Texas 2011 - 82nd Regular

Texas House Bill HB2245 Compare Versions

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1	1	By: Zerwas, et al. (Senate Sponsor - Nelson) H.B. No. 2245
2	2	(In the Senate - Received from the House April 27, 2011;
3	3	May 3, 2011, read first time and referred to Committee on Health
4	4	and Human Services; May 11, 2011, reported favorably by the
5	5	following vote: Yeas 8, Nays 0; May 11, 2011, sent to printer.)
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to physician incentive programs to reduce hospital
11	11	emergency room use for non-emergent conditions by Medicaid
12	12	recipients.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Subchapter B, Chapter 531, Government Code, is
15	15	amended by adding Sections 531.086 and 531.0861 to read as follows:
16	16	Sec. 531.086. STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS
17	17	TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS.
18	18	(a) The commission shall conduct a study to evaluate physician
19	19	incentive programs that attempt to reduce hospital emergency room
20	20	use for non-emergent conditions by recipients under the medical
21	21	assistance program. Each physician incentive program evaluated in
22	22	the study must:
23	23	(1) be administered by a health maintenance
24	24	organization participating in the STAR or STAR + PLUS Medicaid
25	25	managed care program; and
26	26	(2) provide incentives to primary care providers who
27	27	attempt to reduce emergency room use for non-emergent conditions by
28	28	recipients.
29	29	(b) The study conducted under Subsection (a) must evaluate:
30	30	(1) the cost-effectiveness of each component included
31	31	in a physician incentive program; and
32	32	(2) any change in statute required to implement each
33	33	component within the Medicaid fee-for-service or primary care case
34	34	management model.
35	35	(c) Not later than August 31, 2012, the executive
36	36	commissioner shall submit to the governor and the Legislative
37	37	Budget Board a report summarizing the findings of the study
38	38	required by this section.
39	39	(d) This section expires September 1, 2013.
40	40	Sec. 531.0861. PHYSICIAN INCENTIVE PROGRAM TO REDUCE
41	41	HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) The
42	42	executive commissioner by rule shall establish a physician
43	43	incentive program designed to reduce the use of hospital emergency
44	44	room services for non-emergent conditions by recipients under the
45	45	medical assistance program.
46	46	(b) In establishing the physician incentive program under
47	47	Subsection (a), the executive commissioner may include only the
48	48	program components identified as cost-effective in the study
49	49	conducted under Section 531.086.
50	50	(c) If the physician incentive program includes the payment
51	51	of an enhanced reimbursement rate for routine after-hours
52	52	appointments, the executive commissioner shall implement controls
53	53	to ensure that the after-hours services billed are actually being
54	54	provided outside of normal business hours.
55	55	SECTION 2. If before implementing any provision of this Act
56	56	a state agency determines that a waiver or authorization from a
57	57	federal agency is necessary for the implementation of that
58	58	provision, the agency affected by the provision shall request the
59	59	waiver or authorization and may delay implementing that provision
60	60	until the waiver or authorization is granted.
61	61	SECTION 3. This Act takes effect September 1, 2011.
62	62	* * * * *