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


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       
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