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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation and operations of certain health care |
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provider participation programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle D, Title 4, Health and Safety Code, is |
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amended by adding Chapter 292D to read as follows: |
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CHAPTER 292D. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN |
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CERTAIN COUNTIES BORDERING NECHES RIVER |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 292D.001. DEFINITIONS. In this chapter: |
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(1) "Institutional health care provider" means a |
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nonpublic hospital that provides inpatient hospital services. |
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(2) "Paying hospital" means an institutional health |
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care provider required to make a mandatory payment under this |
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chapter. |
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(3) "Program" means the county health care provider |
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participation program authorized by this chapter. |
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Sec. 292D.002. APPLICABILITY. This chapter applies only to |
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a county that: |
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(1) has a population of more than 250,000; and |
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(2) borders the Neches River. |
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Sec. 292D.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION |
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PROGRAM; PARTICIPATION IN PROGRAM. (a) A county health care |
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provider participation program authorizes a county to collect a |
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mandatory payment from each institutional health care provider |
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located in the county to be deposited in a local provider |
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participation fund established by the county. Money in the fund may |
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be used by the county as provided by Section 292D.103(c). |
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(b) The commissioners court may adopt an order authorizing a |
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county to participate in the program, subject to the limitations |
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provided by this chapter. |
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SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT |
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Sec. 292D.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY |
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PAYMENTS. The commissioners court of a county may require a |
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mandatory payment authorized under this chapter by an institutional |
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health care provider in the county only in the manner provided by |
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this chapter. |
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Sec. 292D.052. MAJORITY VOTE REQUIRED. The commissioners |
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court of a county may not authorize the county to collect a |
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mandatory payment authorized under this chapter without an |
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affirmative vote of a majority of the members of the commissioners |
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court. |
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Sec. 292D.053. RULES AND PROCEDURES. The commissioners |
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court may adopt rules relating to the administration of the |
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program, including the collection of a mandatory payment, |
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expenditures, an audit, and any other administrative aspect of the |
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program. |
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Sec. 292D.054. INSTITUTIONAL HEALTH CARE PROVIDER |
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REPORTING; INSPECTION OF RECORDS. (a) If the commissioners court |
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of a county authorizes the county to participate in a program under |
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this chapter, the commissioners court shall require each |
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institutional health care provider to submit to the county a copy of |
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any financial and utilization data required by and reported to the |
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Department of State Health Services under Sections 311.032 and |
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311.033 and any rules adopted by the executive commissioner of the |
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Health and Human Services Commission to implement those sections. |
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(b) The commissioners court of a county that collects a |
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mandatory payment authorized under this chapter may inspect the |
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records of an institutional health care provider to the extent |
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necessary to ensure compliance with the requirements of Subsection |
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(a). |
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SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS |
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Sec. 292D.101. HEARING. (a) In each year that the |
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commissioners court of a county authorizes a program under this |
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chapter, the commissioners court shall hold a public hearing on the |
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amounts of any mandatory payments that the commissioners court |
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intends to require during the year and how the revenue derived from |
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those payments is to be spent. |
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(b) Not later than the fifth day before the date of the |
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hearing required under Subsection (a), the commissioners court of |
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the county shall publish notice of the hearing in a newspaper of |
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general circulation in the county and provide written notice of the |
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hearing to each institutional health care provider located in the |
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county. |
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(c) A representative of a paying hospital is entitled to |
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appear at the public hearing and be heard regarding any matter |
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related to the mandatory payments authorized under this chapter. |
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Sec. 292D.102. DEPOSITORY. (a) The commissioners court of |
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each county that collects a mandatory payment authorized under this |
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chapter by resolution shall designate one or more banks located in |
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the county as the depository for mandatory payments received by the |
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county. |
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(b) All income received by a county under this chapter, |
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including the revenue from mandatory payments remaining after |
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discounts and fees for assessing and collecting the payments are |
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deducted, shall be deposited with the county depository in the |
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county's local provider participation fund and may be withdrawn |
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only as provided by this chapter. |
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(c) All funds under this chapter shall be secured in the |
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manner provided for securing county funds. |
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Sec. 292D.103. LOCAL PROVIDER PARTICIPATION FUND; |
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AUTHORIZED USES OF MONEY. (a) Each county that collects a |
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mandatory payment authorized under this chapter shall create a |
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local provider participation fund. |
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(b) The local provider participation fund of a county |
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consists of: |
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(1) all revenue received by the county attributable to |
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mandatory payments authorized under this chapter, including any |
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penalties and interest attributable to delinquent payments; |
