82R12076 KLA-D
By: Ogden S.B. No. 1580
A BILL TO BE ENTITLED
AN ACT
relating to state fiscal matters related to health and human
services and state agencies administering health and human services
programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. REDUCTION OF EXPENDITURES AND IMPOSITION OF CHARGES AND
COST-SAVING MEASURES GENERALLY
SECTION 1.01. This article applies to any state agency that
receives an appropriation under Article II of the General
Appropriations Act and to any program administered by any of those
agencies.
SECTION 1.02. Notwithstanding any other statute of this
state, each state agency to which this article applies is
authorized to reduce or recover expenditures by:
(1) consolidating any reports or publications the
agency is required to make and filing or delivering any of those
reports or publications exclusively by electronic means;
(2) extending the effective period of any license,
permit, or registration the agency grants or administers;
(3) entering into a contract with another governmental
entity or with a private vendor to carry out any of the agency's
duties;
(4) adopting additional eligibility requirements
consistent with federal law for persons who receive benefits under
any law the agency administers to ensure that those benefits are
received by the most deserving persons consistent with the purposes
for which the benefits are provided, including under the following
laws:
(A) Chapter 62, Health and Safety Code (child
health plan program);
(B) Chapter 31, Human Resources Code (temporary
assistance for needy families program);
(C) Chapter 32, Human Resources Code (Medicaid
program);
(D) Chapter 33, Human Resources Code
(supplemental nutrition assistance and other nutritional
assistance programs); and
(E) Chapter 533, Government Code (Medicaid
managed care);
(5) providing that any communication between the
agency and another person and any document required to be delivered
to or by the agency, including any application, notice, billing
statement, receipt, or certificate, may be made or delivered by
e-mail or through the Internet;
(6) adopting and collecting fees or charges to cover
any costs the agency incurs in performing its lawful functions; and
(7) modifying and streamlining processes used in:
(A) the conduct of eligibility determinations
for programs listed in Subdivision (4) of this subsection by or
under the direction of the Health and Human Services Commission;
(B) the provision of child and adult protective
services by the Department of Family and Protective Services;
(C) the provision of services for the aging and
disabled by the Department of Aging and Disability Services;
(D) the provision of services to children and
other persons with disabilities by the Department of Assistive and
Rehabilitative Services;
(E) the provision of community health services,
consumer protection services, mental health services, and hospital
facilities and services by the Department of State Health Services;
and
(F) the provision or administration of other
services provided or programs operated by the Health and Human
Services Commission or a health and human services agency, as
defined by Section 531.001, Government Code.
ARTICLE 2. HEALTH AND HUMAN SERVICES BENEFITS IN GENERAL
SECTION 2.01. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.0998 to read as follows:
Sec. 531.0998. MEMORANDUM OF UNDERSTANDING REGARDING
PUBLIC ASSISTANCE REPORTING INFORMATION SYSTEM. (a) In this
section, "system" means the Public Assistance Reporting
Information System (PARIS) operated by the Administration for
Children and Families of the United States Department of Health and
Human Services.
(b) The commission, the Department of Aging and Disability
Services, the Texas Veterans Commission, and the Veterans' Land
Board shall enter into a memorandum of understanding for the
purposes of:
(1) coordinating and collecting information about the
use and analysis among state agencies of data received from the
system; and
(2) developing new strategies for state agencies to
use system data in ways that generate fiscal savings for the state.
(c) Not later than October 15, 2012, the commission, the
Department of Aging and Disability Services, the Texas Veterans
Commission, and the Veterans' Land Board collectively shall submit
to the governor and the Legislative Budget Board a report
describing:
(1) the frequency and success with which state
agencies have used the system;
(2) the costs to the state that were avoided as a
result of state agencies' use of the system; and
(3) recommendations for future use of the system by
state agencies.
(d) Subsection (c) and this subsection expire September 2,
2013.
