Bill Text: TX HB3722 | 2013-2014 | 83rd Legislature | Introduced

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Bill Title: Relating to expanding eligibility for benefits under the Medicaid program and transitioning the delivery of benefits under the Medicaid program from delivery through a managed care model or arrangement to delivery through an integrated and coordinated health care delivery system.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Introduced - Dead) 2013-03-21 - Referred to Appropriations [HB3722 Detail]

Download: Texas-2013-HB3722-Introduced.html

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By: Martinez Fischer H.B. No. 3722

A BILL TO BE ENTITLED
AN ACT
relating to expanding eligibility for benefits under the Medicaid
program and transitioning the delivery of benefits under the
Medicaid program from delivery through a managed care model or
arrangement to delivery through an integrated and coordinated
health care delivery system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. INTEGRATED AND COORDINATED HEALTH CARE DELIVERY SYSTEM
SECTION 1.01. Subtitle I, Title 4, Government Code, is
amended by adding Chapter 533B to read as follows:
CHAPTER 533B. INTEGRATED AND COORDINATED HEALTH CARE DELIVERY
SYSTEM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 533B.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission or an agency operating part of the state Medicaid
integrated and coordinated health care delivery system, as
appropriate, notwithstanding Section 531.001.
(2) "Coordinated care organization" means an entity as
described by Section 533B.053 that is responsible for the delivery
of health care services under the integrated and coordinated health
care delivery system.
(3) "Recipient" means a recipient of medical
assistance under Chapter 32, Human Resources Code.
Sec. 533B.002. PURPOSE. (a) The legislature finds that:
(1) a significant amount of public and private money
is spent each year for the provision of health care to Texans;
(2) the state has a strong interest in assisting Texas
businesses and individuals to obtain reasonably available
insurance or other coverage for the costs of necessary basic health
care services;
(3) the lack of basic health care coverage is
detrimental not only to the health of individuals lacking coverage,
but also to the public welfare and the state's need to encourage
employment growth and economic development, and that lack of
coverage results in substantial expenditures for emergency and
remedial health care for all purchasers of health care including
the state; and
(4) the use of integrated and coordinated health care
delivery systems has significant potential to reduce the growth of
health care costs incurred by the people of this state.
(b) The legislature finds that achieving its goals of
improving health, increasing the quality, reliability,
availability, and continuity of care, and reducing the cost of care
requires an integrated and coordinated health care delivery system
in which:
(1) individuals who are eligible for benefits under
both the Medicare and Medicaid programs participate;
(2) health care services, other than Medicaid-funded
long-term care services, are delivered through coordinated care
contracts that use alternative payment methodologies to improve
health and health care by focusing on:
(A) prevention;
(B) improving health equity and reducing health
disparities; and
(C) using:
(i) patient-centered primary care homes;
(ii) evidence-based practices; and
(iii) health information technology;
(3) high-quality information is collected and used to
measure health outcomes, health care quality and costs, and
clinical health information;
(4) communities and regions are accountable for
improving the health of residents of the communities and regions,
reducing avoidable health gaps among different cultural groups and
managing health care resources;
(5) care and services emphasize preventive services
and services supporting individuals to live independently at home
or in their community;
(6) services are person-centered, and provide choice,
independence and dignity as reflected in individual plans and
assistance provided in accessing care and services; and
(7) interactions between the commission and
coordinated care organizations are transparent and public.
(c) The legislature finds that there is an extreme need for
a skilled, diverse workforce to meet the rapidly growing demand for
home and community-based health care. To meet that need, this state
must:
(1) build on existing training programs;
(2) ensure that wages and benefits are at levels that
reduce turnover and increase experience and quality of care; and
(3) provide an opportunity for front-line health care
providers to have a voice in the providers' workplace in order to
effectively advocate for quality care.
Sec. 533B.003. REFERENCE IN OTHER LAW. A reference in law
to a Medicaid managed care delivery system or arrangement under
Chapter 533 is a reference to the integrated and coordinated health
care delivery system implemented under this chapter.
Sec. 533B.004. CONFLICT WITH OTHER LAW. To the extent of a
conflict between a provision of this chapter and another provision
of state law, the provision of this chapter controls.
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 533B.051. INTEGRATED AND COORDINATED HEALTH CARE
DELIVERY SYSTEM. (a) In this section, "medical assistance" has the
meaning assigned by Section 32.003, Human Resources Code.
(b) The commission shall develop and implement a plan to
transition the delivery of medical assistance benefits from
delivery through a managed care model or arrangement to delivery
