By: Perry, et al. S.B. No. 170
 
  (Price, Springer)
 
   
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to reimbursement of rural hospitals under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.02194 to read as follows:
         Sec. 531.02194.  REIMBURSEMENT METHODOLOGY FOR RURAL
  HOSPITALS. (a)  In this section, "rural hospital" has the meaning
  assigned by commission rules for purposes of the reimbursement of
  hospitals for providing inpatient or outpatient services under
  Medicaid.
         (b)  To the extent allowed by federal law and subject to
  limitations on appropriations, the executive commissioner by rule
  shall adopt a prospective reimbursement methodology for the payment
  of rural hospitals participating in Medicaid that ensures the rural
  hospitals are reimbursed on an individual basis for providing
  inpatient and general outpatient services to Medicaid recipients by
  using the hospitals' most recent cost information concerning the
  costs incurred for providing the services.  The commission shall
  calculate the prospective cost-based reimbursement rates once
  every two years.
         (c)  In adopting rules under Subsection (b), the executive
  commissioner may:
               (1)  adopt a methodology that requires:
                     (A)  a managed care organization to reimburse
  rural hospitals for services delivered through the Medicaid managed
  care program using a minimum fee schedule or other method for which
  federal matching money is available; or
                     (B)  both the commission and a managed care
  organization to share in the total amount of reimbursement paid to
  rural hospitals; and
               (2)  require that the amount of reimbursement paid to a
  rural hospital is subject to any applicable adjustments made by the
  commission for payments to or penalties imposed on the rural
  hospital that are based on a quality-based or performance-based
  requirement under the Medicaid managed care program.
         (d)  Not later than September 1 of each even-numbered year,
  the commission shall, for purposes of Subsection (b), determine the
  allowable costs incurred by a rural hospital participating in the
  Medicaid managed care program based on the rural hospital's cost
  reports submitted to the federal Centers for Medicare and Medicaid
  Services and other available information that the commission
  considers relevant in determining the hospital's allowable costs.
         (e)  Notwithstanding Subsection (b) and subject to
  Subsection (f), the executive commissioner shall adopt and the
  commission shall implement, beginning with the state fiscal year
  ending August 31, 2022, a true cost-based reimbursement methodology
  for inpatient and general outpatient services provided to Medicaid
  recipients at rural hospitals that provides:
               (1)  prospective payments during a state fiscal year to
  the hospitals using the reimbursement methodology adopted under
  Subsection (b); and
               (2)  to the extent allowed by federal law, in the
  subsequent state fiscal year a cost settlement to provide
  additional reimbursement as necessary to reimburse the hospitals
  for the true costs incurred in providing inpatient and general
  outpatient services to Medicaid recipients during the previous
  state fiscal year. 
         (f)  Notwithstanding Subsection (e), if federal law does not
  permit the use of a true cost-based reimbursement methodology
  described by that subsection, the commission shall continue to use
  the prospective cost-based reimbursement methodology adopted under
  Subsection (b) for the payment of rural hospitals for providing
  inpatient and general outpatient services to Medicaid recipients.
         SECTION 2.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money specifically for that purpose.  If
  the legislature does not appropriate money specifically for that
  purpose, the commission may, but is not required to, implement a
  provision of this Act using other appropriations available for that
  purpose.
         SECTION 3.  Not later than September 1, 2020, the Health and
  Human Services Commission shall determine the allowable costs
  incurred by a rural hospital participating in the Medicaid managed
  care program before that date as required by Section 531.02194(d),
  Government Code, as added by this Act.
         SECTION 4.  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 5.  This Act takes effect September 1, 2019.