Bill Text: TX HB1761 | 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) 2013-03-04 - Referred to Public Health [HB1761 Detail]
Download: Texas-2013-HB1761-Introduced.html
| 83R2664 KKR-D | ||
| By: Kolkhorst | H.B. No. 1761 | |
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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. | ||
