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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation and operations of a health care provider |
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participation program in certain counties. |
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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 292E to read as follows: |
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CHAPTER 292E. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN |
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CERTAIN COUNTIES |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 292E.001. DEFINITIONS. In this chapter: |
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(1) "Institutional health care provider" means a |
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nonpublic hospital that provides inpatient hospital services. |
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(2) "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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(3) "Program" means a county health care provider |
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participation program authorized by this chapter. |
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Sec. 292E.002. APPLICABILITY. This chapter applies only to |
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a county that: |
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(1) is not served by a hospital district; and |
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(2) is: |
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(A) a county that: |
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(i) has a population of more than 46,000 and |
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less than 50,000; and |
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(ii) is adjacent to the county containing |
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the state capital; |
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(B) a county that: |
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(i) has a population of 900,000 or more; and |
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(ii) borders two counties, each of which |
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has a population of two million or more; or |
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(C) a county that: |
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(i) has a population of one million or more; |
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(ii) contains all or part of a municipality |
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with a population of one million or more; and |
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(iii) is adjacent to a county with a |
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population of 2.5 million or more. |
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Sec. 292E.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION |
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PROGRAM; PARTICIPATION IN PROGRAM. (a) A county health care |
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provider participation program authorizes a county to collect a |
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mandatory payment from each institutional health care provider |
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located in the county to be deposited in a local provider |
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participation fund established by the county. Money in the fund may |
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be used by the county as provided by Section 292E.103(b). |
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(b) The commissioners court of a county may adopt an order |
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authorizing the county to participate in the program, subject to |
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the limitations provided by this chapter. |
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SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT |
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Sec. 292E.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY |
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PAYMENTS. The commissioners court of a county may require a |
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mandatory payment under this chapter by an institutional health |
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care provider in the county only in the manner provided by this |
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chapter. |
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Sec. 292E.052. MAJORITY VOTE REQUIRED. The commissioners |
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court of a county may not authorize the county to collect a |
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mandatory payment under this chapter without an affirmative vote of |
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a majority of the members of the commissioners court. |
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Sec. 292E.053. RULES AND PROCEDURES. After the |
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commissioners court of a county has voted to require a mandatory |
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payment authorized under this chapter, the commissioners court may |
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adopt rules relating to the administration of the program, |
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including the collection of a mandatory payment, expenditures, an |
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audit, and any other administrative aspect of the program. |
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Sec. 292E.054. INSTITUTIONAL HEALTH CARE PROVIDER |
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REPORTING. (a) The commissioners court of a county that authorizes |
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the county to participate in a program under this chapter shall |
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require each institutional health care provider located in the |
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county to submit to the county a copy of any financial and |
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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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(b) The commissioners court may inspect the records of an |
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institutional health care provider in the county to the extent |
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necessary to ensure compliance with the requirements of Subsection |
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(a). |
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SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS |
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Sec. 292E.101. HEARING. (a) In each year that the |
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commissioners court of a county authorizes a mandatory payment |
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under this chapter, the commissioners court shall hold a public |
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hearing on the amounts of any mandatory payments that the county |
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intends to require during the year and how the revenue derived from |
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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 commissioners court |
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shall publish notice of the hearing in a newspaper of general |
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circulation in the county and provide written notice of the hearing |
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to each institutional health care provider located in the county. |
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(c) A representative of a paying hospital is entitled to |
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appear at the public hearing and be heard regarding any matter |
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related to the mandatory payments authorized under this chapter. |
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Sec. 292E.102. LOCAL PROVIDER PARTICIPATION FUND; |
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DEPOSITORY. (a) The commissioners court of a county that requires |
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a mandatory payment under this chapter shall create a local |
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provider participation fund. |
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(b) If the commissioners court of a county creates a local |
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provider participation fund, the commissioners court shall |
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designate one or more banks as the depository for the county's local |
