By: Zerwas, et al. (Senate Sponsor - Nelson) H.B. No. 2245
(In the Senate - Received from the House April 27, 2011;
May 3, 2011, read first time and referred to Committee on Health
and Human Services; May 11, 2011, reported favorably by the
following vote: Yeas 8, Nays 0; May 11, 2011, sent to printer.)
A BILL TO BE ENTITLED
AN ACT
relating to physician incentive programs to reduce hospital
emergency room use for non-emergent conditions by Medicaid
recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.086 and 531.0861 to read as follows:
Sec. 531.086. STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS
TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS.
(a) The commission shall conduct a study to evaluate physician
incentive programs that attempt to reduce hospital emergency room
use for non-emergent conditions by recipients under the medical
assistance program. Each physician incentive program evaluated in
the study must:
(1) be administered by a health maintenance
organization participating in the STAR or STAR + PLUS Medicaid
managed care program; and
(2) provide incentives to primary care providers who
attempt to reduce emergency room use for non-emergent conditions by
recipients.
(b) The study conducted under Subsection (a) must evaluate:
(1) the cost-effectiveness of each component included
in a physician incentive program; and
(2) any change in statute required to implement each
component within the Medicaid fee-for-service or primary care case
management model.
(c) Not later than August 31, 2012, the executive
commissioner shall submit to the governor and the Legislative
Budget Board a report summarizing the findings of the study
required by this section.
(d) This section expires September 1, 2013.
Sec. 531.0861. PHYSICIAN INCENTIVE PROGRAM TO REDUCE
HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) The
executive commissioner by rule shall establish a physician
incentive program designed to reduce the use of hospital emergency
room services for non-emergent conditions by recipients under the
medical assistance program.
(b) In establishing the physician incentive program under
Subsection (a), the executive commissioner may include only the
program components identified as cost-effective in the study
conducted under Section 531.086.
(c) If the physician incentive program includes the payment
of an enhanced reimbursement rate for routine after-hours
appointments, the executive commissioner shall implement controls
to ensure that the after-hours services billed are actually being
provided outside of normal business hours.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for the 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 3. This Act takes effect September 1, 2011.
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