By: Rodriguez S.B. No. 1768
A BILL TO BE ENTITLED
AN ACT
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.