82R6714 KFF-F
By: Nelson S.B. No. 7
A BILL TO BE ENTITLED
AN ACT
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.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. QUALITY-BASED OUTCOME AND PAYMENT INITIATIVES.
(a) Subtitle I, Title 4, Government Code, is amended by adding
Chapter 536, and Section 531.913, Government Code, is transferred
to Subchapter D, Chapter 536, Government Code, redesignated as
Section 536.151, Government Code, and amended to read as follows:
CHAPTER 536. MEDICAID AND CHILD HEALTH PLAN PROGRAMS:
QUALITY-BASED OUTCOMES AND PAYMENTS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 536.001. DEFINITIONS. In this chapter:
(1) "Advisory committee" means the Medicaid and CHIP
Quality-Based Payment Advisory Committee established under Section
536.002.
(2) "Alternative payment system" includes:
(A) a global payment system;
(B) an episode-based bundled payment system; and
(C) a blended payment system.
(3) "Blended payment system" means a system for
compensating a health care provider or facility that includes one
or more features of a global payment system and an episode-based
bundled payment system.
(4) "Child health plan program," "commission,"
"executive commissioner," and "health and human services agencies"
have the meanings assigned by Section 531.001.
(5) "Episode-based bundled payment system" means a
system for compensating a health care provider or facility for
arranging for or providing health care services to child health
plan program enrollees or Medicaid recipients that is based on a
flat payment for all services provided in connection with a single
episode of medical care.
(6) "Global payment system" means a system for
compensating a health care provider or facility for arranging for
or providing a defined set of covered health care services to child
health plan program enrollees or Medicaid recipients for a
specified period that is based on a predetermined payment per
enrollee or recipient, as applicable, for the specified period,
without regard to the quantity of services actually provided.
(7) "Managed care organization" means a person who is
authorized or otherwise permitted by law to arrange for or provide a
managed care plan. The term includes health maintenance
organizations and exclusive provider organizations.
(8) "Managed care plan" means a plan under which a
person undertakes to provide, arrange for, pay for, or reimburse
any part of the cost of any health care services. A part of the plan
must consist of arranging for or providing health care services as
distinguished from indemnification against the cost of those
services on a prepaid basis through insurance or otherwise. The
term includes a primary care case management provider network. The
term does not include a plan that indemnifies a person for the cost
of health care services through insurance.
(9) "Medicaid program" means the medical assistance
program established under Chapter 32, Human Resources Code.
(10) "Potentially preventable admission" means an
admission of a person to a hospital or long-term care facility that
could reasonably have been prevented if care and treatment had been
provided by a health care provider in accordance with accepted
standards of care.
(11) "Potentially preventable ancillary service"
means a health care service provided or ordered by a health care
provider to supplement or support the evaluation or treatment of a
patient, including a diagnostic test, laboratory test, therapy
service, or radiology service, that is not reasonably necessary for
the provision of quality health care or treatment.
(12) "Potentially preventable complication" means a
harmful event or negative outcome with respect to a person,
including an infection or surgical complication, that:
(A) occurs after the person's admission to a
hospital or long-term care facility;
(B) results from the care, lack of care, or
treatment provided during the hospital or long-term care facility
stay, as applicable, rather than from a natural progression of an
underlying disease; and
(C) could reasonably have been prevented if care
and treatment had been provided in accordance with accepted
standards of care.
(13) "Potentially preventable event" means a
potentially preventable admission, a potentially preventable
ancillary service, a potentially preventable complication, a
potentially preventable hospital emergency room visit, a
potentially preventable readmission, or a combination of those
events.
(14) "Potentially preventable hospital emergency room
visit" means treatment of a person in a hospital emergency room for
a condition that does not require emergency medical attention
because the condition could be treated by a health care provider in
a nonemergency setting.
