By: Blanco, Hinojosa, West  S.B. No. 171
         (In the Senate - Filed November 10, 2020; March 3, 2021,
  read first time and referred to Committee on Health & Human
  Services; April 29, 2021, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 9, Nays 0;
  April 29, 2021, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR S.B. No. 171 By:  Blanco
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to a report regarding Medicaid reimbursement rates,
  supplemental payment amounts, and access to care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  (a) In this section:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Supplemental payment amount" includes a payment
  made to a Medicaid provider under the Texas Healthcare
  Transformation and Quality Improvement Program waiver issued under
  Section 1115 of the Social Security Act (42 U.S.C. Section 1315),
  another program operating under a waiver to the state Medicaid plan
  that provides a payment in excess of the Medicaid reimbursement
  rate, or the Medicaid disproportionate share hospital payment
  program.
         (b)  The commission shall prepare a written report regarding
  provider reimbursement rates, supplemental payment amounts paid to
  providers, and access to care under Medicaid. The commission shall
  collaborate with the state Medicaid managed care advisory committee
  to develop and define the scope of the research for the report. The
  report must:
               (1)  review the provider reimbursement rates and
  supplemental payment amounts for at least 20 Medicaid-covered
  services;
               (2)  outline factors of the reimbursement rate and
  supplemental payment amount methodologies used by Medicaid managed
  care organizations;
               (3)  propose alternative reimbursement and
  supplemental payment amount methodologies;
               (4)  evaluate the impact of Medicaid provider
  reimbursement rates and supplemental payment amounts on access to
  care for Medicaid recipients, including specifically evaluating
  the impact of Medicaid provider reimbursement rates and
  supplemental payment amounts for mental health and substance use
  disorder services on that access to care;
               (5)  compare the reimbursement rates and supplemental
  payment amounts paid to mental health and substance use disorder
  providers to the rates and amounts paid to other Medicaid
  providers;
               (6)  compare provider participation in Medicaid by
  region, particularly increases or decreases in the number of
  participating providers per year beginning with the state fiscal
  year ending August 31, 2012, categorized by provider specialty and
  subspecialty;
               (7)  list to the extent the information is available,
  for each state fiscal quarter beginning with the first quarter of
  the state fiscal year ending August 31, 2017:
                     (A)  counties in which provider access standards
  relating to distance have not been met; and
                     (B)  counties in which provider access standards
  relating to travel time have not been met;
               (8)  examine Medicaid directed provider payments and
  their effect on incentivizing providers to participate or continue
  participating in Medicaid, including:
                     (A)  the uniform hospital rate increase program
  described by 1 T.A.C. Section 353.1305;
                     (B)  the quality incentive payment program
  (QIPP); and
                     (C)  the minimum reimbursement rate for nursing
  facilities described by Section 533.00251, Government Code; and
               (9)  determine the feasibility and cost of
  establishing:
                     (A)  a minimum fee schedule for Medicaid providers
  in counties where provider access standards are not being met; and
                     (B)  a different reimbursement rate or
  supplemental payment amount for classes of providers who provide
  care in a county:
                           (i)  located on an international border; or
                           (ii)  with a Medicaid population at least 10
  percent higher than the statewide average Medicaid population.
         (c)  Not later than December 1, 2022, the commission shall
  prepare and submit to the legislature the report described by
  Subsection (b) of this section. Notwithstanding that subsection,
  the commission is not required to include in the report any
  information the commission determines is proprietary.
         SECTION 2.  This Act takes effect September 1, 2021.
 
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