Texas 2009 - 81st Regular

Texas Senate Bill SB288 Compare Versions

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1	1	81R32461 KLA-F
2	2	By: Nelson S.B. No. 288
3	3	Substitute the following for S.B. No. 288:
4	4	By: Coleman C.S.S.B. No. 288
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to improving the quality of health care services provided
10	10	under certain state programs through certain initiatives,
11	11	including payment strategies and medication history review
12	12	requirements.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Subchapter B, Chapter 531, Government Code, is
15	15	amended by adding Sections 531.0961 and 531.0995 to read as
16	16	follows:
17	17	Sec. 531.0961. MEDICAID PROVIDER REVIEW OF ELECTRONIC
18	18	MEDICATION HISTORY. The commission, as part of a quality-based
19	19	payment initiatives pilot program developed under Subchapter W, may
20	20	require a health care provider providing acute care services under
21	21	the state Medicaid program to review, before providing an acute
22	22	care service or procedure to a Medicaid recipient, the recipient's
23	23	prescription and nonprescription medication history included in:
24	24	(1) a health passport provided to the recipient under
25	25	Section 266.006, Family Code, or any other law; or
26	26	(2) any other electronic health records maintained
27	27	under the program with respect to the recipient and to which the
28	28	provider has access.
29	29	Sec. 531.0995. HEALTH CARE QUALITY ADVISORY COMMITTEE.
30	30	(a) The commission shall establish the Health Care Quality
31	31	Advisory Committee to assist the commission as specified by
32	32	Subsection (d) with defining best practices and quality performance
33	33	with respect to health care services and setting standards for
34	34	quality performance by health care providers and facilities for
35	35	purposes of programs administered by the commission or a health and
36	36	human services agency.
37	37	(b) The executive commissioner shall appoint the members of
38	38	the advisory committee. The committee must consist of health care
39	39	providers, representatives of health care facilities, and other
40	40	stakeholders interested in health care services provided in this
41	41	state. At least one member must be a physician who has clinical
42	42	practice expertise, and at least one member must be a member of the
43	43	advisory panel established as provided by Section 98.051, Health
44	44	and Safety Code, who meets the qualifications prescribed by Section
45	45	98.052(a)(4), Health and Safety Code.
46	46	(c) The executive commissioner shall appoint the presiding
47	47	officer of the advisory committee.
48	48	(d) The advisory committee shall advise the commission on:
49	49	(1) quality of care standards, evidence-based
50	50	protocols, and measurable goals for quality-based payment
51	51	initiatives pilot programs implemented under Subchapter W; and
52	52	(2) any other quality of care standards,
53	53	evidence-based protocols, measurable goals, or other related
54	54	issues with respect to which a law or the executive commissioner
55	55	specifies that the committee shall advise.
56	56	SECTION 2. Chapter 531, Government Code, is amended by
57	57	adding Subchapter W to read as follows:
58	58	SUBCHAPTER W. QUALITY-BASED PAYMENT INITIATIVES PILOT PROGRAMS FOR
59	59	PROVISION OF HEALTH CARE SERVICES
60	60	Sec. 531.951. DEFINITIONS. In this subchapter:
61	61	(1) "Pay-for-performance payment system" means a
62	62	system for compensating a health care provider or facility for
63	63	arranging for or providing health care services to child health
64	64	plan program enrollees or Medicaid recipients, or both, that is
65	65	based on the provider or facility meeting or exceeding certain
66	66	defined performance measures. The compensation system may include
67	67	sharing realized cost savings with the provider or facility.
68	68	(2) "Pilot program" means a quality-based payment
69	69	initiatives pilot program established under this subchapter.
70	70	Sec. 531.952. PILOT PROGRAM PROPOSALS; DETERMINATION OF
71	71	BENEFIT TO STATE. (a) Health care providers and facilities may
72	72	submit proposals to the commission for the implementation through
73	73	pilot programs of quality-based payment initiatives that provide
74	74	incentives to the providers and facilities, as applicable, to
75	75	develop health care interventions for child health plan program
76	76	enrollees or Medicaid recipients, or both, that are cost-effective
77	77	to this state and will improve the quality of health care provided
78	78	to the enrollees or recipients.
79	79	(b) The commission shall determine whether it is feasible
80	80	and cost-effective to implement one or more of the proposed pilot
81	81	programs. In addition, the commission shall examine alternative
82	82	payment methodologies used in the Medicare program and consider
83	83	whether implementing one or more of the methodologies, modified as
84	84	necessary to account for programmatic differences, through a pilot
85	85	program under this subchapter would achieve cost savings in the
86	86	Medicaid program while ensuring the use of best practices.
