SECTION 1. Subtitle D, Title
4, Health and Safety Code, is amended by adding Chapter 296 to read as
follows:
CHAPTER 296. COUNTY
HEALTH CARE FUNDING DISTRICT IN CERTAIN COUNTIES
SUBCHAPTER A. GENERAL
PROVISIONS
Sec. 296.001.
DEFINITIONS. In this chapter:
(1) "Commission" means the commission of a district
created under this chapter.
(2) "District" means a county health care funding
district created under this chapter.
(3) "Institutional
health care provider" means a nonpublic hospital licensed under Chapter 241.
(4) "Paying
hospital" means an institutional health care provider required to make
a mandatory payment under this chapter.
Sec. 296.002. CREATION OF DISTRICT. A district may be created by
order of the commissioners court of each county that:
(1) is not served by a
hospital district or a public hospital; and
(2) has a population of
less than 200,000 and contains two municipalities both with populations of
75,000 or more.
Sec. 296.003. DISSOLUTION. A district created under this chapter
may be dissolved in the manner provided for the dissolution of a hospital
district under Subchapter E, Chapter 286.
Sec. 296.004. DISTRICT TERRITORY. The boundaries of each district
are coextensive with the boundaries of the county in which the district is
created. SUBCHAPTER B. DISTRICT ADMINISTRATION
Sec. 296.051. COMMISSION; DISTRICT GOVERNANCE. (a) Each district
created under Section 296.002 is governed by a commission consisting of the
commissioners court of the county in which the district is created.
(b) Service on the commission by a county commissioner or county
judge is an additional duty of that person's office.
(c) A district is a component of county government and is not a
separate political subdivision of this state.
SUBCHAPTER C. POWERS AND
DUTIES
Sec. 296.101. LIMITATION
ON AUTHORITY TO REQUIRE MANDATORY PAYMENT. Each
district may require a mandatory payment only in the manner provided
by this chapter.
Sec. 296.102. MAJORITY
VOTE REQUIRED. (a) A district may
not require any mandatory payment
authorized under this chapter, spend any
money, including for the administrative expenses of the district, or
conduct any other business without an affirmative vote of a majority
of the members of the commission.
(b) Before requiring a mandatory payment under this chapter in any
one year, the commission must obtain the affirmative vote required by
Subsection (a).
Sec. 296.103. RULES AND
PROCEDURES. After the commission
has voted to require a mandatory payment authorized under this chapter, the
commission may adopt rules governing the operation of the district,
including rules relating to the administration of a mandatory
payment authorized under this chapter.
Sec. 296.104.
INSTITUTIONAL HEALTH CARE PROVIDER REPORTING; INSPECTION OF RECORDS. (a) A district shall require each
institutional health care provider to submit to the district a copy of any financial and utilization data
required by and reported to the Department of State Health Services under
Sections 311.032 and 311.033 and any rules adopted by the executive commissioner
of the Health and Human Services Commission to implement those sections.
(b) A district may inspect the records of an
institutional health care provider to the extent necessary to ensure
compliance with the requirements of Subsection (a).
SUBCHAPTER D. GENERAL
FINANCIAL PROVISIONS
Sec. 296.151. HEARING.
(a) Each year, the commission of a
district shall hold a public hearing on the amounts of any mandatory
payments that the commission intends
to require during the year and how the revenue derived from those payments
is to be spent.
(b) Not later than the
10th day before the date of the hearing required under Subsection (a), the commission shall publish notice of the
hearing in a newspaper of general circulation in the county in which the district is located.
(c) A representative of a
paying hospital is entitled to appear at the time and place designated in
the public notice and to be heard regarding any matter related to the
mandatory payments authorized under this chapter.
Sec. 296.152. FISCAL YEAR. Each district's fiscal year begins on
September 1 and ends on August 31 of each year.
Sec. 296.153.
DEPOSITORY. (a) Each commission by
resolution shall designate one or more banks located in the district as the depository for the district. A bank designated as a
depository serves for two years or until a successor is designated.
