By: Blanco, et al. S.B. No. 171
A BILL TO BE ENTITLED
AN ACT
relating to a report regarding Medicaid reimbursement rates,
supplemental payment amounts, and access to care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. (a) In this section:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Supplemental payment amount" includes a payment
made to a Medicaid provider under the Texas Healthcare
Transformation and Quality Improvement Program waiver issued under
Section 1115 of the Social Security Act (42 U.S.C. Section 1315),
another program operating under a waiver to the state Medicaid plan
that provides a payment in excess of the Medicaid reimbursement
rate, or the Medicaid disproportionate share hospital payment
program.
(b) The commission shall prepare a written report regarding
provider reimbursement rates, supplemental payment amounts paid to
providers, and access to care under Medicaid. The commission shall
collaborate with the state Medicaid managed care advisory committee
to develop and define the scope of the research for the report. The
report must:
(1) review the provider reimbursement rates and
supplemental payment amounts for at least 20 Medicaid-covered
services;
(2) outline factors of the reimbursement rate and
supplemental payment amount methodologies used by Medicaid managed
care organizations;
(3) propose alternative reimbursement and
supplemental payment amount methodologies;
(4) evaluate the impact of Medicaid provider
reimbursement rates and supplemental payment amounts on access to
care for Medicaid recipients, including specifically evaluating
the impact of Medicaid provider reimbursement rates and
supplemental payment amounts for mental health and substance use
disorder services on that access to care;
(5) compare the reimbursement rates and supplemental
payment amounts paid to mental health and substance use disorder
providers to the rates and amounts paid to other Medicaid
providers;
(6) compare provider participation in Medicaid by
region, particularly increases or decreases in the number of
participating providers per year beginning with the state fiscal
year ending August 31, 2012, categorized by provider specialty and
subspecialty;
(7) list to the extent the information is available,
for each state fiscal quarter beginning with the first quarter of
the state fiscal year ending August 31, 2017:
(A) counties in which provider access standards
relating to distance have not been met; and
(B) counties in which provider access standards
relating to travel time have not been met;
(8) examine Medicaid directed provider payments and
their effect on incentivizing providers to participate or continue
participating in Medicaid, including:
(A) the uniform hospital rate increase program
described by 1 T.A.C. Section 353.1305;
(B) the quality incentive payment program
(QIPP); and
(C) the minimum reimbursement rate for nursing
facilities described by Section 533.00251, Government Code; and
(9) 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 or
supplemental payment amount 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, 2022, 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, 2021.