(15) "Potentially preventable readmission" means a
return hospitalization of a person within a period specified by the
commission that results from deficiencies in the care or treatment
provided to the person during a previous hospital stay or from
deficiencies in post-hospital discharge follow-up. The term does
not include a hospital readmission necessitated by the occurrence
of unrelated events after the discharge. The term includes the
readmission of a person to a hospital for:
(A) the same condition or procedure for which the
person was previously admitted;
(B) an infection or other complication resulting
from care previously provided;
(C) a condition or procedure that indicates that
a surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
(D) another condition or procedure of a similar
nature, as determined by the executive commissioner.
(16) "Quality-based payment system" means a system for
compensating a health care provider or facility, including an
alternative payment system, that rewards the provider or facility
for providing high-quality, cost-effective care and bases some
portion of the payment made to the provider or facility on quality
of care outcomes, including the extent to which the provider or
facility reduces potentially preventable events.
Sec. 536.002. MEDICAID AND CHIP QUALITY-BASED PAYMENT
ADVISORY COMMITTEE. (a) The Medicaid and CHIP Quality-Based
Payment Advisory Committee is established to assist the commission
with, for purposes of the child health plan and Medicaid programs
administered by the commission or a health and human services
agency:
(1) ensuring that the reimbursement system used to
compensate health care providers and facilities under those
programs rewards the provision of high-quality, cost-effective
health care and quality performance and quality of care outcomes
with respect to health care services;
(2) setting standards and benchmarks for quality
performance, quality of care outcomes, efficiency, and
accountability by managed care organizations and health care
providers and facilities; and
(3) ensuring that programs and reimbursement policies
encourage high-quality, cost-effective health care delivery models
that increase provider collaboration, promote wellness and
prevention, and improve health outcomes.
(b) The executive commissioner shall appoint the members of
the advisory committee. The committee must consist of health care
providers, representatives of health care facilities, and other
stakeholders interested in health care services provided in this
state. At least one member must be a physician who has clinical
practice expertise, and at least one member must be a member of the
Advisory Panel on Health Care-Associated Infections and
Preventable Adverse Events who meets the qualifications prescribed
by Section 98.052(a)(4), Health and Safety Code.
(c) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(d) The advisory committee shall advise the commission on
developing outcome and process measures under Section 536.003.
Sec. 536.003. DEVELOPMENT OF QUALITY-BASED OUTCOME AND
PROCESS MEASURES. (a) The commission, in consultation with the
advisory committee, shall develop quality-based outcome and
process measures that promote the provision of efficient, quality
health care and that can be used in the child health plan and
Medicaid programs to implement quality-based payments for acute and
long-term care services across all delivery models and payment
systems, including fee-for-service and managed care payment
systems. The commission, in developing outcome measures under this
section, must consider measures addressing potentially preventable
events.
(b) To the extent feasible, the commission shall develop
outcome and process measures:
(1) consistently across all child health plan and
Medicaid program delivery models and payment systems;
(2) in a manner that takes into account appropriate
patient risk factors, including the burden of chronic illness on a
patient and the severity of a patient's illness; and
(3) that will have the greatest effect on improving
quality of care and the efficient use of services.
(c) The commission may align outcome and process measures
developed under this section with measures required or recommended
under reporting guidelines established by the federal Centers for
Medicare and Medicaid Services, the Agency for Healthcare Research
and Quality, or another federal agency.
(d) The executive commissioner by rule may require managed
care organizations and health care providers and facilities
participating in the child health plan and Medicaid programs to
report to the commission in a format specified by the executive
commissioner information necessary to develop outcome and process
measures under this section.
(e) If the commission increases provider reimbursement
rates under the child health plan or Medicaid program as a result of
an increase in the amounts appropriated for the programs for a state
fiscal biennium as compared to the preceding state fiscal biennium,
the commission shall, to the extent permitted under federal law,
correlate the increased reimbursement rates with the quality-based
outcome and process measures developed under this section.
