86R10866 KFF-F
By: Raymond H.B. No. 3772
A BILL TO BE ENTITLED
AN ACT
relating to a demonstration project that allows federally qualified
health centers to test innovative health care delivery systems and
data sharing under certain public benefits programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 539A to read as follows:
CHAPTER 539A. INNOVATIVE HEALTH CARE DELIVERY SYSTEM DEMONSTRATION
PROJECT
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 539A.0001. DEFINITIONS. In this chapter:
(1) "Demonstration project" means the demonstration
project established under Section 539A.0051.
(2) "Federally qualified health center" has the
meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
(3) "Federally qualified health center services" has
the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
Sec. 539A.0002. REPORTING. Not later than December 1,
2020, the commission shall submit a report to the legislature
regarding the commission's progress in establishing and operating
the demonstration project and recommendations on continuing or
expanding the demonstration project.
Sec. 539A.0003. EXPIRATION. This chapter expires September
1, 2021.
SUBCHAPTER B. DEMONSTRATION PROJECT
Sec. 539A.0051. DEMONSTRATION PROJECT TO TEST ALTERNATIVE
AND INNOVATIVE HEALTH CARE DELIVERY SYSTEMS AND DATA SHARING. The
commission shall develop and implement a demonstration project to
test alternative and innovative health care delivery systems,
including data sharing and alternative payment systems under
Medicaid, the child health plan program, and other health benefits
programs administered by the commission or other health and human
services agencies. Under the demonstration project, the commission
shall provide services covered under health benefits programs to a
specific patient population under an agreed-on shared savings
arrangement with federally qualified health centers.
Sec. 539A.0052. FEDERALLY QUALIFIED HEALTH CENTERS
PARTICIPATION; CREATION OF INNOVATIVE HEALTH CARE DELIVERY
SYSTEMS. (a) In establishing the demonstration project, the
commission shall, in consultation with federally qualified health
centers, develop a request for proposals for participation in the
demonstration project and formation of innovative health care
delivery systems. To be eligible to participate in the
demonstration project a federally qualified health center must:
(1) be a provider under an applicable public benefits
program capable of providing services that are covered by the
program;
(2) meet minimum quality standards established by the
commission; and
(3) adopt cost-effective methods of care delivery and
coordination, which may include the use of allied health
professionals, telemedicine providers, patient educators, care
coordinators, community health care workers, and services and
providers that are not covered or reimbursed under a health
benefits program.
(b) An innovative health care delivery system may be formed
by federally qualified health centers in this state. A federally
qualified health center may contract with a third party to provide
secure transfer and administrative services under the delivery
system.
(c) The commission may require federally qualified health
centers that have established innovative health care delivery
systems to enter into additional contracts with third parties for
risk assessment and for the purchase of stop-loss coverage or
another form of risk management insurance related to the delivery
system established under the demonstration project.
Sec. 539A.0053. PATIENT PARTICIPATION. A person eligible
for a public benefits program, including Medicaid and the child
health plan program, is eligible for attribution to an innovative
health care delivery system.
Sec. 539A.0054. DATA SHARING PROGRAM. (a) As part of the
demonstration project, the commission shall develop and implement a
program to test data sharing for innovative health care delivery
systems and alternative payment systems. Under the data sharing
program and to the extent permitted by federal law, the commission
shall securely provide federally qualified health centers
participating in the demonstration project, or the centers'
designee, data regarding the centers' patients eligible to
participate in the demonstration project, either individually or as
a group.
(b) Under the data sharing program, a participating
federally qualified health center shall provide to the commission
the names of patients who are enrolled in a public benefits program
to whom the center has provided services in the preceding 12-month
period. After receiving the names of patients under this
subsection, the commission shall immediately provide the federally
qualified health centers, or the centers' designee, a claims data
file that includes information relating to the claims that have
been received under a public benefits program for each patient. The
claims data file must include:
(1) the claims made by or on behalf of the patient
during the 36-month period preceding the date the commission
received the names of patients under this subsection;
(2) patient demographic data, including each patient's
name, address, date of birth, and gender;
(3) patient health benefits coverage information,
including any unique identifier or number assigned to the patient
under a public benefits program, including each patient's Medicaid
number, if applicable;
(4) attribution information of each patient,
including the names of the public benefits program each patient is
enrolled in, the effective date of enrollment, and if the patient is
enrolled in Medicaid:
(A) whether the patient is enrolled in a managed
care program, and if so, the name of the program; and
(B) each patient's primary care provider;
(5) the individual provider codes associated with each
provider who has provided services to the patient, including the
provider's:
(A) federal and state, if applicable, tax
identification numbers;
(B) national provider identifiers;
(C) health care provider taxonomy codes;
(D) professional license numbers; and
(E) other identifiers collected with respect to
the provider; and
(6) patient claims data, including:
(A) any benefits covered by a public benefits
program when provided by an enrolled provider, including:
(i) the names of primary care providers,
urgent care providers, specialty care providers, emergency room
providers, and hospital providers; and
(ii) the type of benefits provided,
including the provision of hospital observation services, hospital
inpatient services, home health services, skilled nursing
services, lab and radiological services, pharmacy benefits,
including prescription information and drug pricing, ambulance
services, care plan oversight services, spinal manipulation
services, early and period screening, diagnosis, and treatment
services, anesthesia services, durable medical equipment, hospice
services, therapy services, and obstetric services; and
(B) onset of illness date, dates of service,
locations at which services were provided, names of service
providers, diagnostic and Current Procedural Terminology codes and
related cause codes, and reimbursement amounts paid.
Sec. 539A.0055. REIMBURSEMENT SYSTEM. (a) In developing a
reimbursement system for innovative health care delivery systems,
the executive commissioner shall establish a reimbursement
methodology that:
(1) is based on a total cost of care benchmark adjusted
for patient acuity; and
(2) is designed to achieve determinable savings.
(b) The reimbursement system may include incentive payments
to innovative health care delivery systems that meet or exceed
annual quality and performance targets.
Sec. 539A.0056. FUNDING. The commission may apply for any
available grants or federal funding that would further the purposes
of or assist in the establishment of the demonstration project or
innovative health care delivery systems established under the
demonstration project.
SECTION 2. As soon as possible after the effective date of
this Act, the Health and Human Services Commission shall apply for
and actively pursue from the federal Centers for Medicare and
Medicaid Services or other appropriate federal agency any waiver or
other authorization necessary to implement Chapter 539A,
Government Code, as added by this Act. The commission may delay
implementing this Act 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, 2019.