By Chavez H.B. No. 2467
77R6491 SGA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to rates and expenditures under the Medicaid and state
1-3 child health plan program in strategic investment areas.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 531, Government Code, is
1-6 amended by adding Section 531.0221 to read as follows:
1-7 Sec. 531.0221. RATES AND EXPENDITURES IN STRATEGIC
1-8 INVESTMENT AREAS. (a) In this section:
1-9 (1) "Child health plan program" means the state child
1-10 health plan program authorized by Chapter 62, Health and Safety
1-11 Code.
1-12 (2) "Committee" means the advisory committee on
1-13 funding disparities in health programs appointed by the
1-14 commissioner under this section.
1-15 (3) "Strategic investment area" has the meaning
1-16 assigned by Section 171.721, Tax Code.
1-17 (b) The commissioner shall appoint an advisory committee to
1-18 develop a strategic plan for eliminating the disparities between
1-19 strategic investment areas and other areas of the state in:
1-20 (1) capitation rates under Medicaid managed care and
1-21 the child health plan program;
1-22 (2) fee for service reimbursement rates under the
1-23 Medicaid program and the child health plan program for inpatient
1-24 and outpatient hospital services; and
2-1 (3) total professional services expenditures per
2-2 Medicaid recipient or per child enrolled in the child health plan
2-3 program.
2-4 (c) Periodically the committee shall perform the research
2-5 necessary to analyze and compare the rates and expenditures
2-6 described by Subsection (b) and, not later than the date specified
2-7 by the commissioner, produce a report based on the results of that
2-8 analysis and comparison.
2-9 (d) The committee shall, as part of the report required by
2-10 Subsection (c), make recommendations to the commissioner for
2-11 addressing the problems created by disparities documented in the
2-12 report, including recommendations for allocation of funds.
2-13 (e) The commissioner shall appoint nine members to the
2-14 advisory committee in a manner that ensures that the committee:
2-15 (1) represents the spectrum of geographic areas
2-16 included in strategic investment areas;
2-17 (2) includes persons who are knowledgeable regarding
2-18 the Medicaid program, including Medicaid managed care, and the
2-19 child health plan program; and
2-20 (3) represents the interests of physicians, hospitals,
2-21 patients, managed care organizations, state agencies involved in
2-22 the management and delivery of medical resources of any kind,
2-23 affected communities, and other areas of the state.
2-24 (f) The committee shall elect officers from among the
2-25 members of the committee.
2-26 (g) Appointments to the committee shall be made without
2-27 regard to the race, color, disability, sex, religion, age, or
3-1 national origin of the appointees.
3-2 (h) A member of the committee may not receive compensation,
3-3 but is entitled to reimbursement of travel expenses incurred by
3-4 the member while conducting the business of the committee as
3-5 provided by the General Appropriations Act.
3-6 (i) The commission shall provide administrative support and
3-7 resources to the committee as necessary for the committee to
3-8 perform the duties under this section.
3-9 (j) The committee is not subject to Chapter 2110, Government
3-10 Code.
3-11 (k) With advice from the committee, the commission shall
3-12 ensure that for the child health plan program, the disparities in
3-13 rates and expenditures described by Subsection (b) are eliminated
3-14 as soon as practicable so that the rates and expenditures in
3-15 strategic investment areas equal the statewide average rates and
3-16 expenditures.
3-17 (l) With advice from the committee, the commission shall
3-18 conduct three pilot programs to equalize Medicaid rates and
3-19 expenditures and provide physician incentives. Each pilot program
3-20 must be located in a county in a strategic investment area and:
3-21 (1) be characterized as a rural, urban, or border
3-22 county;
3-23 (2) demonstrate a high patient-to-physician ratio;
3-24 (3) have a history of low utilization of inpatient,
3-25 outpatient, and professional services;
3-26 (4) demonstrate a relative inequity in rates and
3-27 expenditures described by Subsection (b) compared to the statewide
4-1 averages computed under Subsection (n); and
4-2 (5) have Medicaid managed care service providers.
4-3 (m) With advice from the committee, the commission shall
4-4 ensure in the pilot program areas that:
4-5 (1) the disparities in rates and expenditures
4-6 described by Subsection (b) are eliminated as soon as practicable
4-7 so that Medicaid rates and expenditures in the pilot program areas
4-8 equal the statewide average rates and expenditures; and
4-9 (2) a physician providing a service to a Medicaid
4-10 recipient in the pilot program areas receives, in addition to
4-11 reimbursement at the rate required under Subdivision (1), a bonus
4-12 in the amount of 10 percent of the reimbursement customarily
4-13 provided to a physician providing that service in another region of
4-14 the state.
4-15 (n) For purposes of Subsections (k) and (m), the commission
4-16 shall exclude data from strategic investment areas in determining
4-17 the statewide average capitation rates under Medicaid managed care
4-18 and the child health plan program and the statewide average total
4-19 professional services expenditures per Medicaid recipient or per
4-20 child enrolled in the child health plan program.
4-21 (o) With advice from the committee and other appropriate
4-22 groups, the commission may vary the amount of any rate increases
4-23 for professional services required by Subsections (k) and (m)
4-24 according to the type of service provided.
4-25 (p) The commission shall develop mechanisms to pass any rate
4-26 increase required by Subsections (k) and (m) directly to providers.
4-27 (q) The commission shall contract with a public university
5-1 to:
5-2 (1) measure changes occurring from September 1, 2001,
5-3 to August 31, 2004, in the number of health care providers
5-4 participating in the Medicaid program or the child health plan
5-5 program in strategic investment areas and resulting effects on
5-6 consumer access to health care and consumer utilization;
5-7 (2) determine the effects, if any, of the changes in
5-8 rates and expenditures required by Subsection (k);
5-9 (3) make a recommendation regarding whether the pilot
5-10 program should be expanded to other areas of the state; and
5-11 (4) not later than December 1, 2004, submit a report
5-12 to the legislature.
5-13 (r) This section expires September 1, 2011.
5-14 SECTION 2. If before implementing any provision of this Act
5-15 a state agency determines that a waiver or authorization from a
5-16 federal agency is necessary for implementation of that provision,
5-17 the agency affected by the provision shall request the waiver or
5-18 authorization and may delay implementing that provision until the
5-19 waiver or authorization is granted.
5-20 SECTION 3. (a) The changes in rates and expenditures
5-21 required by Sections 531.0221(k) and (m), Government Code, as added
5-22 by this Act, must be initiated not later than September 1, 2002.
5-23 (b) The advisory committee on funding disparities in health
5-24 programs shall deliver the first report required by Section
5-25 531.0221(c), Government Code, as added by this Act, not later than
5-26 September 1, 2002.
5-27 SECTION 4. This Act takes effect September 1, 2001.