By Chavez H.B. No. 2469
77R6489 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 12 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 with:
2-17 (A) four members from the Texas-Mexico border
2-18 region as defined by Section 2056.002;
2-19 (B) four members from urban centers outside the
2-20 Texas-Mexico border region; and
2-21 (C) four members from rural areas outside the
2-22 Texas-Mexico border region;
2-23 (2) includes persons who are knowledgeable regarding
2-24 the Medicaid program, including Medicaid managed care, and the
2-25 child health plan program; and
2-26 (3) represents the interests of physicians, hospitals,
2-27 patients, managed care organizations, state agencies involved in
3-1 the management and delivery of medical resources of any kind,
3-2 affected communities, and other areas of the state.
3-3 (f) The committee shall elect officers from among the
3-4 members of the committee.
3-5 (g) Appointments to the committee shall be made without
3-6 regard to the race, color, disability, sex, religion, age, or
3-7 national origin of the appointees.
3-8 (h) A member of the committee may not receive compensation,
3-9 but is entitled to reimbursement of travel expenses incurred by
3-10 the member while conducting the business of the committee as
3-11 provided by the General Appropriations Act.
3-12 (i) The commission shall provide administrative support and
3-13 resources to the committee as necessary for the committee to
3-14 perform the duties under this section.
3-15 (j) The committee is not subject to Chapter 2110, Government
3-16 Code.
3-17 (k) With advice from the committee, the commission shall
3-18 ensure that:
3-19 (1) the disparities in rates and expenditures
3-20 described by Subsection (b) are eliminated as soon as practicable
3-21 so that the rates and expenditures in strategic investment areas
3-22 equal the statewide average rates and expenditures; and
3-23 (2) a physician providing a service to a Medicaid
3-24 recipient in a strategic investment area receives, in addition to
3-25 reimbursement at the rate required under Subdivision (1), a bonus
3-26 in the amount of 10 percent of the reimbursement customarily
3-27 provided to a physician providing that service in another region of
4-1 the state.
4-2 (l) For purposes of Subsection (k), the commission shall
4-3 exclude data from strategic investment areas in determining the
4-4 statewide average capitation rates under Medicaid managed care and
4-5 the child health plan program and the statewide average total
4-6 professional services expenditures per Medicaid recipient or per
4-7 child enrolled in the child health plan program.
4-8 (m) With advice from the committee and other appropriate
4-9 groups, the commission may vary the amount of any rate increases
4-10 for professional services required by Subsection (k) according to
4-11 the type of service provided.
4-12 (n) The commission shall develop mechanisms to pass any rate
4-13 increase required by Subsection (k) directly to providers,
4-14 including providers in Medicaid managed care service delivery areas
4-15 with health maintenance organization, prepaid health plan, or
4-16 primary care case management models.
4-17 (o) The commission shall contract with a public university
4-18 to:
4-19 (1) measure changes occurring from September 1, 2001,
4-20 to August 31, 2004, in the number of health care providers
4-21 participating in the Medicaid program or the child health plan
4-22 program in strategic investment areas and resulting effects on
4-23 consumer access to health care and consumer utilization;
4-24 (2) determine the effects, if any, of the changes in
4-25 rates and expenditures required by Subsection (k); and
4-26 (3) not later than December 1, 2004, submit a report
4-27 to the legislature.
5-1 (p) This section expires September 1, 2011.
5-2 SECTION 2. If before implementing any provision of this Act
5-3 a state agency determines that a waiver or authorization from a
5-4 federal agency is necessary for implementation of that provision,
5-5 the agency affected by the provision shall request the waiver or
5-6 authorization and may delay implementing that provision until the
5-7 waiver or authorization is granted.
5-8 SECTION 3. (a) The changes in rates and expenditures
5-9 required by Section 531.0221(k), Government Code, as added by this
5-10 Act, must be initiated not later than September 1, 2002.
5-11 (b) The advisory committee on funding disparities in health
5-12 programs shall deliver the first report required by Section
5-13 531.0221(c), Government Code, as added by this Act, not later than
5-14 September 1, 2002.
5-15 SECTION 4. This Act takes effect September 1, 2001.