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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement of rural hospitals participating in the |
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Medicaid managed care program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 533, Government Code, is |
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amended by adding Section 533.0041 to read as follows: |
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Sec. 533.0041. REIMBURSEMENT METHODOLOGY FOR RURAL |
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HOSPITALS. (a) In this section, "rural hospital" has the meaning |
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assigned by commission rules for purposes of Medicaid. |
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(b) To the extent allowed by federal law and notwithstanding |
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any state law, the executive commissioner shall by rule adopt a |
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reimbursement methodology for the payment of rural hospitals |
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participating in the Medicaid managed care program that ensures the |
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rural hospitals are reimbursed on an individual basis that allows |
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the rural hospitals to fully recover allowable costs incurred in |
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providing services to recipients. In adopting rules under this |
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section, the executive commissioner: |
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(1) may adopt a methodology that requires: |
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(A) the commission to directly reimburse rural |
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hospitals for allowable costs; |
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(B) a managed care organization to reimburse |
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rural hospitals; or |
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(C) both the commission and a managed care |
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organization to share in the total amount of reimbursement paid to |
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rural hospitals; and |
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(2) shall: |
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(A) define "allowable costs" for purposes of this |
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section; and |
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(B) require that the amount of reimbursement paid |
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to a rural hospital is subject to any applicable adjustments made by |
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the commission for payments to or penalties imposed on the rural |
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hospital that are based on a quality-based or performance-based |
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requirement under the Medicaid managed care program. |
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(c) Not later than January 1 of each even-numbered year, |
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the commission shall, as applicable: |
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(1) make an initial determination of the allowable |
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costs incurred by a rural hospital participating in the Medicaid |
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managed care program that is based on the rural hospital's cost |
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reports submitted to the federal Centers for Medicare and Medicaid |
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Services and other available information that the commission |
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considers relevant in determining the hospital's allowable costs; |
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or |
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(2) review and update the allowable costs previously |
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determined or updated under this subsection using the same criteria |
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required under Subdivision (1). |
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SECTION 2. Not later than January 1, 2020, the Health and |
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Human Services Commission shall determine the allowable costs |
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incurred by a rural hospital participating in the Medicaid managed |
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care program before that date as required by Section |
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533.0041(c)(1), Government Code, as added by this Act. |
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SECTION 3. 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 4. This Act takes effect September 1, 2019. |