81R14505 KLA-D
By: Nelson S.B. No. 7
A BILL TO BE ENTITLED
AN ACT
relating to strategies for and improvements in quality of health
care and care management provided through health care facilities
and through the child health plan and medical assistance programs
designed to improve health outcomes.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. CHILD HEALTH PLAN AND MEDICAID PILOT PROGRAMS.
Subchapter B, Chapter 531, Government Code, is amended by adding
Sections 531.0993 and 531.0994 to read as follows:
Sec. 531.0993. OBESITY PREVENTION PILOT PROGRAM. (a) The
commission and the Department of State Health Services shall
coordinate to establish a pilot program designed to:
(1) decrease the rate of obesity in child health plan
program enrollees and Medicaid recipients;
(2) improve nutritional choices by child health plan
program enrollees and Medicaid recipients; and
(3) achieve reductions in child health plan and
Medicaid program costs incurred by the state as a result of obesity.
(b) The commission and the Department of State Health
Services shall implement the pilot program in one or more health
care service regions in this state, as selected by the commission.
In selecting the regions for participation, the commission shall
consider the degree to which child health plan program enrollees
and Medicaid recipients in the region are at higher than average
risk of obesity.
(c) In developing the pilot program, the commission and the
Department of State Health Services shall identify measurable goals
and specific strategies for achieving those goals.
(d) Not later than November 1, 2011, the Health and Human
Services Commission shall submit a report to the standing
committees of the senate and house of representatives having
primary jurisdiction over the child health plan and Medicaid
programs regarding the results of the pilot program under this
section. The report must include:
(1) a summary of the identified goals for the program
and the strategies used to achieve those goals;
(2) a recommendation regarding the continued
operation of the pilot program; and
(3) a recommendation regarding whether the program
should be implemented statewide.
(e) The executive commissioner may adopt rules to implement
this section.
Sec. 531.0994. MEDICAL HOME FOR CHILD HEALTH PLAN PROGRAM
ENROLLEES AND MEDICAID RECIPIENTS. (a) In this section, "medical
home" means a primary care provider who provides preventive and
primary care to a patient on an ongoing basis and coordinates with
specialists when health care services provided by a specialist are
needed.
(b) The commission shall establish a pilot program in one or
more health care service regions in this state designed to
establish a medical home for each child health plan program
enrollee and Medicaid recipient participating in the pilot program.
A primary care provider participating in the program may designate
a care coordinator to support the medical home concept.
(c) Any physician practice group providing services to
participants under the pilot program must meet the Physician
Practice Connections--Patient-Centered Medical Home standards
established by the National Committee for Quality Assurance, as
those standards existed on January 1, 2009.
(d) The commission shall develop the pilot program in a
manner that bases payments made, or incentives provided, to a
participant's medical home on factors that include measurable
wellness and prevention criteria, use of best practices, and
outcomes.
(e) Not later than November 1, 2011, the commission shall
submit a report to the standing committees of the senate and house
of representatives having primary jurisdiction over the child
health plan and Medicaid programs regarding the results of the
pilot program under this section. The report must include:
(1) a recommendation regarding the continued
operation of the pilot program; and
(2) a recommendation regarding whether the program
should be implemented statewide.
(f) The executive commissioner may adopt rules to implement
this section.
SECTION 2. UNCOMPENSATED HOSPITAL CARE DATA. (a) The
heading to Section 531.551, Government Code, is amended to read as
follows:
Sec. 531.551. UNCOMPENSATED HOSPITAL CARE REPORTING AND
ANALYSIS; HOSPITAL AUDIT FEE.
(b) Section 531.551, Government Code, is amended by
amending Subsections (a) and (d) and adding Subsections (a-1),
(a-2), and (m) to read as follows:
(a) Using data submitted to the Department of State Health
Services under Subsection (a-1), the [The] executive commissioner
shall adopt rules providing for:
(1) a standard definition of "uncompensated hospital
care" that reflects unpaid costs incurred by hospitals and accounts
for actual hospital costs and hospital charges and revenue sources;
(2) a methodology to be used by hospitals in this state
to compute the cost of that care that incorporates the standard set
of adjustments described by Section 531.552(g)(4); and
(3) procedures to be used by those hospitals to report
the cost of that care to the commission and to analyze that cost.
(a-1) To assist the executive commissioner in adopting and
amending the rules required by Subsection (a), the Department of
State Health Services shall require each hospital in this state to
provide to the department, not later than a date specified by the
department, uncompensated hospital care data prescribed by the
commission. Each hospital must submit complete and adequate data,
as determined by the department, not later than the specified date.
(a-2) The Department of State Health Services shall notify
the commission of each hospital in this state that fails to submit
complete and adequate data required by the department under
Subsection (a-1) on or before the date specified by the department.
