reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter B. Governmental Liaisons for Faith- And › Section 535.051. Designation of Faith- and Community-Based Liaisons

Text of section effective until April 01, 2025
Sec. 535.051.  DESIGNATION OF FAITH- AND COMMUNITY-BASED LIAISONS.  (a)  The executive commissioner, in consultation with the governor, shall designate one employee from the commission and from each health and human services agency to serve as a liaison for faith- and community-based organizations.
(b)  The chief administrative officer of each of the following state agencies, in consultation with the governor, shall designate one employee from the agency to serve as a liaison for faith- and community-based organizations:
(1)   the Texas Commission on Environmental Quality;
(2)  the Texas Department of Criminal Justice;
(3)  the Texas Department of Housing and Community Affairs;
(4)  the Texas Juvenile Justice Department;
(5)  the Texas Veterans Commission;
(6)  the Texas Workforce Commission;
(7)  the office of the governor;
(8)  the Department of Public Safety;
(9)  the Texas Department of Insurance;
(10)  the Public Utility Commission of Texas;
(11)  the office of the attorney general;
(12)  the Department of Agriculture;
(13)  the office of the comptroller;
(14)  the Department of Information Resources;
(15)  the Office of State-Federal Relations;
(16)  the office of the secretary of state; and
(17)  other state agencies as determined by the governor.
(c)  The commissioner of higher education, in consultation with the presiding officer of the interagency coordinating group, shall designate one employee from an institution of higher education, as that term is defined under Section 61.003, Education Code, to serve as a liaison for faith- and community-based organizations.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 298 (H.B. 1965), Sec. 1, eff. June 17, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1176 (H.B. 3278), Sec. 2, eff. June 17, 2011.
Acts 2013, 83rd Leg., R.S., Ch. 161 (S.B. 1093), Sec. 9.012, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.257, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter B. Governmental Liaisons for Faith- And › Section 535.052. General Duties of Liaisons

Text of section effective until April 01, 2025
Sec. 535.052.  GENERAL DUTIES OF LIAISONS.  (a)  A faith- and community-based liaison designated under Section 535.051 shall:
(1)  identify and remove unnecessary barriers to partnerships between the state agency the liaison represents and faith- and community-based organizations;
(2)  provide information and training, if necessary, for employees of the state agency the liaison represents regarding equal opportunity standards for faith- and community-based organizations seeking to partner with state government;
(3)  facilitate the identification of practices with demonstrated effectiveness for faith- and community-based organizations that partner with the state agency the liaison represents;
(4)  work with the appropriate departments and programs of the state agency the liaison represents to conduct outreach efforts to inform and welcome faith- and community-based organizations that have not traditionally formed partnerships with the agency;
(5)  coordinate all efforts with the governor's office of faith-based and community initiatives and provide information, support, and assistance to that office as requested to the extent permitted by law and as feasible; and
(6)  attend conferences sponsored by federal agencies and offices and other relevant entities to become and remain informed of issues and developments regarding faith- and community-based initiatives.
(b)  A faith- and community-based liaison designated under Section 535.051 may coordinate and interact with statewide organizations that represent faith- or community-based organizations as necessary to accomplish the purposes of this chapter.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter B. Governmental Liaisons for Faith- And › Section 535.053. Interagency Coordinating Group

Text of section effective until April 01, 2025
Sec. 535.053.  INTERAGENCY COORDINATING GROUP.  (a)  The interagency coordinating group for faith- and community-based initiatives is composed of each faith- and community-based liaison designated under Section 535.051 and a liaison from the State Commission on National and Community Service.
(a-1)  Service on the interagency coordinating group is an additional duty of the office or position held by each person designated as a liaison under Section 535.051(b).  The state agencies described by Section 535.051(b) shall provide administrative support for the interagency coordinating group as coordinated by the presiding officer.
(b)  The liaison from the State Commission on National and Community Service is the presiding officer of the interagency coordinating group.  If the State Commission on National and Community Service is abolished, the liaison from the governor's office is the presiding officer of the interagency coordinating group.
(c)  The interagency coordinating group shall:
(1)  meet periodically at the call of the presiding officer;
(2)  work across state agencies and with the State Commission on National and Community Service to facilitate the removal of unnecessary interagency barriers to partnerships between state agencies and faith- and community-based organizations; and
(3)  operate in a manner that promotes effective partnerships between those agencies and organizations to serve residents of this state who need assistance.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 298 (H.B. 1965), Sec. 2, eff. June 17, 2011.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.18, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.18, eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter B. Governmental Liaisons for Faith- And › Section 535.054. Report

