Texas 2019 - 86th Regular

Texas Senate Bill SB2085 Compare Versions

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

Old	New	Differences
1	1	2019S0356-1 03/06/19
2	2	By: Hinojosa S.B. No. 2085
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to Medicaid funding in this state, including the federal
8	8	government's participation in that funding.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 531.02113, Government Code, is amended
11	11	to read as follows:
12	12	Sec. 531.02113. OPTIMIZATION OF MEDICAID FINANCING. The
13	13	commission shall ensure that the Medicaid finance system:
14	14	(1) is optimized to:
15	15	(A) [(1)] maximize the state's receipt of
16	16	federal funds;
17	17	(B) [(2)] create incentives for providers to use
18	18	preventive care;
19	19	(C) [(3)] increase and retain providers in the
20	20	system to maintain an adequate provider network;
21	21	(D) [(4)] more accurately reflect the costs
22	22	borne by providers; and
23	23	(E) [(5)] encourage the improvement of the
24	24	quality of care; and
25	25	(2) complies with the requirements of Chapter 540, if
26	26	applicable.
27	27	SECTION 2. Section 533.00256(a), Government Code, is
28	28	amended to read as follows:
29	29	(a) In consultation with appropriate stakeholders with an
30	30	interest in the provision of acute care services and long-term
31	31	services and supports under the Medicaid managed care program, the
32	32	commission shall:
33	33	(1) establish a clinical improvement program to
34	34	identify goals designed to improve quality of care and care
35	35	management and to reduce potentially preventable events, as defined
36	36	by Section 536.001; [and]
37	37	(2) require managed care organizations to develop and
38	38	implement collaborative program improvement strategies to address
39	39	the goals; and
40	40	(3) evaluate the opportunity to establish a hospital
41	41	value-based purchasing program pursuant to 42 C.F.R. Section
42	42	438.6(c), to be implemented through its contracts with managed care
43	43	organizations, that would provide enhanced reimbursement to
44	44	hospitals that meet achievement goals on defined outcome-based
45	45	performance measures.
46	46	SECTION 3. Subtitle I, Title 4, Government Code, is amended
47	47	by adding Chapter 540 to read as follows:
48	48	CHAPTER 540. MEDICAID FUNDING MODIFICATION
49	49	Sec. 540.0001. APPLICABILITY. This chapter applies to a
50	50	waiver to the requirements of this state's Medicaid state plan or
51	51	other authorization under Medicaid:
52	52	(1) for which the commission seeks approval from the
53	53	federal government; and
54	54	(2) that, if approved, would change this state's
55	55	receipt of federal money for Medicaid from the funding system in
56	56	effect on January 1, 2019, to another funding system.
57	57	Sec. 540.0002. ADEQUACY OF MEDICAID PROGRAM FUNDING. A
58	58	Medicaid funding modification the commission seeks through a waiver
59	59	or other authorization to which this chapter applies:
60	60	(1) must account for and ensure adequate, continued
61	61	funding for:
62	62	(A) anticipated growth in the number of persons
63	63	in this state who will be eligible for and enroll in the Medicaid
64	64	program; and
65	65	(B) health care trends that may affect costs,
66	66	including:
67	67	(i) increases in utilization rates;
68	68	(ii) increases in the acuity of Medicaid
69	69	recipients;
70	70	(iii) advancements in medical technology;
71	71	and
72	72	(iv) advancements in specialized
73	73	prescription drugs; and
74	74	(2) may not be designed in a manner that allows for
75	75	reductions in federal financial participation based on this state's
76	76	effective management of Medicaid cost growth.
77	77	Sec. 540.0003. PROVIDER REIMBURSEMENTS AND OTHER PAYMENTS.
78	78	(a) A waiver or other authorization to which this chapter applies
79	79	must ensure that the Medicaid funding modification the commission
80	80	seeks through the waiver or authorization will:
81	81	(1) support the provision of adequate reimbursements
82	82	to Medicaid providers and support periodic reimbursement rate
83	83	increases based on health care trends;
84	84	(2) ensure continued provision of payments to
85	85	hospitals equal to supplemental payments by this state to hospitals
86	86	under supplemental payment programs in effect on January 1, 2019,
87	87	which may include continued provision through increases in rates
88	88	paid for direct hospital services to Medicaid enrollees; and
89	89	(3) prioritize use of supplemental payments to
90	90	encourage continued development of comprehensive local and
91	91	regional health care systems that include preventive, primary,
92	92	specialty, outpatient, inpatient, mental health, and substance
93	93	abuse services for individuals without health insurance.
94	94	(b) Reimbursement systems under a waiver or other
95	95	authorization to which this chapter applies must encourage
96	96	value-based payment arrangements for Medicaid providers and
97	97	support efforts to promote quality of care.
98	98	SECTION 4. Section 108.0065, Health and Safety Code, is
99	99	amended by amending Subsection (e) and redesignating Subsection (h)
100	100	as Subsection (f) to read as follows:
101	101	(e) The commission shall analyze the data collected in
102	102	accordance with this section and shall use the data to:
103	103	(1) evaluate the effectiveness and efficiency of the
104	104	Medicaid managed care system;
105	105	(2) determine the extent to which Medicaid managed
106	106	care does or does not serve the needs of Medicaid recipients in this
107	107	state; [and]
108	108	(3) assess the cost-effectiveness of the Medicaid
109	109	managed care system in comparison to the fee-for-service system,
110	110	considering any improvement in the quality of care provided; and
111	111	(4) support and assist the commission's activities
112	112	conducted pursuant to Section 533.00256, Government Code.
113	113	(f) [(h)] The commission, using existing funds, may
114	114	contract with an entity to comply with the requirements under
115	115	Subsection (e).
116	116	SECTION 5. If before implementing any provision of this Act
117	117	a state agency determines that a waiver or authorization from a
118	118	federal agency is necessary for implementation of that provision,
119	119	the agency affected by the provision shall request the waiver or
120	120	authorization and may delay implementing that provision until the
121	121	waiver or authorization is granted.
122	122	SECTION 6. This Act takes effect immediately if it receives
123	123	a vote of two-thirds of all the members elected to each house, as
124	124	provided by Section 39, Article III, Texas Constitution. If this
125	125	Act does not receive the vote necessary for immediate effect, this
126	126	Act takes effect September 1, 2019.