87	87	Sec. 531.953. PURPOSE AND IMPLEMENTATION OF PILOT PROGRAMS.
88	88	(a) If the commission determines under Section 531.952 that
89	89	implementation of one or more quality-based payment initiatives
90	90	pilot programs is feasible and cost-effective for this state, the
91	91	commission shall establish one or more programs as provided by this
92	92	subchapter to test pay-for-performance payment system alternatives
93	93	to traditional fee-for-service or other payments made to health
94	94	care providers or facilities participating in the child health plan
95	95	or Medicaid program, as applicable, that are based on best
96	96	practices, outcomes, and efficiency, but ensure high-quality,
97	97	effective health care services.
98	98	(b) The commission shall administer any pilot program
99	99	established under this subchapter. The executive commissioner may
100	100	adopt rules, plans, and procedures and enter into contracts and
101	101	other agreements as the executive commissioner considers
102	102	appropriate and necessary to administer this subchapter.
103	103	(c) The commission may limit a pilot program to:
104	104	(1) one or more regions in this state;
105	105	(2) one or more organized networks of health care
106	106	facilities and providers; or
107	107	(3) specified types of services provided under the
108	108	child health plan or Medicaid program, or specified types of
109	109	enrollees or recipients under those programs.
110	110	(d) A pilot program implemented under this subchapter must
111	111	be operated for at least one state fiscal year.
112	112	Sec. 531.954. STANDARDS; PROTOCOLS. (a) In consultation
113	113	with the Health Care Quality Advisory Committee established under
114	114	Section 531.0995, the executive commissioner shall approve quality
115	115	of care standards, evidence-based protocols, and measurable goals
116	116	for a pilot program to ensure high-quality and effective health
117	117	care services.
118	118	(b) In addition to the standards approved under Subsection
119	119	(a), the executive commissioner may approve efficiency performance
120	120	standards that may include the sharing of realized cost savings
121	121	with health care providers and facilities that provide health care
122	122	services that exceed the efficiency performance standards.
123	123	Sec. 531.955. QUALITY-BASED PAYMENT INITIATIVES. (a) The
124	124	executive commissioner may contract with appropriate entities,
125	125	including qualified actuaries, to assist in determining
126	126	appropriate payment rates for a pilot program implemented under
127	127	this subchapter.
128	128	(b) The executive commissioner may increase a payment rate,
129	129	including a capitation rate, adopted under this section as
130	130	necessary to adjust the rate for inflation.
131	131	(c) The executive commissioner shall ensure that services
132	132	provided to a child health plan program enrollee or Medicaid
133	133	recipient, as applicable, meet the quality of care standards
134	134	required under this subchapter and are at least equivalent to the
135	135	services provided under the child health plan or Medicaid program,
136	136	as applicable, for which the enrollee or recipient is eligible.
137	137	Sec. 531.956. TERMINATION OF PILOT PROGRAM; EXPIRATION OF
138	138	SUBCHAPTER. The pilot program terminates and this subchapter
139	139	expires September 2, 2013.
140	140	SECTION 3. The executive commissioner of the Health and
141	141	Human Services Commission shall appoint the members of the Health
142	142	Care Quality Advisory Committee not later than November 1, 2009.
143	143	SECTION 4. Not later than November 1, 2012, the Health and
144	144	Human Services Commission shall present a report to the governor,
145	145	the lieutenant governor, the speaker of the house of
146	146	representatives, and the members of each legislative committee
147	147	having jurisdiction over the child health plan and Medicaid
148	148	programs. For each pilot program implemented under Subchapter W,
149	149	Chapter 531, Government Code, as added by this Act, the report must:
150	150	(1) describe the operation of the pilot program;
151	151	(2) analyze the quality of health care provided to
152	152	patients under the pilot program;
153	153	(3) compare the per-patient cost under the pilot
154	154	program to the per-patient cost of the traditional fee-for-service
155	155	or other payments made under the child health plan and Medicaid
156	156	programs; and
157	157	(4) make recommendations regarding the continuation
158	158	or expansion of the pilot program.
159	159	SECTION 5. If before implementing any provision of this Act
160	160	a state agency determines that a waiver or authorization from a
161	161	federal agency is necessary for implementation of that provision,
162	162	the agency affected by the provision shall request the waiver or
163	163	authorization and may delay implementing that provision until the
164	164	waiver or authorization is granted.
165	165	SECTION 6. This Act takes effect September 1, 2009.