81R32461 KLA-F
By: Nelson S.B. No. 288
Substitute the following for S.B. No. 288:
By: Coleman C.S.S.B. No. 288
A BILL TO BE ENTITLED
AN ACT
relating to improving the quality of health care services provided
under certain state programs through certain initiatives,
including payment strategies and medication history review
requirements.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.0961 and 531.0995 to read as
follows:
Sec. 531.0961. MEDICAID PROVIDER REVIEW OF ELECTRONIC
MEDICATION HISTORY. The commission, as part of a quality-based
payment initiatives pilot program developed under Subchapter W, may
require a health care provider providing acute care services under
the state Medicaid program to review, before providing an acute
care service or procedure to a Medicaid recipient, the recipient's
prescription and nonprescription medication history included in:
(1) a health passport provided to the recipient under
Section 266.006, Family Code, or any other law; or
(2) any other electronic health records maintained
under the program with respect to the recipient and to which the
provider has access.
Sec. 531.0995. HEALTH CARE QUALITY ADVISORY COMMITTEE.
(a) The commission shall establish the Health Care Quality
Advisory Committee to assist the commission as specified by
Subsection (d) with defining best practices and quality performance
with respect to health care services and setting standards for
quality performance by health care providers and facilities for
purposes of programs administered by the commission or a health and
human services agency.
(b) The executive commissioner shall appoint the members of
the advisory committee. The committee must consist of health care
providers, representatives of health care facilities, and other
stakeholders interested in health care services provided in this
state. At least one member must be a physician who has clinical
practice expertise, and at least one member must be a member of the
advisory panel established as provided by Section 98.051, Health
and Safety Code, who meets the qualifications prescribed by Section
98.052(a)(4), Health and Safety Code.
(c) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(d) The advisory committee shall advise the commission on:
(1) quality of care standards, evidence-based
protocols, and measurable goals for quality-based payment
initiatives pilot programs implemented under Subchapter W; and
(2) any other quality of care standards,
evidence-based protocols, measurable goals, or other related
issues with respect to which a law or the executive commissioner
specifies that the committee shall advise.
SECTION 2. Chapter 531, Government Code, is amended by
adding Subchapter W to read as follows:
SUBCHAPTER W. QUALITY-BASED PAYMENT INITIATIVES PILOT PROGRAMS FOR
PROVISION OF HEALTH CARE SERVICES
Sec. 531.951. DEFINITIONS. In this subchapter:
(1) "Pay-for-performance payment system" means a
system for compensating a health care provider or facility for
arranging for or providing health care services to child health
plan program enrollees or Medicaid recipients, or both, that is
based on the provider or facility meeting or exceeding certain
defined performance measures. The compensation system may include
sharing realized cost savings with the provider or facility.
(2) "Pilot program" means a quality-based payment
initiatives pilot program established under this subchapter.
Sec. 531.952. PILOT PROGRAM PROPOSALS; DETERMINATION OF
BENEFIT TO STATE. (a) Health care providers and facilities may
submit proposals to the commission for the implementation through
pilot programs of quality-based payment initiatives that provide
incentives to the providers and facilities, as applicable, to
develop health care interventions for child health plan program
enrollees or Medicaid recipients, or both, that are cost-effective
to this state and will improve the quality of health care provided
to the enrollees or recipients.
(b) The commission shall determine whether it is feasible
and cost-effective to implement one or more of the proposed pilot
programs. In addition, the commission shall examine alternative
payment methodologies used in the Medicare program and consider
whether implementing one or more of the methodologies, modified as
necessary to account for programmatic differences, through a pilot
program under this subchapter would achieve cost savings in the
Medicaid program while ensuring the use of best practices.
Sec. 531.953. PURPOSE AND IMPLEMENTATION OF PILOT PROGRAMS.
(a) If the commission determines under Section 531.952 that
implementation of one or more quality-based payment initiatives
pilot programs is feasible and cost-effective for this state, the
commission shall establish one or more programs as provided by this
subchapter to test pay-for-performance payment system alternatives
to traditional fee-for-service or other payments made to health
care providers or facilities participating in the child health plan
or Medicaid program, as applicable, that are based on best
practices, outcomes, and efficiency, but ensure high-quality,
effective health care services.
(b) The commission shall administer any pilot program
established under this subchapter. The executive commissioner may
adopt rules, plans, and procedures and enter into contracts and
other agreements as the executive commissioner considers
appropriate and necessary to administer this subchapter.
(c) The commission may limit a pilot program to:
(1) one or more regions in this state;
(2) one or more organized networks of health care
facilities and providers; or
(3) specified types of services provided under the
child health plan or Medicaid program, or specified types of
enrollees or recipients under those programs.
(d) A pilot program implemented under this subchapter must
be operated for at least one state fiscal year.
Sec. 531.954. STANDARDS; PROTOCOLS. (a) In consultation
with the Health Care Quality Advisory Committee established under
Section 531.0995, the executive commissioner shall approve quality
of care standards, evidence-based protocols, and measurable goals
for a pilot program to ensure high-quality and effective health
care services.
(b) In addition to the standards approved under Subsection
(a), the executive commissioner may approve efficiency performance
standards that may include the sharing of realized cost savings
with health care providers and facilities that provide health care
services that exceed the efficiency performance standards.
Sec. 531.955. QUALITY-BASED PAYMENT INITIATIVES. (a) The
executive commissioner may contract with appropriate entities,
including qualified actuaries, to assist in determining
appropriate payment rates for a pilot program implemented under
this subchapter.
(b) The executive commissioner may increase a payment rate,
including a capitation rate, adopted under this section as
necessary to adjust the rate for inflation.
(c) The executive commissioner shall ensure that services
provided to a child health plan program enrollee or Medicaid
recipient, as applicable, meet the quality of care standards
required under this subchapter and are at least equivalent to the
services provided under the child health plan or Medicaid program,
as applicable, for which the enrollee or recipient is eligible.
Sec. 531.956. TERMINATION OF PILOT PROGRAM; EXPIRATION OF
SUBCHAPTER. The pilot program terminates and this subchapter
expires September 2, 2013.
SECTION 3. The executive commissioner of the Health and
Human Services Commission shall appoint the members of the Health
Care Quality Advisory Committee not later than November 1, 2009.
SECTION 4. Not later than November 1, 2012, the Health and
Human Services Commission shall present a report to the governor,
the lieutenant governor, the speaker of the house of
representatives, and the members of each legislative committee
having jurisdiction over the child health plan and Medicaid
programs. For each pilot program implemented under Subchapter W,
Chapter 531, Government Code, as added by this Act, the report must:
(1) describe the operation of the pilot program;
(2) analyze the quality of health care provided to
patients under the pilot program;
(3) compare the per-patient cost under the pilot
program to the per-patient cost of the traditional fee-for-service
or other payments made under the child health plan and Medicaid
programs; and
(4) make recommendations regarding the continuation
or expansion of the pilot program.
SECTION 5. 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 6. This Act takes effect September 1, 2009.