Notwithstanding any other law and to the extent allowed by federal
law, the commission may withhold Medicaid program reimbursements
owed to the hospital until the hospital complies with the
requirement.
(d) If the commission determines through the procedures
adopted under Subsection (b) that a hospital submitted a report
described by Subsection (a)(3) with incomplete or inaccurate
information, the commission shall notify the hospital of the
specific information the hospital must submit and prescribe a date
by which the hospital must provide that information. If the
hospital fails to submit the specified information on or before the
date prescribed by the commission, the commission shall notify the
attorney general of that failure. On receipt of the notice, the
attorney general shall impose an administrative penalty on the
hospital in an amount not to exceed $10,000. In determining the
amount of the penalty to be imposed, the attorney general shall
consider:
(1) the seriousness of the violation;
(2) whether the hospital had previously committed a
violation; and
(3) the amount necessary to deter the hospital from
committing future violations.
(m) The commission may require each hospital that is
required under 42 C.F.R. Section 455.304 to be audited to pay a fee
in an amount equal to the costs incurred in conducting the audit.
(c) As soon as possible after the date the Department of
State Health Services requires each hospital in this state to
initially submit uncompensated hospital care data under Section
531.551(a-1), Government Code, as added by this section, the
executive commissioner of the Health and Human Services Commission
shall adopt rules or amendments to existing rules that conform to
the requirements of Section 531.551(a), Government Code, as amended
by this section.
SECTION 3. MEDICAL TECHNOLOGY; ELECTRONIC HEALTH
INFORMATION EXCHANGE PROGRAM. (a) Section 531.02411, Government
Code, is amended to read as follows:
Sec. 531.02411. STREAMLINING ADMINISTRATIVE PROCESSES.
(a) The commission shall make every effort using the commission's
existing resources to reduce the paperwork and other administrative
burdens placed on Medicaid recipients and providers and other
participants in the Medicaid program and shall use technology and
efficient business practices to decrease those burdens. In
addition, the commission shall make every effort to improve the
business practices associated with the administration of the
Medicaid program by any method the commission determines is
cost-effective, including:
(1) expanding the utilization of the electronic claims
payment system;
(2) developing an Internet portal system for prior
authorization requests;
(3) encouraging Medicaid providers to submit their
program participation applications electronically;
(4) ensuring that the Medicaid provider application is
easy to locate on the Internet so that providers may conveniently
apply to the program;
(5) working with federal partners to take advantage of
every opportunity to maximize additional federal funding for
technology in the Medicaid program; and
(6) encouraging the increased use of medical
technology by providers, including increasing their use of:
(A) electronic communications between patients
and their physicians or other health care providers;
(B) electronic prescribing tools that provide
up-to-date payer formulary information at the time a physician or
other health care practitioner writes a prescription and that
support the electronic transmission of a prescription;
(C) ambulatory computerized order entry systems
that facilitate physician and other health care practitioner orders
at the point of care for medications and laboratory and
radiological tests;
(D) inpatient computerized order entry systems
to reduce errors, improve health care quality, and lower costs in a
hospital setting;
(E) regional data-sharing to coordinate patient
care across a community for patients who are treated by multiple
providers; and
(F) electronic intensive care unit technology to
allow physicians to fully monitor hospital patients remotely.
(b) The commission shall develop and implement a plan
designed to encourage the increased use by Medicaid providers of
the medical technology described by Subsection (a)(6)(B). The plan
must include a goal of achieving by September 1, 2014, a specified
percentage increase in the use of electronic prescribing by
Medicaid providers. Not later than January 1, 2010, the commission
shall submit a report to the legislature describing the plan
developed by the commission in accordance with this subsection.
Not later than January 1, 2011, and January 1, 2013, the commission
shall submit a report to the legislature regarding the
implementation and results of the plan. This subsection expires
September 1, 2014.
(b) Chapter 531, Government Code, is amended by adding
Subchapter V to read as follows:
SUBCHAPTER V. ELECTRONIC HEALTH INFORMATION EXCHANGE PROGRAM
Sec. 531.901. DEFINITIONS. In this subchapter:
(1) "Health care provider" means a person, other than
a physician, who is licensed or otherwise authorized to provide a
health care service in this state.
(2) "Health information exchange system" means the
electronic health information exchange system created under this
subchapter.
Sec. 531.902. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM. (a) The commission shall develop an electronic health
information exchange system to improve the quality, safety, and
efficiency of health care services provided under the child health
plan and Medicaid programs. In developing the system, the
commission shall ensure that:
(1) appropriate information technology systems used
by the commission and health and human services agencies are
interoperable; and
(2) the system and external information technology
systems are interoperable in receiving and exchanging appropriate
electronic health information as necessary to enhance the
comprehensive nature of the information contained in electronic
health records.