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(2) money received from the Health and Human Services |
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Commission as a refund of an intergovernmental transfer from the |
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county to the state, provided that the intergovernmental transfer |
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does not receive a federal matching payment; and |
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(3) the earnings of the fund. |
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(c) Money deposited to the local provider participation |
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fund may be used only to: |
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(1) fund intergovernmental transfers from the county |
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to the state to provide the nonfederal share of Medicaid payments |
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for: |
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(A) uncompensated care payments to nonpublic |
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hospitals, if those payments are authorized under the Texas |
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Healthcare Transformation and Quality Improvement Program waiver |
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issued under Section 1115 of the federal Social Security Act (42 |
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U.S.C. Section 1315), or a successor waiver program authorizing |
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similar Medicaid supplemental payment programs; |
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(B) uniform rate enhancements for nonpublic |
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hospitals in the Medicaid managed care service area in which the |
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county is located; |
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(C) payments available under another waiver |
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program authorizing payments that are substantially similar to |
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Medicaid payments to nonpublic hospitals described by Paragraph (A) |
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or (B); or |
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(D) any reimbursement to nonpublic hospitals for |
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which federal matching funds are available; |
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(2) subject to Section 292D.151(d), pay the |
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administrative expenses of the county in administering the program, |
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including collateralization of deposits; |
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(3) refund all or a portion of a mandatory payment |
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collected in error from a paying hospital; |
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(4) refund to paying hospitals a proportionate share |
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of the money attributable to mandatory payments collected under |
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this chapter that the county: |
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(A) receives from the Health and Human Services |
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Commission that is not used to fund a program for which the county |
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made intergovernmental transfers described by Subdivision (1); or |
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(B) determines cannot be used to fund a program |
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for which the county made intergovernmental transfers described by |
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Subdivision (1); |
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(5) transfer funds to the Health and Human Services |
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Commission if the county is legally required to transfer the funds |
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to address a disallowance of federal matching funds with respect to |
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programs for which the district made intergovernmental transfers |
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described by Subdivision (1); and |
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(6) reimburse the county if the county is required by |
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the rules governing the uniform rate enhancement program described |
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by Subdivision (1)(C) to incur an expense or forego Medicaid |
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reimbursements from the state because the balance of the local |
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provider participation fund is not sufficient to fund that rate |
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enhancement program. |
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(d) Money in the local provider participation fund may not |
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be commingled with other county funds. |
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(e) Notwithstanding any other provision of this chapter, |
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with respect to an intergovernmental transfer of funds described by |
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Subsection (c)(1) made by the county, any funds received by the |
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state or county as a result of the transfer may not be used by the |
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state, county, or any other entity to: |
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(1) expand Medicaid eligibility under the Patient |
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Protection and Affordable Care Act (Pub. L. No. 111-148) as amended |
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by the Health Care and Education Reconciliation Act of 2010 (Pub. L. |
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No. 111-152); or |
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(2) fund the nonfederal share of payments to nonpublic |
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hospitals available through the Medicaid disproportionate share |
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hospital program or the delivery system reform incentive payment |
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program. |
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SUBCHAPTER D. MANDATORY PAYMENTS |
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Sec. 292D.151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL |
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NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if |
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the commissioners court of a county authorizes a program under this |
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chapter, the commissioners court may require an annual mandatory |
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payment to be assessed on the net patient revenue of each |
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institutional health care provider located in the county. The |
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commissioners court shall provide that the mandatory payment is to |
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be assessed at least annually, but not more often than |
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quarterly. In the first year in which the mandatory payment is |
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required, the mandatory payment is assessed on the net patient |
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revenue of an institutional health care provider as determined by |
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the data reported to the Department of State Health Services under |
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Sections 311.032 and 311.033 in the most recent fiscal year for |
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which that data was reported. If the institutional health care |
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provider did not report any data under those sections, the |
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provider's net patient revenue is the amount of that revenue as |
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contained in the provider's Medicare cost report submitted for the |
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previous fiscal year or for the closest subsequent fiscal year for |
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which the provider submitted the Medicare cost report. The |
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commissioners court shall update the amount of the mandatory |
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payment on an annual basis. |
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(b) The amount of a mandatory payment authorized under this |
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chapter must be uniformly proportionate with the amount of net |
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patient revenue generated by each paying hospital in the county. A |
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mandatory payment authorized under this chapter may not hold |
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harmless any institutional health care provider, as required under |
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42 U.S.C. Section 1396b(w). |
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(c) The commissioners court of a county that collects a |
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mandatory payment authorized under this chapter shall set the |
