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A BILL TO BE ENTITLED
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AN ACT
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relating to a report regarding Medicaid reimbursement rates and |
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access to care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. (a) In this section, "commission" means the |
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Health and Human Services Commission. |
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(b) The commission shall prepare a written report regarding |
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provider reimbursement rates and access to care in the Medicaid |
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program. The report must: |
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(1) outline each factor of the reimbursement rate |
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methodology used by Medicaid managed care organizations and that |
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factor's weight in the methodology; |
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(2) explicitly illustrate the manner in which the |
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following affect current methodologies: |
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(A) previously adopted reimbursement rates; |
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(B) the cost of uncompensated care provided to |
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uninsured persons; and |
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(C) use of private insurance benefits; |
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(3) propose alternative reimbursement methodologies |
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that do not consider the items described by Subdivision (2) of this |
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subsection; |
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(4) evaluate how Medicaid provider reimbursement |
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rates affect access to care for Medicaid recipients, measured by |
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the number of providers each year who have stopped participating in |
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Medicaid since the commission began offering Medicaid services |
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through a managed care delivery model; |
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(5) compare provider participation in Medicaid by |
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region, particularly increases or decreases in the number of |
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participating providers since the commission began offering |
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Medicaid services through a managed care delivery model, |
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categorized by provider specialty and subspecialty; |
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(6) list, for each year since the commission began |
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offering Medicaid services through a managed care delivery model, |
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counties in which provider access standards have not been met; |
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(7) examine Medicaid provider incentive payment |
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programs and their effect on incentivizing providers to participate |
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or continue participating in Medicaid; and |
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(8) determine the feasibility and cost of |
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establishing: |
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(A) a minimum fee schedule for Medicaid providers |
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in counties where provider access standards are not being met; and |
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(B) a different reimbursement rate for classes of |
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providers who provide care in a county: |
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(i) located on an international border; or |
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(ii) with a Medicaid population at least 10 |
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percent higher than the statewide average Medicaid population. |
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(c) Not later than December 1, 2020, the commission shall |
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prepare and submit to the legislature the report described by |
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Subsection (b) of this section. Notwithstanding that subsection, |
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the commission is not required to include in the report any |
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information the commission determines is proprietary. |
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SECTION 2. This Act takes effect September 1, 2019. |