1-1 By: Shapleigh, et al. S.B. No. 1053 1-2 (In the Senate - Filed March 2, 2001; March 6, 2001, read 1-3 first time and referred to Committee on Health and Human Services; 1-4 April 20, 2001, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 6, Nays 1; April 20, 2001, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1053 By: Shapleigh 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to rates and expenditures under the Medicaid and state 1-11 child health plan programs in the Texas-Mexico border region. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter B, Chapter 531, Government Code, is 1-14 amended by adding Section 531.0221 to read as follows: 1-15 Sec. 531.0221. RATES AND EXPENDITURES IN TEXAS-MEXICO BORDER 1-16 REGION. (a) In this section: 1-17 (1) "Child health plan program" means the state child 1-18 health plan program authorized by Chapter 62, Health and Safety 1-19 Code. 1-20 (2) "Committee" means the advisory committee on 1-21 funding disparities in health programs appointed by the 1-22 commissioner under this section. 1-23 (3) "Texas-Mexico border region" has the meaning 1-24 assigned by Section 2056.002. 1-25 (b) The commissioner shall appoint an advisory committee to 1-26 develop a strategic plan for eliminating the disparities between 1-27 the Texas-Mexico border region and other areas of the state in: 1-28 (1) capitation rates under Medicaid managed care and 1-29 the child health plan program for services provided to persons 1-30 younger than 19 years of age; 1-31 (2) fee-for-service per capita expenditures under the 1-32 Medicaid program and the child health plan program for inpatient 1-33 and outpatient hospital services for services provided to persons 1-34 younger than 19 years of age; and 1-35 (3) total professional services expenditures per 1-36 Medicaid recipient younger than 19 years of age or per child 1-37 enrolled in the child health plan program. 1-38 (c) Periodically the committee shall perform the research 1-39 necessary to analyze and compare the rates and expenditures 1-40 described by Subsection (b) and, not later than the date specified 1-41 by the commissioner, produce a report based on the results of that 1-42 analysis and comparison. 1-43 (d) The committee shall, as part of the report required by 1-44 Subsection (c), make recommendations to the commissioner for 1-45 addressing the problems created by disparities documented in the 1-46 report, including recommendations for allocation of funds. 1-47 (e) The commissioner shall appoint nine members to the 1-48 advisory committee in a manner that ensures that the committee: 1-49 (1) represents the spectrum of geographic areas 1-50 included in the Texas-Mexico border region; 1-51 (2) includes persons who are knowledgeable regarding 1-52 the Medicaid program, including Medicaid managed care, and the 1-53 child health plan program; and 1-54 (3) represents the interests of physicians, hospitals, 1-55 patients, managed care organizations, state agencies involved in 1-56 the management and delivery of medical resources of any kind, 1-57 affected communities, and other areas of the state. 1-58 (f) The committee shall elect officers from among the 1-59 members of the committee. 1-60 (g) Appointments to the committee shall be made without 1-61 regard to the race, color, disability, sex, religion, age, or 1-62 national origin of the appointees. 1-63 (h) A member of the committee may not receive compensation, 1-64 but is entitled to reimbursement of travel expenses incurred by 2-1 the member while conducting the business of the committee as 2-2 provided by the General Appropriations Act. 2-3 (i) The commission shall provide administrative support and 2-4 resources to the committee as necessary for the committee to 2-5 perform the duties under this section. 2-6 (j) The committee is not subject to Chapter 2110. 2-7 (k) With advice from the committee, the commission shall 2-8 ensure that: 2-9 (1) the disparities in rates and expenditures 2-10 described by Subsection (b) are eliminated as soon as practicable 2-11 for services provided to a person younger than 19 years of age by 2-12 increasing the rates and expenditures in the Texas-Mexico border 2-13 region, to the extent that funds are specifically appropriated for 2-14 purposes of this subsection, so that the rates and expenditures in 2-15 that region equal, or equal as nearly as possible, the statewide 2-16 average rates and expenditures; and 2-17 (2) a physician providing a service to a Medicaid 2-18 recipient younger than 19 years of age or a recipient of services 2-19 under the child health plan program in the Texas-Mexico border 2-20 region receives, in addition to reimbursement at the rate required 2-21 under Subdivision (1), a bonus to the extent possible with funds 2-22 specifically appropriated for purposes of this subsection. 2-23 (l) For purposes of Subsection (k), the commission shall 2-24 exclude data from the Texas-Mexico border region in determining the 2-25 statewide average capitation rates under Medicaid managed care and 2-26 the child health plan program and the statewide average total 2-27 expenditures per Medicaid recipient younger than 19 years of age or 2-28 per child enrolled in the child health plan program. 2-29 (m) With advice from the committee and other appropriate 2-30 groups, the commission may vary the amount of any rate increases 2-31 for services required by Subsection (k) according to the type of 2-32 service provided. 2-33 (n) The commission shall develop mechanisms to pass any rate 2-34 increase required by Subsection (k) directly to providers, 2-35 including providers in Medicaid managed care service delivery areas 2-36 with health maintenance organization, prepaid health plan, or 2-37 primary care case management models. 2-38 (o) The commission shall contract with a public university 2-39 to: 2-40 (1) measure changes occurring from September 1, 2001, 2-41 to August 31, 2004, in the number of health care providers 2-42 participating in the Medicaid program or the child health plan 2-43 program in the Texas-Mexico border region and resulting effects on 2-44 consumer access to health care and consumer utilization; 2-45 (2) determine: 2-46 (A) the effects, if any, of the changes in rates 2-47 and expenditures required by Subsection (k); and 2-48 (B) if funding available and used for changes in 2-49 rates and expenditures was sufficient to produce measurable 2-50 effects; 2-51 (3) make a recommendation regarding whether Medicaid 2-52 rate increases should be expanded to include Medicaid services 2-53 provided to adults in the Texas-Mexico border region; and 2-54 (4) not later than December 1, 2004, submit a report 2-55 to the legislature. 2-56 (p) This section expires September 1, 2011. 2-57 SECTION 2. If before implementing any provision of this Act 2-58 a state agency determines that a waiver or authorization from a 2-59 federal agency is necessary for implementation of that provision, 2-60 the agency affected by the provision shall request the waiver or 2-61 authorization and may delay implementing that provision until the 2-62 waiver or authorization is granted. 2-63 SECTION 3. (a) The changes in rates and expenditures 2-64 required by Subsection (k), Section 531.0221, Government Code, as 2-65 added by this Act, must be initiated not later than September 1, 2-66 2002. 2-67 (b) The advisory committee on funding disparities in health 2-68 programs shall deliver the first report required by Subsection (c), 2-69 Section 531.0221, Government Code, as added by this Act, not later 3-1 than January 1, 2002. 3-2 SECTION 4. This Act takes effect September 1, 2001. 3-3 * * * * *