Bill Text: TX SB2085 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to Medicaid funding in this state, including the federal government's participation in that funding.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-21 - Referred to Health & Human Services [SB2085 Detail]
Download: Texas-2019-SB2085-Introduced.html
2019S0356-1 03/06/19 | ||
By: Hinojosa | S.B. No. 2085 |
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relating to Medicaid funding in this state, including the federal | ||
government's participation in that funding. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.02113, Government Code, is amended | ||
to read as follows: | ||
Sec. 531.02113. OPTIMIZATION OF MEDICAID FINANCING. The | ||
commission shall ensure that the Medicaid finance system: | ||
(1) is optimized to: | ||
(A) [ |
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federal funds; | ||
(B) [ |
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preventive care; | ||
(C) [ |
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system to maintain an adequate provider network; | ||
(D) [ |
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borne by providers; and | ||
(E) [ |
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quality of care; and | ||
(2) complies with the requirements of Chapter 540, if | ||
applicable. | ||
SECTION 2. Section 533.00256(a), Government Code, is | ||
amended to read as follows: | ||
(a) In consultation with appropriate stakeholders with an | ||
interest in the provision of acute care services and long-term | ||
services and supports under the Medicaid managed care program, the | ||
commission shall: | ||
(1) establish a clinical improvement program to | ||
identify goals designed to improve quality of care and care | ||
management and to reduce potentially preventable events, as defined | ||
by Section 536.001; [ |
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(2) require managed care organizations to develop and | ||
implement collaborative program improvement strategies to address | ||
the goals; and | ||
(3) evaluate the opportunity to establish a hospital | ||
value-based purchasing program pursuant to 42 C.F.R. Section | ||
438.6(c), to be implemented through its contracts with managed care | ||
organizations, that would provide enhanced reimbursement to | ||
hospitals that meet achievement goals on defined outcome-based | ||
performance measures. | ||
SECTION 3. Subtitle I, Title 4, Government Code, is amended | ||
by adding Chapter 540 to read as follows: | ||
CHAPTER 540. MEDICAID FUNDING MODIFICATION | ||
Sec. 540.0001. APPLICABILITY. This chapter applies to a | ||
waiver to the requirements of this state's Medicaid state plan or | ||
other authorization under Medicaid: | ||
(1) for which the commission seeks approval from the | ||
federal government; and | ||
(2) that, if approved, would change this state's | ||
receipt of federal money for Medicaid from the funding system in | ||
effect on January 1, 2019, to another funding system. | ||
Sec. 540.0002. ADEQUACY OF MEDICAID PROGRAM FUNDING. A | ||
Medicaid funding modification the commission seeks through a waiver | ||
or other authorization to which this chapter applies: | ||
(1) must account for and ensure adequate, continued | ||
funding for: | ||
(A) anticipated growth in the number of persons | ||
in this state who will be eligible for and enroll in the Medicaid | ||
program; and | ||
(B) health care trends that may affect costs, | ||
including: | ||
(i) increases in utilization rates; | ||
(ii) increases in the acuity of Medicaid | ||
recipients; | ||
(iii) advancements in medical technology; | ||
and | ||
(iv) advancements in specialized | ||
prescription drugs; and | ||
(2) may not be designed in a manner that allows for | ||
reductions in federal financial participation based on this state's | ||
effective management of Medicaid cost growth. | ||
Sec. 540.0003. PROVIDER REIMBURSEMENTS AND OTHER PAYMENTS. | ||
(a) A waiver or other authorization to which this chapter applies | ||
must ensure that the Medicaid funding modification the commission | ||
seeks through the waiver or authorization will: | ||
(1) support the provision of adequate reimbursements | ||
to Medicaid providers and support periodic reimbursement rate | ||
increases based on health care trends; | ||
(2) ensure continued provision of payments to | ||
hospitals equal to supplemental payments by this state to hospitals | ||
under supplemental payment programs in effect on January 1, 2019, | ||
which may include continued provision through increases in rates | ||
paid for direct hospital services to Medicaid enrollees; and | ||
(3) prioritize use of supplemental payments to | ||
encourage continued development of comprehensive local and | ||
regional health care systems that include preventive, primary, | ||
specialty, outpatient, inpatient, mental health, and substance | ||
abuse services for individuals without health insurance. | ||
(b) Reimbursement systems under a waiver or other | ||
authorization to which this chapter applies must encourage | ||
value-based payment arrangements for Medicaid providers and | ||
support efforts to promote quality of care. | ||
SECTION 4. Section 108.0065, Health and Safety Code, is | ||
amended by amending Subsection (e) and redesignating Subsection (h) | ||
as Subsection (f) to read as follows: | ||
(e) The commission shall analyze the data collected in | ||
accordance with this section and shall use the data to: | ||
(1) evaluate the effectiveness and efficiency of the | ||
Medicaid managed care system; | ||
(2) determine the extent to which Medicaid managed | ||
care does or does not serve the needs of Medicaid recipients in this | ||
state; [ |
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(3) assess the cost-effectiveness of the Medicaid | ||
managed care system in comparison to the fee-for-service system, | ||
considering any improvement in the quality of care provided; and | ||
(4) support and assist the commission's activities | ||
conducted pursuant to Section 533.00256, Government Code. | ||
(f) [ |
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contract with an entity to comply with the requirements under | ||
Subsection (e). | ||
SECTION 5. 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 6. 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. |