|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to certain health-related and other task forces and |
|
advisory committees. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
ARTICLE 1. CHANGES TO ENTITIES EFFECTIVE SEPTEMBER 1, 2015 |
|
SECTION 1.01. (a) The Interagency Task Force on Electronic |
|
Benefits Transfers is abolished. |
|
(b) Section 531.045, Government Code, as amended by S.B. |
|
219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.02. (a) The Medicaid and Public Assistance Fraud |
|
Oversight Task Force is abolished. |
|
(b) Section 22.028(c), Human Resources Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
amended to read as follows: |
|
(c) No later than the first day of each month, the |
|
commission shall send the comptroller a report listing the accounts |
|
on which enforcement actions or other steps were taken by the |
|
commission in response to the records received from the EBT |
|
operator under this section, and the action taken by the |
|
commission. The comptroller shall promptly review the report and, |
|
as appropriate, may solicit the advice of the office of the |
|
inspector general [Medicaid and Public Assistance Fraud Oversight
|
|
Task Force] regarding the results of the commission's enforcement |
|
actions. |
|
(c) Section 531.107, Government Code, as amended by S.B. |
|
219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.03. (a) The Advisory Committee on Inpatient |
|
Mental Health Services is abolished. |
|
(b) Section 571.027, Health and Safety Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.04. (a) The Interagency Inspection Task Force is |
|
abolished. |
|
(b) Section 42.0442(c), Human Resources Code, is amended to |
|
read as follows: |
|
(c) [The interagency task force shall establish an
|
|
inspection checklist based on the inspection protocol developed
|
|
under Subsection (b).] Each state agency that inspects a facility |
|
listed in Subsection (a) shall use an [the] inspection checklist |
|
established by the department in performing an inspection. A state |
|
agency shall make a copy of the completed inspection checklist |
|
available to the facility at the facility's request to assist the |
|
facility in maintaining records. |
|
(c) Section 42.0442(b), Human Resources Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.05. (a) The local authority network advisory |
|
committee is abolished. |
|
(b) Section 533.0359(a), Health and Safety Code, is amended |
|
to read as follows: |
|
(a) In developing rules governing local mental health |
|
authorities under Sections 533.035, [533.0351,] 533.03521, |
|
533.0357, and 533.0358, the executive commissioner shall use |
|
rulemaking procedures under Subchapter B, Chapter 2001, Government |
|
Code. |
|
(c) Section 533.0351, Health and Safety Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.06. (a) The Worksite Wellness Advisory Board is |
|
abolished. |
|
(b) Section 664.052, Government Code, is amended to read as |
|
follows: |
|
Sec. 664.052. RULES. The executive commissioner shall |
|
adopt rules for the administration of this subchapter[, including
|
|
rules prescribing the frequency and location of board meetings]. |
|
(c) Section 664.058, Government Code, is amended to read as |
|
follows: |
|
Sec. 664.058. DONATIONS. The department [board] may |
|
receive in-kind and monetary gifts, grants, and donations from |
|
public and private donors to be used for the purposes of this |
|
subchapter. |
|
(d) Section 664.061(a), Government Code, is amended to read |
|
as follows: |
|
(a) A state agency may: |
|
(1) allow each employee 30 minutes during normal |
|
working hours for exercise three times each week; |
|
(2) allow all employees to attend on-site wellness |
|
seminars when offered; |
|
(3) provide eight hours of additional leave time each |
|
year to an employee who: |
|
(A) receives a physical examination; and |
|
(B) completes either an online health risk |
|
assessment tool provided by the department [board] or a similar |
|
health risk assessment conducted in person by a worksite wellness |
|
coordinator; |
|
(4) provide financial incentives, notwithstanding |
|
Section 2113.201, for participation in a wellness program developed |
|
under Section 664.053(e) after the agency establishes a written |
|
policy with objective criteria for providing the incentives; |
|
(5) offer on-site clinic or pharmacy services in |
|
accordance with Subtitles B and J, Title 3, Occupations Code, |
|
including the requirements regarding delegation of certain medical |
|
acts under Chapter 157, Occupations Code; and |
|
(6) adopt additional wellness policies, as determined |
|
by the agency. |
|
(e) Sections 664.051(1), 664.054, 664.055, 664.056, |
|
664.057, 664.059, and 664.060(c) and (f), Government Code, are |
|
repealed. |
|
SECTION 1.07. (a) The Sickle Cell Advisory Committee is |
|
abolished. |
|
(b) Section 33.052, Health and Safety Code, is amended to |
|
read as follows: |
|
Sec. 33.052. DUTIES OF DEPARTMENT. The department shall[:
|
|
[(1)] identify efforts related to the expansion and |
|
coordination of education, treatment, and continuity of care |
|
programs for individuals with sickle cell trait and sickle cell |
|
disease[;
|
|
[(2)
assist the advisory committee created under
|
|
Section 33.053; and
|
|
[(3)
provide the advisory committee created under
|
|
Section 33.053 with staff support necessary for the advisory
|
|
committee to fulfill its duties]. |
|
(c) Section 33.053, Health and Safety Code, is repealed. |
|
SECTION 1.08. (a) The Arthritis Advisory Committee is |
|
abolished. |
|
(b) Section 97.007, Health and Safety Code, is repealed. |
|
SECTION 1.09. (a) The Advisory Panel on Health |
|
Care-Associated Infections and Preventable Adverse Events is |
|
abolished. |
|
(b) Section 536.002(b), Government Code, is amended to read |
|
as follows: |
|
(b) The executive commissioner shall appoint the members of |
|
the advisory committee. The committee must consist of physicians |
|
and other health care providers, representatives of health care |
|
facilities, representatives of managed care organizations, and |
|
other stakeholders interested in health care services provided in |
|
this state, including: |
|
(1) at least one member who is a physician with |
|
clinical practice experience in obstetrics and gynecology; |
|
(2) at least one member who is a physician with |
|
clinical practice experience in pediatrics; |
|
(3) at least one member who is a physician with |
|
clinical practice experience in internal medicine or family |
|
medicine; |
|
(4) at least one member who is a physician with |
|
clinical practice experience in geriatric medicine; |
|
(5) at least three members who are or who represent a |
|
health care provider that primarily provides long-term services and |
|
supports; and |
|
(6) at least one member who is a consumer |
|
representative[; and
|
|
[(7)
at least one member who is a member of the
|
|
Advisory Panel on Health Care-Associated Infections and
|
|
Preventable Adverse Events who meets the qualifications prescribed
|
|
by Section 98.052(a)(4), Health and Safety Code]. |
|
(c) The heading to Subchapter C, Chapter 98, Health and |
|
Safety Code, is amended to read as follows: |
|
SUBCHAPTER C. DUTIES OF DEPARTMENT [AND ADVISORY PANEL]; REPORTING |
|
SYSTEM |
|
(d) Section 98.1045(b), Health and Safety Code, is amended |
|
to read as follows: |
|
(b) The executive commissioner may exclude an adverse event |
|
described by Subsection (a)(2) from the reporting requirement of |
|
Subsection (a) if the executive commissioner [, in consultation
|
|
with the advisory panel,] determines that the adverse event is not |
|
an appropriate indicator of a preventable adverse event. |
|
(e) Section 98.105, Health and Safety Code, is amended to |
|
read as follows: |
|
Sec. 98.105. REPORTING SYSTEM MODIFICATIONS. The [Based on
|
|
the recommendations of the advisory panel, the] executive |
|
commissioner by rule may modify in accordance with this chapter the |
|
list of procedures that are reportable under Section 98.103. The |
|
modifications must be based on changes in reporting guidelines and |
|
in definitions established by the federal Centers for Disease |
|
Control and Prevention. |
|
(f) Section 98.106(c), Health and Safety Code, is amended to |
|
read as follows: |
|
(c) The [In consultation with the advisory panel, the] |
|
department shall publish the departmental summary in a format that |
|
is easy to read. |
|
(g) Section 98.108(a), Health and Safety Code, is amended to |
|
read as follows: |
|
(a) The [In consultation with the advisory panel, the] |
|
executive commissioner by rule shall establish the frequency of |
|
reporting by health care facilities required under Sections 98.103 |
|
and 98.1045. |
|
(h) The following provisions are repealed: |
|
(1) Sections 98.001(1) and 98.002, Health and Safety |
|
Code; and |
|
(2) Subchapter B, Chapter 98, Health and Safety Code. |
|
SECTION 1.10. (a) The Youth Camp Training Advisory |
|
Committee is abolished. |
|
(b) Section 141.0095(d), Health and Safety Code, as amended |
|
by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
amended to read as follows: |
|
(d) In accordance with this section [and the criteria and
|
|
guidelines developed by the training advisory committee
|
|
established under Section 141.0096], the executive commissioner by |
|