Sec. 536.004. DEVELOPMENT OF QUALITY-BASED PAYMENT
SYSTEMS. (a) Using quality-based outcome and process measures
developed under Section 536.003 and subject to this section, the
commission, after consulting with the advisory committee, shall
develop quality-based payment systems for compensating a health
care provider or facility participating in the child health plan or
Medicaid program that:
(1) align payment incentives with high-quality,
cost-effective health care;
(2) reward the use of evidence-based best practices;
(3) promote the coordination of health care;
(4) encourage provider collaboration;
(5) promote effective health care delivery models; and
(6) take into account the specific needs of the child
health plan program enrollee and Medicaid recipient populations.
(b) The commission shall develop quality-based payment
systems in the manner specified by this chapter. To the extent
necessary, the commission shall coordinate the timeline for the
development and implementation of a payment system with the
implementation of other initiatives such as the Medicaid
Information Technology Architecture (MITA) initiative of the
Center for Medicaid and State Operations, the ICD-10 code sets
initiative, or the ongoing Enterprise Data Warehouse (EDW) planning
process in order to maximize the receipt of federal funds or reduce
any administrative burden.
(c) In developing quality-based payment systems under this
chapter, the commission shall examine and consider implementing:
(1) an alternative payment system;
(2) any existing performance-based payment system
used under the Medicare program that meets the requirements of this
chapter, modified as necessary to account for programmatic
differences, if implementing the system would:
(A) reduce any administrative burden; and
(B) align quality-based payment incentives for
health care providers or facilities with the Medicare program; and
(3) alternative payment methodologies within the
system that are used in the Medicare program, modified as necessary
to account for programmatic differences, and that will achieve cost
savings or improve quality of care in the child health plan and
Medicaid programs.
Sec. 536.005. CONVERSION OF PAYMENT METHODOLOGY. To the
extent possible, the commission shall convert reimbursement
systems under the child health plan and Medicaid programs to a
diagnosis-related groups (DRG) methodology that will allow the
commission to more accurately classify specific patient
populations and account for severity of patient illness and
mortality risk.
Sec. 536.006. PERIODIC EVALUATION. (a) At least once each
two-year period, the commission shall evaluate the outcomes and
cost-effectiveness of any quality-based payment system or other
payment initiative implemented under this chapter.
(b) The commission shall present the results of its
evaluation under Subsection (a) to the advisory committee for the
committee's input and recommendations.
Sec. 536.007. ANNUAL REPORT. (a) The commission shall
submit an annual report to the legislature regarding:
(1) the quality-based outcome and process measures
developed under Section 536.003; and
(2) the progress of the implementation of
quality-based payment systems and other payment initiatives
implemented under this chapter.
(b) The commission shall report outcome and process
measures under Subsection (a)(1) by county and service delivery
model.
[Sections 536.008-536.050 reserved for expansion]
SUBCHAPTER B. QUALITY-BASED PAYMENTS RELATING TO MANAGED CARE
ORGANIZATIONS
Sec. 536.051. DEVELOPMENT OF QUALITY-BASED PREMIUM
PAYMENTS; PERFORMANCE REPORTING. (a) The commission shall base a
percentage of the premiums paid to a managed care organization
participating in the child health plan or Medicaid program on the
organization's performance with respect to outcome and process
measures developed under Section 536.003, including outcome
measures addressing potentially preventable events.
(b) The commission shall report information relating to the
performance of a managed care organization with respect to outcome
and process measures under this subchapter to child health plan
program enrollees and Medicaid recipients before those enrollees
and recipients choose their managed care plans.
Sec. 536.052. PAYMENT AND CONTRACT AWARD INCENTIVES FOR
MANAGED CARE ORGANIZATIONS. (a) The commission may allow a managed
care organization participating in the child health plan or
Medicaid program increased flexibility to implement quality
initiatives in a managed care plan offered by the organization,
including flexibility with respect to network requirements and
financial arrangements, in order to:
(1) achieve high-quality, cost-effective health care;
(2) increase the use of high-quality, cost-effective
delivery models; and
(3) reduce potentially preventable events.
