BILL ANALYSIS

C.S.H.B. 2995

By: Ashby

County Affairs

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Interested parties contend that entities in certain counties are unable to draw down available federal dollars to assist with previously unreimbursed and uncompensated health care costs.
C.S.H.B. 2995 seeks to address this issue by providing for a county health care provider participation program in certain counties.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 2995 amends the Health and Safety Code to provide for a county health care provider participation program in a county that is not served by a hospital district or a public hospital, has a population of more than 75,000, and borders or includes a portion of the Sam Rayburn Reservoir. The bill establishes that such a 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. The bill authorizes money in the fund to be used by the county to fund certain intergovernmental transfers and indigent care programs. The bill authorizes the commissioners court to adopt an order authorizing a county to participate in the program, subject to certain limitations. The bill defines, among other terms, "institutional health care provider" as a nonpublic hospital that provides inpatient hospital services.

C.S.H.B. 2995 sets out the powers and duties of a commissioners court with respect to the county health care provider participation program. The bill provides for an annual public hearing on the amounts of any mandatory payments that the commissioners court intends to require during the year. The bill provides for the designation of one or more local banks as the depository for mandatory payments and the creation, composition, and use of a county's local provider participation fund.

C.S.H.B. 2995 provides for the amount, assessment, and collection of a mandatory payment. The bill establishes that interest, penalties, and discounts on mandatory payments are governed by the law applicable to county property taxes. The bill authorizes a county to provide by rule for an alternative provision or procedure that conforms to the requirements of the federal Centers for Medicare and Medicaid Services to the extent any provision or procedure under the bill's provisions causes a mandatory payment to be ineligible for federal matching funds.

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2017.

COMPARISON OF ORIGINAL AND SUBSTITUTE

While C.S.H.B. 2995 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.

INTRODUCED	HOUSE COMMITTEE SUBSTITUTE
SECTION 1.  Subtitle D, Title 4, Health and Safety Code, is amended by adding Chapter 291A to read as follows: CHAPTER 291A.  COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN CERTAIN COUNTIES BORDERING OR INCLUDING THE SAM RAYBURN RESERVOIR SUBCHAPTER A.  GENERAL PROVISIONS Sec. 291A.001.  DEFINITIONS.  Sec. 291A.002.  APPLICABILITY.  Sec. 291A.003.  COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM; PARTICIPATION IN PROGRAM.  SUBCHAPTER B.  POWERS AND DUTIES OF COMMISSIONERS COURT Sec. 291A.051.  LIMITATION ON AUTHORITY TO REQUIRE MANDATORY PAYMENT.  Sec. 291A.052.  MAJORITY VOTE REQUIRED.  Sec. 291A.053.  RULES AND PROCEDURES.  Sec. 291A.054.  INSTITUTIONAL HEALTH CARE PROVIDER REPORTING; INSPECTION OF RECORDS.  SUBCHAPTER C.  GENERAL FINANCIAL PROVISIONS Sec. 291A.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. 291A.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. 291A.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, including through the Medicaid managed care program, under 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 under 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. 291A.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 2015 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 2015 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 the nonfederal share of a Medicaid supplemental payment program as described by Section 291A.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. 291A.152.  ASSESSMENT AND COLLECTION OF MANDATORY PAYMENTS.  Sec. 291A.153.  INTEREST, PENALTIES, AND DISCOUNTS.  Sec. 291A.154.  PURPOSE; CORRECTION OF INVALID PROVISION OR PROCEDURE.	SECTION 1.  Subtitle D, Title 4, Health and Safety Code, is amended by adding Chapter 291A to read as follows: CHAPTER 291A.  COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN CERTAIN COUNTIES BORDERING OR INCLUDING SAM RAYBURN RESERVOIR SUBCHAPTER A.  GENERAL PROVISIONS Sec. 291A.001.  DEFINITIONS.  Sec. 291A.002.  APPLICABILITY.  Sec. 291A.003.  COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM; PARTICIPATION IN PROGRAM.  SUBCHAPTER B.  POWERS AND DUTIES OF COMMISSIONERS COURT Sec. 291A.051.  LIMITATION ON AUTHORITY TO REQUIRE MANDATORY PAYMENT.  Sec. 291A.052.  MAJORITY VOTE REQUIRED.  Sec. 291A.053.  RULES AND PROCEDURES.  Sec. 291A.054.  INSTITUTIONAL HEALTH CARE PROVIDER REPORTING; INSPECTION OF RECORDS.  SUBCHAPTER C.  GENERAL FINANCIAL PROVISIONS Sec. 291A.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. (b)  Not later than the fifth 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. 291A.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. (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. 291A.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: (A)  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; or (B)  payments to Medicaid managed care organizations that are dedicated for payment to hospitals; (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 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. 291A.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 2015 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 2015 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 six percent of the paying hospital's net patient revenue. (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 291A.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. 291A.152.  ASSESSMENT AND COLLECTION OF MANDATORY PAYMENTS.  Sec. 291A.153.  INTEREST, PENALTIES, AND DISCOUNTS.  Sec. 291A.154.  PURPOSE; CORRECTION OF INVALID PROVISION OR PROCEDURE.
SECTION 2.  If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.	SECTION 2. Same as introduced version.
SECTION 3.  This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution.  If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2017.	SECTION 3. Same as introduced version.