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A BILL TO BE ENTITLED
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AN ACT
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relating to the authority of certain entities to create and operate |
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health care provider participation programs in counties not served |
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by a hospital district or a public hospital. |
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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 299 to read as follows: |
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CHAPTER 299. HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN |
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MULTI-COUNTY DISTRICT |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 299.0001. PURPOSE. The purpose of this chapter is to |
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authorize certain counties not served by a hospital district or a |
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public hospital to create a district to administer a health care |
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provider participation program to provide additional compensation |
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to hospitals in the district by collecting mandatory payments from |
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each hospital in the district to be used to provide the nonfederal |
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share of a Medicaid supplemental payment program and for other |
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purposes as authorized under this chapter. |
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Sec. 299.0002. DEFINITIONS. In this chapter: |
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(1) "Board" means the board of directors of a |
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district. |
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(2) "Director" means a member of the board. |
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(3) "District" means a health care provider |
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participation district created under this chapter. |
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(4) "Institutional health care provider" means a |
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nonpublic hospital that provides inpatient hospital services. |
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(5) "Paying hospital" 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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(6) "Program" means a health care provider |
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participation program authorized by this chapter. |
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Sec. 299.0003. APPLICABILITY. This chapter applies only to |
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a county that: |
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(1) is not participating in a health care provider |
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participation program authorized under this subtitle; |
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(2) is not served by a hospital district or public |
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hospital; and |
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(3) has only one hospital that is located in the |
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county. |
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SUBCHAPTER B. CREATION, OPERATION, AND DISSOLUTION OF DISTRICT |
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Sec. 299.0021. CREATION BY CONCURRENT ORDERS. (a) Except |
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as provided by Subsection (b), a county and one or more other |
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counties may create a district by adopting concurrent orders. |
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(b) A county or portion of a county that is in the boundaries |
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of a hospital district may not be a party to the creation of a |
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district. |
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(c) A concurrent order to create a district must: |
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(1) be approved by the governing body of each creating |
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county; |
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(2) contain identical provisions; and |
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(3) define the boundaries of the district to be |
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coextensive with the combined boundaries of each creating county. |
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Sec. 299.0022. POWERS. A district may authorize and |
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administer a health care provider participation program in |
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accordance with this chapter. |
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Sec. 299.0023. BOARD OF DIRECTORS. (a) If three or more |
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counties create a district, the county judge of each county that |
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creates the district shall appoint one director. |
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(b) If two counties create a district: |
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(1) the county judge of the most populous county shall |
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appoint two directors; and |
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(2) the county judge of the other county shall appoint |
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one director. |
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(c) Directors serve staggered two-year terms, with as near |
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as possible to one-half of the directors' terms expiring each year. |
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(d) A vacancy in the office of director shall be filled for |
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the unexpired term in the same manner as the original appointment. |
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(e) The board shall elect from among its members a |
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president. The president may vote and may cast an additional vote |
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to break a tie. |
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(f) The board shall also elect from among its members a vice |
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president. |
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(g) The board shall appoint a secretary, who need not be a |
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director. |
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(h) Each officer of the board serves for a term of one year. |
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(i) The board shall fill a vacancy in a board office for the |
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unexpired term. |
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(j) A majority of the members of the board voting must |
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concur in a matter relating to the business of the district. |
