By: Martinez Fischer H.B. No. 3722

A BILL TO BE ENTITLED

AN ACT

relating to expanding eligibility for benefits under the Medicaid program and transitioning the delivery of benefits under the Medicaid program from delivery through a managed care model or arrangement to delivery through an integrated and coordinated health care delivery system.

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

ARTICLE 1. INTEGRATED AND COORDINATED HEALTH CARE DELIVERY SYSTEM

SECTION 1.01. Subtitle I, Title 4, Government Code, is amended by adding Chapter 533B to read as follows:

CHAPTER 533B. INTEGRATED AND COORDINATED HEALTH CARE DELIVERY

SYSTEM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 533B.001. DEFINITIONS. In this chapter:

(1) "Commission" means the Health and Human Services Commission or an agency operating part of the state Medicaid integrated and coordinated health care delivery system, as appropriate, notwithstanding Section 531.001.

(2) "Coordinated care organization" means an entity as described by Section 533B.053 that is responsible for the delivery of health care services under the integrated and coordinated health care delivery system.

(3) "Recipient" means a recipient of medical assistance under Chapter 32, Human Resources Code.

Sec. 533B.002. PURPOSE. (a) The legislature finds that:

(1) a significant amount of public and private money is spent each year for the provision of health care to Texans;

(2) the state has a strong interest in assisting Texas businesses and individuals to obtain reasonably available insurance or other coverage for the costs of necessary basic health care services;

(3) the lack of basic health care coverage is detrimental not only to the health of individuals lacking coverage, but also to the public welfare and the state's need to encourage employment growth and economic development, and that lack of coverage results in substantial expenditures for emergency and remedial health care for all purchasers of health care including the state; and

(4) the use of integrated and coordinated health care delivery systems has significant potential to reduce the growth of health care costs incurred by the people of this state.

(b) The legislature finds that achieving its goals of improving health, increasing the quality, reliability, availability, and continuity of care, and reducing the cost of care requires an integrated and coordinated health care delivery system in which:

(1) individuals who are eligible for benefits under both the Medicare and Medicaid programs participate;

(2) health care services, other than Medicaid-funded long-term care services, are delivered through coordinated care contracts that use alternative payment methodologies to improve health and health care by focusing on:

(A) prevention;

(B) improving health equity and reducing health disparities; and

(C) using:

(i) patient-centered primary care homes;

(ii) evidence-based practices; and

(iii) health information technology;

(3) high-quality information is collected and used to measure health outcomes, health care quality and costs, and clinical health information;

(4) communities and regions are accountable for improving the health of residents of the communities and regions, reducing avoidable health gaps among different cultural groups and managing health care resources;

(5) care and services emphasize preventive services and services supporting individuals to live independently at home or in their community;

(6) services are person-centered, and provide choice, independence and dignity as reflected in individual plans and assistance provided in accessing care and services; and

(7) interactions between the commission and coordinated care organizations are transparent and public.

(c) The legislature finds that there is an extreme need for a skilled, diverse workforce to meet the rapidly growing demand for home and community-based health care. To meet that need, this state must:

(1) build on existing training programs;

(2) ensure that wages and benefits are at levels that reduce turnover and increase experience and quality of care; and

(3) provide an opportunity for front-line health care providers to have a voice in the providers' workplace in order to effectively advocate for quality care.

Sec. 533B.003. REFERENCE IN OTHER LAW. A reference in law to a Medicaid managed care delivery system or arrangement under Chapter 533 is a reference to the integrated and coordinated health care delivery system implemented under this chapter.

Sec. 533B.004. CONFLICT WITH OTHER LAW. To the extent of a conflict between a provision of this chapter and another provision of state law, the provision of this chapter controls.

SUBCHAPTER B. ADMINISTRATIVE PROVISIONS

Sec. 533B.051. INTEGRATED AND COORDINATED HEALTH CARE DELIVERY SYSTEM. (a) In this section, "medical assistance" has the meaning assigned by Section 32.003, Human Resources Code.

