Bill Text: TX HB1576 | 2019-2020 | 86th Legislature | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relating to the delivery of certain transportation services under Medicaid and certain other health and human services programs.

Spectrum: Bipartisan Bill

Status: (Passed) 2019-06-14 - Effective immediately [HB1576 Detail]

Download: Texas-2019-HB1576-Engrossed.html

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By: Phelan, Paddie, Springer, H.B. No. 1576
González of El Paso, Rose, et al.

A BILL TO BE ENTITLED
AN ACT
relating to the delivery of certain medical transportation
services, including under Medicaid and certain other health and
human services programs; imposing a mandatory payment; authorizing
an administrative penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.02414(a), Government Code, is
amended by amending Subdivision (1) and adding Subdivisions (1-a)
and (3) to read as follows:
(1) "Medical transportation program" means the
program that provides nonemergency transportation services [to and
from covered health care services, based on medical necessity,] to
recipients under Medicaid, the children with special health care
needs program, and the transportation for indigent cancer patients
program, who have no other means of transportation.
(1-a) "Nonemergency transportation service" means a
service provided to transport a person to or from medically
necessary services covered under a health care program in which the
person is enrolled. The term does not include a nonmedical
transportation service as defined by Section 531.024142.
(3) "Transportation network company" has the meaning
assigned by Section 2402.001, Occupations Code.
SECTION 2. Section 531.02414, Government Code, is amended
by amending Subsection (f) and adding Subsections (i), (j), (k),
(l), and (m) to read as follows:
(f) Except as provided by Subsection (j), the [The]
commission shall require compliance with the rules adopted under
Subsection (e) in any contract entered into with a regional
contracted broker to provide nonemergency transportation services
under the medical transportation program.
(i) Emergency medical services personnel and emergency
medical services vehicles, as those terms are defined by Section
773.003, Health and Safety Code, may not provide nonemergency
transportation services under the medical transportation program.
(j) A regional contracted broker may subcontract with a
transportation network company to provide services under this
section. A rule or other requirement adopted by the executive
commissioner under Subsection (e) does not apply to the
subcontracted transportation network company or a motor vehicle
operator who is part of the company's network. The commission or
the regional contracted broker may not require a motor vehicle
operator who is part of the subcontracted transportation network
company's network to enroll as a Medicaid provider to provide
services under this section.
(k) The commission or a regional contracted broker that
subcontracts with a transportation network company under
Subsection (j) may require the transportation network company or a
motor vehicle operator who provides services under this section to
be periodically screened against the list of excluded individuals
and entities maintained by the Office of Inspector General of the
United States Department of Health and Human Services.
(l) Notwithstanding any other law, a motor vehicle operator
who is part of the network of a transportation network company that
subcontracts with a regional contracted broker under Subsection (j)
and who satisfies the driver requirements in Section 2402.107,
Occupations Code, is qualified to provide services under this
section. The commission and the regional contracted broker may not
impose any additional requirements on a motor vehicle operator who
satisfies the driver requirements in Section 2402.107, Occupations
Code, to provide services under this section.
(m) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 3. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.024142 to read as follows:
Sec. 531.024142. NONMEDICAL TRANSPORTATION SERVICES UNDER
MEDICAID. (a) In this section:
(1) "Managed care organization" means a managed care
organization that contracts with the commission to provide health
care services to Medicaid recipients under Chapter 533.
(2) "Nonmedical transportation service" means:
(A) curb-to-curb transportation in a standard
passenger vehicle to and from a medically necessary, nonemergency
covered health care service of a Medicaid recipient enrolled in a
managed care plan that the managed care organization that provides
health care services to the recipient determines meets the level of
care that is medically appropriate for the recipient and that is
scheduled not more than 48 hours before the transportation occurs,
including transportation related to:
(i) discharge of a recipient from a health
care facility;
(ii) receipt of urgent care; and
(iii) obtaining pharmacy services and
prescription drugs; and
(B) any other transportation to or from a
medically necessary, nonemergency covered health care service the
commission considers appropriate to be provided by a transportation
vendor, as determined by commission rule or policy.
(3) "Transportation network company" has the meaning
assigned by Section 2402.001, Occupations Code.
(4) "Transportation vendor" means an entity,
including a transportation network company, that contracts with a
managed care organization to provide nonmedical transportation
services.
(b) The executive commissioner shall adopt rules regarding
the manner in which nonmedical transportation services may be
arranged and provided.
