86R14212 LED-D
By: González of El Paso H.B. No. 3937
A BILL TO BE ENTITLED
AN ACT
relating to a report regarding Medicaid reimbursement rates and
access to care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. (a) In this section, "commission" means the
Health and Human Services Commission.
(b) The commission shall prepare a written report regarding
provider reimbursement rates and access to care in the Medicaid
program. The report must:
(1) outline each factor of the reimbursement rate
methodology used by Medicaid managed care organizations and that
factor's weight in the methodology;
(2) explicitly illustrate the manner in which the
following affect current methodologies:
(A) previously adopted reimbursement rates;
(B) the cost of uncompensated care provided to
uninsured persons; and
(C) use of private insurance benefits;
(3) propose alternative reimbursement methodologies
that do not consider the items described by Subdivision (2) of this
subsection;
(4) evaluate how Medicaid provider reimbursement
rates affect access to care for Medicaid recipients, measured by
the number of providers each year who have stopped participating in
Medicaid since the commission began offering Medicaid services
through a managed care delivery model;
(5) compare provider participation in Medicaid by
region, particularly increases or decreases in the number of
participating providers since the commission began offering
Medicaid services through a managed care delivery model,
categorized by provider specialty and subspecialty;
(6) list, for each year since the commission began
offering Medicaid services through a managed care delivery model,
counties in which provider access standards have not been met;
(7) examine Medicaid provider incentive payment
programs and their effect on incentivizing providers to participate
or continue participating in Medicaid; and
(8) determine the feasibility and cost of
establishing:
(A) a minimum fee schedule for Medicaid providers
in counties where provider access standards are not being met; and
(B) a different reimbursement rate for classes of
providers who provide care in a county:
(i) located on an international border; or
(ii) with a Medicaid population at least 10
percent higher than the statewide average Medicaid population.
(c) Not later than December 1, 2020, the commission shall
prepare and submit to the legislature the report described by
Subsection (b) of this section. Notwithstanding that subsection,
the commission is not required to include in the report any
information the commission determines is proprietary.
SECTION 2. This Act takes effect September 1, 2019.