Texas 2009 - 81st Regular

Texas Senate Bill SB7 Compare Versions

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1	1	81R34598 KLA-D
2	2	By: Nelson S.B. No. 7
3	3	Substitute the following for S.B. No. 7:
4	4	By: McReynolds C.S.S.B. No. 7
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to strategies for and improvements in quality of health
10	10	care and care management provided through health care facilities
11	11	and through the child health plan and medical assistance programs
12	12	designed to improve health outcomes.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. CHILD HEALTH PLAN AND MEDICAID PILOT PROGRAMS.
15	15	Subchapter B, Chapter 531, Government Code, is amended by adding
16	16	Sections 531.0993 and 531.0994 to read as follows:
17	17	Sec. 531.0993. OBESITY PREVENTION PILOT PROGRAM. (a) The
18	18	commission and the Department of State Health Services shall
19	19	coordinate to establish a pilot program designed to:
20	20	(1) decrease the rate of obesity in child health plan
21	21	program enrollees and Medicaid recipients;
22	22	(2) improve the nutritional choices and increase
23	23	physical activity levels of child health plan program enrollees and
24	24	Medicaid recipients; and
25	25	(3) achieve long-term reductions in child health plan
26	26	and Medicaid program costs incurred by the state as a result of
27	27	obesity.
28	28	(b) The commission and the Department of State Health
29	29	Services shall implement the pilot program for a period of at least
30	30	24 months in one or more health care service regions in this state,
31	31	as selected by the commission. In selecting the regions for
32	32	participation, the commission shall consider the degree to which
33	33	child health plan program enrollees and Medicaid recipients in the
34	34	region are at higher than average risk of obesity.
35	35	(c) In developing the pilot program, the commission and the
36	36	Department of State Health Services in consultation with the Health
37	37	Care Quality Advisory Committee established under Section 531.0995
38	38	shall identify measurable goals and specific strategies for
39	39	achieving those goals. The specific strategies may be
40	40	evidence-based to the extent evidence-based strategies are
41	41	available for the purposes of the program.
42	42	(d) The commission shall submit a report on or before each
43	43	November 1 that occurs during the period the pilot program is
44	44	operated to the standing committees of the senate and house of
45	45	representatives having primary jurisdiction over the child health
46	46	plan and Medicaid programs regarding the results of the program. In
47	47	addition, the commission shall submit a final report to the
48	48	committees regarding those results not later than three months
49	49	after the conclusion of the program. Each report must include:
50	50	(1) a summary of the identified goals for the program
51	51	and the strategies used to achieve those goals;
52	52	(2) an analysis of all data collected in the program as
53	53	of the end of the period covered by the report and the capability of
54	54	the data to measure achievement of the identified goals;
55	55	(3) a recommendation regarding the continued
56	56	operation of the program; and
57	57	(4) a recommendation regarding whether the program
58	58	should be implemented statewide.
59	59	(e) The executive commissioner may adopt rules to implement
60	60	this section.
61	61	Sec. 531.0994. MEDICAL HOME FOR CHILD HEALTH PLAN PROGRAM
62	62	ENROLLEES AND MEDICAID RECIPIENTS. (a) In this section, "medical
63	63	home" means a primary care provider who provides preventive and
64	64	primary care to a patient on an ongoing basis and coordinates with
65	65	specialists when health care services provided by a specialist are
66	66	needed.
67	67	(b) The commission shall establish and operate for a period
68	68	of at least 24 months a pilot program in one or more health care
69	69	service regions in this state designed to establish a medical home
70	70	for each child health plan program enrollee and Medicaid recipient
71	71	participating in the pilot program. A primary care provider
72	72	participating in the program may designate a care coordinator to
73	73	support the medical home concept.
74	74	(c) The commission shall develop in consultation with the
75	75	Health Care Quality Advisory Committee established under Section
76	76	531.0995 the pilot program in a manner that:
77	77	(1) bases payments made, or incentives provided, to a
78	78	participant's medical home on factors that include measurable
79	79	wellness and prevention criteria, use of best practices, and
80	80	outcomes; and
81	81	(2) allows for the examination of measurable wellness
82	82	and prevention criteria, use of best practices, and outcomes based
83	83	on type of primary care provider.
84	84	(d) The commission shall submit a report on or before each
85	85	January 1 that occurs during the period the pilot program is
86	86	operated to the standing committees of the senate and house of
87	87	representatives having primary jurisdiction over the child health
88	88	plan and Medicaid programs regarding the status of the pilot
89	89	program. Each report must include:
90	90	(1) preliminary recommendations regarding the
91	91	continued operation of the program or whether the program should be
92	92	implemented statewide; or
93	93	(2) if the commission cannot make the recommendations
94	94	described by Subdivision (1) due to an insufficient amount of data
95	95	having been collected at the time of the report, statements
96	96	regarding the time frames within which the commission anticipates
97	97	collecting sufficient data and making those recommendations.
98	98	(e) The commission shall submit a final report to the
99	99	committees specified by Subsection (d) regarding the results of the
100	100	pilot program not later than three months after the conclusion of
101	101	the program. The final report must include:
102	102	(1) an analysis of all data collected in the program;
103	103	and
104	104	(2) a final recommendation regarding whether the
105	105	program should be implemented statewide.
106	106	SECTION 2. HEALTH CARE QUALITY ADVISORY COMMITTEE.
107	107	(a) Subchapter B, Chapter 531, Government Code, is amended by
108	108	adding Section 531.0995 to read as follows:
109	109	Sec. 531.0995. HEALTH CARE QUALITY ADVISORY COMMITTEE.
110	110	(a) The commission shall establish the Health Care Quality
111	111	Advisory Committee to assist the commission as specified by
112	112	Subsection (e) with defining best practices and quality performance
113	113	with respect to health care services and setting standards for
114	114	quality performance by health care providers and facilities for
115	115	purposes of programs administered by the commission or a health and
116	116	human services agency.
117	117	(b) The executive commissioner shall appoint the members of
118	118	the advisory committee. The committee must consist of:
119	119	(1) the following types of health care providers:
120	120	(A) a physician from an urban area who has
121	121	clinical practice expertise and who may be a pediatrician;
122	122	(B) a physician from a rural area who has
123	123	clinical practice expertise and who may be a pediatrician; and
124	124	(C) a nurse practitioner;
125	125	(2) a representative of each of the following types of
126	126	health care facilities:
127	127	(A) a general acute care hospital; and
128	128	(B) a children's hospital;
129	129	(3) a representative from a care management
130	130	organization;
131	131	(4) a member of the Advisory Panel on Health
132	132	Care-Associated Infections and Preventable Adverse Events who
133	133	meets the qualifications prescribed by Section 98.052(a)(4),
134	134	Health and Safety Code; and
135	135	(5) a representative of health care consumers.
136	136	(c) The credentials of a single member of the advisory
137	137	committee may satisfy more than one of the criteria required of the
138	138	advisory committee members under Subsection (b).
139	139	(d) The executive commissioner shall appoint the presiding
140	140	officer of the advisory committee.
141	141	(e) The advisory committee shall advise the commission on:
142	142	(1) measurable goals for the obesity prevention pilot
143	143	program under Section 531.0993;
144	144	(2) measurable wellness and prevention criteria and
145	145	best practices for the medical home pilot program under Section
146	146	531.0994;
147	147	(3) quality of care standards, evidence-based
148	148	protocols, and measurable goals for quality-based payment
149	149	initiatives pilot programs implemented under Subchapter W; and
150	150	(4) any other quality of care standards,
151	151	evidence-based protocols, measurable goals, or other related
152	152	issues with respect to which a law or the executive commissioner
153	153	specifies that the committee shall advise.
154	154	(b) The executive commissioner of the Health and Human
155	155	Services Commission shall appoint the members of the Health Care
156	156	Quality Advisory Committee not later than November 1, 2009.