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provider participation fund. |
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(c) The commissioners court may withdraw or use money in the |
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county's local provider participation fund only for a purpose |
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authorized under this chapter. |
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(d) All funds collected under this chapter shall be secured |
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in the manner provided for securing other funds of the county. |
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Sec. 292E.103. LOCAL PROVIDER PARTICIPATION FUND; |
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AUTHORIZED USES OF MONEY. (a) The local provider participation |
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fund established by a county under Section 292E.102 consists of: |
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(1) all revenue received by the county attributable to |
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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 described |
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by Subsection (b)(1), provided that the intergovernmental transfer |
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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 a county's local provider |
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participation fund may be used only to: |
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(1) fund intergovernmental transfers from the county |
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to the state to provide the nonfederal share of Medicaid payments |
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for: |
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(A) uncompensated care payments to nonpublic |
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hospitals authorized under the Texas Healthcare Transformation and |
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Quality Improvement Program waiver issued under Section 1115 of the |
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federal Social Security Act (42 U.S.C. Section 1315), or a |
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successor waiver program authorizing similar Medicaid supplemental |
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payment programs; |
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(B) uniform rate enhancements or other directed |
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payment programs for nonpublic hospitals; |
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(C) payments available under another waiver |
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program authorizing payments that are substantially similar to |
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Medicaid payments to nonpublic hospitals described by Paragraph (A) |
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or (B); or |
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(D) any reimbursement to nonpublic hospitals, or |
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that may benefit nonpublic hospitals as determined by the |
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commissioners court, for which federal matching funds are |
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available; |
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(2) subject to Section 292E.151(e), pay the |
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administrative expenses of the county in administering the program, |
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including collateralization of deposits; |
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(3) refund all or a portion of a mandatory payment |
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collected in error from a paying hospital; and |
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(4) refund to paying hospitals a proportionate share |
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of the money that the county: |
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(A) receives from the Health and Human Services |
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Commission that is not used to fund the nonfederal share of Medicaid |
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supplemental payment program payments; or |
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(B) determines cannot be 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 county money. |
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(d) Notwithstanding any other provision of this chapter, |
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with respect to an intergovernmental transfer of funds described by |
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Subsection (b)(1) made by the county, any funds received by the |
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state, county, or other entity as a result of the transfer may not |
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be used by the state, county, or other entity to: |
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(1) 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. |
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No. 111-152); or |
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(2) fund the nonfederal share of payments to nonpublic |
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hospitals available through the Medicaid disproportionate share |
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hospital program. |
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SUBCHAPTER D. MANDATORY PAYMENTS |
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Sec. 292E.151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL |
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NET PATIENT REVENUE. (a) Except as provided by Subsection (f), if |
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the commissioners court of a county authorizes a program under this |
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chapter, the commissioners court shall 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 county. The |
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commissioners court shall provide for the mandatory payment to be |
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assessed quarterly. In the first year in which the mandatory |
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payment is required, the mandatory payment is assessed on the net |
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patient revenue of an institutional health care provider as |
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determined by the data reported to the Department of State Health |
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Services under Sections 311.032 and 311.033 in the most recent |
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fiscal year for which that data was reported. If the institutional |
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health care provider did not report any data under those sections, |
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the provider's net patient revenue is the amount of that revenue as |
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contained in the provider's Medicare cost report submitted for the |
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most recent fiscal year for which the provider submitted the |
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Medicare cost report. The commissioners court shall update the |
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amount of the mandatory payment on an annual basis. |
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(b) The commissioners court of a county that requires a |
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mandatory payment under this chapter shall provide each |
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institutional health care provider on which the payment will be |
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assessed written notice of an assessment under this chapter. The |
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institutional health care provider must pay the assessment not |
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later than the 30th day after the date the provider receives the |
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written notice. |
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(c) The amount of a mandatory payment authorized under this |
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chapter must be uniformly proportionate with the amount of net |
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patient revenue generated by each paying hospital in the county. A |
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program may not hold harmless any institutional health care |
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provider, as required under 42 U.S.C. Section 1396b(w) and 42 |
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C.F.R. Section 433.68. |