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Sec. 299.0024. QUALIFICATIONS FOR OFFICE. (a) To be |
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eligible to serve as a director, a person must be a resident of the |
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county that appoints the person under Section 299.0023. |
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(b) An employee of the district may not serve as a director. |
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Sec. 299.0025. COMPENSATION. (a) Directors and officers |
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serve without compensation but may be reimbursed for actual |
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expenses incurred in the performance of official duties. |
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(b) Expenses reimbursed under this section must be: |
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(1) reported in the district's minute book or other |
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district records; and |
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(2) approved by the board. |
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Sec. 299.0026. AUTHORITY TO SUE AND BE SUED. The board may |
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sue and be sued on behalf of the district. |
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Sec. 299.0027. DISTRICT FINANCES. Subchapter F, Chapter |
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287, other than Sections 287.129 and 287.130, applies to the |
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district in the same manner that those provisions apply to a health |
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services district created under Chapter 287. This section does not |
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authorize the district to issue bonds. |
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Sec. 299.0028. DISSOLUTION. A district shall be dissolved |
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if the counties that created the district adopt concurrent orders |
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to dissolve the district and the concurrent orders contain |
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identical provisions. |
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Sec. 299.0029. ADMINISTRATION OF PROPERTY, DEBTS, AND |
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ASSETS AFTER DISSOLUTION. (a) After dissolution of a district |
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under Section 299.0028, the board shall continue to control and |
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administer any property, debts, and assets of the district until |
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all funds have been disposed of and all district debts have been |
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paid or settled. |
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(b) As soon as practicable after the dissolution of the |
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district, the board shall transfer to each institutional health |
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care provider in the district the provider's proportionate share of |
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any remaining funds in any local provider participation fund |
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created by the district under Section 299.0102. |
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(c) If, after administering any property and assets, the |
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board determines that the district's property and assets are |
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insufficient to pay the debts of the district, the district shall |
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transfer the remaining debts to the counties that created the |
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district in proportion to the funds contributed to the district by |
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each county, including a paying hospital in the county. |
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(d) If, after complying with Subsections (b) and (c) and |
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administering the property and assets, the board determines that |
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unused funds remain, the board shall transfer the unused funds to |
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the counties that created the district in proportion to the funds |
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contributed to the district by each county, including a paying |
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hospital in the county. |
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Sec. 299.0030. ACCOUNTING AFTER DISSOLUTION. After the |
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district has paid all its debts and has disposed of all its assets |
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and funds as prescribed by Section 299.0029, the board shall |
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provide an accounting to each county that created the district. The |
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accounting must show the manner in which the assets and debts of the |
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district were distributed. |
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SUBCHAPTER C. HEALTH CARE PROVIDER PARTICIPATION PROGRAM; POWERS |
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AND DUTIES OF DISTRICT BOARD |
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Sec. 299.0051. HEALTH CARE PROVIDER PARTICIPATION PROGRAM. |
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The board may authorize the district to participate in a health care |
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provider participation program on the affirmative vote of a |
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majority of the board, subject to the provisions of this chapter. |
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Sec. 299.0052. 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. 299.0053. RULES AND PROCEDURES. The board may adopt |
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rules relating to the administration of the health care provider |
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participation program in the district, including collection of the |
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mandatory payments, expenditures, audits, and any other |
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administrative aspects of the program. |
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Sec. 299.0054. INSTITUTIONAL HEALTH CARE PROVIDER |
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REPORTING. If the board authorizes the district to participate in a |
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health care provider participation program under this chapter, the |
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board shall require each institutional health care provider located |
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in the district to submit to the district a copy of any financial |
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and utilization data required by and reported to the Department of |