rule shall establish criteria and guidelines for training and |
|
examination programs on sexual abuse and child molestation. The |
|
department may approve training and examination programs offered by |
|
trainers under contract with youth camps or by online training |
|
organizations or may approve programs offered in another format |
|
authorized by the department. |
|
(c) Section 141.0096, Health and Safety Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 1.11. (a) The Drug Demand Reduction Advisory |
|
Committee is abolished. |
|
(b) Subchapter F, Chapter 461A, Health and Safety Code, as |
|
added by S.B. No. 219, Acts of the 84th Legislature, Regular |
|
Session, 2015, is repealed. |
|
(c) Section 7.030, Education Code, is repealed. |
|
SECTION 1.12. (a) The Texas Medical Child Abuse Resources |
|
and Education System (MEDCARES) Advisory Committee is abolished. |
|
(b) Section 1001.155, Health and Safety Code, as added by |
|
Chapter 1238 (S.B. 2080), Acts of the 81st Legislature, Regular |
|
Session, 2009, is reenacted and amended to read as follows: |
|
Sec. 1001.155. REQUIRED REPORT. Not later than December 1 |
|
of each even-numbered year, the department [, with the assistance
|
|
of the advisory committee established under this subchapter,] shall |
|
submit a report to the governor and the legislature regarding the |
|
grant activities of the program and grant recipients, including the |
|
results and outcomes of grants provided under this subchapter. |
|
(c) Section 1001.153, Health and Safety Code, as added by |
|
Chapter 1238 (S.B. 2080), Acts of the 81st Legislature, Regular |
|
Session, 2009, is repealed. |
|
ARTICLE 2. CHANGES TO ENTITIES EFFECTIVE JANUARY 1, 2016 |
|
SECTION 2.01. Section 262.353(d), Family Code, is amended |
|
to read as follows: |
|
(d) Not later than September 30, 2014, the department and |
|
the Department of State Health Services shall file a report with the |
|
legislature [and the Council on Children and Families] on the |
|
results of the study required by Subsection (a). The report must |
|
include: |
|
(1) each option to prevent relinquishment of parental |
|
custody that was considered during the study; |
|
(2) each option recommended for implementation, if |
|
any; |
|
(3) each option that is implemented using existing |
|
resources; |
|
(4) any policy or statutory change needed to implement |
|
a recommended option; |
|
(5) the fiscal impact of implementing each option, if |
|
any; |
|
(6) the estimated number of children and families that |
|
may be affected by the implementation of each option; and |
|
(7) any other significant information relating to the |
|
study. |
|
SECTION 2.02. (a) Section 531.012, Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
Sec. 531.012. ADVISORY COMMITTEES. (a) The executive |
|
commissioner shall establish and maintain [may appoint] advisory |
|
committees to consider issues and solicit public input across all |
|
major areas of the health and human services system, including |
|
relating to the following issues: |
|
(1) Medicaid and other social services programs; |
|
(2) managed care under Medicaid and the child health |
|
plan program; |
|
(3) health care quality initiatives; |
|
(4) aging; |
|
(5) persons with disabilities, including persons with |
|
autism; |
|
(6) rehabilitation, including for persons with brain |
|
injuries; |
|
(7) children; |
|
(8) public health; |
|
(9) behavioral health; |
|
(10) regulatory matters; |
|
(11) protective services; and |
|
(12) prevention efforts. |
|
(b) Chapter 2110 applies to an advisory committee |
|
established under this section. |
|
(c) The executive commissioner shall adopt rules: |
|
(1) in compliance with Chapter 2110 to govern an |
|
advisory committee's purpose, tasks, reporting requirements, and |
|
date of abolition; and |
|
(2) related to an advisory committee's: |
|
(A) size and quorum requirements; |
|
(B) membership, including: |
|
(i) qualifications to be a member, |
|
including any experience requirements; |
|
(ii) required geographic representation; |
|
(iii) appointment procedures; and |
|
(iv) terms of members; and |
|
(C) duty to comply with the requirements for open |
|
meetings under Chapter 551. |
|
(d) An advisory committee established under this section |
|
shall: |
|
(1) report any recommendations to the executive |
|
commissioner; and |
|
(2) submit a written report to the legislature of any |
|
policy recommendations made to the executive commissioner under |
|
Subdivision (1) [as needed]. |
|
(b) Not later than March 1, 2016, the executive commissioner |
|
of the Health and Human Services Commission shall adopt rules under |
|
Section 531.012, Government Code, as amended by this article. This |
|
subsection takes effect September 1, 2015. |
|
SECTION 2.03. Subchapter A, Chapter 531, Government Code, |
|
is amended by adding Section 531.0121 to read as follows: |
|
Sec. 531.0121. PUBLIC ACCESS TO ADVISORY COMMITTEE |
|
MEETINGS. (a) This section applies to an advisory committee |
|
established under Section 531.012. |
|
(b) The commission shall create a master calendar that |
|
includes all advisory committee meetings across the health and |
|
human services system. |
|
(c) The commission shall make available on the commission's |
|
Internet website: |
|
(1) the master calendar; |
|
(2) all meeting materials for an advisory committee |
|
meeting; and |
|
(3) streaming live video of each advisory committee |
|
meeting. |
|
(d) The commission shall provide Internet access in each |
|
room used for a meeting that appears on the master calendar. |
|
SECTION 2.04. Section 531.0216(b), Government Code, is |
|
amended to read as follows: |
|
(b) In developing the system, the executive commissioner by |
|
rule shall: |
|
(1) review programs and pilot projects in other states |
|
to determine the most effective method for reimbursement; |
|
(2) establish billing codes and a fee schedule for |
|
services; |
|
(3) provide for an approval process before a provider |
|
can receive reimbursement for services; |
|
(4) consult with the Department of State Health |
|
Services [and the telemedicine and telehealth advisory committee] |
|
to establish procedures to: |
|
(A) identify clinical evidence supporting |
|
delivery of health care services using a telecommunications system; |
|
and |
|
(B) annually review health care services, |
|
considering new clinical findings, to determine whether |
|
reimbursement for particular services should be denied or |
|
authorized; |
|
(5) establish a separate provider identifier for |
|
telemedicine medical services providers, telehealth services |
|
providers, and home telemonitoring services providers; and |
|
(6) establish a separate modifier for telemedicine |
|
medical services, telehealth services, and home telemonitoring |
|
services eligible for reimbursement. |
|
SECTION 2.05. Section 531.02441(j), Government Code, is |
|
amended to read as follows: |
|
(j) The task force is abolished and this [This] section |
|
expires September 1, 2017. |
|
SECTION 2.06. Section 531.051(c), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(c) In adopting rules for the consumer direction models, the |
|
executive commissioner shall: |
|
(1) [with assistance from the work group established
|
|
under Section 531.052,] determine which services are appropriate |
|
and suitable for delivery through consumer direction; |
|
(2) ensure that each consumer direction model is |
|
designed to comply with applicable federal and state laws; |
|
(3) maintain procedures to ensure that a potential |
|
consumer or the consumer's legally authorized representative has |
|
adequate and appropriate information, including the |
|
responsibilities of a consumer or representative under each service |
|
delivery option, to make an informed choice among the types of |
|
consumer direction models; |
|
(4) require each consumer or the consumer's legally |
|
authorized representative to sign a statement acknowledging |
|
receipt of the information required by Subdivision (3); |
|
(5) maintain procedures to monitor delivery of |
|
services through consumer direction to ensure: |
|
(A) adherence to existing applicable program |
|
standards; |
|
(B) appropriate use of funds; and |
|
(C) consumer satisfaction with the delivery of |
|
services; |
|
(6) ensure that authorized program services that are |
|
not being delivered to a consumer through consumer direction are |
|
provided by a provider agency chosen by the consumer or the |
|
consumer's legally authorized representative; and |
|
(7) [work in conjunction with the work group
|
|
established under Section 531.052 to] set a timetable to complete |
|
the implementation of the consumer direction models. |
|
SECTION 2.07. Section 531.067, Government Code, as amended |
|
by S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
amended to read as follows: |
|
Sec. 531.067. PROGRAM TO IMPROVE AND MONITOR CERTAIN |
|
OUTCOMES OF RECIPIENTS UNDER CHILD HEALTH PLAN PROGRAM AND MEDICAID |
|
[PUBLIC ASSISTANCE HEALTH BENEFIT REVIEW AND DESIGN COMMITTEE]. |
|
The [(a)
The commission shall appoint a Public Assistance Health
|
|
Benefit Review and Design Committee. The committee consists of
|
|
nine representatives of health care providers participating in
|
|
Medicaid or the child health plan program, or both. The committee
|
|
membership must include at least three representatives from each
|
|
program.
