House members worked from Thursday morning until well after 3 a.m. on Friday to pass House Bill 1, the state’s general appropriations bill. The budget calls for $150.1 billion in spending over the biennium, including a $2.5 billion increase for health and human services. Part of that would go to raise Medicaid provider reimbursement by 7.5 percent, but a contingency deep in the House budget threatens that increase.

A section of HB 1 makes the Medicaid provider reimbursement increase contingent on passage of HB 3778 by Rep. Patrick Rose, D-Dripping Springs, or similar legislation. That bill would essentially place a “quality assurance fee” on nursing homes. The fee could be used to draw down federal funds to reinvest in nursing homes.

According to TAFP’s director of public affairs, Tom Banning, even if the quality assurance fee legislation fails to pass, there is enough political steam behind the Medicaid provider rate hike to override the House contingency.

The House also passed the supplemental appropriations request, HB 15, which contains a restoration of the 2.5-percent cut in Medicaid provider payments enacted in 2003, bringing the total rate increase to 10 percent. The budget debate moves to the Senate next, where there are several advocates for increasing Medicaid provider payments.

“Reimbursement rates for health care providers in Texas with Medicaid are way too low,” said Sen. Robert Deuell, M.D., a family physician from Greenville. “I think if the government -- the state of Texas -- is going to commit to a program then I think we shouldn’t subsidize that program on the backs of the people being asked to provide the health care.”

Sen. Deuell serves as vice chair on the Senate Health and Human Services Committee and has been working on the Senate subcommittee on Article II, the section of the budget that deals with health spending.

“I think we need to provide fair reimbursement rates,” Deuell said in an interview for TAFP’s video Web cast for March 30, Capitol Report. “It has a lot to do with access. Out in the rural areas, as a family physician, I cannot find pediatric subspecialties to take care of Medicaid kids. That then in turn overwhelms the children’s hospitals in Dallas, Fort Worth or Houston, because they’re getting such an influx of Medicaid patients they can’t physically see them all and that creates another access problem.”

State suspends enrollment in Medicaid managed care program

On Tuesday, March 27, state officials shut down enrollment in the Star Plus Medicaid managed care program run by Evercare in Central Texas because too few physicians in the area will accept the plan. The Star Plus model was established in Central Texas on February 1, but already many of the more than 6,000 patients in the Evercare plan report that they can’t find a doctor. Amerigroup also holds a contract for providing Star Plus management for Medicaid patients in Central Texas and reports that their patients are not having similar problems, according to the Austin-American Statesman.

Woefully low reimbursement rates in the state’s Medicaid program combined with the perceived administrative hassles of the managed care delivery system make Star Plus unpopular among physicians.

CHIP restoration bill rescheduled for House debate

House Bill 109 by Rep. Sylvester Turner, D-Houston, has another date on the House floor. The measure that would make it easier for families to enroll their children in the CHIP program is scheduled for debate by the full House on Tuesday, April 3. The bill was sent back to committee last week because of an omitted word in the bill analysis and was then held up in the House Calendars Committee to make time for the budget debate.

TAFP and the Texas Medical Association need your help to ensure that lawmakers and the public know how important CHIP is, not only to the health of some of the state’s most vulnerable citizens, but to the state’s economy. CHIP is a cost-effective way to insure children who would likely join the state’s swelling ranks of uninsured without the program. For every dollar Texas invests in CHIP, the federal government returns $2.63 to the state. By failing to enroll all eligible children in the program, the state has forfeited almost $900 million in federal matching funds since 1998.

Medical associations including TAFP and TMA request that members write letters to their local newspapers as soon as possible to stress the importance of CHIP and the passage of HB 109. Click here for a set of talking points developed by TMA on the issue. You can also download the Primary Care Coalition’s issue brief on Medicaid and CHIP.

Youth fitness initiative advances to Senate floor

An amended Senate Bill 530 by Sen. Jane Nelson, R-Lewisville, passed out of the Senate Committee on Education Tuesday and will now be heard by the full Senate. The bill, which would bring 30 minutes of “moderate or vigorous” daily physical education back for students in grades K-8 and require biannual fitness assessments for students in grades K-12, aims to stem the rising rate of youth obesity.

Summarized data from the fitness assessments, organized by grade level and with names of teachers and students omitted, would be sent to the Texas Education Agency. The TEA would then analyze the data for correlations between a student’s physical health and his or her academic achievement level, attendance level, obesity, disciplinary programs and school meal plan. From there, the agency could then develop future target programs to keep students healthy.

The annual fitness assessment requirement would go into effect for students grades K-12 in the 2007-2008 school year. An amendment to the bill would allow middle schools to implement the legislation in the 2008-2009 school year, giving special consideration for schools with block scheduling. Currently, elementary students must have 135 minutes of physical education per week and middle school students must have physical education twice a week.

A recent report released by Texas Comptroller Susan Combs reveals that obesity cost Texas businesses an estimated $3.3 billion in 2005 and could balloon to almost $16 billion annually by 2025 if the trend continues. The report, titled “Counting Costs and Calories – Measuring the Cost of Obesity to Texas Employers,” details the costs of health care, absenteeism, decreased productivity and disability caused by the obesity population of Texas, which now encompasses nearly two-thirds of Texas adults. Read the report for the full scope of the epidemic as well as for Combs’ suggestions for stopping the rising trend. She recommends a focus on preventive medicine and gives suggested motivations or incentives for employees to lead healthy lifestyles.

Thanks to these Physicians of the Day

TAFP would like to extend a special thanks to this week’s physicians who volunteered to serve at the Texas Capitol as Physician of the Day. Also known as TOMA week, this week celebrated our partnership with the Texas Osteopathic Medical Association. Participating physicians were TOMA members Steve Yount, D.O., of Bastrop; Jeff Rettig, D.O., of Groesbeck; Patrick Hanford, D.O., of Lubbock; Russell Gamber, D.O., of Fort Worth; and Jack McCarty, D.O., of Lubbock.

We still need TAFP members to sign up to serve as the Physician of the Day during the 80th Legislative Session. Open dates in April, April 23, 25 and 26, need to be filled as soon as possible. Many more spots are also available in May. Contact TAFP’s Kate McCann by e-mail or phone at (512) 329-8666 for more information, or visit our Physician of the Day page of the TAFP Web site.