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