Bill Text: TX SB2256 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the creation and operations of health care provider participation programs in local jurisdictions in this state.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-21 - Referred to Health & Human Services [SB2256 Detail]
Download: Texas-2019-SB2256-Introduced.html
By: Kolkhorst | S.B. No. 2256 | |
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relating to the creation and operations of health care provider | ||
participation programs in local jurisdictions in this state. | ||
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 300 to read as follows: | ||
CHAPTER 300. HEALTH CARE PROVIDER PARTICIPATION PROGRAMS IN | ||
CERTAIN POLITICAL SUBDIVISIONS IN THIS STATE | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 300.0001. PURPOSE. The purpose of this chapter is to | ||
authorize a hospital district, county, or municipality in this | ||
state to administer a health care provider participation program to | ||
provide additional compensation to hospitals by collecting | ||
mandatory payments from each hospital in the jurisdiction. | ||
Sec. 300.0002. DEFINITIONS. In this chapter: | ||
(1) "Institutional health care provider" means a nonpublic | ||
hospital in the local jurisdiction that provides | ||
inpatient hospital services. | ||
(2) "Local jurisdiction" means a hospital district, county, | ||
or municipality. | ||
(3) "Paying hospital" means an institutional health care | ||
provider required to make a mandatory payment under this chapter. | ||
(4) "Program" means a health care provider participation | ||
program authorized by this chapter. | ||
Sec. 300.0003. APPLICABILITY. This chapter applies to a | ||
local jurisdiction that is located in this state. | ||
Sec. 300.0004. LOCAL JURISDICTION HEALTH CARE PROVIDER | ||
PARTICIPATION PROGRAM; ORDER REQUIRED FOR PARTICIPATION. The | ||
governing body of a local jurisdiction may only adopt an order | ||
authorizing that local jurisdiction to participate in a health care | ||
provider participation program after an affirmative vote of the | ||
majority of the governing body. | ||
SUBCHAPTER B. POWERS AND DUTIES OF A GOVERNING BODY OF A LOCAL | ||
JURISDICTION | ||
Sec. 300.0051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY | ||
PAYMENT. The governing body of a local jurisdiction may require a | ||
mandatory payment authorized under this chapter by an institutional | ||
health care provider in that local jurisdiction only in the manner | ||
provided by this chapter. | ||
Sec. 300.0052. RULES AND PROCEDURES. The governing body of | ||
a local jurisdiction may adopt rules relating to the administration | ||
of the health care provider participation program in the local | ||
jurisdiction, including collection of the mandatory payments, | ||
expenditures, audits, and any other administrative aspects of the | ||
program. | ||
Sec. 300.0053. INSTITUTIONAL HEALTH CARE PROVIDER | ||
REPORTING. If the governing body of a local jurisdiction | ||
authorizes the local jurisdiction to participate in a health care | ||
provider participation program under this chapter, the governing | ||
body shall require each institutional health care provider to | ||
submit to the local jurisdiction a copy of any financial and | ||
utilization data required by and reported to the Department of | ||
State Health Services under Sections 311.032 and 311.033 and any | ||
rules adopted by the executive commissioner of the Health and Human | ||
Services Commission to implement those sections. | ||
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS | ||
Sec. 300.0101. HEARING. (a) In each year that the | ||
governing body of a local jurisdiction authorizes a health care | ||
provider participation program under this chapter, the governing | ||
body shall hold a public hearing on the amounts of any mandatory | ||
payments that the governing body 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 governing body shall | ||
publish notice of the hearing in a newspaper of general circulation | ||
in the county and provide written notice of the hearing to the chief | ||
operating officer of each institutional health care provider in the | ||
local jurisdiction. | ||
(c) A representative of a paying hospital is entitled to | ||
appear at the time and place designated in the public notice and to | ||
be heard regarding any matter related to the mandatory payments | ||
authorized under this chapter. | ||
Sec. 300.0102. LOCAL PROVIDER PARTICIPATION FUND; | ||
DEPOSITORY. (a) Each governing body of a local jurisdiction that | ||