157	157	SECTION 3. UNCOMPENSATED HOSPITAL CARE DATA. (a) The
158	158	heading to Section 531.551, Government Code, is amended to read as
159	159	follows:
160	160	Sec. 531.551. UNCOMPENSATED HOSPITAL CARE REPORTING AND
161	161	ANALYSIS; HOSPITAL AUDIT FEE.
162	162	(b) Section 531.551, Government Code, is amended by
163	163	amending Subsections (a) and (d) and adding Subsections (a-1),
164	164	(a-2), and (m) to read as follows:
165	165	(a) Using data submitted to the Department of State Health
166	166	Services under Subsection (a-1), the [The] executive commissioner
167	167	shall adopt rules providing for:
168	168	(1) a standard definition of "uncompensated hospital
169	169	care" that reflects unpaid costs incurred by hospitals and accounts
170	170	for actual hospital costs and hospital charges and revenue sources;
171	171	(2) a methodology to be used by hospitals in this state
172	172	to compute the cost of that care that incorporates the standard set
173	173	of adjustments described by Section 531.552(g)(4); and
174	174	(3) procedures to be used by those hospitals to report
175	175	the cost of that care to the commission and to analyze that cost.
176	176	(a-1) To assist the executive commissioner in adopting and
177	177	amending the rules required by Subsection (a), the Department of
178	178	State Health Services shall require each hospital in this state to
179	179	provide to the department, not later than a date specified by the
180	180	department, uncompensated hospital care data prescribed by the
181	181	commission. Each hospital must submit complete and adequate data,
182	182	as determined by the department, not later than the specified date.
183	183	(a-2) The Department of State Health Services shall notify
184	184	the commission of each hospital in this state that fails to submit
185	185	complete and adequate data required by the department under
186	186	Subsection (a-1) on or before the date specified by the department.
187	187	Notwithstanding any other law and to the extent allowed by federal
188	188	law, the commission may withhold Medicaid program reimbursements
189	189	owed to the hospital until the hospital complies with the
190	190	requirement.
191	191	(d) If the commission determines through the procedures
192	192	adopted under Subsection (b) that a hospital submitted a report
193	193	described by Subsection (a)(3) with incomplete or inaccurate
194	194	information, the commission shall notify the hospital of the
195	195	specific information the hospital must submit and prescribe a date
196	196	by which the hospital must provide that information. If the
197	197	hospital fails to submit the specified information on or before the
198	198	date prescribed by the commission, the commission shall notify the
199	199	attorney general of that failure. On receipt of the notice, the
200	200	attorney general shall impose an administrative penalty on the
201	201	hospital in an amount not to exceed $10,000. In determining the
202	202	amount of the penalty to be imposed, the attorney general shall
203	203	consider:
204	204	(1) the seriousness of the violation;
205	205	(2) whether the hospital had previously committed a
206	206	violation; and
207	207	(3) the amount necessary to deter the hospital from
208	208	committing future violations.
209	209	(m) The commission may require each hospital that is
210	210	required under 42 C.F.R. Section 455.304 to be audited to pay a fee
211	211	to offset the cost of the audit in an amount determined by the
212	212	commission. The total amount of fees imposed on hospitals as
213	213	authorized by this subsection may not exceed the total cost
214	214	incurred by the commission in conducting the required audits of the
215	215	hospitals.
216	216	(c) As soon as possible after the date the Department of
217	217	State Health Services requires each hospital in this state to
218	218	initially submit uncompensated hospital care data under Subsection
219	219	(a-1), Section 531.551, Government Code, as added by this section,
220	220	the executive commissioner of the Health and Human Services
221	221	Commission shall adopt rules or amendments to existing rules that
222	222	conform to the requirements of Subsection (a), Section 531.551,
223	223	Government Code, as amended by this section.
224	224	SECTION 4. MEDICAL TECHNOLOGY; ELECTRONIC HEALTH
225	225	INFORMATION EXCHANGE PROGRAM. (a) Chapter 531, Government Code,
226	226	is amended by adding Subchapter V to read as follows:
227	227	SUBCHAPTER V. ELECTRONIC HEALTH INFORMATION EXCHANGE PROGRAM
228	228	Sec. 531.901. DEFINITIONS. In this subchapter:
229	229	(1) "Electronic health record" means an electronic
230	230	record of aggregated health-related information concerning a
231	231	person that conforms to nationally recognized interoperability
232	232	standards and that can be created, managed, and consulted by
233	233	authorized health care providers across two or more health care
234	234	organizations.
235	235	(2) "Electronic medical record" means an electronic
236	236	record of health-related information concerning a person that can
237	237	be created, gathered, managed, and consulted by authorized
238	238	clinicians and staff within a single health care organization.
239	239	(3) "Health information exchange system" means the
240	240	electronic health information exchange system created under this
241	241	subchapter that electronically moves health-related information
242	242	among entities according to nationally recognized standards.
243	243	(4) "Local or regional health information exchange"
244	244	means a health information exchange operating in this state that
245	245	securely exchanges electronic health information, including
246	246	information for patients receiving services under the child health
247	247	plan or Medicaid program, among hospitals, clinics, physicians'
248	248	offices, and other health care providers that are not owned by a
249	249	single entity or included in a single operational unit or network.
250	250	Sec. 531.902. ELECTRONIC HEALTH INFORMATION EXCHANGE
251	251	SYSTEM. (a) The commission shall develop an electronic health
252	252	information exchange system to improve the quality, safety, and
253	253	efficiency of health care services provided under the child health
254	254	plan and Medicaid programs. In developing the system, the
255	255	commission shall ensure that:
256	256	(1) the confidentiality of patients' health
257	257	information is protected and the privacy of those patients is
258	258	maintained in accordance with applicable federal and state law,
259	259	including:
260	260	(A) Section 1902(a)(7), Social Security Act (42
261	261	U.S.C. Section 1396a(a)(7));
262	262	(B) the Health Insurance Portability and
263	263	Accountability Act of 1996 (Pub. L. No. 104-191);
264	264	(C) Chapter 552, Government Code;
265	265	(D) Subchapter G, Chapter 241, Health and Safety
266	266	Code;
267	267	(E) Section 12.003, Human Resources Code; and
268	268	(F) federal and state rules and regulations,
269	269	including:
270	270	(i) 42 C.F.R. Part 431, Subpart F; and
271	271	(ii) 45 C.F.R. Part 164;
272	272	(2) appropriate information technology systems used
273	273	by the commission and health and human services agencies are
274	274	interoperable;
275	275	(3) the system and external information technology
276	276	systems are interoperable in receiving and exchanging appropriate
277	277	electronic health information as necessary to enhance:
278	278	(A) the comprehensive nature of the information
279	279	contained in electronic health records; and
280	280	(B) health care provider efficiency by
281	281	supporting integration of the information into the electronic
282	282	health record used by health care providers;
283	283	(4) the system and other health information systems
284	284	not described by Subdivision (3) and data warehousing initiatives
285	285	are interoperable; and
286	286	(5) the system has the elements described by
287	287	Subsection (b).
288	288	(b) The health information exchange system must include the
289	289	following elements:
290	290	(1) an authentication process that uses multiple forms
291	291	of identity verification before allowing access to information
292	292	systems and data;
293	293	(2) a formal process for establishing data-sharing
294	294	agreements within the community of participating providers in
295	295	accordance with the Health Insurance Portability and
296	296	Accountability Act of 1996 (Pub. L. No. 104-191) and the American
297	297	Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5);
298	298	(3) a method by which the commission may open or
299	299	restrict access to the system during a declared state emergency;
300	300	(4) the capability of appropriately and securely
301	301	sharing health information with state and federal emergency
302	302	responders;
303	303	(5) compatibility with the Nationwide Health
304	304	Information Network (NHIN) and other national health information
305	305	technology initiatives coordinated by the Office of the National
306	306	Coordinator for Health Information Technology;
307	307	(6) an electronic master patient index or similar
308	308	technology that allows for patient identification across multiple
309	309	systems; and
310	310	(7) the capability of allowing a health care provider
311	311	to access the system if the provider has technology that meets
312	312	current national standards.
