HBA-NRS H.B. 2471 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2471
By: Chavez
Public Health
3/13/2001
Introduced



BACKGROUND AND PURPOSE 

The Texas-Mexico border region suffers from an inadequate medical
infrastructure. Patient to physician ratios in the region have historically
been among the highest in the state. 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 state child health
plan (CHIP) reimbursement rates along the Texas-Mexico border. The work
group concluded that the lack of access to health care services along the
border has reduced the utilization rate of these services, that the border
region receives disproportionately low Medicaid reimbursement because 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
reimbursements. The work group also found that lower revenues provide 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 this region to recruit more doctors and increase
access to care. House Bill 2471 requires HHSC to increase Medicaid and CHIP
reimbursement rates for recipients younger than 19 years of age in the
Texas-Mexico border region to an adjusted statewide average and provides
physicians with a 10 percent bonus for providing services in the region. 
 
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 2471 amends the Government Code to require the commissioner of
health and human services (commissioner) to appoint an advisory committee
(committee) to develop a strategic plan for eliminating the disparities
between the Texas-Mexico border region (region) and other areas of the
state in certain Medicaid and state child health plan (CHIP)  rates and
expenditures for recipients younger than 19 years of age. Periodically, the
bill requires the committee to perform the research necessary to analyze
and compare the rates and expenditures and produce a report based on the
results of that analysis and comparison. The bill requires the committee to
make recommendations, including recommendations for allocation of funds, to
the commissioner for addressing the problems created by the disparities
documented in the report. The bill sets forth provisions for the
appointment and administration of the committee. 

With advice from the committee, the bill requires the Health and Human
Services Commission (HHSC) to ensure that: 

 _the disparities in rates and expenditures between the region and other
areas of the state are eliminated so that the rates and expenditures in the
region equal the statewide average; and 

 _a physician providing a service to a Medicaid recipient younger than 19
years of age in the region receives, in addition to reimbursement at the
average statewide rate, 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.  
 
The bill requires HHSC to exclude data from the region in determining the
statewide average capitation rates and the statewide average total
professional services expenditures. With advice from the committee and
other appropriate groups, the bill authorizes HHSC to vary the amount of
any rate increases for professional services according to the type of
service provided. 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 study the
impact of eliminating disparities in rates and expenditures in the region
and to submit a report to the legislature, not later than December 1, 2004.
The bill sets forth provisions relating to changes in rates and
expenditures and delivery of the committee's first report.  The changes in
rates and expenditures must be initiated not later than September 1, 2002.
The bill requires the advisory committee to deliver its report not later
than September 1, 2002.  

EFFECTIVE DATE

September 1, 2001.