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State Health Services under Sections 311.032 and 311.033 and any |
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rules adopted by the executive commissioner of the Health and Human |
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Services Commission to implement those sections. |
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SUBCHAPTER D. GENERAL FINANCIAL PROVISIONS |
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Sec. 299.0101. HEARING. (a) In each year that the board |
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authorizes a health care provider participation program under this |
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chapter, the board shall hold a public hearing on the amounts of any |
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mandatory payments that the board intends to require during the |
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year and how the revenue derived from those payments is to be 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 each |
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county that creates the district and provide written notice of the |
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hearing to the chief operating officer of each institutional health |
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care provider in the district. |
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Sec. 299.0102. LOCAL PROVIDER PARTICIPATION FUND; |
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DEPOSITORY. (a) If the board collects a mandatory payment |
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authorized under this chapter, the board shall create a local |
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provider participation fund in one or more banks designated by the |
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district as a depository for the mandatory payments received by the |
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district. |
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(b) The board may withdraw or use money in the local |
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provider participation fund of the district only for a purpose |
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authorized under this chapter. |
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(c) All funds collected under this chapter shall be secured |
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in the manner provided for securing county funds. |
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Sec. 299.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY. |
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(a) The local provider participation fund established under |
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Section 299.0102 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, including any |
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penalties and interest attributable to delinquent payments; |
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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 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 |
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(3) the earnings of the fund. |
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(b) Money deposited to the local provider participation |
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fund may be used only to: |
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(1) fund intergovernmental transfers from the |
|
district 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 |
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(B) payments to Medicaid managed care |
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organizations that are dedicated for payment to hospitals; |
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(2) subsidize indigent programs in the district; |
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(3) pay the administrative expenses of the district |
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solely for activities under this chapter; |
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(4) refund a portion of a mandatory payment collected |
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in error from a paying hospital; and |
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(5) refund to paying hospitals the proportionate share |
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of money received by the district that is not used to fund the |
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nonfederal share of Medicaid supplemental payment program |
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payments. |
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(c) Money in the local provider participation fund may not |
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be commingled with other district funds or other funds of a county |
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that creates the district. |
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(d) An intergovernmental transfer of funds described by |
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Subsection (b)(1) and any funds received by the district as a result |
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of an intergovernmental transfer described by that subsection may |
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not be used by the district, a county that created the district, or |
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any other entity to 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. |
|
No. 111-152). |
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Sec. 299.0104. ACCOUNTING OF FUNDS. The district shall |
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maintain an accounting of the funds received from each county that |
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creates the district, including a paying hospital in the county. |
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SUBCHAPTER E. MANDATORY PAYMENTS |
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Sec. 299.0151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL |
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NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if |
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the board authorizes a health care provider participation program |
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under this chapter, the district may require an annual mandatory |
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payment to be assessed on the net patient revenue of each |
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institutional health care provider located in the district. The |
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board 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 |
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revenue of an institutional health care provider located in the |
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district as determined by the data reported to the Department of |
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State Health Services under Sections 311.032 and 311.033 in the |
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fiscal year ending in 2017 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 2017 fiscal year or for the |
|
closest subsequent fiscal year for which the provider submitted the |