(b) All income received
by a district, including the revenue
from mandatory payments remaining after discounts and fees for assessing
and collecting the payments are deducted, shall be deposited with the district depository in the district's local provider participation
fund and may be withdrawn only as provided by this chapter.
(c) All district funds shall be secured in the
manner provided for securing county funds.
Sec. 296.154. LOCAL
PROVIDER PARTICIPATION FUND; AUTHORIZED USES OF MONEY. (a) Each district shall create a local provider
participation fund.
(b) The local provider
participation fund consists of:
(1) all revenue from the mandatory payments authorized
under this chapter, including any penalties and interest attributable to
delinquent payments;
(2) money received from
the Health and Human Services Commission as a refund of an
intergovernmental transfer from the district
to the state for the purpose of providing the nonfederal share of Medicaid
supplemental payment program payments, provided that the intergovernmental
transfer does not receive a federal matching payment; and
(3) the earnings of the
fund.
(c) Money deposited to
the local provider participation fund may be used only to:
(1) fund
intergovernmental transfers from the district
to the state to provide the nonfederal share of a Medicaid supplemental
payment program authorized under the state Medicaid plan, the Texas
Healthcare Transformation and Quality Improvement Program waiver issued
under Section 1115 of the federal Social Security Act (42 U.S.C. Section
1315), or a successor waiver program authorizing similar Medicaid
supplemental payment programs;
(2) subsidize indigent
programs;
(3) pay the
administrative expenses of the district;
(4) refund a portion of a
mandatory payment collected in error from a paying hospital; and
(5) refund to paying
hospitals the proportionate share of money received by the district from the Health and Human
Services Commission that is not used to fund the nonfederal share of
Medicaid supplemental payment program payments.
(d) Money in the local
provider participation fund may not be commingled with county funds.
(e) An intergovernmental
transfer of funds described by Subsection (c)(1) and any funds received by
the district as a result of an
intergovernmental transfer described by that subsection may not be used by the district, the county in which the district is
located, or any other entity to expand Medicaid eligibility under
the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
amended by the Health Care and Education Reconciliation Act of 2010 (Pub.
L. No. 111-152).
Sec. 296.155. ALLOCATION OF CERTAIN FUNDS. Not later than the
15th day after the date the district receives a payment described by
Section 296.154(c)(5), the district shall transfer to each paying hospital
an amount equal to the proportionate share of those funds to which the
hospital is entitled.
SUBCHAPTER E. MANDATORY
PAYMENTS
Sec. 296.201. MANDATORY
PAYMENTS BASED ON PAYING HOSPITAL NET PATIENT REVENUE. (a) Except as
provided by Subsection (e), the commission
of a district may require an annual mandatory payment to be assessed
quarterly on the net patient revenue
of each institutional health care provider located in the district.
In the first year in which
the mandatory payment is required, the mandatory payment is assessed on the
net patient revenue of an institutional health care provider as determined
by the data reported to the Department of State Health Services under
Sections 311.032 and 311.033 in the fiscal year ending in 2014.
The district shall update the amount of the
mandatory payment on a biennial
basis.
(b) The amount of a
mandatory payment authorized under this chapter must be uniformly
proportionate with the amount of net patient revenue generated by each
paying hospital in the district. A
mandatory payment authorized under this chapter may not hold harmless any
institutional health care provider, as required under 42 U.S.C. Section
1396b(w).
(c) The commission of a district that collects
a mandatory payment authorized under this chapter shall set the amount of
the mandatory payment. The amount of the mandatory payment required of
each paying hospital may not exceed an amount that, when added to the
amount of the mandatory payments required from all other paying hospitals
in the district, equals an amount of
revenue that exceeds six percent of the aggregate net patient revenue of
all paying hospitals in the district.