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amount of the mandatory payment. The aggregate amount of the |
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mandatory payment required of all paying hospitals may not exceed |
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six percent of the aggregate net patient revenue from hospital |
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services provided by all paying hospitals in the county. |
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(d) Subject to Subsection (c), the commissioners court of a |
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county that collects a mandatory payment authorized under this |
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chapter shall set the mandatory payments in amounts that in the |
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aggregate will generate sufficient revenue to cover the |
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administrative expenses of the county for activities under this |
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chapter and to fund an intergovernmental transfer described by |
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Section 292D.103(c)(1). The annual amount of revenue from mandatory |
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payments that may be used to pay the administrative expenses of the |
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county for activities under this chapter may not exceed $150,000, |
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plus the cost of collateralization of deposits, regardless of |
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actual expenses. |
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(e) A paying hospital may not add a mandatory payment |
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required under this section as a surcharge to a patient. |
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Sec. 292D.152. ASSESSMENT AND COLLECTION OF MANDATORY |
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PAYMENTS. (a) The county may collect or, using a competitive |
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bidding process, contract for the assessment and collection of |
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mandatory payments authorized under this chapter. |
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(b) The person charged by the county with the assessment and |
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collection of mandatory payments shall charge and deduct from the |
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mandatory payments collected for the county a collection fee in an |
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amount not to exceed the person's usual and customary charges for |
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like services. |
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(c) If the person charged with the assessment and collection |
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of mandatory payments is an official of the county, any revenue from |
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a collection fee charged under Subsection (b) shall be deposited in |
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the county general fund and, if appropriate, shall be reported as |
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fees of the county. |
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Sec. 292D.153. INTEREST, PENALTIES, AND |
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DISCOUNTS. Interest, penalties, and discounts on mandatory |
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payments required under this chapter are governed by the law |
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applicable to county ad valorem taxes. |
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Sec. 292D.154. PURPOSE; CORRECTION OF INVALID PROVISION OR |
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PROCEDURE. (a) The purpose of this chapter is to generate revenue |
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by collecting from institutional health care providers a mandatory |
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payment to be used to provide the nonfederal share of certain |
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Medicaid programs as described by Section 292D.103(c)(1). |
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(b) To the extent any provision or procedure under this |
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chapter causes a mandatory payment authorized under this chapter to |
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be ineligible for federal matching funds, the commissioners court |
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of the county administering the program may provide by rule for an |
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alternative provision or procedure that conforms to the |
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requirements of the federal Centers for Medicare and Medicaid |
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Services. A rule adopted under this section may not create, impose, |
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or materially expand the legal or financial liability or |
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responsibility of the county or an institutional health care |
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provider located in the county beyond the provisions of this |
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chapter. This section does not require the commissioners court of a |
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county to adopt a rule. |
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(c) The county may only assess and collect a mandatory |
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payment authorized under this chapter if a waiver program, uniform |
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rate enhancement, or reimbursement described by Section |
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299.103(c)(1) is available to the county. |
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SECTION 2. Section 300.0003, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 300.0003. APPLICABILITY. (a) Except as provided by |
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Subsection (b), this [This] chapter applies only to: |
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(1) a hospital district that is not participating in a |
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health care provider participation program authorized by another |
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chapter of this subtitle; and |
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(2) a county or municipality that: |
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(A) is not participating in a health care |
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provider participation program authorized by another chapter of |
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this subtitle; and |
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(B) is not served by a hospital district or a |
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public hospital. |
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(b) This chapter does not apply to a municipality that: |
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(1) is located in a county described by Section |
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292D.002; and |
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(2) has a population of more than 100,000. |
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SECTION 3. Section 300A.0003, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 300A.0003. APPLICABILITY. (a) Except as provided by |
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Subsection (b), this [This] chapter applies only to: |
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(1) a hospital district that: |
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(A) is not participating in a health care |
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provider participation program authorized by another chapter of |
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this subtitle; and |
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(B) has only one institutional health care |
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provider located in the district; and |
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(2) a county or municipality that: |
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(A) is not participating in a health care |
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provider participation program authorized by another chapter of |
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this subtitle; |
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(B) is not served by a hospital district or a |
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public hospital; and |
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(C) has only one institutional health care |
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provider located in the county or municipality. |
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(b) This chapter does not apply to a municipality that: |
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(1) is located in a county described by Section |
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292D.002; and |
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(2) has a population of more than 100,000. |
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SECTION 4. Chapter 295, Health and Safety Code, is |
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repealed. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. (a) Except as provided by Subsection (b) of this |
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section, this Act takes effect September 1, 2023. |
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(b) The section of this Act adding Chapter 292D, Health and |
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Safety Code, takes effect September 1, 2025. |