|
|
[(b)
The executive commissioner shall designate one member
|
|
to serve as presiding officer for a term of two years.
|
|
[(c)
The committee shall meet at the call of the presiding
|
|
officer.
|
|
[(d)
The committee shall review and provide recommendations
|
|
to the commission regarding health benefits and coverages provided
|
|
under Medicaid, the child health plan program, and any other
|
|
income-based health care program administered by the commission or
|
|
a health and human services agency. In performing its duties under
|
|
this subsection, the committee must:
|
|
[(1)
review benefits provided under each of the
|
|
programs; and
|
|
[(2)
review procedures for addressing high
|
|
utilization of benefits by recipients.
|
|
[(e)
The commission shall provide administrative support
|
|
and resources as necessary for the committee to perform its duties
|
|
under this section.
|
|
[(f) Section 2110.008 does not apply to the committee.
|
|
[(g) In performing the duties under this section, the] |
|
commission may design and implement a program to improve and |
|
monitor clinical and functional outcomes of a recipient of services |
|
under Medicaid or the state child health plan program. The program |
|
may use financial, clinical, and other criteria based on pharmacy, |
|
medical services, and other claims data related to Medicaid or the |
|
child health plan program. [The commission must report to the
|
|
committee on the fiscal impact, including any savings associated
|
|
with the strategies utilized under this section.] |
|
SECTION 2.08. (a) Section 531.0691, Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is redesignated as Section 531.0735, Government Code, to read |
|
as follows: |
|
Sec. 531.0735 [531.0691]. MEDICAID DRUG UTILIZATION REVIEW |
|
PROGRAM: DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section: |
|
(1) "Medicaid Drug Utilization Review Program" means |
|
the program operated by the vendor drug program to improve the |
|
quality of pharmaceutical care under Medicaid. |
|
(2) "Prospective drug use review" means the review of |
|
a patient's drug therapy and prescription drug order or medication |
|
order before dispensing or distributing a drug to the patient. |
|
(3) "Retrospective drug use review" means the review |
|
of prescription drug claims data to identify patterns of |
|
prescribing. |
|
(b) The commission shall provide for an increase in the |
|
number and types of retrospective drug use reviews performed each |
|
year under the Medicaid Drug Utilization Review Program, in |
|
comparison to the number and types of reviews performed in the state |
|
fiscal year ending August 31, 2009. |
|
(c) In determining the number and types of drug use reviews |
|
to be performed, the commission shall: |
|
(1) allow for the repeat of retrospective drug use |
|
reviews that address ongoing drug therapy problems and that, in |
|
previous years, improved client outcomes and reduced Medicaid |
|
spending; |
|
(2) consider implementing disease-specific |
|
retrospective drug use reviews that address ongoing drug therapy |
|
problems in this state and that reduced Medicaid prescription drug |
|
use expenditures in other states; and |
|
(3) regularly examine Medicaid prescription drug |
|
claims data to identify occurrences of potential drug therapy |
|
problems that may be addressed by repeating successful |
|
retrospective drug use reviews performed in this state and other |
|
states. |
|
(d) In addition to any other information required by federal |
|
law, the commission shall include the following information in the |
|
annual report regarding the Medicaid Drug Utilization Review |
|
Program: |
|
(1) a detailed description of the program's |
|
activities; and |
|
(2) estimates of cost savings anticipated to result |
|
from the program's performance of prospective and retrospective |
|
drug use reviews. |
|
(e) The cost-saving estimates for prospective drug use |
|
reviews under Subsection (d) must include savings attributed to |
|
drug use reviews performed through the vendor drug program's |
|
electronic claims processing system and clinical edits screened |
|
through the prior authorization system implemented under Section |
|
531.073. |
|
(f) The commission shall post the annual report regarding |
|
the Medicaid Drug Utilization Review Program on the commission's |
|
website. |
|
(b) Subchapter B, Chapter 531, Government Code, is amended |
|
by adding Section 531.0736 to read as follows: |
|
Sec. 531.0736. DRUG UTILIZATION REVIEW BOARD. (a) In this |
|
section, "board" means the Drug Utilization Review Board. |
|
(b) In addition to performing any other duties required by |
|
federal law, the board shall: |
|
(1) develop and submit to the commission |
|
recommendations for preferred drug lists adopted by the commission |
|
under Section 531.072; |
|
(2) suggest to the commission restrictions or clinical |
|
edits on prescription drugs; |
|
(3) recommend to the commission educational |
|
interventions for Medicaid providers; |
|
(4) review drug utilization across Medicaid; and |
|
(5) perform other duties that may be specified by law |
|
and otherwise make recommendations to the commission. |
|
(c) The executive commissioner shall determine the |
|
composition of the board, which must: |
|
(1) comply with applicable federal law, including 42 |
|
C.F.R. Section 456.716; |
|
(2) include two representatives of managed care |
|
organizations as nonvoting members, one of whom must be a physician |
|
and one of whom must be a pharmacist; |
|
(3) include at least 17 physicians and pharmacists |
|
who: |
|
(A) provide services across the entire |
|
population of Medicaid recipients and represent different |
|
specialties, including at least one of each of the following types |
|
of physicians: |
|
(i) a pediatrician; |
|
(ii) a primary care physician; |
|
(iii) an obstetrician and gynecologist; |
|
(iv) a child and adolescent psychiatrist; |
|
and |
|
(v) an adult psychiatrist; and |
|
(B) have experience in either developing or |
|
practicing under a preferred drug list; and |
|
(4) include a consumer advocate who represents |
|
Medicaid recipients. |
|
(c-1) The executive commissioner by rule shall develop and |
|
implement a process by which a person may apply to become a member |
|
of the board and shall post the application and information |
|
regarding the application process on the commission's Internet |
|
website. |
|
(d) Members appointed under Subsection (c)(2) may attend |
|
quarterly and other regularly scheduled meetings, but may not: |
|
(1) attend executive sessions; or |
|
(2) access confidential drug pricing information. |
|
(e) Members of the board serve staggered four-year terms. |
|
(f) The voting members of the board shall elect from among |
|
the voting members a presiding officer. The presiding officer must |
|
be a physician. |
|
(g) The board shall hold a public meeting quarterly at the |
|
call of the presiding officer and shall permit public comment |
|
before voting on any changes in the preferred drug lists, the |
|
adoption of or changes to drug use criteria, or the adoption of |
|
prior authorization or drug utilization review proposals. The |
|
board shall hold public meetings at other times at the call of the |
|
presiding officer. Minutes of each meeting shall be made available |
|
to the public not later than the 10th business day after the date |
|
the minutes are approved. The board may meet in executive session |
|
to discuss confidential information as described by Subsection (i). |
|
(h) In developing its recommendations for the preferred |
|
drug lists, the board shall consider the clinical efficacy, safety, |
|
and cost-effectiveness of and any program benefit associated with a |
|
product. |
|
(i) The executive commissioner shall adopt rules governing |
|
the operation of the board, including rules governing the |
|
procedures used by the board for providing notice of a meeting and |
|
rules prohibiting the board from discussing confidential |
|
information described by Section 531.071 in a public meeting. The |
|
board shall comply with the rules adopted under this subsection and |
|
Subsection (j). |
|
(j) In addition to the rules under Subsection (i), the |
|