SECTIONਂ.02. Not later than December 1, 2011, the Health
and Human Services Commission, the Department of Aging and
Disability Services, the Texas Veterans Commission, and the
Veterans' Land Board shall enter into a memorandum of understanding
as required by Section 531.0998, Government Code, as added by this
article.
ARTICLE 3. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS
SECTION 3.01. Section 31.0325, Human Resources Code, is
repealed.
SECTION 3.02. On the effective date of this Act, the Health
and Human Services Commission and each health and human services
agency, as defined by Section 531.001, Government Code, shall
discontinue using electronic fingerprint-imaging or photo-imaging
of applicants for and recipients of financial assistance under
Chapter 31, Human Resources Code, or food stamp benefits under
Chapter 33, Human Resources Code.
ARTICLE 4. MEDICAID PROGRAM
SECTION 4.01. (a) Section 531.001, Government Code, is
amended by adding Subdivision (7) to read as follows:
(7) "Telemonitoring" means the use of
telecommunications and information technology to provide access to
health assessment, intervention, consultation, supervision, and
information across distance. Telemonitoring includes the use of
technologies such as telephones, facsimile machines, e-mail
systems, text messaging systems, and remote patient monitoring
devices to collect and transmit patient data for monitoring and
interpretation.
(b) Subchapter B, Chapter 531, Government Code, is amended
by adding Sections 531.02176, 531.02177, and 531.02178 to read as
follows:
Sec. 531.02176. MEDICAID TELEMONITORING PILOT PROGRAMS FOR
DIABETES. (a) The commission shall determine whether the Medicaid
Enhanced Care program's diabetes self-management training
telemonitoring pilot program was cost neutral.
(b) In determining whether the pilot program described by
Subsection (a) was cost neutral, the commission shall, at a
minimum, compare:
(1) the health care costs of program participants who
received telemonitoring services with the health care costs of a
group of Medicaid recipients who did not receive telemonitoring
services;
(2) the health care services used by program
participants who received telemonitoring services with the health
care services used by a group of Medicaid recipients who did not
receive telemonitoring services;
(3) for program participants who received
telemonitoring services, the amount spent on health care services
before, during, and after the receipt of telemonitoring services;
and
(4) for program participants who received
telemonitoring services, the health care services used before,
during, and after the receipt of telemonitoring services.
(c) If the commission determines that the pilot program
described by Subsection (a) was cost neutral, the executive
commissioner shall adopt rules for providing telemonitoring
services through the Medicaid Texas Health Management Program for
select diabetes patients in a manner comparable to that program.
(d) If the commission determines that the pilot program
described by Subsection (a) was not cost neutral, the commission
shall develop and implement within the Medicaid Texas Health
Management Program for select diabetes patients a new diabetes
telemonitoring pilot program based on evidence-based best
practices, provided that the commission determines implementing
the new diabetes telemonitoring pilot program would be cost
neutral.
(e) In determining whether implementing a new diabetes
telemonitoring pilot program under Subsection (d) would be cost
neutral, the commission shall consider appropriate factors,
including the following:
(1) the target population, participant eligibility
criteria, and the number of participants to whom telemonitoring
services would be provided;
(2) the type of telemonitoring technology to be used;
(3) the estimated cost of the telemonitoring services
to be provided;
(4) the estimated cost differential to the state based
on changes in participants' use of emergency department services,
outpatient services, pharmaceutical and ancillary services, and
inpatient services other than inpatient labor and delivery
services; and
(5) other indirect costs that may result from the
provision of telemonitoring services.
Sec. 531.02177. MEDICAID TELEMONITORING PILOT PROGRAM FOR
CERTAIN CONDITIONS. (a) The commission shall develop and
implement a pilot program within the Medicaid Texas Health
Management Program to evaluate the cost neutrality of providing
telemonitoring services to persons who are diagnosed with health
conditions other than diabetes, if the commission determines
implementing the pilot program would be cost neutral.
