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  S.B. No. 1542
 
 
 
 
AN ACT
  relating to clinical initiatives to improve the quality of care and
  cost-effectiveness of the Medicaid program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 538 to read as follows:
  CHAPTER 538.  MEDICAID QUALITY IMPROVEMENT PROCESS FOR CLINICAL
  INITIATIVES
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 538.001.  DEFINITION. In this chapter, "Medicaid
  program" means the medical assistance program established under
  Chapter 32, Human Resources Code.
         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 the Medicaid program;
               (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 the Medicaid program.
         Sec. 538.003.  RULES.  The executive commissioner shall
  adopt rules necessary to implement this chapter.
  SUBCHAPTER B.  MEDICAID QUALITY IMPROVEMENT PROCESS TO ASSESS
  CERTAIN CLINICAL INITIATIVES
         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 the
  Medicaid program; and
                     (B)  the cost-effectiveness of the Medicaid
  program;
               (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) and of required clinical initiatives under
  Section 538.0521.
         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 the Department of Aging and
  Disability Services;
               (4)  the commissioner of the Department of State Health
  Services;
               (5)  the commissioner of the Department of Family and
  Protective Services;
               (6)  the commissioner of the Department of Assistive
  and Rehabilitative Services;
               (7)  the medical care advisory committee established
  under Section 32.022, Human Resources Code;
               (8)  the physician payment advisory committee created
  under Section 32.022(d), Human Resources Code; and
               (9)  the Electronic Health Information Exchange System
  Advisory Committee established under Section 531.904.
         (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.
         Sec. 538.0521.  REQUIRED CLINICAL INITIATIVES.  (a)  In
  addition to the clinical initiatives selected for analysis under
  Section 538.054, the commission shall conduct an analysis and issue
  a final report in accordance with the requirements of this chapter
  for the following:
               (1)  an initiative that would require hospitals to
  implement evidence-based protocols, including early goal-directed
  therapy, in the treatment of severe sepsis and septicemia; and
               (2)  an initiative that would authorize the Medicaid
  program to provide blood-based allergy testing for patients with
  persistent asthma to develop an appropriate treatment strategy that
  would minimize exposure to allergy-induced asthma attacks.
         (b)  This section expires August 31, 2014.
         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.
         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 the
  Medicaid program if implemented in this state, including:
                     (A)  an estimate of the number of recipients under
  the Medicaid program 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.
         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 the
  Medicaid program; 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.
         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.
         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 the Medicaid program, 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 the Medicaid program; and
               (2)  if the commission has determined that the
  initiative is not cost-effective or will not improve quality of
  care under the Medicaid program, the commission may not implement
  the initiative.
         SECTION 2.  Not later than January 1, 2014, the Health and
  Human Services Commission shall conduct an analysis and submit a
  final report on the clinical initiatives required under Section
  538.0521, Government Code, as added by this Act.
         SECTION 3.  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 4.  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.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1542 passed the Senate on
  May 6, 2013, by the following vote:  Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1542 passed the House on
  May 20, 2013, by the following vote:  Yeas 142, Nays 5, two
  present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor