By:  Shapleigh, et al.                                S.B. No. 1053
                                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 programs 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 TEXAS-MEXICO BORDER
 1-8     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.
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 for services provided to persons
1-22     younger than 19 years of age;
1-23                 (2)  fee-for-service per capita expenditures under the
1-24     Medicaid program and the child health plan program for inpatient
1-25     and outpatient hospital services for services provided to persons
 2-1     younger than 19 years of age; and
 2-2                 (3)  total professional services expenditures per
 2-3     Medicaid recipient younger than 19 years of age or per child
 2-4     enrolled in the child health plan program.
 2-5           (c)  Periodically the committee shall perform the research
 2-6     necessary to analyze and compare the rates and expenditures
 2-7     described by Subsection (b) and, not later than the date specified
 2-8     by the commissioner, produce a report based on the results of that
 2-9     analysis and comparison.
2-10           (d)  The committee shall, as part of the report required by
2-11     Subsection (c), make recommendations to the commissioner for
2-12     addressing the problems created by disparities documented in the
2-13     report, including recommendations for allocation of funds.
2-14           (e)  The commissioner shall appoint nine members to the
2-15     advisory committee in a manner that ensures that the committee:
2-16                 (1)  represents the spectrum of geographic areas
2-17     included in the Texas-Mexico border region;
2-18                 (2)  includes persons who are knowledgeable regarding
2-19     the Medicaid program, including Medicaid managed care, and the
2-20     child health plan program; and
2-21                 (3)  represents the interests of physicians, hospitals,
2-22     patients, managed care organizations, state agencies involved in
2-23     the management and delivery of medical resources of any kind,
2-24     affected communities, and other areas of the state.
2-25           (f)  The committee shall elect officers from among the
2-26     members of the committee.
 3-1           (g)  Appointments to the committee shall be made without
 3-2     regard to the race, color, disability, sex, religion, age, or
 3-3     national origin of the appointees.
 3-4           (h)  A member of the committee may not receive compensation,
 3-5     but is entitled to reimbursement  of travel expenses incurred by
 3-6     the member while conducting the business of the committee as
 3-7     provided by the General Appropriations Act.
 3-8           (i)  The commission shall provide administrative support and
 3-9     resources to the committee as necessary for the committee to
3-10     perform the duties under this section.
3-11           (j)  The committee is not subject to Chapter 2110.
3-12           (k)  With advice from the committee, the commission shall
3-13     ensure that:
3-14                 (1)  the disparities in rates and expenditures
3-15     described by Subsection (b) are eliminated as soon as practicable
3-16     for services provided to a person younger than 19 years of age by
3-17     increasing the rates and expenditures in the Texas-Mexico border
3-18     region, to the extent that funds are specifically appropriated for
3-19     purposes of this subsection, so that the rates and expenditures in
3-20     that region equal, or equal as nearly as possible, the statewide
3-21     average rates and expenditures; and
3-22                 (2)  a physician providing a service to a Medicaid
3-23     recipient younger than 19 years of age or a recipient of services
3-24     under the child health plan program in the Texas-Mexico border
3-25     region receives, in addition to reimbursement at the rate required
3-26     under Subdivision (1), a bonus to the extent possible with funds
 4-1     specifically appropriated for purposes of this subsection.
 4-2           (l)  For purposes of Subsection (k), the commission shall
 4-3     exclude data from the Texas-Mexico border region 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     expenditures per Medicaid recipient younger than 19 years of age or
 4-7     per 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 services required by Subsection (k) according to the type of
4-11     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 the Texas-Mexico border region and resulting effects on
4-23     consumer access to health care and consumer utilization;
4-24                 (2)  determine:
4-25                       (A)  the effects, if any, of the changes in rates
4-26     and expenditures required by Subsection (k); and
 5-1                       (B)  if funding available and used for changes in
 5-2     rates and expenditures was sufficient to produce measurable
 5-3     effects;
 5-4                 (3)  make a recommendation regarding whether Medicaid
 5-5     rate increases should be expanded to include Medicaid services
 5-6     provided to adults in the Texas-Mexico border region; and
 5-7                 (4)  not later than December 1, 2004, submit a report
 5-8     to the legislature.
 5-9           (p)  This section expires September 1, 2011.
5-10           SECTION 2.  If before implementing any provision of this Act
5-11     a state agency determines that a waiver or authorization from a
5-12     federal agency is necessary for implementation of that provision,
5-13     the agency affected by the provision shall request the waiver or
5-14     authorization and may delay implementing that provision until the
5-15     waiver or authorization is granted.
5-16           SECTION 3.  (a)  The changes in rates and expenditures
5-17     required by Subsection (k), Section 531.0221, Government Code, as
5-18     added by this Act, must be initiated not later than September 1,
5-19     2002.
5-20           (b)  The advisory committee on funding disparities in health
5-21     programs shall deliver the first report required by Subsection (c),
5-22     Section 531.0221, Government Code, as added by this Act, not later
5-23     than January 1, 2002.
5-24           SECTION 4.  This Act takes effect September 1, 2001.