TX
Texas Senate Bill SB2170

Texas 2017 - 85th Regular

Texas Senate Bill SB2170 Compare Versions

OldNewDifferences
11 By: Huffines S.B. No. 2170
2- (In the Senate - Filed March 10, 2017; March 29, 2017, read
3- first time and referred to Committee on Intergovernmental
4- Relations; April 26, 2017, reported adversely, with favorable
5- Committee Substitute by the following vote: Yeas 6, Nays 0;
6- April 26, 2017, sent to printer.)
7-Click here to see the committee vote
8- COMMITTEE SUBSTITUTE FOR S.B. No. 2170 By: Huffines
92
103
114 A BILL TO BE ENTITLED
125 AN ACT
13- relating to the creation and operations of a health care provider
14- participation program by the Dallas County Hospital District.
6+ relating to the creation and operations of health care provider
7+ participation programs in hospital districts established under
8+ Chapter 281, Health & Safety Code.
159 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1610 SECTION 1. Subtitle D, Title 4, Health and Safety Code, is
17- amended by adding Chapter 298A to read as follows:
18- CHAPTER 298A. DALLAS COUNTY HOSPITAL DISTRICT HEALTH CARE PROVIDER
19- PARTICIPATION PROGRAM
11+ amended by adding Chapter 298 to read as follows:
12+ CHAPTER 298. DISTRICT HEALTH CARE PROVIDER PARTICIPATION PROGRAM
13+ IN CERTAIN DISTRICTS
2014 SUBCHAPTER A. GENERAL PROVISIONS
21- Sec. 298A.001. DEFINITIONS. In this chapter:
22- (1) "Board" means the board of hospital managers of
23- the district.
24- (2) "District" means the Dallas County Hospital
15+ Sec. 298.001. DEFINITIONS. In this chapter:
16+ (1) "Board" means the board of hospital managers of a
2517 district.
26- (3) "Institutional health care provider" means a
27- nonpublic hospital located in the district that provides inpatient
28- hospital services.
29- (4) "Paying provider" means an institutional health
18+ (2) "Collection Agent" means an official of the
19+ district or another person engaged by the district to assess and
20+ collect mandatory payments.
21+ (3) "District" means a hospital district to which this
22+ chapter is applicable.
23+ (4) "Institutional health care provider" means a
24+ nonpublic health care provider that provides inpatient hospital
25+ services in the jurisdiction governed by the District.
26+ (5) "Paying provider" means an institutional health
3027 care provider required to make a mandatory payment under this
3128 chapter.
32- (5) "Program" means the health care provider
33- participation program authorized by this chapter.
34- Sec. 298A.002. APPLICABILITY. This chapter applies only to
35- the Dallas County Hospital District.
36- Sec. 298A.003. HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
37- PARTICIPATION IN PROGRAM. The board may authorize the district to
38- participate in a health care provider participation program on the
39- affirmative vote of a majority of the board, subject to the
40- provisions of this chapter.
41- Sec. 298A.004. EXPIRATION. (a) Subject to Section
42- 298A.153(d), the authority of the district to administer and
43- operate a program under this chapter expires December 31, 2019.
44- (b) This chapter expires December 31, 2019.
29+ (6) "Provider participation program" means a district
30+ health care provider participation program authorized under this
31+ chapter.
32+ Sec. 298.002. APPLICABILITY. This chapter applies only to
33+ a hospital district located in Dallas County.
34+ Sec. 298.003. DISTRICT HEALTH CARE PROVIDER PARTICIPATION
35+ PROGRAM. A district, pursuant to the affirmative vote of a majority
36+ of the members of the board, is authorized to have a provider
37+ participation program, subject to the provisions of this chapter.
4538 SUBCHAPTER B. POWERS AND DUTIES OF BOARD
46- Sec. 298A.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
47- PAYMENT. The board may require a mandatory payment authorized
48- under this chapter by an institutional health care provider in the
39+ Sec. 298.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
40+ PAYMENT. A board may require a mandatory payment authorized under
41+ this chapter by an institutional health care provider in its
4942 district only in the manner provided by this chapter.