Text of section effective until April 01, 2025
Sec. 535.054.  REPORT.  (a)  Not later than December 1 of each year, the interagency coordinating group shall submit a report to the legislature that describes in detail the activities, goals, and progress of the interagency coordinating group.
(b)  The report made under Subsection (a) must be made available to the public through posting on the office of the governor's Internet website.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 298 (H.B. 1965), Sec. 3, eff. June 17, 2011.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter C. Renewing Our Communities Account › Section 535.101. Definition

Text of section effective until April 01, 2025
Sec. 535.101.  DEFINITION.  In this subchapter, "account" means the renewing our communities account.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter C. Renewing Our Communities Account › Section 535.102. Purposes of Subchapter

Text of section effective until April 01, 2025
Sec. 535.102.  PURPOSES OF SUBCHAPTER.  Recognizing that faith- and community-based organizations provide a range of vital charitable services to persons in this state, the purposes of this subchapter are to:
(1)  increase the impact and effectiveness of those organizations;
(2)  forge stronger partnerships between those organizations and state government so that communities are empowered to serve persons in need and community capacity for providing services is strengthened; and
(3)  create a funding mechanism that builds on the established efforts of those organizations and operates to create new partnerships in local communities for the benefit of this state.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter C. Renewing Our Communities Account › Section 535.103. Renewing Our Communities Account

Text of section effective until April 01, 2025
Sec. 535.103.  RENEWING OUR COMMUNITIES ACCOUNT.  (a)  The renewing our communities account is an account in the general revenue fund that may be appropriated only to the commission for the purposes and activities authorized by this subchapter and for reasonable administrative expenses under this subchapter.
(b)  The account consists of:
(1)  all money appropriated for the purposes of this subchapter; and
(2)  any gifts, grants, or donations received for the purposes of this subchapter.
(c)  The account is exempt from the application of Section 403.095.
(d)  The purposes of the account are to:
(1)  increase the capacity of faith- and community-based organizations to provide charitable services and to manage human resources and funds;
(2)  assist local governmental entities in establishing local offices to promote faith- and community-based initiatives; and
(3)  foster better partnerships between state government and faith- and community-based organizations.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.258, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter C. Renewing Our Communities Account › Section 535.105. Administration of Account Funds

Text of section effective until April 01, 2025
Sec. 535.105.  ADMINISTRATION OF ACCOUNT FUNDS.  If under Section 535.104 the commission contracts with or awards a grant to the State Commission on National and Community Service, that entity:
(1)  may award grants from funds appropriated from the account to:
(A)  faith- and community-based organizations that provide charitable services to persons in this state for capacity-building purposes; and
(B)  local governmental entities to provide seed money for local offices for faith- and community-based initiatives; and
(2)  shall monitor performance and outcome measures for persons to whom that entity awards grants using the measures established by the commission under Section 535.104(a)(6).
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter C. Renewing Our Communities Account › Section 535.106. Reports and Public Information

Text of section effective until April 01, 2025
Sec. 535.106.  REPORTS AND PUBLIC INFORMATION.  (a)  The commission shall provide a link on the commission's Internet website to the Internet website of the State Commission on National and Community Service if the commission contracts with or awards a grant to that entity under Section 535.104.  The entity's Internet website must provide:
(1)  a list of the names of each person to whom the entity awarded a grant from money appropriated from the account and the amount and purpose of the grant; and
(2)  information regarding the methods by which the public may request information about those grants.
(b)  If awarded a contract or grant under Section 535.104, the State Commission on National and Community Service must provide to the commission periodic reports on a schedule determined by the executive commissioner.  The schedule of periodic reports must include an annual report that includes:
(1)  a specific accounting with respect to the use by that entity of money appropriated from the account, including the names of persons to whom grants have been awarded and the purposes of those grants; and
(2)  a summary of the efforts of the faith- and community-based liaisons designated under Section 535.051 to comply with the duties imposed by and the purposes of Sections 535.052 and 535.053.
(c)  The commission shall post the annual report made under Subsection (b) on the commission's Internet website and shall provide copies of the report to the governor, the lieutenant governor, and the members of the legislature.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 A. General Provisions › Section 536.005. Conversion of Payment Methodology

