88R20646 MPF-F
 
  By: Clardy H.B. No. 4700
 
  Substitute the following for H.B. No. 4700:
 
  By:  Stucky C.S.H.B. No. 4700
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the creation and operations of a health care provider
  participation program by the Nacogdoches County Hospital District.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle D, Title 4, Health and Safety Code, is
  amended by adding Chapter 298H to read as follows:
  CHAPTER 298H. NACOGDOCHES COUNTY HOSPITAL DISTRICT HEALTH CARE
  PROVIDER PARTICIPATION PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 298H.001.  DEFINITIONS. In this chapter:
               (1)  "Board" means the board of directors of the
  district.
               (2)  "District" means the Nacogdoches County Hospital
  District.
               (3)  "Institutional health care provider" means a
  nonpublic hospital located in the district that provides inpatient
  hospital services.
               (4)  "Paying provider" means an institutional health
  care provider required to make a mandatory payment under this
  chapter.
               (5)  "Program" means the health care provider
  participation program authorized by this chapter.
         Sec. 298H.002.  APPLICABILITY. This chapter applies only to
  the Nacogdoches County Hospital District.
         Sec. 298H.003.  HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
  PARTICIPATION IN PROGRAM. (a) The board may authorize the district
  to participate in a health care provider participation program on
  the affirmative vote of a majority of the board, subject to the
  provisions of this chapter.
         (b)  The board may not authorize the district to participate
  in a health care provider participation program under Chapter 300
  or 300A. 
         Sec. 298H.004.  EXPIRATION. (a)  Subject to Section
  298H.153(d), the authority of the district to administer and
  operate a program under this chapter expires December 31, 2027.
         (b)  This chapter expires December 31, 2027.
  SUBCHAPTER B. POWERS AND DUTIES OF BOARD
         Sec. 298H.051.  LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
  PAYMENT. The board may require a mandatory payment authorized
  under this chapter by an institutional health care provider located
  in the district only in the manner provided by this chapter.
         Sec. 298H.052.  RULES AND PROCEDURES. The board may adopt
  rules relating to the administration of the program, including
  collection of the mandatory payments, expenditures, audits, and
  other administrative aspects of the program.
         Sec. 298H.053.  INSTITUTIONAL HEALTH CARE PROVIDER
  REPORTING. If the board authorizes the district to participate in a
  program under this chapter, the board may require each
  institutional health care provider to submit to the district a copy
  of any financial and utilization data reported in the provider's
  Medicare cost report submitted for the most recent fiscal year for
  which the provider submitted the Medicare cost report.
  SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
         Sec. 298H.101.  HEARING. (a) In each year that the board
  authorizes a program under this chapter, the board shall hold a
  public hearing on the amounts of any mandatory payments that the
  board 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 board shall publish
  notice of the hearing in a newspaper of general circulation in the
  district.
         (c)  A representative of a paying provider is entitled to
  appear at the public hearing and be heard regarding any matter
  related to the mandatory payments authorized under this chapter.
         Sec. 298H.102.  DEPOSITORY.  (a)  If the board requires a
  mandatory payment authorized under this chapter, the board shall
  designate one or more banks as a depository for the district's local
  provider participation fund.
         (b)  All funds collected under this chapter shall be secured
  in the manner provided for securing other district funds.
         Sec. 298H.103.  LOCAL PROVIDER PARTICIPATION FUND;
  AUTHORIZED USES OF MONEY.  (a)  If the district requires a
  mandatory payment authorized under this chapter, the district shall
  create a local provider participation fund.
         (b)  The local provider participation fund consists of:
               (1)  all revenue received by the district attributable
  to the mandatory payments authorized under this chapter;
               (2)  money received from the Health and Human Services
  Commission as a refund of an intergovernmental transfer under the
  program, provided that the intergovernmental transfer does not
  receive a federal matching payment; and
               (3)  the earnings of the fund.
         (c)  Money deposited to the local provider participation
  fund of the district may be used only to:
               (1)  fund intergovernmental transfers from the
  district to the state to provide the nonfederal share of Medicaid
  supplemental payments for:
                     (A)  uncompensated care payments to nonpublic
  hospitals, if those payments are authorized under 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);
                     (B)  rate enhancements for nonpublic hospitals in
  the Medicaid managed care service area in which the district is
  located;
                     (C)  payments available under another waiver
  program authorizing payments that are substantially similar to
  Medicaid payments to nonpublic hospitals described by Paragraph (A)
  or (B); or
                     (D)  any reimbursement to nonpublic hospitals for
  which federal matching funds are available;
               (2)  subject to Section 298H.151(d), pay the
  administrative expenses of the district in administering the
  program, including collateralization of deposits;
               (3)  refund a mandatory payment collected in error from
  a paying provider;
               (4)  refund to paying providers a proportionate share
  of the money that the district:
                     (A)  receives from the Health and Human Services
  Commission that is not used to fund the nonfederal share of Medicaid