50- Sec. 298A.052. RULES AND PROCEDURES. The board may adopt
51- rules relating to the administration of the program, including
52- collection of the mandatory payments, expenditures, audits, and any
53- other administrative aspects of the program.
54- Sec. 298A.053. INSTITUTIONAL HEALTH CARE PROVIDER
55- REPORTING. If the board authorizes the district to participate in a
56- program under this chapter, the board shall require each
57- institutional health care provider to submit to the district a copy
58- of any financial and utilization data required by and reported to
59- the Department of State Health Services under Sections 311.032 and
60- 311.033 and any rules adopted by the executive commissioner of the
61- Health and Human Services Commission to implement those sections.
43+ Sec. 298.052. RULES AND PROCEDURES. The board may adopt
44+ rules and procedures relating to the administration, collection,
45+ administrative expenditures, audit, and other aspects of the
46+ district's provider participation program.
47+ Sec. 298.053. INSTITUTIONAL HEALTH CARE PROVIDER
48+ REPORTING; INSPECTION OF RECORDS. A board that has enacted a
49+ provider participation program under this chapter shall require
50+ each institutional health care provider to submit to the district a
51+ copy of all financial and utilization data required by and reported
52+ to the Department of State Health Services under Sections 311.032
53+ and 311.033, as amended, and any rules adopted by the executive
54+ commissioner of the Health and Human Services Commission to
55+ implement those sections.
56+ Sec. 298.054. EXPIRATION. The authority of the district to
57+ administer and operate a provider participation program expires
58+ December 31, 2019.
6259 SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
63- Sec. 298A.101. HEARING. (a) In each year that the board
64- authorizes a program under this chapter, the board shall hold a
65- public hearing on the amounts of any mandatory payments that the
66- board intends to require during the year and how the revenue derived
67- from those payments is to be spent.
68- (b) Not later than the fifth day before the date of the
69- hearing required under Subsection (a), the board shall publish
70- notice of the hearing in a newspaper of general circulation in the
71- district and provide written notice of the hearing to each
72- institutional health care provider in the district.
73- Sec. 298A.102. DEPOSITORY. (a) If the board requires a
74- mandatory payment authorized under this chapter, the board shall
60+ Sec. 298.101. HEARING. (a) Each year, the board that has
61+ enacted a provider participation program under this chapter shall
62+ hold a public hearing on the amounts of any mandatory payments that
63+ the board intends to require during the year and how the revenue
64+ derived from those payments is to be spent.
65+ (b) Not later than the 5th day before the date of the hearing
66+ required under Subsection (a), the board shall publish notice of
67+ the hearing in a newspaper of general circulation in its district
68+ and provide written notice of the hearing to each institutional
69+ health care provider in its district.
70+ Sec. 298.102. DEPOSITORY. (a) A board that has authorized
71+ the collection of a mandatory payment under this chapter shall
7572 designate one or more banks as a depository for the district's local
7673 provider participation fund.
77- (b) All funds collected under this chapter shall be secured
78- in the manner provided for securing other district funds.
79- Sec. 298A.103. LOCAL PROVIDER PARTICIPATION FUND;
80- AUTHORIZED USES OF MONEY. (a) If the district requires a
81- mandatory payment authorized under this chapter, the district shall
82- create a local provider participation fund.
83- (b) The local provider participation fund consists of:
74+ (b) All depository funds collected under this chapter shall
75+ be secured in the manner provided for securing other district
76+ funds.
77+ Sec. 298.103. LOCAL PROVIDER PARTICIPATION FUND;
78+ AUTHORIZED USES OF MONEY. (a) A district collecting mandatory
79+ payments authorized under this chapter shall create a local
80+ provider participation fund.
81+ (b) The local provider participation fund of a district
82+ shall consist of:
8483 (1) all revenue received by the district attributable
8584 to mandatory payments authorized under this chapter;
8685 (2) money received from the Health and Human Services
87- Commission as a refund of an intergovernmental transfer under the
86+ Commission as a refund of an intergovernmental transfer under this
8887 program, provided that the intergovernmental transfer does not
8988 receive a federal matching payment; and
9089 (3) the earnings of the fund.
