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.
Structure Texas Statutes
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
Section 536.203. Purpose and Implementation of Payment Initiatives