(d) Subject to the
maximum amount prescribed by Subsection (c), the
commission shall set the mandatory payments in amounts that in the
aggregate will generate sufficient revenue to cover the administrative expenses
of the district, to fund the nonfederal share of a Medicaid supplemental
payment program, and to pay for indigent programs, except that the
amount of revenue from mandatory payments used for administrative expenses
of the district in a year may not
exceed the lesser of four percent of the total revenue generated from the
mandatory payment or $20,000.
(e) A paying hospital may
not add a mandatory payment required under this section as a surcharge to a
patient.
Sec. 296.202. ASSESSMENT
AND COLLECTION OF MANDATORY PAYMENTS. (a) Except as provided by
Subsection (b), the county tax assessor-collector shall collect the
mandatory payment authorized under this chapter. The county tax
assessor-collector shall charge and deduct from mandatory payments
collected for the district a fee for
collecting the mandatory payment in an amount determined by the commission, not to exceed the county
tax assessor-collector's usual and customary charges.
(b) If determined by the commission to be appropriate, the commission may contract for the
assessment and collection of mandatory payments in the manner provided by
Title 1, Tax Code, for the assessment and collection of ad valorem taxes.
(c) Revenue from a fee
charged by a county tax assessor-collector for collecting the mandatory
payment shall be deposited in the county general fund and, if appropriate,
shall be reported as fees of the county tax assessor-collector.
Sec. 296.203. INTEREST,
PENALTIES, AND DISCOUNTS. Interest, penalties, and discounts on mandatory
payments required under this chapter are governed by the law applicable to
county ad valorem taxes.
Sec. 296.204. PURPOSE;
CORRECTION OF INVALID PROVISION OR PROCEDURE. (a) The purpose of this
chapter is to generate revenue by collecting from institutional health care
providers a mandatory payment to be used to provide the nonfederal share of
a Medicaid supplemental payment program.
(b) To the extent any
provision or procedure under this chapter causes a mandatory payment
authorized under this chapter to be ineligible for federal matching funds,
the district may provide by rule for
an alternative provision or procedure that conforms to the requirements of
the federal Centers for Medicare and Medicaid Services.
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SECTION 1. Subtitle D, Title
4, Health and Safety Code, is amended by adding Chapter 296 to read as
follows:
CHAPTER 296. COUNTY
HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN CERTAIN COUNTIES
SUBCHAPTER A. GENERAL
PROVISIONS
Sec. 296.001.
DEFINITIONS. In this chapter:
(1) "Institutional
health care provider" means a nonpublic hospital that provides inpatient hospital services.
(2) "Paying
hospital" means an institutional health care provider required to make
a mandatory payment under this chapter.
(3) "Program" means the county health care provider
participation program authorized by this chapter.
Sec. 296.002. APPLICABILITY. This chapter applies only to a
county that:
(1) is not served by a
hospital district or a public hospital; and
(2) has a population of
less than 200,000 and contains two municipalities both with populations of
75,000 or more.
Sec. 296.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
PARTICIPATION IN PROGRAM. (a) A county health care provider participation
program authorizes a county to collect a mandatory payment from each
institutional health care provider located in the county to be deposited in
a local provider participation fund established by the county. Money in
the fund may be used by the county to fund certain intergovernmental
transfers and indigent care programs as provided by this chapter.
(b) The commissioners court may adopt an order authorizing a
county to participate in the program, subject to the limitations provided
by this chapter.
SUBCHAPTER B. POWERS AND
DUTIES OF COMMISSIONERS COURT
Sec. 296.051. LIMITATION
ON AUTHORITY TO REQUIRE MANDATORY PAYMENT. The
commissioners court of a county may require a mandatory payment authorized under this chapter by an institutional
health care provider in the county only in the manner provided by
this chapter.
Sec. 296.052. MAJORITY
VOTE REQUIRED. The commissioners court of
a county may not authorize the
county to collect a mandatory payment authorized under this chapter
without an affirmative vote of a majority of the members of the commissioners court.
Sec. 296.053. RULES AND
PROCEDURES. After the commissioners court
has voted to require a mandatory payment authorized under this chapter, the
commissioners court may adopt rules relating
to the administration of the mandatory payment.