9190 (c) Money deposited to the local provider participation
92- fund of the district may be used only to:
91+ fund of a district may be used only to:
9392 (1) fund intergovernmental transfers from the
9493 district to the state to provide the nonfederal share of Medicaid
95- payments for:
96- (A) uncompensated care payments to nonpublic
97- hospitals affiliated with the district, if those payments are
98- authorized under the Texas Healthcare Transformation and Quality
94+ payments for: (A) Uncompensated Care Payments to nonpublic
95+ hospitals affiliated with the district, where such payments are
96+ available through the Texas Healthcare Transformation and Quality
9997 Improvement Program waiver issued under Section 1115 of the federal
100- Social Security Act (42 U.S.C. Section 1315);
101- (B) uniform rate enhancements for nonpublic
102- hospitals in the Medicaid managed care service area in which the
103- district is located;
104- (C) payments available under another waiver
105- program authorizing payments that are substantially similar to
106- Medicaid payments to nonpublic hospitals described by Paragraph (A)
107- or (B); or
108- (D) any reimbursement to nonpublic hospitals for
109- which federal matching funds are available;
110- (2) subject to Section 298A.151(d), pay the
111- administrative expenses of the district in administering the
112- program, including collateralization of deposits;
113- (3) refund a mandatory payment collected in error from
114- a paying provider;
115- (4) refund to paying providers a proportionate share
116- of the money that the district:
117- (A) receives from the Health and Human Services
98+ Social Security Act (42 U.S.C. Section 1315) or any successor
99+ program, (B) uniform rate enhancements for nonpublic hospitals in
100+ the Medicaid managed care service area in which the district is
101+ located, (C) payments available under a successor waiver program
102+ authorizing substantially similar Medicaid payments to nonpublic
103+ hospitals, or (D) any reimbursement that provides matching funds to
104+ such providers;
105+ (2) subject to the limitation set forth in
106+ Sec. 298.103(d) below, pay the administrative expenses incurred by
107+ the district in administering the provider participation program,
108+ including collateralization of deposits;
109+ (3) make refunds of any mandatory payment collected in
110+ error from a paying provider;
111+ (4) refund to paying providers the proportionate share
112+ of money received by the district from the Health and Human Services
118113 Commission that is not used to fund the nonfederal share of Medicaid
119- supplemental payment program payments; or
120- (B) determines cannot be used to fund the
121- nonfederal share of Medicaid supplemental payment program
122- payments;
123- (5) transfer funds to the Health and Human Services
124- Commission if the district is legally required to transfer the
125- funds to address a disallowance of federal matching funds with
126- respect to programs for which the district made intergovernmental
127- transfers described by Subdivision (1); and
128- (6) reimburse the district if the district is required
129- by the rules governing the uniform rate enhancement program
130- described by Subdivision (1)(B) to incur an expense or forego
131- Medicaid reimbursements from the state because the balance of the
132- local provider participation fund is not sufficient to fund that
133- rate enhancement program.
114+ supplemental payment program payments;
115+ (5) refund to paying providers the proportionate share
116+ of money that cannot be used to fund the nonfederal share of
117+ Medicaid supplemental payment program payments; and
118+ (6) transfer funds to the Health and Human Services
119+ Commission, if the district is legally required to transfer funds
120+ to address a disallowance of federal matching funds with respect to
121+ programs for which the district made intergovernmental transfers as
122+ described in Sec. 298.103(c)(1) above.
123+ (7) reimburse the district, if the district is
124+ required by the rules governing the uniform rate enhancement
125+ program described in subsection (c)(1)(B) of this Section to incur
126+ an expense or forego Medicaid reimbursements from the State due to a
127+ shortfall in the local provider participation fund for funding the
128+ rate enhancement program for the nonpublic hospitals in the
129+ district's service delivery area.
134130 (d) Money in the local provider participation fund may not
135131 be commingled with other district funds.