through an integrated and coordinated health care delivery system
implemented in accordance with this chapter. In developing the plan
under this section, the commission shall use as a guide the
provisions of other states' laws regarding integrated and
coordinated health care delivery systems, including Oregon Laws
Chapter 602 (H.B. 3650), Acts of the 76th Legislature, 2011.
Sec. 533B.052. REQUIRED CONTRACT CRITERIA. The executive
commissioner shall by rule adopt criteria for a contract with a
coordinated care organization. The commission shall integrate the
criteria into each contract with a coordinated care organization.
The criteria must include:
(1) provisions that ensure each recipient has a
consistent and stable relationship with a care team that is
responsible for comprehensive care management and service
delivery;
(2) provisions that require the use of health
information technology to link services and care providers across
the continuum of care to the greatest extent possible;
(3) a requirement that each coordinated care
organization convenes a community advisory council made up mostly
of consumers of health care services but that also includes
representatives from the community and of local government, and
that the council meets regularly to ensure that the health care
needs of the consumers and the community are being addressed;
(4) a requirement that each coordinated care
organization submits to the commission a report of outcome and
quality measures as determined by the commission; and
(5) a requirement that each coordinated care
organization enter into a contract with a dental care organization
that serves recipients of the coordinated care organization in the
region in which the recipients reside.
Sec. 533B.053. COORDINATED CARE ORGANIZATION ELIGIBILITY
REQUIREMENTS. In order to enter into a contract with the commission
to provide health care services as a coordinated care organization,
an entity must:
(1) be a locally based community organization, or a
statewide organization that has participants that are locally based
community organizations; and
(2) have a governance structure that includes:
(A) a majority interest consisting of the persons
that share in the financial risk of the organization;
(B) the major components of the health care
delivery system, as determined by the commission; and
(C) the community at large, to ensure that the
organization's decision-making is consistent with the values of the
members and the community.
Sec. 533B.054. ALTERNATIVE PAYMENT METHODS. The commission
shall develop and implement the integrated and coordinated health
care delivery system in a manner that promotes and encourages the
use of alternative payment methods that:
(1) reimburse providers on the basis of health
outcomes and quality measures rather than the volume of care; and
(2) use payment structures that create incentives to:
(A) promote prevention;
(B) provide patient-centered care; and
(C) reward comprehensive care coordination using
delivery models such as patient-centered primary care homes.
SECTION 1.02. Chapter 533, Government Code, is repealed.
SECTION 1.03. As soon as possible after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall take all necessary actions to transition
the delivery of medical assistance benefits under the Medicaid
program from using a managed care delivery model or arrangement to
using an integrated and coordinated health care delivery system
beginning January 1, 2014, and in accordance with Chapter 533B,
Government Code, as added by this article.
SECTION 1.04. Notwithstanding Chapter 533B, Government
Code, as added by this article, and Section 1.02 of this article,
the Health and Human Services Commission shall continue to provide
medical assistance through a Medicaid managed care delivery model
or arrangement until the integrated and coordinated health care
delivery system is implemented under Chapter 533B, Government Code,
as added by this article.
ARTICLE 2. MEDICAID EXPANSION
SECTION 2.01. Chapter 32, Human Resources Code, is amended
by adding Subchapter H to read as follows:
SUBCHAPTER H. EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE
Sec. 32.351. DEFINITIONS. In this subchapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
Sec. 32.352. EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a)
Notwithstanding any other law, the commission shall provide medical
assistance to all persons who apply for that assistance and for whom
federal matching funds are available under the Patient Protection
and Affordable Care Act (Pub. L. No. 111-148) as amended by the
Health Care and Education Reconciliation Act of 2010 (Pub. L. No.
111-152) to provide that assistance.
(b) The executive commissioner shall adopt rules regarding
the provision of medical assistance as required by this section.
SECTION 2.02. Section 32.352, Human Resources Code, as
added by this article, applies only to an initial determination or
recertification of eligibility of a person for medical assistance
under Chapter 32, Human Resources Code, made on or after January 1,
2014, regardless of the date the person applied for that
assistance.
SECTION 2.03. As soon as possible after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall take all necessary actions to expand
eligibility for medical assistance under Chapter 32, Human
Resources Code, beginning January 1, 2014, and in accordance with
Section 32.352, Human Resources Code, as added by this article,
including notifying appropriate federal agencies of that expanded
eligibility.
ARTICLE 3. FEDERAL AUTHORIZATION AND EFFECTIVE DATE
SECTION 3.01. 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 3.02. 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, 2013.