By: Metcalf (Senate Sponsor - Nichols) H.B. No. 4835
         (In the Senate - Received from the House May 3, 2023;
  May 5, 2023, read first time and referred to Committee on Local
  Government; May 22, 2023, reported favorably by the following
  vote:  Yeas 9, Nays 0; May 22, 2023, sent to printer.)
Click here to see the committee vote
 
 
 
  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.
 
  * * * * *