HBA-NRS S.B. 1053 77(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1053 By: Shapleigh Public Health 5/7/2001 Engrossed BACKGROUND AND PURPOSE The Texas-Mexico border region suffers from an inadequate medical infrastructure. Patient to physician ratios in the region have historically been among the highest in the state. In February 2000, the Health and Human Services Commission (HHSC) convened the Border Rate Work Group (work group) to study and recommend solutions regarding Medicaid and state child health plan (CHIP) reimbursement rates along the Texas-Mexico border. The work group concluded that the lack of access to health care services along the border has reduced the utilization rate of these services, that the border region receives disproportionately low Medicaid reimbursement because of low utilization, and that Medicaid and CHIP capitation rates are locked into a historic disparity because they are based on past fee for service reimbursements. The work group also found that lower revenues provide a disincentive for health care providers to locate and remain in the border region. The work group recommended increasing Medicaid and CHIP reimbursement rates in this region to recruit more doctors and increase access to care. Senate Bill 1053 requires HHSC to increase Medicaid and CHIP reimbursement rates for recipients younger than 19 years of age in the Texas-Mexico border region to an adjusted statewide average and to provide physicians a bonus for serving in the region with funds specifically appropriated for those purposes. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. ANALYSIS Senate Bill 1053 amends the Government Code to require the commissioner of health and human services (commissioner) to appoint an advisory committee (committee) to develop a strategic plan for eliminating the disparities between the Texas-Mexico border region (region) and other areas of the state in certain Medicaid and state child health plan (CHIP) rates and expenditures for recipients younger than 19 years of age. The bill requires the committee periodically to perform the research necessary to analyze and compare the rates and expenditures and to produce a report based on the results of that analysis and comparison. The bill requires the committee to make recommendations, including recommendations for allocation of funds, to the commissioner for addressing the problems created by the disparities documented in the report. The bill sets forth provisions for the appointment and administration of the committee. With advice from the committee, the bill requires the Health and Human Services Commission (HHSC) to ensure that: _the disparities in rates and expenditures between the region and other areas of the state are eliminated by increasing the rates and expenditures in the region to the extent that funds are specifically appropriated so that the rates and expenditures in the region equal, or equal as nearly as possible, the statewide average; and _a physician providing a service to a Medicaid recipient younger than 19 years of age or a CHIP recipient in the region receives, in addition to reimbursement at the average statewide rate, a bonus to the extent possible with funds specifically appropriated for these purposes. The bill requires HHSC to exclude data from the region in determining the statewide average capitation rates and the statewide average total expenditures. With advice from the committee and other appropriate groups, the bill authorizes HHSC to vary the amount of any rate increases for services according to the type of service provided. The bill requires HHSC to develop mechanisms to pass any rate increase directly to providers. The bill requires HHSC to contract with a public university to study the impact of eliminating disparities in rates and expenditures in the region and to submit a report to the legislature, not later than December 1, 2004. The changes in rates and expenditures must be initiated not later than September 1, 2002. The bill requires the advisory committee to deliver its first report not later than January 1, 2002. The bill expires September 1, 2011. EFFECTIVE DATE September 1, 2001.