(c) The rules must require a managed care organization to
create a process to:
(1) verify that a passenger is eligible to receive
nonmedical transportation services;
(2) ensure that nonmedical transportation services
are provided only to and from covered health care services in areas
in which a transportation network company operates;
(3) refer a Medicaid recipient enrolled in a managed
care plan offered by the managed care organization to the medical
transportation program described by Section 531.02414 if:
(A) by rule the managed care organization is not
responsible for providing transportation services; or
(B) the recipient requires an accessible or
specialized vehicle that is not available through a transportation
vendor; and
(4) ensure the timely delivery of nonmedical
transportation services to a Medicaid recipient, including by
setting reasonable service response goals.
(d) A rule adopted in accordance with Subsection (c)(4) may
not penalize a managed care organization that contracts with a
transportation vendor under this section if the vendor is unable to
provide nonmedical transportation services to a Medicaid recipient
after the managed care organization has made a specific request for
those services.
(e) The rules must require a transportation vendor to,
before permitting a motor vehicle operator to provide nonmedical
transportation services:
(1) confirm that the operator:
(A) is at least 18 years of age;
(B) maintains a valid driver's license issued by
this state, another state, or the District of Columbia; and
(C) possesses proof of registration and
automobile financial responsibility for each motor vehicle to be
used to provide nonmedical transportation services;
(2) conduct, or cause to be conducted, a local, state,
and national criminal background check for the operator that
includes the use of:
(A) a commercial multistate and
multijurisdiction criminal records locator or other similar
commercial nationwide database; and
(B) the national sex offender public website
maintained by the United States Department of Justice or a
successor agency;
(3) confirm that any vehicle to be used to provide
nonmedical transportation services:
(A) meets the applicable requirements of Chapter
548, Transportation Code; and
(B) except as provided by Subsection (j), has at
least four doors; and
(4) obtain and review the operator's driving record.
(f) The rules may not permit a motor vehicle operator to
provide nonmedical transportation services if the operator:
(1) has been convicted in the three-year period
preceding the issue date of the driving record obtained under
Subsection (e)(4) of:
(A) more than three offenses classified by the
Department of Public Safety as moving violations; or
(B) one or more of the following offenses:
(i) fleeing or attempting to elude a police
officer under Section 545.421, Transportation Code;
(ii) reckless driving under Section
545.401, Transportation Code;
(iii) driving without a valid driver's
license under Section 521.025, Transportation Code; or
(iv) driving with an invalid driver's
license under Section 521.457, Transportation Code;
(2) has been convicted in the preceding seven-year
period of any of the following:
(A) driving while intoxicated under Section
49.04 or 49.045, Penal Code;
(B) use of a motor vehicle to commit a felony;
(C) a felony crime involving property damage;
(D) fraud;
(E) theft;
(F) an act of violence; or
(G) an act of terrorism; or
(3) is found to be registered in the national sex
offender public website maintained by the United States Department
of Justice or a successor agency.
(g) The commission may not require:
(1) a motor vehicle operator to enroll as a Medicaid
provider to provide nonmedical transportation services; or
(2) a managed care organization to credential a motor
vehicle operator to provide nonmedical transportation services.
(h) The commission or a managed care organization that
contracts with a transportation vendor may require the
transportation vendor or a motor vehicle operator who provides
services under this section to be periodically screened against the
list of excluded individuals and entities maintained by the Office
of Inspector General of the United States Department of Health and
Human Services.
(i) Notwithstanding any other law, a motor vehicle operator
who is part of a transportation network company's network and who
satisfies the driver requirements in Section 2402.107, Occupations
Code, is qualified to provide nonmedical transportation services.
The commission and a managed care organization may not impose any
additional requirements on a motor vehicle operator who satisfies
the driver requirements in Section 2402.107, Occupations Code, to
provide nonmedical transportation services.
(j) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 4. Section 533.00257(a), Government Code, is
amended by adding Subdivision (2-a) to read as follows:
(2-a) "Transportation network company" has the
meaning assigned by Section 2402.001, Occupations Code.
SECTION 5. Section 533.00257, Government Code, is amended
by amending Subsections (d) and (g) and adding Subsections (k),
(l), (m), and (n) to read as follows:
(d) Except as provided by Subsections (k) and (m), a [A]
managed transportation organization that participates in the
medical transportation program must attempt to contract with
medical transportation providers that:
(1) are considered significant traditional providers,
as defined by rule by the executive commissioner;
(2) meet the minimum quality and efficiency measures
required under Subsection (g) and other requirements that may be
imposed by the managed transportation organization; and
(3) agree to accept the prevailing contract rate of
the managed transportation organization.
