| |
|
|
|
| |
|
|
COMMITTEE VOTE |
|
|
|
| |
|
|
YeaNayAbsentPNV |
|
|
BettencourtX |
|
|
SpringerX |
|
|
EckhardtX |
|
|
GutierrezX |
|
|
HallX |
|
|
NicholsX |
|
|
ParkerX |
|
|
PaxtonX |
|
|
WestX |
|
|
|
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
| |
|
|
relating to the creation and operations of certain health care |
|
|
provider participation programs. |
|
|
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 292D to read as follows: |
|
|
CHAPTER 292D. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN |
|
|
CERTAIN COUNTIES BORDERING NECHES RIVER |
|
|
SUBCHAPTER A. GENERAL PROVISIONS |
|
|
Sec. 292D.001. 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 the county health care provider |
|
|
participation program authorized by this chapter. |
|
|
Sec. 292D.002. APPLICABILITY. This chapter applies only to |
|
|
a county that: |
|
|
(1) is not served by a hospital district; |
|
|
(2) has a population of more than 250,000; and |
|
|
(3) borders the Neches River. |
|
|
Sec. 292D.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION |
|
|
PROGRAM; PARTICIPATION IN PROGRAM. (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 as provided by Section 292D.103(c). |
|
|
(b) The commissioners court may adopt an order authorizing a |
|
|
county to participate in the program, subject to the limitations |
|
|
provided by this chapter. |
|
|
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT |
|
|
Sec. 292D.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY |
|
|
PAYMENTS. 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. 292D.052. MAJORITY VOTE REQUIRED. The commissioners |
|
|
court of a county may not authorize the county to collect a |
|
|
mandatory payment authorized under this chapter without an |
|
|
affirmative vote of a majority of the members of the commissioners |
|
|
court. |
|
|
Sec. 292D.053. RULES AND PROCEDURES. The commissioners |
|
|
court may adopt rules relating to the administration of the |
|
|
program, including the collection of a mandatory payment, |
|
|
expenditures, an audit, and any other administrative aspect of the |
|
|
program. |
|
|
Sec. 292D.054. INSTITUTIONAL HEALTH CARE PROVIDER |
|
|
REPORTING; INSPECTION OF RECORDS. (a) If the commissioners court |
|
|
of a county authorizes the county to participate in a 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. |
|
|
(b) The commissioners court of a county that collects a |
|
|
mandatory payment authorized under this chapter may inspect the |
|
|
records of an institutional health care provider to the extent |
|
|
necessary to ensure compliance with the requirements of Subsection |
|
|
(a). |
|
|
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS |
|
|
Sec. 292D.101. HEARING. (a) In each year that the |
|
|
commissioners court of a county authorizes a 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 of |
|
|
the county shall publish notice of the hearing in a newspaper of |
|
|
general circulation in the county and provide written notice of the |
|
|
hearing to each institutional health care provider located in the |
|
|
county. |
|
|
(c) A representative of a paying hospital is entitled to |
|
|
appear at the public hearing and be heard regarding any matter |
|
|
related to the mandatory payments authorized under this chapter. |
|
|
Sec. 292D.102. DEPOSITORY. (a) The commissioners court of |
|
|
each county that collects a mandatory payment authorized under this |
|
|
chapter by resolution shall designate one or more banks located in |
|
|
the county as the depository for mandatory payments received by the |
|
|
county. |
|
|
(b) All income received by a county under this chapter, |
|
|
including the revenue from mandatory payments remaining after |
|
|
discounts and fees for assessing and collecting the payments are |
|
|
deducted, shall be deposited with the county depository in the |
|
|
county's local provider participation fund and may be withdrawn |
|
|
only as provided by this chapter. |
|
|
(c) All funds under this chapter shall be secured in the |
|
|
manner provided for securing county funds. |
|
|
Sec. 292D.103. LOCAL PROVIDER PARTICIPATION FUND; |
|
|
AUTHORIZED USES OF MONEY. (a) Each county that collects a |
|
|
mandatory payment authorized under this chapter shall create a |
|
|
local provider participation fund. |
|
|
(b) The local provider participation fund of a county |
|
|
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. |
|
|
(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 the nonfederal share of Medicaid 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), or a successor waiver program authorizing |
|
|
similar Medicaid supplemental payment programs; |
|
|
(B) uniform rate enhancements for nonpublic |
|
|
hospitals in the Medicaid managed care service area in which the |
|
|
county 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); |
|
|
(D) payments to Medicaid managed care |
|
|
organizations that are dedicated for payment to hospitals; or |
|
|
(E) any reimbursement to nonpublic hospitals for |
|
|
which federal matching funds are available; |
|
|
(2) subject to Section 292D.151(d), pay the |
|
|
administrative expenses of the county in administering the program, |
|
|
including collateralization of deposits; |
|
|
(3) refund all or a portion of a mandatory payment |
|
|
collected in error from a paying hospital; |
|
|
(4) refund to paying hospitals a proportionate share |
|
|
of the money attributable to mandatory payments collected under |
|
|
this chapter that the county: |
|
|
(A) receives from the Health and Human Services |
|
|
Commission 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; |
|
|
(5) transfer funds to the Health and Human Services |
|
|
Commission if the county is legally required to transfer the funds |
|
|
to address a disallowance of federal matching funds with respect to |
|
|
payments, rate enhancements, and reimbursements for which the |
|
|
county made intergovernmental transfers described by Subdivision |
