86R10866 KFF-F
 
  By: Rodríguez S.B. No. 1922
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to a demonstration project that allows federally qualified
  health centers to test innovative health care delivery systems and
  data sharing under certain public benefits programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 539A to read as follows:
  CHAPTER 539A. INNOVATIVE HEALTH CARE DELIVERY SYSTEM DEMONSTRATION
  PROJECT
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 539A.0001.  DEFINITIONS.  In this chapter:
               (1)  "Demonstration project" means the demonstration
  project established under Section 539A.0051.
               (2)  "Federally qualified health center" has the
  meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
               (3)  "Federally qualified health center services" has
  the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
         Sec. 539A.0002.  REPORTING. Not later than December 1,
  2020, the commission shall submit a report to the legislature
  regarding the commission's progress in establishing and operating
  the demonstration project and recommendations on continuing or
  expanding the demonstration project.
         Sec. 539A.0003.  EXPIRATION. This chapter expires September
  1, 2021.
  SUBCHAPTER B. DEMONSTRATION PROJECT
         Sec. 539A.0051.  DEMONSTRATION PROJECT TO TEST ALTERNATIVE
  AND INNOVATIVE HEALTH CARE DELIVERY SYSTEMS AND DATA SHARING. The
  commission shall develop and implement a demonstration project to
  test alternative and innovative health care delivery systems,
  including data sharing and alternative payment systems under
  Medicaid, the child health plan program, and other health benefits
  programs administered by the commission or other health and human
  services agencies. Under the demonstration project, the commission
  shall provide services covered under health benefits programs to a
  specific patient population under an agreed-on shared savings
  arrangement with federally qualified health centers.
         Sec. 539A.0052.  FEDERALLY QUALIFIED HEALTH CENTERS
  PARTICIPATION; CREATION OF INNOVATIVE HEALTH CARE DELIVERY
  SYSTEMS. (a) In establishing the demonstration project, the
  commission shall, in consultation with federally qualified health
  centers, develop a request for proposals for participation in the
  demonstration project and formation of innovative health care
  delivery systems. To be eligible to participate in the
  demonstration project a federally qualified health center must:
               (1)  be a provider under an applicable public benefits
  program capable of providing services that are covered by the
  program;
               (2)  meet minimum quality standards established by the
  commission; and
               (3)  adopt cost-effective methods of care delivery and
  coordination, which may include the use of allied health
  professionals, telemedicine providers, patient educators, care
  coordinators, community health care workers, and services and
  providers that are not covered or reimbursed under a health
  benefits program.
         (b)  An innovative health care delivery system may be formed
  by federally qualified health centers in this state. A federally
  qualified health center may contract with a third party to provide
  secure transfer and administrative services under the delivery
  system.
         (c)  The commission may require federally qualified health
  centers that have established innovative health care delivery
  systems to enter into additional contracts with third parties for
  risk assessment and for the purchase of stop-loss coverage or
  another form of risk management insurance related to the delivery
  system established under the demonstration project.
         Sec. 539A.0053.  PATIENT PARTICIPATION. A person eligible
  for a public benefits program, including Medicaid and the child
  health plan program, is eligible for attribution to an innovative
  health care delivery system.
         Sec. 539A.0054.  DATA SHARING PROGRAM. (a) As part of the
  demonstration project, the commission shall develop and implement a
  program to test data sharing for innovative health care delivery
  systems and alternative payment systems. Under the data sharing
  program and to the extent permitted by federal law, the commission
  shall securely provide federally qualified health centers
  participating in the demonstration project, or the centers'
  designee, data regarding the centers' patients eligible to
  participate in the demonstration project, either individually or as
  a group.
         (b)  Under the data sharing program, a participating
  federally qualified health center shall provide to the commission
  the names of patients who are enrolled in a public benefits program
  to whom the center has provided services in the preceding 12-month
  period. After receiving the names of patients under this
  subsection, the commission shall immediately provide the federally
  qualified health centers, or the centers' designee, a claims data
  file that includes information relating to the claims that have
  been received under a public benefits program for each patient. The
  claims data file must include:
               (1)  the claims made by or on behalf of the patient
  during the 36-month period preceding the date the commission
  received the names of patients under this subsection;
               (2)  patient demographic data, including each patient's
  name, address, date of birth, and gender;
               (3)  patient health benefits coverage information,
  including any unique identifier or number assigned to the patient
  under a public benefits program, including each patient's Medicaid
  number, if applicable;
               (4)  attribution information of each patient,
  including the names of the public benefits program each patient is
  enrolled in, the effective date of enrollment, and if the patient is
  enrolled in Medicaid:
                     (A)  whether the patient is enrolled in a managed
  care program, and if so, the name of the program; and
                     (B)  each patient's primary care provider;
               (5)  the individual provider codes associated with each
  provider who has provided services to the patient, including the
  provider's:
                     (A)  federal and state, if applicable, tax
  identification numbers;
                     (B)  national provider identifiers;
                     (C)  health care provider taxonomy codes;
                     (D)  professional license numbers; and 
                     (E)  other identifiers collected with respect to
  the provider; and
               (6)  patient claims data, including:
                     (A)  any benefits covered by a public benefits
  program when provided by an enrolled provider, including:
                           (i)  the names of primary care providers,
  urgent care providers, specialty care providers, emergency room
  providers, and hospital providers; and 
                           (ii)  the type of benefits provided,
  including the provision of hospital observation services, hospital
  inpatient services, home health services, skilled nursing
  services, lab and radiological services, pharmacy benefits,
  including prescription information and drug pricing, ambulance
  services, care plan oversight services, spinal manipulation
  services, early and period screening, diagnosis, and treatment
  services, anesthesia services, durable medical equipment, hospice
  services, therapy services, and obstetric services; and
                     (B)  onset of illness date, dates of service,
  locations at which services were provided, names of service
  providers, diagnostic and Current Procedural Terminology codes and
  related cause codes, and reimbursement amounts paid.
         Sec. 539A.0055.  REIMBURSEMENT SYSTEM. (a) In developing a
  reimbursement system for innovative health care delivery systems,
  the executive commissioner shall establish a reimbursement
  methodology that:
               (1)  is based on a total cost of care benchmark adjusted
  for patient acuity; and
               (2)  is designed to achieve determinable savings. 
         (b)  The reimbursement system may include incentive payments
  to innovative health care delivery systems that meet or exceed
  annual quality and performance targets.
         Sec. 539A.0056.  FUNDING. The commission may apply for any
  available grants or federal funding that would further the purposes
  of or assist in the establishment of the demonstration project or
  innovative health care delivery systems established under the
  demonstration project.
         SECTION 2.  As soon as possible after the effective date of
  this Act, the Health and Human Services Commission shall apply for
  and actively pursue from the federal Centers for Medicare and
  Medicaid Services or other appropriate federal agency any waiver or
  other authorization necessary to implement Chapter 539A,
  Government Code, as added by this Act. The commission may delay
  implementing this Act until the waiver or authorization is granted.
         SECTION 3.  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, 2019.