By: Van de Putte S.B. No. 1542
(Zerwas)
A BILL TO BE ENTITLED
AN ACT
relating to clinical initiatives to improve the quality of care and
cost-effectiveness of the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 538 to read as follows:
CHAPTER 538. MEDICAID QUALITY IMPROVEMENT PROCESS FOR CLINICAL
INITIATIVES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 538.001. DEFINITION. In this chapter, "Medicaid
program" means the medical assistance program established under
Chapter 32, Human Resources Code.
Sec. 538.002. EFFECT OF CHAPTER; AUTHORITY OF COMMISSION.
This chapter does not affect or give the commission additional
authority to:
(1) affect any individual health care treatment
decision for a Medicaid recipient;
(2) replace or affect the process of determining
Medicaid benefits, including the approval process for receiving
benefits for durable medical equipment, or any applicable approval
process required for reimbursement for services or other equipment
under the Medicaid program;
(3) implement a clinical initiative or associated rule
or program policy that is otherwise prohibited under state or
federal law; or
(4) implement any initiative that would expand
eligibility for benefits under the Medicaid program.
Sec. 538.003. RULES. The executive commissioner shall
adopt rules necessary to implement this chapter.
SUBCHAPTER B. MEDICAID QUALITY IMPROVEMENT PROCESS TO ASSESS
CERTAIN CLINICAL INITIATIVES
Sec. 538.051. MEDICAID QUALITY IMPROVEMENT PROCESS. The
commission shall, according to the provisions of this chapter,
develop and implement a quality improvement process by which the
commission:
(1) receives suggestions for clinical initiatives
designed to improve:
(A) the quality of care provided under the
Medicaid program; and
(B) the cost-effectiveness of the Medicaid
program;
(2) conducts a preliminary review under Section
538.053(4) of each suggestion received under Section 538.052 to
determine whether the suggestion warrants further consideration
and analysis; and
(3) conducts an analysis under Section 538.054 of
clinical initiative suggestions that are selected for analysis
under Subdivision (2) and of required clinical initiatives under
Section 538.0521.
Sec. 538.052. SOLICITATION OF SUGGESTIONS FOR CLINICAL
INITIATIVES. (a) Subject to Subsection (b), the commission shall
solicit and accept suggestions for clinical initiatives, in either
written or electronic form, from:
(1) a member of the state legislature;
(2) the executive commissioner;
(3) the commissioner of the Department of Aging and
Disability Services;
(4) the commissioner of the Department of State Health
Services;
(5) the commissioner of the Department of Family and
Protective Services;
(6) the commissioner of the Department of Assistive
and Rehabilitative Services;
(7) the medical care advisory committee established
under Section 32.022, Human Resources Code;
(8) the physician payment advisory committee created
under Section 32.022(d), Human Resources Code; and
(9) the Electronic Health Information Exchange System
Advisory Committee established under Section 531.904.
(b) The commission may not accept suggestions under this
section for an initiative that:
(1) is undergoing clinical trials; or
(2) expands a health care provider's scope of practice
beyond the law governing the provider's practice.
Sec. 538.0521. REQUIRED CLINICAL INITIATIVES. (a) In
addition to the clinical initiatives selected for analysis under
Section 538.054, the commission shall conduct an analysis and issue
a final report in accordance with the requirements of this chapter
for the following:
(1) an initiative that would require hospitals to
implement evidence-based protocols, including early goal-directed
therapy, in the treatment of severe sepsis and septicemia; and
(2) an initiative that would authorize the Medicaid
program to provide blood-based allergy testing for patients with
persistent asthma to develop an appropriate treatment strategy that
would minimize exposure to allergy-induced asthma attacks.
(b) This section expires August 31, 2014.
