Bill Text: TX HB3772 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to a demonstration project that allows federally qualified health centers to test innovative health care delivery systems and data sharing under certain public benefits programs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-19 - Referred to Human Services [HB3772 Detail]
Download: Texas-2019-HB3772-Introduced.html
86R10866 KFF-F | ||
By: Raymond | H.B. No. 3772 |
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relating to a demonstration project that allows federally qualified | ||
health centers to test innovative health care delivery systems and | ||
data sharing under certain public benefits programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle I, Title 4, Government Code, is amended | ||
by adding Chapter 539A to read as follows: | ||
CHAPTER 539A. INNOVATIVE HEALTH CARE DELIVERY SYSTEM DEMONSTRATION | ||
PROJECT | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 539A.0001. DEFINITIONS. In this chapter: | ||
(1) "Demonstration project" means the demonstration | ||
project established under Section 539A.0051. | ||
(2) "Federally qualified health center" has the | ||
meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B). | ||
(3) "Federally qualified health center services" has | ||
the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A). | ||
Sec. 539A.0002. REPORTING. Not later than December 1, | ||
2020, the commission shall submit a report to the legislature | ||
regarding the commission's progress in establishing and operating | ||
the demonstration project and recommendations on continuing or | ||
expanding the demonstration project. | ||
Sec. 539A.0003. EXPIRATION. This chapter expires September | ||
1, 2021. | ||
SUBCHAPTER B. DEMONSTRATION PROJECT | ||
Sec. 539A.0051. DEMONSTRATION PROJECT TO TEST ALTERNATIVE | ||
AND INNOVATIVE HEALTH CARE DELIVERY SYSTEMS AND DATA SHARING. The | ||
commission shall develop and implement a demonstration project to | ||
test alternative and innovative health care delivery systems, | ||
including data sharing and alternative payment systems under | ||
Medicaid, the child health plan program, and other health benefits | ||
programs administered by the commission or other health and human | ||
services agencies. Under the demonstration project, the commission | ||
shall provide services covered under health benefits programs to a | ||
specific patient population under an agreed-on shared savings | ||
arrangement with federally qualified health centers. | ||
Sec. 539A.0052. FEDERALLY QUALIFIED HEALTH CENTERS | ||
PARTICIPATION; CREATION OF INNOVATIVE HEALTH CARE DELIVERY | ||
SYSTEMS. (a) In establishing the demonstration project, the | ||
commission shall, in consultation with federally qualified health | ||
centers, develop a request for proposals for participation in the | ||
demonstration project and formation of innovative health care | ||
delivery systems. To be eligible to participate in the | ||
demonstration project a federally qualified health center must: | ||
(1) be a provider under an applicable public benefits | ||
program capable of providing services that are covered by the | ||
program; | ||
(2) meet minimum quality standards established by the | ||
commission; and | ||
(3) adopt cost-effective methods of care delivery and | ||
coordination, which may include the use of allied health | ||
professionals, telemedicine providers, patient educators, care | ||
coordinators, community health care workers, and services and | ||
providers that are not covered or reimbursed under a health | ||
benefits program. | ||
(b) An innovative health care delivery system may be formed | ||
by federally qualified health centers in this state. A federally | ||
qualified health center may contract with a third party to provide | ||
secure transfer and administrative services under the delivery | ||
system. | ||
(c) The commission may require federally qualified health | ||
centers that have established innovative health care delivery | ||
systems to enter into additional contracts with third parties for | ||
risk assessment and for the purchase of stop-loss coverage or | ||
another form of risk management insurance related to the delivery | ||
system established under the demonstration project. | ||
Sec. 539A.0053. PATIENT PARTICIPATION. A person eligible | ||
for a public benefits program, including Medicaid and the child | ||
health plan program, is eligible for attribution to an innovative | ||
health care delivery system. | ||
Sec. 539A.0054. DATA SHARING PROGRAM. (a) As part of the | ||
demonstration project, the commission shall develop and implement a | ||
program to test data sharing for innovative health care delivery | ||
systems and alternative payment systems. Under the data sharing | ||
