| TO: | Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services |
| FROM: | Ursula Parks, Director, Legislative Budget Board |
| IN RE: | SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced |
| Fiscal Year | Probable Net Positive/(Negative) Impact to General Revenue Related Funds |
|---|---|
| 2014 | $6,886,054 |
| 2015 | $7,612,980 |
| 2016 | $8,261,067 |
| 2017 | $8,895,463 |
| 2018 | $9,578,576 |
| Fiscal Year | Probable Savings/(Cost) from General Revenue Fund 1 |
Probable Savings/(Cost) from Federal Funds 555 |
|---|---|---|
| 2014 | $6,886,054 | $9,788,249 |
| 2015 | $7,612,980 | $10,599,891 |
| 2016 | $8,261,067 | $11,483,358 |
| 2017 | $8,895,463 | $12,365,204 |
| 2018 | $9,578,576 | $13,314,770 |
The bill would implement the recommendation in the report "Require Non-Physician Medicaid Services Be Reimbursed At Non-Physician Rates," in the Legislative Budget Board's Government Effectiveness and Efficiency Report submitted to the Eighty-Third Texas Legislature, 2013.
The bill would amend the Human Resources Code to require that Medicaid services rendered by advanced practice nurses (APNs) and physician assistants (PAs) be reimbursed at the rate set for those providers by the Health and Human Services Commission (HHSC). Under current Texas Medicaid policy, APNs and PAs are reimbursed at 92 percent of a physician's rate for most services.
The bill would result in General Revenue Fund savings of $14.5 million and All Funds savings of $34.9 million in the 2014-15 biennium.
APNs and PAs are healthcare providers educated and trained according to national standards to provide primary and acute care within limited scopes of practice in a variety of settings. HHSC estimates that these mid-level providers could potentially comprise as much as 25 percent of the primary care physician workforce for services that fall within the APN's or PA's professional scope of practice. HHSC estimates the bill will result in savings to the Medicaid program by shifting approximately 10 percent of the current services provided by APNs and PAs and billed at the full physician rate to the 92 percent reimbursement rate.
HHSC estimates one-time costs associated with professional fees to modify provider enrollment information and claims processing policies of $62,305 in fiscal year 2014. HHSC estimates a 75/25 federal match for the claims processing changes and a 50/50 federal match for modifications to the provider enrollment information.
| Source Agencies: | 529 Health and Human Services Commission
|
| LBB Staff: | UP, CL, JI, BH
|