Bill Text: TX HB2798 | 2019-2020 | 86th Legislature | Comm Sub


Bill Title: Relating to the reimbursement of certain urban teaching hospitals for the provision of inpatient hospital care under Medicaid.

Spectrum: Bipartisan Bill

Status: (Introduced) 2019-05-09 - Placed on General State Calendar [HB2798 Detail]

Download: Texas-2019-HB2798-Comm_Sub.html
  86R26244 KFF-D
 
  By: Klick, Deshotel, Clardy, Hinojosa, H.B. No. 2798
      et al.
 
  Substitute the following for H.B. No. 2798:
 
  By:  Clardy C.S.H.B. No. 2798
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the reimbursement of certain urban teaching hospitals
  for the provision of inpatient hospital care under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.0285 to read as follows:
         Sec. 32.0285.  CALCULATION OF MEDICAL EDUCATION ADD-ON FOR
  REIMBURSEMENT OF CERTAIN URBAN TEACHING HOSPITALS. (a) In this
  section:
               (1)  "Base standard dollar amount" means the
  standardized payment amount calculated by the commission for costs
  incurred by prospectively paid hospitals in this state for
  providing inpatient hospital care under Medicaid.
               (2)  "Children's hospital" means a hospital designated
  by the Centers for Medicare and Medicaid Services as a children's
  hospital.
               (3)  "Medical education add-on" means an adjustment to
  the base standard dollar amount for an urban teaching hospital to
  reflect higher patient care costs relative to nonteaching urban
  hospitals.
               (4)  "Rural hospital" means a hospital enrolled as a
  Medicaid provider that:
                     (A)  is located in a county with a population of
  not more than 60,000;
                     (B)  is designated by the Centers for Medicare and
  Medicaid Services as a critical access hospital, sole community
  hospital, or rural referral center and is not located in an area
  defined by the United States Office of Management and Budget as a
  metropolitan statistical area; or
                     (C)  meets all of the following criteria:
                           (i)  has 100 or fewer beds;
                           (ii)  is designated by the Centers for
  Medicare and Medicaid Services as a critical access hospital, sole
  community hospital, or rural referral center; and
                           (iii)  is located in an area defined by the
  United States Office of Management and Budget as a metropolitan
  statistical area.
               (5)  "State-owned teaching hospital" means:
                     (A)  The University of Texas Medical Branch at
  Galveston;
                     (B)  The University of Texas Health Science Center
  at Tyler; and
                     (C)  The University of Texas M.D. Anderson Cancer
  Center.
               (6)  "Teaching hospital" means a hospital that incurs
  indirect costs for operating graduate medical education programs
  and for which the Centers for Medicare and Medicaid Services has
  calculated and assigned a percentage Medicare education adjustment
  factor under 42 C.F.R. Section 412.105.
               (7)  "Urban hospital" means a hospital that:
                     (A)  is located in an area defined by the United
  States Office of Management and Budget as a metropolitan
  statistical area; and
                     (B)  is not a rural hospital, children's hospital,
  state-owned teaching hospital, or freestanding psychiatric
  facility.
         (b)  To the extent permitted by federal law, in order to
  ensure that urban teaching hospitals are accurately reimbursed for
  the provision of inpatient hospital care to recipients under
  Medicaid, the commission shall at least annually update the
  education adjustment factor used to calculate the medical education
  add-on using the most current data available, including:
               (1)  data related to the number of interns and
  residents enrolled in a hospital's approved teaching program; and
               (2)  the Medicare education adjustment factor assigned
  under 42 C.F.R. Section 412.105 in effect at the time the commission
  makes the update.
         SECTION 2.  (a) In this section:
               (1)  "Medicaid" has the meaning assigned by Section
  531.001, Government Code.
               (2)  "Medical education add-on," "teaching hospital,"
  and "urban hospital" have the meanings assigned by Section 32.0285,
  Human Resources Code, as added by this Act.
         (b)  As soon as practicable after the effective date of this
  Act, the Health and Human Services Commission shall conduct a study
  to evaluate the impacts and effectiveness of using the Medicare
  education adjustment factor assigned under 42 C.F.R. Section
  412.105 in effect on the effective date of this Act to calculate the
  medical education add-on used to reimburse teaching hospitals for
  the provision of inpatient hospital care under Medicaid. The
  commission shall develop and make recommendations on alternative
  factors and methodologies for calculating and annually updating the
  medical education add-on that:
               (1)  best recognize the higher costs incurred by
  teaching hospitals; and
               (2)  mitigate issues identified with using the Medicare
  education adjustment factor without reducing reimbursements to
  urban teaching hospitals that have maintained or increased the
  number of interns and residents enrolled in the hospitals' approved
  teaching programs.
         (c)  Not later than December 1, 2020, the Health and Human
  Services Commission shall report its findings and recommendations
  under Subsection (b) of this section to the governor, the standing
  committees of the senate and house of representatives having
  primary jurisdiction over matters relating to state finance and
  appropriations from the state treasury, the standing committees of
  the senate and house of representatives having primary jurisdiction
  over Medicaid, and the Legislative Budget Board.
         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 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.
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