Signed by Governor Rick Perry

Vote Smart's Synopsis:

Vote to pass a bill that revises and establishes laws and procedures relating to the administration, quality, and efficiency of health care, health and human services, and health benefit programs in this state.

Highlights:

• Requires the executive commissioner of the Health and Human Services Commission to adopt cost-sharing provisions for recipients of non-emergency medical care through a hospital emergency room (Sec. 1).

• Authorizes public hospitals that provide health care services to individuals that are sponsored immigrants to recover the costs of the services from the sponsor that executed an affidavit of support on behalf of the individual (Sec. 1).

• Establishes the Medicaid and CHIP Quality-Based Payment Advisory Committee to advise the commission on developing quality-based outcome and process measures, and consisting of the following members (Sec. 1):
• At least one physician with experience in each of the following fields:
• Obstetrics and gynecology;
• Pediatrics;
• Family Medicine; and
• Geriatric Medicine;
• At least one representative of a health care provider that provides long-term services;
• At least one consumer representative; and
• At least one member who is a member of the Advisory Panel on Health Care-Associated Infections and Preventable Adverse Events.

• Requires the Medicaid and CHIP Quality-Based Payment Advisory Committee to develop quality-based payment systems for compensating physicians or other providers of Medicaid or the child health plan that include the following (Sec.1):
• Aligning payment incentives with high-quality, cost-effective health care;
• Rewarding the use of evidence-based practices;
• Promoting the coordination of health care;
• Encouraging physician or other provider collaboration;
• Promoting effective health care delivery models; and
• Taking into account specific needs of the child health plan enrollees and Medicaid recipients.

• Establishes the Texas Institute of Health Care Quality and Efficiency with the goal of improving health care quality, accountability, education, and costs by encouraging collaboration, effective delivery, and coordination of services and consisting of the following members (Sec. 3):
• 15 directors appointed by the governor;
• The executive commissioner of the Health and Human Services Commission;
• The commissioner of the Department of State Health Services;
• The commissioner of insurance;
• The executive directors of the Employees Retirement System of Texas, the Teacher Retirement System of Texas, and the Texas Workforce commission;
• The state Medicaid director;
• The executive director of the Texas Medical Board;
• The commissioner of the Department of Aging and Disability Services;
• The commissioner of the Texas Higher Education Coordinating Board; and
• A representative from each institution of higher education that purchases health care services.

• Establishes the powers and duties of the Texas Institute of Health Care Quality and Efficiency as including, but not limited to, the following (Sec. 3):
• Making recommendations to the legislature on improving health care quality and efficiency;
• Improving reporting, transparency, and consolidation of health care information;
• Studying and making recommendations for alternative health care delivery systems; and
• Studying the feasibility of establishing a centralized database for health care claims information.

• Authorizes a department certified health care collaborative to provide health care services under contract with a governmental or private entity (Sec. 4).

• Defines "health care collaborative" as an entity that arranges for medical and health care services for insurers, health maintenance organizations, or other payers in exchange for payments in cash or otherwise, and that consists of the following (Sec. 4):
• Physicians;
• Physicians and other health care providers;
• Physicians and insurers or health maintenance organizations; or
• Physicians, other health care providers, and insurers or health maintenance organizations.

• Establishes the powers and duties of a health care collaborative as including, but not limited to, the following (Sec. 4):
• Providing or arranging for services;
• Enter into contracts with insurers to provide insurance, reinsurance, indemnification, or reimbursement for services;
• Enter into contracts with and accept payments from a governmental or private entity based on "free-for-service" or alternative payment mechanisms including quality-based payment; and
• All powers of a partnership, association, corporation, or limited liability company.

• Prohibits a health care collaborative from excluding a physician or other provider from participation in another health care collaborative (Sec. 4).

• Requires a health care collaborative to establish policies to improve health care quality and costs, including, but not limited to, the following procedures (Sec. 4):
• The selection and credentialing of physicians and other providers;
• The development, implementation, and evaluation of evidence-based practices to improve health care quality and cost including practices to reduce the occurrence of preventable events;
• The development, implementation, and evaluation of processes to improve patient engagement and coordination of services; and
• Complaints from participating physicians, providers, and patients.

• Authorizes the commissioner to impose sanctions, issue a cease and desist order, impose administrative penalties, or suspend or revoke the certification of a health care collaborative under certain circumstances (Sec. 4).

• Authorizes a public hospital or hospital district to form and sponsor a nonprofit health care collaborative (Sec. 4).

• Exempts a certified health care collaborative from antitrust laws (Sec. 2).

• Requires the Department of State Health Services to develop a standardized patient risk identification system that indicates to health care providers the existence of specific medical risks in patients, and requires hospitals to implement the system (Sec. 5).

• Requires all health care facilities to develop and implement a policy to protect patients from vaccine preventable diseases that includes the following, beginning September 1, 2012 (Sec. 8):
• Requiring employees and individuals providing direct patient care to receive vaccines based on the level of risk the individual presents to patients;
• Specifying the vaccines individuals are required to receive;
• Procedures and records to verify that individuals have complied with the policy;
• Procedures for certain individuals to be exempted, and for exempted individuals to protect patients from exposure;
• Prohibiting discrimination or retaliatory action against exempted individuals; and
• Disciplinary action for individuals that fail to comply with the policy.

• Repeals the State Kids Insurance Program, and transfers eligible children to the Child Health Insurance Program (Sec. 1).

• Rep. Alvarado was excused to attend a committee meeting, he would have voted no.

• Rep. Coleman was shown voting yes, he intended to vote no.

• Rep. Green was excused to attend a committee meeting, he would have voted yes.

• Rep. Harless was excused to attend a committee meeting, he would have voted yes.

Full Bill Text