LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 83RD LEGISLATIVE REGULAR SESSION April 1, 2013 TO: Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services FROM: Ursula Parks, Director, Legislative Budget Board IN RE:SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for SB682, As Introduced: a positive impact of $14,499,034 through the biennium ending August 31, 2015. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 83RD LEGISLATIVE REGULAR SESSION
April 1, 2013
TO: Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services FROM: Ursula Parks, Director, Legislative Budget Board IN RE:SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced
TO: Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services
FROM: Ursula Parks, Director, Legislative Budget Board
IN RE: SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced
Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services
Honorable Jane Nelson, Chair, Senate Committee on Health & Human Services
Ursula Parks, Director, Legislative Budget Board
Ursula Parks, Director, Legislative Budget Board
SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced
SB682 by Campbell (Relating to reimbursement for services provided by advanced practice nurses and physician assistants under the Medicaid program.), As Introduced
Estimated Two-year Net Impact to General Revenue Related Funds for SB682, As Introduced: a positive impact of $14,499,034 through the biennium ending August 31, 2015. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
Estimated Two-year Net Impact to General Revenue Related Funds for SB682, As Introduced: a positive impact of $14,499,034 through the biennium ending August 31, 2015.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
General Revenue-Related Funds, Five-Year Impact: Fiscal Year Probable Net Positive/(Negative) Impact to General Revenue Related Funds 2014 $6,886,054 2015 $7,612,980 2016 $8,261,067 2017 $8,895,463 2018 $9,578,576
2014 $6,886,054
2015 $7,612,980
2016 $8,261,067
2017 $8,895,463
2018 $9,578,576
All Funds, Five-Year Impact: Fiscal Year Probable Savings/(Cost) fromGeneral Revenue Fund1 Probable Savings/(Cost) fromFederal Funds555 2014 $6,886,054 $9,788,249 2015 $7,612,980 $10,599,891 2016 $8,261,067 $11,483,358 2017 $8,895,463 $12,365,204 2018 $9,578,576 $13,314,770
Fiscal Year Probable Savings/(Cost) fromGeneral Revenue Fund1 Probable Savings/(Cost) fromFederal Funds555 2014 $6,886,054 $9,788,249 2015 $7,612,980 $10,599,891 2016 $8,261,067 $11,483,358 2017 $8,895,463 $12,365,204 2018 $9,578,576 $13,314,770
2014 $6,886,054 $9,788,249
2015 $7,612,980 $10,599,891
2016 $8,261,067 $11,483,358
2017 $8,895,463 $12,365,204
2018 $9,578,576 $13,314,770
Fiscal Analysis
The bill would implement the recommendation in the report "Require Non-Physician Medicaid Services Be Reimbursed At Non-Physician Rates," in the Legislative Budget Board's Government Effectiveness and Efficiency Report submitted to the Eighty-Third Texas Legislature, 2013. The bill would amend the Human Resources Code to require that Medicaid services rendered by advanced practice nurses (APNs) and physician assistants (PAs) be reimbursed at the rate set for those providers by the Health and Human Services Commission (HHSC). Under current Texas Medicaid policy, APNs and PAs are reimbursed at 92 percent of a physician's rate for most services.
The bill would implement the recommendation in the report "Require Non-Physician Medicaid Services Be Reimbursed At Non-Physician Rates," in the Legislative Budget Board's Government Effectiveness and Efficiency Report submitted to the Eighty-Third Texas Legislature, 2013.
The bill would amend the Human Resources Code to require that Medicaid services rendered by advanced practice nurses (APNs) and physician assistants (PAs) be reimbursed at the rate set for those providers by the Health and Human Services Commission (HHSC). Under current Texas Medicaid policy, APNs and PAs are reimbursed at 92 percent of a physician's rate for most services.
Methodology
The bill would result in General Revenue Fund savings of $14.5 million and All Funds savings of $34.9 million in the 2014-15 biennium. APNs and PAs are healthcare providers educated and trained according to national standards to provide primary and acute care within limited scopes of practice in a variety of settings. HHSC estimates that these mid-level providers could potentially comprise as much as 25 percent of the primary care physician workforce for services that fall within the APN's or PA's professional scope of practice. HHSC estimates the bill will result in savings to the Medicaid program by shifting approximately 10 percent of the current services provided by APNs and PAs and billed at the full physician rate to the 92 percent reimbursement rate. HHSC estimates one-time costs associated with professional fees to modify provider enrollment information and claims processing policies of $62,305 in fiscal year 2014. HHSC estimates a 75/25 federal match for the claims processing changes and a 50/50 federal match for modifications to the provider enrollment information.
The bill would result in General Revenue Fund savings of $14.5 million and All Funds savings of $34.9 million in the 2014-15 biennium.
APNs and PAs are healthcare providers educated and trained according to national standards to provide primary and acute care within limited scopes of practice in a variety of settings. HHSC estimates that these mid-level providers could potentially comprise as much as 25 percent of the primary care physician workforce for services that fall within the APN's or PA's professional scope of practice. HHSC estimates the bill will result in savings to the Medicaid program by shifting approximately 10 percent of the current services provided by APNs and PAs and billed at the full physician rate to the 92 percent reimbursement rate.
HHSC estimates one-time costs associated with professional fees to modify provider enrollment information and claims processing policies of $62,305 in fiscal year 2014. HHSC estimates a 75/25 federal match for the claims processing changes and a 50/50 federal match for modifications to the provider enrollment information.
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: UP, CL, JI, BH
UP, CL, JI, BH