executive commissioner by rule shall require the board or the |
|
board's designee to present a summary of any clinical efficacy and |
|
safety information or analyses regarding a drug under consideration |
|
for a preferred drug list that is provided to the board by a private |
|
entity that has contracted with the commission to provide the |
|
information. The board or the board's designee shall provide the |
|
summary in electronic form before the public meeting at which |
|
consideration of the drug occurs. Confidential information |
|
described by Section 531.071 must be omitted from the summary. The |
|
summary must be posted on the commission's Internet website. |
|
(k) To the extent feasible, the board shall review all drug |
|
classes included in the preferred drug lists adopted under Section |
|
531.072 at least once every 12 months and may recommend inclusions |
|
to and exclusions from the lists to ensure that the lists provide |
|
for a range of clinically effective, safe, cost-effective, and |
|
medically appropriate drug therapies for the diverse segments of |
|
the Medicaid population, children receiving health benefits |
|
coverage under the child health plan program, and any other |
|
affected individuals. |
|
(l) The commission shall provide administrative support and |
|
resources as necessary for the board to perform its duties. |
|
(m) Chapter 2110 does not apply to the board. |
|
(n) The commission or the commission's agent shall publicly |
|
disclose, immediately after the board's deliberations conclude, |
|
each specific drug recommended for or against preferred drug list |
|
status for each drug class included in the preferred drug list for |
|
the Medicaid vendor drug program. The disclosure must be posted on |
|
the commission's Internet website not later than the 10th business |
|
day after the date of conclusion of board deliberations that result |
|
in recommendations made to the executive commissioner regarding the |
|
placement of drugs on the preferred drug list. The public |
|
disclosure must include: |
|
(1) the general basis for the recommendation for each |
|
drug class; and |
|
(2) for each recommendation, whether a supplemental |
|
rebate agreement or a program benefit agreement was reached under |
|
Section 531.070. |
|
(c) Section 531.0692, Government Code, is redesignated as |
|
Section 531.0737, Government Code, and amended to read as follows: |
|
Sec. 531.0737 [531.0692]. [MEDICAID] DRUG UTILIZATION |
|
REVIEW BOARD: CONFLICTS OF INTEREST. (a) A voting member of the |
|
[board of the Medicaid] Drug Utilization Review Board [Program] may |
|
not have a contractual relationship, ownership interest, or other |
|
conflict of interest with a pharmaceutical manufacturer or labeler |
|
or with an entity engaged by the commission to assist in the |
|
development of the preferred drug lists or in the administration of |
|
the Medicaid Drug Utilization Review Program. |
|
(b) The executive commissioner may implement this section |
|
by adopting rules that identify prohibited relationships and |
|
conflicts or requiring the board to develop a conflict-of-interest |
|
policy that applies to the board. |
|
(d) Sections 531.072(c) and (e), Government Code, are |
|
amended to read as follows: |
|
(c) In making a decision regarding the placement of a drug |
|
on each of the preferred drug lists, the commission shall consider: |
|
(1) the recommendations of the Drug Utilization Review |
|
Board [Pharmaceutical and Therapeutics Committee established] |
|
under Section 531.0736 [531.074]; |
|
(2) the clinical efficacy of the drug; |
|
(3) the price of competing drugs after deducting any |
|
federal and state rebate amounts; and |
|
(4) program benefit offerings solely or in conjunction |
|
with rebates and other pricing information. |
|
(e) In this subsection, "labeler" and "manufacturer" have |
|
the meanings assigned by Section 531.070. The commission shall |
|
ensure that: |
|
(1) a manufacturer or labeler may submit written |
|
evidence supporting the inclusion of a drug on the preferred drug |
|
lists before a supplemental agreement is reached with the |
|
commission; and |
|
(2) any drug that has been approved or has had any of |
|
its particular uses approved by the United States Food and Drug |
|
Administration under a priority review classification will be |
|
reviewed by the Drug Utilization Review Board [Pharmaceutical and
|
|
Therapeutics Committee] at the next regularly scheduled meeting of |
|
the board [committee]. On receiving notice from a manufacturer or |
|
labeler of the availability of a new product, the commission, to the |
|
extent possible, shall schedule a review for the product at the next |
|
regularly scheduled meeting of the board [committee]. |
|
(e) Section 531.073(b), Government Code, is amended to read |
|
as follows: |
|
(b) The commission shall establish procedures for the prior |
|
authorization requirement under the Medicaid vendor drug program to |
|
ensure that the requirements of 42 U.S.C. Section 1396r-8(d)(5) and |
|
its subsequent amendments are met. Specifically, the procedures |
|
must ensure that: |
|
(1) a prior authorization requirement is not imposed |
|
for a drug before the drug has been considered at a meeting of the |
|
Drug Utilization Review Board [Pharmaceutical and Therapeutics
|
|
Committee established] under Section 531.0736 [531.074]; |
|
(2) there will be a response to a request for prior |
|
authorization by telephone or other telecommunications device |
|
within 24 hours after receipt of a request for prior authorization; |
|
and |
|
(3) a 72-hour supply of the drug prescribed will be |
|
provided in an emergency or if the commission does not provide a |
|
response within the time required by Subdivision (2). |
|
(f) Section 531.0741, Government Code, is amended to read as |
|
follows: |
|
Sec. 531.0741. PUBLICATION OF INFORMATION REGARDING |
|
COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT. The |
|
commission shall publish on the commission's Internet website any |
|
decisions on preferred drug list placement, including: |
|
(1) a list of drugs reviewed and the commission's |
|
decision for or against placement on a preferred drug list of each |
|
drug reviewed; |
|
(2) for each recommendation, whether a supplemental |
|
rebate agreement or a program benefit agreement was reached under |
|
Section 531.070; and |
|
(3) the rationale for any departure from a |
|
recommendation of the Drug Utilization Review Board |
|
[pharmaceutical and therapeutics committee established] under |
|
Section 531.0736 [531.074]. |
|
(g) Section 531.074, Government Code, as amended by S.B. |
|
219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
(h) The term of a member serving on the Medicaid Drug |
|
Utilization Review Board on January 1, 2016, expires on February |
|
29, 2016. Not later than March 1, 2016, the executive commissioner |
|
of the Health and Human Services Commission shall appoint the |
|
initial members to the Drug Utilization Review Board in accordance |
|
with Section 531.0736, Government Code, as added by this article, |
|
for terms beginning March 1, 2016. In making the initial |
|
appointments and notwithstanding Section 531.0736(e), Government |
|
Code, as added by this article, the executive commissioner shall |
|
designate as close to one-half as possible of the members to serve |
|
for terms expiring March 1, 2018, and the remaining members to serve |
|
for terms expiring March 1, 2020. |
|
(i) Not later than February 1, 2016, and before making |
|
initial appointments to the Drug Utilization Review Board as |
|
provided by Subsection (h) of this section, the executive |
|
commissioner of the Health and Human Services Commission shall |
|
adopt and implement the application process required under Section |
|
531.0736(c-1), Government Code, as added by this article. |
|
(j) Not later than May 1, 2016, and except as provided by |
|
Subsection (i) of this section, the executive commissioner of the |
|
Health and Human Services Commission shall adopt or amend rules as |
|
necessary to reflect the changes in law made to the Drug Utilization |
|
Review Board under Section 531.0736, Government Code, as added by |
|
