Office of House Bill AnalysisH.B. 2469
By: Chavez
Public Health


The Texas-Mexico border region suffers from an inadequate medical
infrastructure.  Physician to patient ratios are lowest along the border
region, and in rural areas and inner cities, which are known as strategic
investment areas.  In February 2000, the Health and Human Services
Commission (HHSC) convened the Border Rate Work Group (work group) to study
and recommend solutions regarding Medicaid and the state child health plan
(CHIP) reimbursement rates along the Texas-Mexico border.  The work group
concluded that a lack of access to health care services along the border
has reduced the utilization rates of these services, that the border region
receives disproportionately low Medicaid reimbursement as a result of low
utilization, and that Medicaid  and CHIP capitation rates are locked into a
historic disparity because they are based on past fee for service
reimbursement rates.  The work group also found that lower revenue provides
a disincentive for health care providers to locate and remain in the border
region.  The work group recommended increasing Medicaid and CHIP
reimbursement rates in these strategic investment areas to recruit more
doctors and increase access to care.  House Bill 2469 requires HHSC to
increase per capita Medicaid and CHIP expenditures in strategic investment
areas to an adjusted statewide average and provides physicians with a 10
percent bonus for providing health care services in these regions. 


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. 


House Bill 2469 amends the Government Code to require the commissioner of
health and human services to appoint an advisory committee (committee) to
develop a plan for eliminating the disparities in certain Medicaid and
state child health plan (CHIP) rules and expenditures between  strategic
investment areas, which includes the Texas-Mexico border region, rural
areas, and inner cities, and other areas of the state. The bill sets forth
provisions for the appointment and administration of the committee.  The
bill requires the committee to perform the research necessary to analyze
and compare the rates and expenditures and to produce a report of the
results no later than a date specified by the commissioner or September 1,
2002. The bill also requires the committee to make recommendations for
addressing the problems created by disparities documented in the report.   

H.B. 2469 requires the Health and Human Services Commission (HHSC), with
advice from the committee, to ensure that: 

 _the disparities in rates and expenditures are eliminated as soon as
practicable so that the rates and expenditures in strategic investment
areas equal the statewide average; and 
 _a physician providing a service to a Medicaid recipient in a strategic
investment area receives a bonus in the amount of 10 percent of the
reimbursement customarily provided to a physician providing that service in
another region of the state. 
 HHSC is required to exclude data from strategic investment areas in
determining the statewide average rates and expenditures.  With advice from
the committee and other appropriate groups, HHSC may vary the amount of any
rate increases for required professional services according to the type of
service.  The bill requires HHSC to develop mechanisms to pass any rate
increase directly to providers.   

The bill requires HHSC to contract with a public university to measure
changes occurring from September 1, 2001, to August 31, 2004, in the number
of health care providers participating in Medicaid or CHIP in strategic
investment areas and resulting effects on consumer access to health care
and consumer utilization, to determine the effects, if any, of the changes
in rates and expenditures, and to submit a report to the legislature no
later than December 1, 2004.   


September 1, 2001.