LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
March 23, 2001
TO: Honorable Mike Moncrief, Chair, Senate Committee on
Health & Human Services
FROM: John Keel, Director, Legislative Budget Board
IN RE: SB1055 by Shapleigh (Relating to rates and expenditures
under the Medicaid and state child health plan program in
strategic investment areas.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* SB1055, As Introduced: negative impact of $(142,091,809) 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. *
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General Revenue-Related Funds, Five-Year Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2002 $(69,025,896) *
* 2003 (73,065,913) *
* 2004 (76,543,113) *
* 2005 (80,361,566) *
* 2006 (84,516,450) *
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All Funds, Five-Year Impact:
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*Fiscal Probable Probable Probable *
* Year Savings/(Cost) from Savings/(Cost) from Savings/(Cost) from *
* GR Match for GR Match for Title Federal Funds - *
* Medicaid XXI (CHIP) Federal *
* 0758 8010 0555 *
* 2002 $(63,084,587) $(5,941,309) $(110,464,227) *
* 2003 (66,518,236) (6,547,677) (116,649,211) *
* 2004 (69,681,512) (6,861,601) (122,245,111) *
* 2005 (73,159,445) (7,202,121) (128,358,094) *
* 2006 (76,956,972) (7,559,478) (134,995,347) *
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Fiscal Analysis
The bill would require the Health and Human Services Commissioner appoint
an advisory committee to develop a strategic plan for eliminating the
disparities between strategic investment areas and other areas of the
state in the Children's Health Insurance Program (CHIP) and Medicaid.
Disparities are to be eliminated in the following areas: 1) managed care
capitation rates; 2) fee-for-service reimbursements for inpatient and
outpatient hospital services and professional services; 3) total
professional services expenditures per Medicaid recipient or per child
enrolled in the child health program. With advice from the committee,
the Health and Human Services Commission (HHSC) shall conduct three pilot
programs to equalize Medicaid rates and expenditures and provide
physician incentives.
The HHSC would be required to contract with a public university to:
measure changes in the number of Medicaid and CHIP providers in the
border counties between September 1, 2001 and August 31, 2004, and the
effects on consumer access and utilization; determine the effects of the
changes in rates and expenditures; and submit a report to the Legislature
by December 1, 2004.
Reimbursement for travel and related expenses for the advisory committee
would require authorization in the General Appropriations Act.
Methodology
The fiscal impact, provided by the Department of Health (TDH), was based
on work done by TDH for the Border Rate Work Group Report, December 20,
2000. Strategic Investment area counties are defined under state law by
the Comptroller and are counties that must meet one of three criteria:
higher than state average unemployment rate and lower than average per
capita income rate, a federal urban enterprise community designation, or
a population of less than 50,000. Three pilot counties were selected for
purposes of analysis and a sixteen percent overall increase in
reimbursements was assumed, as well as a 10 percent increase for
professional services for both the CHIP and the Medicaid programs.
The HHSC could additional operating costs that would include operations
of the pilot program and the contract with the public university for the
study.
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, AJ, KF