313	313	(c) The commission shall implement the health information
314	314	exchange system in stages as described by this subchapter, except
315	315	that the commission may deviate from those stages if technological
316	316	advances make a deviation advisable or more efficient.
317	317	(d) The health information exchange system must be
318	318	developed in accordance with the Medicaid Information Technology
319	319	Architecture (MITA) initiative of the Center for Medicaid and State
320	320	Operations and conform to other standards required under federal
321	321	law.
322	322	Sec. 531.903. ELECTRONIC HEALTH INFORMATION EXCHANGE
323	323	SYSTEM ADVISORY COMMITTEE. (a) The commission shall establish the
324	324	Electronic Health Information Exchange System Advisory Committee
325	325	to assist the commission in the performance of the commission's
326	326	duties under this subchapter.
327	327	(b) The executive commissioner shall appoint to the
328	328	advisory committee at least 12 and not more than 16 members who have
329	329	an interest in health information technology and who have
330	330	experience in serving persons receiving health care through the
331	331	child health plan and Medicaid programs.
332	332	(c) The advisory committee must include the following
333	333	members:
334	334	(1) Medicaid providers;
335	335	(2) child health plan program providers;
336	336	(3) fee-for-service providers;
337	337	(4) at least one representative of the Texas Health
338	338	Services Authority established under Chapter 182, Health and Safety
339	339	Code;
340	340	(5) at least one representative of each health and
341	341	human services agency;
342	342	(6) at least one representative of a major provider
343	343	association;
344	344	(7) at least one representative of a health care
345	345	facility;
346	346	(8) at least one representative of a managed care
347	347	organization;
348	348	(9) at least one representative of the pharmaceutical
349	349	industry;
350	350	(10) at least one representative of Medicaid
351	351	recipients and child health plan enrollees;
352	352	(11) at least one representative of a local or
353	353	regional health information exchange; and
354	354	(12) at least one representative who is skilled in
355	355	pediatric medical informatics.
356	356	(d) The members of the advisory committee must represent the
357	357	geographic and cultural diversity of the state.
358	358	(e) The executive commissioner shall appoint the presiding
359	359	officer of the advisory committee.
360	360	(f) The advisory committee shall advise the commission on
361	361	issues regarding the development and implementation of the
362	362	electronic health information exchange system, including any issue
363	363	specified by the commission and the following specific issues:
364	364	(1) data to be included in an electronic health
365	365	record;
366	366	(2) presentation of data;
367	367	(3) useful measures for quality of service and patient
368	368	health outcomes;
369	369	(4) federal and state laws regarding privacy and
370	370	management of private patient information;
371	371	(5) incentives for increasing health care provider
372	372	adoption and usage of an electronic health record and the health
373	373	information exchange system; and
374	374	(6) data exchange with local or regional health
375	375	information exchanges to enhance:
376	376	(A) the comprehensive nature of the information
377	377	contained in electronic health records; and
378	378	(B) health care provider efficiency by
379	379	supporting integration of the information into the electronic
380	380	health record used by health care providers.
381	381	(g) The advisory committee shall collaborate with the Texas
382	382	Health Services Authority to ensure that the health information
383	383	exchange system is interoperable with, and not an impediment to,
384	384	the electronic health information infrastructure that the
385	385	authority assists in developing.
386	386	Sec. 531.904. STAGE ONE: ELECTRONIC HEALTH RECORD. (a) In
387	387	stage one of implementing the health information exchange system,
388	388	the commission shall develop and establish an electronic health
389	389	record for each person who receives medical assistance under the
390	390	Medicaid program. The electronic health record must be available
391	391	through a browser-based format.
392	392	(b) The commission shall consult and collaborate with, and
393	393	accept recommendations from, physicians and other stakeholders to
394	394	ensure that electronic health records established under this
395	395	section support health information exchange with electronic
396	396	medical records systems in use by physicians in the public and
397	397	private sectors in a manner that:
398	398	(1) allows those physicians to exclusively use their
399	399	own electronic medical records systems; and
400	400	(2) does not require the purchase of a new electronic
401	401	medical records system.
402	402	(c) The executive commissioner shall adopt rules specifying
403	403	the information required to be included in the electronic health
404	404	record. The required information may include, as appropriate:
405	405	(1) the name and address of each of the person's health
406	406	care providers;
407	407	(2) a record of each visit to a health care provider,
408	408	including diagnoses, procedures performed, and laboratory test
409	409	results;
410	410	(3) an immunization record;
411	411	(4) a prescription history;
412	412	(5) a list of due and overdue Texas Health Steps
413	413	medical and dental checkup appointments; and
414	414	(6) any other available health history that health
415	415	care providers who provide care for the person determine is
416	416	important.
417	417	(d) Information under Subsection (c) may be added to any
418	418	existing electronic health record or health information technology
419	419	and may be exchanged with local and regional health information
420	420	exchanges.
421	421	(e) The commission shall make an electronic health record
422	422	for a patient available to the patient through the Internet.
423	423	Sec. 531.9041. STAGE ONE: ENCOUNTER DATA. In stage one of
424	424	implementing the health information exchange system, the
425	425	commission shall require for purposes of the implementation each
426	426	managed care organization with which the commission contracts under
427	427	Chapter 533 for the provision of Medicaid managed care services or
428	428	Chapter 62, Health and Safety Code, for the provision of child
429	429	health plan program services to submit to the commission complete
430	430	and accurate encounter data not later than the 30th day after the
431	431	last day of the month in which the managed care organization
432	432	adjudicated the claim.
433	433	Sec. 531.905. STAGE ONE: ELECTRONIC PRESCRIBING. (a) In
434	434	stage one of implementing the health information exchange system,
435	435	the commission shall support and coordinate electronic prescribing
436	436	tools used by health care providers and health care facilities
437	437	under the child health plan and Medicaid programs.
438	438	(b) The commission shall consult and collaborate with, and
439	439	accept recommendations from, physicians and other stakeholders to
440	440	ensure that the electronic prescribing tools described by
441	441	Subsection (a):
442	442	(1) are integrated with existing electronic
443	443	prescribing systems otherwise in use in the public and private
444	444	sectors; and
445	445	(2) to the extent feasible:
446	446	(A) provide current payer formulary information
447	447	at the time a health care provider writes a prescription; and
448	448	(B) support the electronic transmission of a
449	449	prescription.
450	450	(c) The commission may take any reasonable action to comply
451	451	with this section, including establishing information exchanges
452	452	with national electronic prescribing networks or providing health
453	453	care providers with access to an Internet-based prescribing tool
454	454	developed by the commission.
455	455	(d) The commission shall apply for and actively pursue any
456	456	waiver to the child health plan program or the state Medicaid plan
457	457	from the federal Centers for Medicare and Medicaid Services or any
458	458	other federal agency as necessary to remove an identified
459	459	impediment to supporting and implementing electronic prescribing
460	460	tools under this section, including the requirement for handwritten
461	461	certification of certain drugs under 42 C.F.R. Section 447.512. If
462	462	the commission with assistance from the Legislative Budget Board
463	463	determines that the implementation of operational modifications in
464	464	accordance with a waiver obtained as required by this subsection
465	465	has resulted in cost increases in the child health plan or Medicaid
466	466	program, the commission shall take the necessary actions to reverse
467	467	the operational modifications.