(b) The commission shall implement the health information
exchange system in stages as described by this subchapter.
(c) The health information exchange system must be
developed in accordance with the Medicaid Information Technology
Architecture (MITA) initiative of the Center for Medicaid and State
Operations.
Sec. 531.903. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM ADVISORY COMMITTEE. (a) The commission shall establish the
Electronic Health Information Exchange System Advisory Committee
to assist the commission in the performance of the commission's
duties under this subchapter.
(b) The executive commissioner shall appoint to the
advisory committee at least 12 and not more than 15 members who have
an interest in health information technology and who have
experience in serving persons receiving health care through the
child health plan and Medicaid programs.
(c) The advisory committee must include the following
members:
(1) Medicaid providers;
(2) child health plan program providers;
(3) fee-for-service providers;
(4) at least one representative of the Texas Health
Services Authority established under Chapter 182, Health and Safety
Code;
(5) at least one representative of each health and
human services agency; and
(6) at least one representative of a major provider
association.
(d) The members of the advisory committee must represent the
geographic and cultural diversity of the state.
(e) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(f) The advisory committee shall advise the commission on
issues regarding the development and implementation of the
electronic health information exchange system, including any issue
specified by the commission and the following specific issues:
(1) data to be included in an electronic health
record;
(2) presentation of data;
(3) useful measures for quality of service and patient
health outcomes;
(4) federal and state laws regarding privacy and
management of private patient information; and
(5) incentives for increasing provider adoption and
usage of an electronic health record and the health information
exchange system.
Sec. 531.904. STAGE ONE: ELECTRONIC HEALTH RECORD. (a) In
stage one of implementing the health information exchange system,
the commission shall develop and establish a claims-based
electronic health record for each person who receives medical
assistance under the Medicaid program. The electronic health
record must be available through an Internet-based format.
(b) The executive commissioner shall adopt rules specifying
the information required to be included in the electronic health
record. The required information may include, as appropriate:
(1) the name and address of each of the person's
physicians and health care providers;
(2) a record of each visit to a physician or health
care provider, including diagnoses, procedures performed, and
laboratory test results;
(3) an immunization record;
(4) a prescription history;
(5) a list of pending and past due appointments based
on Texas Health Steps program guidelines; and
(6) any other available health history that physicians
and health care providers who provide care for the person determine
is important.
(c) Information under Subsection (b) may be added to any
existing electronic health record or health information
technology.
(d) The commission shall make an electronic health record
for a patient available to the patient through the Internet.
Sec. 531.905. STAGE ONE: ELECTRONIC PRESCRIBING. (a) In
stage one of implementing the health information exchange system,
the commission shall develop and coordinate electronic prescribing
tools for use by physicians and health care providers under the
child health plan and Medicaid programs.
(b) To the extent feasible, the electronic prescribing
tools must:
(1) provide current payer formulary information at the
time a physician or health care provider writes a prescription; and
(2) support the electronic transmission of a
prescription.
(c) The commission may take any reasonable action to comply
with this section, including establishing information exchanges
with national electronic prescribing networks or providing
physicians and health care providers with access to an
Internet-based prescribing tool developed by the commission.
Sec. 531.906. STAGE TWO: EXPANSION. Based on the
recommendations of the advisory committee established under
Section 531.903 and feedback provided by interested parties, the
commission in stage two of implementing the health information
exchange system may expand the system by:
(1) providing an electronic health record for each
child enrolled in the child health plan program;
(2) including state laboratory results information in
an electronic health record, including the results of newborn
screenings and tests conducted under the Texas Health Steps
program, based on the system developed for the health passport
under Section 266.006, Family Code;
(3) improving data-gathering capabilities for an
electronic health record so that the record may include basic
health and clinical information in addition to available claims
information, as determined by the executive commissioner; or
(4) using predictive modeling techniques and medical
profiling capabilities to create a unique health profile for a
person to be included in the person's electronic health record to
alert physicians and health care providers regarding the need for
education, counseling, or health management activities.
Sec. 531.907. STAGE THREE: EXPANSION. In stage three of
implementing the health information exchange system, the
commission may expand the system by:
(1) continuing to enhance the electronic health record
created under Section 531.904 as technology becomes available and
interoperability capabilities improve;
(2) developing benchmarking tools that can be used to
evaluate the performance of physicians and health care providers
and overall health care quality; or
(3) expanding the system to include state agencies,
additional physicians, health care providers, laboratories,
diagnostic facilities, hospitals, and medical offices.
