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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement of rural hospitals under Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02194 to read as follows: |
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Sec. 531.02194. REIMBURSEMENT METHODOLOGY FOR RURAL |
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HOSPITALS. (a) In this section, "rural hospital" has the meaning |
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assigned by commission rules for purposes of the reimbursement of |
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hospitals for providing inpatient or outpatient services under |
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Medicaid. |
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(b) To the extent allowed by federal law and subject to |
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limitations on appropriations, the executive commissioner by rule |
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shall adopt a prospective reimbursement methodology for the payment |
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of rural hospitals participating in Medicaid that ensures the rural |
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hospitals are reimbursed on an individual basis for providing |
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inpatient and general outpatient services to Medicaid recipients by |
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using the hospitals' most recent cost information concerning the |
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costs incurred for providing the services. The commission shall |
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calculate the prospective cost-based reimbursement rates once |
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every two years. |
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(c) In adopting rules under Subsection (b), the executive |
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commissioner may: |
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(1) adopt a methodology that requires: |
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(A) a managed care organization to reimburse |
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rural hospitals for services delivered through the Medicaid managed |
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care program using a minimum fee schedule or other method for which |
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federal matching money is available; or |
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(B) both the commission and a managed care |
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organization to share in the total amount of reimbursement paid to |
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rural hospitals; and |
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(2) require that the amount of reimbursement paid to a |
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rural hospital is subject to any applicable adjustments made by the |
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commission for payments to or penalties imposed on the rural |
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hospital that are based on a quality-based or performance-based |
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requirement under the Medicaid managed care program. |
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(d) Not later than September 1 of each even-numbered year, |
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the commission shall, for purposes of Subsection (b), determine the |
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allowable costs incurred by a rural hospital participating in the |
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Medicaid managed care program based on the rural hospital's cost |
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reports submitted to the federal Centers for Medicare and Medicaid |
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Services and other available information that the commission |
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considers relevant in determining the hospital's allowable costs. |
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(e) Notwithstanding Subsection (b) and subject to |
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Subsection (f), the executive commissioner shall adopt and the |
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commission shall implement, beginning with the state fiscal year |
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ending August 31, 2022, a true cost-based reimbursement methodology |
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for inpatient and general outpatient services provided to Medicaid |
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recipients at rural hospitals that provides: |
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(1) prospective payments during a state fiscal year to |
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the hospitals using the reimbursement methodology adopted under |
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Subsection (b); and |
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(2) to the extent allowed by federal law, in the |
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subsequent state fiscal year a cost settlement to provide |
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additional reimbursement as necessary to reimburse the hospitals |
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for the true costs incurred in providing inpatient and general |
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outpatient services to Medicaid recipients during the previous |
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state fiscal year. |
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(f) Notwithstanding Subsection (e), if federal law does not |
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permit the use of a true cost-based reimbursement methodology |
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described by that subsection, the commission shall continue to use |
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the prospective cost-based reimbursement methodology adopted under |
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Subsection (b) for the payment of rural hospitals for providing |
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inpatient and general outpatient services to Medicaid recipients. |
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SECTION 2. The Health and Human Services Commission is |
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required to implement a provision of this Act only if the |
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legislature appropriates money specifically for that purpose. If |
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the legislature does not appropriate money specifically for that |
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purpose, the commission may, but is not required to, implement a |
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provision of this Act using other appropriations available for that |
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purpose. |
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SECTION 3. Not later than September 1, 2020, the Health and |
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Human Services Commission shall determine the allowable costs |
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incurred by a rural hospital participating in the Medicaid managed |
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care program before that date as required by Section 531.02194(d), |
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Government Code, as added by this Act. |
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SECTION 4. 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 5. This Act takes effect September 1, 2019. |