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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation and operations of health care provider |
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participation programs in Harris County Hospital District. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle D, Title 4, Health and Safety Code, is |
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amended by adding Chapter ___ to read as follows: |
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CHAPTER ___. HARRIS COUNTY HOSPITAL DISTRICT HEALTH CARE PROVIDER |
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PARTICIPATION PROGRAM. |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. ___.001 DEFINITIONS. In this chapter: |
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(1) "Board" means the board of trustees of the |
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district. |
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(2) "District" means the Harris County Hospital |
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District. |
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(3) "Institutional health care provider" means a |
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nonpublic hospital located in the district that provides inpatient |
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hospital services. |
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(4) "Paying provider" means an institutional health |
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care provider required to make a mandatory payment under this |
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chapter. |
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(5) "Program" means the health care provider |
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participation program authorized by this chapter. |
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Sec. ___.002 APPLICABILITY. This chapter applies only to the |
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Harris County Hospital District. |
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Sec. ___.003 HEALTH CARE PROVIDER PARTICIPATION PROGRAM; |
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PARTICIPATION IN PROGRAM. The board may authorize the district to |
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participate in a health care provider participation program on the |
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affirmative vote of the majority of the board, subject to the |
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provisions of this chapter. |
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Sec. ___.004 EXPIRATION. |
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(a) The authority of the district to administer and operate |
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a program under this chapter expires December 31, 2021. |
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(b) This chapter expires December 31, 2021. |
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SUBCHAPTER B. POWERS AND DUTIES OF BOARD |
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Sec. ___.051 LIMITATION ON AUTHORITY TO REQUIRE MANDATORY |
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PAYMENT. The board may require a mandatory payment authorized |
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under this chapter by an institutional health care provider in the |
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district only in the manner provided by this chapter. |
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Sec. ___.052 RULES AND PROCEDURES. The board may adopt rules |
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relating to the administration of the program, including collection |
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of the mandatory payments, expenditures, audits, and any other |
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administrative aspects of the program. |
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Sec. ___.053 PAYING PROVIDER REPORTING. If the board |
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authorizes the district to participate in a program under this |
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chapter, the board shall require each paying provider to submit to |
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the district a copy of any financial and utilization data as |
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reported in the paying provider's Medicare cost report for the |
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previous fiscal year or for the closest subsequent fiscal year for |
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which the paying provider submitted the Medicare cost report. |
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SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS |
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Sec. ___.101 HEARING. |
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(a) In each year that the board authorizes a program under |
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this chapter, the board shall hold a public hearing on the amounts |
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of any mandatory payments that the board intends to require during |
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the year and how the revenue derived from those payments is to be |
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spent. |
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(b) Not later than the fifth day before the date of the |
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hearing required under Subsection (a), the board shall publish |
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notice of the hearing in a newspaper of general circulation in the |
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district and provide written notice. |
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(c) A representative of a paying provider is entitled to |
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appear at the public hearing and to be heard regarding any matter |
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related to the mandatory payments authorized under this chapter. |
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Sec. ___.102 DEPOSITORY. |
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(a) If the board requires a mandatory payment authorized |
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under this chapter, the board shall designate one or more banks as a |
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depository for the district's local provider participation fund. |
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(b) All funds collected under this chapter shall be secured |
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in the manner provided for securing other district funds. |
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Sec. ___.103 LOCAL PROVIDER PARTICIPATION FUND; AUTHORIZED |
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USES OF MONEY. |
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(a) If the district requires a mandatory payment authorized |
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under this chapter, the district shall create a local provider |
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participation fund. |
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(b) The local provider participation fund consists of: |
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(1) all revenue received by the district attributable |
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to mandatory payments authorized under this chapter; |
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(2) money received from the Health and Human Services |
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Commission as a refund of an intergovernmental transfer under the |
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program, provided that the intergovernmental transfer does not |
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receive a federal matching payment; and |
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(3) the earnings of the fund. |
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(c) Money deposited to the local provider participation |
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fund of the district may be used only to: |
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(1) fund intergovernmental transfers from the |
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district to the state to provide the nonfederal share of Medicaid |
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payments for: |
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(A) uncompensated care payments to nonpublic |
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hospitals, if those payments are authorized under the Texas |
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Healthcare Transformation and Quality Improvement Program waiver |
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issued under Section 1115 of the federal Social Security Act (42 |
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U.S.C. Section 1315); |
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(B) uniform rate enhancements for nonpublic |
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hospitals in the Medicaid managed care service area in which the |
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district is located; |
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(C) payments available under another waiver |
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program authorizing payments that are substantially similar to |
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Medicaid payments to nonpublic hospitals described by Subdivision |
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(A) or (B); or |
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(D) any reimbursement to nonpublic hospitals for |
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which federal matching funds are available; |
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(2) subject to Section ___.151(d), pay the |
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administrative expenses of the district in administering the |
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program, including collateralization of deposits; |
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(3) refund a mandatory payment collected in error from |
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a paying provider; |
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(4) refund to paying providers a proportionate share |
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of a mandatory payment that the district: |
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(A) receives from the Health and Human Services |
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Commission that is not used to fund the nonfederal share of Medicaid |
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supplemental payment program payments; or |
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(B) determines cannot be used to fund the |
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nonfederal share of Medicaid supplemental payment program |
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payments; and |
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(5) transfer funds to the Health and Human Services |
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Commission if the district is legally required to transfer funds to |