Text of section effective until April 01, 2025
Sec. 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) methodology that will allow the commission to more accurately classify specific patient populations and account for severity of patient illness and mortality risk.
(b)  Subsection (a) does not authorize the commission to direct a managed care organization to compensate physicians and other health care providers providing services under the organization's managed care plan based on a diagnosis-related groups (DRG) methodology.
(c)  Notwithstanding Subsection (a) and to the extent possible, the commission shall convert outpatient hospital reimbursement systems under the child health plan program and Medicaid to an appropriate prospective payment system that will allow the commission to:
(1)  more accurately classify the full range of outpatient service episodes;
(2)  more accurately account for the intensity of services provided; and
(3)  motivate outpatient service providers to increase efficiency and effectiveness.
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. 4.09, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.263, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 A. General Provisions › Section 536.006. Transparency

Text of section effective until April 01, 2025
Sec. 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, C, and D, including the development of outcome and process measures under Section 536.003; and
(B)  quality-based payment initiatives under Subchapter E, including the development of quality of care and cost-efficiency benchmarks under Section 536.204(a) and efficiency performance standards under Section 536.204(b);
(2)  develop guidelines establishing procedures for providing notice and information to, and receiving input from, managed care organizations, health care providers, including physicians and experts in the various medical specialty fields, and other stakeholders, as appropriate, for purposes of developing and establishing the quality-based payment and reimbursement systems and initiatives described under Subdivision (1);
(3)  in developing and establishing the quality-based payment and reimbursement systems and initiatives described under Subdivision (1), consider that as the performance of a managed care organization or physician or other health care provider improves with respect to an outcome or process measure, quality of care and cost-efficiency benchmark, or efficiency performance standard, as applicable, there will be a diminishing rate of improved performance over time; and
(4)  develop web-based capability to provide managed care organizations and health care providers with data on their clinical and utilization performance, including comparisons to peer organizations and providers located in this state and in the provider's respective region.
(b)  The web-based capability required by Subsection (a)(4) must support the requirements of the electronic health information exchange system under Sections 531.907 through 531.909.
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. 4.10, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.24, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.24, eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 A. General Provisions › Section 536.007. Periodic Evaluation

Text of section effective until April 01, 2025
Sec. 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 under this chapter.
(b)  Repealed by Acts 2015, 84th Leg., R.S., Ch. 946, Sec. 2.37(b)(24), and Ch. 837, Sec. 3.40(a)(23), eff. January 1, 2016.
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. 3.40(a)(23), eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.37(b)(24), eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 A. General Provisions › Section 536.008. Annual Report

Text of section effective until April 01, 2025
Sec. 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 developed under Section 536.003, including measures based on each potentially preventable event; and
(2)  the progress of the implementation of quality-based payment systems and other payment initiatives implemented under this chapter.
(b)  As appropriate, the commission shall report outcome and process measures under Subsection (a)(1) by:
(1)  geographic location, which may require reporting by county, health care service region, or other appropriately defined geographic area;
(2)  recipient population or eligibility group served;
(3)  type of health care provider, such as acute care or long-term care provider;
(4)  number of recipients who relocated to a community-based setting from a less integrated setting;
(5)  quality-based payment system; and
(6)  service delivery model.
(c)  The report required under this section may not identify specific health care providers.
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. 4.11, eff. September 1, 2013.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 B. Quality-Based Payments Relating to Managed Care Organizations › Section 536.051. Development of Quality-Based Premium Payments; Performance Reporting

Text of section effective until April 01, 2025
Sec. 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 premiums paid to a managed care organization participating in the child health plan program or Medicaid on the organization's performance with respect to outcome and process measures developed under Section 536.003 that address potentially preventable events.  The percentage of the premiums paid may increase each year.
(b)  The commission shall make available information relating to the performance of a managed care organization with respect to outcome and process measures under this subchapter to child health plan program enrollees and Medicaid recipients before those enrollees and recipients choose their managed care plans.
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. 4.12, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.264, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 B. Quality-Based Payments Relating to Managed Care Organizations › Section 536.052. Payment and Contract Award Incentives for Managed Care Organizations