(b) In determining whether implementing a pilot program
under Subsection (a) would be cost neutral, the commission shall
consider appropriate factors, including the following:
(1) the types of health conditions that could be
assessed through the program by reviewing existing research and
other evidence on the effectiveness of providing telemonitoring
services to persons with those conditions;
(2) the target population, participant eligibility
criteria, and the number of participants to whom telemonitoring
services would be provided;
(3) the type of telemonitoring technology to be used;
(4) the estimated cost of the telemonitoring services
to be provided;
(5) the estimated cost differential to the state based
on changes in participants' use of emergency department services,
outpatient services, pharmaceutical and ancillary services, and
inpatient services other than inpatient labor and delivery
services; and
(6) other indirect costs that may result from the
provision of telemonitoring services.
Sec. 531.02178. DISSEMINATION OF INFORMATION ABOUT
EFFECTIVE TELEMONITORING STRATEGIES. The commission shall
annually:
(1) identify telemonitoring strategies implemented
within the Medicaid program that have demonstrated cost neutrality
or resulted in improved performance on key health measures; and
(2) disseminate information about the identified
strategies to encourage the adoption of effective telemonitoring
strategies.
(c) Not later than January 1, 2012, the executive
commissioner of the Health and Human Services Commission shall
adopt the rules required by Section 531.02176(c), Government Code,
as added by this section, if the commission determines that the
Medicaid Enhanced Care program's diabetes self-management training
telemonitoring pilot program was cost neutral.
(d) Not later than September 1, 2012, the Health and Human
Services Commission shall determine whether implementing a new
diabetes telemonitoring pilot program would be cost neutral if
required by Section 531.02176(d), Government Code, as added by this
section, and report that determination to the governor and the
Legislative Budget Board.
(e) Not later than September 1, 2012, the Health and Human
Services Commission shall determine whether implementing a
telemonitoring pilot program for health conditions other than
diabetes would be cost neutral as required by Section 531.02177(a),
Government Code, as added by this section, and report that
determination to the governor and the Legislative Budget Board.
SECTION 4.02. Subchapter B, Chapter 531, Government Code,
is amended by adding Sections 531.02417 and 531.024171 to read as
follows:
Sec. 531.02417. MEDICAID NURSING SERVICES ASSESSMENTS. (a)
In this section, "acute nursing services" means home health skilled
nursing services, home health aide services, and private duty
nursing services.
(b) The commission shall develop an objective assessment
process for use in assessing the needs of a Medicaid recipient for
acute nursing services. The commission shall require that:
(1) the assessment be conducted by a state employee or
contractor who is not the person who will deliver any necessary
services to the recipient and is not affiliated with the person who
will deliver those services; and
(2) the process include:
(A) an assessment of specified criteria and
documentation of the assessment results on a standard form; and
(B) completion by the person conducting the
assessment of any documents related to obtaining prior
authorization for necessary nursing services.
(c) The commission shall:
(1) implement the objective assessment process
developed under Subsection (b) within the Medicaid fee-for-service
model and the primary care case management Medicaid managed care
model; and
(2) take necessary actions, including modifying
contracts with managed care organizations under Chapter 533 to the
extent allowed by law, to implement the process within the STAR and
STAR+PLUS Medicaid managed care programs.
Sec. 531.024171. THERAPY SERVICES ASSESSMENTS. (a) In
this section, "therapy services" includes occupational, physical,
and speech therapy services.
(b) After implementing the objective assessment process for
acute nursing services as required by Section 531.02417, the
commission shall consider whether implementing a comparable
process with respect to assessing the needs of a Medicaid recipient
for therapy services would be feasible and beneficial.
(c) If the commission determines that implementing a
comparable process with respect to one or more types of therapy
services is feasible and would be beneficial, the commission may
implement the process within:
(1) the Medicaid fee-for-service model;
(2) the primary care case management Medicaid managed
care model; and
(3) the STAR and STAR+PLUS Medicaid managed care
programs.
SECTION 4.03. 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.
ARTICLE 5. FEDERAL AUTHORIZATION; EFFECTIVE DATE
SECTION 5.01. 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 5.02. This Act takes effect September 1, 2011.