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.
Structure Texas Statutes
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 536.003. Development of Quality-Based Outcome and Process Measures
Section 536.004. Development of Quality-Based Payment Systems
Section 536.005. Conversion of Payment Methodology