80R5144 CLG-D

By: Shapleigh S.B. No. 627

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 531.02231 to read as follows:

Sec. 531.02231. 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as a strategic investment area under Subchapter O, Chapter 171, Tax Code, or, if that subchapter expires or is repealed, an area that qualified as a strategic investment area under that subchapter immediately before its expiration or repeal.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 531.02231, Government Code, as added by this Act, must be implemented not later than September 1, 2008.

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, 2007.