LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 82ND LEGISLATIVE REGULAR SESSION April 20, 2011 TO: Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health FROM: John S O'Brien, Director, Legislative Budget Board IN RE:HB2368 by Parker (Relating to copayments and other cost-sharing payments under the medical assistance program.), Committee Report 1st House, Substituted No significant fiscal implication to the State is anticipated. The bill would require or authorize the executive commissioner of the Health and Human Services Commission (HHSC) to require Medicaid recipients to pay copayments in certain situations and for certain services. An existing prohibition on reducing hospital payments to reflect the potential receipt of payment from a recipient receiving services through a hospital emergency room is removed. Medicaid providers would not be required to bill, or collect from a recipient, a copayment. According to HHSC, extensive system changes would be required to implement the provisions in the bill; estimated costs are $3.5 million in fiscal year 2012 for one-time system changes and ongoing operations costs of $1.9 million in fiscal year 2013, $2.4 million in fiscal year 2014, $2.5 million in fiscal year 2015, and $2.6 million in fiscal year 2016. According to HHSC, copayments could act as a deterrent to accessing care, resulting in a reduction to utilization or a shifting to a lower-cost setting; however, federal requirements limit application of cost sharing to a small percentage of the Texas Medicaid population, services cannot be denied if clients do not contribute toward cost-sharing, and the bill does not require providers to collect the copayments. Further, hospitals are required to meet the requirements of the Emergency Medical Treatment and Active Labor Act. It is unlikely that implementing copayments alone would result in a significant savings. It is assumed that HHSC would have to reduce hospital, or other provider payments, in order to achieve the level of savings necessary to offset implementation and administrative costs or to produce significant savings. Local Government Impact No significant fiscal implication to units of local government is anticipated. Source Agencies:529 Health and Human Services Commission LBB Staff: JOB, CL, MB, LR
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 82ND LEGISLATIVE REGULAR SESSION
April 20, 2011
TO: Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health FROM: John S O'Brien, Director, Legislative Budget Board IN RE:HB2368 by Parker (Relating to copayments and other cost-sharing payments under the medical assistance program.), Committee Report 1st House, Substituted
TO: Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health
FROM: John S O'Brien, Director, Legislative Budget Board
IN RE: HB2368 by Parker (Relating to copayments and other cost-sharing payments under the medical assistance program.), Committee Report 1st House, Substituted
Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health
Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health
John S O'Brien, Director, Legislative Budget Board
John S O'Brien, Director, Legislative Budget Board
HB2368 by Parker (Relating to copayments and other cost-sharing payments under the medical assistance program.), Committee Report 1st House, Substituted
HB2368 by Parker (Relating to copayments and other cost-sharing payments under the medical assistance program.), Committee Report 1st House, Substituted
No significant fiscal implication to the State is anticipated.
No significant fiscal implication to the State is anticipated.
The bill would require or authorize the executive commissioner of the Health and Human Services Commission (HHSC) to require Medicaid recipients to pay copayments in certain situations and for certain services. An existing prohibition on reducing hospital payments to reflect the potential receipt of payment from a recipient receiving services through a hospital emergency room is removed. Medicaid providers would not be required to bill, or collect from a recipient, a copayment. According to HHSC, extensive system changes would be required to implement the provisions in the bill; estimated costs are $3.5 million in fiscal year 2012 for one-time system changes and ongoing operations costs of $1.9 million in fiscal year 2013, $2.4 million in fiscal year 2014, $2.5 million in fiscal year 2015, and $2.6 million in fiscal year 2016. According to HHSC, copayments could act as a deterrent to accessing care, resulting in a reduction to utilization or a shifting to a lower-cost setting; however, federal requirements limit application of cost sharing to a small percentage of the Texas Medicaid population, services cannot be denied if clients do not contribute toward cost-sharing, and the bill does not require providers to collect the copayments. Further, hospitals are required to meet the requirements of the Emergency Medical Treatment and Active Labor Act. It is unlikely that implementing copayments alone would result in a significant savings. It is assumed that HHSC would have to reduce hospital, or other provider payments, in order to achieve the level of savings necessary to offset implementation and administrative costs or to produce significant savings.
The bill would require or authorize the executive commissioner of the Health and Human Services Commission (HHSC) to require Medicaid recipients to pay copayments in certain situations and for certain services. An existing prohibition on reducing hospital payments to reflect the potential receipt of payment from a recipient receiving services through a hospital emergency room is removed. Medicaid providers would not be required to bill, or collect from a recipient, a copayment.
According to HHSC, extensive system changes would be required to implement the provisions in the bill; estimated costs are $3.5 million in fiscal year 2012 for one-time system changes and ongoing operations costs of $1.9 million in fiscal year 2013, $2.4 million in fiscal year 2014, $2.5 million in fiscal year 2015, and $2.6 million in fiscal year 2016. According to HHSC, copayments could act as a deterrent to accessing care, resulting in a reduction to utilization or a shifting to a lower-cost setting; however, federal requirements limit application of cost sharing to a small percentage of the Texas Medicaid population, services cannot be denied if clients do not contribute toward cost-sharing, and the bill does not require providers to collect the copayments. Further, hospitals are required to meet the requirements of the Emergency Medical Treatment and Active Labor Act. It is unlikely that implementing copayments alone would result in a significant savings. It is assumed that HHSC would have to reduce hospital, or other provider payments, in order to achieve the level of savings necessary to offset implementation and administrative costs or to produce significant savings.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission
529 Health and Human Services Commission
LBB Staff: JOB, CL, MB, LR
JOB, CL, MB, LR