Bill Text: TX HB3823 | 2015-2016 | 84th Legislature | Enrolled

Texas House Bill 3823 (Prior Session Legislation)

Bill Title: Relating to rate-setting and data collection processes under the program of all-inclusive care for the elderly.

Spectrum: Slight Partisan Bill (Republican 5-2)

Status: (Passed) 2015-06-17 - Effective immediately [HB3823 Detail]

Download: Texas-2015-HB3823-Enrolled.html



	H.B. No. 3823




	AN ACT
	relating to rate-setting and data collection processes under the
	program of all-inclusive care for the elderly.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
	is amended by adding Sections 32.0532, 32.0533, and 32.0534 to read
	as follows:
	Sec. 32.0532. PACE PROGRAM REIMBURSEMENT METHODOLOGY. (a)
	In this section and Sections 32.0533 and 32.0534, "PACE program"
	means the program of all-inclusive care for the elderly (PACE)
	established under Section 32.053.
	(b) In setting the reimbursement rates under the PACE
	program, the executive commissioner shall ensure that:
	(1) reimbursement rates for providers under the
	program are adequate to sustain the program; and
	(2) the program is cost-neutral or costs less when
	compared to the cost to serve a population in the STAR + PLUS
	Medicaid managed care program that is comparable in:
	(A) age;
	(B) eligibility factors, including:
	(i) income level;
	(ii) health status; and
	(iii) impairment level;
	(C) geographic location;
	(D) living environment; and
	(E) other factors determined to be necessary.
	(c) For purposes of Subsection (b)(2), the commission shall
	consider data on the cost of services provided to comparable
	recipients enrolled in the STAR + PLUS Medicaid managed care
	program to calculate the upper payment limit component of the PACE
	program reimbursement rates. The cost of those services includes
	the Medicaid capitation payment per recipient and Medicaid payments
	made on a fee-for-service basis for services not covered by the
	capitation payment.
	Sec. 32.0533. DATA COLLECTION: PACE AND STAR + PLUS
	MEDICAID MANAGED CARE PROGRAMS. The commission, in collaboration
	with the Department of Aging and Disability Services and
	appropriate stakeholder groups, shall modify the methods by which
	the commission and the department collect data for evaluation of
	the PACE and STAR + PLUS Medicaid managed care programs to allow
	comparison of recipient outcomes between the programs. The
	modification to data collection methods must include changes to:
	(1) survey instruments that measure recipient
	experience;
	(2) compilation of the same or similar complaint,
	disenrollment, and appeals data; and
	(3) compilation of the same or similar hospital
	admissions and readmissions data.
	Sec. 32.0534. EVALUATION AND REPORT COMPARING PACE AND STAR
	+ PLUS MEDICAID MANAGED CARE PROGRAMS. (a) The commission, in
	collaboration with the Department of Aging and Disability Services
	and appropriate stakeholder groups, shall conduct an evaluation of
	the PACE program that compares Medicaid costs and client outcomes
	under the PACE program to Medicaid costs and client outcomes under
	the STAR + PLUS Medicaid managed care program. The commission must
	design the evaluation in a manner that:
	(1) compares similar recipient types between the
	programs in terms of recipient:
	(A) age;
	(B) eligibility factors, including:
	(i) income level;
	(ii) health status; and
	(iii) impairment level; and
	(C) living environment; and
	(2) accounts for differences among recipients in:
	(A) geographic location;
	(B) health care acuity; and
	(C) other factors determined to be necessary.
	(b) The evaluation required under this section must include
	an assessment of future cost implications if the commission fails
	to establish a reimbursement methodology under the PACE program in
	accordance with Section 32.0532.
	(c) The commission shall compile a report on the findings of
	the evaluation under this section. Not later than December 1, 2016,
	the commission shall submit the report to the Legislative Budget
	Board and the governor.
	(d) This section expires September 1, 2017.
	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 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 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, 2015.


	______________________________	______________________________
	President of the Senate	Speaker of the House


	I certify that H.B. No. 3823 was passed by the House on April
	27, 2015, by the following vote: Yeas 134, Nays 0, 1 present, not
	voting.

	______________________________
	Chief Clerk of the House


	I certify that H.B. No. 3823 was passed by the Senate on May
	22, 2015, by the following vote: Yeas 31, Nays 0.

	______________________________
	Secretary of the Senate
	APPROVED: _____________________
	Date

	_____________________
	Governor