Text of section effective until April 01, 2025
Sec. 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 a managed care plan offered by the organization, including flexibility with respect to financial arrangements, in order to:
(1)  achieve high-quality, cost-effective health care;
(2)  increase the use of high-quality, cost-effective delivery models;
(3)  reduce the incidence of unnecessary institutionalization and potentially preventable events; and
(4)  increase the use of alternative payment systems, including shared savings models, in collaboration with physicians and other health care providers.
(b)  The commission shall develop quality of care and cost-efficiency benchmarks, including benchmarks based on a managed care organization's performance with respect to reducing potentially preventable events and containing the growth rate of health care costs.
(c)  The commission may include in a contract between a managed care organization and the commission financial incentives that are based on the organization's successful implementation of quality initiatives under Subsection (a) or success in achieving quality of care and cost-efficiency benchmarks under Subsection (b).
(d)  In awarding contracts to managed care organizations under the child health plan program and Medicaid, the commission shall, in addition to considerations under Section 533.003 of this code and Section 62.155, Health and Safety Code, give preference to an organization that offers a managed care plan that successfully implements quality initiatives under Subsection (a) as determined by the commission based on data or other evidence provided by the organization or meets quality of care and cost-efficiency benchmarks under Subsection (b).
(e)  The commission may implement financial incentives under this section only if implementing the incentives would be cost-effective.
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. 4.13, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.265, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.25, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.25, eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 C. Quality-Based Health Home Payment Systems › Section 536.101. Definitions

Text of section effective until April 01, 2025
Sec. 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 care coordination, family-centered care, and data management, that are focused on improving outcome-based quality of care and increasing patient and provider satisfaction under the child health plan program and Medicaid.
(2)  "Participating enrollee" means a child health plan program enrollee or Medicaid recipient who has a health home.
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. 2.266, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 C. Quality-Based Health Home Payment Systems › Section 536.102. Quality-Based Health Home Payments

Text of section effective until April 01, 2025
Sec. 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 the provision of unnecessary medical services.  A quality-based payment system developed under this section must:
(1)  base payments made to a participating enrollee's health home 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 health home, and ensuring quality of care outcomes, including a reduction in potentially preventable events; and
(2)  allow for the examination of measurable wellness and prevention criteria, use of evidence-based best practices, and quality of care outcomes based on the type of primary or specialty care provider practice.
(b)  The commission may develop a quality-based payment system for health homes under this subchapter only if implementing the system would be feasible and cost-effective.
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. 3.26, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.26, eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 C. Quality-Based Health Home Payment Systems › Section 536.103. Provider Eligibility

Text of section effective until April 01, 2025
Sec. 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 indirectly, with access to health care services outside of regular business hours;
(2)  educate participating enrollees about the availability of health care services outside of regular business hours; and
(3)  provide evidence satisfactory to the commission that the provider meets the requirement of Subdivision (1).
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.12(a), eff. September 28, 2011.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 D. Quality-Based Hospital Reimbursement System › Section 536.151. Collection and Reporting of Certain Information

Text of section effective until April 01, 2025
Sec. 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 preventable admissions to long-term care facilities;
(2)  potentially preventable ancillary services provided to or ordered for child health plan program enrollees and Medicaid recipients;
(3)  potentially preventable emergency room visits by child health plan program enrollees and Medicaid recipients; and
(4)  potentially preventable complications experienced by child health plan program enrollees and Medicaid recipients.
(a-1)  The commission shall collect data from hospitals on present-on-admission indicators for purposes of this section.
(b)  The commission shall establish a program to provide a confidential report to each hospital in this state that participates in the child health plan program or Medicaid regarding the hospital's performance with respect to each potentially preventable event described under Subsection (a).  To the extent possible, a report provided under this section should include all potentially preventable events across all child health plan program and Medicaid payment systems.  A hospital shall distribute the information contained in the report to physicians and other health care providers providing services at the hospital.
(c)  Except as provided by Subsection (d), a report provided to a hospital 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 hospital; and
(2)  only after deleting any data that relates to a hospital's performance with respect to particular diagnosis-related groups or individual patients.
Added by Acts 2009, 81st Leg., R.S., Ch. 1120 (H.B. 1218), Sec. 1, eff. September 1, 2009.
Transferred, redesignated and amended from Government Code, Section 531.913 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. 4.14, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.267, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 D. Quality-Based Hospital Reimbursement System › Section 536.152. Reimbursement Adjustments

Text of section effective until April 01, 2025
Sec. 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 commission shall to the extent feasible adjust child health plan and Medicaid reimbursements to hospitals, including payments made under the disproportionate share hospitals and upper payment limit supplemental payment programs, based on the hospital's performance with respect to exceeding, or failing to achieve, outcome and process measures developed under Section 536.003 that address the rates of potentially preventable readmissions and potentially preventable complications.
(b)  The commission must provide the report required under Section 536.151(b) to a hospital at least one year before the commission adjusts child health plan and Medicaid reimbursements to the hospital under this section.
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. 4.15, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.27, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.27, eff. January 1, 2016.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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 536.201. Definition

Text of section effective until April 01, 2025
Sec. 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. 7), Sec. 1.12(a), eff. September 28, 2011.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 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

Text of section effective until April 01, 2025
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.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.