Texas 2019 - 86th Regular

Texas Senate Bill SB1922 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R10866 KFF-F
2	2	By: Rodríguez S.B. No. 1922
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a demonstration project that allows federally qualified
8	8	health centers to test innovative health care delivery systems and
9	9	data sharing under certain public benefits programs.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle I, Title 4, Government Code, is amended
12	12	by adding Chapter 539A to read as follows:
13	13	CHAPTER 539A. INNOVATIVE HEALTH CARE DELIVERY SYSTEM DEMONSTRATION
14	14	PROJECT
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 539A.0001. DEFINITIONS. In this chapter:
17	17	(1) "Demonstration project" means the demonstration
18	18	project established under Section 539A.0051.
19	19	(2) "Federally qualified health center" has the
20	20	meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
21	21	(3) "Federally qualified health center services" has
22	22	the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
23	23	Sec. 539A.0002. REPORTING. Not later than December 1,
24	24	2020, the commission shall submit a report to the legislature
25	25	regarding the commission's progress in establishing and operating
26	26	the demonstration project and recommendations on continuing or
27	27	expanding the demonstration project.
28	28	Sec. 539A.0003. EXPIRATION. This chapter expires September
29	29	1, 2021.
30	30	SUBCHAPTER B. DEMONSTRATION PROJECT
31	31	Sec. 539A.0051. DEMONSTRATION PROJECT TO TEST ALTERNATIVE
32	32	AND INNOVATIVE HEALTH CARE DELIVERY SYSTEMS AND DATA SHARING. The
33	33	commission shall develop and implement a demonstration project to
34	34	test alternative and innovative health care delivery systems,
35	35	including data sharing and alternative payment systems under
36	36	Medicaid, the child health plan program, and other health benefits
37	37	programs administered by the commission or other health and human
38	38	services agencies. Under the demonstration project, the commission
39	39	shall provide services covered under health benefits programs to a
40	40	specific patient population under an agreed-on shared savings
41	41	arrangement with federally qualified health centers.
42	42	Sec. 539A.0052. FEDERALLY QUALIFIED HEALTH CENTERS
43	43	PARTICIPATION; CREATION OF INNOVATIVE HEALTH CARE DELIVERY
44	44	SYSTEMS. (a) In establishing the demonstration project, the
45	45	commission shall, in consultation with federally qualified health
46	46	centers, develop a request for proposals for participation in the
47	47	demonstration project and formation of innovative health care
48	48	delivery systems. To be eligible to participate in the
49	49	demonstration project a federally qualified health center must:
50	50	(1) be a provider under an applicable public benefits
51	51	program capable of providing services that are covered by the
52	52	program;
53	53	(2) meet minimum quality standards established by the
54	54	commission; and
55	55	(3) adopt cost-effective methods of care delivery and
56	56	coordination, which may include the use of allied health
57	57	professionals, telemedicine providers, patient educators, care
58	58	coordinators, community health care workers, and services and
59	59	providers that are not covered or reimbursed under a health
60	60	benefits program.
61	61	(b) An innovative health care delivery system may be formed
62	62	by federally qualified health centers in this state. A federally
63	63	qualified health center may contract with a third party to provide
64	64	secure transfer and administrative services under the delivery
65	65	system.
66	66	(c) The commission may require federally qualified health
67	67	centers that have established innovative health care delivery
68	68	systems to enter into additional contracts with third parties for
69	69	risk assessment and for the purchase of stop-loss coverage or
70	70	another form of risk management insurance related to the delivery
71	71	system established under the demonstration project.
72	72	Sec. 539A.0053. PATIENT PARTICIPATION. A person eligible
73	73	for a public benefits program, including Medicaid and the child
74	74	health plan program, is eligible for attribution to an innovative
75	75	health care delivery system.
76	76	Sec. 539A.0054. DATA SHARING PROGRAM. (a) As part of the
77	77	demonstration project, the commission shall develop and implement a
78	78	program to test data sharing for innovative health care delivery
79	79	systems and alternative payment systems. Under the data sharing
80	80	program and to the extent permitted by federal law, the commission
81	81	shall securely provide federally qualified health centers
82	82	participating in the demonstration project, or the centers'
83	83	designee, data regarding the centers' patients eligible to
84	84	participate in the demonstration project, either individually or as
85	85	a group.
