| |
| |
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|
A BILL TO BE ENTITLED
|
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|
AN ACT
|
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|
relating to the operations of health care provider participation |
|
|
programs in certain counties. |
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|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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|
SECTION 1. Section 291A.001, Health and Safety Code, is |
|
|
amended by amending Subdivisions (1) and (2) and adding Subdivision |
|
|
(4) to read as follows: |
|
|
(1) "Institutional health care provider" means a |
|
|
[nonpublic] hospital that is not owned and operated by a federal or |
|
|
state government and provides inpatient hospital services. The term |
|
|
includes a hospital that is owned and operated by a municipality or |
|
|
county and provides inpatient hospital services. |
|
|
(2) "Paying provider [hospital]" means an |
|
|
institutional health care provider required to make a mandatory |
|
|
payment under this chapter. |
|
|
(4) "Qualifying assessment basis" means the health |
|
|
care item, health care service, or other health care-related basis |
|
|
consistent with 42 U.S.C. Section 1396b(w) on which a commissioners |
|
|
court requires mandatory payments to be assessed under this |
|
|
chapter. |
|
|
SECTION 2. Section 291A.003(a), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(a) A county health care provider participation 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. Money in the fund may be used by the county to fund certain |
|
|
intergovernmental transfers [and indigent care programs] as |
|
|
provided by this chapter. |
|
|
SECTION 3. Section 291A.054(a), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(a) The commissioners court of a county that collects a |
|
|
mandatory payment authorized under this chapter may [shall] require |
|
|
each institutional health care provider to submit to the county a |
|
|
copy of any financial and utilization data as [required by and] |
|
|
reported in: |
|
|
(1) the provider's Medicare cost report for the most |
|
|
recent fiscal year for which the provider submitted the Medicare |
|
|
cost report; or |
|
|
(2) a report other than the report described by |
|
|
Subdivision (1) that the commissioners court considers reliable and |
|
|
is submitted by or to the provider for the most recent fiscal year |
|
|
[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]. |
|
|
SECTION 4. Section 291A.101, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 291A.101. HEARING. (a) Each year, the commissioners |
|
|
court of a county that collects a mandatory payment authorized |
|
|
under this chapter shall hold at least one [a] public hearing on the |
|
|
amounts of the [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 a [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 provider [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. |
|
|
SECTION 5. Section 291A.103(c), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(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 payments 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; |
|
|
(3) [(4)] refund a portion of a mandatory payment |
|
|
collected in error from a paying provider [hospital]; and |
|
|
(4) [(5)] refund to a paying provider, in an amount |
|
|
that is proportionate to the mandatory payments made under this |
|
|
chapter by the provider during the 12 months preceding the date of |
|
|
the refund, the [hospitals the proportionate share of] money |
|
|
attributable to mandatory payments collected under this chapter |
|
|
that the county: |
|
|
(A) receives from the Health and Human Services |
|
|
Commission [received by the county] that is not used to fund the |
|
|
nonfederal share of Medicaid supplemental payment program |
|
|
payments; or |
|
|
(B) determines cannot be used to fund the |
|
|
nonfederal share of Medicaid supplemental payment program |
|
|
payments. |
|
|
SECTION 6. Section 291A.151, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 291A.151. MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL |
|
|
NET PATIENT REVENUE]. (a) The [Except as provided by Subsection |
|
|
(e), the] commissioners court of a county that authorizes a county |
|
|
health care provider participation program [collects a mandatory |
|
|
payment authorized] under this chapter may require [an annual] |
|
|
mandatory payments [payment] to be assessed against [on the net |
|
|
patient revenue of] each institutional health care provider located |
|
|
in the county, either annually or periodically throughout the year |
|
|
at the discretion of the commissioners court, on the basis of a |
|
|
health care item, health care service, or other health care-related |
|
|
basis that is consistent with the requirements of 42 U.S.C. Section |
|
|
1396b(w). The commissioners court shall provide an institutional |
|
|
health care provider written notice of each assessment under this |
|
|
section not later than 30 days before the date the assessment is |
|
|
due. The qualifying assessment basis must be the same for each |
|
|
institutional health care provider in the county. |
|
|
(a-1) Except as otherwise provided by this subsection, the |
|
|
qualifying assessment basis must be determined by the commissioners |
|
|
court using information contained in an institutional health care |
|
|
provider's Medicare cost report for the most recent fiscal year for |
|
|
which the provider submitted the report. If the provider is not |
|
|
required to submit a Medicare cost report, or if the Medicare cost |
|
|
report submitted by the provider does not contain information |
|
|
necessary to determine the qualifying assessment basis, the |
|
|
