Texas 2015 - 84th Regular

Texas House Bill HB3823 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	By: Price, et al. (Senate Sponsor - Rodríguez) H.B. No. 3823
2		-	(In the Senate - Received from the House April 28, 2015;
3		-	May 4, 2015, read first time and referred to Committee on Health
4		-	and Human Services; May 15, 2015, reported favorably by the
5		-	following vote: Yeas 9, Nays 0; May 15, 2015, sent to printer.)
6		-	Click here to see the committee vote
	1	+	H.B. No. 3823
7	2
8	3
9		-	A BILL TO BE ENTITLED
10	4		AN ACT
11	5		relating to rate-setting and data collection processes under the
12	6		program of all-inclusive care for the elderly.
13	7		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	8		SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
15	9		is amended by adding Sections 32.0532, 32.0533, and 32.0534 to read
16	10		as follows:
17	11		Sec. 32.0532. PACE PROGRAM REIMBURSEMENT METHODOLOGY. (a)
18	12		In this section and Sections 32.0533 and 32.0534, "PACE program"
19	13		means the program of all-inclusive care for the elderly (PACE)
20	14		established under Section 32.053.
21	15		(b) In setting the reimbursement rates under the PACE
22	16		program, the executive commissioner shall ensure that:
23	17		(1) reimbursement rates for providers under the
24	18		program are adequate to sustain the program; and
25	19		(2) the program is cost-neutral or costs less when
26	20		compared to the cost to serve a population in the STAR + PLUS
27	21		Medicaid managed care program that is comparable in:
28	22		(A) age;
29	23		(B) eligibility factors, including:
30	24		(i) income level;
31	25		(ii) health status; and
32	26		(iii) impairment level;
33	27		(C) geographic location;
34	28		(D) living environment; and
35	29		(E) other factors determined to be necessary.
36	30		(c) For purposes of Subsection (b)(2), the commission shall
37	31		consider data on the cost of services provided to comparable
38	32		recipients enrolled in the STAR + PLUS Medicaid managed care
39	33		program to calculate the upper payment limit component of the PACE
40	34		program reimbursement rates. The cost of those services includes
41	35		the Medicaid capitation payment per recipient and Medicaid payments
42	36		made on a fee-for-service basis for services not covered by the
43	37		capitation payment.
44	38		Sec. 32.0533. DATA COLLECTION: PACE AND STAR + PLUS
45	39		MEDICAID MANAGED CARE PROGRAMS. The commission, in collaboration
46	40		with the Department of Aging and Disability Services and
47	41		appropriate stakeholder groups, shall modify the methods by which
48	42		the commission and the department collect data for evaluation of
49	43		the PACE and STAR + PLUS Medicaid managed care programs to allow
50	44		comparison of recipient outcomes between the programs. The
51	45		modification to data collection methods must include changes to:
52	46		(1) survey instruments that measure recipient
53	47		experience;
54	48		(2) compilation of the same or similar complaint,
55	49		disenrollment, and appeals data; and
56	50		(3) compilation of the same or similar hospital
57	51		admissions and readmissions data.
58	52		Sec. 32.0534. EVALUATION AND REPORT COMPARING PACE AND STAR
59	53		+ PLUS MEDICAID MANAGED CARE PROGRAMS. (a) The commission, in
60	54		collaboration with the Department of Aging and Disability Services
61	55		and appropriate stakeholder groups, shall conduct an evaluation of
62	56		the PACE program that compares Medicaid costs and client outcomes
63	57		under the PACE program to Medicaid costs and client outcomes under
64	58		the STAR + PLUS Medicaid managed care program. The commission must
65	59		design the evaluation in a manner that:
66	60		(1) compares similar recipient types between the
67	61		programs in terms of recipient:
68	62		(A) age;
69	63		(B) eligibility factors, including:
70	64		(i) income level;
71	65		(ii) health status; and
72	66		(iii) impairment level; and
73	67		(C) living environment; and
74	68		(2) accounts for differences among recipients in:
75	69		(A) geographic location;
76	70		(B) health care acuity; and
77	71		(C) other factors determined to be necessary.
78	72		(b) The evaluation required under this section must include
79	73		an assessment of future cost implications if the commission fails
80	74		to establish a reimbursement methodology under the PACE program in
81	75		accordance with Section 32.0532.
82	76		(c) The commission shall compile a report on the findings of
83	77		the evaluation under this section. Not later than December 1, 2016,
84	78		the commission shall submit the report to the Legislative Budget
85	79		Board and the governor.
86	80		(d) This section expires September 1, 2017.
87	81		SECTION 2. If before implementing any provision of this Act
88	82		a state agency determines that a waiver or authorization from a
89	83		federal agency is necessary for implementation of that provision,
90	84		the agency affected by the provision shall request the waiver or
91	85		authorization and may delay implementing that provision until the
92	86		waiver or authorization is granted.
93	87		SECTION 3. This Act takes effect immediately if it receives
94	88		a vote of two-thirds of all the members elected to each house, as
95	89		provided by Section 39, Article III, Texas Constitution. If this
96	90		Act does not receive the vote necessary for immediate effect, this
97	91		Act takes effect September 1, 2015.
98		-	* * * * *
	92	+	______________________________ ______________________________
	93	+	President of the Senate Speaker of the House
	94	+	I certify that H.B. No. 3823 was passed by the House on April
	95	+	27, 2015, by the following vote: Yeas 134, Nays 0, 1 present, not
	96	+	voting.
	97	+	______________________________
	98	+	Chief Clerk of the House
	99	+	I certify that H.B. No. 3823 was passed by the Senate on May
	100	+	22, 2015, by the following vote: Yeas 31, Nays 0.
	101	+	______________________________
	102	+	Secretary of the Senate
	103	+	APPROVED: _____________________
	104	+	Date
	105	+	_____________________
	106	+	Governor