2019S0356-1 03/06/19
By: Hinojosa S.B. No. 2085
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid funding in this state, including the federal
government's participation in that funding.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02113, Government Code, is amended
to read as follows:
Sec. 531.02113. OPTIMIZATION OF MEDICAID FINANCING. The
commission shall ensure that the Medicaid finance system:
(1) is optimized to:
(A) [(1)] maximize the state's receipt of
federal funds;
(B) [(2)] create incentives for providers to use
preventive care;
(C) [(3)] increase and retain providers in the
system to maintain an adequate provider network;
(D) [(4)] more accurately reflect the costs
borne by providers; and
(E) [(5)] encourage the improvement of the
quality of care; and
(2) complies with the requirements of Chapter 540, if
applicable.
SECTION 2. Section 533.00256(a), Government Code, is
amended to read as follows:
(a) In consultation with appropriate stakeholders with an
interest in the provision of acute care services and long-term
services and supports under the Medicaid managed care program, the
commission shall:
(1) establish a clinical improvement program to
identify goals designed to improve quality of care and care
management and to reduce potentially preventable events, as defined
by Section 536.001; [and]
(2) require managed care organizations to develop and
implement collaborative program improvement strategies to address
the goals; and
(3) evaluate the opportunity to establish a hospital
value-based purchasing program pursuant to 42 C.F.R. Section
438.6(c), to be implemented through its contracts with managed care
organizations, that would provide enhanced reimbursement to
hospitals that meet achievement goals on defined outcome-based
performance measures.
SECTION 3. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 540 to read as follows:
CHAPTER 540. MEDICAID FUNDING MODIFICATION
Sec. 540.0001. APPLICABILITY. This chapter applies to a
waiver to the requirements of this state's Medicaid state plan or
other authorization under Medicaid:
(1) for which the commission seeks approval from the
federal government; and
(2) that, if approved, would change this state's
receipt of federal money for Medicaid from the funding system in
effect on January 1, 2019, to another funding system.
Sec. 540.0002. ADEQUACY OF MEDICAID PROGRAM FUNDING. A
Medicaid funding modification the commission seeks through a waiver
or other authorization to which this chapter applies:
(1) must account for and ensure adequate, continued
funding for:
(A) anticipated growth in the number of persons
in this state who will be eligible for and enroll in the Medicaid
program; and
(B) health care trends that may affect costs,
including:
(i) increases in utilization rates;
(ii) increases in the acuity of Medicaid
recipients;
(iii) advancements in medical technology;
and
(iv) advancements in specialized
prescription drugs; and
(2) may not be designed in a manner that allows for
reductions in federal financial participation based on this state's
effective management of Medicaid cost growth.
Sec. 540.0003. PROVIDER REIMBURSEMENTS AND OTHER PAYMENTS.
(a) A waiver or other authorization to which this chapter applies
must ensure that the Medicaid funding modification the commission
seeks through the waiver or authorization will:
(1) support the provision of adequate reimbursements
to Medicaid providers and support periodic reimbursement rate
increases based on health care trends;
(2) ensure continued provision of payments to
hospitals equal to supplemental payments by this state to hospitals
under supplemental payment programs in effect on January 1, 2019,
which may include continued provision through increases in rates
paid for direct hospital services to Medicaid enrollees; and
(3) prioritize use of supplemental payments to
encourage continued development of comprehensive local and
regional health care systems that include preventive, primary,
specialty, outpatient, inpatient, mental health, and substance
abuse services for individuals without health insurance.
(b) Reimbursement systems under a waiver or other
authorization to which this chapter applies must encourage
value-based payment arrangements for Medicaid providers and
support efforts to promote quality of care.
SECTION 4. Section 108.0065, Health and Safety Code, is
amended by amending Subsection (e) and redesignating Subsection (h)
as Subsection (f) to read as follows:
(e) The commission shall analyze the data collected in
accordance with this section and shall use the data to:
(1) evaluate the effectiveness and efficiency of the
Medicaid managed care system;
(2) determine the extent to which Medicaid managed
care does or does not serve the needs of Medicaid recipients in this
state; [and]
(3) assess the cost-effectiveness of the Medicaid
managed care system in comparison to the fee-for-service system,
considering any improvement in the quality of care provided; and
(4) support and assist the commission's activities
conducted pursuant to Section 533.00256, Government Code.
(f) [(h)] The commission, using existing funds, may
contract with an entity to comply with the requirements under
Subsection (e).
SECTION 5. 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 6. 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.