Bill Text: TX HB2035 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to reimbursement of rural hospitals participating in the Medicaid managed care program.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced) 2019-03-05 - Referred to Human Services [HB2035 Detail]

Download: Texas-2019-HB2035-Introduced.html
  86R9410 KKR-F
 
  By: Price H.B. No. 2035
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to reimbursement of rural hospitals participating in the
  Medicaid managed care program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.0041 to read as follows:
         Sec. 533.0041.  REIMBURSEMENT METHODOLOGY FOR RURAL
  HOSPITALS. (a)  In this section, "rural hospital" has the meaning
  assigned by commission rules for purposes of Medicaid.
         (b)  To the extent allowed by federal law and notwithstanding
  any state law, the executive commissioner shall by rule adopt a
  reimbursement methodology for the payment of rural hospitals
  participating in the Medicaid managed care program that ensures the
  rural hospitals are reimbursed on an individual basis that allows
  the rural hospitals to fully recover allowable costs incurred in
  providing services to recipients. In adopting rules under this
  section, the executive commissioner:
               (1)  may adopt a methodology that requires:
                     (A)  the commission to directly reimburse rural
  hospitals for allowable costs;
                     (B)  a managed care organization to reimburse
  rural hospitals; or
                     (C)  both the commission and a managed care
  organization to share in the total amount of reimbursement paid to
  rural hospitals; and
               (2)  shall:
                     (A)  define "allowable costs" for purposes of this
  section; and
                     (B)  require that the amount of reimbursement paid
  to a rural hospital is subject to any applicable adjustments made by
  the commission for payments to or penalties imposed on the rural
  hospital that are based on a quality-based or performance-based
  requirement under the Medicaid managed care program.
         (c)  Not later than January 1 of each even-numbered year,
  the commission shall, as applicable:
               (1)  make an initial determination of the allowable
  costs incurred by a rural hospital participating in the Medicaid
  managed care program that is based on the rural hospital's cost
  reports submitted to the federal Centers for Medicare and Medicaid
  Services and other available information that the commission
  considers relevant in determining the hospital's allowable costs;
  or
               (2)  review and update the allowable costs previously
  determined or updated under this subsection using the same criteria
  required under Subdivision (1).
         SECTION 2.  Not later than January 1, 2020, the Health and
  Human Services Commission shall determine the allowable costs
  incurred by a rural hospital participating in the Medicaid managed
  care program before that date as required by Section
  533.0041(c)(1), Government Code, as added by this Act.
         SECTION 3.  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 may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 4.  This Act takes effect September 1, 2019.
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