Bill Text: TX SB1059 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to the consideration of strategies by the Health and Human Services Commission to ensure the appropriate use of diagnostic ancillary services in the Medicaid program.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2013-03-12 - Referred to Health & Human Services [SB1059 Detail]
Download: Texas-2013-SB1059-Introduced.html
83R2664 KKR-D | ||
By: Nelson | S.B. No. 1059 |
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relating to the consideration of strategies by the Health and Human | ||
Services Commission to ensure the appropriate use of diagnostic | ||
ancillary services in the Medicaid program. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.024162 to read as follows: | ||
Sec. 531.024162. STRATEGIES TO ENSURE APPROPRIATE USE OF | ||
DIAGNOSTIC ANCILLARY SERVICES. (a) The commission shall: | ||
(1) adopt new cost-effective strategies to ensure the | ||
appropriate use of diagnostic ancillary services in the Medicaid | ||
program; and | ||
(2) strengthen existing methods to reduce the use of | ||
unnecessary diagnostic ancillary services in the Medicaid program. | ||
(b) When considering the adoption of new cost-effective | ||
strategies to ensure the appropriate use of diagnostic ancillary | ||
services in the Medicaid program, the commission shall examine | ||
implementing within the Medicaid fee-for-service model and the STAR | ||
and STAR + PLUS Medicaid managed care programs a prior notification | ||
program in which: | ||
(1) outlier health care providers' use of diagnostic | ||
ancillary services are compared to evidence-based clinical | ||
guidelines; and | ||
(2) health care providers are educated about the | ||
appropriate use of diagnostic ancillary services. | ||
(c) When considering strengthening existing methods to | ||
reduce the use of unnecessary diagnostic ancillary services in the | ||
Medicaid program, the commission shall examine: | ||
(1) requiring every STAR and STAR + PLUS Medicaid | ||
managed care program to implement a prior authorization program; | ||
and | ||
(2) modifying the existing prior authorization | ||
programs within the Medicaid fee-for-service model and the STAR and | ||
STAR + PLUS Medicaid managed care programs so that: | ||
(A) the programs target health care providers who | ||
order significantly more diagnostic ancillary services than other | ||
providers who treat similar patients; | ||
(B) outlier providers who order diagnostic | ||
ancillary services inappropriately are required to participate in | ||
the programs; and | ||
(C) the programs are expanded to include | ||
additional types of diagnostic ancillary services that account for | ||
a significant share of spending, have evidence-based standards for | ||
appropriate use, and exhibit variations in use among providers and | ||
geographic areas. | ||
(d) The commission shall examine options within the | ||
Medicaid fee-for-service model and the STAR and STAR + PLUS | ||
Medicaid managed care programs to improve payment accuracy for | ||
diagnostic ancillary services and to reduce the financial incentive | ||
for a health care provider to order unnecessary diagnostic | ||
ancillary services to be performed at a facility in which the | ||
provider has a financial interest. Options the commission shall | ||
examine under this subsection and may consider implementing | ||
include: | ||
(1) accounting for duplications in the work of a | ||
provider and the expenses relating to that work that occur when two | ||
or more diagnostic ancillary services are provided at the same time | ||
by: | ||
(A) combining into a single payment rate or | ||
comprehensive code multiple discrete diagnostic ancillary services | ||
that are often provided at the same time by the same provider; or | ||
(B) reducing the payment rate for subsequent | ||
diagnostic ancillary services that are provided to a patient at the | ||
same time by the same provider; and | ||
(2) reducing the payment rates for certain diagnostic | ||
ancillary services that are ordered and provided by the same | ||
provider. | ||
(e) The commission shall review strategies recommended by | ||
the federal Medicare Payment Advisory Commission during fiscal year | ||
2011 to reduce the use of unnecessary diagnostic ancillary services | ||
in the Medicare program and consider adopting those strategies for | ||
the Medicaid program. | ||
(f) The commission shall identify cost-effective strategies | ||
used by STAR and STAR + PLUS Medicaid managed care programs to | ||
reduce the use of unnecessary diagnostic ancillary services and | ||
consider: | ||
(1) implementing those strategies within the Medicaid | ||
fee-for-service model; and | ||
(2) requiring the use of those strategies in other | ||
STAR and STAR + PLUS Medicaid managed care programs. | ||
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, 2013. |