86R6969 LED-F
By: Paddie H.B. No. 2333
A BILL TO BE ENTITLED
AN ACT
relating to the Texas ambulance response safety net program;
imposing a mandatory payment; authorizing an administrative
penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 773.003, Health and Safety Code, is
amended by adding Subdivision (5) to read as follows:
(5) "Commission" means the Health and Human Services
Commission.
SECTION 2. Chapter 773, Health and Safety Code, is amended
by adding Subchapter J to read as follows:
SUBCHAPTER J. TEXAS AMBULANCE RESPONSE SAFETY NET PROGRAM
Sec. 773.301. PURPOSE. The purpose of this subchapter is to
authorize the commission to establish and administer the Texas
ambulance response safety net program as a self-funded ground
transport emergency medical services provider participation
program for ground transport emergency medical services providers
in accordance with this subchapter.
Sec. 773.302. DEFINITIONS. In this subchapter:
(1) "Average commercial rate" means the average amount
payable by commercial payors for the same services. The rate is
calculated by:
(A) aligning the paid Medicaid claims with the
Medicare fees for each Healthcare Common Procedure Coding System
code or Current Procedural Terminology code for a ground transport
emergency medical services provider;
(B) calculating the Medicare payment for the
claims described in Paragraph (A);
(C) calculating a commercial-to-Medicare
conversion factor for each ground transport emergency medical
services provider by dividing the total amount of the average
commercial payments for the claims by the total Medicare payments
for the claims; and
(D) recalculating at least once every three years
the commercial-to-Medicare ratio for ground transport emergency
medical services providers.
(2) "Net patient revenue" means a ground transport
emergency medical services provider's estimated net realizable
revenue from patients, third-party payors, and other entities for
ground transport emergency medical services rendered, including
estimated retroactive adjustments required by reimbursement
agreements with third-party payors. The term does not include:
(A) the amounts the provider reduces for payors
who have a fee schedule established by federal or state statute or a
contractual agreement;
(B) Medicaid payments received by the provider,
including any payments for individuals who are dually eligible for
Medicaid and Medicare;
(C) amounts the provider reduces to zero as an
uncollectible payment from any payor that are not contractual
allowances, provided that the provider attempted to collect the
payment; or
(D) amounts related to ground transport
emergency medical services that are waived or forgiven by a paying
entity due to the financial hardship of the patient, provided that
the waiver or forgiveness is implemented in accordance with a
written policy of the entity that is consistent with national
standards adopted by the Healthcare Financial Management
Association or a similar organization.
Sec. 773.303. APPLICABILITY. (a) This subchapter applies
only to a ground transport emergency medical services provider that
is:
(1) licensed as an emergency medical services provider
under this chapter;
(2) a private, nonfederal provider of ground transport
emergency medical services; and
(3) a participant in the state Medicaid program.
(b) This subchapter does not apply to an entity that:
(1) provides only nonemergency ground transport
ambulance services; or
(2) is required to hold a license under Section
773.045(b).
Sec. 773.304. MANDATORY PAYMENTS BASED ON NET PATIENT
REVENUE. (a) Except as otherwise provided by this subchapter, the
commission shall require an annual mandatory payment to be assessed
on each ground transport emergency medical services provider's net
patient revenue related to the provision of ground transport
emergency medical services. The mandatory payment is to be
collected quarterly. The commission shall update the amount of the
mandatory payment at least annually.
(b) The commission shall uniformly and consistently impose
the mandatory payment on each ground transport emergency medical
services provider and use the same formula for each provider in
calculating the mandatory payment.
(c) The total amount of all mandatory payments for the state
fiscal year in which the mandatory payments are imposed may not
exceed:
(1) the state portion, excluding any federal financial
participation, of the cost of reimbursement enhancements provided
in this subchapter that are directly attributable to reimbursements
to ground transport emergency medical services providers; or
(2) an amount equal to six percent of the net operating
revenue of all ground transport emergency medical services
providers for the provision of emergency ground transport ambulance
services, or a greater amount as permitted by federal law, provided
that the maximum mandatory payment for a provider in any year may
not exceed the provider's net patient revenue, as reported by the
provider, subject to Section 773.306(b).
(d) Subject to the maximum amount prescribed by Subsection
(c), the commission shall set the mandatory payment in an amount
that in the aggregate generates sufficient revenue to cover the
administrative expenses of the commission for activities under this
subchapter.
(e) Not later than the 30th day before the end of each
quarter, the commission shall issue to each ground transport
emergency medical services provider a notice of the amount of the
mandatory payment required to be paid by the provider in the next
quarter.
