Bill Text: TX SB1768 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to the authorization for and imposition of hospital assessments by counties.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-03-25 - Referred to Health & Human Services [SB1768 Detail]
Download: Texas-2013-SB1768-Introduced.html
By: Rodriguez | S.B. No. 1768 | |
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relating to the authorization for and imposition of hospital | ||
assessments by counties. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter ___ of the ____ Code is amended by adding | ||
new subchapter A to read as follows: | ||
SUBCHAPTER A. HOSPITAL ASSESSMENTS | ||
Sec. 000.01. DEFINITIONS. In this subchapter: | ||
(a) "Assessment" means the fee authorized to be implemented | ||
under this subchapter on every general acute care hospital within a | ||
county. | ||
(b) "Assessment advisory committee" means the committee | ||
comprised of representatives of general acute care hospitals that | ||
are subject to the assessment. | ||
(c) "Commission" means the Health and Human Services | ||
Commission or an agency operating the Medicaid program. | ||
(d) "County" means a county of this state. | ||
(e) "Critical access hospital" means any hospital that has | ||
qualified under 20 U.S.C. Section 1395x as a critical access | ||
hospital under Medicare. | ||
(f) "General acute care hospital" means a hospital other | ||
than a hospital that the Department of State Health Services or | ||
other appropriate federal or state agency has determined is: | ||
(1) a federal veterans' affairs hospital; | ||
(2) a hospital that provides care, including inpatient | ||
hospital services, to all patients free of charge; | ||
(3) a private psychiatric hospital; | ||
(4) a critical access hospital; or | ||
(5) a long-term acute care hospital. | ||
(g) "Hospital" means a facility licensed by the Department | ||
of State Health Services under Chapter 241, Health and Safety Code. | ||
(h) "Long-term acute care hospital" means a hospital or unit | ||
of a hospital whose patients have a length of stay of greater than | ||
25 days and that provides specialized acute care of medically | ||
complex patients who are critically ill. | ||
(i) "Medicaid" means the medical assistance program | ||
established under Chapter 32, Human Resources Code. | ||
(j) "Medicaid DSH program" means the Medicaid | ||
disproportionate share hospital program as provided for by 42 | ||
U.S.C. Section 1394r-(4). | ||
(k) "Medicaid Transformation Waiver" means the Texas | ||
Healthcare Transformation and Quality Improvement Program, a | ||
demonstration project under 42 U.S.C. Section 1315(a) that was | ||
approved by the Centers for Medicare and Medicaid Services of the | ||
United States Department of Health and Human Services in December | ||
2011. | ||
(l) "Medicare" means the federal health insurance program | ||
that is operated under the Health Insurance for the Aged Act (42 | ||
U.S.C. Section 1395 et seq.). | ||
(m) "Net patient revenue" means the estimated net | ||
realizable amounts from patients, third-party payors, and others | ||
for services rendered, including estimated retroactive adjustments | ||
under reimbursement agreements with third-party payors. | ||
Retroactive adjustments are accrued on an estimated basis in the | ||
period the related services are rendered and adjusted in future | ||
periods, as final settlements are determined. | ||
Sec. 000.03. AUTHORIZATION. (a) General Rule. In order to | ||
generate additional revenues for the purpose of assuring that | ||
Medicaid recipients have access to hospital services, subject to | ||
the conditions and requirements specified under this subchapter, a | ||
county may, by order, impose a monetary assessment on the net | ||
patient revenue of each general acute care hospital located in the | ||
county. Any assessment under this subchapter will be imposed | ||
annually and collected quarterly. | ||
(b) Administrative Provisions. The orders adopted pursuant | ||
to Subsection (a) of this section shall include appropriate | ||
administrative provisions, including, without limitation, | ||
provisions for the collection of interest and penalties. The | ||
amount of interest and penalties shall not exceed the amounts | ||
provided in Title 1, Subtitle E, Chapter 33, Tax Code. | ||
(c) Maximum Assessment. In each year in which the | ||
assessment is implemented, the assessment shall be subject to the | ||
maximum aggregate amount that may be assessed under 42 C.F.R. | ||
Section 433.68 or any other maximum established under federal law. | ||
(d) Assessment Amount. In determining the amount of the | ||
assessment, interest and penalties, the county shall consider: | ||
(1) the recommendation of the assessment advisory | ||
committee; | ||
(2) the maximum assessment as set out in Subsection | ||
(c) of this section; and | ||
(3) the assessment necessary to generate sufficient | ||
revenue to accomplish the purposes of the assessment and to pay the | ||
expenses of collection. | ||
Sec. 000.05. IMPLEMENTATION. The assessment authorized | ||
under this subchapter, once imposed, shall be implemented as a | ||
health-care related fee as defined under 42 U.S.C. Section 1396b | ||
and may be collected only to the extent and for the periods for | ||
which the Commission determines that the revenues generated by the | ||