this article, including rules that reflect the changes to the |
|
board's functions and composition. |
|
SECTION 2.09. The heading to Subchapter D, Chapter 531, |
|
Government Code, is amended to read as follows: |
|
SUBCHAPTER D. PLAN TO SUPPORT GUARDIANSHIPS [GUARDIANSHIP ADVISORY
|
|
BOARD] |
|
SECTION 2.10. Section 531.124, Government Code, is amended |
|
to read as follows: |
|
Sec. 531.124. COMMISSION DUTIES. The [(a)
With the advice
|
|
of the advisory board, the] commission shall develop and, subject |
|
to appropriations, implement a plan to: |
|
(1) ensure that each incapacitated individual in this |
|
state who needs a guardianship or another less restrictive type of |
|
assistance to make decisions concerning the incapacitated |
|
individual's own welfare and financial affairs receives that |
|
assistance; and |
|
(2) foster the establishment and growth of local |
|
volunteer guardianship programs. |
|
[(b)
The advisory board shall biennially review and comment
|
|
on the minimum standards adopted under Section 111.041 and the plan
|
|
implemented under Subsection (a) and shall include its conclusions
|
|
in the report submitted under Section 531.1235.] |
|
SECTION 2.11. Section 531.907(a), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(a) Based on [the recommendations of the advisory committee
|
|
established under Section 531.904 and] feedback provided by |
|
interested parties, the commission in stage two of implementing the |
|
health information exchange system may expand the system by: |
|
(1) providing an electronic health record for each |
|
child enrolled in the child health plan program; |
|
(2) including state laboratory results information in |
|
an electronic health record, including the results of newborn |
|
screenings and tests conducted under the Texas Health Steps |
|
program, based on the system developed for the health passport |
|
under Section 266.006, Family Code; |
|
(3) improving data-gathering capabilities for an |
|
electronic health record so that the record may include basic |
|
health and clinical information in addition to available claims |
|
information, as determined by the executive commissioner; |
|
(4) using evidence-based technology tools to create a |
|
unique health profile to alert health care providers regarding the |
|
need for additional care, education, counseling, or health |
|
management activities for specific patients; and |
|
(5) continuing to enhance the electronic health record |
|
created for each Medicaid recipient as technology becomes available |
|
and interoperability capabilities improve. |
|
SECTION 2.12. Section 531.909, Government Code, is amended |
|
to read as follows: |
|
Sec. 531.909. INCENTIVES. The commission [and the advisory
|
|
committee established under Section 531.904] shall develop |
|
strategies to encourage health care providers to use the health |
|
information exchange system, including incentives, education, and |
|
outreach tools to increase usage. |
|
SECTION 2.13. Section 533.00251(c), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(c) Subject to Section 533.0025 and notwithstanding any |
|
other law, the commission[, in consultation with the advisory
|
|
committee,] shall provide benefits under Medicaid to recipients who |
|
reside in nursing facilities through the STAR + PLUS Medicaid |
|
managed care program. In implementing this subsection, the |
|
commission shall ensure: |
|
(1) that the commission is responsible for setting the |
|
minimum reimbursement rate paid to a nursing facility under the |
|
managed care program, including the staff rate enhancement paid to |
|
a nursing facility that qualifies for the enhancement; |
|
(2) that a nursing facility is paid not later than the |
|
10th day after the date the facility submits a clean claim; |
|
(3) the appropriate utilization of services |
|
consistent with criteria established by the commission; |
|
(4) a reduction in the incidence of potentially |
|
preventable events and unnecessary institutionalizations; |
|
(5) that a managed care organization providing |
|
services under the managed care program provides discharge |
|
planning, transitional care, and other education programs to |
|
physicians and hospitals regarding all available long-term care |
|
settings; |
|
(6) that a managed care organization providing |
|
services under the managed care program: |
|
(A) assists in collecting applied income from |
|
recipients; and |
|
(B) provides payment incentives to nursing |
|
facility providers that reward reductions in preventable acute care |
|
costs and encourage transformative efforts in the delivery of |
|
nursing facility services, including efforts to promote a |
|
resident-centered care culture through facility design and |
|
services provided; |
|
(7) the establishment of a portal that is in |
|
compliance with state and federal regulations, including standard |
|
coding requirements, through which nursing facility providers |
|
participating in the STAR + PLUS Medicaid managed care program may |
|
submit claims to any participating managed care organization; |
|
(8) that rules and procedures relating to the |
|
certification and decertification of nursing facility beds under |
|
Medicaid are not affected; and |
|
(9) that a managed care organization providing |
|
services under the managed care program, to the greatest extent |
|
possible, offers nursing facility providers access to: |
|
(A) acute care professionals; and |
|
(B) telemedicine, when feasible and in |
|
accordance with state law, including rules adopted by the Texas |
|
Medical Board. |
|
SECTION 2.14. Section 533.00253, Government Code, is |
|
amended by amending Subsection (b), as amended by S.B. 219, Acts of |
|
the 84th Legislature, Regular Session, 2015, and Subsection (f) to |
|
read as follows: |
|
(b) Subject to Section 533.0025, the commission shall, in |
|
consultation with the [advisory committee and the] Children's |
|
Policy Council established under Section 22.035, Human Resources |
|
Code, establish a mandatory STAR Kids capitated managed care |
|
program tailored to provide Medicaid benefits to children with |
|
disabilities. The managed care program developed under this |
|
section must: |
|
(1) provide Medicaid benefits that are customized to |
|
meet the health care needs of recipients under the program through a |
|
defined system of care; |
|
(2) better coordinate care of recipients under the |
|
program; |
|
(3) improve the health outcomes of recipients; |
|
(4) improve recipients' access to health care |
|
services; |
|
(5) achieve cost containment and cost efficiency; |
|
(6) reduce the administrative complexity of |
|
delivering Medicaid benefits; |
|
(7) reduce the incidence of unnecessary |
|
institutionalizations and potentially preventable events by |
|
ensuring the availability of appropriate services and care |
|
management; |
|
(8) require a health home; and |
|
(9) coordinate and collaborate with long-term care |
|
service providers and long-term care management providers, if |
|
recipients are receiving long-term services and supports outside of |
|
the managed care organization. |
|
(f) The commission shall seek ongoing input from the |
|
Children's Policy Council regarding the establishment and |
|
implementation of the STAR Kids managed care program. This |
|
subsection expires on the date the Children's Policy Council is |
|
abolished under Section 22.035(n), Human Resources Code. |
|
SECTION 2.15. Section 533.00254(f), Government Code, is |
|
amended to read as follows: |
|
(f) On the first anniversary of the date the commission |
|
completes implementation of the STAR Kids Medicaid managed care |
|
program under Section 533.00253 [September 1, 2016]: |
|
(1) the advisory committee is abolished; and |
|
(2) this section expires. |
|
SECTION 2.16. Section 533.00256(a), Government Code, is |
|
amended to read as follows: |
|
(a) In consultation with [the Medicaid and CHIP
|
|
Quality-Based Payment Advisory Committee established under Section
|
|
536.002 and other] 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. |
|
SECTION 2.17. Section 534.053(g), Government Code, is |
|
amended to read as follows: |
|
(g) On the one-year anniversary of the date the commission |
