reglab/housing_qa huggingface dataset:
TX Govt Code § 536.202 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter E. Quality-Based Payment Initiatives|Section 536.202. Payment Initiatives; Determination of Benefit to State

Sec. 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 that provide incentives to physicians and other health care providers to develop health care interventions for child health plan program enrollees or Medicaid recipients, or both, that will:(1)  improve the quality of health care provided to the enrollees or recipients;(2)  reduce potentially preventable events;(3)  promote prevention and wellness;(4)  increase the use of evidence-based best practices;(5)  increase appropriate physician and other health care provider collaboration;(6)  contain costs; and(7)  improve integration of acute care services and long-term services and supports, including discharge planning from acute care services to community-based long-term services and supports.(b)  The commission shall:(1)  establish a process by which managed care organizations and physicians and other health care providers may submit proposals for payment initiatives described by Subsection (a); and(2)  determine whether it is feasible and cost-effective to implement one or more of the proposed payment initiatives.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.12(a), eff. September 28, 2011.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 4.16, eff. September 1, 2013.Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.28, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.28, eff. January 1, 2016.|
TX Govt Code § 536.203 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter E. Quality-Based Payment Initiatives|Section 536.203. Purpose and Implementation of Payment Initiatives

Sec. 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 shall establish one or more payment initiatives as provided by this subchapter.(b)  The commission shall administer any payment initiative established under this subchapter.  The executive commissioner may adopt rules, plans, and procedures and enter into contracts and other agreements as the executive commissioner considers appropriate and necessary to administer this subchapter.(c)  The commission may limit a payment initiative to:(1)  one or more regions in this state;(2)  one or more organized networks of physicians and other health care providers; or(3)  specified types of services provided under the child health plan program or Medicaid, or specified types of enrollees or recipients under those programs.(d)  A payment initiative implemented under this subchapter must be operated for at least one calendar year.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.12(a), eff. September 28, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.268, eff. April 2, 2015.|
TX Govt Code § 536.204 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter E. Quality-Based Payment Initiatives|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 to ensure high-quality and cost-effective health care services and healthy outcomes.(b)  In addition to the benchmarks and goals under Subsection (a), the executive commissioner may approve efficiency performance standards that may include the sharing of realized cost savings with physicians and other health care providers who provide health care services that exceed the efficiency performance standards.  The efficiency performance standards may not create any financial incentive for or involve making a payment to a physician or other health care provider that directly or indirectly induces the limitation of medically necessary services.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.12(a), eff. September 28, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.29, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.29, eff. January 1, 2016.|
TX Govt Code § 536.205 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter E. Quality-Based Payment Initiatives|Section 536.205. Payment Rates Under Payment Initiatives

Sec. 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 subchapter.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.12(a), eff. September 28, 2011.|
TX Govt Code § 536.251 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter F. Quality-Based Long-Term Services and Supports Payment Systems|Section 536.251. Quality-Based Long-Term Services and Supports Payments

Sec. 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 and supports, may develop and implement quality-based payment systems for Medicaid long-term services and supports providers designed to improve quality of care and reduce the provision of unnecessary services.  A quality-based payment system developed under this section must base payments to providers on quality and efficiency measures that may include measurable wellness and prevention criteria and use of evidence-based best practices, sharing a portion of any realized cost savings achieved by the provider, and ensuring quality of care outcomes, including a reduction in potentially preventable events.(b)  The commission may develop a quality-based payment system for Medicaid long-term services and supports providers under this subchapter only if implementing the system would be feasible and cost-effective.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 4.17, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.30, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.30, eff. January 1, 2016.|
TX Govt Code § 536.252 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter F. Quality-Based Long-Term Services and Supports Payment Systems|Section 536.252. Evaluation of Data Sets

Sec. 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 shall evaluate the reliability, validity, and functionality of post-acute and long-term services and supports data sets.  The commission's evaluation under this section should assess:(1)  to what degree data sets relied on by the commission meet a standard:(A)  for integrating care;(B)  for developing coordinated care plans; and(C)  that would allow for the meaningful development of risk adjustment techniques;(2)  whether the data sets will provide value for outcome or performance measures and cost containment; and(3)  how classification systems and data sets used for Medicaid long-term services and supports providers can be standardized and, where possible, simplified.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 4.17, eff. September 1, 2013.|
TX Govt Code § 536.253 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 536 - Medicaid and the Child Health Plan Program: Quality-Based Outcomes and Payments|Subchapter F. Quality-Based Long-Term Services and Supports Payment Systems|Section 536.253. Collection and Reporting of Certain Information

