Texas 2009 - 81st Regular

Texas House Bill HB2197 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R10180 KFF-D
2	2	By: Davis of Harris H.B. No. 2197
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the implementation of a quality improvement initiative
8	8	in the Medicaid program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
11	11	is amended by adding Section 32.077 to read as follows:
12	12	Sec. 32.077. IMPLEMENTATION OF QUALITY IMPROVEMENT
13	13	INITIATIVE. (a) In this section, "commission" means the Health and
14	14	Human Services Commission.
15	15	(b) The commission may implement a quality improvement
16	16	initiative in the medical assistance program designed to improve
17	17	the quality of care provided to medical assistance recipients.
18	18	Subject to Subsections (c) and (d), the initiative may consist of
19	19	one or more of the following quality improvement strategies not
20	20	implemented under other law:
21	21	(1) establishing a disease management outcomes
22	22	measurement system that measures improvements in outcomes
23	23	experienced by recipients with chronic diseases specified by the
24	24	commission, including diabetes and asthma;
25	25	(2) establishing a pay-for-performance reimbursement
26	26	system for acute care services and long-term care services provided
27	27	by nursing facilities under the program, provided that the system
28	28	complies with Subsection (e);
29	29	(3) expanding the use of evidence-based standards of
30	30	care in the program; and
31	31	(4) developing the use of a medical home through which
32	32	a primary care physician provides preventive and primary care
33	33	services on an ongoing basis to a recipient and coordinates with
34	34	specialists when health care services provided by a specialist are
35	35	needed.
36	36	(c) Before implementing a quality improvement strategy
37	37	under Subsection (b), the commission shall:
38	38	(1) study the cost-effectiveness of implementing that
39	39	strategy;
40	40	(2) assess whether the implementation is anticipated
41	41	to have a positive effect on the quality of care provided to medical
42	42	assistance recipients; and
43	43	(3) determine whether the implementation would:
44	44	(A) be consistent with federal law; and
45	45	(B) require a waiver or authorization from a
46	46	federal agency.
47	47	(d) A quality improvement strategy may not be implemented
48	48	under Subsection (b) unless:
49	49	(1) based on the study and assessment conducted under
50	50	Subsection (c), the commission anticipates that the strategy will
51	51	be cost-effective and positively affect quality of care; and
52	52	(2) the commission obtains any necessary waiver or
53	53	authorization identified under Subsection (c)(3) from a federal
54	54	agency.
55	55	(e) A pay-for-performance reimbursement system implemented
56	56	under Subsection (b)(2) must be based on a pilot project developed
57	57	by the federal Centers for Medicare and Medicaid Services and use
58	58	alternative reimbursement methods that are designed to reward the
59	59	provision of efficient, quality services resulting in successful
60	60	health outcomes. The system must be data-driven,
61	61	recipient-centered, and transparent, but may not impose
62	62	significant additional administrative burdens on medical
63	63	assistance providers.
64	64	(f) To develop evidence-based standards of care for
65	65	implementation under Subsection (b)(3), the commission shall study
66	66	the use of performance measures in other states and determine
67	67	whether adopting similar standards, and corresponding incentives
68	68	for meeting or exceeding those standards, will improve health care
69	69	outcomes under the medical assistance program.
70	70	(g) To develop a medical home model for implementation under
71	71	Subsection (b)(4), the commission shall examine policies and
72	72	practices in other states relating to the use of a medical home
73	73	under those states' medical assistance programs and determine
74	74	whether similar policies and practices could be effectively
75	75	implemented in this state.
76	76	SECTION 2. This Act takes effect September 1, 2009.