(g) Except as provided by Subsections (k) and (m), the [The]
commission shall require that managed transportation organizations
and providers participating in the medical transportation program
meet minimum quality and efficiency measures as determined by the
commission.
(k) A managed transportation organization may subcontract
with a transportation network company to provide services under
this section. A rule or other requirement adopted by the executive
commissioner under this section or Section 531.02414 does not apply
to the subcontracted transportation network company or a motor
vehicle operator who is part of the company's network. The
commission or the managed transportation organization may not
require a motor vehicle operator who is part of the subcontracted
transportation network company's network to enroll as a Medicaid
provider to provide services under this section.
(l) The commission or a managed transportation organization
that subcontracts with a transportation network company under
Subsection (k) may require the transportation network company or a
motor vehicle operator who provides services under this section to
be periodically screened against the list of excluded individuals
and entities maintained by the Office of Inspector General of the
United States Department of Health and Human Services.
(m) Notwithstanding any other law, a motor vehicle operator
who is part of the network of a transportation network company that
subcontracts with a managed transportation organization under
Subsection (k) and who satisfies the driver requirements in Section
2402.107, Occupations Code, is qualified to provide services under
this section. The commission and the managed transportation
organization may not impose any additional requirements on a motor
vehicle operator who satisfies the driver requirements in Section
2402.107, Occupations Code, to provide services under this section.
(n) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 6. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.00259 to read as follows:
Sec. 533.00259. DELIVERY OF NONMEDICAL TRANSPORTATION
SERVICES. (a) In this section, "nonmedical transportation
service" and "transportation vendor" have the meanings assigned by
Section 531.024142.
(b) The commission shall:
(1) not later than January 1, 2020, designate at least
four managed care service areas, two of which must be urban service
areas, and require each managed care organization that contracts
with the commission to provide health care services to recipients
in those areas to arrange for the provision of nonmedical
transportation services;
(2) not later than July 1, 2020, designate at least
eight managed care service areas, four of which must be urban
service areas, and require each managed care organization that
contracts with the commission to provide health care services to
recipients in those areas to arrange for the provision of
nonmedical transportation services; and
(3) not later than January 1, 2021, require each
managed care organization that contracts with the commission to
provide health care services to recipients to arrange for the
provision of nonmedical transportation services.
(b-1) A managed care organization may contract with a
transportation vendor or other third party to arrange for the
provision of nonmedical transportation services. If a managed care
organization contracts with a third party that is not a
transportation vendor to arrange for the provision of nonmedical
transportation services, the third party shall contract with a
transportation vendor to deliver the nonmedical transportation
services.
(c) A managed care organization that contracts with a
transportation vendor or other third party to arrange for the
provision of nonmedical transportation services shall ensure the
effective sharing and integration of service coordination, service
authorization, and utilization management data between the managed
care organization and the transportation vendor or third party.
(d) A managed care organization may not require:
(1) a motor vehicle operator to enroll as a Medicaid
provider to provide nonmedical transportation services; or
(2) the credentialing of a motor vehicle operator to
provide nonmedical transportation services.
(e) For purposes of this section and notwithstanding
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
operator who provides services under this section may use a
wheelchair-accessible vehicle equipped with a lift or ramp that is
capable of transporting passengers using a fixed-frame wheelchair
in the cabin of the vehicle if the vehicle otherwise meets the
requirements of Section 2402.111, Occupations Code.
SECTION 7. Section 773.003, Health and Safety Code, is
amended by adding Subdivision (5) to read as follows:
(5) "Commission" means the Health and Human Services
Commission.
SECTION 8. Chapter 773, Health and Safety Code, is amended
by adding Subchapter J to read as follows:
SUBCHAPTER J. TEXAS AMBULANCE RESPONSE SAFETY NET PROGRAM
Sec. 773.301. PURPOSE. The purpose of this subchapter is to
authorize the commission to establish and administer the Texas
ambulance response safety net program as a self-funded ground
ambulance service provider participation program for ground
ambulance service providers in accordance with this subchapter.
Sec. 773.302. DEFINITIONS. In this subchapter:
(1) "Average commercial rate" means the average amount
payable by commercial payors for the same service. The rate is
calculated by:
(A) aligning the paid Medicaid claims with the
Medicare fees for each Healthcare Common Procedure Coding System
code or Current Procedural Terminology code for a ground ambulance
service provider;
(B) calculating the Medicare payment for the
claims described in Paragraph (A);
(C) calculating a commercial-to-Medicare
conversion factor for each ground ambulance service provider by
dividing the total amount of the average commercial payments for
the claims by the total Medicare payments for the claims; and
(D) recalculating at least once every three years
the commercial-to-Medicare ratio for ground ambulance service
providers.
