 to read as follows:
         Sec. 531.086.  STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS
  TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS.
  (a) The commission shall conduct a study to evaluate physician
  incentive programs that attempt to reduce hospital emergency room
  use for non-emergent conditions by recipients under the medical
  assistance program. Each physician incentive program evaluated in
  the study must:
               (1)  be administered by a health maintenance
  organization participating in the STAR or STAR + PLUS Medicaid
  managed care program; and
               (2)  provide incentives to primary care providers who
  attempt to reduce emergency room use for non-emergent conditions by
  recipients.
         (b)  The study conducted under Subsection (a) must evaluate:
               (1)  the cost-effectiveness of each component included
  in a physician incentive program; and
               (2)  any change in statute required to implement each
  component within the Medicaid fee-for-service or primary care case
  management model.
         (c)  Not later than August 31, 2012, the executive
  commissioner shall submit to the governor and the Legislative
  Budget Board a report summarizing the findings of the study
  required by this section.
         (d)  This section expires September 1, 2013.
         Sec. 531.0861.  PHYSICIAN INCENTIVE PROGRAM TO REDUCE
  HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a)  The
  executive commissioner by rule shall establish a physician
  incentive program designed to reduce the use of hospital emergency
  room services for non-emergent conditions by recipients under the
  medical assistance program.
         (b)  In establishing the physician incentive program under
  Subsection (a), the executive commissioner may include only the
  program components identified as cost-effective in the study
  conducted under Section 531.086.
         (c)  If the physician incentive program includes the payment
  of an enhanced reimbursement rate for routine after-hours
  appointments, the executive commissioner shall implement controls
  to ensure that the after-hours services billed are actually being
  provided outside of normal business hours.
         SECTION 2.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for the 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 3.  This Act takes effect September 1, 2011.