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Medicare cost report. The district shall update the amount of the |
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mandatory payment on an annual basis. |
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(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. |
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A mandatory payment authorized under this chapter may not hold |
|
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) The board shall set the amount of a mandatory payment |
|
authorized under this chapter. 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 board shall set a mandatory payment authorized under this |
|
chapter in amounts that in the aggregate will generate sufficient |
|
revenue to cover the administrative expenses of the district for |
|
activities under this chapter, to fund an intergovernmental |
|
transfer described by Section 299.0103(b)(1), and to pay for |
|
indigent programs in the district, except that the amount of |
|
revenue from mandatory payments used for administrative expenses of |
|
the district for activities under this chapter in a year may not |
|
exceed four percent of the total revenue generated from the |
|
mandatory payment. |
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(e) A paying hospital may not add a mandatory payment |
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required under this section as a surcharge to a patient. |
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Sec. 299.0152. ASSESSMENT AND COLLECTION OF MANDATORY |
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PAYMENTS. The district may collect or contract for the assessment |
|
and collection of mandatory payments authorized under this chapter. |
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Sec. 299.0153. 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. |
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Sec. 299.0154. CORRECTION OF INVALID PROVISION OR |
|
PROCEDURE. 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 board may provide by |
|
rule for an alternative provision or procedure that conforms to the |
|
requirements of the federal Centers for Medicare and Medicaid |
|
Services. |
|
SECTION 2. Subtitle D, Title 4, Health and Safety Code, is |
|
amended by adding Chapter 299A to read as follows: |
|
CHAPTER 299A. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN |
|
COUNTY NOT SERVED BY HOSPITAL DISTRICT OR PUBLIC HOSPITAL |
|
SUBCHAPTER A. GENERAL PROVISIONS |
|
Sec. 299A.0001. PURPOSE. The purpose of this chapter is to |
|
authorize a county not served by a hospital district or a public |
|
hospital to administer a county health care provider participation |
|
program to provide additional compensation to hospitals in the |
|
county by collecting mandatory payments from each hospital in the |
|
county to be used to provide the nonfederal share of a Medicaid |
|
supplemental payment program and for other purposes as authorized |
|
under this chapter. |
|
Sec. 299A.0002. 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 a county health care provider |
|
participation program authorized by this chapter. |
|
Sec. 299A.0003. APPLICABILITY. This chapter applies only |
|
to a county that is not served by a hospital district or a public |
|
hospital. |
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Sec. 299A.0004. COUNTY HEALTH CARE PROVIDER PARTICIPATION |
|
PROGRAM; COUNTY ORDER REQUIRED FOR PARTICIPATION. The |
|
commissioners court of a county may adopt an order authorizing the |
|
county to participate in a health care provider participation |
|
program, subject to the limitations provided by this chapter. |
|
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT |
|
Sec. 299A.0051. 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. 299A.0052. RULES AND PROCEDURES. The commissioners |
|
court of a county may adopt rules relating to the administration of |
|
the health care provider participation program in the county, |
|
including collection of the mandatory payments, expenditures, |
|
audits, and any other administrative aspects of the program. |
|
Sec. 299A.0053. INSTITUTIONAL HEALTH CARE PROVIDER |
|
REPORTING. If the commissioners court of a county authorizes the |
|
county to participate in a health care provider participation |
|
program under this chapter, the commissioners court 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. |
|
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS |
|
Sec. 299A.0101. HEARING. (a) In each year that the |
|
commissioners court of a county authorizes a health care provider |
|
participation program under this chapter, the commissioners court |
|
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 fifth day before the date of the |
|
hearing required under Subsection (a), the commissioners court |
|
shall publish notice of the hearing in a newspaper of general |
|
circulation in the county and provide written notice of the hearing |
|
to the chief operating officer of each institutional health care |
|
provider in the county. |
|
Sec. 299A.0102. LOCAL PROVIDER PARTICIPATION FUND; |
|
DEPOSITORY. (a) Each commissioners court of a county that collects |
|
a mandatory payment authorized under this chapter shall create a |
|
local provider participation fund in one or more banks designated |
|
by the county as a depository for the mandatory payments received by |
|
the county. |
|
(b) The commissioners court of a county may withdraw or use |
|
money in the local provider participation fund of the county only |
|
for a purpose authorized under this chapter. |
|
(c) All funds collected under this chapter shall be secured |
|
in the manner provided for securing other county funds. |
|
Sec. 299A.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY. |
|
(a) The local provider participation fund established by a county |
|
under Section 299A.0102 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. |
|
(b) Money deposited to the local provider participation |
|
fund of a county 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 in the county; |
|
(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. |
|
(c) Money in the local provider participation fund of a |
|
county may not be commingled with other county funds. |
|
(d) An intergovernmental transfer of funds described by |
|
Subsection (b)(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. 299A.0151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL |
|
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if |
|
the commissioners court of a county authorizes a health care |
|
provider participation program under this chapter, the |
|
commissioners court 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 located in the county 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 2017 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 2017 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 in the county 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 299A.103(b)(1), and to pay for |
|
indigent programs in the county, 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. 299A.0152. ASSESSMENT AND COLLECTION OF MANDATORY |
|
PAYMENTS. A county may collect or contract for the assessment and |
|
collection of mandatory payments authorized under this chapter. |
|
Sec. 299A.0153. 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. 299A.0154. CORRECTION OF INVALID PROVISION OR |
|
PROCEDURE. 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. |
|
SECTION 3. 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 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |