LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 77th Regular Session
  
                              March 13, 2001
  
  
          TO:  Honorable Patricia Gray, Chair, House Committee on Public
               Health
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  HB2468  by Chavez (Relating to capitation and
               reimbursement rates under the state child health plan in
               the Texas-Mexico border region.), As Introduced
  
**************************************************************************
*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  HB2468, As Introduced:  negative impact of $(13,137,200) through      *
*  the biennium ending August 31, 2003.                                  *
*                                                                        *
*  The bill would make no appropriation but could provide the legal      *
*  basis for an appropriation of funds to implement the provisions of    *
*  the bill.                                                             *
**************************************************************************
  
General Revenue-Related Funds, Five-Year Impact:
  
          ****************************************************
          *  Fiscal Year  Probable Net Positive/(Negative)   *
          *               Impact to General Revenue Related  *
          *                             Funds                *
          *       2002                         $(6,254,000)  *
          *       2003                          (6,883,200)  *
          *       2004                          (7,227,360)  *
          *       2005                          (7,588,729)  *
          *       2006                          (7,968,165)  *
          ****************************************************
  
All Funds, Five-Year Impact:
  
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*Fiscal  Probable Savings/(Cost) from GR   Probable Savings/(Cost) from   *
* Year      Match for Title XXI (CHIP)       Federal Funds - Federal      *
*                      8010                            0555               *
*  2002                      $(6,254,000)                   $(12,408,000) *
*  2003                       (6,883,200)                    (13,645,000) *
*  2004                       (7,227,360)                    (14,327,250) *
*  2005                       (7,588,729)                    (15,043,612) *
*  2006                       (7,968,165)                    (15,795,793) *
***************************************************************************
  
Fiscal Analysis
  
The bill would require the Health and Human Services Commission to form a
work group to study issues and make recommendations regarding capitation
and reimbursement rates in the Texas-Mexico border region under the
medical assistance program (Medicaid) and the state child health program
(Children's Health Insurance Program, or CHIP).  With advice from the
work group, the department shall ensure that in the Texas-Mexico border
region capitation rates under CHIP are equal to the statewide average and
fee-for-service reimbursements for inpatient and outpatient hospital and
professional services result in an average expenditure for each enrollee
that is at least equal to the statewide average for each enrollee in
CHIP, and a physician providing a service to each enrollee in CHIP
receive a bonus equal to 10 percent of the reimbursement customarily
provided to a physician providing that service in another region of the
state.

The bill would require the commission to exclude data from the
Texas-Mexico border region in determining the statewide average
capitation rate under the state child health plan and the statewide
average expenditure per enrollee in the plan.
  
  
Methodology
  
The Health and Human Services Commission estimates that the rate
adjustments required under this legislation would result in increased
expenditures in the child health plan (CHIP) as follows:  $18,662,000 in
FY 2002, $20,528,200 in FY 2003, $21,554,610 in FY 2004, $22,632,341 in
FY 2005, and $23,763,958 in FY 2005.
  
  
Local Government Impact
  
No fiscal implication to units of local government is anticipated.
  
  
Source Agencies:   529   Health and Human Services Commission, 501
                   Texas Department of Health
LBB Staff:         JK, HD, KF