(b) The commission shall develop and implement a plan to transition the delivery of medical assistance benefits from delivery through a managed care model or arrangement to delivery through an integrated and coordinated health care delivery system implemented in accordance with this chapter. In developing the plan under this section, the commission shall use as a guide the provisions of other states' laws regarding integrated and coordinated health care delivery systems, including Oregon Laws Chapter 602 (H.B. 3650), Acts of the 76th Legislature, 2011.

Sec. 533B.052. REQUIRED CONTRACT CRITERIA. The executive commissioner shall by rule adopt criteria for a contract with a coordinated care organization. The commission shall integrate the criteria into each contract with a coordinated care organization. The criteria must include:

(1) provisions that ensure each recipient has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery;

(2) provisions that require the use of health information technology to link services and care providers across the continuum of care to the greatest extent possible;

(3) a requirement that each coordinated care organization convenes a community advisory council made up mostly of consumers of health care services but that also includes representatives from the community and of local government, and that the council meets regularly to ensure that the health care needs of the consumers and the community are being addressed;

(4) a requirement that each coordinated care organization submits to the commission a report of outcome and quality measures as determined by the commission; and

(5) a requirement that each coordinated care organization enter into a contract with a dental care organization that serves recipients of the coordinated care organization in the region in which the recipients reside.

Sec. 533B.053. COORDINATED CARE ORGANIZATION ELIGIBILITY REQUIREMENTS. In order to enter into a contract with the commission to provide health care services as a coordinated care organization, an entity must:

(1) be a locally based community organization, or a statewide organization that has participants that are locally based community organizations; and

(2) have a governance structure that includes:

(A) a majority interest consisting of the persons that share in the financial risk of the organization;

(B) the major components of the health care delivery system, as determined by the commission; and

(C) the community at large, to ensure that the organization's decision-making is consistent with the values of the members and the community.

Sec. 533B.054. ALTERNATIVE PAYMENT METHODS. The commission shall develop and implement the integrated and coordinated health care delivery system in a manner that promotes and encourages the use of alternative payment methods that:

(1) reimburse providers on the basis of health outcomes and quality measures rather than the volume of care; and

(2) use payment structures that create incentives to:

(A) promote prevention;

(B) provide patient-centered care; and

(C) reward comprehensive care coordination using delivery models such as patient-centered primary care homes.

SECTION 1.02. Chapter 533, Government Code, is repealed.

SECTION 1.03. As soon as possible after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall take all necessary actions to transition the delivery of medical assistance benefits under the Medicaid program from using a managed care delivery model or arrangement to using an integrated and coordinated health care delivery system beginning January 1, 2014, and in accordance with Chapter 533B, Government Code, as added by this article.

SECTION 1.04. Notwithstanding Chapter 533B, Government Code, as added by this article, and Section 1.02 of this article, the Health and Human Services Commission shall continue to provide medical assistance through a Medicaid managed care delivery model or arrangement until the integrated and coordinated health care delivery system is implemented under Chapter 533B, Government Code, as added by this article.

ARTICLE 2. MEDICAID EXPANSION

SECTION 2.01. Chapter 32, Human Resources Code, is amended by adding Subchapter H to read as follows:

SUBCHAPTER H. EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE

Sec. 32.351. DEFINITIONS. In this subchapter:

(1) "Commission" means the Health and Human Services Commission.

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

Sec. 32.352. EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a) Notwithstanding any other law, the commission shall provide medical assistance to all persons who apply for that assistance and for whom federal matching funds are available under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152) to provide that assistance.

(b) The executive commissioner shall adopt rules regarding the provision of medical assistance as required by this section.

SECTION 2.02. Section 32.352, Human Resources Code, as added by this article, applies only to an initial determination or recertification of eligibility of a person for medical assistance under Chapter 32, Human Resources Code, made on or after January 1, 2014, regardless of the date the person applied for that assistance.

SECTION 2.03. As soon as possible after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall take all necessary actions to expand eligibility for medical assistance under Chapter 32, Human Resources Code, beginning January 1, 2014, and in accordance with Section 32.352, Human Resources Code, as added by this article, including notifying appropriate federal agencies of that expanded eligibility.

ARTICLE 3. FEDERAL AUTHORIZATION AND EFFECTIVE DATE

SECTION 3.01. 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 3.02. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2013.