468	468	Sec. 531.906. STAGE TWO: EXPANSION. (a) Based on the
469	469	recommendations of the advisory committee established under
470	470	Section 531.903 and feedback provided by interested parties, the
471	471	commission in stage two of implementing the health information
472	472	exchange system may expand the system by:
473	473	(1) providing an electronic health record for each
474	474	child enrolled in the child health plan program;
475	475	(2) including state laboratory results information in
476	476	an electronic health record, including the results of newborn
477	477	screenings and tests conducted under the Texas Health Steps
478	478	program, based on the system developed for the health passport
479	479	under Section 266.006, Family Code;
480	480	(3) improving data-gathering capabilities for an
481	481	electronic health record so that the record may include basic
482	482	health and clinical information in addition to available claims
483	483	information, as determined by the executive commissioner;
484	484	(4) using evidence-based technology tools to create a
485	485	unique health profile to alert health care providers regarding the
486	486	need for additional care, education, counseling, or health
487	487	management activities for specific patients; and
488	488	(5) continuing to enhance the electronic health record
489	489	created under Section 531.904 as technology becomes available and
490	490	interoperability capabilities improve.
491	491	(b) In expanding the system, the commission shall consult
492	492	and collaborate with, and accept recommendations from, physicians
493	493	and other stakeholders to ensure that electronic health records
494	494	provided under this section support health information exchange
495	495	with electronic medical records systems in use by physicians in the
496	496	public and private sectors in a manner that:
497	497	(1) allows those physicians to exclusively use their
498	498	own electronic medical records systems; and
499	499	(2) does not require the purchase of a new electronic
500	500	medical records system.
501	501	Sec. 531.907. STAGE THREE: EXPANSION. In stage three of
502	502	implementing the health information exchange system, the
503	503	commission may expand the system by:
504	504	(1) developing evidence-based benchmarking tools that
505	505	can be used by health care providers to evaluate their own
506	506	performances on health care outcomes and overall quality of care as
507	507	compared to aggregated performance data regarding peers; and
508	508	(2) expanding the system to include state agencies,
509	509	additional health care providers, laboratories, diagnostic
510	510	facilities, hospitals, and medical offices.
511	511	Sec. 531.908. INCENTIVES. The commission and the advisory
512	512	committee established under Section 531.903 shall develop
513	513	strategies to encourage health care providers to use the health
514	514	information exchange system, including incentives, education, and
515	515	outreach tools to increase usage.
516	516	Sec. 531.909. REPORTS. (a) The commission shall provide
517	517	an initial report to the Senate Committee on Health and Human
518	518	Services or its successor, the House Committee on Human Services or
519	519	its successor, and the House Committee on Public Health or its
520	520	successor regarding the health information exchange system not
521	521	later than January 1, 2011, and shall provide a subsequent report to
522	522	those committees not later than January 1, 2013. Each report must:
523	523	(1) describe the status of the implementation of the
524	524	system;
525	525	(2) specify utilization rates for each health
526	526	information technology implemented as a component of the system;
527	527	and
528	528	(3) identify goals for utilization rates described by
529	529	Subdivision (2) and actions the commission intends to take to
530	530	increase utilization rates.
531	531	(b) This section expires September 2, 2013.
532	532	Sec. 531.910. RULES. The executive commissioner may adopt
533	533	rules to implement this subchapter.
534	534	(b) Subchapter B, Chapter 62, Health and Safety Code, is
535	535	amended by adding Section 62.060 to read as follows:
536	536	Sec. 62.060. HEALTH INFORMATION TECHNOLOGY STANDARDS.
537	537	(a) In this section, "health information technology" means
538	538	information technology used to improve the quality, safety, or
539	539	efficiency of clinical practice, including the core
540	540	functionalities of an electronic health record, an electronic
541	541	medical record, a computerized health care provider order entry,
542	542	electronic prescribing, and clinical decision support technology.
543	543	(b) The commission shall ensure that any health information
544	544	technology used by the commission or any entity acting on behalf of
545	545	the commission in the child health plan program conforms to
546	546	standards required under federal law.
547	547	(c) Subchapter B, Chapter 32, Human Resources Code, is
548	548	amended by adding Section 32.073 to read as follows:
549	549	Sec. 32.073. HEALTH INFORMATION TECHNOLOGY STANDARDS.
550	550	(a) In this section, "health information technology" means
551	551	information technology used to improve the quality, safety, or
552	552	efficiency of clinical practice, including the core
553	553	functionalities of an electronic health record, an electronic
554	554	medical record, a computerized health care provider order entry,
555	555	electronic prescribing, and clinical decision support technology.
556	556	(b) The Health and Human Services Commission shall ensure
557	557	that any health information technology used by the commission or
558	558	any entity acting on behalf of the commission in the medical
559	559	assistance program conforms to standards required under federal
560	560	law.
561	561	(d) As soon as practicable after the effective date of this
562	562	Act, the executive commissioner of the Health and Human Services
563	563	Commission shall adopt rules to implement the electronic health
564	564	record and electronic prescribing system required by Subchapter V,
565	565	Chapter 531, Government Code, as added by this section.
566	566	(e) The executive commissioner of the Health and Human
567	567	Services Commission shall appoint the members of the Electronic
568	568	Health Information Exchange System Advisory Committee established
569	569	under Section 531.903, Government Code, as added by this section,
570	570	as soon as practicable after the effective date of this Act.
571	571	SECTION 5. QUALITY-BASED PAYMENT INITIATIVES.
572	572	(a) Chapter 531, Government Code, is amended by adding Subchapter
573	573	W to read as follows:
574	574	SUBCHAPTER W. QUALITY-BASED PAYMENT INITIATIVES PILOT PROGRAMS FOR
575	575	PROVISION OF HEALTH CARE SERVICES
576	576	Sec. 531.951. DEFINITIONS. In this subchapter:
577	577	(1) "Pay-for-performance payment system" means a
578	578	system for compensating a health care provider or facility for
579	579	arranging for or providing health care services to child health
580	580	plan program enrollees or Medicaid recipients, or both, that is
581	581	based on the provider or facility meeting or exceeding certain
582	582	defined performance measures. The compensation system may include
583	583	sharing realized cost savings with the provider or facility.
584	584	(2) "Pilot program" means a quality-based payment
585	585	initiatives pilot program established under this subchapter.
586	586	Sec. 531.952. PILOT PROGRAM PROPOSALS; DETERMINATION OF
587	587	BENEFIT TO STATE. (a) Health care providers and facilities and
588	588	disease or care management organizations may submit proposals to
589	589	the commission for the implementation through pilot programs of
590	590	quality-based payment initiatives that provide incentives to the
591	591	providers and facilities, as applicable, to develop health care
592	592	interventions for child health plan program enrollees or Medicaid
593	593	recipients, or both, that are cost-effective to this state and will
594	594	improve the quality of health care provided to the enrollees or
595	595	recipients.
596	596	(b) The commission shall determine whether it is feasible
597	597	and cost-effective to implement one or more of the proposed pilot
598	598	programs. In addition, the commission shall examine alternative
599	599	payment methodologies used in the Medicare program and consider
600	600	whether implementing one or more of the methodologies, modified as
601	601	necessary to account for programmatic differences, through a pilot
602	602	program under this subchapter would achieve cost savings in the
603	603	Medicaid program while ensuring the use of best practices.
604	604	Sec. 531.953. PURPOSE AND IMPLEMENTATION OF PILOT PROGRAMS.
605	605	(a) If the commission determines under Section 531.952 that
606	606	implementation of one or more quality-based payment initiatives
607	607	pilot programs is feasible and cost-effective for this state, the
608	608	commission shall establish one or more programs as provided by this
609	609	subchapter to test pay-for-performance payment system alternatives
610	610	to traditional fee-for-service or other payments made to health
611	611	care providers or facilities participating in the child health plan
612	612	or Medicaid program, as applicable, that are based on best
613	613	practices, outcomes, and efficiency, but ensure high-quality,
614	614	effective health care services.
615	615	(b) The commission shall administer any pilot program
616	616	established under this subchapter. The executive commissioner may
617	617	adopt rules, plans, and procedures and enter into contracts and
618	618	other agreements as the executive commissioner considers
619	619	appropriate and necessary to administer this subchapter.
620	620	(c) The commission may limit a pilot program to:
621	621	(1) one or more regions in this state;
622	622	(2) one or more organized networks of health care
623	623	facilities and providers; or
624	624	(3) specified types of services provided under the
625	625	child health plan or Medicaid program, or specified types of
626	626	enrollees or recipients under those programs.