(b) The commission, after consulting with the advisory
committee, shall develop quality of care and cost-efficiency
benchmarks, including benchmarks based on a managed care
organization's performance with respect to reducing potentially
preventable events and containing the growth rate of health care
costs.
(c) The commission may include in a contract between a
managed care organization and the commission financial incentives
that are based on the organization's successful implementation of
quality initiatives under Subsection (a) or success in achieving
quality of care and cost-efficiency benchmarks under Subsection
(b).
(d) In awarding contracts to managed care organizations
under the child health plan and Medicaid programs, the commission
shall, in addition to considerations under Section 533.003 of this
code and Section 62.155, Health and Safety Code, give preference to
an organization that offers a managed care plan that implements
quality initiatives under Subsection (a) or meets quality of care
and cost-efficiency benchmarks under Subsection (b).
(e) The commission may implement financial incentives under
this section only if implementing the incentives would not require
additional state funding because the cost associated with the
implementation would be offset by expected savings or additional
federal funding.
[Sections 536.053-536.100 reserved for expansion]
SUBCHAPTER C. QUALITY-BASED HEALTH HOME PAYMENT SYSTEMS
Sec. 536.101. DEFINITIONS. In this subchapter:
(1) "Health home" means a primary care provider
practice or if appropriate, a specialty practice, incorporating
several features, including comprehensive care coordination,
family-centered care, and data management, that are focused on
improving outcome-based quality of care and increasing patient and
provider satisfaction under the child health plan and Medicaid
programs.
(2) "Participating enrollee" means a child health plan
program enrollee or Medicaid recipient who has a health home.
Sec. 536.102. QUALITY-BASED HEALTH HOME PAYMENTS. (a)
Subject to this subchapter, the commission, after consulting with
the advisory committee, may develop and implement quality-based
payment systems for health homes designed to improve quality of
care and reduce the provision of unnecessary medical services. A
quality-based payment system developed under this section must:
(1) base payments made to a participating enrollee's
health home on quality and efficiency measures that may include
measurable wellness and prevention criteria and use of
evidence-based best practices, sharing a portion of any realized
cost savings achieved by the health home, and ensuring quality of
care outcomes, including a reduction in potentially preventable
events; and
(2) allow for the examination of measurable wellness
and prevention criteria, use of evidence-based best practices, and
quality of care outcomes based on the type of primary or specialty
care provider.
(b) The commission may develop a quality-based payment
system for health homes under this subchapter only if implementing
the system would not require additional state funding because the
costs associated with the implementation would be offset by
expected savings or additional federal funding.
Sec. 536.103. PROVIDER ELIGIBILITY. To be eligible to
receive reimbursement under a quality-based payment system under
this subchapter, a provider must:
(1) provide participating enrollees, directly or
indirectly, with access to health care services outside of regular
business hours;
(2) educate participating enrollees about the
availability of health care services outside of regular business
hours; and
(3) provide evidence satisfactory to the commission
that the provider meets the requirement of Subdivision (1).
[Sections 536.104-536.150 reserved for expansion]
SUBCHAPTER D. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
Sec. 536.151 [531.913]. COLLECTION AND REPORTING OF
CERTAIN [HOSPITAL HEALTH] INFORMATION [EXCHANGE]. (a) [In this
section, "potentially preventable readmission" means a return
hospitalization of a person within a period specified by the
commission that results from deficiencies in the care or treatment
provided to the person during a previous hospital stay or from
deficiencies in post-hospital discharge follow-up. The term does
not include a hospital readmission necessitated by the occurrence
of unrelated events after the discharge. The term includes the
readmission of a person to a hospital for:
[(1) the same condition or procedure for which the
person was previously admitted;
[(2) an infection or other complication resulting from
care previously provided;
[(3) a condition or procedure that indicates that a
surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
[(4) another condition or procedure of a similar
nature, as determined by the executive commissioner.