assessment will qualify as the state share of Medicaid expenditures | ||
eligible for federal financial participation. | ||
Sec. 000.07. ASSESSMENT AND COLLECTION. (a) If a county | ||
imposes an assessment as provided for in this subchapter, | ||
(1) the county shall make the assessment; and | ||
(2) general acute care hospitals shall submit to the | ||
county the information required by Sections 311.032 and 311.033, | ||
Health and Safety Code, at the same time that the information is | ||
submitted to the Department of State Health Services from which the | ||
assessment shall be calculated. | ||
(b) If an assessment is imposed, the county tax | ||
assessor-collector shall collect the assessment quarterly. | ||
(c) Revenue that the county collects under this subchapter | ||
shall be deposited in a dedicated fund or special account | ||
established for the purpose of the hospital assessment in the | ||
county depository and secured as provided by Title 4, Local | ||
Government Code. | ||
Sec. 000.09. USE OF FUNDS. The assessments collected under | ||
this subchapter shall be used only to: | ||
(a) provide the state share of the Medicaid DSH program or | ||
the Medicaid Transformation Waiver; and | ||
(b) pay collection expenses. | ||
Sec. 000.11. NO HOLD HARMLESS. No general acute care | ||
hospital shall be directly guaranteed a repayment of its assessment | ||
in derogation of 42 C.F.R. Section 433.68, except that, in each | ||
fiscal year in which an assessment is implemented, the county shall | ||
use all of the funds received under section 000.03(a) only for the | ||
purposes outlined under section 000.09 to the extent permissible | ||
under federal and state law or regulation and without creating an | ||
indirect guarantee to hold harmless, as those terms are used under | ||
42 C.F.R. Section 433.68, and for the costs of collection as | ||
provided for in section 000.09 of this subchapter. | ||
Sec. 000.13. PLAN AMENDMENT; FEDERAL WAIVER. To the extent | ||
necessary in order to implement this subchapter, the Commission | ||
shall submit any state Medicaid plan amendment to the United States | ||
Department of Health and Human Services and/or seek a waiver under | ||
42 C.F.R. Section 433.68 from the Center for Medicare and Medicaid | ||
Services of the United States Department of Health and Human | ||
Services. | ||
Sec. 000.15. TAX EXEMPTION. Notwithstanding any exemptions | ||
granted by any other federal, state, or local tax or other law, no | ||
general acute care hospital in the county shall be exempt from the | ||
assessment. | ||
Sec. 000.17. ASSESSMENT ADVISORY COMMITTEE. (a) The | ||
commissioners court shall appoint an assessment advisory | ||
committee. The committee must include one representative of each | ||
hospital that will be subject to the hospital assessment to be | ||
implemented under this subchapter. | ||
(b) An advisory committee member serves a two-year term, | ||
except that the commissioners court may make some initial | ||
appointments for one year in order to stagger terms, with as near as | ||
possible to one-half of the members' terms expiring each year. | ||
(c) An advisory committee shall select from among its | ||
members a presiding officer. The presiding officer shall preside | ||
over the advisory committee and report to the commissioners court. | ||
(d) Prior to the adoption of any hospital assessment, or any | ||
change to a previously adopted assessment, the committee shall | ||
advise the county on the amount of the assessment. The committee | ||
shall also advise the county on the interest rate and amount or | ||
schedule of penalties to be imposed, or any proposed change to an | ||
adopted interest rate or penalty, for late or non-payment of the | ||
assessment subject to the requirements of Section 000.03(b). | ||
(e) The advisory committee members shall serve without | ||
compensation or remuneration of any kind, including reimbursement | ||
of expenses for serving on the advisory committee. | ||
Sec. 000.19. EXPIRATION. This subchapter expires on August | ||
31, 2017. | ||
SECTION 2. If the Commission or the United States | ||
Department of Health and Human Services determines that the | ||
assessment does not qualify as the state share of Medicaid | ||
expenditures eligible for federal financial participation, after | ||
consultation with the Commission, the United States Department of | ||
Health and Human Services, and the assessment advisory committee, | ||
the county shall either retain the revenue collected under this | ||
subchapter if the determination is made that the funds will qualify | ||
as the state share of Medicaid expenditures eligible for federal | ||
financial participation at a date prior to the expiration of this | ||
subchapter or, if that determination is not made, return the | ||
remainder to the general acute care hospitals paying the assessment | ||
on a pro rata basis. | ||
SECTION 3. If this subchapter is not continued in existence | ||
by the legislature, any assessments held by the county at the time | ||
this subchapter expires shall be used to pay any outstanding costs | ||
of collection, and the remainder shall be returned to the general | ||
acute care hospitals paying the assessment on a pro rata basis. | ||
SECTION 4. This Act takes effect September 1, 2013. |