Sec. 531.908. INCENTIVES. The commission and the advisory
committee established under Section 531.903 shall develop
strategies to encourage physicians and health care providers to use
the health information exchange system, including incentives,
education, and outreach tools to increase usage.
Sec. 531.909. RULES. The executive commissioner may adopt
rules to implement this subchapter.
(c) Subchapter B, Chapter 62, Health and Safety Code, is
amended by adding Section 62.060 to read as follows:
Sec. 62.060. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
In this section, "health information technology" means information
technology used to improve the quality, safety, or efficiency of
clinical practice, including the core functionalities of an
electronic health record, an electronic medical record, a
computerized physician or health care provider order entry,
electronic prescribing, and clinical decision support technology.
(b) The commission shall ensure that any health information
technology used in the child health plan program conforms to the
standards adopted by the Healthcare Information Technology
Standards Panel sponsored by the American National Standards
Institute.
(d) Subchapter B, Chapter 32, Human Resources Code, is
amended by adding Section 32.073 to read as follows:
Sec. 32.073. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
In this section, "health information technology" means information
technology used to improve the quality, safety, or efficiency of
clinical practice, including the core functionalities of an
electronic health record, an electronic medical record, a
computerized physician or health care provider order entry,
electronic prescribing, and clinical decision support technology.
(b) The Health and Human Services Commission shall ensure
that any health information technology used in the medical
assistance program conforms to the standards adopted by the
Healthcare Information Technology Standards Panel sponsored by the
American National Standards Institute.
(e) As soon as practicable after the effective date of this
Act, the executive commissioner of the Health and Human Services
Commission shall adopt rules to implement the electronic health
record and electronic prescribing system required by Subchapter V,
Chapter 531, Government Code, as added by this section.
(f) The executive commissioner of the Health and Human
Services Commission shall appoint the members of the Electronic
Health Information Exchange System Advisory Committee established
under Section 531.903, Government Code, as added by this section,
as soon as practicable after the effective date of this Act.
SECTION 4. QUALITY-BASED PAYMENT INITIATIVES. (a) 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 physician or health care provider for
arranging for or providing health care services to child health
plan program enrollees or Medicaid recipients, or both, that is
based on the physician or health care provider meeting or exceeding
certain defined performance measures. The compensation system may
include sharing realized cost savings with the physician or other
health care provider.
(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) Physicians and other health care providers
may submit proposals to the commission for the implementation
through pilot programs of quality-based payment initiatives that
provide incentives to the physicians or other health care providers
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 the bundled
payment system used in the Medicare program and consider whether
implementing the system, 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 physicians
and other health care providers 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 physicians,
hospitals, and other health care 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) The executive
commissioner shall approve quality of care standards and
evidence-based protocols 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 physicians and other health care providers who 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.
(b) 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 section, 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. QUALITY-BASED HOSPITAL PAYMENTS. Chapter 531,
Government Code, is amended by adding Subchapter X to read as
follows:
SUBCHAPTER X. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
Sec. 531.981. DEFINITIONS. In this subchapter:
(1) "Potentially preventable complication" means a
harmful event or negative outcome with respect to a person,
including an infection or surgical complication, that:
(A) occurs after the person's admission to a
hospital;
(B) results from the care or treatment provided
during the hospital stay rather than from a natural progression of
an underlying disease; and
(C) could reasonably have been prevented if care
and treatment had been provided in accordance with accepted
standards of care.
(2) "Potentially preventable readmission" means a
return hospitalization of a person that results from deficiencies
in the care or treatment provided to the person during a previous
hospital stay or from deficiencies in post-hospital discharge
follow-up. The term does not include a hospital readmission
necessitated by the occurrence of unrelated events after the
discharge. The term includes the readmission of a person to a
hospital for:
(A) the same condition or procedure for which the
person was previously admitted;
(B) an infection or other complication resulting
from care previously provided;
(C) a condition or procedure that indicates that
a surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
(D) another condition or procedure of a similar
nature, as determined by the executive commissioner.
Sec. 531.982. DEVELOPMENT OF QUALITY-BASED HOSPITAL
REIMBURSEMENT SYSTEM. (a) Subject to Subsection (b), the
commission shall develop a quality-based hospital reimbursement
system for paying Medicaid reimbursements to hospitals. The system
is intended to align Medicaid provider payment incentives, promote
coordination of health care, and reduce potentially preventable
complications and readmissions.
(b) The commission shall develop the quality-based hospital
reimbursement system in phases as provided by this subchapter. To
the extent possible, the commission shall coordinate the timeline
for the development and implementation with the implementation of
the Medicaid Information Technology Architecture (MITA) initiative
of the Center for Medicaid and State Operations and the ICD-10 code
sets initiative and with the ongoing Enterprise Data Warehouse
(EDW) planning process to maximize receipt of federal funds.
