78R2004 KEG-D

By:  Shapleigh                                                    S.B. No. 398



A BILL TO BE ENTITLED

AN ACT

relating to rates and expenditures under the Medicaid program and 
the state child health plan program in certain strategic investment 
areas.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter B, Chapter 531, Government Code, is 
amended by adding Section 531.0224 to read as follows:
	Sec. 531.0224.  RATES AND EXPENDITURES IN CERTAIN STRATEGIC 
INVESTMENT AREAS. (a)  In this section:
		(1)  "Child health plan program" means the state child 
health plan program authorized by Chapter 62, Health and Safety 
Code.
		(2)  "Strategic investment area" means an area of this 
state that qualifies as a strategic investment area under 
Subchapter O, Chapter 171, Tax Code, or, if that subchapter expires 
or is repealed, an area that qualified as a strategic investment 
area under that subchapter immediately before its expiration or 
repeal.
	(b)  The commission shall ensure in each strategic 
investment area that:
		(1)  the capitation rates under the Medicaid managed 
care program and the child health plan program are at least equal to 
the respective statewide average capitation rates under those 
programs;
		(2)  the fee-for-service reimbursement rates for 
inpatient and outpatient hospital services under the Medicaid 
program and the child health plan program are at least equal to the 
respective statewide average reimbursement rates for those 
services under those programs;
		(3)  the total professional services expenditures per 
Medicaid recipient in the strategic investment area result in an 
average expenditure per recipient in that area that is at least 
equal to the statewide average expenditure per Medicaid recipient; 
and
		(4)  the total professional services expenditures per 
enrollee under the child health plan program in the strategic 
investment area result in an average expenditure per enrollee in 
that area that is at least equal to the statewide average 
expenditure per enrollee under that program.
	(c)  For purposes of Subsection (b), the commission shall 
exclude data from strategic investment areas in determining the 
statewide averages for capitation rates, fee-for-service 
reimbursement rates, and professional services expenditures.
	SECTION 2.  The changes in rates and expenditures required 
by Section 531.0224, Government Code, as added by this Act, must be 
implemented not later than September 1, 2004.
	SECTION 3.  If before implementing any provision of this Act 
a state agency determines that a waiver or authorization from a 
federal agency is necessary for implementation of that provision, 
the agency affected by the provision shall request the waiver or 
authorization and may delay implementing that provision until the 
waiver or authorization is granted.
	SECTION 4.  This Act takes effect September 1, 2003.