Bill Text: TX HB2245 | 2011-2012 | 82nd Legislature | Enrolled
Bill Title: Relating to physician incentive programs to reduce hospital emergency room use for non-emergent conditions by Medicaid recipients.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Passed) 2011-06-17 - Effective on 9/1/11 [HB2245 Detail]
Download: Texas-2011-HB2245-Enrolled.html
H.B. No. 2245 |
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relating to physician incentive programs to reduce hospital | ||
emergency room use for non-emergent conditions by Medicaid | ||
recipients. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Sections 531.086 and 531.0861 to read as follows: | ||
Sec. 531.086. STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS | ||
TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. | ||
(a) The commission shall conduct a study to evaluate physician | ||
incentive programs that attempt to reduce hospital emergency room | ||
use for non-emergent conditions by recipients under the medical | ||
assistance program. Each physician incentive program evaluated in | ||
the study must: | ||
(1) be administered by a health maintenance | ||
organization participating in the STAR or STAR + PLUS Medicaid | ||
managed care program; and | ||
(2) provide incentives to primary care providers who | ||
attempt to reduce emergency room use for non-emergent conditions by | ||
recipients. | ||
(b) The study conducted under Subsection (a) must evaluate: | ||
(1) the cost-effectiveness of each component included | ||
in a physician incentive program; and | ||
(2) any change in statute required to implement each | ||
component within the Medicaid fee-for-service or primary care case | ||
management model. | ||
(c) Not later than August 31, 2012, the executive | ||
commissioner shall submit to the governor and the Legislative | ||
Budget Board a report summarizing the findings of the study | ||
required by this section. | ||
(d) This section expires September 1, 2013. | ||
Sec. 531.0861. PHYSICIAN INCENTIVE PROGRAM TO REDUCE | ||
HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) The | ||
executive commissioner by rule shall establish a physician | ||
incentive program designed to reduce the use of hospital emergency | ||
room services for non-emergent conditions by recipients under the | ||
medical assistance program. | ||
(b) In establishing the physician incentive program under | ||
Subsection (a), the executive commissioner may include only the | ||
program components identified as cost-effective in the study | ||
conducted under Section 531.086. | ||
(c) If the physician incentive program includes the payment | ||
of an enhanced reimbursement rate for routine after-hours | ||
appointments, the executive commissioner shall implement controls | ||
to ensure that the after-hours services billed are actually being | ||
provided outside of normal business hours. | ||
SECTION 2. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for the 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. This Act takes effect September 1, 2011. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I certify that H.B. No. 2245 was passed by the House on April | ||
26, 2011, by the following vote: Yeas 148, Nays 0, 2 present, not | ||
voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
I certify that H.B. No. 2245 was passed by the Senate on May | ||
19, 2011, by the following vote: Yeas 31, Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
APPROVED: _____________________ | ||
Date | ||
_____________________ | ||
Governor |