Bill Text: TX HB3640 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the creation and operations of a health care provider participation program by the El Paso County Hospital District.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced) 2019-04-16 - Companion considered in lieu of in committee [HB3640 Detail]

Download: Texas-2019-HB3640-Introduced.html
 
 
  By: Moody H.B. No. 3640
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the creation and operations of a health care provider
  participation program by the El Paso County Hospital District.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle D, Title 4, Health and Safety Code, is
  amended by adding Chapter 298G to read as follows:
  CHAPTER 298G. EL PASO COUNTY HOSPITAL DISTRICT HEALTH CARE
  PROVIDER PARTICIPATION PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 298G.001.  DEFINITIONS. In this chapter:
               (1)  "Board" means the board of hospital managers of
  the district.
               (2)  "District" means the El Paso County Hospital
  District.
               (3)  "Institutional health care provider" means a
  nonpublic hospital located in the district that provides inpatient
  hospital services.
               (4)  "Paying provider" means an institutional health
  care provider required to make a mandatory payment under this
  chapter.
               (5)  "Program" means the health care provider
  participation program authorized by this chapter.
         Sec. 298G.002.  APPLICABILITY. This chapter applies only to
  the El Paso County Hospital District.
         Sec. 298G.003.  HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
  PARTICIPATION IN PROGRAM. The board may authorize the district to
  participate in a health care provider participation program on the
  affirmative vote of a majority of the board, subject to the
  provisions of this chapter.
         Sec. 298G.004.  EXPIRATION. (a) Subject to Section
  298G.153(d), the authority of the district to administer and
  operate a program under this chapter expires December 31, 2023.
         (b)  This chapter expires December 31, 2023.
  SUBCHAPTER B. POWERS AND DUTIES OF BOARD
         Sec. 298G.051.  LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
  PAYMENT. The board may require a mandatory payment authorized
  under this chapter by an institutional health care provider in the
  district only in the manner provided by this chapter.
         Sec. 298G.052.  RULES AND PROCEDURES. The board may adopt
  rules relating to the administration of the program, including
  collection of the mandatory payments, expenditures, audits, and any
  other administrative aspects of the program.
         Sec. 298G.053.  INSTITUTIONAL HEALTH CARE PROVIDER
  REPORTING. If the board authorizes the district to participate in a
  program under this chapter, the board shall require each
  institutional health care provider to submit to the district a copy
  of any financial and utilization data reported in the provider's
  Medicare cost report submitted for the previous fiscal year or for
  the closest subsequent fiscal year for which the provider submitted
  the Medicare cost report.
  SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
         Sec. 298G.101.  HEARING. (a) In each year that the board
  authorizes a program under this chapter, the board shall hold a
  public hearing on the amounts of any mandatory payments that the
  board intends to require during the year and how the revenue derived
  from those payments is to be spent.
         (b)  Not later than the fifth day before the date of the
  hearing required under Subsection (a), the board shall publish
  notice of the hearing in a newspaper of general circulation in the
  district.
         (c)  A representative of a paying provider is entitled to
  appear at the public hearing and be heard regarding any matter
  related to the mandatory payments authorized under this chapter.
         Sec. 298G.102.  DEPOSITORY. (a) If the board requires a
  mandatory payment authorized under this chapter, the board shall
  designate one or more banks as a depository for the district's local
  provider participation fund.
         (b)  All funds collected under this chapter shall be secured
  in the manner provided for securing other district funds.
         Sec. 298G.103.  LOCAL PROVIDER PARTICIPATION FUND;
  AUTHORIZED USES OF MONEY. (a) If the district requires a mandatory
  payment authorized under this chapter, the district shall create a
  local provider participation fund.
         (b)  The local provider participation fund consists of:
               (1)  all revenue received by the district attributable
  to mandatory payments authorized under this chapter;
               (2)  money received from the Health and Human Services
  Commission as a refund of an intergovernmental transfer under the
  program, provided that the intergovernmental transfer does not
  receive a federal matching payment; and
               (3)  the earnings of the fund.
         (c)  Money deposited to the local provider participation
  fund of the district may be used only to:
               (1)  fund intergovernmental transfers from the
  district to the state to provide the nonfederal share:
                     (A)  any Medicaid payment to nonpublic hospitals
  or physicians contracted to provide services at the nonpublic
  hospitals;
                     (B)  any payment to nonpublic hospitals, if those
  payments are authorized under the Texas Healthcare Transformation
  and Quality Improvement Program waiver issued under Section 1115 of
  the federal Social Security Act (42 U.S.C. Section 1315);
                     (C)  uniform rate enhancements for nonpublic
  hospitals in the Medicaid managed care service area in which the
  district is located;
                     (D)  payments available under another waiver
  program authorizing Medicaid payments to nonpublic hospitals or any
  payments to Medicaid managed care organizations for the benefit of
  nonpublic hospitals; or
                     (E)  any reimbursement to nonpublic hospitals in
  which the district is located for which federal matching funds are
  available.
               (2)  subject to Section .151(d), pay the administrative
  expenses of the district in administering the program, including
  collateralization of deposits;
               (3)  payments for indigent healthcare in the El Paso
  community in an amount not to exceed fifteen percent (15%) of the
  total mandatory payment collected;
               (4)  refund a mandatory payment collected in error from
  a paying provider;
               (5)  refund to paying providers a proportionate share
  of the money that the district:
                     (A)  receives from the Health and Human Services
  Commission that is not used to fund the nonfederal share of Medicaid
  payments; or
                     (B)  determines cannot be used to fund the
  nonfederal share of Medicaid supplemental payment program
  payments; and
               (6)  transfer funds to the Health and Human Services
  Commission if the district is legally required to transfer funds to
  address a disallowance of federal matching funds with respect to
  programs for which the district made intergovernmental transfers
  described by Subdivision (1).
