82R10636 CJC-F
 
  By: Ellis S.B. No. 1819
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to charity care provided by certain nonprofit hospitals.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 311.031(16), Health and Safety Code, is
  amended to read as follows:
               (16)  "Unreimbursed costs" means the costs a hospital
  incurs for providing individuals inpatient and outpatient services
  for which the hospital does not receive reimbursement from any
  source, including a third-party payor. The term does not include
  payor discounts or contractual adjustments in reimbursements to
  third-party payors or costs for which the hospital receives any
  partial payment for the related service, [after subtracting
  payments received from any source for such services] including but
  not limited to the following: third-party insurance payments;
  Medicare payments; Medicaid payments; Medicare education
  reimbursements; payments from Tricare or the Civilian Health and
  Medical Program of the Uniformed Services; state reimbursements for
  education; payments from drug companies to pursue research; grant
  funds for research; and disproportionate share payments. For
  purposes of this definition, the term "costs" shall be calculated
  by applying the cost to charge ratios, according to the hospital's
  most recently filed Medicare cost report, [derived in accordance
  with generally accepted accounting principles for hospitals] to
  billed charges. For [The calculation of the cost to charge ratios
  shall be based on the most recently completed and audited prior
  fiscal year of the hospital or hospital system. Prior to January 1,
  1996, for purposes of this definition, charitable contributions and
  grants to a hospital, including transfers from endowment or other
  funds controlled by the hospital or its nonprofit supporting
  entities, shall not be subtracted from the costs of providing
  services for purposes of determining unreimbursed costs. After
  January 1, 1996, for] purposes of this definition, charitable
  contributions and grants to a hospital, including transfers from
  endowment or other funds controlled by the hospital or its
  nonprofit supporting entities, shall not be subtracted from the
  costs of providing services for purposes of determining the
  unreimbursed costs of charity care and government-sponsored
  indigent health care.
         SECTION 2.  Section 311.033(a), Health and Safety Code, is
  amended to read as follows:
         (a)  A hospital shall submit to the department financial and
  utilization data for that hospital, including data relating to the
  hospital's:
               (1)  total gross revenue, including:
                     (A)  Medicare gross revenue;
                     (B)  Medicaid gross revenue;
                     (C)  other revenue from state programs;
                     (D)  revenue from local government programs;
                     (E)  local tax support;
                     (F)  charitable contributions;
                     (G)  other third party payments;
                     (H)  gross inpatient revenue; [and]
                     (I)  gross outpatient revenue;
                     (J)  disproportionate share hospitals payment
  program revenue;
                     (K)  upper payment limit supplemental payment
  program revenue;
                     (L)  tobacco settlement proceeds; and
                     (M)  federal grant funding, including payments
  made for care for undocumented persons;
               (2)  total deductions from gross revenue, including:
                     (A)  contractual allowance; and
                     (B)  any other deductions;
               (3)  charity care;
               (4)  bad debt expense;
               (5)  total admissions, including:
                     (A)  Medicare admissions;
                     (B)  Medicaid admissions;
                     (C)  admissions under a local government program;
                     (D)  charity care admissions; and
                     (E)  any other type of admission;
               (6)  total discharges;
               (7)  total patient days;
               (8)  average length of stay;
               (9)  total outpatient visits;
               (10)  total assets;
               (11)  total liabilities;
               (12)  estimates of unreimbursed costs of subsidized
  health services reported separately in the following categories:
                     (A)  emergency care and trauma care;
                     (B)  neonatal intensive care;
                     (C)  free-standing community clinics;
                     (D)  collaborative efforts with local government
  or private agencies in preventive medicine, such as immunization
  programs; and
                     (E)  other services that satisfy the definition of
  "subsidized health services" contained in Section 311.031(15) 
  [311.031(13)];
               (13)  donations;
               (14)  total cost of reimbursed and unreimbursed
  research;
               (15)  total cost of reimbursed and unreimbursed
  education separated into the following categories:
                     (A)  education of physicians, nurses,
  technicians, and other medical professionals and health care
  providers;
                     (B)  scholarships and funding to medical schools,
  colleges, and universities for health professions education;
                     (C)  education of patients concerning disease
  management [diseases] and in-home [home] care in response to
  community needs;
                     (D)  community health education through promotion
  and disease prevention [informational] programs, publications, and
  outreach activities in response to community needs; and
                     (E)  other educational services that satisfy the
  definition of "education-related costs" under Section 311.031(6);
  and
               (16)  charge description master or charge master.
         SECTION 3.  Section 311.042(2), Health and Safety Code, is
  amended to read as follows:
               (2)  "Community benefits" means the unreimbursed cost
  to a hospital of providing charity care, government-sponsored
  indigent health care, donations, education, government-sponsored
  program services, including unreimbursed costs resulting from
  defined services covered by Medicare, Medicaid, Tricare, or the
  Civilian Health and Medical Program of the Uniformed Services,
  research, and subsidized health services. Community benefits
  include community-based prevention programs and programs or
  services to reduce health disparities in the community served by
  the hospital by increasing the proportion of the population that
  has access to health information and disease prevention that are
  described by the Guide to Community Preventive Services published
  by the Centers for Disease Control and Prevention of the United
  States Public Health Service.  The term does not include the cost to
  the hospital of paying any taxes or other governmental assessments,
  uncollected fees, or accounts written off as bad debt.
         SECTION 4.  Section 311.043(c), Health and Safety Code, is
  amended to read as follows:
         (c)  Reductions in the amount of community benefits, which
  include [includes] charity care and government-sponsored indigent
  health care, provided by a nonprofit hospital shall be considered
  reasonable when [the financial reserves of the hospital are reduced
  to such a level that the hospital would be in violation of any
  applicable bond covenants, when] necessary to prevent the hospital
  from endangering its ability to continue operations, or if the
  hospital, as a result of a natural or other disaster, is required
  substantially to curtail its operations.
         SECTION 5.  This Act takes effect September 1, 2011.