qualifying assessment basis may be determined by the commissioners |
|
|
court using information contained in another report the |
|
|
commissioners court considers reliable that is submitted by or to |
|
|
the provider for the most recent fiscal year. To the extent |
|
|
practicable, the commissioners court shall use the same type of |
|
|
report to determine the qualifying assessment basis for each paying |
|
|
provider in the county. |
|
|
(a-2) If mandatory payments are required, the [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 payments periodically [payment on an annual basis]. |
|
|
(b) The amount of a mandatory payment authorized under this |
|
|
chapter must be determined in a manner that ensures the revenue |
|
|
generated qualifies for federal matching funds under federal law, |
|
|
consistent with [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 authorizes a |
|
|
county health care provider participation program [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 provider [hospital] may not exceed |
|
|
an amount that, when added to the amount of the mandatory payments |
|
|
required from all other paying providers in the county, equals an |
|
|
amount of revenue that exceeds six percent of the aggregate net |
|
|
patient revenue of all paying providers in the county [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 and [,] to fund the nonfederal share |
|
|
of Medicaid supplemental payment program payments [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 provider [hospital] may not add a mandatory |
|
|
payment required under this section as a surcharge to a patient. |
|
|
SECTION 7. Section 291A.154, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 291A.154. PURPOSE; CORRECTION OF INVALID PROVISION OR |
|
|
PROCEDURE. (a) The purpose of this chapter is to generate revenue |
|
|
by collecting from institutional health care providers a mandatory |
|
|
payment to be used to provide the nonfederal share of [a] Medicaid |
|
|
supplemental payment program payments. |
|
|
(b) 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, a [the] county that |
|
|
authorizes a county health care provider participation program |
|
|
under this chapter may provide by rule for an alternative provision |
|
|
or procedure that conforms to the requirements of the federal |
|
|
Centers for Medicare and Medicaid Services. A rule adopted under |
|
|
this section may not create, impose, or materially expand the legal |
|
|
or financial liability or responsibility of the county or an |
|
|
institutional health care provider in the county beyond the |
|
|
provisions of this chapter. This section does not require the |
|
|
commissioners court to adopt a rule. |
|
|
(c) This chapter does not authorize a county that authorizes |
|
|
a county health care provider participation program under this |
|
|
chapter to collect mandatory payments for the purpose of raising |
|
|
general revenue or any amount in excess of the amount reasonably |
|
|
necessary for the purposes described by Sections 291A.103(c)(1) and |
|
|
(2). |
|
|
SECTION 8. Section 292.001, Health and Safety Code, is |
|
|
amended by amending Subdivisions (1) and (2) and adding Subdivision |
|
|
(4) to read as follows: |
|
|
(1) "Institutional health care provider" means a |
|
|
[nonpublic] hospital that is not owned and operated by a federal or |
|
|
state government and provides inpatient hospital services. The term |
|
|
includes a hospital that is owned and operated by a municipality or |
|
|
county and provides inpatient hospital services. |
|
|
(2) "Paying provider [hospital]" means an |
|
|
institutional health care provider required to make a mandatory |
|
|
payment under this chapter. |
|
|
(4) "Qualifying assessment basis" means the health |
|
|
care item, health care service, or other health care-related basis |
|
|
consistent with 42 U.S.C. Section 1396b(w) on which a commissioners |
|
|
court requires mandatory payments to be assessed under this |
|
|
chapter. |
|
|
SECTION 9. Section 292.003(a), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(a) A county health care provider participation 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. Money in the fund may be used by the county to fund certain |
|
|
intergovernmental transfers [and indigent care programs] as |
|
|
provided by this chapter. |
|
|
SECTION 10. Section 292.054(a), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(a) The commissioners court of a county that collects a |
|
|
mandatory payment authorized under this chapter may [shall] require |
|
|
each institutional health care provider to submit to the county a |
|
|
copy of any financial and utilization data as [required by and] |
|
|
reported in: |
|
|
(1) the provider's Medicare cost report for the most |
|
|
recent fiscal year for which the provider submitted the Medicare |
|
|
cost report; or |
|
|
(2) a report other than the report described by |
|
|
Subdivision (1) that the commissioners court considers reliable and |
|
|
is submitted by or to the provider for the most recent fiscal year |
|
|
[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]. |
|
|
SECTION 11. Section 292.101, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 292.101. HEARING. (a) Each year, the commissioners |
|
|
court of a county that collects a mandatory payment authorized |
|
|
under this chapter shall hold at least one [a] public hearing on the |
|
|
amounts of the [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 a [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 provider [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. |
|
|
SECTION 12. Section 292.103(c), Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
(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 payments 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; |
