Texas Government Code Title 4, Chapter 536 - Medicaid And The Child Health Plan Program: Quality-based Outcomes And Payments
SUBCHAPTER A GENERAL PROVISIONS
- Texas Section 536.001 - Definitions
In this chapter: (1) Repealed by Acts 2015, 84th Leg., R.S., Ch. 837, Sec. 3.40(a)(21), and Ch. 946, Sec. 2.37(b)(20), eff. January 1, 2016. (2)...
- Texas Section 536.003 - Development Of Quality-based Outcome And Process Measures
(a) The commission shall develop quality-based outcome and process measures that promote the provision of efficient, quality health care and that can be used in...
- Texas Section 536.004 - Development Of Quality-based Payment Systems
(a) Using quality-based outcome and process measures developed under Section 536.003 and subject to this section, the commission, after consulting with appropriate stakeholders with an...
- Texas Section 536.005 - Conversion Of Payment Methodology
(a) To the extent possible, the commission shall convert hospital reimbursement systems under the child health plan program and Medicaid to a diagnosis-related groups (DRG)...
- Texas Section 536.006 - Transparency
(a) The commission shall: (1) ensure transparency in the development and establishment of: (A) quality-based payment and reimbursement systems under Section 536.004 and Subchapters B,...
- Texas Section 536.007 - Periodic Evaluation
(a) At least once each two-year period, the commission shall evaluate the outcomes and cost-effectiveness of any quality-based payment system or other payment initiative implemented...
SUBCHAPTER B QUALITY-BASED PAYMENTS RELATING TO MANAGED CARE ORGANIZATIONS
- Texas Section 536.008 - Annual Report
(a) The commission shall submit to the legislature and make available to the public an annual report regarding: (1) the quality-based outcome and process measures...
- Texas Section 536.051 - Development Of Quality-based Premium Payments; Performance Reporting
(a) Subject to Section 1903(m)(2)(A), Social Security Act (42 U.S.C. Section 1396b(m)(2)(A)), and other applicable federal law, the commission shall base a percentage of the...
SUBCHAPTER C QUALITY-BASED HEALTH HOME PAYMENT SYSTEMS
- Texas Section 536.052 - Payment And Contract Award Incentives For Managed Care Organizations
(a) The commission may allow a managed care organization participating in the child health plan program or Medicaid increased flexibility to implement quality initiatives in...
- Texas Section 536.101 - Definitions
In this subchapter: (1) "Health home" means a primary care provider practice or, if appropriate, a specialty care provider practice, incorporating several features, including comprehensive...
- Texas Section 536.102 - Quality-based Health Home Payments
(a) Subject to this subchapter, the commission may develop and implement quality-based payment systems for health homes designed to improve quality of care and reduce...
SUBCHAPTER D QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
- Texas Section 536.103 - Provider Eligibility
To be eligible to receive reimbursement under a quality-based payment system under this subchapter, a health home provider must: (1) provide participating enrollees, directly or...
- Texas Section 536.151 - Collection And Reporting Of Certain Information
(a) The executive commissioner shall adopt rules for identifying: (1) potentially preventable admissions and readmissions of child health plan program enrollees and Medicaid recipients, including...
SUBCHAPTER E QUALITY-BASED PAYMENT INITIATIVES
- Texas Section 536.152 - Reimbursement Adjustments
(a) Subject to Subsection (b), using the data collected under Section 536.151 and the diagnosis-related groups (DRG) methodology implemented under Section 536.005, if applicable, the...
- Texas Section 536.201 - Definition
In this subchapter, "payment initiative" means a quality-based payment initiative established under this subchapter. Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B....
- Texas Section 536.202 - Payment Initiatives; Determination Of Benefit To State
(a) The commission shall establish payment initiatives to test the effectiveness of quality-based payment systems, alternative payment methodologies, and high-quality, cost-effective health care delivery models...
- Texas Section 536.203 - Purpose And Implementation Of Payment Initiatives
(a) If the commission determines under Section 536.202 that implementation of one or more payment initiatives is feasible and cost-effective for this state, the commission...
- Texas Section 536.204 - Standards; Protocols
Sec. 536.204. STANDARDS; PROTOCOLS. (a) The executive commissioner shall develop quality of care and cost-efficiency benchmarks and measurable goals that a payment initiative must meet...
SUBCHAPTER F QUALITY-BASED LONG-TERM SERVICES AND SUPPORTS PAYMENT SYSTEMS
- Texas Section 536.205 - Payment Rates Under Payment Initiatives
The executive commissioner may contract with appropriate entities, including qualified actuaries, to assist in determining appropriate payment rates for a payment initiative implemented under this...
- Texas Section 536.251 - Quality-based Long-term Services And Supports Payments
(a) Subject to this subchapter, the commission, after consulting with appropriate stakeholders representing nursing facility providers with an interest in the provision of long-term services...
- Texas Section 536.252 - Evaluation Of Data Sets
To ensure that the commission is using the best data to inform the development and implementation of quality-based payment systems under Section 536.251, the commission...
- Texas Section 536.253 - Collection And Reporting Of Certain Information
(a) The executive commissioner shall adopt rules for identifying the incidence of potentially preventable admissions, potentially preventable readmissions, and potentially preventable emergency room visits by...
Last modified: September 28, 2016