collects a mandatory payment authorized under this chapter shall | ||
create a local provider participation fund. | ||
(b) If a governing body of a local jurisdiction creates a | ||
local provider participation fund, the governing body shall | ||
designate one or more banks as a depository for the mandatory | ||
payments received by the local jurisdiction. | ||
(c) All funds collected under this chapter shall be secured | ||
in the manner provided for securing other local jurisdiction funds. | ||
Sec. 300.0103. LOCAL PROVIDER PARTICIPATION FUND; | ||
AUTHORIZED USES OF MONEY. (a) The local provider participation | ||
fund established by a local jurisdiction under Section 300.0102 | ||
consists of: | ||
(1) all revenue received by the local jurisdiction | ||
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 from the | ||
local jurisdiction to the state for the purpose of providing the | ||
nonfederal share of Medicaid supplemental payment program | ||
payments, provided that the intergovernmental transfer does not | ||
receive a federal matching payment; and | ||
(3) the earnings of the fund. | ||
(b) Money deposited to the local provider participation | ||
fund of a local jurisdiction may be used only to: | ||
1) fund intergovernmental transfers from the local | ||
jurisdiction to the state to provide the nonfederal share of | ||
Medicaid payments for: | ||
(A) uncompensated care payments 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); | ||
(B) uniform rate enhancements for nonpublic | ||
hospitals in Medicaid managed care; | ||
(C) payments available under another waiver | ||
program authorizing payments that are substantially similar to | ||
Medicaid payments to nonpublic hospitals described by Subdivision | ||
(A) or (B); or | ||
(D) any reimbursement to nonpublic hospitals for | ||
which federal matching funds are available; | ||
(2) pay costs associated with indigent care provided | ||
by institutional health care providers in the local jurisdiction; | ||
(3) pay the administrative expenses of the local | ||
jurisdiction in administering the program, including | ||
collateralization of deposits; | ||
(4) refund a portion of a mandatory payment collected | ||
in error from a paying hospital; | ||
(5) refund to paying hospitals a proportionate share | ||
of the money that the local jurisdiction: | ||
(A) receives from the Health and Human Services | ||
Commission that is not used to fund the nonfederal share of Medicaid | ||
supplemental payment program payments; or | ||
(B) determines cannot be used to fund the | ||
nonfederal share of Medicaid supplemental payment program | ||
payments. | ||
(6) transfer funds to the Health and Human Services | ||
Commission if the local jurisdiction is legally required to | ||
transfer the funds to address a disallowance of federal matching | ||
funds with respect to programs for which the local jurisdiction | ||
made intergovernmental transfers described in Subdivision (1); and | ||
(7) reimburse the local jurisdiction if the local | ||
jurisdiction is required by the rules governing the uniform rate | ||
enhancement program described by Subdivision (1)(B) to incur an | ||
expense or forego Medicaid reimbursements from the state because | ||
the balance of the local provider participation fund is not | ||
sufficient to fund that rate enhancement program. | ||
(c) Money in the local provider participation fund of a | ||
local jurisdiction may not be commingled with other local | ||
jurisdiction funds. | ||
(d) Notwithstanding any other provision of this chapter, | ||
with respect to an intergovernmental transfer of funds described by | ||
Subsection (b)(1) made by the local jurisdiction, any funds | ||
received by the state, local jurisdiction, or other entity as a | ||
result of that transfer may not be used by the state, local | ||
jurisdiction, or any other entity to: | ||
(1) 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); or | ||
(2) fund the nonfederal share of payments to nonpublic | ||
hospitals available through the Medicaid disproportionate share | ||
hospital program or the delivery system reform incentive payment | ||
program. | ||
SUBCHAPTER D. MANDATORY PAYMENTS | ||
Sec. 300.0151. MANDATORY PAYMENTS. (a) Except as provided | ||
by Subsection (e), if the governing body of a local jurisdiction | ||
authorizes a health care provider participation program under this | ||
chapter, the governing body shall require an annual mandatory | ||
payment to be assessed on the net patient revenue of each | ||