program and to the extent permitted by federal law, the commission | ||
shall securely provide federally qualified health centers | ||
participating in the demonstration project, or the centers' | ||
designee, data regarding the centers' patients eligible to | ||
participate in the demonstration project, either individually or as | ||
a group. | ||
(b) Under the data sharing program, a participating | ||
federally qualified health center shall provide to the commission | ||
the names of patients who are enrolled in a public benefits program | ||
to whom the center has provided services in the preceding 12-month | ||
period. After receiving the names of patients under this | ||
subsection, the commission shall immediately provide the federally | ||
qualified health centers, or the centers' designee, a claims data | ||
file that includes information relating to the claims that have | ||
been received under a public benefits program for each patient. The | ||
claims data file must include: | ||
(1) the claims made by or on behalf of the patient | ||
during the 36-month period preceding the date the commission | ||
received the names of patients under this subsection; | ||
(2) patient demographic data, including each patient's | ||
name, address, date of birth, and gender; | ||
(3) patient health benefits coverage information, | ||
including any unique identifier or number assigned to the patient | ||
under a public benefits program, including each patient's Medicaid | ||
number, if applicable; | ||
(4) attribution information of each patient, | ||
including the names of the public benefits program each patient is | ||
enrolled in, the effective date of enrollment, and if the patient is | ||
enrolled in Medicaid: | ||
(A) whether the patient is enrolled in a managed | ||
care program, and if so, the name of the program; and | ||
(B) each patient's primary care provider; | ||
(5) the individual provider codes associated with each | ||
provider who has provided services to the patient, including the | ||
provider's: | ||
(A) federal and state, if applicable, tax | ||
identification numbers; | ||
(B) national provider identifiers; | ||
(C) health care provider taxonomy codes; | ||
(D) professional license numbers; and | ||
(E) other identifiers collected with respect to | ||
the provider; and | ||
(6) patient claims data, including: | ||
(A) any benefits covered by a public benefits | ||
program when provided by an enrolled provider, including: | ||
(i) the names of primary care providers, | ||
urgent care providers, specialty care providers, emergency room | ||
providers, and hospital providers; and | ||
(ii) the type of benefits provided, | ||
including the provision of hospital observation services, hospital | ||
inpatient services, home health services, skilled nursing | ||
services, lab and radiological services, pharmacy benefits, | ||
including prescription information and drug pricing, ambulance | ||
services, care plan oversight services, spinal manipulation | ||
services, early and period screening, diagnosis, and treatment | ||
services, anesthesia services, durable medical equipment, hospice | ||
services, therapy services, and obstetric services; and | ||
(B) onset of illness date, dates of service, | ||
locations at which services were provided, names of service | ||
providers, diagnostic and Current Procedural Terminology codes and | ||
related cause codes, and reimbursement amounts paid. | ||
Sec. 539A.0055. REIMBURSEMENT SYSTEM. (a) In developing a | ||
reimbursement system for innovative health care delivery systems, | ||
the executive commissioner shall establish a reimbursement | ||
methodology that: | ||
(1) is based on a total cost of care benchmark adjusted | ||
for patient acuity; and | ||
(2) is designed to achieve determinable savings. | ||
(b) The reimbursement system may include incentive payments | ||
to innovative health care delivery systems that meet or exceed | ||
annual quality and performance targets. | ||
Sec. 539A.0056. FUNDING. The commission may apply for any | ||
available grants or federal funding that would further the purposes | ||
of or assist in the establishment of the demonstration project or | ||
innovative health care delivery systems established under the | ||
demonstration project. | ||
SECTION 2. As soon as possible after the effective date of | ||
this Act, the Health and Human Services Commission shall apply for | ||
and actively pursue from the federal Centers for Medicare and | ||
Medicaid Services or other appropriate federal agency any waiver or | ||
other authorization necessary to implement Chapter 539A, | ||
Government Code, as added by this Act. The commission may delay | ||
implementing this Act until the waiver or authorization is granted. | ||
SECTION 3. 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. |