Reimbursement and Billing
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Hospitals’ reimbursement for health care services comes from multiple public and private payers. Public payers, including Medicare and Medicaid, pay below cost. Among public and private payers alike, there is increased interest in paying for performance, rather than just for services provided. The Texas Hospital Association tracks and will help educate lawmakers in their effort to:

  • Monitor coordination efforts among state agencies to improve health care and reduce costs pursuant to two riders in the 2018-19 General Appropriations Act, which require state agencies to:
    • Develop a plan for an integrated information system to compare data related to health care systems funded by state appropriations.
    • Develop and implement potential value-based payment strategies such as episode-based bundling and pay for quality initiatives. (Article IX, Section 10.06, Analysis of Certain Health Care Data and Section 10.07, Cross-agency Collaboration on Value-based Payment Strategies).
    Senate Finance Committee
  • Monitor the implementation of Employee Retirement System Rider 18 of the General Appropriations Act. Evaluate the impact of obtaining savings through reduced contracted provider rates and innovative value-based plan design models with Health Related Institutions. Examine the impact to HRIs of providing patient care at discounted rates, as well as potential free market implications, the methodology used to determine each HRI’s savings obligation and progress on initiating innovative plan redesign based on HRI proposals. House Committee on Appropriations
  • Review the state's readiness to care for aging Texans by reviewing the reimbursement methodologies for nursing homes and assisted living facilities, including supplemental payments, Medicaid add-on payments and availability of alternative methods of finance. Identify methodologies to adequately finance Medicaid rates for long-term care facilities under managed care capitation, support high-quality care for Texas seniors, accommodate new models of care and encourage care coordination to treat higher incidence of complex conditions. House Committee on Appropriations
  • Monitor:
    • Implementation of a capitated correctional managed health care rate.
    • Medicaid cost-containment efforts.
    House Committee on Appropriations

Transparency

  • Study efforts by the Texas Department of State Health Services and the Texas Department of Insurance to increase health care cost transparency, including a review of the Texas Health Care Information Collection system and the Consumer Guide to Healthcare. Recommend ways to make provider and facility fees more accessible to consumers to improve health care cost transparency, increase quality of care and create a more informed health care consumer base. Senate Health and Human Services Committee
  • Monitor the implementation of legislation related to the settlement of out-of-network health benefit claims involving balance billing and patient's explanation of benefits statements. Senate Committee on Business and Commerce
  • Evaluate recent efforts by the legislature and the Texas Department of Insurance to minimize instances of surprise medical billing and to ensure the adequacy of health insurance networks. Identify instances in which surprise billing most often occurs and ways to decrease its frequency through enhanced transparency or other methods. House Committee on Insurance

Contacts

John Hawkins, senior vice president of advocacy and public policy, 512/465-1505

Jennifer Banda, vice president of advocacy, public policy and HOSPAC, 512/465-1046

Sara Gonzalez, vice president of advocacy and public policy, 512/465-1596

Richard Schirmer, vice president of policy analysis, 512,465-1056

Cameron Duncan, III, J.D., assistant general counsel, 512/465-1539