Tex. Gov't Code Section 542.0103
Alternative Payment Rate or Methodology


(a)

The pilot program must be designed to test the use of innovative payment rates and methodologies for the provision of long-term services and supports to achieve the goals of the pilot program. The payment methodologies must include:

(1)

the payment of a bundled amount without downside risk to a comprehensive long-term services and supports provider for some or all services delivered as part of a comprehensive array of long-term services and supports;

(2)

enhanced incentive payments to comprehensive long-term services and supports providers based on the completion of predetermined outcomes or quality metrics; and

(3)

any other payment model the commission approves.

(b)

An alternative payment rate or methodology may be used for a managed care organization and comprehensive long-term services and supports provider only if the organization and provider agree in advance and in writing to use the rate or methodology.

(c)

In developing an alternative payment rate or methodology, the commission, managed care organizations, and comprehensive long-term services and supports providers shall consider:

(1)

the historical costs of long-term services and supports, including Medicaid fee-for-service rates;

(2)

reasonable cost estimates for new services under the pilot program; and

(3)

whether an alternative payment rate or methodology is sufficient to promote quality outcomes and ensure a provider’s continued participation in the pilot program.

(d)

An alternative payment rate or methodology may not reduce the minimum payment a provider receives for delivering long-term services and supports under the pilot program to an amount that is less than the fee-for-service reimbursement rate the provider received for delivering those services before participating in the pilot program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.

Source: Section 542.0103 — Alternative Payment Rate or Methodology, https://statutes.­capitol.­texas.­gov/Docs/GV/htm/GV.­542.­htm#542.­0103 (accessed Jun. 5, 2024).

542.0001
Definitions
542.0002
Conflict with Other Law
542.0003
Delayed Implementation Authorized
542.0051
Redesign of Acute Care Services and Long-term Services and Supports System for Individuals with an Intellectual or Developmental Disability
542.0052
Intellectual and Developmental Disability System Redesign Advisory Committee
542.0053
Implementation of System Redesign
542.0054
Annual Report on Implementation
542.0101
Definitions
542.0102
Pilot Program to Test Person-centered Managed Care Strategies and Improvements Based on Capitation
542.0103
Alternative Payment Rate or Methodology
542.0104
Pilot Program Work Group
542.0105
Stakeholder Input
542.0106
Measurable Goals
542.0107
Managed Care Organization Selection
542.0108
Managed Care Organization Participation Requirements
542.0109
Required Benefits
542.0110
Provider Participation
542.0111
Care Coordination
542.0112
Person-centered Planning
542.0113
Use of Innovative Technology
542.0114
Informational Materials
542.0115
Implementation, Location, and Duration
542.0116
Recipient Enrollment, Participation, and Eligibility
542.0117
Pilot Program Information Collection and Analysis
542.0118
Pilot Program Conclusion
542.0119
Evaluations and Reports
542.0120
Transition Between Programs
542.0121
Service Transition Requirements
542.0151
Delivery of Acute Care Services to Individuals with an Intellectual or Developmental Disability
542.0201
Transition of Icf-iid Program Recipients and Certain Other Medicaid Waiver Program Recipients to Managed Care Program
542.0202
Recipient Choice of Delivery Model
542.0203
Required Contract Provisions
542.0204
Responsibilities of Commission Under Subchapter

Accessed:
Jun. 5, 2024

§ 542.0103’s source at texas​.gov