Texas 2009 - 81st Regular

Texas Senate Bill SB8 Compare Versions

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1	1	81R35109 JSC-D
2	2	By: Nelson, et al. S.B. No. 8
3	3	Substitute the following for S.B. No. 8:
4	4	By: McReynolds C.S.S.B. No. 8
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the administration, powers, and duties of the Texas
10	10	Health Services Authority.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 182.001, Health and Safety Code, is
13	13	amended to read as follows:
14	14	Sec. 182.001. PURPOSE. This chapter establishes the Texas
15	15	Health Services Authority as a public-private collaborative to:
16	16	(1) implement the state-level health information
17	17	technology functions identified by the Texas Health Information
18	18	Technology Advisory Committee by serving as a catalyst for the
19	19	development of a seamless electronic health information
20	20	infrastructure to support the health care system in the state and to
21	21	improve patient safety and quality of care; and
22	22	(2) make recommendations to improve the quality of
23	23	health care funded by both public and private payors and to increase
24	24	accountability and transparency.
25	25	SECTION 2. Section 182.002, Health and Safety Code, is
26	26	amended by amending Subdivision (5) and adding Subdivisions (1-a),
27	27	(3-a), (3-b), and (3-c) to read as follows:
28	28	(1-a) "Clinical integration" means a network of health
29	29	care practitioners implementing an active and ongoing program to
30	30	evaluate and modify practice patterns by the network's participants
31	31	and create a high degree of interdependence and cooperation to
32	32	control costs and ensure quality and operating in accordance with
33	33	the antitrust laws of the United States and this state.
34	34	(3-a) "Global payments" means compensation paid to a
35	35	health care practitioner and a health care facility for providing
36	36	or arranging a defined set of covered health care services to
37	37	participating persons for a specific period.
38	38	(3-b) "Health care facility" means a hospital,
39	39	emergency clinic, outpatient clinic, birthing center, ambulatory
40	40	surgical center, or other facility providing health care services.
41	41	(3-c) "Health care practitioner" means an individual
42	42	who is licensed or otherwise authorized to provide health care
43	43	services in this state.
44	44	(5) "Payor" ["Physician"] means:
45	45	(A) an insurer that writes health insurance
46	46	policies [individual licensed to practice medicine in this state
47	47	under the authority of Subtitle B, Title 3, Occupations Code];
48	48	(B) a preferred provider organization, health
49	49	maintenance organization, or self-insurance plan [professional
50	50	entity organized in conformity with Title 7, Business Organizations
51	51	Code, and permitted to practice medicine under Subtitle B, Title 3,
52	52	Occupations Code]; or
53	53	(C) any other person that provides, offers to
54	54	provide, or administers hospital, outpatient, medical, or other
55	55	health benefits to a person treated by a health care practitioner
56	56	under a policy, plan, or contract [a partnership organized in
57	57	conformity with Title 4, Business Organizations Code, composed
58	58	entirely of individuals licensed to practice medicine under
59	59	Subtitle B, Title 3, Occupations Code;
60	60	[(D) an approved nonprofit health corporation
61	61	certified under Chapter 162, Occupations Code;
62	62	[(E) a medical school or medical and dental unit,
63	63	as defined or described by Section 61.003, 61.501, or 74.601,
64	64	Education Code, that employs or contracts with physicians to teach
65	65	or provide medical services or employs physicians and contracts
66	66	with physicians in a practice plan; or
67	67	[(F) an entity wholly owned by individuals
68	68	licensed to practice medicine under Subtitle B, Title 3,
69	69	Occupations Code].