(2) "Net patient revenue" means a ground ambulance
service provider's estimated net realizable revenue from patients,
third-party payors, and other entities for ground ambulance
services rendered, including estimated retroactive adjustments
required by reimbursement agreements with third-party payors. The
term does not include:
(A) the amounts the provider reduces for payors
who have a fee schedule established by federal or state statute or a
contractual agreement;
(B) Medicaid payments received by the provider,
including any payments for individuals who are dually eligible for
Medicaid and Medicare;
(C) amounts the provider reduces to zero as an
uncollectible payment from any payor that are not contractual
allowances, provided that the provider attempted to collect the
payment; or
(D) amounts related to ground ambulance services
that are waived or forgiven by a paying entity due to the financial
hardship of the patient, provided that the waiver or forgiveness is
implemented in accordance with a written policy of the entity that
is consistent with national standards adopted by the Healthcare
Financial Management Association or a similar organization.
Sec. 773.303. APPLICABILITY. (a) This subchapter applies
only to a ground ambulance service provider that is:
(1) an emergency medical services provider as defined
by Section 773.003 and licensed under this chapter;
(2) a nonpublic, nonfederal provider of ground
ambulance services; and
(3) a participant in the state Medicaid program.
(b) This subchapter does not apply to:
(1) an entity that provides only nonemergency ground
ambulance services;
(2) a state or local governmental entity that provides
ground ambulance services; or
(3) an entity that is required to hold a license under
Section 773.045(b).
(c) The executive commissioner may not modify the
applicability of this subchapter in an effort to comply with the
requirements of 42 C.F.R. Section 433.68.
Sec. 773.304. MANDATORY PAYMENTS BASED ON NET PATIENT
REVENUE. (a) Except as otherwise provided by this subchapter, the
commission shall require an annual mandatory payment to be assessed
on each ground ambulance service provider's net patient revenue
related to the provision of emergency ground ambulance services.
The mandatory payment is to be collected quarterly. The commission
shall update the amount of the mandatory payment at least annually.
(b) The commission shall uniformly and consistently impose
the mandatory payment on each ground ambulance service provider and
use the same formula for each provider in calculating the mandatory
payment.
(c) The total amount of all mandatory payments for the state
fiscal year in which the mandatory payments are imposed may not
exceed:
(1) the state portion, excluding any federal financial
participation, of the cost of reimbursement enhancements provided
in this subchapter that are directly attributable to reimbursements
to ground ambulance service providers; or
(2) an amount equal to six percent of the net operating
revenue of all ground ambulance service providers for the provision
of emergency ground ambulance services, or an amount otherwise
permitted by federal law, provided that the maximum mandatory
payment for a provider in any year may not exceed the provider's net
patient revenue, as reported by the provider, subject to Section
773.306(b).
(d) Subject to the maximum amount prescribed by Subsection
(c), the commission shall set the mandatory payment in an amount
that in the aggregate generates sufficient revenue to cover the
administrative expenses of the commission for activities under this
subchapter.
(e) Not later than the 30th day before the end of each
quarter, the commission shall issue to each ground ambulance
service provider a notice of the amount of the mandatory payment
required to be paid by the provider in the next quarter.
(f) A ground ambulance service provider may not add a
mandatory payment required under this subchapter as a surcharge to
a patient or a third-party payor.
(g) A ground ambulance service provider shall make
mandatory payments only in the manner provided by this subchapter.
Sec. 773.305. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. (a) Subject to Subsection (b), the commission shall
collect a mandatory payment required under this subchapter.
(b) The commission may contract for the assessment and
collection of mandatory payments under this subchapter.
Sec. 773.306. REPORT; INSPECTION OF RECORDS. (a) The
commission shall require a ground ambulance service provider to
submit a report at least annually, but not more than quarterly, that
includes information necessary to assist the commission in making a
determination on mandatory payments under this subchapter.
(b) The executive commissioner may audit or inspect the
records of a ground ambulance service provider to the extent
necessary to ensure the accuracy of any data submitted to the
commission under this subchapter.
Sec. 773.307. FAILURE TO SUBMIT TIMELY OR ACCURATE REPORT
OR PAYMENT; AUDIT; ADMINISTRATIVE PENALTY. (a) The commission may
assess a reasonable penalty against a ground ambulance service
provider, not to exceed 15 percent of the quarterly portion of the
provider's mandatory payment, for failure to timely submit the
quarterly portion of a mandatory payment or a report required under
this subchapter.
(b) If a ground ambulance service provider submits an
inaccurate report required under this subchapter, the commission
may conduct an audit of the provider's records and may require the
provider to pay the cost of any audit expenses and related hearings.