|
|
(3) [(4)] refund a portion of a mandatory payment |
|
|
collected in error from a paying provider [hospital]; and |
|
|
(4) [(5)] refund to a paying provider, in an amount |
|
|
that is proportionate to the mandatory payments made under this |
|
|
chapter by the provider during the 12 months preceding the date of |
|
|
the refund, the [hospitals the proportionate share of] money |
|
|
attributable to mandatory payments collected under this chapter |
|
|
that the county: |
|
|
(A) receives [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; or [and] |
|
|
(B) [(6) refund to paying hospitals the |
|
|
proportionate share of money that the county] determines cannot be |
|
|
used to fund the nonfederal share of Medicaid supplemental payment |
|
|
program payments. |
|
|
SECTION 13. Section 292.151, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 292.151. MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL |
|
|
NET PATIENT REVENUE]. (a) The [Except as provided by Subsection |
|
|
(e), the] commissioners court of a county that authorizes a county |
|
|
health care provider participation program [collects a mandatory |
|
|
payment authorized] under this chapter may require [an annual] |
|
|
mandatory payments [payment] to be assessed against [on the net |
|
|
patient revenue of] each institutional health care provider located |
|
|
in the county, either annually or periodically throughout the year |
|
|
at the discretion of the commissioners court, on the basis of a |
|
|
health care item, health care service, or other health care-related |
|
|
basis that is consistent with the requirements of 42 U.S.C. Section |
|
|
1396b(w). The commissioners court shall provide an institutional |
|
|
health care provider written notice of each assessment under this |
|
|
section not later than 30 days before the date the assessment is |
|
|
due. The qualifying assessment basis must be the same for each |
|
|
institutional health care provider in the county. |
|
|
(a-1) Except as otherwise provided by this subsection, the |
|
|
qualifying assessment basis must be determined by the commissioners |
|
|
court using information contained in an institutional health care |
|
|
provider's Medicare cost report for the most recent fiscal year for |
|
|
which the provider submitted the report. If the provider is not |
|
|
required to submit a Medicare cost report, or if the Medicare cost |
|
|
report submitted by the provider does not contain information |
|
|
necessary to determine the qualifying assessment basis, the |
|
|
qualifying assessment basis may be determined by the commissioners |
|
|
court using information contained in another report the |
|
|
commissioners court considers reliable that is submitted by or to |
|
|
the provider for the most recent fiscal year. To the extent |
|
|
practicable, the commissioners court shall use the same type of |
|
|
report to determine the qualifying assessment basis for each paying |
|
|
provider in the county. |
|
|
(a-2) If mandatory payments are required, the [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 2013 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 2013 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 payments periodically [payment on an annual basis]. |
|
|
(b) The amount of a mandatory payment authorized under this |
|
|
chapter must be determined in a manner that ensures the revenue |
|
|
generated qualifies for federal matching funds under federal law, |
|
|
consistent with [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 authorizes a |
|
|
county health care provider participation program [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 provider [hospital] may not exceed |
|
|
an amount that, when added to the amount of the mandatory payments |
|
|
required from all other paying providers [hospitals] in the county, |
|
|
equals an amount of revenue that exceeds six percent of the |
|
|
aggregate net patient revenue of all paying providers [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 and [,] to fund the nonfederal share |
|
|
of [a] Medicaid supplemental payment program payments, [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 provider [hospital] may not add a mandatory |
|
|
payment required under this section as a surcharge to a patient. |
|
|
SECTION 14. Section 292.154, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 292.154. PURPOSE; CORRECTION OF INVALID PROVISION OR |
|
|
PROCEDURE. (a) The purpose of this chapter is to generate revenue |
|
|
by collecting from institutional health care providers a mandatory |
|
|
payment to be used to provide the nonfederal share of [a] Medicaid |
|
|
supplemental payment program payments. |
|
|
(b) 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, a [the] county that |
|
|
authorizes a county health care provider participation program |
|
|
under this chapter may provide by rule for an alternative provision |
|
|
or procedure that conforms to the requirements of the federal |
|
|
Centers for Medicare and Medicaid Services. A rule adopted under |
|
|
this section may not create, impose, or materially expand the legal |
|
|
or financial liability or responsibility of the county or an |
|
|
institutional health care provider in the county beyond the |
|
|
provisions of this chapter. This section does not require the |
|
|
commissioners court to adopt a rule. |
|
|
(c) This chapter does not authorize a county that authorizes |
|
|
a county health care provider participation program under this |
|
|
chapter to collect mandatory payments for the purpose of raising |
|
|
general revenue or any amount in excess of the amount reasonably |
|
|
necessary for the purposes described by Sections 292.103(c)(1) and |
|
|
(2). |
|
|
SECTION 15. 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, 2021. |