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HOUSE CONCURRENT RESOLUTION
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WHEREAS, In January 2007 the Centers for Medicare and |
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Medicaid Services (CMS) proposed a new regulation that would |
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radically alter the method by which the federal government |
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determines its contribution to state Medicaid providers; if |
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implemented, this rule would threaten Texas' health care safety net |
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and jeopardize the solvency of facilities that provide crucial but |
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unprofitable services, including trauma centers, rural emergency |
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departments, university research hospitals, nursing homes, and |
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school-based clinics; and |
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WHEREAS, The proposed rule, CMS-2258-P, includes a number of |
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provisions with potentially devastating consequences to the |
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state's health care system; the rule seeks to narrow the definition |
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of a "unit of government," thereby prohibiting the care provided by |
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certain entities from being used to calculate a state's Medicaid |
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contribution, to restrict the way a state is permitted to use |
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federal matching funds, and to limit the amount a state can |
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attribute to a particular service provided under Medicaid for |
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purposes of determining the federal reimbursement; and |
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WHEREAS, Texas is particularly vulnerable to the limitations |
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of the new definition; many of the state's health care providers |
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operate under contractual agreements with the state, county |
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governments, or hospital districts, but under the new rule services |
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provided by these entities would no longer be permitted to |
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contribute to the state's share of the Medicaid program; the |
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consequence of this new limitation is most troubling for rural |
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Texas, where access to care is already inadequate; and |
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WHEREAS, Moreover, the many public hospitals in Texas that |
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perform a critical dual purpose by delivering costly, highly |
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specialized treatment such as trauma care, neonatal intensive care, |
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and burn patient care, while also providing Medicaid services to |
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the severely disabled, aged, indigent, and uninsured, depend on the |
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federal allocation under Medicaid to remain financially viable; the |
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new restriction on the use of federal matching funds proposed under |
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CMS-2258-P would jeopardize these hospitals' solvency and further |
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strain their capacity to serve as the state's health care safety net |
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while also providing essential emergency medical services to the |
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community at large; and |
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WHEREAS, Unfortunately, the ill effects of the new rule also |
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extend to non-hospital providers such as nursing homes, |
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intermediate care facilities, community health centers, and |
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school-based health clinics for which Medicaid reimbursement and |
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supplemental payments are a vital source of funding; these entities |
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are essential components of the state's health care delivery |
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system, and the loss of federal funds currently used in their |
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operation would require the state to find alternative sources, |
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shifting money from other state priorities; and |
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WHEREAS, The Texas Health and Human Services Commission |
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estimates the implementation of CMS-2258-P will cost Texas $788 |
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million annually in combined state and federal funds, not including |
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the considerable administrative costs associated with the rule's |
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new documentation and auditing requirements; and |
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WHEREAS, The potential impact of CMS-2258-P has raised broad |
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bipartisan objection to its implementation; in the 109th United |
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States Congress, 300 members of the house of representatives and 55 |
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members of the senate wrote to the secretary of the United States |
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Department of Health and Human Services (HHS) with the request that |
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the agency abandon plans to approve a similar rule; and |
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WHEREAS, Since CMS-2258-P was proposed in January, a vast |
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majority of the United States Congress has once again expressed |
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opposition to adoption of the policy; likewise, states across the |
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nation have communicated their concerns about the measure, and the |
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National Governors Association has requested that the rule be |
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withdrawn; and |
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WHEREAS, The Texas Health and Human Services Commission has |
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also written the secretary of HHS to emphasize the consequences of |
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the rule to the state's health care system and to request that the |
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rule be withdrawn; given the significance of CMS-2258-P to health |
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care providers across the country, concerns of state Medicaid |
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administrators relating to the ambiguities of the rule, the |
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overwhelming bipartisan congressional opposition to its adoption, |
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and the fact that the adoption of the rule would permit CMS to |
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overstep its statutory authority as prescribed by congress, it is |
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fitting that congress intervene at this time; now, therefore, be it |
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RESOLVED, That the 80th Legislature of the State of Texas |
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hereby respectfully request the United States Congress to direct |
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the secretary of the United States Department of Health and Human |
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Services to withdraw proposed rule CMS-2258-P, published on pages |
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2236 through 2258, volume 72, number 11, of the Federal Register, |
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relating to 42 Code of Federal Regulations Parts 433, 447, and 457; |
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and, be it further |
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RESOLVED, That the Texas secretary of state forward official |
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copies of this resolution to the president of the United States, the |
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speaker of the house of representatives and the president of the |
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senate of the United States Congress, the secretary of the United |
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States Department of Health and Human Services, and all members of |
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the Texas delegation to the congress with the request that this |
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resolution be officially entered in the Congressional Record as a |
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memorial to the Congress of the United States of America. |