627	627	(d) A pilot program implemented under this subchapter must
628	628	be operated for at least one state fiscal year.
629	629	Sec. 531.954. STANDARDS; PROTOCOLS. (a) In consultation
630	630	with the Health Care Quality Advisory Committee established under
631	631	Section 531.0995, the executive commissioner shall approve quality
632	632	of care standards, evidence-based protocols, and measurable goals
633	633	for a pilot program to ensure high-quality and effective health
634	634	care services.
635	635	(b) In addition to the standards approved under Subsection
636	636	(a), the executive commissioner may approve efficiency performance
637	637	standards that may include the sharing of realized cost savings
638	638	with health care providers and facilities that provide health care
639	639	services that exceed the efficiency performance standards. The
640	640	efficiency performance standards may not create any financial
641	641	incentive for or involve making a payment to a health care provider
642	642	that directly or indirectly induces the limitation of medically
643	643	necessary services.
644	644	Sec. 531.955. QUALITY-BASED PAYMENT INITIATIVES. (a) The
645	645	executive commissioner may contract with appropriate entities,
646	646	including qualified actuaries, to assist in determining
647	647	appropriate payment rates for a pilot program implemented under
648	648	this subchapter.
649	649	(b) The executive commissioner may increase a payment rate,
650	650	including a capitation rate, adopted under this section as
651	651	necessary to adjust the rate for inflation.
652	652	(c) The executive commissioner shall ensure that services
653	653	provided to a child health plan program enrollee or Medicaid
654	654	recipient, as applicable, meet the quality of care standards
655	655	required under this subchapter and are at least equivalent to the
656	656	services provided under the child health plan or Medicaid program,
657	657	as applicable, for which the enrollee or recipient is eligible.
658	658	Sec. 531.956. TERMINATION OF PILOT PROGRAM; EXPIRATION OF
659	659	SUBCHAPTER. The pilot program terminates and this subchapter
660	660	expires September 2, 2013.
661	661	(b) Not later than November 1, 2012, the Health and Human
662	662	Services Commission shall present a report to the governor, the
663	663	lieutenant governor, the speaker of the house of representatives,
664	664	and the members of each legislative committee having jurisdiction
665	665	over the child health plan and Medicaid programs. For each pilot
666	666	program implemented under Subchapter W, Chapter 531, Government
667	667	Code, as added by this section, the report must:
668	668	(1) describe the operation of the pilot program;
669	669	(2) analyze the quality of health care provided to
670	670	patients under the pilot program;
671	671	(3) compare the per-patient cost under the pilot
672	672	program to the per-patient cost of the traditional fee-for-service
673	673	or other payments made under the child health plan and Medicaid
674	674	programs; and
675	675	(4) make recommendations regarding the continuation
676	676	or expansion of the pilot program.
677	677	SECTION 6. QUALITY-BASED HOSPITAL PAYMENTS. Chapter 531,
678	678	Government Code, is amended by adding Subchapter X to read as
679	679	follows:
680	680	SUBCHAPTER X. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
681	681	Sec. 531.981. DEFINITIONS. In this subchapter:
682	682	(1) "DRG methodology" means a diagnoses-related
683	683	groups methodology.
684	684	(2) "Potentially preventable complication" means a
685	685	harmful event or negative outcome with respect to a person,
686	686	including an infection or surgical complication, that:
687	687	(A) occurs after the person's admission to a
688	688	hospital;
689	689	(B) results from the care or treatment provided
690	690	during the hospital stay rather than from a natural progression of
691	691	an underlying disease; and
692	692	(C) could reasonably have been prevented if care
693	693	and treatment had been provided in accordance with accepted
694	694	standards of care.
695	695	(3) "Potentially preventable readmission" means a
696	696	return hospitalization of a person within a period specified by the
697	697	commission that results from deficiencies in the care or treatment
698	698	provided to the person during a previous hospital stay or from
699	699	deficiencies in post-hospital discharge follow-up. The term does
700	700	not include a hospital readmission necessitated by the occurrence
701	701	of unrelated events after the discharge. The term includes the
702	702	readmission of a person to a hospital for:
703	703	(A) the same condition or procedure for which the
704	704	person was previously admitted;
705	705	(B) an infection or other complication resulting
706	706	from care previously provided;
707	707	(C) a condition or procedure that indicates that
708	708	a surgical intervention performed during a previous admission was
709	709	unsuccessful in achieving the anticipated outcome; or
710	710	(D) another condition or procedure of a similar
711	711	nature, as determined by the executive commissioner.
712	712	Sec. 531.982. DEVELOPMENT OF QUALITY-BASED HOSPITAL
713	713	REIMBURSEMENT SYSTEM. (a) Subject to Subsection (b), the
714	714	commission shall develop a quality-based hospital reimbursement
715	715	system for paying Medicaid reimbursements to hospitals. The system
716	716	is intended to align Medicaid provider payment incentives with
717	717	improved quality of care, promote coordination of health care, and
718	718	reduce potentially preventable complications and readmissions.
719	719	(b) The commission shall develop the quality-based hospital
720	720	reimbursement system in phases as provided by this subchapter. To
721	721	the extent possible, the commission shall coordinate the timeline
722	722	for the development and implementation with the implementation of
723	723	the Medicaid Information Technology Architecture (MITA) initiative
724	724	of the Center for Medicaid and State Operations and the ICD-10 code
725	725	sets initiative and with the ongoing Enterprise Data Warehouse
726	726	(EDW) planning process to maximize receipt of federal funds.
727	727	Sec. 531.983. PHASE ONE: COLLECTION AND REPORTING OF
728	728	CERTAIN INFORMATION. (a) The first phase of the development of
729	729	the quality-based hospital reimbursement system consists of the
730	730	elements described by this section.
731	731	(b) The executive commissioner shall adopt rules for
732	732	identifying potentially preventable readmissions of Medicaid
733	733	recipients and the commission shall collect data on
734	734	present-on-admission indicators for purposes of this section.
735	735	(c) The commission shall establish a program to provide a
736	736	confidential report to each hospital in this state regarding the
737	737	hospital's performance with respect to potentially preventable
738	738	readmissions. A hospital shall provide the information contained
739	739	in the report provided to the hospital to health care providers
740	740	providing services at the hospital.
741	741	(d) After the commission provides the reports to hospitals
742	742	as provided by Subsection (c), each hospital will be afforded a
743	743	period of two years during which the hospital may adjust its
744	744	practices in an attempt to reduce its potentially preventable
745	745	readmissions. During this period, reimbursements paid to the
746	746	hospital may not be adjusted on the basis of potentially
747	747	preventable readmissions.
748	748	(e) The commission shall convert hospitals that are
749	749	reimbursed using a DRG methodology to a DRG methodology that will
750	750	allow the commission to more accurately classify specific patient
751	751	populations and account for severity of patient illness and
752	752	mortality risk. For purposes of hospitals that are not reimbursed
753	753	using a DRG methodology, the commission may modify data collection
754	754	requirements to allow the commission to more accurately classify
755	755	specific patient populations and account for severity of patient
756	756	illness and mortality risk.
757	757	Sec. 531.984. PHASE TWO: REIMBURSEMENT ADJUSTMENTS. (a)
758	758	The second phase of the development of the quality-based hospital
759	759	reimbursement system consists of the elements described by this
760	760	section and must be based on the information reported, data
761	761	collected, and DRG methodology implemented during phase one of the
762	762	development.
763	763	(b) Using the information reported by hospitals that are not
764	764	reimbursed using a DRG methodology during phase one of the
765	765	development of the quality-based hospital reimbursement system,
766	766	and using the DRG methodology for hospitals that are reimbursed
767	767	using the DRG methodology implemented during that phase, the
768	768	commission shall adjust Medicaid reimbursements to hospitals based
769	769	on performance in reducing potentially preventable readmissions.
