Arizona grabbed the Medicaid headlines this week after federal officials said the state could drop safety-net coverage for 280,000 residents. Minnesota, too, made news as the CMS approved a Medicaid expansion in that state.
In Texas, a less splashy, but nonetheless interesting Medicaid proposal was put forward by a Republican state senator. The Texas health commissioner would gain broad authority to devise Medicaid payments tied to quality and cost savings under a newly introduced bill by Jane Nelson.
No sector would be exempt. Managed-care plans, primary-care doctors or specialists, and hospitals could all see pay tied to performance under the bill. A state agency would study performance incentives for nursing homes.
Nelson, who chairs the Texas Senate Health and Human Service Committee, oversaw a study last year of Medicaid payment reform.
The legislation introduced this week could make hospitals eligible for bonuses and penalties or a share of savings for those that surpass efficiency targets. The Texas Hospital Association endorsed the bill and companion legislation.
Details are few, but the Texas bill directs architects of the proposed performance payments to consider any similar efforts by Medicare. The agency that oversees Medicare and Medicaid recently proposed rules for value-based purchasing under the Patient Protection and Affordable Care Act, which also includes provisions for bundled service payments and accountable care organizations. Rules for accountable care groups, which tie financial incentives to quality gains and cost controls, are expected this month.
Payment models that will not cost Texas more than it already spends could be tested (for at least one year) by region, provider network, or by various healthcare services.
The Texas law also proposes an advisory committee, which must include a doctor with experience in clinical practice and a member of the state's healthcare-associated infection and preventable adverse event panel.
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