         (d)  Money in the local provider participation fund may not
  be commingled with other district funds.
         (e)  Notwithstanding any other provision of this chapter,
  with respect to an intergovernmental transfer of funds described by
  Subsection (c)(1) made by the district, any funds received by the
  state, district, or other entity as a result of the transfer may not
  be used by the state, district, or any other entity 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).
  SUBCHAPTER D. MANDATORY PAYMENTS
         Sec. 298G.151  MANDATORY PAYMENTS BASED ON PAYING PROVIDER
  NET PATIENT REVENUE. (a) If the board authorizes a health care
  provider participation program under this chapter, the board may
  require a mandatory payment to be assessed on the net patient
  revenue of each institutional health care provider located in the
  district. The board may provide for the mandatory payment to be
  assessed periodically throughout the year; provided, however, that
  institutional health care providers shall have thirty (30) calendar
  days upon receipt of written notice from the district to make any
  mandatory payment. In the first year in which the mandatory payment
  is required, the mandatory payment is assessed on the net patient
  revenue of an institutional health care provider as determined by
  the institutional health care provider's copy of its Medicare cost
  report for the previous fiscal year or for the closest subsequent
  fiscal year for which the institutional health care provider
  submitted the Medicare cost report.
         (b)  The amount of a mandatory payment authorized under this
  chapter must be uniformly proportionate with the amount of net
  patient revenue generated by each paying provider in the district
  as permitted under federal law. A health care provider
  participation program authorized under this chapter may not hold
  harmless any paying provider, as required under 42 U.S.C. Section
  1396b(w).
         (c)  If the board requires a mandatory payment authorized
  under this chapter, the board shall set the amount of the mandatory
  payment, subject to the limitations of this chapter. The aggregate
  amount of the mandatory payments required of all paying providers
  in the district may not exceed six percent of the aggregate net
  patient revenue from hospital services provided by all paying
  providers in the district.
         (d)  Subject to Subsection (c), if the board requires a
  mandatory payment authorized under this chapter, the board shall
  set the mandatory payments in amounts that in the aggregate will
  generate sufficient revenue to cover the administrative expenses of
  the district for activities under this chapter and to fund an
  intergovernmental transfer described by Section .103(c)(1). The
  annual amount of revenue from mandatory payments that shall be paid
  for administrative expenses of the program by the district may not
  exceed two-and-a-half percent (2.5%) of the total revenue generated
  from the mandatory payments, regardless of actual expense.
         (e)  A paying provider may not add a mandatory payment
  required under this section as a surcharge to a patient.
         (f)  A mandatory payment assessed under this chapter is not a
  tax for hospital purposes for purposes of Section 4, Article IX,
  Texas Constitution, or Section 281.045.
         Sec. 298G.152.  ASSESSMENT AND COLLECTION OF MANDATORY
  PAYMENTS. (a) The district may designate an official of the
  district or contract with another person to assess and collect the
  mandatory payments authorized under this chapter.
         (b)  The person charged by the district with the assessment
  and collection of mandatory payments shall charge and deduct from
  the mandatory payments collected for the district a collection fee
  in an amount not to exceed the person's usual and customary charges
  for like services.
         (c)  If the person charged with the assessment and collection
  of mandatory payments is an official of the district, any revenue
  from a collection fee charged under Subsection (b) shall be
  deposited in the district general fund and, if appropriate, shall
  be reported as fees of the district.
         Sec. 298G.153.  PURPOSE; CORRECTION OF INVALID PROVISION OR
  PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this
  chapter is to authorize the district to establish a program to
  enable the district to collect mandatory payments from
  institutional health care providers to fund the nonfederal share of
  a Medicaid supplemental payment program or the Medicaid managed
  care rate enhancements for nonpublic hospitals to support the
  provision of health care by institutional health care providers to
  district residents in need of health care.
         (b)  This chapter does not authorize the district to collect
  mandatory payments for the purpose of raising general revenue or
  any amount in excess of the amount reasonably necessary to fund the
  nonfederal share of a Medicaid supplemental payment program or
  Medicaid managed care rate enhancements for nonpublic hospitals and
  to cover the administrative expenses of the district associated
  with activities under this chapter and other amounts for which the
  fund may be used as described by Section 298G.103(c).
         (c)  To the extent any provision or procedure under this
  chapter causes a mandatory payment authorized under this chapter to
  be ineligible for federal matching funds, the board may provide by
  rule for an alternative provision or procedure that conforms to the
  requirements of the federal Centers for Medicare and Medicaid
  Services. A rule adopted under this section may not create, impose,
  or materially expand the legal or financial liability or
  responsibility of the district or an institutional health care
  provider in the district beyond the provisions of this chapter.
  This section does not require the board to adopt a rule.
         (d)  The district may only assess and collect a mandatory
  payment authorized under this chapter if a waiver program, uniform
  rate enhancement, or reimbursement described by Section
  298G.103(c)(1) is available to the district.
         SECTION 2.  As soon as practicable after the expiration of
  the authority of the El Paso County Hospital District to administer
  and operate a health care provider participation program under
  Chapter 298G, Health and Safety Code, as added by this Act, the
  board of hospital managers of the El Paso County Hospital District
  shall transfer to each institutional health care provider in the
  district that provider's proportionate share of any remaining funds
  in any local provider participation fund created by the district
  under Section 298G.103, Health and Safety 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 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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