136- (e) Notwithstanding any other provision of this chapter,
137- with respect to an intergovernmental transfer of funds described by
138- Subsection (c)(1) made by the district, any funds received by the
139- state, district, or other entity as a result of that transfer may
140- not be used by the state, district, or any other entity to:
141- (1) expand Medicaid eligibility under the Patient
142- Protection and Affordable Care Act (Pub. L. No. 111-148) as amended
143- by the Health Care and Education Reconciliation Act of 2010 (Pub. L.
144- No. 111-152); or
145- (2) fund the nonfederal share of payments to nonpublic
146- hospitals available through the Medicaid disproportionate share
147- hospital program or the delivery system reform incentive payment
148- program.
132+ (e) Notwithstanding any other provision of this Chapter
133+ 298, with respect to any intergovernmental transfer of funds, as
134+ described by Subsection (c)(1), made by a district, any funds
135+ received by the state, the district, or any other entity as a result
136+ of such an intergovernmental transfer may not be used by the state,
137+ the district, or any other entity to expand Medicaid eligibility
138+ under the Patient Protection and Affordable Care Act (Pub. L.
139+ No. 111-148) as amended by the Health Care and Education
140+ Reconciliation Act of 2010 (Pub. L. No. 111-152), or to fund the
141+ non-federal share of payments to nonpublic hospitals available
142+ through the Disproportionate Share Hospital program or the Delivery
143+ Service Reform Incentive Payment program.
149144 SUBCHAPTER D. MANDATORY PAYMENTS
150- Sec. 298A.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER
151- NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if
152- the board authorizes a health care provider participation program
153- under this chapter, the board may require an annual mandatory
154- payment to be assessed on the net patient revenue of each
155- institutional health care provider located in the district. The
156- board may provide for the mandatory payment to be assessed
157- quarterly. In the first year in which the mandatory payment is
158- required, the mandatory payment is assessed on the net patient
159- revenue of an institutional health care provider as determined by
160- the data reported to the Department of State Health Services under
161- Sections 311.032 and 311.033 in the most recent fiscal year for
162- which that data was reported. If the institutional health care
163- provider did not report any data under those sections, the
164- provider's net patient revenue is the amount of that revenue as
165- contained in the provider's Medicare cost report submitted for the
166- previous fiscal year or for the closest subsequent fiscal year for
167- which the provider submitted the Medicare cost report. If the
168- mandatory payment is required, the district shall update the amount
169- of the mandatory payment on an annual basis.
145+ Sec. 298.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER
146+ NET PATIENT REVENUE. (a) Except as provided by Subsection (d), a
147+ board that has authorized the collection of a mandatory payment
148+ under this chapter may require an annual mandatory payment to be
149+ assessed on the net patient revenue of each institutional health
150+ care provider located in its district. The board may provide for
151+ the mandatory payment to be assessed quarterly. In the first year
152+ in which the mandatory payment is required, the mandatory payment
153+ is assessed on the net patient revenue of an institutional health
154+ care provider as determined by the data reported to the Department
155+ of State Health Services under Sections 311.032 and 311.033 in the
156+ most recently completed fiscal year. If the institutional health
157+ care provider did not report any data under those sections, then the
158+ net patient revenue shall be determined by the institutional health
159+ care provider's Medicare cost report submitted for the previous
160+ fiscal year or for the closest subsequent fiscal year for which the
161+ provider submitted the Medicare cost report. The district shall
162+ update the amount of the mandatory payment on an annual basis.
170163 (b) The amount of a mandatory payment authorized under this
171164 chapter must be uniformly proportionate with the amount of net
172- patient revenue generated by each paying provider in the district
173- as permitted under federal law. A health care provider
174- participation program authorized under this chapter may not hold
175- harmless any institutional health care provider, as required under
176- 42 U.S.C. Section 1396b(w).
177- (c) If the board requires a mandatory payment authorized
178- under this chapter, the board shall set the amount of the mandatory
179- payment, subject to the limitations of this chapter. The aggregate
180- amount of the mandatory payments required of all paying providers
181- in the district may not exceed six percent of the aggregate net
182- patient revenue from hospital services provided by all paying
183- providers in the district.
