HBA-CCH H.B. 2469 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2469 By: Chavez Public Health 3/13/2001 Introduced BACKGROUND AND PURPOSE 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. 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. ANALYSIS 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. EFFECTIVE DATE September 1, 2001.