Sec. 296.054.
INSTITUTIONAL HEALTH CARE PROVIDER REPORTING; INSPECTION OF RECORDS. (a) The commissioners court of a county that collects
a mandatory payment authorized under this chapter shall require each
institutional health care provider to submit to the county a copy of any financial and utilization data required
by and reported to the Department of State Health Services under Sections
311.032 and 311.033 and any rules adopted by the executive commissioner of
the Health and Human Services Commission to implement those sections.
(b) The commissioners court of a county that collects
a mandatory payment authorized under this chapter may inspect the
records of an institutional health care provider to the extent necessary to
ensure compliance with the requirements of Subsection (a).
SUBCHAPTER C. GENERAL
FINANCIAL PROVISIONS
Sec. 296.101. HEARING.
(a) Each year, the commissioners court of
a county that collects a mandatory payment authorized under this chapter
shall hold a public hearing on the amounts of any mandatory payments that
the commissioners court intends to
require during the year and how the revenue derived from those payments is
to be spent.
(b) Not later than the
10th day before the date of the hearing required under Subsection (a), the commissioners court of the county shall
publish notice of the hearing in a newspaper of general circulation in the
county.
(c) A representative of a
paying hospital is entitled to appear at the time and place designated in
the public notice and to be heard regarding any matter related to the
mandatory payments authorized under this chapter.
Sec. 296.102.
DEPOSITORY. (a) The commissioners court of each county that collects
a mandatory payment authorized under this chapter by resolution
shall designate one or more banks located in the county as the depository for mandatory
payments received by the county. A bank designated as a depository
serves for two years or until a successor is designated.
(b) All income received
by a county under this chapter,
including the revenue from mandatory payments remaining after discounts and
fees for assessing and collecting the payments are deducted, shall be
deposited with the county depository
in the county's local provider
participation fund and may be withdrawn only as provided by this chapter.
(c) All funds under this chapter shall be secured in the
manner provided for securing county funds.
Sec. 296.103. LOCAL
PROVIDER PARTICIPATION FUND; AUTHORIZED USES OF MONEY. (a) Each county that collects a mandatory payment
authorized under this chapter shall create a local provider
participation fund.
(b) The local provider
participation fund of a county
consists of:
(1) all revenue received by the county attributable to
mandatory payments authorized under this chapter, including any penalties
and interest attributable to delinquent payments;
(2) money received from
the Health and Human Services Commission as a refund of an
intergovernmental transfer from the county
to the state for the purpose of providing the nonfederal share of Medicaid
supplemental payment program payments, provided that the intergovernmental
transfer does not receive a federal matching payment; and
(3) the earnings of the
fund.
(c) Money deposited to
the local provider participation fund may be used only to:
(1) fund
intergovernmental transfers from the county
to the state to provide the nonfederal share of a Medicaid supplemental
payment program authorized under the state Medicaid plan, the Texas
Healthcare Transformation and Quality Improvement Program waiver issued
under Section 1115 of the federal Social Security Act (42 U.S.C. Section
1315), or a successor waiver program authorizing similar Medicaid
supplemental payment programs;
(2) subsidize indigent
programs;
(3) pay the
administrative expenses of the county
solely for activities under this chapter;
(4) refund a portion of a
mandatory payment collected in error from a paying hospital; and
(5) refund to paying
hospitals the proportionate share of money received by the county from the Health and Human Services
Commission that is not used to fund the nonfederal share of Medicaid
supplemental payment program payments.
(d) Money in the local
provider participation fund may not be commingled with other county funds.
(e) An intergovernmental
transfer of funds described by Subsection (c)(1) and any funds received by
the county as a result of an
intergovernmental transfer described by that subsection may not be used by the county or any other entity to expand
Medicaid eligibility under the Patient Protection and Affordable Care Act
(Pub. L. No. 111-148) as amended by the Health Care and Education
Reconciliation Act of 2010 (Pub. L. No. 111-152).
SUBCHAPTER D. MANDATORY
PAYMENTS
Sec. 296.151. MANDATORY
PAYMENTS BASED ON PAYING HOSPITAL NET PATIENT REVENUE. (a) Except as
provided by Subsection (e), the
commissioners court of a county that collects a mandatory payment
authorized under this chapter may require an annual mandatory
payment to be assessed on the net patient revenue of each institutional
health care provider located in the county.
The commissioners court may provide for the
mandatory payment to be assessed quarterly.
In the first year in which
the mandatory payment is required, the mandatory payment is assessed on the
net patient revenue of an institutional health care provider as determined
by the data reported to the Department of State Health Services under
Sections 311.032 and 311.033 in the fiscal year ending in 2013 or, if the institutional health care
provider did not report any data under those sections in that fiscal year,
as determined by the institutional health care provider's Medicare cost
report submitted for the 2013 fiscal year or for the closest subsequent
fiscal year for which the provider submitted the Medicare cost report.
The county shall update the amount
of the mandatory payment on an annual
basis.
(b) The amount of a
mandatory payment authorized under this chapter must be uniformly
proportionate with the amount of net patient revenue generated by each
paying hospital in the county. A
mandatory payment authorized under this chapter may not hold harmless any
institutional health care provider, as required under 42 U.S.C. Section
1396b(w).
(c) The commissioners court of a county that
collects a mandatory payment authorized under this chapter shall set the
amount of the mandatory payment. The amount of the mandatory payment
required of each paying hospital may not exceed an amount that, when added
to the amount of the mandatory payments required from all other paying
hospitals in the county, equals an
amount of revenue that exceeds six percent of the aggregate net patient
revenue of all paying hospitals in the county.
(d) Subject to the
maximum amount prescribed by Subsection (c), the
commissioners court of a county that collects a mandatory payment
authorized under this chapter shall set the mandatory payments in
amounts that in the aggregate will generate sufficient revenue to cover the
administrative expenses of the county for
activities under this chapter, to fund an
intergovernmental transfer described by Section 296.103(c)(1), and
to pay for indigent programs, except that the amount of revenue from
mandatory payments used for administrative expenses of the county for activities under this chapter
in a year may not exceed the lesser of four percent of the total revenue
generated from the mandatory payment or $20,000.
(e) A paying hospital may
not add a mandatory payment required under this section as a surcharge to a
patient.
Sec. 296.152. ASSESSMENT
AND COLLECTION OF MANDATORY PAYMENTS. (a) Except as provided by
Subsection (b), the county tax assessor-collector shall collect the
mandatory payment authorized under this chapter. The county tax
assessor-collector shall charge and deduct from mandatory payments
collected for the county a fee for
collecting the mandatory payment in an amount determined by the commissioners court of the county, not
to exceed the county tax assessor-collector's usual and customary charges.
(b) If determined by the commissioners court to be appropriate,
the commissioners court may contract
for the assessment and collection of mandatory payments in the manner
provided by Title 1, Tax Code, for the assessment and collection of ad
valorem taxes.
(c) Revenue from a fee
charged by a county tax assessor-collector for collecting the mandatory
payment shall be deposited in the county general fund and, if appropriate,
shall be reported as fees of the county tax assessor-collector.
Sec. 296.153. INTEREST,
PENALTIES, AND DISCOUNTS. Interest, penalties, and discounts on mandatory
payments required under this chapter are governed by the law applicable to
county ad valorem taxes.
Sec. 296.154. PURPOSE;
CORRECTION OF INVALID PROVISION OR PROCEDURE. (a) The purpose of this
chapter is to generate revenue by collecting from institutional health care
providers a mandatory payment to be used to provide the nonfederal share of
a Medicaid supplemental payment program.
(b) To the extent any
provision or procedure under this chapter causes a mandatory payment
authorized under this chapter to be ineligible for federal matching funds,
the county may provide by rule for
an alternative provision or procedure that conforms to the requirements of
the federal Centers for Medicare and Medicaid Services.
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