770	770	An adjustment:
771	771	(1) may not be applied to a hospital if the patient's
772	772	readmission to that hospital is classified as a potentially
773	773	preventable readmission, but that hospital is not the same hospital
774	774	to which the person was previously admitted; and
775	775	(2) must be focused on addressing potentially
776	776	preventable readmissions that are continuing, significant
777	777	problems, as determined by the commission.
778	778	Sec. 531.985. PHASE THREE: STUDY OF POTENTIALLY
779	779	PREVENTABLE COMPLICATIONS. (a) In phase three of the development
780	780	of the quality-based hospital reimbursement system, the executive
781	781	commissioner shall adopt rules for identifying potentially
782	782	preventable complications and the commission shall study the
783	783	feasibility of:
784	784	(1) collecting data from hospitals concerning
785	785	potentially preventable complications;
786	786	(2) adjusting Medicaid reimbursements based on
787	787	performance in reducing those complications; and
788	788	(3) developing reconsideration review processes that
789	789	provide basic due process in challenging a reimbursement adjustment
790	790	described by Subdivision (2).
791	791	(b) The commission shall provide a report to the standing
792	792	committees of the senate and house of representatives having
793	793	primary jurisdiction over the Medicaid program concerning the
794	794	results of the study conducted under this section when the study is
795	795	completed.
796	796	(c) Rules adopted by the executive commissioner regarding
797	797	potentially preventable complications are not admissible in a civil
798	798	action for purposes of establishing a standard of care applicable
799	799	to a physician.
800	800	SECTION 7. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
801	801	Subchapter B, Chapter 32, Human Resources Code, is amended by
802	802	adding Section 32.0424 to read as follows:
803	803	Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
804	804	(a) A third-party health insurer is required to provide to the
805	805	department, on the department's request, information in a form
806	806	prescribed by the department necessary to determine:
807	807	(1) the period during which an individual entitled to
808	808	medical assistance, the individual's spouse, or the individual's
809	809	dependents may be, or may have been, covered by coverage issued by
810	810	the health insurer;
811	811	(2) the nature of the coverage; and
812	812	(3) the name, address, and identifying number of the
813	813	health plan under which the person may be, or may have been,
814	814	covered.
815	815	(b) A third-party health insurer shall accept the state's
816	816	right of recovery and the assignment under Section 32.033 to the
817	817	state of any right of an individual or other entity to payment from
818	818	the third-party health insurer for an item or service for which
819	819	payment was made under the medical assistance program.
820	820	(c) A third-party health insurer shall respond to any
821	821	inquiry by the department regarding a claim for payment for any
822	822	health care item or service reimbursed by the department under the
823	823	medical assistance program not later than the third anniversary of
824	824	the date the health care item or service was provided.
825	825	(d) A third-party health insurer may not deny a claim
826	826	submitted by the department or the department's designee for which
827	827	payment was made under the medical assistance program solely on the
828	828	basis of the date of submission of the claim, the type or format of
829	829	the claim form, or a failure to present proper documentation at the
830	830	point of service that is the basis of the claim, if:
831	831	(1) the claim is submitted by the department or the
832	832	department's designee not later than the third anniversary of the
833	833	date the item or service was provided; and
834	834	(2) any action by the department or the department's
835	835	designee to enforce the state's rights with respect to the claim is
836	836	commenced not later than the sixth anniversary of the date the
837	837	department or the department's designee submits the claim.
838	838	(e) This section does not limit the scope or amount of
839	839	information required by Section 32.042.
840	840	SECTION 8. PREVENTABLE ADVERSE EVENT REPORTING. (a) The
841	841	heading to Chapter 98, Health and Safety Code, as added by Chapter
842	842	359 (S.B. 288), Acts of the 80th Legislature, Regular Session,
843	843	2007, is amended to read as follows:
844	844	CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
845	845	PREVENTABLE ADVERSE EVENTS
846	846	(b) Subdivisions (1) and (11), Section 98.001, Health and
847	847	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
848	848	Legislature, Regular Session, 2007, are amended to read as follows:
849	849	(1) "Advisory panel" means the Advisory Panel on
850	850	Health Care-Associated Infections and Preventable Adverse Events.
851	851	(11) "Reporting system" means the Texas Health
852	852	Care-Associated Infection and Preventable Adverse Events Reporting
853	853	System.
854	854	(c) Section 98.051, Health and Safety Code, as added by
855	855	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
856	856	Session, 2007, is amended to read as follows:
857	857	Sec. 98.051. ESTABLISHMENT. The commissioner shall
858	858	establish the Advisory Panel on Health Care-Associated Infections
859	859	and Preventable Adverse Events within [the infectious disease
860	860	surveillance and epidemiology branch of] the department to guide
861	861	the implementation, development, maintenance, and evaluation of
862	862	the reporting system. The commissioner may establish one or more
863	863	subcommittees to assist the advisory panel in addressing health
864	864	care-associated infections and preventable adverse events relating
865	865	to hospital care provided to children or other special patient
866	866	populations.
867	867	(d) Subsection (a), Section 98.052, Health and Safety Code,
868	868	as added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
869	869	Regular Session, 2007, is amended to read as follows:
870	870	(a) The advisory panel is composed of 18 [16] members as
871	871	follows:
872	872	(1) two infection control professionals who:
873	873	(A) are certified by the Certification Board of
874	874	Infection Control and Epidemiology; and
875	875	(B) are practicing in hospitals in this state, at
876	876	least one of which must be a rural hospital;
877	877	(2) two infection control professionals who:
878	878	(A) are certified by the Certification Board of
879	879	Infection Control and Epidemiology; and
880	880	(B) are nurses licensed to engage in professional
881	881	nursing under Chapter 301, Occupations Code;
882	882	(3) three board-certified or board-eligible
883	883	physicians who:
884	884	(A) are licensed to practice medicine in this
885	885	state under Chapter 155, Occupations Code, at least two of whom have
886	886	active medical staff privileges at a hospital in this state and at
887	887	least one of whom is a pediatric infectious disease physician with
888	888	expertise and experience in pediatric health care epidemiology;
889	889	(B) are active members of the Society for
890	890	Healthcare Epidemiology of America; and
891	891	(C) have demonstrated expertise in quality
892	892	assessment and performance improvement or infection control in
893	893	health care facilities;
894	894	(4) four additional [two] professionals in quality
895	895	assessment and performance improvement[, one of whom is employed by
896	896	a general hospital and one of whom is employed by an ambulatory
897	897	surgical center];
898	898	(5) one officer of a general hospital;
899	899	(6) one officer of an ambulatory surgical center;
900	900	(7) three nonvoting members who are department
901	901	employees representing the department in epidemiology and the
902	902	licensing of hospitals or ambulatory surgical centers; and
903	903	(8) two members who represent the public as consumers.
904	904	(e) Subsections (a) and (c), Section 98.102, Health and
905	905	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
906	906	Legislature, Regular Session, 2007, are amended to read as follows:
907	907	(a) The department shall establish the Texas Health
908	908	Care-Associated Infection and Preventable Adverse Events Reporting
909	909	System within the [infectious disease surveillance and
910	910	epidemiology branch of the] department. The purpose of the
911	911	reporting system is to provide for:
912	912	(1) the reporting of health care-associated
913	913	infections by health care facilities to the department;
914	914	(2) the reporting of health care-associated
915	915	preventable adverse events by health care facilities to the
916	916	department;
917	917	(3) the public reporting of information regarding the
918	918	health care-associated infections by the department;
919	919	(4) the public reporting of information regarding
920	920	health care-associated preventable adverse events by the
921	921	department; and
922	922	(5) [(3)] the education and training of health care
923	923	facility staff by the department regarding this chapter.
924	924	(c) The data reported by health care facilities to the
925	925	department must contain sufficient patient identifying information
926	926	to:
927	927	(1) avoid duplicate submission of records;
928	928	(2) allow the department to verify the accuracy and
929	929	completeness of the data reported; and
930	930	(3) for data reported under Section 98.103 or 98.104,
931	931	allow the department to risk adjust the facilities' infection
932	932	rates.