|
completes implementation of the transition required under Section |
|
534.202 [January 1, 2024]: |
|
(1) the advisory committee is abolished; and |
|
(2) this section expires. |
|
SECTION 2.18. Section 535.053, Government Code, is amended |
|
by amending Subsection (a) and adding Subsection (a-1) to read as |
|
follows: |
|
(a) The interagency coordinating group for faith- and |
|
community-based initiatives is composed of each faith- and |
|
community-based liaison designated under Section 535.051 and a |
|
liaison from the State Commission on National and Community |
|
Service. [The commission shall provide administrative support to
|
|
the interagency coordinating group.] |
|
(a-1) Service on the interagency coordinating group is an |
|
additional duty of the office or position held by each person |
|
designated as a liaison under Section 531.051(b). The state |
|
agencies described by Section 535.051(b) shall provide |
|
administrative support for the interagency coordinating group as |
|
coordinated by the presiding officer. |
|
SECTION 2.19. Sections 535.055(a) and (b), Government Code, |
|
are amended to read as follows: |
|
(a) The Texas Nonprofit Council is established to help |
|
direct the interagency coordinating group in carrying out the |
|
group's duties under this section. The state agencies of the |
|
interagency coordinating group described by Section 531.051(b) |
|
[commission] shall provide administrative support to the council as |
|
coordinated by the presiding officer of the interagency |
|
coordinating group. |
|
(b) The governor [executive commissioner], in consultation |
|
with the presiding officer of the interagency coordinating group, |
|
shall appoint as members of the council two representatives from |
|
each of the following groups and entities to represent each group's |
|
and entity's appropriate sector: |
|
(1) statewide nonprofit organizations; |
|
(2) local governments; |
|
(3) faith-based groups, at least one of which must be a |
|
statewide interfaith group; |
|
(4) community-based groups; |
|
(5) consultants to nonprofit corporations; and |
|
(6) statewide associations of nonprofit |
|
organizations. |
|
SECTION 2.20. Section 535.104(a), Government Code, is |
|
amended to read as follows: |
|
(a) The commission shall: |
|
(1) contract with the State Commission on National and |
|
Community Service to administer funds appropriated from the account |
|
in a manner that: |
|
(A) consolidates the capacity of and strengthens |
|
national service and community and faith- and community-based |
|
initiatives; and |
|
(B) leverages public and private funds to benefit |
|
this state; |
|
(2) develop a competitive process to be used in |
|
awarding grants from account funds that is consistent with state |
|
law and includes objective selection criteria; |
|
(3) oversee the delivery of training and other |
|
assistance activities under this subchapter; |
|
(4) develop criteria limiting awards of grants under |
|
Section 535.105(1)(A) to small and medium-sized faith- and |
|
community-based organizations that provide charitable services to |
|
persons in this state; |
|
(5) establish general state priorities for the |
|
account; |
|
(6) establish and monitor performance and outcome |
|
measures for persons to whom grants are awarded under this |
|
subchapter; and |
|
(7) establish policies and procedures to ensure that |
|
any money appropriated from the account to the commission that is |
|
allocated to build the capacity of a faith-based organization or |
|
for a faith-based initiative[, including money allocated for the
|
|
establishment of the advisory committee under Section 535.108,] is |
|
not used to advance a sectarian purpose or to engage in any form of |
|
proselytization. |
|
SECTION 2.21. Section 536.001(20), Government Code, is |
|
amended to read as follows: |
|
(20) "Potentially preventable readmission" means a |
|
return hospitalization of a person within a period specified by the |
|
commission that may have resulted from deficiencies in the care or |
|
treatment provided to the person during a previous hospital stay or |
|
from deficiencies in post-hospital discharge follow-up. The term |
|
does not include a hospital readmission necessitated by the |
|
occurrence of unrelated events after the discharge. The term |
|
includes the readmission of a person to a hospital for: |
|
(A) the same condition or procedure for which the |
|
person was previously admitted; |
|
(B) an infection or other complication resulting |
|
from care previously provided; |
|
(C) a condition or procedure that indicates that |
|
a surgical intervention performed during a previous admission was |
|
unsuccessful in achieving the anticipated outcome; or |
|
(D) another condition or procedure of a similar |
|
nature, as determined by the executive commissioner [after
|
|
consulting with the advisory committee]. |
|
SECTION 2.22. Section 536.003(a), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(a) The commission[, in consultation with the advisory
|
|
committee,] shall develop quality-based outcome and process |
|
measures that promote the provision of efficient, quality health |
|
care and that can be used in the child health plan program and |
|
Medicaid to implement quality-based payments for acute care |
|
services and long-term services and supports across all delivery |
|
models and payment systems, including fee-for-service and managed |
|
care payment systems. Subject to Subsection (a-1), the commission, |
|
in developing outcome and process measures under this section, must |
|
include measures that are based on potentially preventable events |
|
and that advance quality improvement and innovation. The |
|
commission may change measures developed: |
|
(1) to promote continuous system reform, improved |
|
quality, and reduced costs; and |
|
(2) to account for managed care organizations added to |
|
a service area. |
|
SECTION 2.23. Section 536.004(a), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(a) Using quality-based outcome and process measures |
|
developed under Section 536.003 and subject to this section, the |
|
commission, after consulting with [the advisory committee and
|
|
other] appropriate stakeholders with an interest in the provision |
|
of acute care and long-term services and supports under the child |
|
health plan program and Medicaid, shall develop quality-based |
|
payment systems, and require managed care organizations to develop |
|
quality-based payment systems, for compensating a physician or |
|
other health care provider participating in the child health plan |
|
program or Medicaid that: |
|
(1) align payment incentives with high-quality, |
|
cost-effective health care; |
|
(2) reward the use of evidence-based best practices; |
|
(3) promote the coordination of health care; |
|
(4) encourage appropriate physician and other health |
|
care provider collaboration; |
|
(5) promote effective health care delivery models; and |
|
(6) take into account the specific needs of the child |
|
health plan program enrollee and Medicaid recipient populations. |
|
SECTION 2.24. Section 536.006(a), Government Code, is |
|
amended to read as follows: |
|
(a) The commission [and the advisory committee] shall: |
|
(1) ensure transparency in the development and |
|
establishment of: |
|
(A) quality-based payment and reimbursement |
|
systems under Section 536.004 and Subchapters B, C, and D, |
|
including the development of outcome and process measures under |
|
Section 536.003; and |
|
(B) quality-based payment initiatives under |
|
Subchapter E, including the development of quality of care and |
|
cost-efficiency benchmarks under Section 536.204(a) and efficiency |
|
performance standards under Section 536.204(b); |
|
(2) develop guidelines establishing procedures for |
|
providing notice and information to, and receiving input from, |
|
managed care organizations, health care providers, including |
|
physicians and experts in the various medical specialty fields, and |
|
other stakeholders, as appropriate, for purposes of developing and |
|
establishing the quality-based payment and reimbursement systems |
|
and initiatives described under Subdivision (1); |
|