70	70	SECTION 3. Subsection (a), Section 182.051, Health and
71	71	Safety Code, is amended to read as follows:
72	72	(a) The corporation is established to:
73	73	(1) promote, implement, and facilitate the voluntary
74	74	and secure electronic exchange of health information[;] and
75	75	[(2)] create incentives to promote, implement, and
76	76	facilitate the voluntary and secure electronic exchange of health
77	77	information; and
78	78	(2) research, develop, support, and promote
79	79	recommended strategies, including strategies based on standards
80	80	created by nationally recognized organizations such as the
81	81	Physician Consortium for Performance Improvement, the National
82	82	Quality Forum, or the AQA Alliance, to improve the quality of health
83	83	care in this state and to increase accountability and transparency
84	84	through voluntary implementation of the recommendations by health
85	85	care practitioners, health care facilities, and payors, including
86	86	recommendations for:
87	87	(A) evidence-based best practice standards for
88	88	health care facilities and health care practitioners as identified
89	89	by the advisory committee established under Section
90	90	182.0595(a)(2);
91	91	(B) performance measures for health care
92	92	practitioners as identified by the advisory committee established
93	93	under Section 182.0595(a)(2);
94	94	(C) improved payment methodologies to reward
95	95	adoption of clinical best practices and improved outcomes;
96	96	(D) streamlined administrative processes,
97	97	including standardized claims;
98	98	(E) verification and authentication of the
99	99	source data used in performance measures; and
100	100	(F) development and distribution of electronic
101	101	applications for use by a health care practitioner in
102	102	self-evaluation of individual performance compared to the
103	103	practitioner's peers.
104	104	SECTION 4. Subchapter B, Chapter 182, Health and Safety
105	105	Code, is amended by adding Sections 182.0515 and 182.0516 to read as
106	106	follows:
107	107	Sec. 182.0515. ADMINISTRATIVE ATTACHMENT. (a) The
108	108	corporation is administratively attached to the Health and Human
109	109	Services Commission.
110	110	(b) Notwithstanding any other law, the Health and Human
111	111	Services Commission shall:
112	112	(1) provide administrative assistance, services, and
113	113	materials to the corporation, including budget planning and
114	114	purchasing;
115	115	(2) accept, deposit, and disburse money made available
116	116	to the corporation;
117	117	(3) seek and accept gifts and grants, including
118	118	applicable federal grants, on behalf of the corporation from any
119	119	public or private entity;
120	120	(4) pay the salaries and benefits of the staff of the
121	121	corporation;
122	122	(5) reimburse expenses of the members of the board
123	123	incurred in the performance of official duties;
124	124	(6) apply for and receive on behalf of the corporation
125	125	any appropriations, gifts, or other money from the state or federal
126	126	government or any other public or private entity, subject to
127	127	limitations and conditions prescribed by legislative
128	128	appropriation;
129	129	(7) provide the corporation with adequate computer
130	130	equipment and support; and
131	131	(8) provide the corporation with adequate office
132	132	space.
133	133	(c) If the board hires a chief executive officer under
134	134	Section 182.059, the chief executive officer and any staff hired
135	135	under that section are employees of the corporation and not
136	136	employees of the Health and Human Services Commission.
137	137	Sec. 182.0516. APPLICABILITY OF CERTAIN LAWS RELATING TO
138	138	POLITICAL ACTIVITIES. The corporation is subject to Chapter 556,
139	139	Government Code, and for purposes of that chapter:
140	140	(1) the corporation is considered to be a state
141	141	agency; and
142	142	(2) each corporation employee is considered to be a
143	143	state employee.
144	144	SECTION 5. Subsections (a), (b), and (c), Section 182.053,
145	145	Health and Safety Code, are amended to read as follows:
146	146	(a) The corporation is governed by a board of 15 [11]
147	147	directors appointed as follows:
148	148	(1) five members appointed by the governor;
149	149	(2) five members appointed by the governor from a list
150	150	of candidates prepared by the speaker of the house of
151	151	representatives; and
152	152	(3) five members appointed by the lieutenant
153	153	governor[, with the advice and consent of the senate].