Sec. 531.983. PHASE ONE: COLLECTION AND REPORTING OF
CERTAIN INFORMATION. (a) The first phase of the development of the
quality-based hospital reimbursement system consists of the
elements described by this section.
(b) The executive commissioner shall adopt rules requiring
hospitals in this state to collect data with respect to Medicaid
recipients regarding any indicators that are present at the time of
a recipient's admission to the hospital that the recipient may
experience potentially preventable complications on discharge from
the hospital. The rules must:
(1) be consistent with policies established for the
Medicare program for the collection of present-on-admission
indicators; and
(2) require each hospital to report data on the
indicators to the Texas Health Care Information Collection
maintained by the Department of State Health Services.
(c) The commission shall establish a program to provide a
confidential report to each hospital in this state regarding the
hospital's performance with respect to potentially preventable
readmissions of Medicaid recipients. The commission shall select a
method for identifying potentially preventable readmissions for
purposes of this subsection.
(d) After the commission provides the reports to hospitals
as provided by Subsection (c), each hospital will be afforded a
period of two years during which the hospital may adjust its
practices in an attempt to reduce its potentially preventable
readmissions. During this period, reimbursements paid to the
hospital may not be adjusted on the basis of potentially
preventable readmissions.
(e) The commission shall convert the hospital Medicaid
reimbursement system to an all patient refined diagnoses related
groups (APR-DRG) payment system that will allow the commission to
more accurately classify specific patient populations and account
for severity of patient illness and mortality risk.
Sec. 531.984. PHASE TWO: REIMBURSEMENT ADJUSTMENTS. (a)
The second phase of the development of the quality-based hospital
reimbursement system consists of the elements described by this
section and must be based on the information reported, and the all
patient refined diagnoses related groups (APR-DRG) payment system
implemented, during phase one of the development.
(b) Using the information reported and the all patient
refined diagnoses related groups (APR-DRG) payment system
implemented during phase one of the development of the
quality-based hospital reimbursement system, the commission shall
adjust Medicaid reimbursements to hospitals based on performance in
reducing potentially preventable readmissions. The adjustment may
be a partial reduction of the reimbursement, but may not entirely
eliminate the reimbursement.
(c) The commission shall review present-on-admission
indicator data reported by hospitals under Section 531.983(b) to
determine the feasibility of establishing a program related to
potentially preventable complications. If the program is
determined feasible, the commission may establish a program to
provide confidential reports to each hospital in this state
regarding the hospital's performance with respect to potentially
preventable complications experienced by Medicaid recipients. The
commission shall select a method for identifying potentially
preventable complications for purposes of this subsection.
(d) After the commission provides the reports to hospitals
as provided by Subsection (c), each hospital will be afforded a
period during which the hospital may adjust its practices in an
attempt to reduce its potentially preventable complications.
During this period, reimbursements paid to the hospital may not be
adjusted on the basis of potentially preventable complications.
Sec. 531.985. PHASE THREE: ADDITIONAL REIMBURSEMENT
ADJUSTMENTS. (a) The third phase of the development of the
quality-based hospital reimbursement system consists of the
elements described by this section, and is based on the information
reported during phase two of the development.
(b) The commission shall use the information reported
during phase two of the development of the quality-based hospital
reimbursement system to guide decision-making on the option of
adjusting Medicaid reimbursements to hospitals based on
performance in reducing potentially preventable complications. If
the commission adjusts the reimbursements, the adjustment may be in
the amount of a portion of the reimbursement, but may not entirely
eliminate the reimbursement.
(c) The commission may expand the applicability of
reimbursement adjustments to additional bases.
SECTION 6. PREVENTABLE ADVERSE EVENT REPORTING. (a) The
heading to Chapter 98, Health and Safety Code, as added by Chapter
359 (S.B. 288), Acts of the 80th Legislature, Regular Session,
2007, is amended to read as follows:
CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
PREVENTABLE ADVERSE EVENTS
(b) Sections 98.001(1) and (11), Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, are amended to read as follows:
(1) "Advisory panel" means the Advisory Panel on
Health Care-Associated Infections and Preventable Adverse Events.
(11) "Reporting system" means the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System.
(c) Section 98.051, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.051. ESTABLISHMENT. The commissioner shall
establish the Advisory Panel on Health Care-Associated Infections
and Preventable Adverse Events within [the infectious disease
surveillance and epidemiology branch of] the department to guide
the implementation, development, maintenance, and evaluation of
the reporting system.