[(b)] The executive commissioner shall adopt rules for
identifying potentially preventable readmissions of child health
plan program enrollees and Medicaid recipients and potentially
preventable complications experienced by child health plan program
enrollees and Medicaid recipients. The [and the] commission shall
collect [exchange] data from [with] hospitals on
present-on-admission indicators for purposes of this section.
(b) [(c)] The commission shall establish a [health
information exchange] program to provide a [exchange] confidential
report to [information with] each hospital in this state that
participates in the child health plan or Medicaid program regarding
the hospital's performance with respect to potentially preventable
readmissions and potentially preventable complications. To the
extent possible, a report provided under this section should
include potentially preventable readmissions and potentially
preventable complications information across all payment systems.
A hospital shall distribute the information contained in the report
[received from the commission] to health care providers providing
services at the hospital.
(c) A report provided to a hospital under this section is
confidential and is not subject to Chapter 552.
Sec. 536.152. REIMBURSEMENT ADJUSTMENTS. (a) Subject to
Subsection (b), using the data collected under Section 536.151 and
the diagnosis-related groups (DRG) methodology implemented under
Section 536.005, the commission, after consulting with the advisory
committee, shall to the extent feasible adjust child health plan
and Medicaid reimbursements to hospitals, including payments made
under the disproportionate share hospitals and upper payment limit
supplemental payment programs, in a manner that rewards or
penalizes a hospital based on the hospital's performance in
reducing potentially preventable readmissions and potentially
preventable complications.
(b) The commission must provide the report required under
Section 536.151(b) to a hospital at least one year before the
commission adjusts child health plan and Medicaid reimbursements to
the hospital under this section.
[Sections 536.153-536.200 reserved for expansion]
SUBCHAPTER E. QUALITY-BASED PAYMENT INITIATIVES
Sec. 536.201. DEFINITION. In this subchapter, "payment
initiative" means a quality-based payment initiative established
under this subchapter.
Sec. 536.202. PAYMENT INITIATIVES; DETERMINATION OF
BENEFIT TO STATE. (a) The commission shall, after consulting with
health care providers and facilities and disease and care
management organizations, establish payment initiatives to test
the effectiveness of quality-based payment systems, alternative
payment methodologies, and high-quality, cost-effective health
care delivery models that provide incentives to the providers and
facilities, as applicable, to develop health care interventions for
child health plan program enrollees or Medicaid recipients, or
both, that will:
(1) improve the quality of health care provided to the
enrollees or recipients;
(2) reduce potentially preventable events;
(3) promote prevention and wellness;
(4) increase the use of evidence-based best practices;
and
(5) increase provider collaboration.
(b) The commission shall:
(1) establish a process by which health care providers
and facilities and disease and care management organizations may
submit proposals for payment initiatives described by Subsection
(a); and
(2) determine whether it is feasible and
cost-effective to implement one or more of the proposed payment
initiatives.
(c) For purposes of Subsection (b), an initiative is
cost-effective if implementing the initiative would not require
additional state funding because the costs associated with the
implementation would be offset by expected savings or additional
federal funding.
Sec. 536.203. PURPOSE AND IMPLEMENTATION OF PAYMENT
INITIATIVES. (a) If the commission determines under Section
536.202 that implementation of one or more payment initiatives is
feasible and cost-effective for this state, the commission shall
establish one or more payment initiatives as provided by this
subchapter.
(b) The commission shall administer any payment initiative
established under this subchapter. The executive commissioner may
adopt rules, plans, and procedures and enter into contracts and
other agreements as the executive commissioner considers
appropriate and necessary to administer this subchapter.
(c) The commission may limit a payment initiative to:
(1) one or more regions in this state;
(2) one or more organized networks of health care
facilities and providers; or
(3) specified types of services provided under the
child health plan or Medicaid program, or specified types of
enrollees or recipients under those programs.
