By Chavez                                             H.B. No. 2468
         77R7039 JAT-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to capitation and reimbursement rates under the state
 1-3     child health plan in the Texas-Mexico border region.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. Subchapter D, Chapter 62, Health and Safety Code,
 1-6     is amended by adding Section 62.157 to read as follows:
 1-7           Sec. 62.157.  CAPITATION AND REIMBURSEMENT RATES IN THE
 1-8     TEXAS-MEXICO BORDER REGION. (a)  In this section:
 1-9                 (1)  "Texas-Mexico border region" has the meaning
1-10     assigned by Section 2056.002, Government Code.
1-11                 (2)  "Work group" means the Border Rate Work Group on
1-12     Medicaid and CHIP formed by the Health and Human Services
1-13     Commission to study issues and make recommendations regarding
1-14     capitation and reimbursement rates in the Texas-Mexico border
1-15     region under the medical assistance program and the state child
1-16     health plan program under Chapter 62, Health and Safety Code.
1-17           (b)  With advice from the work group, the department shall
1-18     ensure that in the Texas-Mexico border region:
1-19                 (1)  any capitation rate under the state child health
1-20     plan under this chapter is at least equal to the statewide average
1-21     capitation rate under the plan;
1-22                 (2)  any fee-for-service reimbursement rates under the
1-23     state child health plan under this chapter for inpatient and
1-24     outpatient hospital services and professional services result in an
 2-1     average expenditure for each enrollee in the state child health
 2-2     plan in that region that is at least equal to the statewide average
 2-3     expenditure for each enrollee in the plan; and
 2-4                 (3)  a physician providing a service to an enrollee in
 2-5     the state child health plan in that region receives, in addition to
 2-6     reimbursement at the rate required under Subdivision (2), a bonus
 2-7     in the amount of 10 percent of the reimbursement customarily
 2-8     provided to a physician providing that service in another region of
 2-9     the state.
2-10           (c)  For purposes of Subsections (b)(1) and (2), the
2-11     department shall exclude data from the Texas-Mexico border region
2-12     in determining the statewide average capitation rate under the
2-13     state child health plan and the statewide average expenditure per
2-14     enrollee in the plan.
2-15           (d)  With advice from the work group and other appropriate
2-16     groups, the department may vary the amount of rate increases for
2-17     professional services according to the type of service provided.
2-18           (e)  The department shall develop mechanisms to pass any rate
2-19     increase required by this section directly to health care
2-20     providers, regardless of which type of health plan provider is
2-21     providing payment.
2-22           SECTION 2. If before implementing any provision of this Act a
2-23     state agency determines that a waiver or authorization from a
2-24     federal agency is necessary for implementation of that provision,
2-25     the agency affected by the provision shall request the waiver or
2-26     authorization and may delay implementing that provision until the
2-27     waiver or authorization is granted.
 3-1           SECTION 3. The rates required by Section 62.157, Health and
 3-2     Safety Code, as added by this Act, must be implemented not later
 3-3     than September 1, 2001.
 3-4           SECTION 4.  This Act takes effect September 1, 2001.