(d) Sections 98.102(a) and (c), Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, are amended to read as follows:
(a) The department shall establish the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System within the [infectious disease surveillance and
epidemiology branch of the] department. The purpose of the
reporting system is to provide for:
(1) the reporting of health care-associated
infections by health care facilities to the department;
(2) the reporting of health care-associated
preventable adverse events by health care facilities to the
department;
(3) the public reporting of information regarding the
health care-associated infections by the department;
(4) the public reporting of information regarding
health care-associated preventable adverse events by the
department; and
(5) [(3)] the education and training of health care
facility staff by the department regarding this chapter.
(c) The data reported by health care facilities to the
department must contain sufficient patient identifying information
to:
(1) avoid duplicate submission of records;
(2) allow the department to verify the accuracy and
completeness of the data reported; and
(3) for data reported under Section 98.103 or 98.104,
allow the department to risk adjust the facilities' infection
rates.
(e) Subchapter C, Chapter 98, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, is amended by adding Section 98.1045 to read
as follows:
Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS. (a)
In this section:
(1) "Infant" means a child younger than one year of
age.
(2) "Serious disability" means:
(A) a physical or mental impairment that
substantially limits one or more major life activities of an
individual such as seeing, hearing, speaking, walking, or
breathing, or a loss of a bodily function, if the impairment or loss
lasts more than seven days or is still present at the time of
discharge from an inpatient health care facility; or
(B) loss of a body part.
(3) "Serious injury" means a bodily injury that
results in:
(A) death;
(B) permanent and serious impairment of an
important bodily function; or
(C) permanent and significant disfigurement.
(b) Each health care facility shall report to the department
the following preventable adverse events involving the facility's
patient, if applicable:
(1) surgery performed on the wrong body part;
(2) surgery performed on the wrong person;
(3) the wrong surgical procedure performed on the
patient;
(4) the unintended retention of a foreign object in
the patient after surgery or another procedure;
(5) death during or immediately after surgery if the
patient would be classified as a normal, healthy patient under
guidelines published by a national association of
anesthesiologists;
(6) death or serious disability caused by the use of a
contaminated drug, device, or biologic provided by a health care
professional if the contamination was the result of a generally
detectable contaminant in drugs, devices, or biologics regardless
of the source of the contamination or product;
(7) death or serious disability caused by the use or
function of a device during the patient's care in which the device
was used for a function other than as intended;
(8) death or serious disability caused by an
intravascular air embolism that occurred while the patient was
receiving care, excluding a death associated with a neurological
procedure known to present a high risk of intravascular air
embolism;
(9) an infant being discharged to the wrong person;
(10) death or serious disability associated with the
patient's disappearance for more than four hours, excluding the
death or serious disability of an adult patient who has
decision-making capacity;
(11) suicide or attempted suicide resulting in serious
disability while the patient was receiving care at the facility if
the suicide or attempted suicide was due to the patient's actions
after admission to the facility, excluding a death resulting from a
self-inflicted injury that was the reason for the patient's
admission to the facility;
(12) death or serious disability caused by a
medication error, including an error involving the wrong drug,
wrong dose, wrong patient, wrong time, wrong rate, wrong
preparation, or wrong route of administration;
(13) death or serious disability caused by a hemolytic
reaction resulting from the administration of ABO-incompatible
blood or blood products;
(14) death or serious disability caused by labor or
delivery in a low-risk pregnancy while the patient was receiving
care at the facility, including death or serious disability
occurring not later than 42 days after the delivery date;
(15) death or serious disability directly related to
the following manifestations of poor glycemic control, the onset of
which occurred while the patient was receiving care at the
facility:
(A) diabetic ketoacidosis;
(B) nonketotic hyperosmolar coma;
(C) hypoglycemic coma;
(D) secondary diabetes with ketoacidosis; and
(E) secondary diabetes with hyperosmolarity;
(16) death or serious disability, including
kernicterus, caused by failure to identify and treat
hyperbilirubinemia in a neonate before discharge from the facility;
(17) stage three or four pressure ulcers acquired
after admission to the facility;
(18) death or serious disability resulting from spinal
manipulative therapy;
(19) death or serious disability caused by an electric
shock while the patient was receiving care at the facility,
excluding an event involving a planned treatment such as electric
countershock;
(20) an incident in which a line designated for oxygen
or other gas to be delivered to the patient contained the wrong gas
or was contaminated by a toxic substance;
(21) death or serious disability caused by a burn
incurred from any source while the patient was receiving care at the
facility;
(22) death or serious disability caused by a fall
while the patient was receiving care at the facility;
(23) death or serious disability caused by the use of a
restraint or bed rail while the patient was receiving care at the
facility;
(24) an instance of care for the patient ordered or
provided by an individual impersonating a physician, nurse,
pharmacist, or other licensed health care professional;
(25) abduction of the patient from the facility;
(26) sexual assault of the patient within or on the
grounds of the facility;
(27) death or serious injury resulting from a physical
assault of the patient that occurred within or on the grounds of the
facility;
(28) artificial insemination with the wrong donor
sperm or implantation with the wrong donor egg;
(29) death or serious disability caused by a surgical
site infection occurring as a result of the following procedures:
(A) a coronary artery bypass graft;
(B) bariatric surgery such as laparoscopic
gastric bypass surgery, gastroenterostomy, and laparoscopic
gastric restrictive surgery; and
(C) orthopedic procedures involving the spine,
neck, shoulder, or elbow;
(30) death or serious disability caused by a pulmonary
embolism or deep vein thrombosis that occurred while the patient
was receiving care at the facility following a total knee
arthroplasty or hip arthroplasty;
(31) a health care-associated adverse condition or
event for which the Medicare program will not provide additional
payment to the facility under a policy adopted by the Centers for
Medicare and Medicaid Services; and
(32) any other preventable adverse event for which the
facility is denied reimbursement under Section 32.0312, Human
Resources Code.
