81R10180 KFF-D
By: Davis of Harris H.B. No. 2197
A BILL TO BE ENTITLED
AN ACT
relating to the implementation of a quality improvement initiative
in the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.077 to read as follows:
Sec. 32.077. IMPLEMENTATION OF QUALITY IMPROVEMENT
INITIATIVE. (a) In this section, "commission" means the Health and
Human Services Commission.
(b) The commission may implement a quality improvement
initiative in the medical assistance program designed to improve
the quality of care provided to medical assistance recipients.
Subject to Subsections (c) and (d), the initiative may consist of
one or more of the following quality improvement strategies not
implemented under other law:
(1) establishing a disease management outcomes
measurement system that measures improvements in outcomes
experienced by recipients with chronic diseases specified by the
commission, including diabetes and asthma;
(2) establishing a pay-for-performance reimbursement
system for acute care services and long-term care services provided
by nursing facilities under the program, provided that the system
complies with Subsection (e);
(3) expanding the use of evidence-based standards of
care in the program; and
(4) developing the use of a medical home through which
a primary care physician provides preventive and primary care
services on an ongoing basis to a recipient and coordinates with
specialists when health care services provided by a specialist are
needed.
(c) Before implementing a quality improvement strategy
under Subsection (b), the commission shall:
(1) study the cost-effectiveness of implementing that
strategy;
(2) assess whether the implementation is anticipated
to have a positive effect on the quality of care provided to medical
assistance recipients; and
(3) determine whether the implementation would:
(A) be consistent with federal law; and
(B) require a waiver or authorization from a
federal agency.
(d) A quality improvement strategy may not be implemented
under Subsection (b) unless:
(1) based on the study and assessment conducted under
Subsection (c), the commission anticipates that the strategy will
be cost-effective and positively affect quality of care; and
(2) the commission obtains any necessary waiver or
authorization identified under Subsection (c)(3) from a federal
agency.
(e) A pay-for-performance reimbursement system implemented
under Subsection (b)(2) must be based on a pilot project developed
by the federal Centers for Medicare and Medicaid Services and use
alternative reimbursement methods that are designed to reward the
provision of efficient, quality services resulting in successful
health outcomes. The system must be data-driven,
recipient-centered, and transparent, but may not impose
significant additional administrative burdens on medical
assistance providers.
(f) To develop evidence-based standards of care for
implementation under Subsection (b)(3), the commission shall study
the use of performance measures in other states and determine
whether adopting similar standards, and corresponding incentives
for meeting or exceeding those standards, will improve health care
outcomes under the medical assistance program.
(g) To develop a medical home model for implementation under
Subsection (b)(4), the commission shall examine policies and
practices in other states relating to the use of a medical home
under those states' medical assistance programs and determine
whether similar policies and practices could be effectively
implemented in this state.
SECTION 2. This Act takes effect September 1, 2009.