154	154	(b) The following [governor shall also appoint at least two]
155	155	ex officio, nonvoting members also serve on the board:
156	156	(1) the commissioner of [representing] the Department
157	157	of State Health Services;
158	158	(2) the executive commissioner of the Health and Human
159	159	Services Commission;
160	160	(3) the commissioner of insurance;
161	161	(4) the executive director of the Employees Retirement
162	162	System of Texas;
163	163	(5) the executive director of the Teacher Retirement
164	164	System of Texas; and
165	165	(6) the state Medicaid director of the Health and
166	166	Human Services Commission.
167	167	(c) The governor and lieutenant governor shall appoint as
168	168	voting board members individuals who represent consumers, clinical
169	169	laboratories, health benefit plans, hospitals, regional health
170	170	information exchange initiatives, pharmacies, physicians, or rural
171	171	health providers, or who possess expertise in any other area the
172	172	governor or lieutenant governor finds necessary for the successful
173	173	operation of the corporation.
174	174	SECTION 6. Section 182.054, Health and Safety Code, is
175	175	amended to read as follows:
176	176	Sec. 182.054. TERMS OF OFFICE. Appointed members of the
177	177	board serve two-year terms and may continue to serve until a
178	178	successor has been appointed by the appropriate appointing
179	179	authority [governor].
180	180	SECTION 7. Section 182.058, Health and Safety Code, is
181	181	amended by amending Subsection (a) and adding Subsections (c) and
182	182	(d) to read as follows:
183	183	(a) The board may meet as often as necessary, but shall meet
184	184	at least once each calendar quarter [twice a year].
185	185	(c) Board meetings are open to the public.
186	186	(d) The board shall provide notice of the meeting in
187	187	accordance with Chapter 551, Government Code.
188	188	SECTION 8. Section 182.059, Health and Safety Code, is
189	189	amended to read as follows:
190	190	Sec. 182.059. CHIEF EXECUTIVE OFFICER; MEDICAL ADVISOR;
191	191	PERSONNEL. (a) The board may hire a chief executive officer.
192	192	Under the direction of the board, the chief executive officer shall
193	193	perform the duties required by this chapter or designated by the
194	194	board.
195	195	(b) The board may employ or contract with a medical advisor
196	196	who:
197	197	(1) is a physician licensed to practice medicine in
198	198	this state;
199	199	(2) has provided direct medical care to patients
200	200	during the physician's career; and
201	201	(3) has expertise in health care quality improvement
202	202	and health care performance measures.
203	203	(c) The chief executive officer may employ a technology
204	204	director who must have education, training, and experience in
205	205	planning, developing, and implementing health information exchange
206	206	initiatives.
207	207	(d) The chief executive officer may hire additional staff to
208	208	carry out the responsibilities of the corporation.
209	209	(e) Personnel hired under this section are state employees
210	210	for all purposes, including accrual of leave time, insurance
211	211	benefits, retirement benefits, and travel regulations.
212	212	SECTION 9. Subchapter B, Chapter 182, Health and Safety
213	213	Code, is amended by adding Section 182.0595 to read as follows:
214	214	Sec. 182.0595. ADVISORY COMMITTEES. (a) The board shall
215	215	establish the following advisory committees to assist the board in
216	216	performing its functions under this chapter:
217	217	(1) an advisory committee on technology; and
218	218	(2) an advisory committee on evidence-based best
219	219	practices and quality of care.
220	220	(b) The board may establish additional advisory committees
221	221	that the board considers necessary to assist the board in
222	222	performing its functions under this chapter.
223	223	(c) The board shall appoint to the advisory committees
224	224	established under this section persons who:
225	225	(1) have significant expertise in the relevant areas,
226	226	with at least one member of each committee having practical
227	227	experience in the relevant area; and
228	228	(2) represent both the private and public sectors and
229	229	groups likely to be affected by the implementation of the
230	230	recommendations of the corporation.
231	231	(d) Members of the advisory committees serve without
232	232	compensation but are entitled to reimbursement for the members'
233	233	travel expenses as provided by Chapter 660, Government Code, and
234	234	the General Appropriations Act.
