Bill Text: TX HB3823 | 2015-2016 | 84th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Introduced.html
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-Introduced.html
84R5379 JSL-D | ||
By: Price | H.B. No. 3823 |
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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: | ||
(1) "Commission" means the Health and Human Services | ||
Commission. | ||
(2) "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 of the commission shall ensure | ||
that: | ||
(1) reimbursement rates for providers under the | ||
program are adequate to sustain the program; | ||
(2) reimbursements paid under the program do not, in | ||
the aggregate, exceed the reasonable and necessary costs to operate | ||
the program; and | ||
(3) the program is cost-neutral when compared to the | ||
cost to serve a comparable population in the STAR + PLUS Medicaid | ||
managed care program. | ||
(c) For purposes of Subsections (b)(1) and (2), the | ||
commission shall consider requiring providers under the PACE | ||
program to report historical cost and utilization data. If the | ||
commission requires providers to report historical cost and | ||
utilization data under this section: | ||
(1) the commission may establish a cost-reporting | ||
structure that accommodates data collection from providers by | ||
modifying as appropriate an existing cost-reporting structure used | ||
for other programs administered by the commission; and | ||
(2) the commission shall determine which costs the | ||
commission considers reasonable and necessary under the program. | ||
(d) For purposes of Subsection (b)(3), 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, 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, | ||
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; and | ||
(2) accounts for geographic differences and recipient | ||
acuity. | ||
(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. |