(f) Sections 98.106(a), (b), and (g), Health and Safety
Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, are amended to read as follows:
(a) The department shall compile and make available to the
public a summary, by health care facility, of:
(1) the infections reported by facilities under
Sections 98.103 and 98.104; and
(2) the preventable adverse events reported by
facilities under Section 98.1045.
(b) Information included in the [The] departmental summary
with respect to infections reported by facilities under Sections
98.103 and 98.104 must be risk adjusted and include a comparison of
the risk-adjusted infection rates for each health care facility in
this state that is required to submit a report under Sections 98.103
and 98.104.
(g) The department shall make the departmental summary
available on an Internet website administered by the department and
may make the summary available through other formats accessible to
the public. The website must contain a statement informing the
public of the option to report suspected health care-associated
infections and preventable adverse events to the department.
(g) Section 98.108, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.108. FREQUENCY OF REPORTING. In consultation with
the advisory panel, the executive commissioner by rule shall
establish the frequency of reporting by health care facilities
required under Sections 98.103, [and] 98.104, and 98.1045.
Facilities may not be required to report more frequently than
quarterly.
(h) Section 98.109, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended by adding Subsection (b-1) and amending
Subsection (e) to read as follows:
(b-1) A state employee or officer may not be examined in a
civil, criminal, or special proceeding, or any other proceeding,
regarding the existence or contents of information or materials
obtained, compiled, or reported by the department under this
chapter.
(e) A department summary or disclosure may not contain
information identifying a [facility] patient, employee,
contractor, volunteer, consultant, health care professional,
student, or trainee in connection with a specific [infection]
incident.
(i) Sections 98.110 and 98.111, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, are amended to read as follows:
Sec. 98.110. DISCLOSURE AMONG CERTAIN AGENCIES [WITHIN
DEPARTMENT]. Notwithstanding any other law, the department may
disclose information reported by health care facilities under
Section 98.103, [or] 98.104, or 98.1045 to other programs within
the department, to the Health and Human Services Commission, and to
other health and human services agencies, as defined by Section
531.001, Government Code, for public health research or analysis
purposes only, provided that the research or analysis relates to
health care-associated infections or preventable adverse events.
The privilege and confidentiality provisions contained in this
chapter apply to such disclosures.
Sec. 98.111. CIVIL ACTION. Published infection rates or
preventable adverse events may not be used in a civil action to
establish a standard of care applicable to a health care facility.
(j) Not later than February 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt rules and procedures necessary to implement the reporting of
health care-associated preventable adverse events as required
under Chapter 98, Health and Safety Code, as amended by this
section.
SECTION 7. LONG-TERM CARE INCENTIVES. (a) Subchapter B,
Chapter 32, Human Resources Code, is amended by adding Section
32.0283 to read as follows:
Sec. 32.0283. PAY-FOR-PERFORMANCE INCENTIVES FOR CERTAIN
LONG-TERM CARE PROVIDERS. (a) In this section, "long-term care
provider" means a provider of long-term care services, as defined
by Section 22.0011, to medical assistance recipients. The term
includes:
(1) a convalescent or nursing home or related
institution licensed under Chapter 242, Health and Safety Code;
(2) an intermediate care facility for persons with
mental retardation licensed under Chapter 252, Health and Safety
Code; and
(3) a provider of community-based long-term care
services.
(b) If feasible, the executive commissioner of the Health
and Human Services Commission by rule shall establish an incentive
payment program for long-term care providers that is designed to
improve the quality of care provided to medical assistance
recipients. The program must provide additional reimbursement
payments in accordance with this section to the providers that
exceed performance standards established by the executive
commissioner.
