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A BILL TO BE ENTITLED
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AN ACT
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relating to a report regarding Medicaid reimbursement rates, |
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supplemental payment amounts, and access to care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. (a) In this section: |
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(1) "Commission" means the Health and Human Services |
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Commission. |
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(2) "Supplemental payment amount" includes a payment |
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made to a Medicaid provider under the Texas Healthcare |
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Transformation and Quality Improvement Program waiver issued under |
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Section 1115 of the Social Security Act (42 U.S.C. Section 1315), |
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another program operating under a waiver to the state Medicaid plan |
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that provides a payment in excess of the Medicaid reimbursement |
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rate, or the Medicaid disproportionate share hospital payment |
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program. |
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(b) The commission shall prepare a written report regarding |
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provider reimbursement rates, supplemental payment amounts paid to |
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providers, and access to care under Medicaid. The commission shall |
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collaborate with the state Medicaid managed care advisory committee |
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to develop and define the scope of the research for the report. The |
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report must: |
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(1) review the provider reimbursement rates and |
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supplemental payment amounts for at least 20 Medicaid-covered |
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services; |
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(2) outline factors of the reimbursement rate and |
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supplemental payment amount methodologies used by Medicaid managed |
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care organizations; |
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(3) propose alternative reimbursement and |
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supplemental payment amount methodologies; |
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(4) evaluate the impact of Medicaid provider |
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reimbursement rates and supplemental payment amounts on access to |
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care for Medicaid recipients, including specifically evaluating |
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the impact of Medicaid provider reimbursement rates and |
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supplemental payment amounts for mental health and substance use |
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disorder services on that access to care; |
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(5) compare the reimbursement rates and supplemental |
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payment amounts paid to mental health and substance use disorder |
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providers to the rates and amounts paid to other Medicaid |
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providers; |
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(6) compare provider participation in Medicaid by |
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region, particularly increases or decreases in the number of |
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participating providers per year beginning with the state fiscal |
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year ending August 31, 2012, categorized by provider specialty and |
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subspecialty; |
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(7) list to the extent the information is available, |
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for each state fiscal quarter beginning with the first quarter of |
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the state fiscal year ending August 31, 2017: |
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(A) counties in which provider access standards |
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relating to distance have not been met; and |
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(B) counties in which provider access standards |
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relating to travel time have not been met; |
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(8) examine Medicaid directed provider payments and |
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their effect on incentivizing providers to participate or continue |
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participating in Medicaid, including: |
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(A) the uniform hospital rate increase program |
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described by 1 T.A.C. Section 353.1305; |
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(B) the quality incentive payment program |
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(QIPP); and |
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(C) the minimum reimbursement rate for nursing |
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facilities described by Section 533.00251, Government Code; and |
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(9) determine the feasibility and cost of |
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establishing: |
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(A) a minimum fee schedule for Medicaid providers |
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in counties where provider access standards are not being met; and |
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(B) a different reimbursement rate or |
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supplemental payment amount for classes of providers who provide |
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care in a county: |
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(i) located on an international border; or |
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(ii) with a Medicaid population at least 10 |
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percent higher than the statewide average Medicaid population. |
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(c) Not later than December 1, 2022, the commission shall |
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prepare and submit to the legislature the report described by |
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Subsection (b) of this section. Notwithstanding that subsection, |
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the commission is not required to include in the report any |
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information the commission determines is proprietary. |
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SECTION 2. This Act takes effect September 1, 2021. |