(f) A ground transport emergency medical services provider
may not add a mandatory payment required under this subchapter as a
surcharge to a patient or a third-party payor.
(g) A ground transport emergency medical services provider
shall make mandatory payments only in the manner provided by this
subchapter.
Sec. 773.305. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. (a) Subject to Subsection (b), the commission shall
collect a mandatory payment required under this subchapter.
(b) The commission may contract for the assessment and
collection of mandatory payments under this subchapter.
Sec. 773.306. REPORT; INSPECTION OF RECORDS. (a) The
commission shall require a ground transport emergency medical
services provider to submit a report at least annually, but not more
than quarterly, that includes information necessary to assist the
commission in making a determination on mandatory payments under
this subchapter.
(b) The executive commissioner may audit or inspect the
records of a ground transport emergency medical services provider
to the extent necessary to ensure the accuracy of any data submitted
to the commission under this subchapter.
Sec. 773.307. FAILURE TO SUBMIT TIMELY OR ACCURATE REPORT
OR PAYMENT; AUDIT; ADMINISTRATIVE PENALTY. (a) The commission may
assess a reasonable penalty against a ground transport emergency
medical services provider, not to exceed 15 percent of the
quarterly portion of the provider's mandatory payment, for failure
to timely submit the quarterly portion of a mandatory payment or a
report required under this subchapter.
(b) If a ground transport emergency medical services
provider submits an inaccurate report required under this
subchapter, the commission may conduct an audit of the provider's
records and may require the provider to pay the cost of any audit
expenses and related hearings.
(c) A penalty assessed under this section is in addition to
any other penalties and remedies applicable under state or federal
law.
(d) If a ground transport emergency medical services
provider refuses to submit a quarterly portion of a mandatory
payment, the commission may suspend all Medicaid payments to the
provider until:
(1) the provider submits the quarterly portion of the
mandatory payment and any associated penalties; or
(2) the provider and the commission reach a negotiated
settlement.
Sec. 773.308. TEXAS AMBULANCE RESPONSE SAFETY NET TRUST
FUND. (a) The Texas ambulance response safety net trust fund is
established as a trust fund to be held by the comptroller outside
the state treasury and administered by the commission as trustee.
(b) The trust fund consists of:
(1) all revenue from the mandatory payments required
by this subchapter, including any administrative penalties and any
interest attributable to delinquent payments; and
(2) the earnings of the fund.
(c) Money deposited to the trust fund may be used only to:
(1) provide reimbursements for ground transport
emergency medical services delivered to Medicaid recipients based
on the provider's average commercial rate, including reimbursement
enhancements to the statewide dollar amount rate used to reimburse
ground transport emergency medical services providers;
(2) pay the administrative expenses of the commission
solely for activities under this subchapter; and
(3) refund a portion of a mandatory payment collected
in error from a provider.
(d) All revenue from the mandatory payments required by this
subchapter must be deposited in the trust fund.
(e) Money in the trust fund may not be used to expand
Medicaid eligibility under the Patient Protection and Affordable
Care Act (Pub. L. No. 111-148) as amended by the Health Care and
Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
Sec. 773.309. INVALIDITY; FEDERAL FUNDS. If any provision
of or procedure under this subchapter is held invalid by a final
court order that is not subject to appeal, or if the commission
determines that the imposition of the mandatory payment and the
expenditure of amounts collected as prescribed by this subchapter
will not entitle the state to receive federal matching funds under
the Medicaid program or will be inconsistent with the objectives
described by Section 537.002(b)(7), Government Code, the
commission shall:
(1) stop collection of the payment; and
(2) not later than the 30th day after the date
collection is stopped, return to each ground transport emergency
medical services provider, in proportion to the total amount paid
by each provider compared to the total amount paid by all providers,
any unspent money deposited to the credit of the trust fund.
Sec. 773.310. RULES. The executive commissioner shall
adopt rules necessary to implement this subchapter.
SECTION 3. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall:
(1) adopt the rules necessary to implement Subchapter
J, Chapter 773, Health and Safety Code, as added by this Act; and
(2) establish the amount of the initial mandatory
payment imposed under Subchapter J, Chapter 773, Health and Safety
Code, as added by this Act, based on available net patient revenue
information.
SECTION 4. 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 shall delay implementing that provision until the
waiver or authorization is granted. The agency shall begin
implementing the provision on the date the waiver or authorization
is granted.
SECTION 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2019.