Government Code § 543A.0201

Sec. 543A.0201. PAYMENT INITIATIVES; DETERMINATION OF BENEFIT TO STATE. (a) The commission shall establish payment initiatives to test the effectiveness of quality-based payment systems, alternative payment methodologies, and high-quality, cost-effective health care delivery models that provide incentives to physicians and other health care providers to develop health care interventions for enrollees or recipients that will: (1) improve the quality of health care provided to the enrollees or recipients; (2) reduce potentially preventable events; (3) promote prevention and wellness; (4) increase the use of evidence-based best practices; (5) increase appropriate physician and other health care provider collaboration; (6) contain costs; and (7) improve integration of acute care services and long-term services and supports, including discharge planning from acute care services to community-based long-term services and supports. (b) The commission shall: (1) establish a process through which a physician, other health care provider, or managed care organization may submit a proposal for a payment initiative; and (2) determine whether implementing one or more proposed payment initiatives is feasible and cost-effective. (c) If the commission determines that implementing one or more payment initiatives is feasible and cost-effective for this state, the commission shall establish one or more payment initiatives as provided by this subchapter. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.