Sec. 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 Medicaid long-term services and supports recipients.(b)  The commission shall establish a program to provide a report to each Medicaid long-term services and supports provider in this state regarding the provider's performance with respect to potentially preventable admissions, potentially preventable readmissions, and potentially preventable emergency room visits.  To the extent possible, a report provided under this section should include applicable potentially preventable events information across all Medicaid payment systems.(c)  Subject to Subsection (d), a report provided to a provider under this section is confidential and is not subject to Chapter 552.(d)  The commission may release the information in the report described by Subsection (b):(1)  not earlier than one year after the date the report is submitted to the provider; and(2)  only after deleting any data that relates to a provider's performance with respect to particular resource utilization groups or individual recipients.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 4.17, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.269, eff. April 2, 2015.|
TX Govt Code § 538.002 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter A. General Provisions|Section 538.002. Effect of Chapter; Authority of Commission

Sec. 538.002.  EFFECT OF CHAPTER; AUTHORITY OF COMMISSION.  This chapter does not affect or give the commission additional authority to:(1)  affect any individual health care treatment decision for a Medicaid recipient;(2)  replace or affect the process of determining Medicaid benefits, including the approval process for receiving benefits for durable medical equipment, or any applicable approval process required for reimbursement for services or other equipment under Medicaid;(3)  implement a clinical initiative or associated rule or program policy that is otherwise prohibited under state or federal law; or(4)  implement any initiative that would expand eligibility for benefits under Medicaid.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.271, eff. April 2, 2015.|
TX Govt Code § 538.003 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter A. General Provisions|Section 538.003. Rules

Sec. 538.003.  RULES.  The executive commissioner shall adopt rules necessary to implement this chapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.|
TX Govt Code § 538.051 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.051. Medicaid Quality Improvement Process

Sec. 538.051.  MEDICAID QUALITY IMPROVEMENT PROCESS.  The commission shall, according to the provisions of this chapter, develop and implement a quality improvement process by which the commission:(1)  receives suggestions for clinical initiatives designed to improve:(A)  the quality of care provided under Medicaid; and(B)  the cost-effectiveness of Medicaid;(2)  conducts a preliminary review under Section 538.053(4) of each suggestion received under Section 538.052 to determine whether the suggestion warrants further consideration and analysis; and(3)  conducts an analysis under Section 538.054 of clinical initiative suggestions that are selected for analysis under Subdivision (2).|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.272, eff. April 2, 2015.|
TX Govt Code § 538.052 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.052. Solicitation of Suggestions for Clinical Initiatives

Sec. 538.052.  SOLICITATION OF SUGGESTIONS FOR CLINICAL INITIATIVES.(a)  Subject to Subsection (b), the commission shall solicit and accept suggestions for clinical initiatives, in either written or electronic form, from:(1)  a member of the state legislature;(2)  the executive commissioner;(3)  the commissioner of aging and disability services;(4)  the commissioner of state health services;(5)  the commissioner of the Department of Family and Protective Services;(6)  the commissioner of assistive and rehabilitative services;(7)  the medical care advisory committee established under Section 32.022, Human Resources Code; and(8)  the physician payment advisory committee created under Section 32.022(d), Human Resources Code.(b)  The commission may not accept suggestions under this section for an initiative that:(1)  is undergoing clinical trials; or(2)  expands a health care provider's scope of practice beyond the law governing the provider's practice.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.273, eff. April 2, 2015.Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.31, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.31, eff. January 1, 2016.|
TX Govt Code § 538.053 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.053. Clinical Initiative Evaluation Process