|
|
(1); and |
|
|
(6) reimburse the county if the county is required by |
|
|
the rules governing the uniform rate enhancement program described |
|
|
by Subdivision (1)(B) to incur an expense or forego Medicaid |
|
|
reimbursements from the state because the balance of the local |
|
|
provider participation fund is not sufficient to fund that rate |
|
|
enhancement program. |
|
|
(d) Money in the local provider participation fund may not |
|
|
be commingled with other county 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 county, any funds received by the |
|
|
state or county as a result of the transfer may not be used by the |
|
|
state, county, or any other entity to: |
|
|
(1) 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); or |
|
|
(2) fund the nonfederal share of payments to nonpublic |
|
|
hospitals available through the Medicaid disproportionate share |
|
|
hospital program. |
|
|
SUBCHAPTER D. MANDATORY PAYMENTS |
|
|
Sec. 292D.151. 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 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 shall provide that the mandatory payment is to |
|
|
be assessed at least annually, but not more often than |
|
|
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 most recent fiscal year for |
|
|
which that data was reported. If the institutional health care |
|
|
provider did not report any data under those sections, the |
|
|
provider's net patient revenue is the amount of that revenue as |
|
|
contained in the provider's Medicare cost report submitted for the |
|
|
previous fiscal year or for the closest subsequent fiscal year for |
|
|
which the provider submitted the Medicare cost report. The |
|
|
commissioners court 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 aggregate amount of the |
|
|
mandatory payment required of all paying hospitals may not exceed |
|
|
six percent of the aggregate net patient revenue from hospital |
|
|
services provided by all paying hospitals in the county. |
|
|
(d) Subject to 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 an intergovernmental transfer described by |
|
|
Section 292D.103(c)(1). The annual amount of revenue from mandatory |
|
|
payments that may be used to pay the administrative expenses of the |
|
|
county for activities under this chapter may not exceed $150,000, |
|
|
plus the cost of collateralization of deposits, regardless of |
|
|
actual expenses. |
|
|
(e) A paying hospital may not add a mandatory payment |
|
|
required under this section as a surcharge to a patient. |
|
|
Sec. 292D.152. ASSESSMENT AND COLLECTION OF MANDATORY |
|
|
PAYMENTS. (a) The county may collect or, using a competitive |
|
|
bidding process, contract for the assessment and collection of |
|
|
mandatory payments authorized under this chapter. |
|
|
(b) The person charged by the county with the assessment and |
|
|
collection of mandatory payments shall charge and deduct from the |
|
|
mandatory payments collected for the county a collection fee in an |
|
|
amount not to exceed the person's usual and customary charges for |
|
|
like services. |
|
|
(c) If the person charged with the assessment and collection |
|
|
of mandatory payments is an official of the county, any revenue from |
|
|
a collection fee charged under Subsection (b) shall be deposited in |
|
|
the county general fund and, if appropriate, shall be reported as |
|
|
fees of the county. |
|
|
Sec. 292D.153. 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. 292D.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 certain |
|
|
Medicaid programs as described by Section 292D.103(c)(1). |
|
|
(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, the commissioners court |
|
|
of the county administering the program 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 located in the county beyond the provisions of this |
|
|
chapter. This section does not require the commissioners court of a |
|
|
county to adopt a rule. |
|
|
(c) The county may only assess and collect a mandatory |
|
|
payment authorized under this chapter if a waiver program, uniform |
|
|
rate enhancement, or reimbursement described by Section |
|
|
292D.103(c)(1) is available to the county. |
|
|
SECTION 2. Section 300.0003, Health and Safety Code, is |
|
|
amended to read as follows: |
|
|
Sec. 300.0003. APPLICABILITY. (a) Except as provided by |
|
|
Subsection (b), this [This] chapter applies only to: |
|
|
(1) a hospital district that is not participating in a |
|
|
health care provider participation program authorized by another |
|
|
chapter of this subtitle; and |
|
|
(2) a county or municipality that: |
|
|
(A) is not participating in a health care |
|
|
provider participation program authorized by another chapter of |
|
|
this subtitle; and |
|
|
(B) is not served by a hospital district or a |
|
|
public hospital. |
|
|
(b) This chapter does not apply to a municipality that is |
|
|
located in a county described by Section 292D.002. |
|
|
SECTION 3. Chapter 295, Health and Safety Code, is |
|
|
repealed. |
|
|
SECTION 4. (a) In this section, "paying hospital" has the |
|
|
meaning assigned by Section 295.001, Health and Safety Code. |
|
|
(b) If on the date Chapter 295, Health and Safety Code, is |
|
|
repealed by this Act a municipality to which that chapter applies |
|
|
has not transferred any remaining amount of mandatory payments |
|
|
assessed and collected by the municipality under that chapter |
|
|
before its repeal to the Health and Human Services Commission, the |
|
|
municipality shall refund to each paying hospital in the |
|
|
municipality that hospital's proportionate share of the remaining |
|
|
amount of mandatory payments. |
|
|
(c) This section expires September 1, 2025. |
|
|
SECTION 5. (a) Except as provided by Subsection (b) of this |
|
|
section, this Act takes effect September 1, 2023. |
|
|
(b) The section of this Act adding Chapter 292D, Health and |
|
|
Safety Code, takes effect September 1, 2025. |
|
|
|
|
|
* * * * * |