933	933	(f) Subchapter C, Chapter 98, Health and Safety Code, as
934	934	added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
935	935	Regular Session, 2007, is amended by adding Section 98.1045 to read
936	936	as follows:
937	937	Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS.
938	938	(a) Each health care facility shall report to the department the
939	939	occurrence of any of the following preventable adverse events
940	940	involving the facility's patient:
941	941	(1) a health care-associated adverse condition or
942	942	event for which the Medicare program will not provide additional
943	943	payment to the facility under a policy adopted by the federal
944	944	Centers for Medicare and Medicaid Services; and
945	945	(2) subject to Subsection (b), an event included in
946	946	the list of adverse events identified by the National Quality Forum
947	947	that is not included under Subdivision (1).
948	948	(b) The executive commissioner may exclude an adverse event
949	949	described by Subsection (a)(2) from the reporting requirement of
950	950	Subsection (a) if the executive commissioner, in consultation with
951	951	the advisory panel, determines that the adverse event is not an
952	952	appropriate indicator of a preventable adverse event.
953	953	(g) Subsections (a), (b), and (g), Section 98.106, Health
954	954	and Safety Code, as added by Chapter 359 (S.B. 288), Acts of the
955	955	80th Legislature, Regular Session, 2007, are amended to read as
956	956	follows:
957	957	(a) The department shall compile and make available to the
958	958	public a summary, by health care facility, of:
959	959	(1) the infections reported by facilities under
960	960	Sections 98.103 and 98.104; and
961	961	(2) the preventable adverse events reported by
962	962	facilities under Section 98.1045.
963	963	(b) Information included in the [The] departmental summary
964	964	with respect to infections reported by facilities under Sections
965	965	98.103 and 98.104 must be risk adjusted and include a comparison of
966	966	the risk-adjusted infection rates for each health care facility in
967	967	this state that is required to submit a report under Sections 98.103
968	968	and 98.104.
969	969	(g) The department shall make the departmental summary
970	970	available on an Internet website administered by the department and
971	971	may make the summary available through other formats accessible to
972	972	the public. The website must contain a statement informing the
973	973	public of the option to report suspected health care-associated
974	974	infections and preventable adverse events to the department.
975	975	(h) Section 98.108, Health and Safety Code, as added by
976	976	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
977	977	Session, 2007, is amended to read as follows:
978	978	Sec. 98.108. FREQUENCY OF REPORTING. In consultation with
979	979	the advisory panel, the executive commissioner by rule shall
980	980	establish the frequency of reporting by health care facilities
981	981	required under Sections 98.103, [and] 98.104, and 98.1045.
982	982	Facilities may not be required to report more frequently than
983	983	quarterly.
984	984	(i) Section 98.109, Health and Safety Code, as added by
985	985	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
986	986	Session, 2007, is amended by adding Subsection (b-1) and amending
987	987	Subsection (e) to read as follows:
988	988	(b-1) A state employee or officer may not be examined in a
989	989	civil, criminal, or special proceeding, or any other proceeding,
990	990	regarding the existence or contents of information or materials
991	991	obtained, compiled, or reported by the department under this
992	992	chapter.
993	993	(e) A department summary or disclosure may not contain
994	994	information identifying a [facility] patient, employee,
995	995	contractor, volunteer, consultant, health care professional,
996	996	student, or trainee in connection with a specific [infection]
997	997	incident.
998	998	(j) Sections 98.110 and 98.111, Health and Safety Code, as
999	999	added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
1000	1000	Regular Session, 2007, are amended to read as follows:
1001	1001	Sec. 98.110. DISCLOSURE AMONG CERTAIN AGENCIES [WITHIN
1002	1002	DEPARTMENT]. Notwithstanding any other law, the department may
1003	1003	disclose information reported by health care facilities under
1004	1004	Section 98.103, [or] 98.104, or 98.1045 to other programs within
1005	1005	the department, to the Health and Human Services Commission, and to
1006	1006	other health and human services agencies, as defined by Section
1007	1007	531.001, Government Code, for public health research or analysis
1008	1008	purposes only, provided that the research or analysis relates to
1009	1009	health care-associated infections or preventable adverse events.
1010	1010	The privilege and confidentiality provisions contained in this
1011	1011	chapter apply to such disclosures.
1012	1012	Sec. 98.111. CIVIL ACTION. Published infection rates or
1013	1013	preventable adverse events may not be used in a civil action to
1014	1014	establish a standard of care applicable to a health care facility.
1015	1015	(k) As soon as possible after the effective date of this
1016	1016	Act, the commissioner of state health services shall appoint two
1017	1017	additional members to the advisory panel who meet the
1018	1018	qualifications prescribed by Subdivision (4), Subsection (a),
1019	1019	Section 98.052, Health and Safety Code, as amended by this section.
1020	1020	(l) Not later than February 1, 2010, the executive
1021	1021	commissioner of the Health and Human Services Commission shall
1022	1022	adopt rules and procedures necessary to implement the reporting of
1023	1023	health care-associated preventable adverse events as required
1024	1024	under Chapter 98, Health and Safety Code, as amended by this
1025	1025	section.
1026	1026	SECTION 9. LONG-TERM CARE INCENTIVES. (a) Subchapter B,
1027	1027	Chapter 32, Human Resources Code, is amended by adding Section
1028	1028	32.0283 to read as follows:
1029	1029	Sec. 32.0283. PAY-FOR-PERFORMANCE INCENTIVES FOR CERTAIN
1030	1030	NURSING FACILITIES. (a) In this section, "nursing facility" means
1031	1031	a convalescent or nursing home or related institution licensed
1032	1032	under Chapter 242, Health and Safety Code, that provides long-term
1033	1033	care services, as defined by Section 22.0011, to medical assistance
1034	1034	recipients.
1035	1035	(b) If feasible, the executive commissioner of the Health
1036	1036	and Human Services Commission by rule shall establish an incentive
1037	1037	payment program for nursing facilities that is designed to improve
1038	1038	the quality of care and services provided to medical assistance
1039	1039	recipients. Subject to Subsection (g), the program must provide
1040	1040	additional payments in accordance with this section to the
1041	1041	facilities that meet or exceed performance standards established by
1042	1042	the executive commissioner.
1043	1043	(c) In establishing an incentive payment program under this
1044	1044	section, the executive commissioner of the Health and Human
1045	1045	Services Commission shall, subject to Subsection (d), adopt
1046	1046	outcome-based performance measures. The performance measures:
1047	1047	(1) must be:
1048	1048	(A) recognized by the executive commissioner as
1049	1049	valid indicators of the overall quality of care received by medical
1050	1050	assistance recipients; and
1051	1051	(B) designed to encourage and reward
1052	1052	evidence-based practices among nursing facilities; and
1053	1053	(2) may include measures of:
1054	1054	(A) quality of life;
1055	1055	(B) direct-care staff retention and turnover;
1056	1056	(C) recipient satisfaction;
1057	1057	(D) employee satisfaction and engagement;
1058	1058	(E) the incidence of preventable acute care
1059	1059	emergency room services use;
1060	1060	(F) regulatory compliance;
1061	1061	(G) level of person-centered care; and
1062	1062	(H) level of occupancy or of facility
1063	1063	utilization.
1064	1064	(d) The executive commissioner of the Health and Human
1065	1065	Services Commission shall:
1066	1066	(1) maximize the use of available information
1067	1067	technology and limit the number of performance measures adopted
1068	1068	under Subsection (c) to achieve administrative cost efficiency and
1069	1069	avoid an unreasonable administrative burden on nursing facilities;
1070	1070	and
1071	1071	(2) for each performance measure adopted under
1072	1072	Subsection (c), establish a performance threshold for purposes of
1073	1073	determining eligibility for an incentive payment under the program.