institutional health care provider located in the local | ||
jurisdiction. The governing body of the local jurisdiction shall | ||
provide that the mandatory payment is to be collected at least | ||
annually, but not more often than quarterly. 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 located in the local jurisdiction as determined by the | ||
data reported to the Department of State Health Services under | ||
Sections 311.032 and 311.033 in the most recent fiscal year for | ||
which that data was reported. If the institutional health care | ||
provider did not report any data under those sections, the | ||
provider's net patient revenue is the amount of that revenue as | ||
contained 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. The local | ||
jurisdiction shall update the amount of the mandatory payment on an | ||
annual basis. | ||
(b) The amount of a mandatory payment authorized under this | ||
chapter for a local jurisdiction must be uniformly proportionate | ||
with the amount of net patient revenue generated by each paying | ||
hospital in the local jurisdiction as permitted under federal law. | ||
A health care provider participation program authorized under this | ||
chapter may not hold harmless any institutional health care | ||
provider, as required under 42 U.S.C. Section 1396b(w). | ||
(c) The governing body of a local jurisdiction that | ||
authorizes a program under this chapter shall set the amount of the | ||
mandatory payment. The aggregate amount of the mandatory payments | ||
required of all paying providers in the local jurisdiction may not | ||
exceed six percent of the aggregate net patient revenue from | ||
hospital services provided by all paying providers in the local | ||
jurisdiction. | ||
(d) Subject to Subsection (c), if the governing body of a | ||
local jurisdiction requires a mandatory payment authorized under | ||
this chapter, the governing body 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 300.103(b)(1). The annual amount of revenue | ||
from mandatory payments that shall be paid for administrative | ||
expenses by the local jurisdiction is not to exceed $150,000, plus | ||
the cost of collateralization of deposits, regardless of actual | ||
expenses. | ||
(e) A paying hospital may not add a mandatory payment | ||
required under this section as a surcharge to a patient. | ||
(f) A mandatory payment under this chapter is not a tax for | ||
purposes of Section 5(a), Article IX, Texas Constitution. | ||
Sec. 300.0152. ASSESSMENT AND COLLECTION OF MANDATORY | ||
PAYMENTS. (a) The local jurisdiction may designate an official of | ||
the local jurisdiction or contract with another person to assess | ||
and collect the mandatory payments authorized under this chapter. | ||
(b) The person charged by the local jurisdiction with the | ||
assessment and collection of mandatory payments shall charge and | ||
deduct from the mandatory payments collected for the local | ||
jurisdiction 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 local jurisdiction, any | ||
revenue from a collection fee charged under Subsection (b) shall be | ||
deposited in the local jurisdiction general fund and, if | ||
appropriate, shall be reported as fees of the local jurisdiction. | ||
Sec. 300.0153. CORRECTION OF INVALID PROVISION OR | ||
PROCEDURE. (a) This chapter does not authorize a local | ||
jurisdiction 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 local jurisdiction associated with | ||
activities under this chapter. | ||
(b) 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 local jurisdiction | ||
may provide by rule or order for an alternative provision or | ||
procedure that conforms to the requirements of the federal Centers | ||
for Medicare and Medicaid Services. A rule or order adopted under | ||
this section may not create, impose, or materially expand the legal | ||
or financial liability or responsibility of the local jurisdiction | ||
or an institutional health care provider in the local jurisdiction | ||
beyond the provisions of this chapter. This section does not | ||
require the governing body of a local jurisdiction to adopt a rule | ||
or order. | ||
(c) The local jurisdiction may only assess and collect a | ||
mandatory payment authorized under this chapter if a waiver | ||
program, uniform rate enhancement, or reimbursement described by | ||
Section 300.103(b)(1) is available to the local jurisdiction. | ||
SECTION 2. 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 3. 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. |