(c) In establishing an incentive payment program under this
section, the executive commissioner of the Health and Human
Services Commission shall, subject to Subsection (d), adopt
outcome-based performance measures. The performance measures:
(1) must be indicators of:
(A) whether a long-term care provider is
providing evidence-based care; and
(B) the overall quality of care received by
medical assistance recipients; and
(2) may include measures of:
(A) quality of life;
(B) direct-care staff stability;
(C) recipient satisfaction;
(D) regulatory compliance;
(E) level of person-centered care; and
(F) level of occupancy.
(d) The executive commissioner of the Health and Human
Services Commission shall:
(1) limit the number of performance measures adopted
under Subsection (c) to avoid an unreasonable administrative burden
on long-term care providers; and
(2) for each performance measure adopted under
Subsection (c), establish a performance threshold for purposes of
determining eligibility for an incentive payment under the program.
(e) To be eligible for an incentive payment under the
program, a long-term care provider must exceed applicable
performance thresholds in at least two of the performance measures
adopted under Subsection (c), at least one of which is an indicator
of quality of care.
(f) The amount of an incentive payment under the program
must be based on a long-term care provider's ability to achieve each
performance measure, with greater weight given to performance
measures that are strong indicators of quality of care.
(g) The executive commissioner of the Health and Human
Services Commission may enter into a contract with a person for the
following services related to the program:
(1) data collection;
(2) data analysis; and
(3) reporting of long-term care provider performance
on the performance measures.
(b) As soon as practicable after the effective date of this
Act, the executive commissioner of the Health and Human Services
Commission shall adopt the rules required by Section 32.0283, Human
Resources Code, as added by this section.
SECTION 8. NEVER EVENT REIMBURSEMENT. (a) Subchapter B,
Chapter 32, Human Resources Code, is amended by adding Section
32.0312 to read as follows:
Sec. 32.0312. REIMBURSEMENT PROHIBITED FOR SERVICES
ASSOCIATED WITH PREVENTABLE ADVERSE EVENTS. (a) In this section,
"health care provider" means a person or facility licensed,
certified, or otherwise authorized by the laws of this state to
administer health care, for profit or otherwise, in the ordinary
course of business or professional practice.
(b) The department may not provide reimbursement under the
medical assistance program to a health care provider for a health
care service provided in association with a preventable adverse
event involving a recipient of medical assistance while in the
provider's care, including a health care service provided as a
result of or to correct the consequences of a preventable adverse
event.
(c) The executive commissioner of the Health and Human
Services Commission shall adopt rules necessary to implement this
section, including rules defining a preventable adverse event for
purposes of Subsection (b). In adopting rules under this
subsection, the executive commissioner shall:
(1) ensure that the department does not provide
reimbursement for health care services provided in association with
the same types of health care-associated adverse conditions for
which the Medicare program will not provide additional payment
under a policy adopted by the Centers for Medicare and Medicaid
Services;
(2) consider the list of adverse events identified by
the National Quality Forum; and
(3) consult with health care providers, including
hospitals, physicians, and nurses, and representatives of health
benefit plan issuers to obtain the recommendations of those
providers and representatives regarding denial of reimbursement
claims for any other preventable adverse events that cause patient
death or serious disability in health care settings.
(b) Not later than November 1, 2009, the executive
commissioner of the Health and Human Services Commission shall
adopt rules necessary to implement Section 32.0312, Human Resources
Code, as added by this section.
(c) Notwithstanding Section 32.0312, Human Resources Code,
as added by this section, Section 32.0312 applies only to a
preventable adverse event occurring on or after the effective date
of the rules adopted by the executive commissioner of the Health and
Human Services Commission under Subsection (b) of this section.
SECTION 9. PATIENT WRISTBANDS. Subchapter A, Chapter 311,
Health and Safety Code, is amended by adding Section 311.004 to read
as follows:
Sec. 311.004. STANDARDIZED PATIENT WRISTBANDS. (a) In
this section:
(1) "Department" means the Department of State Health
Services.
(2) "Hospital" means a hospital licensed under Chapter
241.
(b) The department shall coordinate with hospitals to
develop a statewide standardized patient wristband identification
system under which a patient with a specific medical characteristic
may be readily identified through the use of a colored wristband
that indicates to hospital personnel the existence of that
characteristic. The executive commissioner of the Health and Human
Services Commission shall appoint an ad hoc committee of hospital
representatives to assist the department in developing the
statewide system.
(c) The department shall require each hospital to implement
and enforce the statewide standardized patient wristband
identification system developed under Subsection (b).
(d) The executive commissioner of the Health and Human
Services Commission may adopt rules to implement this section.
SECTION 10. FEDERAL AUTHORIZATION. 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 11. EFFECTIVE DATE. This Act takes effect
September 1, 2009.