tient Protection and Affordable Care Act (PPACA) could add unwieldy costs to the state budget. They also point to un- certainty over the federal government’s ability to back out of subsidizing an ex- pansion after the first few years. On the other hand, a number of re- cent studies point to several economic benefits that could come along with ex- panding the Medicaid program in Texas. According to the Urban Institute and


Kaiser Family Foundation, states stand to lower their uncompensated care costs as more uninsured gain coverage through Medicaid expansion. In Texas, 1.75 mil- lion people with incomes below 133 per- cent of the federal poverty level (FPL) are uninsured and could qualify for ex- panded Medicaid coverage. If Texas opts out, Texans with incomes between 100 percent and 133 percent of FPL would be eligible for federal subsidies to pur- chase coverage in a health insurance ex- change. Those earning below FPL would not, which would still leave an estimat- ed 1.33 million Texans uninsured. (See “The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis” at www.kff. org/medicaid/8384.cfm.) Texas economist Ray Perryman says expansion would involve costs, but also benefits. “Medicaid expenditures lead to substantial economic activity, federal funds inflow, reduction in costs for un- compensated care and insurance, and enhanced productivity from a healthier population. … Every $1 spent by the state returns $1.29 in dynamic state gov- ernment revenue over the first 10 years of the expansion.” His research shows that from 2013 to 2017, the state could draw down $28 billion in federal funds in exchange for putting up $3.1 billion. (See “Only One Rational Choice: Texas Should Participate in Medicaid Expan- sion Under the Affordable Care Act” at www.perrymangroup.com/reports/Med- icaidExpansion12_1003.pdf.) In a follow up to his initial report favoring a Medicaid expansion, former chief revenue estimator for Texas, Billy Hamilton released a county-by-county analysis showing local tax revenues across the state would increase by $2.1 billion from the $23 billion in federal


32 TEXAS MEDICINE April 2013


health care funds the state could re- ceive to expand coverage to low-income adults from 2014 to 2017. (See “Ex- panding Medicaid in Texas: Smart, Af- fordable and Fair” at http://mhm.org/ images/stories/advocacy_and_public_ policy/Smart%20Affordable%20and%20 Fair_FNL_FULL.pdf, and a county-by- county tax analysis at www.texasimpact .org/2013-Medicaid-Expansion-Report.)


e-signature feature on the Medicaid pro- vider web portal, physicians will have to mail the completed self-attestation form back to TMHP. At press time in February, HHSC had


not yet released a final deadline for sub- mitting the forms, but said it would offer a three- to four-month grace period for physicians to complete the process. Payments should begin in mid-2013 and will be retroactive to Jan. 1. To avoid any payment issues, TMA


Mail in your Medicaid primary care rate increase forms


The Texas Health and Human Services Commission (HHSC) will release forms to apply for the Medicaid primary care rate increase and make them available on the Texas Medicaid and Healthcare Partnership (TMHP) website, www.tmhp .com/Pages/default.aspx. The Texas Medical Association also will post the forms on its website, www.texmed.org/ MedicaidAndCHIP.


Due to federal delays in releasing the rules, HHSC has postponed implementa- tion of the rate increase, which was sup- posed to take effect Jan. 1. Under the federal rules, physicians may qualify for the rate increase if:


• They are board certified in a specialty designation of family practice, gener- al internal medicine, or pediatrics, or a subspecialty within those designa- tions that is recognized by the Ameri- can Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Spe- cialties; or


• More than 60 percent of the services they provide are primary care services eligible for the rate increase, such as physician office visits and administra- tion of vaccines.


Eligible physicians must complete a


self-attestation form to verify they meet the requirements. Because the state does not have an


staff urges physicians to check the TMHP website and complete the attestation process as soon as possible.


Federal lawmakers take up medicine’s plea on SGR, IPAB


Texas Medical Association officials are optimistic about proposals to reform Medicare’s physician payment system this year, a top goal for the association’s federal legislative agenda. TMA physicians met with congres- sional leaders as part of the American Medical Association’s National Advocacy Conference in February to advocate for an alternative to Medicare’s Sustainable Growth Rate (SGR) formula, which doc- tors say does not keep up with the cost of care and deters them from caring for senior patients.


The doctors’ call was apparently


heard. Republican leaders of the House Ways and Means Committee and the En- ergy and Commerce Committee unveiled plans for a three-phase bill that would start with eliminating the SGR and move toward a system that pays doctors based on physician-endorsed quality measures and later on efficiency. Also in February, Rep. Allyson Schwartz (D-Pa.) and Rep. Joe Heck, DO (R-Nev.), reintroduced the Medicare Physician Payment Innovation Act (HR 574), a bill that would permanently re- peal the SGR formula and test new pay- ment models that promote quality and reduce costs.


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