81R35109 JSC-D
By: Nelson, et al. S.B. No. 8
Substitute the following for S.B. No. 8:
By: McReynolds C.S.S.B. No. 8
A BILL TO BE ENTITLED
AN ACT
relating to the administration, powers, and duties of the Texas
Health Services Authority.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 182.001, Health and Safety Code, is
amended to read as follows:
Sec. 182.001. PURPOSE. This chapter establishes the Texas
Health Services Authority as a public-private collaborative to:
(1) implement the state-level health information
technology functions identified by the Texas Health Information
Technology Advisory Committee by serving as a catalyst for the
development of a seamless electronic health information
infrastructure to support the health care system in the state and to
improve patient safety and quality of care; and
(2) make recommendations to improve the quality of
health care funded by both public and private payors and to increase
accountability and transparency.
SECTION 2. Section 182.002, Health and Safety Code, is
amended by amending Subdivision (5) and adding Subdivisions (1-a),
(3-a), (3-b), and (3-c) to read as follows:
(1-a) "Clinical integration" means a network of health
care practitioners implementing an active and ongoing program to
evaluate and modify practice patterns by the network's participants
and create a high degree of interdependence and cooperation to
control costs and ensure quality and operating in accordance with
the antitrust laws of the United States and this state.
(3-a) "Global payments" means compensation paid to a
health care practitioner and a health care facility for providing
or arranging a defined set of covered health care services to
participating persons for a specific period.
(3-b) "Health care facility" means a hospital,
emergency clinic, outpatient clinic, birthing center, ambulatory
surgical center, or other facility providing health care services.
(3-c) "Health care practitioner" means an individual
who is licensed or otherwise authorized to provide health care
services in this state.
(5) "Payor" ["Physician"] means:
(A) an insurer that writes health insurance
policies [individual licensed to practice medicine in this state
under the authority of Subtitle B, Title 3, Occupations Code];
(B) a preferred provider organization, health
maintenance organization, or self-insurance plan [professional
entity organized in conformity with Title 7, Business Organizations
Code, and permitted to practice medicine under Subtitle B, Title 3,
Occupations Code]; or
(C) any other person that provides, offers to
provide, or administers hospital, outpatient, medical, or other
health benefits to a person treated by a health care practitioner
under a policy, plan, or contract [a partnership organized in
conformity with Title 4, Business Organizations Code, composed
entirely of individuals licensed to practice medicine under
Subtitle B, Title 3, Occupations Code;
[(D) an approved nonprofit health corporation
certified under Chapter 162, Occupations Code;
[(E) a medical school or medical and dental unit,
as defined or described by Section 61.003, 61.501, or 74.601,
Education Code, that employs or contracts with physicians to teach
or provide medical services or employs physicians and contracts
with physicians in a practice plan; or
[(F) an entity wholly owned by individuals
licensed to practice medicine under Subtitle B, Title 3,
Occupations Code].
SECTION 3. Subsection (a), Section 182.051, Health and
Safety Code, is amended to read as follows:
(a) The corporation is established to:
(1) promote, implement, and facilitate the voluntary
and secure electronic exchange of health information[;] and
[(2)] create incentives to promote, implement, and
facilitate the voluntary and secure electronic exchange of health
information; and
(2) research, develop, support, and promote
recommended strategies, including strategies based on standards
created by nationally recognized organizations such as the
Physician Consortium for Performance Improvement, the National
Quality Forum, or the AQA Alliance, to improve the quality of health
care in this state and to increase accountability and transparency
through voluntary implementation of the recommendations by health
care practitioners, health care facilities, and payors, including
recommendations for:
(A) evidence-based best practice standards for
health care facilities and health care practitioners as identified
by the advisory committee established under Section
182.0595(a)(2);
(B) performance measures for health care
practitioners as identified by the advisory committee established
under Section 182.0595(a)(2);
(C) improved payment methodologies to reward
adoption of clinical best practices and improved outcomes;
(D) streamlined administrative processes,
including standardized claims;
(E) verification and authentication of the
source data used in performance measures; and
(F) development and distribution of electronic
applications for use by a health care practitioner in
self-evaluation of individual performance compared to the
practitioner's peers.
SECTION 4. Subchapter B, Chapter 182, Health and Safety
Code, is amended by adding Sections 182.0515 and 182.0516 to read as
follows:
Sec. 182.0515. ADMINISTRATIVE ATTACHMENT. (a) The
corporation is administratively attached to the Health and Human
Services Commission.
(b) Notwithstanding any other law, the Health and Human
Services Commission shall:
(1) provide administrative assistance, services, and
materials to the corporation, including budget planning and
purchasing;
(2) accept, deposit, and disburse money made available
to the corporation;
(3) seek and accept gifts and grants, including
applicable federal grants, on behalf of the corporation from any
public or private entity;
(4) pay the salaries and benefits of the staff of the
corporation;
(5) reimburse expenses of the members of the board
incurred in the performance of official duties;
(6) apply for and receive on behalf of the corporation
any appropriations, gifts, or other money from the state or federal
government or any other public or private entity, subject to
limitations and conditions prescribed by legislative
appropriation;
(7) provide the corporation with adequate computer
equipment and support; and
(8) provide the corporation with adequate office
space.
(c) If the board hires a chief executive officer under
Section 182.059, the chief executive officer and any staff hired
under that section are employees of the corporation and not
employees of the Health and Human Services Commission.
Sec. 182.0516. APPLICABILITY OF CERTAIN LAWS RELATING TO
POLITICAL ACTIVITIES. The corporation is subject to Chapter 556,
Government Code, and for purposes of that chapter:
(1) the corporation is considered to be a state
agency; and
(2) each corporation employee is considered to be a
state employee.
SECTION 5. Subsections (a), (b), and (c), Section 182.053,
Health and Safety Code, are amended to read as follows:
(a) The corporation is governed by a board of 15 [11]
directors appointed as follows:
(1) five members appointed by the governor;
(2) five members appointed by the governor from a list
of candidates prepared by the speaker of the house of
representatives; and
(3) five members appointed by the lieutenant
governor[, with the advice and consent of the senate].
(b) The following [governor shall also appoint at least two]
ex officio, nonvoting members also serve on the board:
(1) the commissioner of [representing] the Department
of State Health Services;
(2) the executive commissioner of the Health and Human
Services Commission;
(3) the commissioner of insurance;
(4) the executive director of the Employees Retirement
System of Texas;
(5) the executive director of the Teacher Retirement
System of Texas; and
(6) the state Medicaid director of the Health and
Human Services Commission.
(c) The governor and lieutenant governor shall appoint as
voting board members individuals who represent consumers, clinical
laboratories, health benefit plans, hospitals, regional health
information exchange initiatives, pharmacies, physicians, or rural
health providers, or who possess expertise in any other area the
governor or lieutenant governor finds necessary for the successful
operation of the corporation.
SECTION 6. Section 182.054, Health and Safety Code, is
amended to read as follows:
Sec. 182.054. TERMS OF OFFICE. Appointed members of the
board serve two-year terms and may continue to serve until a
successor has been appointed by the appropriate appointing
authority [governor].
SECTION 7. Section 182.058, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsections (c) and
(d) to read as follows:
(a) The board may meet as often as necessary, but shall meet
at least once each calendar quarter [twice a year].
(c) Board meetings are open to the public.
(d) The board shall provide notice of the meeting in
accordance with Chapter 551, Government Code.
SECTION 8. Section 182.059, Health and Safety Code, is
amended to read as follows:
Sec. 182.059. CHIEF EXECUTIVE OFFICER; MEDICAL ADVISOR;
PERSONNEL. (a) The board may hire a chief executive officer.
Under the direction of the board, the chief executive officer shall
perform the duties required by this chapter or designated by the
board.
(b) The board may employ or contract with a medical advisor
who:
(1) is a physician licensed to practice medicine in
this state;
(2) has provided direct medical care to patients
during the physician's career; and
(3) has expertise in health care quality improvement
and health care performance measures.
(c) The chief executive officer may employ a technology
director who must have education, training, and experience in
planning, developing, and implementing health information exchange
initiatives.
(d) The chief executive officer may hire additional staff to
carry out the responsibilities of the corporation.
(e) Personnel hired under this section are state employees
for all purposes, including accrual of leave time, insurance
benefits, retirement benefits, and travel regulations.
SECTION 9. Subchapter B, Chapter 182, Health and Safety
Code, is amended by adding Section 182.0595 to read as follows:
Sec. 182.0595. ADVISORY COMMITTEES. (a) The board shall
establish the following advisory committees to assist the board in
performing its functions under this chapter:
(1) an advisory committee on technology; and
(2) an advisory committee on evidence-based best
practices and quality of care.
(b) The board may establish additional advisory committees
that the board considers necessary to assist the board in
performing its functions under this chapter.
(c) The board shall appoint to the advisory committees
established under this section persons who:
(1) have significant expertise in the relevant areas,
with at least one member of each committee having practical
experience in the relevant area; and
(2) represent both the private and public sectors and
groups likely to be affected by the implementation of the
recommendations of the corporation.
(d) Members of the advisory committees serve without
compensation but are entitled to reimbursement for the members'
travel expenses as provided by Chapter 660, Government Code, and
the General Appropriations Act.
(e) Chapter 2110, Government Code, does not apply to the
size, composition, or duration of the advisory committees.
(f) Meetings of the advisory committees under this section
are subject to Chapter 551, Government Code.
SECTION 10. Section 182.101, Health and Safety Code, is
amended to read as follows:
Sec. 182.101. GENERAL POWERS AND DUTIES. (a) The
corporation may:
(1) establish statewide health information exchange
capabilities, including capabilities for electronic laboratory
results, diagnostic studies, and medication history delivery, and
capabilities for enabling patients to access their own medical
records through the internet, and, where applicable, promote
definitions and standards for electronic interactions statewide;
(2) seek funding to:
(A) implement, promote, and facilitate the
voluntary exchange of secure electronic health information between
and among individuals and entities that are providing or paying for
health care services or procedures; and
(B) create incentives to implement, promote, and
facilitate the voluntary exchange of secure electronic health
information between and among individuals and entities that are
providing or paying for health care services or procedures;
(3) establish statewide health information exchange
capabilities for streamlining health care administrative functions
including:
(A) communicating point of care services,
including laboratory results, diagnostic imaging, and prescription
histories;
(B) communicating patient identification and
emergency room required information in conformity with state and
federal privacy laws;
(C) real-time communication of enrollee status
in relation to health plan coverage, including enrollee
cost-sharing responsibilities; and
(D) current census and status of health plan
contracted providers;
(4) support regional health information exchange
initiatives by:
(A) identifying data and messaging standards for
health information exchange;
(B) administering programs providing financial
incentives, including grants and loans for the creation and support
of regional health information networks, subject to available
funds;
(C) providing technical expertise where
appropriate;
(D) sharing intellectual property developed
under Section 182.105;
(E) waiving the corporation's fees associated
with intellectual property, data, expertise, and other services or
materials provided to regional health information exchanges
operated on a nonprofit basis; and
(F) applying operational and technical standards
developed by the corporation to existing health information
exchanges only on a voluntary basis, except for standards related
to ensuring effective privacy and security of individually
identifiable health information; and
(5) [identify standards for streamlining health care
administrative functions across payors and providers, including
electronic patient registration, communication of enrollment in
health plans, and information at the point of care regarding
services covered by health plans; and
[(6)] support the secure, electronic exchange of
health information through other strategies identified by the
board.
(b) The corporation shall research, develop, support, and
promote:
(1) evidence-based best practice standards for health
care practitioners and health care facilities, such as the
standards developed by the Physician Consortium for Performance
Improvement, the National Quality Forum, or the AQA Alliance;
(2) strategies to require or encourage adherence to
evidence-based best practice standards, including providing health
care practitioners and health care facilities with the support
tools and information necessary to promote adherence to
evidence-based best practice standards;
(3) performance measures that may be used to evaluate
the quality of care that a patient population receives from similar
health care practitioners or health care facilities;
(4) standards for reporting the results of performance
measures under Subdivision (3), comparing health care
practitioners and health care facilities based on the performance
measures, and sharing this information among health care
practitioners, health care facilities, and payors;
(5) recommendations for disseminating the results of
the performance measures under Subdivision (3) to the public;
(6) standards for technology to collect information to
measure medical outcomes, quality of care, and adherence to
evidence-based best practice standards;
(7) strategies for use of existing resources that are
available for the exchange of health care information;
(8) strategies for use by the state to facilitate the
exchange of health care information, the interoperability of
different information storage and transmission systems, including
the formation of statewide interoperability among local health
information exchanges, and the standardization of health care
information in the system;
(9) recommendations to encourage clinical integration
and collaboration of health care practitioners to control costs and
improve quality;
(10) alternative payment methodologies for payors of
health care practitioners and health care facilities that are
developed recognizing the infrastructure and system investments
needed to deliver primary care in a patient-centered medical home
and to reward health care practitioners and health care facilities
and that are for improving efficiency, promoting a higher quality
of patient care, and using evidence-based best practices,
including:
(A) bundling payments for episodes of care and
using global payments to health care practitioners and health care
facilities;
(B) replacing payment methodologies that are
based on number of patients seen or procedures performed;
(C) promoting the use of new payment
methodologies by both public and private payors;
(D) aligning incentives for health care
practitioners and health care facilities; and
(E) allowing for the adjustment of payment based
on the risk factors of the patient, including age, comorbidity, and
severity;
(11) standards for streamlining health care
administrative functions across payors, health care practitioners,
and health care facilities, including electronic patient
registration, communication of enrollment in health plans, and
information at the point of care regarding services covered by
health plans;
(12) recommendations for streamlining health care
administrative functions, including:
(A) communicating point of care services,
including laboratory results, diagnostic imaging, and prescription
histories;
(B) communicating patient identification and
emergency room required information in conformity with state and
federal privacy laws;
(C) real-time communication at the point of
service of enrollee status in relation to health plan coverage,
including communication of enrollee cost-sharing responsibilities
at the point of service; and
(D) a current census and the status of
health-plan-contracted health care practitioners and health care
facilities; and
(13) standards for verification and authentication of
source data used in performance measures.
(c) In performing the board's duties under Subsection (b),
the board shall:
(1) examine:
(A) existing standards, guidelines, strategies,
and methodologies created by nationally recognized organizations;
and
(B) existing standards, guidelines, strategies,
and methodologies used in the federal Medicare program; and
(2) review all standards, guidelines, strategies,
recommendations, and methodologies to ensure they are safe,
effective, timely, efficient, equitable, and patient-centered,
considering the six aims of quality care identified by the
Institute of Medicine.
(d) The board shall develop recommendations on achieving
maximum participation of health care practitioners, health care
facilities, and payors in using the standards, guidelines,
strategies, and methodologies developed under Subsection (b).
(e) The board shall develop recommendations for the use of
electronic applications by a health care practitioner in
self-evaluation of individual performance compared to the
practitioner's peers.
SECTION 11. Subchapter C, Chapter 182, Health and Safety
Code, is amended by adding Section 182.1015 to read as follows:
Sec. 182.1015. STUDIES ON PAYMENT METHODOLOGIES. (a) The
corporation shall conduct a study or contract for a study to be
conducted to develop payment incentives to increase access to
primary care. The study must evaluate proposals for changes to
payment methodologies for implementation by multiple public and
private payors. In evaluating the proposals, the study must
consider the six aims of quality care identified by the Institute of
Medicine and must consider payment methodologies that:
(1) reward primary health care practitioners for
patient retention;
(2) encourage primary health care practitioners to
spend an appropriate amount of time with each patient;
(3) reward primary health care practitioners for
monitoring patients, including reminders to obtain follow-up care;
(4) provide incentives for having 24-hour
availability of a primary health care practitioner in the practice
and taking other action to reduce unnecessary emergency room
visits; and
(5) improve access to primary care.
(b) The corporation shall conduct a study or contract for a
study to be conducted to develop payment methodologies based on
risk-adjusted episodes of care, including global payments, that
create incentives for a higher quality of services and reduce
unnecessary services. The study must:
(1) evaluate payment methodologies that:
(A) align incentives for health care
practitioners and health care facilities;
(B) bundle payments based on episodes of care or
provide global payments to address variation in cost while
providing incentives for higher-quality care;
(C) allow for the adjustment of payments based on
the risk factors of the patient, including age, comorbidity, and
severity; and
(D) may be adopted by private and public payors;
and
(2) identify high-cost, frequently performed
procedures for which the cost would be most affected by a change in
payment methodologies.
(c) The studies under Subsections (a) and (b) must:
(1) examine:
(A) payment methodologies created by nationally
recognized organizations;
(B) payment methodologies that promote
evidence-based best practices; and
(C) payment methodologies used by the federal
Medicare system, including methodologies designed to increase
provision of primary care services;
(2) review all payment methodologies to ensure that
they are safe, effective, timely, efficient, equitable, and
patient-centered, considering the six aims of quality care
identified by the Institute of Medicine; and
(3) include recommendations on achieving maximum
participation of health care practitioners, health care
facilities, and payors in using the payment methodologies evaluated
under those studies.
(d) The corporation shall submit to the legislature not
later than January 1, 2011:
(1) a summary of the results of the studies conducted
under this section; and
(2) legislative recommendations regarding the
studies' findings, including methods to require or encourage as
many payors as possible to use the payment methodologies
recommended by the studies.
(e) This section expires September 1, 2011.
SECTION 12. Subsection (a), Section 182.102, Health and
Safety Code, is repealed.
SECTION 13. (a) The term of a voting member of the board of
directors of the Texas Health Services Authority serving
immediately before the effective date of this Act expires on that
date.
(b) The governor and lieutenant governor shall appoint
voting members of the board of directors of the Texas Health
Services Authority under Subsection (a), Section 182.053, Health
and Safety Code, as amended by this Act, as soon as possible after
the effective date of this Act. A person who is a voting member of
the board of directors immediately before the effective date of
this Act may be reappointed to the board.
SECTION 14. This Act takes effect September 1, 2009.