| TO: | Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services |
| FROM: | John S. O'Brien, Director, Legislative Budget Board |
| IN RE: | SB531 by Patrick, Dan (Relating to the billing coordination system for claims submitted for payment from the Medicaid program.), Committee Report 1st House, Substituted |
The bill would amend Section 531.02413, Government Code, to require the Health and Human
Services Commission (HHSC) to expand the Medicaid Billing Coordination System (BCS), if cost
effective and feasible, and to process claims for all other health care services provided through the
Medicaid program in the manner claims for acute care services are currently processed by the system. However, this would not apply if claims were being processed by an alternative billing coordination system prior to September 1, 2009.
HHSC assumes that the language referring to processing claims would exclude services provided
under managed care, since managed care payments to providers are not processed through the Texas Medical Healthcare Partnership (TMHP) acute care claims system. A Medicaid BCS is already in place for other types of service delivery, including fee-for-service, primary care case management, and pharmacy claims. Therefore, HHSC assumes no significant fiscal impact.
The Department of Aging and Disability Services (DADS) states that the agency is currently using an alternative BCS for the Home and Community-based Services program and the Texas Home Living Waiver program. Other long-term care Medicaid programs are currently processed by TMHP, but based on additional information obtained by DADS, TMHP would require significant system changes in order to change to a cost avoidance BCS. These costs would be approximately $2.5 million in FY 2010, $1.4 million in FY 2011 and $1.1 million in FY 2012-13.
Also, DADS estimates an increase in the operating costs of using a cost avoidance BCS, without a significant increase in third party recoveries. This is because most Medicaid recipients are not able to purchase Medicare supplemental insurance or long-term care insurance and thus do not have a third party that DADS could bill. Since the costs are projected to outweigh the potential recoveries, these actions are deemed by DADS to not be cost-effective. Therefore, DADS would not implement the provisions of the bill and estimates no significant fiscal impact.
| Source Agencies: | 529 Health and Human Services Commission, 539 Aging and Disability Services, Department of
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| LBB Staff: | JOB, CL, PP, MB
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