HBA-MPA C.S.H.B. 897 76(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 897
By: Haggerty
Public Health
4/11/1999
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Currently, there is a shortfall between the cost of ambulance service and
what Medicare will pay for this service.  Medicare pays 80 percent of the
cost of service for those who qualify for the program. Since many Medicare
clients also qualify for medical assistance, that program could potentially
make up for the shortfall, thereby removing ambulance operators, who are
required by law to respond to all emergency calls, from the need to absorb
this expense or pass it on to other clients.  

C.S.H.B. 897 requires the medical assistance program to pay the Medicare
deductibles and coinsurance on ambulance service.  This bill allows
Medicare recipients to spend less on their Medicare benefits.  Ambulance
service providers would receive the same reimbursement rates that they
currently receive.  Medicare recipients would have their deductibles and
coinsurance covered by  the medical assistance program only if the service
provided was an ambulance service. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 32.043, Human Resource Code, as added by Chapter
1153, Acts of the 75th Legislature, Regular Session, 1997, by adding
Subsection (c), as follows: 

(c) Requires the medical assistance program, for ambulance service provided
to an individual who is eligible under the medical assistance program and
Medicare, to pay the Medicare deductibles and coinsurance. 

SECTION 2.  Effective date: September 1, 1999.
            Makes application of this Act prospective.

SECTION 3.  Requires the Health and Human Services Commission, if it
determines before this Act is implemented that a waiver or authorization
from a federal agency is necessary, to request the waiver or authorization
and authorizes the delay of implementation until such waiver is granted. 

SECTION 4.  Emergency clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 897 differs from the original bill in SECTION 1 by replacing, in
proposed Subsection (c), language calling for the medical assistance
program to pay the difference between the customary rate that prevails in
the community for the service provided and the maximum Medicare allowable
charge, with the phrase "pay the Medicare deductibles and coinsurance."