Sec. 538.053.  CLINICAL INITIATIVE EVALUATION PROCESS.  The commission shall establish and implement an evaluation process for the submission, preliminary review, analysis, and approval of a clinical initiative.  The process must:(1)  require that a suggestion for a clinical initiative be submitted to the state Medicaid director;(2)  require that a suggestion for a clinical initiative selected for analysis under Section 538.054 be published on the Internet website created under Section 538.056 not later than the 30th day after the date on which the state Medicaid director receives the suggestion;(3)  provide for a formal public comment period that lasts at least 30 days during which the public may submit comments and research relating to a suggested clinical initiative;(4)  allow the commission to conduct with the assistance of appropriate advisory committees or similar groups as determined by the commission a preliminary review of each suggested clinical initiative to determine whether the initiative warrants further consideration and analysis under Section 538.054;(5)  limit the number of suggestions that receive analysis under Section 538.054;(6)  require the commission to publish on the Internet website created under Section 538.056 the criteria the commission uses in the preliminary review under Subdivision (4) to determine whether an initiative warrants analysis under Section 538.054;(7)  require commission employees to perform an analysis of each suggested clinical initiative selected for analysis in accordance with Section 538.054; and(8)  require the development and publication of a final report in accordance with Section 538.055 on each clinical initiative selected for analysis under Section 538.054 not later than the 180th day after the date on which the state Medicaid director receives the suggestion.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.|
TX Govt Code § 538.054 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.054. Analysis of Clinical Initiatives

Sec. 538.054.  ANALYSIS OF CLINICAL INITIATIVES.  The commission shall conduct an analysis of each clinical initiative selected by the commission after having conducted the commission's preliminary review under Section 538.053(4).  The analysis required under this section must include a review of:(1)  any public comments and submitted research relating to the initiative;(2)  the available clinical research and historical utilization information relating to the initiative;(3)  published medical literature relating to the initiative;(4)  any adoption of the initiative by medical societies or other clinical groups;(5)  whether the initiative has been implemented under:(A)  the Medicare program;(B)  another state medical assistance program; or(C)  a state-operated health care program, including the child health plan program;(6)  the results of reports, research, pilot programs, or clinical studies relating to the initiative conducted by:(A)  institutions of higher education, including related medical schools;(B)  governmental entities and agencies; and(C)  private and nonprofit think tanks and research groups;(7)  the impact that the initiative would have on Medicaid if the initiative were implemented in this state, including:(A)  an estimate of the number of recipients under Medicaid that would be impacted by implementation of the initiative; and(B)  a description of any potential cost savings to the state that would result from implementation of the initiative; and(8)  any statutory barriers to implementation of the initiative.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.274, eff. April 2, 2015.|
TX Govt Code § 538.055 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.055. Final Report on Clinical Initiative

Sec. 538.055.  FINAL REPORT ON CLINICAL INITIATIVE.  The commission shall prepare a final report based on the commission's analysis of a clinical initiative under Section 538.054.  The final report must include:(1)  a final determination of:(A)  the feasibility of implementing the initiative;(B)  the likely impact implementing the initiative would have on the quality of care provided under Medicaid; and(C)  the anticipated cost savings to the state that would result from implementing the initiative;(2)  a summary of the public comments, including a description of any opposition to the initiative;(3)  an identification of any statutory barriers to implementation of the initiative; and(4)  if the initiative is not implemented, an explanation of the decision not to implement the initiative.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.275, eff. April 2, 2015.|
TX Govt Code § 538.056 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.056. Internet Website

Sec. 538.056.  INTERNET WEBSITE.  The commission shall maintain an Internet website related to the quality improvement process required under this chapter.  The website must include:(1)  an explanation of the process for submission, preliminary review, analysis, and approval of clinical initiatives under this chapter;(2)  an explanation of how members of the public may submit comments or research related to an initiative;(3)  a copy of each initiative selected for analysis under Section 538.054;(4)  the status of each initiative in the approval process; and(5)  a copy of each final report prepared under this chapter.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.|
TX Govt Code § 538.057 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 538 - Medicaid Quality Improvement Process for Clinical Initiatives|Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives|Section 538.057. Action on Clinical Initiative by Commission

Sec. 538.057.  ACTION ON CLINICAL INITIATIVE BY COMMISSION.  After the commission conducts an analysis of a clinical initiative under Section 538.054:(1)  if the commission has determined that the initiative is cost-effective and will improve the quality of care under Medicaid, the commission may:(A)  implement the initiative if implementation of the initiative is not otherwise prohibited by law; or(B)  if implementation requires a change in law, submit a copy of the final report together with recommendations relating to the initiative's implementation to the standing committees of the senate and house of representatives having jurisdiction over Medicaid; and(2)  if the commission has determined that the initiative is not cost-effective or will not improve quality of care under Medicaid, the commission may not implement the initiative.|Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.276, eff. April 2, 2015.|