235	235	(e) Chapter 2110, Government Code, does not apply to the
236	236	size, composition, or duration of the advisory committees.
237	237	(f) Meetings of the advisory committees under this section
238	238	are subject to Chapter 551, Government Code.
239	239	SECTION 10. Section 182.101, Health and Safety Code, is
240	240	amended to read as follows:
241	241	Sec. 182.101. GENERAL POWERS AND DUTIES. (a) The
242	242	corporation may:
243	243	(1) establish statewide health information exchange
244	244	capabilities, including capabilities for electronic laboratory
245	245	results, diagnostic studies, and medication history delivery, and
246	246	capabilities for enabling patients to access their own medical
247	247	records through the internet, and, where applicable, promote
248	248	definitions and standards for electronic interactions statewide;
249	249	(2) seek funding to:
250	250	(A) implement, promote, and facilitate the
251	251	voluntary exchange of secure electronic health information between
252	252	and among individuals and entities that are providing or paying for
253	253	health care services or procedures; and
254	254	(B) create incentives to implement, promote, and
255	255	facilitate the voluntary exchange of secure electronic health
256	256	information between and among individuals and entities that are
257	257	providing or paying for health care services or procedures;
258	258	(3) establish statewide health information exchange
259	259	capabilities for streamlining health care administrative functions
260	260	including:
261	261	(A) communicating point of care services,
262	262	including laboratory results, diagnostic imaging, and prescription
263	263	histories;
264	264	(B) communicating patient identification and
265	265	emergency room required information in conformity with state and
266	266	federal privacy laws;
267	267	(C) real-time communication of enrollee status
268	268	in relation to health plan coverage, including enrollee
269	269	cost-sharing responsibilities; and
270	270	(D) current census and status of health plan
271	271	contracted providers;
272	272	(4) support regional health information exchange
273	273	initiatives by:
274	274	(A) identifying data and messaging standards for
275	275	health information exchange;
276	276	(B) administering programs providing financial
277	277	incentives, including grants and loans for the creation and support
278	278	of regional health information networks, subject to available
279	279	funds;
280	280	(C) providing technical expertise where
281	281	appropriate;
282	282	(D) sharing intellectual property developed
283	283	under Section 182.105;
284	284	(E) waiving the corporation's fees associated
285	285	with intellectual property, data, expertise, and other services or
286	286	materials provided to regional health information exchanges
287	287	operated on a nonprofit basis; and
288	288	(F) applying operational and technical standards
289	289	developed by the corporation to existing health information
290	290	exchanges only on a voluntary basis, except for standards related
291	291	to ensuring effective privacy and security of individually
292	292	identifiable health information; and
293	293	(5) [identify standards for streamlining health care
294	294	administrative functions across payors and providers, including
295	295	electronic patient registration, communication of enrollment in
296	296	health plans, and information at the point of care regarding
297	297	services covered by health plans; and
298	298	[(6)] support the secure, electronic exchange of
299	299	health information through other strategies identified by the
300	300	board.
