April 24, 2009
By Christopher D. DeMeo, Connie R. Crawford, and Amy L. Osborn
Children's Health Insurance Program (CHIP)
Legislators have introduced multiple bills that would increase CHIP eligibility to 300% of the federal poverty level,1 extend eligibility to twelve months from the current six months,2 and allow a sliding-scale buy-in for families above 200-300% of the Federal Poverty Level (FPL).3 Most of the bills are pending in House Human Services Committee.
The Senate's budget, which was presented on April 1, 2009, contained little funding for CHIP or Medicaid, but the House budget, which was presented on April 17, 2009, contains a more generous funding proposal. If the Senate Health and Human Services Committee considers the bills and acts favorably, a Conference Committee, consisting of five members from each chamber, will be the key to any expansion of CHIP coverage. The Conference Committee report is not subject to amendment but must be accepted or rejected in its entirety by both chambers before the legislative session ends on June 1, 2009.
Senate Bill 7 is the vehicle for most proposed changes to Medicaid. Significant provisions include:
- A standard definition of "uncompensated hospital care" coupled with a requirement that hospitals report that data or risk withholding of Medicaid reimbursements;
- Increased use of electronic prescribing tools by Medicaid providers; and
- Feasibility study regarding the use of the Medicare bundled payment system in a Medicaid pilot project.
Healthcare Access in Rural Areas
The Texas Legislature is also tackling the problem of limited access to healthcare in rural areas of the state. Most notably,
SB 1128 and HB 1924 look to provide incentives and lower barriers in this regard.
SB 1128 provides incentives for medical practices in areas in Texas designated by the federal or state government as a medically underserved area or a health professional shortage area through a tax exemption on equipment used to diagnose, prevent, alleviate, or cure a human illness or injury. No action has been taken on the bill in over a month, however, and it is still in committee.
HB 1924 endeavors to increase access to pharmacy services in "rural hospitals" which include hospitals with 100 beds or fewer that are located in a county with a population of 50,000 or less; or have been designated by the Centers for Medicare and Medicaid Services as a critical access hospital, rural referral center, or sole community hospital. The bill would authorize hospitals that meet certain statutory requirements to allow properly certified pharmacy technicians to perform certain essential functions ordinarily reserved for pharmacists when the technician's actions are verified by a licensed nurse and/or remote order review by a pharmacist. The bill left committee on April 15, 2009.
Texas Health Insurance Risk Pool
On April 8, 2009, the Texas House of Representatives passed HB 2064 in an effort to increase the utilization of the Texas Health Insurance Risk Pool. The Texas Health Insurance Risk Pool provides health insurance for certain individuals who are unable to obtain health insurance. The current statutory formula for Risk Pool premiums is cost prohibitive for many individuals otherwise eligible to participate because premiums are set at twice the average premium in the individual market. HB 2064 provides discounts to certain participants on a sliding scale based upon financial need. Individuals with an income at or below 200% of the federal poverty level will be eligible for a 50% discount on their premiums. A person whose income is between 200 and 300% of the poverty level will be eligible for a 30% discount on their premiums. The bill also provides a correlating premium tax credit for the issuer of such a discounted policy. The legislation caps the two year aggregate discount at $20 Million.
SB 879 is a companion bill that has already been reported out of committee on the Senate side.
1 HB 676, HB 743, HB 862, HB 1200 HB 1329 HB1699, HB 2200, HB 2962, SB 187, and SB 841.
2 HB 647, HB 843, HB 1541, HB 2199, and HB 2204.
3 HB 743, HB 862, HB 1329, HB 1699, HB 1769, HB 2200, HB 2388, HB 2962, SB 187, and SB 841.
*AHLA wishes to thank Christopher D. DeMeo, Esquire (McGlinchey Stafford PLLC, Houston, TX), Connie R. Crawford, Esquire (El Paso County Hospital District Legal Unit, El Paso, TX), and Amy L. Osborn, Esquire (Rogaliner Law Offices PC, Frisco, TX).
The Healthcare Reform Educational Task Force is a joint endeavor of the Healthcare Liability and Litigation; Hospitals and Health Systems; In-House Counsel; Payors, Plans, and Managed Care; Physician Organizations; Regulation, Accreditation, and Payment; and Teaching Hospitals and Academic Medical Centers Practice Groups.