By: Coleman H.B. No. 4214
A BILL TO BE ENTITLED
AN ACT
relating to Medicaid
funding in this state, including the federal
government's participation in that funding.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02113, Government Code, is amended
to read as follows:
Sec. 531.02113. OPTIMIZATION OF MEDICAID FINANCING. The
commission shall ensure that the Medicaid finance system:
(1) is optimized to:
(A) [(1)] maximize the state's receipt of
federal funds;
(B) [(2)] create incentives for providers to use
preventive care;
(C) [(3)] increase and retain providers in the
system to maintain an adequate provider network;
(D) [(4)] more accurately reflect the costs
borne by providers; and
(E) [(5)] encourage the improvement of the
quality of care; and
(2) complies with the requirements of Chapter 540, if
applicable.
SECTION 2. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 540 to read as follows:
CHAPTER 540. MEDICAID FUNDING MODIFICATION
Sec. 540.0001. APPLICABILITY. This chapter applies to a
waiver to the requirements of this state's Medicaid state plan or
other authorization under Medicaid:
(1) for which the commission seeks approval from the
federal government; and
(2) that, if approved, would change this state's
receipt of federal money for Medicaid from the funding system in
effect on January 1, 2017, to a block grant or other funding system.
Sec. 540.0002. PRIMARY GOAL OF MEDICAID FUNDING
MODIFICATION. (a) The primary goal of a Medicaid funding
modification the commission seeks through a waiver or other
authorization to which this chapter applies must be to preserve the
best interests of the residents of this state.
(b) The commission may not seek a waiver or other
authorization to which this chapter applies that is contrary to the
primary goal specified by Subsection (a) or that otherwise does not
meet the requirements of this chapter.
Sec. 540.0003. ADEQUACY OF MEDICAID PROGRAM FUNDING. A
Medicaid funding modification the commission seeks through a waiver
or other authorization to which this chapter applies:
(1) must account for and ensure adequate, continued
funding for:
(A) anticipated growth in the number of persons
in this state who will be eligible for and enroll in the Medicaid
program; and
(B) health care trends that may affect costs,
including:
(i) increases in utilization rates;
(ii) increases in the acuity of Medicaid
recipients;
(iii) advancements in medical technology;
and
(iv) advancements in specialized
prescription drugs; and
(2) may not be designed in a manner that allows for
reductions in federal financial participation based on this state's
effective management of Medicaid cost growth.
Sec. 540.0004. MAINTENANCE OF ELIGIBILITY REQUIREMENTS AND
COVERED SERVICES. A waiver or other authorization to which this
chapter applies must ensure that, at a minimum:
(1) the eligibility criteria for full Medicaid
benefits in effect on January 1, 2017, are not made more restrictive
under the waiver or authorization, including the eligibility
criteria for low-income families, pregnant women, children,
persons who are 65 years of age or older, and persons with
disabilities;
(2) the eligibility criteria for limited Medicaid
benefits in effect on January 1, 2017, are not made more restrictive
under the waiver or authorization; and
(3) all acute care services and long-term services and
supports covered by Medicaid on January 1, 2017, continue to be
covered, regardless of whether those services are mandatory or
optional services under federal law.
Sec. 540.0005. PROVIDER REIMBURSEMENTS AND OTHER PAYMENTS.
(a) A waiver or other authorization to which this chapter applies
must ensure that the Medicaid funding modification the commission
seeks through the waiver or authorization will:
(1) support the provision of adequate reimbursements
to Medicaid providers, require reimbursement rates for those
providers for the provision of Medicaid services to be at least
equal to the rates in effect on January 1, 2017, and support
periodic reimbursement rate increases based on health care trends;
(2) ensure continued provision of payments to
hospitals equal to supplemental payments by this state to hospitals
under supplemental payment programs in effect on January 1, 2017,
which may include continued provision through increases in rates
paid for direct hospital services to Medicaid enrollees; and
(3) prioritize use of supplemental payments to
encourage continued development of comprehensive local and
regional health care systems that include preventive, primary,
specialty, outpatient, inpatient, mental health, and substance
abuse services for individuals without health insurance.
(b) Reimbursement systems under a waiver or other
authorization to which this chapter applies must encourage
value-based payment arrangements for Medicaid providers and
support efforts to promote quality of care.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2017.