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. 

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Public Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
CMS Health Care Innovation Award - University of Texas Health Science Center Grant Wider Houston area CMS Health Care Innovation Award (Round 1)
Coordinating All Resources Effectively (CARE) - Texas Grant California, Colorado, Florida, Missouri, Pennsylvania, Texas, Ohio CMS Health Care Innovation Award (Round 2)
PTN - VHA/UHC Alliance Newco (Vizient) Grant All 50 states Transforming Clinical Practices Initiative (TCPI)
Texas Dual Eligible Demonstration Medicare, Medicaid Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant counties CMS Dual Eligible Demonstration

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Aetna Medicare Advantage Network - Baylor Medical System Commercial Dallas
Blue Cross Blue Shield Texas Patient Centered Medical Home Program Commercial Dallas, Denton, Tarran, Collin and Johnson Counties Blue Cross Blue Shield Value-Based Care Program
Cigna Collaborative Accountable Care Program - HealthTexas Provider Network (HTPN) Commercial Dallas-Fort Worth Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Medical Clinic of North Texas (MCNT) Commercial North Texas Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Patient Physician Network Commercial Dallas Metro Area Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - St. Luke's Health Ssytem Clinically Integrated Providers and Renaissance Physician Organization Commercial Houston area Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Texas Health Resources/Texas Health Physicians Group Commercial North Texas Cigna Collaborative Care Program
Cigna Collaborative Accountable Care Program - Village Health Partners Commercial North Texas Cigna Collaborative Care Program
Cigna Collaborative Care Program - Austin Diagnostic Clinic Commercial Brazos Valley Cigna Collaborative Care Program
Cigna Collaborative Care Program - St. Joseph Health System Commercial Brazos Valley Cigna Collaborative Care Program
Humana medical home program - MHMD Commercial Houston Humana Medical Home Program
UnitedHealthcare Patient-Centered Medical Home Program- Texas Commercial UnitedHealthcare PCMH Program

State Legislation

Legislation Status Year
S.B. 58, 83rd Legislature, Regular Session, 201

The legislation charges HHSC with integrating behavioral and physical health services within the Medicaid managed care program.

Active 2013
S.B. 7, 82nd Legislature

The legislation called for a study by the Health and Human Services Commission (HHSC) 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.

Active 2011

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

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