184- (d) Subject to Subsection (c), if the board requires a
185- mandatory payment authorized under this chapter, the board shall
186- set the mandatory payments in amounts that in the aggregate will
165+ patient revenue generated by each paying provider in such district
166+ as permitted under federal law. A provider participation program
167+ may not hold harmless any institutional health care provider, as
168+ required under 42 U.S.C. Section 1396b(w).
169+ (c) A board that has authorized the collection of a
170+ mandatory payment under this chapter shall, within the limitations
171+ set out in this Chapter 298, set the amount of the mandatory
172+ payment. The aggregate amount of the mandatory payments required
173+ of all paying providers in the district may not exceed six percent
174+ of the aggregate net patient revenue from hospital services
175+ provided by all paying providers in the district.
176+ (d) Subject to Subsection (c), a board that has authorized
177+ the collection of a mandatory payment under this chapter shall set
178+ the mandatory payments in amounts that in the aggregate will
187179 generate sufficient revenue to cover the administrative expenses of
188- the district for activities under this chapter and to fund an
189- intergovernmental transfer described by Section 298A.103(c)(1).
190- The annual amount of revenue from mandatory payments that shall be
191- paid for administrative expenses by the district is $150,000, plus
192- the cost of collateralization of deposits, regardless of actual
193- expenses.
180+ the district for activities under this chapter, and to fund
181+ intergovernmental transfers described by Section 298.103. The
182+ annual amount to be paid for the administrative expenses of the
183+ district shall be $150,000 plus the cost of collateralization of
184+ deposits, regardless of actual expenses.
194185 (e) A paying provider may not add a mandatory payment
195186 required under this section as a surcharge to a patient.
196- (f) A mandatory payment assessed under this chapter is not a
197- tax for hospital purposes for purposes of Section 4, Article IX,
198- Texas Constitution, or Section 281.045.
199- Sec. 298A.152. ASSESSMENT AND COLLECTION OF MANDATORY
200- PAYMENTS. (a) The district may designate an official of the
201- district or contract with another person to assess and collect the
202- mandatory payments authorized under this chapter.
203- (b) The person charged by the district with the assessment
204- and collection of mandatory payments shall charge and deduct from
205- the mandatory payments collected for the district a collection fee
206- in an amount not to exceed the person's usual and customary charges
207- for like services.
208- (c) If the person charged with the assessment and collection
209- of mandatory payments is an official of the district, any revenue
210- from a collection fee charged under Subsection (b) shall be
211- deposited in the district general fund and, if appropriate, shall
212- be reported as fees of the district.
213- Sec. 298A.153. PURPOSE; CORRECTION OF INVALID PROVISION OR
187+ (f) A mandatory payment imposed under this chapter is not a
188+ "tax for hospital purposes" as referenced in Article IX, Section 4
189+ of the Texas Constitution or in Section 281.045 of the Health and
190+ Safety Code.
191+ Sec. 298.152. ASSESSMENT AND COLLECTION OF MANDATORY
192+ PAYMENTS. (a) If the Collection Agent is not an official of the
193+ district, the Collection Agent shall collect the mandatory payments
194+ on behalf of the district and shall charge and deduct from such
195+ mandatory payments a collection fee in an amount not to exceed the
196+ Collection Agent's usual and customary charges for like services.
197+ (b) If determined to be appropriate by the board, the board
198+ may contract for the assessment and collection of mandatory
199+ payments authorized under this chapter.
200+ (c) Revenue from a fee charged by the Collection Agent for
201+ collecting the mandatory payment shall be deposited in the district
202+ general fund and, if appropriate, shall be reported as fees of the
203+ district.
204+ Sec. 298.153. PURPOSE; CORRECTION OF INVALID PROVISION OR
214205 PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this
215- chapter is to authorize the district to establish a program to
216- enable the district to collect mandatory payments from
217- institutional health care providers to fund the nonfederal share of
218- a Medicaid supplemental payment program or the Medicaid managed
219- care rate enhancements for nonpublic hospitals to support the
220- provision of health care by institutional health care providers to
221- district residents in need of health care.
