By Chavez H.B. No. 2470 77R2896 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 the Texas-Mexico border region. 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 THE TEXAS-MEXICO 1-8 BORDER REGION. (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) "Texas-Mexico border region" has the meaning 1-16 assigned by Section 2056.002, Government 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 the Texas-Mexico border region 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 the Texas-Mexico border region; 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: 3-13 (1) the disparities in rates and expenditures 3-14 described by Subsection (b) are eliminated as soon as practicable 3-15 so that the rates and expenditures in the Texas-Mexico border 3-16 region equal the statewide average rates and expenditures; and 3-17 (2) a physician providing a service to a Medicaid 3-18 recipient in the Texas-Mexico border region receives, in addition 3-19 to reimbursement at the rate required under Subdivision (1), a 3-20 bonus in the amount of 10 percent of the reimbursement customarily 3-21 provided to a physician providing that service in another region of 3-22 the state. 3-23 (l) For purposes of Subsection (k), the commission shall 3-24 exclude data from the Texas-Mexico border region in determining the 3-25 statewide average capitation rates under Medicaid managed care and 3-26 the child health plan program and the statewide average total 3-27 professional services expenditures per Medicaid recipient or per 4-1 child enrolled in the child health plan program. 4-2 (m) With advice from the committee and other appropriate 4-3 groups, the commission may vary the amount of any rate increases 4-4 for professional services required by Subsection (k) according to 4-5 the type of service provided. 4-6 (n) The commission shall develop mechanisms to pass any rate 4-7 increase required by Subsection (k) directly to providers, 4-8 including providers in Medicaid managed care service delivery areas 4-9 with health maintenance organization, prepaid health plan, or 4-10 primary care case management models. 4-11 (o) The commission shall contract with a public university 4-12 to: 4-13 (1) measure changes occurring from September 1, 2001, 4-14 to August 31, 2004, in the number of health care providers 4-15 participating in the Medicaid program or the child health plan 4-16 program in the Texas-Mexico border region and resulting effects on 4-17 consumer access to health care and consumer utilization; 4-18 (2) determine the effects, if any, of the changes in 4-19 rates and expenditures required by Subsection (k); and 4-20 (3) not later than December 1, 2004, submit a report 4-21 to the legislature. 4-22 (p) This section expires September 1, 2011. 4-23 SECTION 2. If before implementing any provision of this Act 4-24 a state agency determines that a waiver or authorization from a 4-25 federal agency is necessary for implementation of that provision, 4-26 the agency affected by the provision shall request the waiver or 4-27 authorization and may delay implementing that provision until the 5-1 waiver or authorization is granted. 5-2 SECTION 3. (a) The changes in rates and expenditures 5-3 required by Section 531.0221(k), Government Code, as added by this 5-4 Act, must be initiated not later than September 1, 2002. 5-5 (b) The advisory committee on funding disparities in health 5-6 programs shall deliver the first report required by Section 5-7 531.0221(c), Government Code, as added by this Act, not later than 5-8 September 1, 2002. 5-9 SECTION 4. This Act takes effect September 1, 2001.