Texas
In 2011, S.B. 7, 82nd Legislature called for a study by the Health and Human Services Commission to submit a report to the Texas Legislature regarding the commission's work to ensure that Medicaid managed care organizations promote the development of patient-centered medical homes (PCMH) for recipients of medical assistance and provide payment incentives for clinicians that meet the requirements of a PCMH as required under Section 533.0029, Government Code. Beginning December 1, 2013, MCOs must develop and submit to HHSC an annual plan for expansion of alternative payment structures with its providers that encourage innovation, collaboration and increase quality and efficiency. The plans must include mechanisms by which the MCO will provide incentive payments to hospitals, physicians, and other providers for quality of care. Plans will include quality metrics required for incentives, recruitment strategies of providers, and a proposed structure for incentive payments, shared savings, or both.
S.B. 58, 83rd Legislature, Regular Session, 2013 charges HHSC with integrating behavioral and physical health services within the Medicaid managed care program. Under this legislation, by September 1, 2014, HHSC shall establish two health home pilot programs in two health service areas, representing two distinct regions of the state for persons who are diagnosed with a serious mental illness and at least one other chronic condition.
The Texas Department of State Health Services has an active Medical Home Learning Collaborative (MHLC), formerly the Medical Home Workgroup, which meets quarterly via conference call in order for members to share knowledge, implement strategies, and best practices on the philosophy and effectiveness of medical homes. Their mission is to enhance the development and promote the principles of the Patient-Centered Medical Home model within the state of Texas for all children and youth including those with special health care needs.
On May 23, 2014 the state of Texas signed a Memorandum of Understanding with the Centers for Medicare & Medicaid Services regarding a Federal-State partnership to test a capitated financial alignment model for the dual eligible population.
CHIPRA:
No
MAPCP:
No
Dual Eligible:
Yes
2703 Health Home:
No
CPCi:
No
SIM Awards:
No
PCMH in QHP:
No
Legislative PCMH Initiative:
Yes
Private Payer Program:
Yes
State Facts:
Population:
26,422,500
Uninsured Population:
20%
Total Medicaid Spending FY 2013:
$28.3 Billion
Overweight/Obese Adults:
66.1%
Poor Mental Health among Adults:
28.1%
Medicaid Expansion:
No
CPC+:
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