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(d) The commissioners court of a county that requires a |
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mandatory payment under this chapter shall set the amount of the |
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mandatory payment. The aggregate amount of the mandatory payment |
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required of all paying hospitals in the county may not exceed six |
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percent of the aggregate net patient revenue from hospital services |
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provided by all paying hospitals in the county. |
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(e) Subject to Subsection (d), the commissioners court of a |
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county that requires a mandatory payment under this chapter shall |
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set the mandatory payments in amounts that in the aggregate will |
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generate sufficient revenue to cover the administrative expenses of |
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the county for activities under this chapter and to fund an |
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intergovernmental transfer described by Section 292E.103(b)(1). |
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The annual amount of revenue from mandatory payments that may be |
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used to pay the administrative expenses of the county for |
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activities under this chapter may not exceed $150,000, plus the |
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cost of collateralization of deposits, regardless of actual |
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expenses. |
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(f) 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. 292E.152. ASSESSMENT AND COLLECTION OF MANDATORY |
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PAYMENTS. (a) The county may collect or contract for the assessment |
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and collection of mandatory payments authorized under this chapter. |
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(b) The person charged by the county with the assessment and |
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collection of mandatory payments shall charge and deduct from the |
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mandatory payments collected for the county a collection fee in an |
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amount not to exceed the person's usual and customary charges for |
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like services. |
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(c) If the person charged with the assessment and collection |
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of mandatory payments is an official of the county, any revenue from |
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a collection fee charged under Subsection (b) shall be deposited in |
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the county general fund and, if appropriate, shall be reported as |
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fees of the county. |
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Sec. 292E.153. PURPOSE; CORRECTION OF INVALID PROVISION OR |
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PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this |
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chapter is to authorize a county to establish a program to enable |
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the county to collect mandatory payments from institutional health |
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care providers to fund the nonfederal share of certain Medicaid |
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programs as described by Section 292E.103(b)(1). |
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(b) To the extent any provision or procedure under this |
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chapter causes a mandatory payment authorized under this chapter to |
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be ineligible for federal matching funds, the commissioners court |
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of the county administering the program may provide by rule for an |
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alternative provision or procedure that conforms to the |
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requirements of the federal Centers for Medicare and Medicaid |
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Services. A rule adopted under this section may not create, impose, |
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or materially expand the legal or financial liability or |
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responsibility of the county or an institutional health care |
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provider located in the county beyond the provisions of this |
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chapter. This section does not require the commissioners court of a |
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county to adopt a rule. |
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(c) A county administering a program may only assess and |
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collect a mandatory payment authorized under this chapter if a |
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waiver program, uniform rate enhancement, or reimbursement |
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described by Section 292E.103(b)(1) is available to the county. |
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(d) This chapter does not authorize a county administering a |
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program to collect mandatory payments for the purpose of raising |
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general revenue or any amount in excess of the amount reasonably |
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necessary to fund the nonfederal share of a Medicaid supplemental |
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payment program or Medicaid managed care rate enhancements for |
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nonpublic hospitals and to cover the administrative expenses of the |
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county associated with activities under this chapter. |
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Sec. 292E.154. REPORTING REQUIREMENTS. (a) The |
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commissioners court of a county that authorizes a program under |
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this chapter shall report information to the Health and Human |
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Services Commission regarding the program on a schedule determined |
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by the commission. |
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(b) The information must include: |
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(1) the amount of the mandatory payments required and |
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collected in each year the program is authorized; and |
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(2) any expenditure or other use of money attributable |
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to mandatory payments collected under this chapter. |
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(c) The executive commissioner of the Health and Human |
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Services Commission may adopt rules to administer this section. |
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Sec. 292E.155. AUTHORITY TO REFUSE FOR VIOLATION. The |
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Health and Human Services Commission may refuse to accept money |
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from a local provider participation fund administered under this |
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chapter if the commission determines that acceptance of the money |
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may violate federal law. |
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Sec. 292E.156. INTEREST AND PENALTIES. The county may |
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impose and collect interest and penalties on delinquent mandatory |
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payments assessed under this chapter in any amount that does not |
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exceed the maximum amount authorized for other delinquent payments |
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owed to the county. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2025. |
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* * * * * |