SRC-JEC S.B. 1056 77(R)   BILL ANALYSIS


Senate Research Center   S.B. 1056
77R7039 JAT-DBy: Shapleigh
Health & Human Services
3/20/2001
As Filed


DIGEST AND PURPOSE 

Currently, the Children's Health Insurance Program (CHIP) capitation rates
for the 43 border counties are significantly lower than those of other
counties in the state, due to historical underutilization of services.  As
proposed, S.B. 1056 requires the Texas Health and Human Services Commission
to increase CHIP capitation rates for Texas-Mexico border counties to a
statewide average and to provide a financial incentive for CHIP physicians
practicing in the border region. 

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a
state officer, institution, or agency.  

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 62D, Health and Safety Code, by adding Section
62.157, as follows: 

Sec. 62.157.  CAPITATION AND REIMBURSEMENT RATES IN THE TEXASMEXICO BORDER
REGION.  (a)  Defines "Texas-Mexico border region" and "work group." 

(b)  Requires the Texas Department of Health (department) to ensure that in
the TexasMexico border region: 

(1)  any capitation rate under the state child health plan under this
chapter is at least equal to the statewide average capitation rate under
the plan; 

(2)  any fee-for-service reimbursement rates under the state child health
plan under this chapter for inpatient and outpatient hospital services and
professional services result in an average expenditure for each enrollee in
the state child health plan in that region that is at least equal to the
statewide average expenditure for each enrollee in the plan; and 

(3)  a physician providing a service to an enrollee in the state child
health plan in that region receives, in addition to reimbursement at the
rate required under Subdivision (2), a bonus in the amount of 10 percent of
the reimbursement customarily provided to a physician providing that
service in another region of the state. 

(c)  Requires the department, for purposes of Subsections (b)(1) and (2),
to exclude data from the Texas-Mexico border region in determining the
statewide average capitation rate under the state child health plan and the
statewide average expenditure per enrollee in the plan. 

(d)  Authorizes the department, with advice from the work group and other
appropriate  groups, to vary the amount of rate increases for professional
services according to the type of service provided. 

(e)  Requires the department to develop mechanisms to pass any rate
increase required by this section directly to health care providers,
regardless of which type of health plan provider is providing payment. 

SECTION 2.  Requires a state agency, if before implementing this Act it
determines that a waiver or authorization from a federal agency is
necessary for implementation, to request the waiver or authorization and
authorizes the state agency to delay implementing that provision until the
waiver or authorization is granted. 

SECTION 3.  Requires the rates required by Section 62.157, Health and
Safety Code, as added by this Act, to be implemented not later than
September 1, 2001. 

SECTION 4.  Effective date: September 1, 2001.