Sec. 538.053. CLINICAL INITIATIVE EVALUATION PROCESS. The
commission shall establish and implement an evaluation process for
the submission, preliminary review, analysis, and approval of a
clinical initiative. The process must:
(1) require that a suggestion for a clinical
initiative be submitted to the state Medicaid director;
(2) require that a suggestion for a clinical
initiative selected for analysis under Section 538.054 be published
on the Internet website created under Section 538.056 not later
than the 30th day after the date on which the state Medicaid
director receives the suggestion;
(3) provide for a formal public comment period that
lasts at least 30 days during which the public may submit comments
and research relating to a suggested clinical initiative;
(4) allow the commission to conduct with the
assistance of appropriate advisory committees or similar groups as
determined by the commission a preliminary review of each suggested
clinical initiative to determine whether the initiative warrants
further consideration and analysis under Section 538.054;
(5) limit the number of suggestions that receive
analysis under Section 538.054;
(6) require the commission to publish on the Internet
website created under Section 538.056 the criteria the commission
uses in the preliminary review under Subdivision (4) to determine
whether an initiative warrants analysis under Section 538.054;
(7) require commission employees to perform an
analysis of each suggested clinical initiative selected for
analysis in accordance with Section 538.054; and
(8) require the development and publication of a final
report in accordance with Section 538.055 on each clinical
initiative selected for analysis under Section 538.054 not later
than the 180th day after the date on which the state Medicaid
director receives the suggestion.
Sec. 538.054. ANALYSIS OF CLINICAL INITIATIVES. The
commission shall conduct an analysis of each clinical initiative
selected by the commission after having conducted the commission's
preliminary review under Section 538.053(4). The analysis required
under this section must include a review of:
(1) any public comments and submitted research
relating to the initiative;
(2) the available clinical research and historical
utilization information relating to the initiative;
(3) published medical literature relating to the
initiative;
(4) any adoption of the initiative by medical
societies or other clinical groups;
(5) whether the initiative has been implemented under:
(A) the Medicare program;
(B) another state medical assistance program; or
(C) a state-operated health care program,
including the child health plan program;
(6) the results of reports, research, pilot programs,
or clinical studies relating to the initiative conducted by:
(A) institutions of higher education, including
related medical schools;
(B) governmental entities and agencies; and
(C) private and nonprofit think tanks and
research groups;
(7) the impact that the initiative would have on the
Medicaid program if implemented in this state, including:
(A) an estimate of the number of recipients under
the Medicaid program that would be impacted by implementation of
the initiative; and
(B) a description of any potential cost savings
to the state that would result from implementation of the
initiative; and
(8) any statutory barriers to implementation of the
initiative.
Sec. 538.055. FINAL REPORT ON CLINICAL INITIATIVE. The
commission shall prepare a final report based on the commission's
analysis of a clinical initiative under Section 538.054. The final
report must include:
(1) a final determination of:
(A) the feasibility of implementing the
initiative;
(B) the likely impact implementing the
initiative would have on the quality of care provided under the
Medicaid program; and
(C) the anticipated cost savings to the state
that would result from implementing the initiative;
(2) a summary of the public comments, including a
description of any opposition to the initiative;
(3) an identification of any statutory barriers to
implementation of the initiative; and
(4) if the initiative is not implemented, an
explanation of the decision not to implement the initiative.
Sec. 538.056. INTERNET WEBSITE. The commission shall
maintain an Internet website related to the quality improvement
process required under this chapter. The website must include:
(1) an explanation of the process for submission,
preliminary review, analysis, and approval of clinical initiatives
under this chapter;
(2) an explanation of how members of the public may
submit comments or research related to an initiative;
(3) a copy of each initiative selected for analysis
under Section 538.054;
(4) the status of each initiative in the approval
process; and
(5) a copy of each final report prepared under this
chapter.
Sec. 538.057. ACTION ON CLINICAL INITIATIVE BY COMMISSION.
After the commission conducts an analysis of a clinical initiative
under Section 538.054:
(1) if the commission has determined that the
initiative is cost-effective and will improve the quality of care
under the Medicaid program, the commission may:
(A) implement the initiative if implementation
of the initiative is not otherwise prohibited by law; or
(B) if implementation requires a change in law,
submit a copy of the final report together with recommendations
relating to the initiative's implementation to the standing
committees of the senate and house of representatives having
jurisdiction over the Medicaid program; and
(2) if the commission has determined that the
initiative is not cost-effective or will not improve quality of
care under the Medicaid program, the commission may not implement
the initiative.
SECTION 2. Not later than January 1, 2014, the Health and
Human Services Commission shall conduct an analysis and submit a
final report on the clinical initiatives required under Section
538.0521, Government Code, as added by this Act.
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, 2013.