Bill Text: TX SB170 | 2019-2020 | 86th Legislature | Enrolled
Bill Title: Relating to reimbursement of rural hospitals under Medicaid.
Spectrum: Moderate Partisan Bill (Republican 8-1)
Status: (Passed) 2019-06-04 - Effective on 9/1/19 [SB170 Detail]
Download: Texas-2019-SB170-Enrolled.html
S.B. No. 170 |
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relating to reimbursement of rural hospitals under Medicaid. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.02194 to read as follows: | ||
Sec. 531.02194. REIMBURSEMENT METHODOLOGY FOR RURAL | ||
HOSPITALS. (a) In this section, "rural hospital" has the meaning | ||
assigned by commission rules for purposes of the reimbursement of | ||
hospitals for providing inpatient or outpatient services under | ||
Medicaid. | ||
(b) To the extent allowed by federal law and subject to | ||
limitations on appropriations, the executive commissioner by rule | ||
shall adopt a prospective reimbursement methodology for the payment | ||
of rural hospitals participating in Medicaid that ensures the rural | ||
hospitals are reimbursed on an individual basis for providing | ||
inpatient and general outpatient services to Medicaid recipients by | ||
using the hospitals' most recent cost information concerning the | ||
costs incurred for providing the services. The commission shall | ||
calculate the prospective cost-based reimbursement rates once | ||
every two years. | ||
(c) In adopting rules under Subsection (b), the executive | ||
commissioner may: | ||
(1) adopt a methodology that requires: | ||
(A) a managed care organization to reimburse | ||
rural hospitals for services delivered through the Medicaid managed | ||
care program using a minimum fee schedule or other method for which | ||
federal matching money is available; or | ||
(B) both the commission and a managed care | ||
organization to share in the total amount of reimbursement paid to | ||
rural hospitals; and | ||
(2) 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. | ||
(d) Not later than September 1 of each even-numbered year, | ||
the commission shall, for purposes of Subsection (b), determine the | ||
allowable costs incurred by a rural hospital participating in the | ||
Medicaid managed care program 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. | ||
(e) Notwithstanding Subsection (b) and subject to | ||
Subsection (f), the executive commissioner shall adopt and the | ||
commission shall implement, beginning with the state fiscal year | ||
ending August 31, 2022, a true cost-based reimbursement methodology | ||
for inpatient and general outpatient services provided to Medicaid | ||
recipients at rural hospitals that provides: | ||
(1) prospective payments during a state fiscal year to | ||
the hospitals using the reimbursement methodology adopted under | ||
Subsection (b); and | ||
(2) to the extent allowed by federal law, in the | ||
subsequent state fiscal year a cost settlement to provide | ||
additional reimbursement as necessary to reimburse the hospitals | ||
for the true costs incurred in providing inpatient and general | ||
outpatient services to Medicaid recipients during the previous | ||
state fiscal year. | ||
(f) Notwithstanding Subsection (e), if federal law does not | ||
permit the use of a true cost-based reimbursement methodology | ||
described by that subsection, the commission shall continue to use | ||
the prospective cost-based reimbursement methodology adopted under | ||
Subsection (b) for the payment of rural hospitals for providing | ||
inpatient and general outpatient services to Medicaid recipients. | ||
SECTION 2. The Health and Human Services Commission is | ||
required to implement a provision of this Act only if the | ||
legislature appropriates money specifically for that purpose. If | ||
the legislature does not appropriate money specifically for that | ||
purpose, the commission may, but is not required to, implement a | ||
provision of this Act using other appropriations available for that | ||
purpose. | ||
SECTION 3. Not later than September 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 531.02194(d), | ||
Government Code, as added by this Act. | ||
SECTION 4. 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 5. This Act takes effect September 1, 2019. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I hereby certify that S.B. No. 170 passed the Senate on | ||
April 17, 2019, by the following vote: Yeas 31, Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
I hereby certify that S.B. No. 170 passed the House on | ||
May 17, 2019, by the following vote: Yeas 140, Nays 6, | ||
one present not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
Approved: | ||
______________________________ | ||
Date | ||
______________________________ | ||
Governor |