(d) A payment initiative implemented under this subchapter
must be operated for at least one calendar year.
Sec. 536.204. STANDARDS; PROTOCOLS. (a) The executive
commissioner shall:
(1) consult with the advisory committee to develop
quality of care and cost-efficiency benchmarks and measurable goals
that a payment initiative must meet to ensure high-quality and
cost-effective health care services and healthy outcomes; and
(2) approve benchmarks and goals developed as provided
by Subdivision (1).
(b) In addition to the benchmarks and goals under Subsection
(a), the executive commissioner may approve efficiency performance
standards that may include the sharing of realized cost savings
with health care providers and facilities that provide health care
services that exceed the efficiency performance standards. The
efficiency performance standards may not create any financial
incentive for or involve making a payment to a health care provider
or facility that directly or indirectly induces the limitation of
medically necessary services.
Sec. 536.205. PROVISION OF SERVICES AND PAYMENT RATES UNDER
PAYMENT INITIATIVES. (a) The executive commissioner may contract
with appropriate entities, including qualified actuaries, to
assist in determining appropriate payment rates for a payment
initiative implemented under this subchapter.
(b) The executive commissioner shall ensure that services
provided to a child health plan program enrollee or Medicaid
recipient, as applicable, meet or exceed the quality of care and
cost-efficiency benchmarks required under this subchapter and are
at least equivalent to the services provided under the child health
plan or Medicaid program, as applicable, for which the enrollee or
recipient is eligible.
(b) As soon as practicable after the effective date of this
Act, but not later than September 1, 2012, the Health and Human
Services Commission shall convert the reimbursement systems used
under the child health plan program under Chapter 62, Health and
Safety Code, and medical assistance program under Chapter 32, Human
Resources Code, to the diagnosis-related groups (DRG) methodology
to the extent possible as required by Section 536.005, Government
Code, as added by this Act.
(c) Not later than September 1, 2012, the Health and Human
Services Commission shall begin providing performance reports to
hospitals regarding the hospitals' performances with respect to
potentially preventable complications as required by Section
536.151, Government Code, as transferred, redesignated, and
amended by this Act.
(d) Subject to Section 536.004(b), Government Code, as
added by this Act, the Health and Human Services Commission shall
begin making adjustments to child health plan and Medicaid
reimbursements to hospitals as required by Section 536.152,
Government Code, as added by this Act:
(1) not later than September 1, 2012, based on the
hospitals' performances with respect to reducing potentially
preventable readmissions; and
(2) not later than September 1, 2013, based on the
hospitals' performances with respect to reducing potentially
preventable complications.
SECTION 2. COST SHARING FOR CERTAIN HEALTH CARE SERVICES.
Section 32.0641, Human Resources Code, is amended to read as
follows:
Sec. 32.0641. RECIPIENT ACCOUNTABILITY PROVISIONS;
COST-SHARING REQUIREMENT TO IMPROVE APPROPRIATE UTILIZATION OF
[COST SHARING FOR CERTAIN HIGH-COST MEDICAL] SERVICES. (a) To [If
the department determines that it is feasible and cost-effective,
and to] the extent permitted under Title XIX, Social Security Act
(42 U.S.C. Section 1396 et seq.) and any other applicable law or
regulation or under a federal waiver or other authorization, the
executive commissioner of the Health and Human Services Commission
shall adopt, after consulting with the Medicaid and CHIP
Quality-Based Payment Advisory Committee established under Section
536.002, Government Code, cost-sharing provisions that encourage
personal accountability and appropriate utilization of health care
services, including a cost-sharing provision applicable to
[require] a recipient who chooses to receive a nonemergency [a
high-cost] medical service [provided] through a hospital emergency
room [to pay a copayment, premium payment, or other cost-sharing
payment for the high-cost medical service] if:
(1) the hospital from which the recipient seeks
service:
(A) performs an appropriate medical screening
and determines that the recipient does not have a condition
requiring emergency medical services;
(B) informs the recipient:
(i) that the recipient does not have a
condition requiring emergency medical services;
(ii) that, if the hospital provides the
nonemergency service, the hospital may require payment of a
copayment, premium payment, or other cost-sharing payment by the
recipient in advance; and
(iii) of the name and address of a
nonemergency Medicaid provider who can provide the appropriate
medical service without imposing a cost-sharing payment; and
(C) offers to provide the recipient with a
referral to the nonemergency provider to facilitate scheduling of
the service; and
(2) after receiving the information and assistance
described by Subdivision (1) from the hospital, the recipient
chooses to obtain [emergency] medical services through the hospital
emergency room despite having access to medically acceptable,
appropriate [lower-cost] medical services.
