84R5379 JSL-D
By: Price, Keough H.B. No. 3823
A BILL TO BE ENTITLED
AN ACT
relating to rate-setting and data collection processes under the
program of all-inclusive care for the elderly.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Sections 32.0532, 32.0533, and 32.0534 to read
as follows:
Sec. 32.0532. PACE PROGRAM REIMBURSEMENT METHODOLOGY. (a)
In this section and Sections 32.0533 and 32.0534:
(1) "Commission" means the Health and Human Services
Commission.
(2) "PACE program" means the program of all-inclusive
care for the elderly (PACE) established under Section 32.053.
(b) In setting the reimbursement rates under the PACE
program, the executive commissioner of the commission shall ensure
that:
(1) reimbursement rates for providers under the
program are adequate to sustain the program;
(2) reimbursements paid under the program do not, in
the aggregate, exceed the reasonable and necessary costs to operate
the program; and
(3) the program is cost-neutral when compared to the
cost to serve a comparable population in the STAR + PLUS Medicaid
managed care program.
(c) For purposes of Subsections (b)(1) and (2), the
commission shall consider requiring providers under the PACE
program to report historical cost and utilization data. If the
commission requires providers to report historical cost and
utilization data under this section:
(1) the commission may establish a cost-reporting
structure that accommodates data collection from providers by
modifying as appropriate an existing cost-reporting structure used
for other programs administered by the commission; and
(2) the commission shall determine which costs the
commission considers reasonable and necessary under the program.
(d) For purposes of Subsection (b)(3), the commission shall
consider data on the cost of services provided to comparable
recipients enrolled in the STAR + PLUS Medicaid managed care
program to calculate the upper payment limit component of the PACE
program reimbursement rates. The cost of those services includes
the Medicaid capitation payment per recipient and Medicaid payments
made on a fee-for-service basis for services not covered by the
capitation payment.
Sec. 32.0533. DATA COLLECTION: PACE AND STAR + PLUS
MEDICAID MANAGED CARE PROGRAMS. The commission, in collaboration
with the Department of Aging and Disability Services, shall modify
the methods by which the commission and the department collect data
for evaluation of the PACE and STAR + PLUS Medicaid managed care
programs to allow comparison of recipient outcomes between the
programs. The modification to data collection methods must include
changes to:
(1) survey instruments that measure recipient
experience;
(2) compilation of the same or similar complaint,
disenrollment, and appeals data; and
(3) compilation of the same or similar hospital
admissions and readmissions data.
Sec. 32.0534. EVALUATION AND REPORT COMPARING PACE AND STAR
+ PLUS MEDICAID MANAGED CARE PROGRAMS. (a) The commission, in
collaboration with the Department of Aging and Disability Services,
shall conduct an evaluation of the PACE program that compares
Medicaid costs and client outcomes under the PACE program to
Medicaid costs and client outcomes under the STAR + PLUS Medicaid
managed care program. The commission must design the evaluation in
a manner that:
(1) compares similar recipient types between the
programs; and
(2) accounts for geographic differences and recipient
acuity.
(b) The evaluation required under this section must include
an assessment of future cost implications if the commission fails
to establish a reimbursement methodology under the PACE program in
accordance with Section 32.0532.
(c) The commission shall compile a report on the findings of
the evaluation under this section. Not later than December 1, 2016,
the commission shall submit the report to the Legislative Budget
Board and the governor.
(d) This section expires September 1, 2017.
SECTION 2. 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 3. 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, 2015.