(3) in developing and establishing the quality-based |
|
payment and reimbursement systems and initiatives described under |
|
Subdivision (1), consider that as the performance of a managed care |
|
organization or physician or other health care provider improves |
|
with respect to an outcome or process measure, quality of care and |
|
cost-efficiency benchmark, or efficiency performance standard, as |
|
applicable, there will be a diminishing rate of improved |
|
performance over time; and |
|
(4) develop web-based capability to provide managed |
|
care organizations and health care providers with data on their |
|
clinical and utilization performance, including comparisons to |
|
peer organizations and providers located in this state and in the |
|
provider's respective region. |
|
SECTION 2.25. Section 536.052(b), Government Code, is |
|
amended to read as follows: |
|
(b) The commission[, after consulting with the advisory
|
|
committee,] shall develop quality of care and cost-efficiency |
|
benchmarks, including benchmarks based on a managed care |
|
organization's performance with respect to reducing potentially |
|
preventable events and containing the growth rate of health care |
|
costs. |
|
SECTION 2.26. Section 536.102(a), Government Code, is |
|
amended to read as follows: |
|
(a) Subject to this subchapter, the commission[, after
|
|
consulting with the advisory committee,] may develop and implement |
|
quality-based payment systems for health homes designed to improve |
|
quality of care and reduce the provision of unnecessary medical |
|
services. A quality-based payment system developed under this |
|
section must: |
|
(1) base payments made to a participating enrollee's |
|
health home on quality and efficiency measures that may include |
|
measurable wellness and prevention criteria and use of |
|
evidence-based best practices, sharing a portion of any realized |
|
cost savings achieved by the health home, and ensuring quality of |
|
care outcomes, including a reduction in potentially preventable |
|
events; and |
|
(2) allow for the examination of measurable wellness |
|
and prevention criteria, use of evidence-based best practices, and |
|
quality of care outcomes based on the type of primary or specialty |
|
care provider practice. |
|
SECTION 2.27. Section 536.152(a), Government Code, is |
|
amended to read as follows: |
|
(a) Subject to Subsection (b), using the data collected |
|
under Section 536.151 and the diagnosis-related groups (DRG) |
|
methodology implemented under Section 536.005, if applicable, the |
|
commission[, after consulting with the advisory committee,] shall |
|
to the extent feasible adjust child health plan and Medicaid |
|
reimbursements to hospitals, including payments made under the |
|
disproportionate share hospitals and upper payment limit |
|
supplemental payment programs, based on the hospital's performance |
|
with respect to exceeding, or failing to achieve, outcome and |
|
process measures developed under Section 536.003 that address the |
|
rates of potentially preventable readmissions and potentially |
|
preventable complications. |
|
SECTION 2.28. Section 536.202(a), Government Code, is |
|
amended to read as follows: |
|
(a) The commission shall[, after consulting with the
|
|
advisory committee,] establish payment initiatives to test the |
|
effectiveness of quality-based payment systems, alternative |
|
payment methodologies, and high-quality, cost-effective health |
|
care delivery models that provide incentives to physicians and |
|
other health care providers to develop health care interventions |
|
for child health plan program enrollees or Medicaid recipients, or |
|
both, that will: |
|
(1) improve the quality of health care provided to the |
|
enrollees or recipients; |
|
(2) reduce potentially preventable events; |
|
(3) promote prevention and wellness; |
|
(4) increase the use of evidence-based best practices; |
|
(5) increase appropriate physician and other health |
|
care provider collaboration; |
|
(6) contain costs; and |
|
(7) improve integration of acute care services and |
|
long-term services and supports, including discharge planning from |
|
acute care services to community-based long-term services and |
|
supports. |
|
SECTION 2.29. Section 536.204(a), Government Code, is |
|
amended to read as follows: |
|
(a) The executive commissioner shall[:
|
|
[(1) consult with the advisory committee to] develop |
|
quality of care and cost-efficiency benchmarks and measurable goals |
|
that a payment initiative must meet to ensure high-quality and |
|
cost-effective health care services and healthy outcomes[; and
|
|
[(2)
approve benchmarks and goals developed as
|
|
provided by Subdivision (1)]. |
|
SECTION 2.30. Section 536.251(a), Government Code, is |
|
amended to read as follows: |
|
(a) Subject to this subchapter, the commission, after |
|
consulting with [the advisory committee and other] appropriate |
|
stakeholders representing nursing facility providers with an |
|
interest in the provision of long-term services and supports, may |
|
develop and implement quality-based payment systems for Medicaid |
|
long-term services and supports providers designed to improve |
|
quality of care and reduce the provision of unnecessary services. A |
|
quality-based payment system developed under this section must base |
|
payments to providers on quality and efficiency measures that may |
|
include measurable wellness and prevention criteria and use of |
|
evidence-based best practices, sharing a portion of any realized |
|
cost savings achieved by the provider, and ensuring quality of care |
|
outcomes, including a reduction in potentially preventable events. |
|
SECTION 2.31. Section 538.052(a), Government Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(a) Subject to Subsection (b), the commission shall solicit |
|
and accept suggestions for clinical initiatives, in either written |
|
or electronic form, from: |
|
(1) a member of the state legislature; |
|
(2) the executive commissioner; |
|
(3) the commissioner of aging and disability services; |
|
(4) the commissioner of state health services; |
|
(5) the commissioner of the Department of Family and |
|
Protective Services; |
|
(6) the commissioner of assistive and rehabilitative |
|
services; |
|
(7) the medical care advisory committee established |
|
under Section 32.022, Human Resources Code; and |
|
(8) the physician payment advisory committee created |
|
under Section 32.022(d), Human Resources Code[; and
|
|
[(9)
the Electronic Health Information Exchange
|
|
System Advisory Committee established under Section 531.904]. |
|
SECTION 2.32. Sections 1002.060(c) and (e), Health and |
|
Safety Code, are amended to read as follows: |
|
(c) The commission, department, or institute or an officer |
|
or employee of the commission, department, or institute[, including
|
|
a board member,] may not disclose any information that is |
|
confidential under this section. |
|
(e) An officer or employee of the commission, department, or |
|
institute[, including a board member,] may not be examined in a |
|
civil, criminal, special, administrative, or other proceeding as to |
|
information that is confidential under this section. |
|
SECTION 2.33. Section 1002.061, Health and Safety Code, is |
|
amended by amending Subsection (c) and adding Subsection (c-1) to |
|
read as follows: |
|
(c) Except as otherwise provided by law, each of the |
|
following state agencies or systems [agency represented on the
|
|
board as a nonvoting member] shall provide funds to support the |
|
institute and implement this chapter: |
|
(1) the department; |
|
(2) the commission; |
|
(3) the Texas Department of Insurance; |
|
(4) the Employees Retirement System of Texas; |
|
(5) the Teacher Retirement System of Texas; |
|
(6) the Texas Medical Board; |
|
(7) the Department of Aging and Disability Services; |
|
(8) the Texas Workforce Commission; |
|
(9) the Texas Higher Education Coordinating Board; and |
|
(10) each state agency or system of higher education |
|
that purchases or provides health care services, as determined by |
|
the governor. |
|
(c-1) The commission shall establish a funding formula to |
|
determine the level of support each state agency or system listed in |
