By: Rodriguez S.B. No. 1767
A BILL TO BE ENTITLED
AN ACT
relating to the authorization for and imposition of hospital
assessments by hospital districts.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 281 of the Health and Safety Code is
amended by adding new subchapter H to read as follows:
SUBCHAPTER H. HOSPITAL ASSESSMENTS
Sec. 281.131. DEFINITIONS. In this subchapter:
(a) "Assessment" means the fee authorized to be implemented
under this subchapter on every general acute care hospital within a
hospital district.
(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) "Comprehensive medical rehabilitation hospital" means a
general hospital that specializes in providing comprehensive
medical rehabilitation services, including surgery and related
ancillary services.
(e) "General acute care hospital" means a hospital other
than:
(1) a psychiatric hospital;
(2) a comprehensive medical rehabilitation hospital;
or
(3) a long-term acute care hospital.
(f) "Hospital" means a facility licensed by the Department
of State Health Services under Chapter 241, Health and Safety Code.
(g) "Hospital district" means the El Paso County Hospital
District.
(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) "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.
(m) "Psychiatric hospital" means a hospital licensed under
Chapter 577, Health and Safety Code.
Sec. 281.132. 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
hospital district may, by order, impose a monetary assessment on
the net patient revenue of each general acute care hospital located
in the district. 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 hospital district 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. 281.133. FINAL APPROVAL OF HOSPITAL ASSESSMENT. With
respect to the imposition or collection of a hospital assessment
imposed under this subchapter, the commissioners court of the
county in which the hospital district is located must finally
approve the imposition and collection of the assessment.
Sec. 281.134. 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. 281.135. ASSESSMENT AND COLLECTION. (a) If a hospital
district imposes an assessment as provided for in this subchapter,
(1) the district may make the assessment or may enter
into an interlocal contract as provided under Chapter 791,
Government Code, with the county tax assessor-collector to make the
assessment; and
(2) general acute care hospitals shall submit to the
district, or to the county tax assessor-collector at the district's
direction, 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 imposed, a hospital district shall collect the
assessment quarterly:
(1) through its tax assessor and collector if the
hospital district has appointed a tax assessor and collector;
(2) through an intergovernmental agreement or other
arrangement with a county tax assessor and collector;
(3) through a contract with a private entity; or
(4) through an internal process by which the district
collects the assessment directly.
(c) Revenue that the hospital district collects under this
subchapter shall be deposited in a dedicated fund or special
account established for the purpose of the hospital assessment in
the district depository and secured as provided by Title 4, Chapter
116, Local Government Code.
Sec. 281.136. USE OF FUNDS. The assessments collected
under this subchapter shall be used only to:
(a) provide equally the state share of the Medicaid DSH
program and the Medicaid Transformation Waiver; and
(b) pay collection expenses.
Sec. 281.137. 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 hospital
district shall use all of the funds received under section
281.132(a) only for the purposes outlined under section 281.136 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.
Sec. 281.138. 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. 281.139. NO EXEMPTION. Notwithstanding any exemptions
granted by any other federal, state, or local tax or other law, no
general acute care hospital in the hospital district shall be
exempt from the assessment.
Sec. 281.140. ASSESSMENT ADVISORY COMMITTEE. (a) The
hospital district board 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 hospital district board 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 hospital district
board.
(d) Prior to the adoption of any hospital assessment, or any
change to a previously adopted assessment, the committee shall
advise the hospital district on the amount of the assessment. The
committee shall also advise the hospital district 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 281.132(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. 281.141. 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 district 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 district 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.