(b) The department may not seek a federal waiver or other
authorization under this section [Subsection (a)] that would:
(1) prevent a Medicaid recipient who has a condition
requiring emergency medical services from receiving care through a
hospital emergency room; or
(2) waive any provision under Section 1867, Social
Security Act (42 U.S.C. Section 1395dd).
[(c) If the executive commissioner of the Health and Human
Services Commission adopts a copayment or other cost-sharing
payment under Subsection (a), the commission may not reduce
hospital payments to reflect the potential receipt of a copayment
or other payment from a recipient receiving medical services
provided through a hospital emergency room.]
SECTION 3. LONG-TERM CARE PAYMENT INCENTIVE INITIATIVES.
(a) The heading to Section 531.912, Government Code, is amended to
read as follows:
Sec. 531.912. PAY-FOR-PERFORMANCE INCENTIVES FOR [QUALITY
OF CARE HEALTH INFORMATION EXCHANGE WITH] CERTAIN NURSING
FACILITIES.
(b) Sections 531.912(b), (c), and (f), Government Code, are
amended to read as follows:
(b) If feasible, the executive commissioner by rule shall
establish an incentive payment program for [a quality of care
health information exchange with] nursing facilities that choose to
participate. The [in a] program must be designed to improve the
quality of care and services provided to medical assistance
recipients. Subject to Subsection (f), the program may provide
incentive payments in accordance with this section to encourage
facilities to participate in the program.
(c) In establishing an incentive payment [a quality of care
health information exchange] program under this section, the
executive commissioner shall, subject to Subsection (d), adopt
outcome-based [exchange information with participating nursing
facilities regarding] performance measures. The performance
measures:
(1) must be:
(A) recognized by the executive commissioner as
valid indicators of the overall quality of care received by medical
assistance recipients; and
(B) designed to encourage and reward
evidence-based practices among nursing facilities; and
(2) may include measures of:
(A) quality of life;
(B) direct-care staff retention and turnover;
(C) recipient satisfaction;
(D) employee satisfaction and engagement;
(E) the incidence of preventable acute care
emergency room services use;
(F) regulatory compliance;
(G) level of person-centered care; and
(H) level of occupancy or of facility
utilization.
(f) The commission may make incentive payments under the
program only if money is [specifically] appropriated for that
purpose.
(c) The Department of Aging and Disability Services shall
conduct a study to evaluate the feasibility of expanding any
incentive payment program established for nursing facilities under
Section 531.912, Government Code, as amended by this Act, by
providing incentive payments for the following types of providers
of long-term care services, as defined by Section 22.0011, Human
Resources Code, under the medical assistance program:
(1) intermediate care facilities for persons with
mental retardation licensed under Chapter 252, Health and Safety
Code; and
(2) providers of home and community-based services, as
described by 42 U.S.C. Section 1396n(c), who are licensed or
otherwise authorized to provide those services in this state.
(d) Not later than September 1, 2012, the Department of
Aging and Disability Services shall submit to the legislature a
written report containing the findings of the study conducted under
Subsection (c) of this section and the department's
recommendations.
SECTION 4. FEDERAL AUTHORIZATION. 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. EFFECTIVE DATE. This Act takes effect September
1, 2011.