|
Subsection (c) is required to provide. |
|
SECTION 2.34. Section 22.035, Human Resources Code, is |
|
amended by adding Subsection (n) to read as follows: |
|
(n) The work group is abolished and this section expires |
|
September 1, 2017. |
|
SECTION 2.35. (a) Section 32.022(b), Human Resources |
|
Code, as amended by S.B. 219, Acts of the 84th Legislature, Regular |
|
Session, 2015, is amended to read as follows: |
|
(b) The executive commissioner shall appoint the committee |
|
in compliance with the requirements of the federal agency |
|
administering medical assistance. The appointments shall: |
|
(1) provide for a balanced representation of the |
|
general public, providers, consumers, and other persons, state |
|
agencies, or groups with knowledge of and interest in the |
|
committee's field of work; and |
|
(2) include one member who is the representative of a |
|
managed care organization. |
|
(b) Not later than January 1, 2016, the executive |
|
commissioner of the Health and Human Services Commission shall |
|
appoint an additional member to the medical care advisory committee |
|
in accordance with Section 32.022(b)(2), Human Resources Code, as |
|
added by this article. |
|
SECTION 2.36. Section 32.0641(a), Human Resources Code, as |
|
amended by S.B. 219, Acts of the 84th Legislature, Regular Session, |
|
2015, is amended to read as follows: |
|
(a) To the extent permitted under and in a manner that is |
|
consistent with Title XIX, Social Security Act (42 U.S.C. Section |
|
1396 et seq.) and any other applicable law or regulation or under a |
|
federal waiver or other authorization, the executive commissioner |
|
shall adopt[, after consulting with the Medicaid and CHIP
|
|
Quality-Based Payment Advisory Committee established under Section
|
|
536.002, Government Code,] cost-sharing provisions that encourage |
|
personal accountability and appropriate utilization of health care |
|
services, including a cost-sharing provision applicable to a |
|
recipient who chooses to receive a nonemergency medical service |
|
through a hospital emergency room. |
|
SECTION 2.37. Section 1352.004(b), Insurance Code, is |
|
amended to read as follows: |
|
(b) The commissioner by rule shall require a health benefit |
|
plan issuer to provide adequate training to personnel responsible |
|
for preauthorization of coverage or utilization review under the |
|
plan. The purpose of the training is to prevent denial of coverage |
|
in violation of Section 1352.003 and to avoid confusion of medical |
|
benefits with mental health benefits. The commissioner[, in
|
|
consultation with the Texas Traumatic Brain Injury Advisory
|
|
Council,] shall prescribe by rule the basic requirements for the |
|
training described by this subsection. |
|
SECTION 2.38. Section 1352.005(b), Insurance Code, is |
|
amended to read as follows: |
|
(b) The commissioner[, in consultation with the Texas
|
|
Traumatic Brain Injury Advisory Council,] shall prescribe by rule |
|
the specific contents and wording of the notice required under this |
|
section. |
|
SECTION 2.39. (a) The following provisions of the |
|
Government Code, including provisions amended by S.B. 219, Acts of |
|
the 84th Legislature, Regular Session, 2015, are repealed: |
|
(1) Section 531.0217(j); |
|
(2) Section 531.02172; |
|
(3) Section 531.02173(c); |
|
(4) Section 531.052; |
|
(5) Section 531.0571; |
|
(6) Section 531.068; |
|
(7) Sections 531.121(1), (5), and (6); |
|
(8) Section 531.122; |
|
(9) Section 531.123; |
|
(10) Section 531.1235; |
|
(11) Section 531.251; |
|
(12) Subchapters R and T, Chapter 531; |
|
(13) Section 531.904; |
|
(14) Section 533.00251(a)(1); |
|
(15) Section 533.00252; |
|
(16) Sections 533.00255(e) and (f); |
|
(17) Section 533.00285; |
|
(18) Subchapters B and C, Chapter 533; |
|
(19) Section 535.055(f); |
|
(20) Section 535.108; |
|
(21) Section 536.001(1); |
|
(22) the heading to Section 536.002; |
|
(23) Sections 536.002(a) and (c); |
|
(24) Section 536.002(b), as amended by Article 1 of |
|
this Act; and |
|
(25) Section 536.007(b). |
|
(b) The following provisions of the Health and Safety Code, |
|
including provisions amended by S.B. 219, Acts of the 84th |
|
Legislature, Regular Session, 2015, are repealed: |
|
(1) Subchapter C, Chapter 32; |
|
(2) Section 62.151(e); |
|
(3) Section 62.1571(c); |
|
(4) Section 81.010; |
|
(5) Section 92.011; |
|
(6) Subchapter B, Chapter 92; |
|
(7) Chapter 115; |
|
(8) Section 1002.001(1); |
|
(9) Section 1002.051; |
|
(10) Section 1002.052; |
|
(11) Section 1002.053; |
|
(12) Section 1002.055; |
|
(13) Section 1002.056; |
|
(14) Section 1002.057; |
|
(15) Section 1002.058; and |
|
(16) Section 1002.059. |
|
(c) Section 32.022(e), Human Resources Code, as amended by |
|
S.B. 219, Acts of the 84th Legislature, Regular Session, 2015, is |
|
repealed. |
|
SECTION 2.40. On the effective date of this article, the |
|
following advisory committees are abolished: |
|
(1) the advisory committee on Medicaid and child |
|
health plan program rate and expenditure disparities; |
|
(2) the Advisory Committee on Qualifications for |
|
Health Care Translators and Interpreters; |
|
(3) the Behavioral Health Integration Advisory |
|
Committee; |
|
(4) the Consumer Direction Work Group; |
|
(5) the Council on Children and Families; |
|
(6) the Electronic Health Information Exchange System |
|
Advisory Committee; |
|
(7) the Guardianship Advisory Board; |
|
(8) the hospital payment advisory committee; |
|
(9) the Interagency Coordinating Council for HIV and |
|
Hepatitis; |
|
(10) the Medicaid and CHIP Quality-Based Payment |
|
Advisory Committee; |
|
(11) each Medicaid managed care advisory committee |
|
appointed for a health care service region under Subchapter B, |
|
Chapter 533, Government Code; |
|
(12) the Public Assistance Health Benefit Review and |
|
Design Committee; |
|
(13) the renewing our communities account advisory |
|
committee; |
|
(14) the STAR + PLUS Nursing Facility Advisory |
|
Committee; |
|
(15) the STAR + PLUS Quality Council; |
|
(16) the state Medicaid managed care advisory |
|
committee; |
|
(17) the task force on domestic violence; |
|
(18) the Interagency Task Force for Children With |
|
Special Needs; |
|
(19) the telemedicine and telehealth advisory |
|
committee; |
|
(20) the board of directors of the Texas Institute of |
|
Health Care Quality and Efficiency; |
|
(21) the Texas System of Care Consortium; |
|
(22) the Texas Traumatic Brain Injury Advisory |
|
Council; and |
|
(23) the volunteer advocate program advisory |
|
committee. |
|
SECTION 2.41. (a) Not later than November 1, 2015, the |
|
executive commissioner of the Health and Human Services Commission |
|
shall publish in the Texas Register: |
|
(1) a list of the new advisory committees established |
|
or to be established as a result of this article, including the |
|
advisory committees required under Section 531.012(a), Government |
|
Code, as amended by this article; and |
|
(2) a list that identifies the advisory committees |
|
listed in Section 2.40 of this article: |
|
(A) that will not be continued in any form; or |
|
(B) whose functions will be assumed by a new |
|
advisory committee established under Section 531.012(a), |
|
Government Code, as amended by this article. |
|
(b) The executive commissioner of the Health and Human |
|
Services Commission shall ensure that an advisory committee |
|
established under Section 531.012(a), Government Code, as amended |
|
by this article, begins operations immediately on its establishment |
|
to ensure ongoing public input and engagement. |
|
(c) This section takes effect September 1, 2015. |
|
SECTION 2.42. Except as otherwise provided by this article, |
|
this article takes effect January 1, 2016. |
|
ARTICLE 3. TRANSITION, FEDERAL AUTHORIZATION, AND GENERAL |
|
EFFECTIVE DATE |
|
SECTION 3.01. If an entity that is abolished by this Act has |
|
property, records, or other assets, the Health and Human Services |
|
Commission shall take custody of the entity's property, records, or |
|
other assets. |
|
SECTION 3.02. 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 3.03. Except as otherwise provided by this Act, |
|
this Act takes effect September 1, 2015. |