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address a disallowance of federal matching funds with respect to |
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programs for which the district made intergovernmental transfers |
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described by Subdivision (1). |
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(d) Money in the local provider participation fund may not |
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be commingled with other district funds. |
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(e) Notwithstanding any other provision of this chapter, |
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with respect to an intergovernmental transfer of funds described by |
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Subsection (c)(1) made by the district, any funds received by the |
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state, district, or other entity as a result of the transfer may not |
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be used by the state, district, or any other entity to: |
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(1) expand Medicaid eligibility under the Patient |
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Protection and Affordable Care Act (Pub. L. No. 111-148) as amended |
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by the Health Care and Education Reconciliation Act of 2010 (Pub. L. |
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No. 111-152); or |
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(2) fund the nonfederal share of payments to nonpublic |
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hospitals available through the Medicaid disproportionate share |
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hospital program or the delivery system reform incentive payment |
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program. |
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SUBCHAPTER D. MANDATORY PAYMENTS |
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Sec. ___.151 MANDATORY PAYMENTS BASED ON PAYING PROVIDER NET |
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PATIENT REVENUE. |
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(a) If the board authorizes a health care provider |
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participation program under this chapter, the board may require a |
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mandatory payment to be assessed on the net patient revenue of each |
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paying provider located in the district. The board may provide for |
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the mandatory payment to be assessed incrementally throughout the |
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year; provided, however, that paying providers shall have thirty |
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(30) calendar days upon receipt of written notice from the district |
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to make any mandatory payment. In the first year in which the |
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mandatory payment is required, the mandatory payment is assessed on |
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the net patient revenue of a paying provider as determined by the |
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paying provider's copy of its Medicare cost report for the previous |
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fiscal year or for the closest subsequent fiscal year for which the |
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paying provider submitted the Medicare cost report. |
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(b) The amount of a mandatory payment authorized under this |
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chapter must be uniformly proportionate with the amount of net |
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patient revenue generated by each paying provider in the district |
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as permitted under federal law. A health care provider |
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participation program authorized under this chapter may not hold |
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harmless any institutional health care provider, as required under |
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42 U.S.C. Section 1396b(w). |
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(c) If the board requires a mandatory payment authorized |
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under this chapter, the board shall set the amount of the mandatory |
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payment, subject to the limitations of this chapter. The aggregate |
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amount of the mandatory payments required of all paying providers |
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in the district may not exceed four percent of the aggregate net |
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patient revenue from hospital services provided by all paying |
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providers in the district. |
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(d) Subject to Subsection (c), if the board requires a |
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mandatory payment authorized under this chapter, the board shall |
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set the mandatory payments in amounts that in the aggregate will |
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generate sufficient revenue to cover the administrative expenses of |
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the district for activities under this chapter and to fund an |
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intergovernmental transfer described by Section ___.103(c)(1). Of |
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the annual amount of revenue received by the district attributable |
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to mandatory payments authorized under this chapter, 0.25% shall be |
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paid to the district for administrative expenses. |
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(e) A paying provider may not add a mandatory payment |
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required under this section as a surcharge to a patient. |
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(f) A mandatory payment assessed under this chapter is not a |
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tax for hospital purposes for purposes of Section 4, Article IX, |
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Texas Constitution, or Section 281.045. |
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Sec. ___.152 ASSESSMENT AND COLLECTION OF MANDATORY |
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PAYMENTS. |
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(a) The district may designate an official of the district |
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or contract with another person to assess and collect the mandatory |
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payments authorized under this chapter. |
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(b) The person charged by the district with the assessment |
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and collection of mandatory payments shall charge and deduct from |
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the mandatory payments collected for the district a collection fee |
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in an amount not to exceed the person's usual and customary charges |
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for like services. |
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(c) If the person charged with the assessment and collection |
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of mandatory payments is an official of the district, any revenue |
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from a collection fee charged under Subsection (b) shall be |
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deposited in the district general fund and, if appropriate, shall |
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be reported as fees of the district. |
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Sec. ___.153 PURPOSE; CORRECTION OF INVALID PROVISION OR |
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PROCEDURE; LIMITATION OF AUTHORITY. |
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(a) The purpose of this chapter is to authorize the district |
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to establish a program to enable the district to collect mandatory |
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payments from institutional health care providers to fund the |
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nonfederal share of a Medicaid supplemental payment program or the |
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Medicaid managed care rate enhancements for nonpublic hospitals to |
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support the provision of health care by institutional health care |
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providers to district residents in need of health care. |
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(b) This chapter does not authorize the district to collect |
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mandatory payments for the purpose of raising general revenue or |
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any amount in excess of the amount reasonably necessary to fund the |
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uses described in Section _____.103(c) to cover the administrative |
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expenses of the district associated with activities under this |
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chapter. |
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(c) To the extent any provision or procedure under this |
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chapter causes a mandatory payment authorized under this chapter to |
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be ineligible for federal matching funds, the board may provide by |
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rule for an alternative provision or procedure that conforms to the |
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requirements of the federal Centers for Medicare and Medicaid |
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Services. A rule adopted under this section may not create, impose, |
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or materially expand the legal or financial liability or |
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responsibility of the district or an institutional health care |
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provider in the district beyond the provisions of this chapter. |
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This section does not require the board to adopt a rule. |
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(d) The district may only assess and collect a mandatory |
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payment authorized under this chapter if a waiver program, uniform |
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rate enhancement, or reimbursement described by Section |
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___.103(c)(1) is available to the district. |