  supplemental payments or rate enhancements described by
  Subdivision (1); or
                     (B)  determines cannot be used to fund the
  nonfederal share of Medicaid supplemental payments or rate
  enhancements described by Subdivision (1); and
               (5)  transfer funds to the Health and Human Services
  Commission if the district is legally required to transfer the
  funds to address a disallowance of federal matching funds with
  respect to Medicaid supplemental payments for which the district
  made intergovernmental transfers described by Subdivision (1).
         (d)  Money in the local provider participation fund may not
  be commingled with other district funds.
         (e)  Notwithstanding any other provision of this chapter,
  with respect to an intergovernmental transfer of funds described by
  Subsection (c)(1) made by the district, any funds received by the
  state, district, or other entity as a result of that transfer may
  not be used by the state, district, or 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. 298H.151.  MANDATORY PAYMENTS BASED ON PAYING PROVIDER
  NET PATIENT REVENUE. (a) If the board authorizes a health care
  provider participation program under this chapter, the board may
  require a mandatory payment to be assessed, either annually or
  periodically throughout the year at the discretion of the board, on
  the net patient revenue of each institutional health care provider
  located in the district.  The board shall provide an institutional
  health care provider written notice of each assessment under this
  subsection, and the provider has 30 calendar days following the
  date of receipt of the notice to make the assessed mandatory
  payment.  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 provider's Medicare cost report submitted for the most recent
  fiscal year for which the provider submitted the Medicare cost
  report.  If the mandatory payment is required, the district shall
  periodically update the amount of the mandatory payment.
         (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 42 U.S.C. Section 1396b(w).
         (c)  If the board requires a mandatory payment authorized
  under this chapter, the board shall set the amount of the mandatory
  payment, subject to the limitations of this chapter. The aggregate
  amount of the mandatory payments required of all paying providers
  in the district may not exceed six percent of the aggregate net
  patient revenue from hospital services provided in the district.
         (d)  Subject to Subsection (c), if the board requires a
  mandatory payment authorized under this chapter, the board shall
  set the mandatory payments in amounts that in the aggregate will
  generate sufficient revenue to cover the administrative expenses of
  the district for activities under this chapter and to fund an
  intergovernmental transfer described by Section 298H.103(c)(1).
  The annual amount of revenue from the mandatory payments used by the
  district may not exceed $150,000, plus the cost of
  collateralization of deposits, regardless of actual expenses.
         (e)  A paying provider may not add a mandatory payment
  required under this section as a surcharge to a patient.
         (f)  A mandatory payment assessed under this chapter is not a
  tax for hospital purposes for purposes of Section 9, Article IX,
  Texas Constitution, or Section 1069.301, Special District Local
  Laws Code.
         Sec. 298H.152.  ASSESSMENT AND COLLECTION OF MANDATORY
  PAYMENTS.  (a)  The district may designate an official of the
  district or contract with another person to assess and collect the
  mandatory payments authorized under this chapter.
         (b)  The person charged by the district with the assessment
  and collection of the mandatory payments may not charge the
  district a fee for assessing and collecting the payments unless the
  district authorizes the fee in writing.
         (c)  If the person charged with the assessment and collection
  of the mandatory payments is an official of the district, any
  revenue from a fee authorized under Subsection (b) shall be
  deposited in the district general fund and, if appropriate, shall
  be reported as fees of the district.
         Sec. 298H.153.  PURPOSE; CORRECTION OF INVALID PROVISION OR
  PROCEDURE; LIMITATION OF AUTHORITY.  (a)  The purpose of this
  chapter is to authorize the district to establish a program to
  enable the district to collect the mandatory payments from
  institutional health care providers to fund the nonfederal share of
  a Medicaid supplemental payment program or the Medicaid managed
  care rate enhancements for nonpublic hospitals to support the
  provision of health care by institutional health care providers to
  district residents in need of health care.
         (b)  This chapter does not authorize the district to collect
  the mandatory payments for the purpose of raising general revenue
  or any amount in excess of the amount reasonably necessary to:
               (1)  fund the nonfederal share of a Medicaid
  supplemental payment program or the Medicaid managed care rate
  enhancements for nonpublic hospitals; and
               (2)  cover the administrative expenses of the district
  associated with activities under this chapter and other uses of the
  fund described by Section 298H.103(c).
         (c)  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.  A rule adopted under this section may not create,
  impose, or materially expand the legal or financial liability or
  responsibility of the district or an institutional health care
  provider in the district beyond the provisions of this
  chapter.  This section does not require the board to adopt a rule.
         (d)  The district may only assess and collect a mandatory
  payment authorized under this chapter if a waiver program, rate
  enhancement, or reimbursement described by Section 298H.103(c)(1)
  is available for nonpublic hospitals located in the district.
         SECTION 2.  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, 2023.