Relating to strategies for and improvements in quality of health care provided through and care management in the child health plan and medical assistance programs designed to achieve healthy outcomes and efficiency.
Impact
The bill proposes to significantly alter the current reimbursement structures for Medicaid and child health services, highlighting a shift towards value-based care. By converting to diagnosis-related group (DRG) methodologies and establishing payment adjustments based on the performance of healthcare providers, SB7 aims to promote accountability and reduce unnecessary healthcare expenditures. This change is expected to improve care delivery and reduce costs associated with potentially preventable events, such as readmissions and complications.
Summary
Senate Bill 7 (SB7) focuses on enhancing the quality of healthcare provided through the Medicaid and child health plan programs in Texas. The bill establishes a framework for quality-based payment initiatives that aim to improve efficiency and health outcomes. The legislation introduces new definitions and guidelines for various payment systems, emphasizing alternative payment strategies that include global and episode-based payments. It also creates a Medicaid and CHIP Quality-Based Payment Advisory Committee to oversee the development of quality measures and reimbursement systems to align with high-quality care standards.
Contention
One of the notable points of contention surrounding SB7 concerns its operational impact on healthcare providers, particularly regarding managed care organizations and hospitals. Stakeholders may raise concerns over the feasibility of implementing the bill's provisions within existing frameworks, especially relating to the balance between incentivizing quality care while ensuring access to necessary medical services. Additionally, there may be apprehensions regarding the potential for increased administrative burdens as providers adapt to new compliance requirements and performance measures mandated by the bill.
Relating to the nonsubstantive revision of the health and human services laws governing the Health and Human Services Commission, Medicaid, and other social services.
Relating to the development of a strategic plan for home and community-based services provided under Medicaid and the child health plan program and the establishment of an advisory committee on home and community-based services.
Relating to the establishment of the case assistance affiliate program to provide certain assistance to Medicaid recipients and child health plan program enrollees.
Relating to the establishment of the case assistance affiliate program to provide certain assistance to Medicaid recipients and child health plan program enrollees.
Relating to a "Texas solution" to reforming and addressing issues related to the Medicaid program, including the creation of an alternative program designed to ensure health benefit plan coverage to certain low-income individuals through the private marketplace; requiring a fee.
Relating to the development of a strategic plan for home and community-based services provided under Medicaid and the child health plan program and the establishment of an advisory committee on home and community-based services.
Relating to local mental health authority and local behavioral health authority audits and mental and behavioral health reporting, services, and programs.
Relating to strategies for and improvements in quality of health care and care management provided through health care facilities and through the child health plan and medical assistance programs designed to improve health outcomes.
Relating to the administration, quality, and efficiency of health care, health and human services, and health benefits programs in this state; creating an offense; providing penalties.
Relating to improving the delivery and quality of certain health and human services, including the delivery and quality of Medicaid acute care services and long-term services and supports.
Relating to improving the delivery and quality of certain health and human services, including the delivery and quality of Medicaid acute care services and long-term services and supports.