86	86	(b) Under the data sharing program, a participating
87	87	federally qualified health center shall provide to the commission
88	88	the names of patients who are enrolled in a public benefits program
89	89	to whom the center has provided services in the preceding 12-month
90	90	period. After receiving the names of patients under this
91	91	subsection, the commission shall immediately provide the federally
92	92	qualified health centers, or the centers' designee, a claims data
93	93	file that includes information relating to the claims that have
94	94	been received under a public benefits program for each patient. The
95	95	claims data file must include:
96	96	(1) the claims made by or on behalf of the patient
97	97	during the 36-month period preceding the date the commission
98	98	received the names of patients under this subsection;
99	99	(2) patient demographic data, including each patient's
100	100	name, address, date of birth, and gender;
101	101	(3) patient health benefits coverage information,
102	102	including any unique identifier or number assigned to the patient
103	103	under a public benefits program, including each patient's Medicaid
104	104	number, if applicable;
105	105	(4) attribution information of each patient,
106	106	including the names of the public benefits program each patient is
107	107	enrolled in, the effective date of enrollment, and if the patient is
108	108	enrolled in Medicaid:
109	109	(A) whether the patient is enrolled in a managed
110	110	care program, and if so, the name of the program; and
111	111	(B) each patient's primary care provider;
112	112	(5) the individual provider codes associated with each
113	113	provider who has provided services to the patient, including the
114	114	provider's:
115	115	(A) federal and state, if applicable, tax
116	116	identification numbers;
117	117	(B) national provider identifiers;
118	118	(C) health care provider taxonomy codes;
119	119	(D) professional license numbers; and
120	120	(E) other identifiers collected with respect to
121	121	the provider; and
122	122	(6) patient claims data, including:
123	123	(A) any benefits covered by a public benefits
124	124	program when provided by an enrolled provider, including:
125	125	(i) the names of primary care providers,
126	126	urgent care providers, specialty care providers, emergency room
127	127	providers, and hospital providers; and
128	128	(ii) the type of benefits provided,
129	129	including the provision of hospital observation services, hospital
130	130	inpatient services, home health services, skilled nursing
131	131	services, lab and radiological services, pharmacy benefits,
132	132	including prescription information and drug pricing, ambulance
133	133	services, care plan oversight services, spinal manipulation
134	134	services, early and period screening, diagnosis, and treatment
135	135	services, anesthesia services, durable medical equipment, hospice
136	136	services, therapy services, and obstetric services; and
137	137	(B) onset of illness date, dates of service,
138	138	locations at which services were provided, names of service
139	139	providers, diagnostic and Current Procedural Terminology codes and
140	140	related cause codes, and reimbursement amounts paid.
141	141	Sec. 539A.0055. REIMBURSEMENT SYSTEM. (a) In developing a
142	142	reimbursement system for innovative health care delivery systems,
143	143	the executive commissioner shall establish a reimbursement
144	144	methodology that:
145	145	(1) is based on a total cost of care benchmark adjusted
146	146	for patient acuity; and
147	147	(2) is designed to achieve determinable savings.
148	148	(b) The reimbursement system may include incentive payments
149	149	to innovative health care delivery systems that meet or exceed
150	150	annual quality and performance targets.
151	151	Sec. 539A.0056. FUNDING. The commission may apply for any
152	152	available grants or federal funding that would further the purposes
153	153	of or assist in the establishment of the demonstration project or
154	154	innovative health care delivery systems established under the
155	155	demonstration project.
156	156	SECTION 2. As soon as possible after the effective date of
157	157	this Act, the Health and Human Services Commission shall apply for
158	158	and actively pursue from the federal Centers for Medicare and
159	159	Medicaid Services or other appropriate federal agency any waiver or
160	160	other authorization necessary to implement Chapter 539A,
161	161	Government Code, as added by this Act. The commission may delay
162	162	implementing this Act until the waiver or authorization is granted.
163	163	SECTION 3. This Act takes effect immediately if it receives
164	164	a vote of two-thirds of all the members elected to each house, as
165	165	provided by Section 39, Article III, Texas Constitution. If this
166	166	Act does not receive the vote necessary for immediate effect, this
167	167	Act takes effect September 1, 2019.