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A BILL TO BE ENTITLED
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AN ACT
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relating to a demonstration project that allows federally qualified |
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health centers to test innovative health care delivery systems and |
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data sharing under certain public benefits programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle I, Title 4, Government Code, is amended |
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by adding Chapter 539A to read as follows: |
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CHAPTER 539A. INNOVATIVE HEALTH CARE DELIVERY SYSTEM DEMONSTRATION |
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PROJECT |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 539A.0001. DEFINITIONS. In this chapter: |
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(1) "Demonstration project" means the demonstration |
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project established under Section 539A.0051. |
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(2) "Federally qualified health center" has the |
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meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B). |
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(3) "Federally qualified health center services" has |
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the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A). |
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Sec. 539A.0002. REPORTING. Not later than December 1, |
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2020, the commission shall submit a report to the legislature |
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regarding the commission's progress in establishing and operating |
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the demonstration project and recommendations on continuing or |
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expanding the demonstration project. |
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Sec. 539A.0003. EXPIRATION. This chapter expires September |
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1, 2021. |
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SUBCHAPTER B. DEMONSTRATION PROJECT |
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Sec. 539A.0051. DEMONSTRATION PROJECT TO TEST ALTERNATIVE |
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AND INNOVATIVE HEALTH CARE DELIVERY SYSTEMS AND DATA SHARING. The |
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commission shall develop and implement a demonstration project to |
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test alternative and innovative health care delivery systems, |
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including data sharing and alternative payment systems under |
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Medicaid, the child health plan program, and other health benefits |
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programs administered by the commission or other health and human |
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services agencies. Under the demonstration project, the commission |
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shall provide services covered under health benefits programs to a |
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specific patient population under an agreed-on shared savings |
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arrangement with federally qualified health centers. |
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Sec. 539A.0052. FEDERALLY QUALIFIED HEALTH CENTERS |
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PARTICIPATION; CREATION OF INNOVATIVE HEALTH CARE DELIVERY |
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SYSTEMS. (a) In establishing the demonstration project, the |
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commission shall, in consultation with federally qualified health |
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centers, develop a request for proposals for participation in the |
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demonstration project and formation of innovative health care |
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delivery systems. To be eligible to participate in the |
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demonstration project a federally qualified health center must: |
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(1) be a provider under an applicable public benefits |
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program capable of providing services that are covered by the |
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program; |
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(2) meet minimum quality standards established by the |
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commission; and |
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(3) adopt cost-effective methods of care delivery and |
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coordination, which may include the use of allied health |
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professionals, telemedicine providers, patient educators, care |
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coordinators, community health care workers, and services and |
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providers that are not covered or reimbursed under a health |
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benefits program. |
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(b) An innovative health care delivery system may be formed |
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by federally qualified health centers in this state. A federally |
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qualified health center may contract with a third party to provide |
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secure transfer and administrative services under the delivery |
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system. |
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(c) The commission may require federally qualified health |
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centers that have established innovative health care delivery |
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systems to enter into additional contracts with third parties for |
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risk assessment and for the purchase of stop-loss coverage or |
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another form of risk management insurance related to the delivery |
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system established under the demonstration project. |
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Sec. 539A.0053. PATIENT PARTICIPATION. A person eligible |
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for a public benefits program, including Medicaid and the child |
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health plan program, is eligible for attribution to an innovative |
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health care delivery system. |
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Sec. 539A.0054. DATA SHARING PROGRAM. (a) As part of the |
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demonstration project, the commission shall develop and implement a |
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program to test data sharing for innovative health care delivery |
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systems and alternative payment systems. Under the data sharing |
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program and to the extent permitted by federal law, the commission |
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shall securely provide federally qualified health centers |
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participating in the demonstration project, or the centers' |
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designee, data regarding the centers' patients eligible to |
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participate in the demonstration project, either individually or as |
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a group. |
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(b) Under the data sharing program, a participating |
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federally qualified health center shall provide to the commission |
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the names of patients who are enrolled in a public benefits program |
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to whom the center has provided services in the preceding 12-month |
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period. After receiving the names of patients under this |
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subsection, the commission shall immediately provide the federally |
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qualified health centers, or the centers' designee, a claims data |
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file that includes information relating to the claims that have |
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been received under a public benefits program for each patient. The |
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claims data file must include: |
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(1) the claims made by or on behalf of the patient |
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during the 36-month period preceding the date the commission |
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received the names of patients under this subsection; |
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(2) patient demographic data, including each patient's |
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name, address, date of birth, and gender; |
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(3) patient health benefits coverage information, |
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including any unique identifier or number assigned to the patient |
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under a public benefits program, including each patient's Medicaid |
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number, if applicable; |
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(4) attribution information of each patient, |
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including the names of the public benefits program each patient is |
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enrolled in, the effective date of enrollment, and if the patient is |
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enrolled in Medicaid: |
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(A) whether the patient is enrolled in a managed |
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care program, and if so, the name of the program; and |
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(B) each patient's primary care provider; |
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(5) the individual provider codes associated with each |
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provider who has provided services to the patient, including the |
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provider's: |
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(A) federal and state, if applicable, tax |
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identification numbers; |
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(B) national provider identifiers; |
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(C) health care provider taxonomy codes; |
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(D) professional license numbers; and |
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(E) other identifiers collected with respect to |
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the provider; and |
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(6) patient claims data, including: |
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(A) any benefits covered by a public benefits |
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program when provided by an enrolled provider, including: |
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(i) the names of primary care providers, |
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urgent care providers, specialty care providers, emergency room |
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providers, and hospital providers; and |
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(ii) the type of benefits provided, |
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including the provision of hospital observation services, hospital |
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inpatient services, home health services, skilled nursing |
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services, lab and radiological services, pharmacy benefits, |
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including prescription information and drug pricing, ambulance |
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services, care plan oversight services, spinal manipulation |
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services, early and period screening, diagnosis, and treatment |
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services, anesthesia services, durable medical equipment, hospice |
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services, therapy services, and obstetric services; and |
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(B) onset of illness date, dates of service, |
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locations at which services were provided, names of service |
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providers, diagnostic and Current Procedural Terminology codes and |
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related cause codes, and reimbursement amounts paid. |
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Sec. 539A.0055. REIMBURSEMENT SYSTEM. (a) In developing a |
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reimbursement system for innovative health care delivery systems, |
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the executive commissioner shall establish a reimbursement |
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methodology that: |
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(1) is based on a total cost of care benchmark adjusted |
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for patient acuity; and |
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(2) is designed to achieve determinable savings. |
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(b) The reimbursement system may include incentive payments |
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to innovative health care delivery systems that meet or exceed |
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annual quality and performance targets. |
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Sec. 539A.0056. FUNDING. The commission may apply for any |
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available grants or federal funding that would further the purposes |
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of or assist in the establishment of the demonstration project or |
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innovative health care delivery systems established under the |
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demonstration project. |
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SECTION 2. As soon as possible after the effective date of |
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this Act, the Health and Human Services Commission shall apply for |
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and actively pursue from the federal Centers for Medicare and |
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Medicaid Services or other appropriate federal agency any waiver or |
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other authorization necessary to implement Chapter 539A, |
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Government Code, as added by this Act. The commission may delay |
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implementing this Act until the waiver or authorization is granted. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |