81R7422 KFF-F
By: Nelson S.B. No. 805
A BILL TO BE ENTITLED
AN ACT
relating to incentive payments for certain nursing facilities
providing services under the medical assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.021(f), Human Resources Code, is
amended to read as follows:
(f) To encourage nursing facilities to provide the best
possible care, the department shall operate [develop] an incentive
payment program as provided by Section 32.0283 to recognize
facilities providing the highest quality care to Medicaid
residents.
SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0283 to read as follows:
Sec. 32.0283. PERFORMANCE-BASED INCENTIVES FOR CERTAIN
NURSING FACILITIES. (a) In this section:
(1) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(2) "Nursing facility" means a convalescent or nursing
home or related institution licensed under Chapter 242, Health and
Safety Code, that provides long-term care services, as defined by
Section 22.0011, to medical assistance recipients.
(b) The executive commissioner by rule shall establish an
incentive payment program for nursing facilities that is designed
to motivate continuing improvement in the quality of care provided
to medical assistance recipients. The program must:
(1) specify that participation in the program by
facilities is voluntary;
(2) provide incentive payments in accordance with this
section to the facilities that meet or exceed performance
thresholds established by the executive commissioner, as provided
by Subsection (f); and
(3) offer incentives that are distinct from those
offered under Section 32.028(g).
(c) In establishing an incentive payment program under this
section, the executive commissioner shall adopt independent and
objective performance measures on which to award incentive
payments. The performance measures must include measures of:
(1) quality of care;
(2) quality of life;
(3) direct-care staff stability;
(4) recipient and family satisfaction;
(5) employee satisfaction;
(6) regulatory compliance;
(7) level of person-centered care, which must be based
on recognized measures of the degree to which a nursing facility
respects the needs and desires of the facility's residents and
their families; and
(8) the number of occupied Medicaid beds in the
nursing facility and the facility's total occupancy.
(d) The executive commissioner shall:
(1) for each performance measure adopted under
Subsection (c), establish a performance threshold for purposes of
determining eligibility for an incentive payment under the program;
(2) allocate points or payment values to each
performance measure adopted under Subsection (c) as the executive
commissioner determines appropriate, and award incentive payments
based on those allocations; and
(3) on a quarterly basis, determine the facilities
eligible for an incentive payment under this section and the
amounts of those payments.
(e) The department shall evaluate participating nursing
facilities' performances with respect to the performance measures
adopted under Subsection (c) at least quarterly, except that the
department shall evaluate those facilities' performances with
respect to the performance measures adopted under Subsections
(c)(4), (5), (6), and (7) either semiannually or annually, as
determined by the department.
(f) To be eligible for an incentive payment under the
program, a nursing facility must meet or exceed applicable
performance thresholds in at least two of the performance measures
adopted under Subsection (c), at least one of which must be quality
of care or quality of life.
(g) To the extent the executive commissioner determines
that appropriated funds are available after accounting for funds
necessary to pay nursing facility base rate reimbursement payments
and incentive payments under Section 32.028(g)(1), an incentive
paid during a period under this section must be at least one percent
but not more than five percent of the average medical assistance
nursing facility base rate reimbursement for that period,
determined without regard to:
(1) previous incentive payments made under this
section; or
(2) payments made under Section 32.028(g)(1).
(h) If the executive commissioner determines that it is
cost-effective and feasible, the executive commissioner shall
enter into a contract with a person who meets the requirements
specified by Subsection (i) to provide the following services
related to the program:
(1) data collection;
(2) data analysis; and
(3) reporting of nursing facility performance with
respect to adopted performance measures and the amounts of
incentive payments paid to facilities under this section.
(i) A person with whom the executive commissioner contracts
under Subsection (h) must have:
(1) previous successful and cost-effective
experience, as determined by the executive commissioner,
supporting state Medicaid programs that offer performance
incentive payments in connection with providing nursing facility
services;
(2) demonstrated ability to collect from public and
private sources, analyze, and report the information required under
Subsection (h) through the efficient use of Internet-based
technology and dedicated electronic databases;
(3) experience providing statistically valid national
and regional comparative benchmarking of nursing facilities'
performance with respect to one or more of the performance measures
under Subsection (c);
(4) recognized experience in providing actionable
performance data to nursing facilities that enables the facilities
to engage in continuing evidence-based quality improvement;
(5) successful experience, as determined by the
executive commissioner, in creating or populating public Internet
websites that:
(A) inform consumers of the relative performance
of nursing facilities; and
(B) assist consumers in choosing a nursing
facility to provide services; and
(6) relevant research experience, as determined by the
executive commissioner, that would enable the person to assist
with:
(A) evaluations of the program under this
section; and
(B) evidence-based modifications of performance
measurements and reward strategies used in the program.
(j) The executive commissioner shall, through the
department's Internet website and other means, use the performance
data collected through the incentive payment program to inform
consumers of the actual and comparative performance of each nursing
facility participating in the program. The executive commissioner
shall develop, with the assistance of any contractor under
Subsection (h), a performance rating index or comparable
methodology to provide consumers with valid and understandable
information. That information must be updated at least quarterly.
(k) The executive commissioner shall consult with other
state agencies, nursing facilities, and consumer representatives
that the executive commissioner determines appropriate to assist in
developing the incentive payment program under this section.
SECTION 3. Section 32.060(a), Human Resources Code, as
added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th
Legislature, Regular Session, 2003, is amended to read as follows:
(a) The following are not admissible as evidence in a civil
action:
(1) any finding by the department that an institution
licensed under Chapter 242, Health and Safety Code, has violated a
standard for participation in the medical assistance program under
this chapter; [or]
(2) the fact of the assessment of a monetary penalty
against an institution under Section 32.021 or the payment of the
penalty by an institution; or
(3) any information obtained or used by the department
to determine the eligibility of a nursing facility for an incentive
payment, or to determine the facility's performance rating, under
Section 32.028(g) or 32.0283(f).
SECTION 4. (a) Not later than February 1, 2010, the
executive commissioner of the Health and Human Services Commission
shall establish the performance thresholds required under Section
32.0283(d)(1), Human Resources Code, as added by this Act.
(b) Not later than January 1, 2011, the executive
commissioner of the Health and Human Services Commission, if the
executive commissioner determines it cost-effective and feasible,
shall enter into the contract required by Section 32.0283(h), Human
Resources Code, as added by this Act.
(c) Not later than April 1, 2011, the Health and Human
Services Commission shall publish on the commission's Internet
website the information required under Section 32.0283(j), Human
Resources Code, as added by this Act.
SECTION 5. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 6. This Act takes effect September 1, 2009.