81R7673 TJS-F
By: Ellis S.B. No. 2278
A BILL TO BE ENTITLED
AN ACT
relating to charity care provided by certain nonprofit hospitals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 311.031(16), Health and Safety Code, is
amended to read as follows:
(16) "Unreimbursed costs" means the costs a hospital
incurs for providing individuals inpatient and outpatient services
for which the hospital does not receive reimbursement from any
source, including a third-party payor. The term does not include
payor discounts or contractual adjustments in reimbursements to
third-party payors or costs for which the hospital receives any
partial payment for the related service, [after subtracting
payments received from any source for such services] including but
not limited to the following: third-party insurance payments;
Medicare payments; Medicaid payments; Medicare education
reimbursements; payments from Tricare or the Civilian Health and
Medical Program of the Uniformed Services; state reimbursements for
education; payments from drug companies to pursue research; grant
funds for research; and disproportionate share payments. [For
purposes of this definition, the term "costs" shall be calculated
by applying the cost to charge ratios derived in accordance with
generally accepted accounting principles for hospitals to billed
charges. The calculation of the cost to charge ratios shall be
based on the most recently completed and audited prior fiscal year
of the hospital or hospital system. Prior to January 1, 1996, for
purposes of this definition, charitable contributions and grants to
a hospital, including transfers from endowment or other funds
controlled by the hospital or its nonprofit supporting entities,
shall not be subtracted from the costs of providing services for
purposes of determining unreimbursed costs. After January 1, 1996,
for purposes of this definition, charitable contributions and
grants to a hospital, including transfers from endowment or other
funds controlled by the hospital or its nonprofit supporting
entities, shall not be subtracted from the costs of providing
services for purposes of determining the unreimbursed costs of
charity care and government-sponsored indigent health care.]
SECTION 2. Section 311.033(a), Health and Safety Code, is
amended to read as follows:
(a) A hospital shall submit to the department financial and
utilization data for that hospital, including data relating to the
hospital's:
(1) total gross revenue, including:
(A) Medicare gross revenue;
(B) Medicaid gross revenue;
(C) other revenue from state programs;
(D) revenue from local government programs;
(E) local tax support;
(F) charitable contributions;
(G) other third party payments;
(H) gross inpatient revenue; [and]
(I) gross outpatient revenue;
(J) disproportionate share hospitals payment
program revenue;
(K) upper payment limit supplemental payment
program revenue;
(L) tobacco settlement proceeds; and
(M) federal grant funding, including payments
made for care for undocumented persons;
(2) total deductions from gross revenue, including:
(A) contractual allowance; and
(B) any other deductions;
(3) charity care;
(4) bad debt expense;
(5) total admissions, including:
(A) Medicare admissions;
(B) Medicaid admissions;
(C) admissions under a local government program;
(D) charity care admissions; and
(E) any other type of admission;
(6) total discharges;
(7) total patient days;
(8) average length of stay;
(9) total outpatient visits;
(10) total assets;
(11) total liabilities;
(12) estimates of unreimbursed costs of subsidized
health services reported separately in the following categories:
(A) emergency care and trauma care;
(B) neonatal intensive care;
(C) free-standing community clinics;
(D) collaborative efforts with local government
or private agencies in preventive medicine, such as immunization
programs; and
(E) other services that satisfy the definition of
"subsidized health services" contained in Section 311.031(13);
(13) donations;
(14) total cost of reimbursed and unreimbursed
research;
(15) total cost of reimbursed and unreimbursed
education separated into the following categories:
(A) education of physicians, nurses,
technicians, and other medical professionals and health care
providers;
(B) scholarships and funding to medical schools,
colleges, and universities for health professions education;
(C) education of patients concerning diseases
and home care in response to community needs;
(D) community health education through
informational programs, publications, and outreach activities in
response to community needs; and
(E) other educational services that satisfy the
definition of "education-related costs" under Section 311.031(6);
and
(16) the hospital's charge description master or
charge master.
SECTION 3. Section 311.042(2), Health and Safety Code, is
amended to read as follows:
(2) "Community benefits" means the unreimbursed cost
to a hospital of providing charity care, government-sponsored
indigent health care, donations, education, government-sponsored
program services, research, and subsidized health services.
Community benefits include programs or services to reduce
disparities by increasing the proportion of the population that has
access to health information and disease prevention and that are
described by the Community Guide to Preventive Services published
by the Centers for Disease Control and Prevention of the United
States Public Health Service. The term does not include the cost to
the hospital of paying any taxes or other governmental assessments,
uncollected fees or accounts written off as bad debt, costs
incurred as a result of partial but incomplete payment by
third-party insurance payments, Medicare payments, Medicaid
payments, or payments from Tricare or the Civilian Health and
Medical Program of the Uniformed Services.
SECTION 4. Section 311.045(b)(1), Health and Safety Code,
is amended to read as follows:
(1) A nonprofit hospital or hospital system may elect
to provide community benefits, which include charity care and
government-sponsored indigent health care, according to any of the
following standards:
(A) charity care and government-sponsored
indigent health care are provided at a level which is reasonable in
relation to the community needs, as determined through the
community needs assessment, the available resources of the hospital
or hospital system, and the tax-exempt benefits received by the
hospital or hospital system;
(B) charity care and government-sponsored
indigent health care are provided in an amount equal to at least 100
percent of the hospital's or hospital system's tax-exempt benefits,
excluding federal income tax; or
(C) charity care and community benefits are
provided in a combined amount equal to at least 10 [five] percent of
the hospital's or hospital system's net patient revenue, provided
that charity care and government-sponsored indigent health care are
provided in an amount equal to at least eight [four] percent of net
patient revenue.
SECTION 5. This Act takes effect September 1, 2009.