301	301	(b) The corporation shall research, develop, support, and
302	302	promote:
303	303	(1) evidence-based best practice standards for health
304	304	care practitioners and health care facilities, such as the
305	305	standards developed by the Physician Consortium for Performance
306	306	Improvement, the National Quality Forum, or the AQA Alliance;
307	307	(2) strategies to require or encourage adherence to
308	308	evidence-based best practice standards, including providing health
309	309	care practitioners and health care facilities with the support
310	310	tools and information necessary to promote adherence to
311	311	evidence-based best practice standards;
312	312	(3) performance measures that may be used to evaluate
313	313	the quality of care that a patient population receives from similar
314	314	health care practitioners or health care facilities;
315	315	(4) standards for reporting the results of performance
316	316	measures under Subdivision (3), comparing health care
317	317	practitioners and health care facilities based on the performance
318	318	measures, and sharing this information among health care
319	319	practitioners, health care facilities, and payors;
320	320	(5) recommendations for disseminating the results of
321	321	the performance measures under Subdivision (3) to the public;
322	322	(6) standards for technology to collect information to
323	323	measure medical outcomes, quality of care, and adherence to
324	324	evidence-based best practice standards;
325	325	(7) strategies for use of existing resources that are
326	326	available for the exchange of health care information;
327	327	(8) strategies for use by the state to facilitate the
328	328	exchange of health care information, the interoperability of
329	329	different information storage and transmission systems, including
330	330	the formation of statewide interoperability among local health
331	331	information exchanges, and the standardization of health care
332	332	information in the system;
333	333	(9) recommendations to encourage clinical integration
334	334	and collaboration of health care practitioners to control costs and
335	335	improve quality;
336	336	(10) alternative payment methodologies for payors of
337	337	health care practitioners and health care facilities that are
338	338	developed recognizing the infrastructure and system investments
339	339	needed to deliver primary care in a patient-centered medical home
340	340	and to reward health care practitioners and health care facilities
341	341	and that are for improving efficiency, promoting a higher quality
342	342	of patient care, and using evidence-based best practices,
343	343	including:
344	344	(A) bundling payments for episodes of care and
345	345	using global payments to health care practitioners and health care
346	346	facilities;
347	347	(B) replacing payment methodologies that are
348	348	based on number of patients seen or procedures performed;
349	349	(C) promoting the use of new payment
350	350	methodologies by both public and private payors;
351	351	(D) aligning incentives for health care
352	352	practitioners and health care facilities; and
353	353	(E) allowing for the adjustment of payment based
354	354	on the risk factors of the patient, including age, comorbidity, and
355	355	severity;
356	356	(11) standards for streamlining health care
357	357	administrative functions across payors, health care practitioners,
358	358	and health care facilities, including electronic patient
359	359	registration, communication of enrollment in health plans, and
360	360	information at the point of care regarding services covered by
361	361	health plans;
362	362	(12) recommendations for streamlining health care
363	363	administrative functions, including:
364	364	(A) communicating point of care services,
365	365	including laboratory results, diagnostic imaging, and prescription
366	366	histories;
367	367	(B) communicating patient identification and
368	368	emergency room required information in conformity with state and
369	369	federal privacy laws;
370	370	(C) real-time communication at the point of
371	371	service of enrollee status in relation to health plan coverage,
372	372	including communication of enrollee cost-sharing responsibilities
373	373	at the point of service; and
374	374	(D) a current census and the status of
375	375	health-plan-contracted health care practitioners and health care
376	376	facilities; and
377	377	(13) standards for verification and authentication of
378	378	source data used in performance measures.
379	379	(c) In performing the board's duties under Subsection (b),
380	380	the board shall:
381	381	(1) examine:
382	382	(A) existing standards, guidelines, strategies,
383	383	and methodologies created by nationally recognized organizations;
384	384	and
385	385	(B) existing standards, guidelines, strategies,
386	386	and methodologies used in the federal Medicare program; and
387	387	(2) review all standards, guidelines, strategies,
388	388	recommendations, and methodologies to ensure they are safe,
389	389	effective, timely, efficient, equitable, and patient-centered,
390	390	considering the six aims of quality care identified by the
391	391	Institute of Medicine.
392	392	(d) The board shall develop recommendations on achieving
393	393	maximum participation of health care practitioners, health care
394	394	facilities, and payors in using the standards, guidelines,
395	395	strategies, and methodologies developed under Subsection (b).
396	396	(e) The board shall develop recommendations for the use of
397	397	electronic applications by a health care practitioner in
398	398	self-evaluation of individual performance compared to the
399	399	practitioner's peers.