(c) A penalty assessed under this section is in addition to
any other penalties and remedies applicable under state or federal
law.
(d) If a ground ambulance service provider refuses to submit
a quarterly portion of a mandatory payment, the commission may
suspend all Medicaid payments to the provider until:
(1) the provider submits the quarterly portion of the
mandatory payment and any associated penalties; or
(2) the provider and the commission reach a negotiated
settlement.
Sec. 773.308. TEXAS AMBULANCE RESPONSE SAFETY NET TRUST
FUND. (a) The Texas ambulance response safety net trust fund is
established as a trust fund to be held by the comptroller outside
the state treasury and administered by the commission as trustee.
(b) The trust fund consists of:
(1) all revenue from the mandatory payments required
by this subchapter, including any administrative penalties and any
interest attributable to delinquent payments; and
(2) the earnings of the fund.
(c) Money deposited to the trust fund may be used only to:
(1) provide reimbursements for ground ambulance
services delivered to Medicaid recipients under a fee-for-service
arrangement by a ground ambulance service provider to which this
subchapter applies based on the provider's average commercial rate,
including reimbursement enhancements to the statewide dollar
amount rate used to reimburse ground ambulance service providers;
(2) pay the administrative expenses of the commission
solely for activities under this subchapter; and
(3) refund a portion of a mandatory payment collected
in error from a provider.
(d) All revenue from the mandatory payments required by this
subchapter must be deposited in the trust fund.
(e) Money in the trust fund may not be used 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).
Sec. 773.309. INVALIDITY; FEDERAL FUNDS. The commission
shall stop collection of the mandatory payment and, not later than
the 30th day after the date collection is stopped, return to each
ground ambulance service provider, in proportion to the total
amount paid by each provider compared to the total amount paid by
all providers, any unspent money deposited to the credit of the
trust fund, if:
(1) any provision of or procedure under this
subchapter is held invalid by a final court order that is not
subject to appeal;
(2) the commission determines that the imposition of
the mandatory payment and the expenditure of amounts collected as
prescribed by this subchapter will not entitle the state to receive
federal matching funds under the Medicaid program or will be
inconsistent with the objectives described by Section
537.002(b)(7), Government Code; or
(3) the commission determines that the amount of the
mandatory payments collected would exceed the amount paid in
increased Medicaid fee-for-service reimbursement rates for
services provided to individuals who are dually eligible for
Medicaid and Medicare.
Sec. 773.310. RULES. The executive commissioner shall
adopt rules necessary to implement this subchapter.
SECTION 9. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.080 to read as follows:
Sec. 32.080. ENHANCED PAYMENT MODEL FOR CERTAIN AMBULANCE
PROVIDERS. (a) The executive commissioner, in consultation with
ambulance providers, by rule shall establish an enhanced payment
model for reimbursing non-state operated public ambulance
providers who provide ground emergency medical transportation
services to recipients of medical assistance. The enhanced payment
model must be implemented under the Medicaid fee-for-service
delivery model through supplemental payments and the Medicaid
managed care delivery model through an enhanced reimbursement or
payment rate.
(b) The commission may not use general revenue to reimburse
non-state operated public ambulance providers under or administer
the enhanced payment model.
(c) Reimbursements made under the enhanced payment model
must be:
(1) in addition to money appropriated to the
commission for reimbursing non-state operated public ambulance
providers; and
(2) provided in a manner that maximizes the
availability of federal money.
(d) Under the enhanced payment model, the commission may:
(1) receive and spend money from an intergovernmental
transfer on:
(A) reimbursing non-state operated public
ambulance providers; and
(B) covering the cost of establishing and
administering the enhanced payment model; and
(2) as necessary, certify that reimbursements made
under the enhanced payment model are public funds eligible for
federal financial participation in accordance with the
requirements of 42 C.F.R. Section 433.51.
SECTION 10. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall establish the amount of the initial
mandatory payment imposed under Subchapter J, Chapter 773, Health
and Safety Code, as added by this Act, based on available net
patient revenue information.
SECTION 11. If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and:
(1) for a provision of Subchapter J, Chapter 773,
Health and Safety Code, as added by this Act, shall delay
implementing that provision, including the collection of a
mandatory payment, until the waiver or authorization is granted and
begin implementing the provision on the date the waiver or
authorization is granted; and
(2) for any other provision, may delay implementing
the provision until the waiver or authorization is granted.
SECTION 12. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules as necessary to implement the
changes in law made by this Act.
SECTION 13. 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, 2019.