1074	1074	(e) To be eligible for an incentive payment under the
1075	1075	program, a nursing facility must meet or exceed applicable
1076	1076	performance thresholds in at least two of the performance measures
1077	1077	adopted under Subsection (c), at least one of which is an indicator
1078	1078	of quality of care.
1079	1079	(f) The executive commissioner of the Health and Human
1080	1080	Services Commission may:
1081	1081	(1) determine the amount of an incentive payment under
1082	1082	the program based on a performance index that gives greater weight
1083	1083	to performance measures that are shown to be stronger indicators of
1084	1084	a nursing facility's overall performance quality; and
1085	1085	(2) enter into a contract with a qualified person, as
1086	1086	determined by the executive commissioner, for the following
1087	1087	services related to the program:
1088	1088	(A) data collection;
1089	1089	(B) data analysis; and
1090	1090	(C) reporting of nursing facility performance on
1091	1091	the performance measures adopted under Subsection (c).
1092	1092	(g) The Health and Human Services Commission may make
1093	1093	incentive payments under the program only if money is specifically
1094	1094	appropriated for that purpose.
1095	1095	(b) Subsection (a), Section 32.060, Human Resources Code,
1096	1096	as added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th
1097	1097	Legislature, Regular Session, 2003, is amended to read as follows:
1098	1098	(a) The following are not admissible as evidence in a civil
1099	1099	action:
1100	1100	(1) any finding by the department that an institution
1101	1101	licensed under Chapter 242, Health and Safety Code, has violated a
1102	1102	standard for participation in the medical assistance program under
1103	1103	this chapter; [or]
1104	1104	(2) the fact of the assessment of a monetary penalty
1105	1105	against an institution under Section 32.021 or the payment of the
1106	1106	penalty by an institution; or
1107	1107	(3) any information obtained or used by the department
1108	1108	to determine the eligibility of a nursing facility for an incentive
1109	1109	payment, or to determine the facility's performance rating, under
1110	1110	Section 32.028(g) or 32.0283(f).
1111	1111	(c) The Health and Human Services Commission shall conduct a
1112	1112	study to evaluate the feasibility of providing an incentive payment
1113	1113	program for the following types of providers of long-term care
1114	1114	services, as defined by Section 22.0011, Human Resources Code,
1115	1115	under the medical assistance program similar to the incentive
1116	1116	payment program established for nursing facilities under Section
1117	1117	32.0283, Human Resources Code, as added by this section:
1118	1118	(1) intermediate care facilities for persons with
1119	1119	mental retardation licensed under Chapter 252, Health and Safety
1120	1120	Code; and
1121	1121	(2) providers of home and community-based services, as
1122	1122	described by 42 U.S.C. Section 1396n(c), who are licensed or
1123	1123	otherwise authorized to provide those services in this state.
1124	1124	(d) Not later than September 1, 2010, the Health and Human
1125	1125	Services Commission shall submit to the legislature a written
1126	1126	report containing the findings of the study conducted under
1127	1127	Subsection (c) of this section and the commission's
1128	1128	recommendations.
1129	1129	(e) As soon as practicable after the effective date of this
1130	1130	Act, the executive commissioner of the Health and Human Services
1131	1131	Commission shall adopt the rules required by Section 32.0283, Human
1132	1132	Resources Code, as added by this section.
1133	1133	SECTION 10. PREVENTABLE ADVERSE EVENT REIMBURSEMENT.
1134	1134	(a) Subchapter B, Chapter 32, Human Resources Code, is amended by
1135	1135	adding Section 32.0312 to read as follows:
1136	1136	Sec. 32.0312. REIMBURSEMENT FOR SERVICES ASSOCIATED WITH
1137	1137	PREVENTABLE ADVERSE EVENTS. The executive commissioner of the
1138	1138	Health and Human Services Commission shall adopt rules regarding
1139	1139	the denial or reduction of reimbursement under the medical
1140	1140	assistance program for preventable adverse events that occur in a
1141	1141	hospital setting. In adopting the rules, the executive
1142	1142	commissioner:
1143	1143	(1) shall ensure that the commission imposes the same
1144	1144	reimbursement denials or reductions for preventable adverse events
1145	1145	as the Medicare program imposes for the same types of health
1146	1146	care-associated adverse conditions and the same types of health
1147	1147	care providers and facilities under a policy adopted by the federal
1148	1148	Centers for Medicare and Medicaid Services;
1149	1149	(2) shall consult with the Health Care Quality
1150	1150	Advisory Committee established under Section 531.0995, Government
1151	1151	Code, to obtain the advice of that committee regarding denial or
1152	1152	reduction of reimbursement claims for any other preventable adverse
1153	1153	events that cause patient death or serious disability in health
1154	1154	care settings, including events on the list of adverse events
1155	1155	identified by the National Quality Forum; and
1156	1156	(3) may allow the commission to impose reimbursement
1157	1157	denials or reductions for preventable adverse events described by
1158	1158	Subdivision (2).
1159	1159	(b) Not later than September 1, 2010, the executive
1160	1160	commissioner of the Health and Human Services Commission shall
1161	1161	adopt the rules required by Section 32.0312, Human Resources Code,
1162	1162	as added by this section.
1163	1163	(c) Rules adopted by the executive commissioner of the
1164	1164	Health and Human Services Commission under Section 32.0312, Human
1165	1165	Resources Code, as added by this section, may apply only to a
1166	1166	preventable adverse event occurring on or after the effective date
1167	1167	of the rules.
1168	1168	SECTION 11. PATIENT RISK IDENTIFICATION SYSTEM. Subchapter
1169	1169	A, Chapter 311, Health and Safety Code, is amended by adding Section
1170	1170	311.004 to read as follows:
1171	1171	Sec. 311.004. STANDARDIZED PATIENT RISK IDENTIFICATION
1172	1172	SYSTEM. (a) In this section:
1173	1173	(1) "Department" means the Department of State Health
1174	1174	Services.
1175	1175	(2) "Hospital" means a general or special hospital as
1176	1176	defined by Section 241.003. The term includes a hospital
1177	1177	maintained or operated by this state.
1178	1178	(b) The department shall coordinate with hospitals to
1179	1179	develop a statewide standardized patient risk identification
1180	1180	system under which a patient with a specific medical risk may be
1181	1181	readily identified through the use of a system that communicates to
1182	1182	hospital personnel the existence of that risk. The executive
1183	1183	commissioner of the Health and Human Services Commission shall
1184	1184	appoint an ad hoc committee of hospital representatives to assist
1185	1185	the department in developing the statewide system.
1186	1186	(c) The department shall require each hospital to implement
1187	1187	and enforce the statewide standardized patient risk identification
1188	1188	system developed under Subsection (b) unless the department
1189	1189	authorizes an exemption for the reason stated in Subsection (d).
1190	1190	(d) The department may exempt from the statewide
1191	1191	standardized patient risk identification system a hospital that
1192	1192	seeks to adopt another patient risk identification methodology
1193	1193	supported by evidence-based protocols for the practice of medicine.
1194	1194	(e) The department shall modify the statewide standardized
1195	1195	patient risk identification system in accordance with
1196	1196	evidence-based medicine as necessary.
1197	1197	(f) The executive commissioner of the Health and Human
1198	1198	Services Commission may adopt rules to implement this section.
1199	1199	SECTION 12. FEDERAL AUTHORIZATION. If before implementing
1200	1200	any provision of this Act a state agency determines that a waiver or
1201	1201	authorization from a federal agency is necessary for implementation
1202	1202	of that provision, the agency affected by the provision shall
1203	1203	request the waiver or authorization and may delay implementing that
1204	1204	provision until the waiver or authorization is granted.
1205	1205	SECTION 13. NO APPROPRIATION. This Act does not make an
1206	1206	appropriation. This Act takes effect only if a specific
1207	1207	appropriation for the implementation of the Act is provided in a
1208	1208	general appropriations act of the 81st Legislature.
1209	1209	SECTION 14. EFFECTIVE DATE. This Act takes effect
1210	1210	September 1, 2009.