LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 76th Regular Session March 15, 1999 TO: Honorable Patricia Gray, Chair, House Committee on Public Health FROM: John Keel, Director, Legislative Budget Board IN RE: HB897 by Haggerty (Relating to medical assistance payments for ambulance services.), As Introduced ************************************************************************** * Estimated Two-year Net Impact to General Revenue Related Funds for * * HB897, As Introduced: negative impact of $(29,447,074) through * * the biennium ending August 31, 2001. * * * * The bill would make no appropriation but could provide the legal * * basis for an appropriation of funds to implement the provisions of * * the bill. * ************************************************************************** The bill would require the Medicaid program, for ambulance services for individuals eligible for Medicaid and Medicare, to pay the difference between the customary rate prevailing in a community and the maximum Medicare allowable charges for the same service. General Revenue-Related Funds, Five-Year Impact: **************************************************** * Fiscal Year Probable Net Positive/(Negative) * * Impact to General Revenue Related * * Funds * * 2000 $(14,723,537) * * 2001 (14,723,537) * * 2002 (14,723,537) * * 2003 (14,723,537) * * 2004 (14,723,537) * **************************************************** All Funds, Five-Year Impact: ***************************************************** * Fiscal Year Probable Savings/(Cost) from * * General Revenue Fund * * 0001 * * 2000 $(14,723,537) * * 2001 (14,723,537) * * 2002 (14,723,537) * * 2003 (14,723,537) * * 2004 (14,723,537) * ***************************************************** Fiscal Analysis According to analysis by the Department of Health, the bill would define customary rate to mean amounts billed by ambulance services in local areas. Methodology The average ambulance charge in the state is assumed to be $428.88. The average Medicaid payment per claim amount is the 20 percent share of the Medicare maximum allowed reimbursement. The Medicare average payment per claim is $274.80. The Medicare maximum reimbursement is the sum of $68.30 plus $274.80 equals $343.10. The difference between the billed amount ($428.88) and the average paid claim amount would be $85.78, paid from general revenue. The number of ambulance trips per year is assumed to be 171,643. According to the Department of Health, federal matching funds would not be available for these increased reimbursement amounts and therefore the difference between the billed amount estimated above and the average paid claim amount estimated above would be paid from 100 percent state dollars. Local Government Impact No significant fiscal implication to units of local government is anticipated. Source Agencies: LBB Staff: JK, TP, AZ, KF