86R9410 KKR-F
By: Price H.B. No. 2035
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement of rural hospitals participating in the
Medicaid managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0041 to read as follows:
Sec. 533.0041. REIMBURSEMENT METHODOLOGY FOR RURAL
HOSPITALS. (a) In this section, "rural hospital" has the meaning
assigned by commission rules for purposes of Medicaid.
(b) To the extent allowed by federal law and notwithstanding
any state law, the executive commissioner shall by rule adopt a
reimbursement methodology for the payment of rural hospitals
participating in the Medicaid managed care program that ensures the
rural hospitals are reimbursed on an individual basis that allows
the rural hospitals to fully recover allowable costs incurred in
providing services to recipients. In adopting rules under this
section, the executive commissioner:
(1) may adopt a methodology that requires:
(A) the commission to directly reimburse rural
hospitals for allowable costs;
(B) a managed care organization to reimburse
rural hospitals; or
(C) both the commission and a managed care
organization to share in the total amount of reimbursement paid to
rural hospitals; and
(2) shall:
(A) define "allowable costs" for purposes of this
section; and
(B) require that the amount of reimbursement paid
to a rural hospital is subject to any applicable adjustments made by
the commission for payments to or penalties imposed on the rural
hospital that are based on a quality-based or performance-based
requirement under the Medicaid managed care program.
(c) Not later than January 1 of each even-numbered year,
the commission shall, as applicable:
(1) make an initial determination of the allowable
costs incurred by a rural hospital participating in the Medicaid
managed care program that is based on the rural hospital's cost
reports submitted to the federal Centers for Medicare and Medicaid
Services and other available information that the commission
considers relevant in determining the hospital's allowable costs;
or
(2) review and update the allowable costs previously
determined or updated under this subsection using the same criteria
required under Subdivision (1).
SECTION 2. Not later than January 1, 2020, the Health and
Human Services Commission shall determine the allowable costs
incurred by a rural hospital participating in the Medicaid managed
care program before that date as required by Section
533.0041(c)(1), Government Code, as added by this Act.
SECTION 3. 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 4. This Act takes effect September 1, 2019.