222- (b) This chapter does not authorize the district to collect
223- mandatory payments for the purpose of raising general revenue or
224- any amount in excess of the amount reasonably necessary to fund the
225- nonfederal share of a Medicaid supplemental payment program or
226- Medicaid managed care rate enhancements for nonpublic hospitals and
227- to cover the administrative expenses of the district associated
228- with activities under this chapter.
229- (c) To the extent any provision or procedure under this
206+ chapter is to authorize a district to establish a program that
207+ enables the district to collect mandatory payments from
208+ institutional health care providers in order to fund the nonfederal
209+ share of a Medicaid supplemental payment program or to fund the
210+ nonfederal share of Medicaid managed care rate enhancements for
211+ nonpublic hospitals, thereby supporting the provision of health
212+ care by institutional health care providers to those in need. This
213+ chapter is not intended to authorize a district to collect
214+ mandatory payments for general revenue raising or to raise amounts
215+ in excess of what is reasonably necessary for funding the
216+ nonfederal share of a Medicaid supplemental payment program or the
217+ nonfederal share of Medicaid managed care rate enhancements for
218+ nonpublic hospitals, and the associated administrative expenses of
219+ the district for activities under this chapter.
220+ (b) To the extent any provision or procedure under this
230221 chapter causes a mandatory payment authorized under this chapter to
231- be ineligible for federal matching funds, the board may provide by
222+ be ineligible for federal matching funds, a district may provide by
232223 rule for an alternative provision or procedure that conforms to the
233224 requirements of the federal Centers for Medicare and Medicaid
234- Services. A rule adopted under this section may not create, impose,
235- or materially expand the legal or financial liability or
236- responsibility of the district or an institutional health care
237- provider in the district beyond the provisions of this chapter.
238- This section does not require the board to adopt a rule.
239- (d) The district may only assess and collect a mandatory
240- payment authorized under this chapter if a waiver program, uniform
241- rate enhancement, or reimbursement described by Section
242- 298A.103(c)(1) is available to the district.
243- SECTION 2. As soon as practicable after the expiration of
244- the authority of the Dallas County Hospital District to administer
245- and operate a health care provider participation program under
246- Chapter 298A, Health and Safety Code, as added by this Act, the
247- board of hospital managers of the Dallas County Hospital District
248- shall transfer to each institutional health care provider in the
249- district that provider's proportionate share of any remaining funds
250- in any local provider participation fund created by the district
251- under Section 298A.103, Health and Safety Code, as added by this
252- Act.
253- SECTION 3. If before implementing any provision of this Act
225+ Services. Nothing in this section shall be construed to require the
226+ district to adopt any such rule. Any such remedial rule shall not
227+ create, impose, or materially expand the legal or financial
228+ liability or program responsibilities of either the district or any
229+ institutional healthcare provider beyond the provisions of this
230+ subchapter.
231+ (c) The district may only collect a mandatory payment
232+ authorized under this chapter as long as the Medicaid supplemental
233+ payment program authorized under the state Medicaid plan through
234+ the Texas Healthcare Transformation and Quality Improvement
235+ Program waiver issued under Section 1115 of the federal Social
236+ Security Act (42 U.S.C. Section 1315), a successor waiver program
237+ authorizing substantially similar Medicaid supplemental payment
238+ program is available, or as long as enhanced Medicaid managed care
239+ rates funded by IGTs are available.
240+ SECTION 2. If before implementing any provision of this Act
254241 a state agency determines that a waiver or authorization from a
255242 federal agency is necessary for implementation of that provision,
256243 the agency affected by the provision shall request the waiver or
257244 authorization and may delay implementing that provision until the
258245 waiver or authorization is granted.
259- SECTION 4. This Act takes effect immediately if it receives
246+ SECTION 3. This Act takes effect immediately if it receives
260247 a vote of two-thirds of all the members elected to each house, as
261248 provided by Section 39, Article III, Texas Constitution. If this
262249 Act does not receive the vote necessary for immediate effect, this
263250 Act takes effect September 1, 2017.
264- * * * * *