82R3037 KFF-D
By: Gonzales of Hidalgo H.B. No. 3744
A BILL TO BE ENTITLED
AN ACT
relating to the reimbursement methodology used for certain services
provided to 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 Section 531.02115 to read as follows:
Sec. 531.02115. REIMBURSEMENT METHODOLOGY FOR MEDICAID
INPATIENT HOSPITAL SERVICES. (a) The commission shall convert the
reimbursement methodology used under the Medicaid program to
reimburse inpatient hospital services to an all patient refined
diagnosis-related groups (DRG) methodology, subject to adjustments
required by this section, to incentivize controlling costs and
improving efficiency.
(b) The commission shall adjust rates under the
reimbursement methodology required by Subsection (a) to ensure the
equitable reimbursement of hospitals for inpatient services by
adjusting the rates as necessary to take into account different
markets and provider responsibilities, including by making rate
adjustments to account for:
(1) whether a hospital is a teaching institution;
(2) market wage indexes; and
(3) the extent to which a hospital provides
comparatively high levels of uncompensated care.
(c) The commission shall adjust rates under the
reimbursement methodology required by Subsection (a) to provide
incentives for hospitals to provide higher quality of care. To
provide the incentives, the commission shall establish a hospital
value-based purchasing program that includes quality standards
established by the executive commissioner by rule. Incentives
provided under the program must be based on whether a hospital
meets, or improves the hospital's performance with respect to
meeting, those quality standards. Under the program, the
commission may:
(1) reduce a hospital's reimbursement rates by two
percent each fiscal year the hospital fails to meet, or to make
progress towards meeting, the quality standards; and
(2) use money saved as a result of the reimbursement
rate reductions to award hospitals that meet, or make progress
towards meeting, the quality standards.
(d) Notwithstanding Subsection (c)(1), the commission may
reduce reimbursement rates as provided by that subsection only by
the following percentages:
(1) one percent for the state fiscal year beginning
September 1, 2012;
(2) 1.25 percent for the state fiscal year beginning
September 1, 2013;
(3) 1.5 percent for the state fiscal year beginning
September 1, 2014; and
(4) 1.75 percent for the state fiscal year beginning
September 1, 2015.
(e) This subsection and Subsection (d) expire September 1,
2017.
SECTION 2. (a) As soon as possible after the effective date
of this Act:
(1) the Health and Human Services Commission shall
convert the Medicaid hospital services reimbursement methodology
and implement the hospital value-based purchasing program as
required by Section 531.02115, Government Code, as added by this
Act; and
(2) the executive commissioner of the Health and Human
Services Commission shall adopt the quality standards for use in
the hospital value-based purchasing program as required by that
section.
(b) Notwithstanding Sections 531.02115(c) and (d),
Government Code, as added by this Act, the Health and Human Services
Commission may not reduce reimbursement rates as provided by those
sections before September 1, 2012.
SECTION 3. 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 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2011.