400	400	SECTION 11. Subchapter C, Chapter 182, Health and Safety
401	401	Code, is amended by adding Section 182.1015 to read as follows:
402	402	Sec. 182.1015. STUDIES ON PAYMENT METHODOLOGIES. (a) The
403	403	corporation shall conduct a study or contract for a study to be
404	404	conducted to develop payment incentives to increase access to
405	405	primary care. The study must evaluate proposals for changes to
406	406	payment methodologies for implementation by multiple public and
407	407	private payors. In evaluating the proposals, the study must
408	408	consider the six aims of quality care identified by the Institute of
409	409	Medicine and must consider payment methodologies that:
410	410	(1) reward primary health care practitioners for
411	411	patient retention;
412	412	(2) encourage primary health care practitioners to
413	413	spend an appropriate amount of time with each patient;
414	414	(3) reward primary health care practitioners for
415	415	monitoring patients, including reminders to obtain follow-up care;
416	416	(4) provide incentives for having 24-hour
417	417	availability of a primary health care practitioner in the practice
418	418	and taking other action to reduce unnecessary emergency room
419	419	visits; and
420	420	(5) improve access to primary care.
421	421	(b) The corporation shall conduct a study or contract for a
422	422	study to be conducted to develop payment methodologies based on
423	423	risk-adjusted episodes of care, including global payments, that
424	424	create incentives for a higher quality of services and reduce
425	425	unnecessary services. The study must:
426	426	(1) evaluate payment methodologies that:
427	427	(A) align incentives for health care
428	428	practitioners and health care facilities;
429	429	(B) bundle payments based on episodes of care or
430	430	provide global payments to address variation in cost while
431	431	providing incentives for higher-quality care;
432	432	(C) allow for the adjustment of payments based on
433	433	the risk factors of the patient, including age, comorbidity, and
434	434	severity; and
435	435	(D) may be adopted by private and public payors;
436	436	and
437	437	(2) identify high-cost, frequently performed
438	438	procedures for which the cost would be most affected by a change in
439	439	payment methodologies.
440	440	(c) The studies under Subsections (a) and (b) must:
441	441	(1) examine:
442	442	(A) payment methodologies created by nationally
443	443	recognized organizations;
444	444	(B) payment methodologies that promote
445	445	evidence-based best practices; and
446	446	(C) payment methodologies used by the federal
447	447	Medicare system, including methodologies designed to increase
448	448	provision of primary care services;
449	449	(2) review all payment methodologies to ensure that
450	450	they are safe, effective, timely, efficient, equitable, and
451	451	patient-centered, considering the six aims of quality care
452	452	identified by the Institute of Medicine; and
453	453	(3) include recommendations on achieving maximum
454	454	participation of health care practitioners, health care
455	455	facilities, and payors in using the payment methodologies evaluated
456	456	under those studies.
457	457	(d) The corporation shall submit to the legislature not
458	458	later than January 1, 2011:
459	459	(1) a summary of the results of the studies conducted
460	460	under this section; and
461	461	(2) legislative recommendations regarding the
462	462	studies' findings, including methods to require or encourage as
463	463	many payors as possible to use the payment methodologies
464	464	recommended by the studies.
465	465	(e) This section expires September 1, 2011.
466	466	SECTION 12. Subsection (a), Section 182.102, Health and
467	467	Safety Code, is repealed.
468	468	SECTION 13. (a) The term of a voting member of the board of
469	469	directors of the Texas Health Services Authority serving
470	470	immediately before the effective date of this Act expires on that
471	471	date.
472	472	(b) The governor and lieutenant governor shall appoint
473	473	voting members of the board of directors of the Texas Health
474	474	Services Authority under Subsection (a), Section 182.053, Health
475	475	and Safety Code, as amended by this Act, as soon as possible after
476	476	the effective date of this Act. A person who is a voting member of
477	477	the board of directors immediately before the effective date of
478	478	this Act may be reappointed to the board.
479	479	SECTION 14. This Act takes effect September 1, 2009.