Texas 2019 - 86th Regular

Texas House Bill HB2333 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R6969 LED-F
2	2	By: Paddie H.B. No. 2333
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the Texas ambulance response safety net program;
8	8	imposing a mandatory payment; authorizing an administrative
9	9	penalty.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 773.003, Health and Safety Code, is
12	12	amended by adding Subdivision (5) to read as follows:
13	13	(5) "Commission" means the Health and Human Services
14	14	Commission.
15	15	SECTION 2. Chapter 773, Health and Safety Code, is amended
16	16	by adding Subchapter J to read as follows:
17	17	SUBCHAPTER J. TEXAS AMBULANCE RESPONSE SAFETY NET PROGRAM
18	18	Sec. 773.301. PURPOSE. The purpose of this subchapter is to
19	19	authorize the commission to establish and administer the Texas
20	20	ambulance response safety net program as a self-funded ground
21	21	transport emergency medical services provider participation
22	22	program for ground transport emergency medical services providers
23	23	in accordance with this subchapter.
24	24	Sec. 773.302. DEFINITIONS. In this subchapter:
25	25	(1) "Average commercial rate" means the average amount
26	26	payable by commercial payors for the same services. The rate is
27	27	calculated by:
28	28	(A) aligning the paid Medicaid claims with the
29	29	Medicare fees for each Healthcare Common Procedure Coding System
30	30	code or Current Procedural Terminology code for a ground transport
31	31	emergency medical services provider;
32	32	(B) calculating the Medicare payment for the
33	33	claims described in Paragraph (A);
34	34	(C) calculating a commercial-to-Medicare
35	35	conversion factor for each ground transport emergency medical
36	36	services provider by dividing the total amount of the average
37	37	commercial payments for the claims by the total Medicare payments
38	38	for the claims; and
39	39	(D) recalculating at least once every three years
40	40	the commercial-to-Medicare ratio for ground transport emergency
41	41	medical services providers.
42	42	(2) "Net patient revenue" means a ground transport
43	43	emergency medical services provider's estimated net realizable
44	44	revenue from patients, third-party payors, and other entities for
45	45	ground transport emergency medical services rendered, including
46	46	estimated retroactive adjustments required by reimbursement
47	47	agreements with third-party payors. The term does not include:
48	48	(A) the amounts the provider reduces for payors
49	49	who have a fee schedule established by federal or state statute or a
50	50	contractual agreement;
51	51	(B) Medicaid payments received by the provider,
52	52	including any payments for individuals who are dually eligible for
53	53	Medicaid and Medicare;
54	54	(C) amounts the provider reduces to zero as an
55	55	uncollectible payment from any payor that are not contractual
56	56	allowances, provided that the provider attempted to collect the
57	57	payment; or
58	58	(D) amounts related to ground transport
59	59	emergency medical services that are waived or forgiven by a paying
60	60	entity due to the financial hardship of the patient, provided that
61	61	the waiver or forgiveness is implemented in accordance with a
62	62	written policy of the entity that is consistent with national
63	63	standards adopted by the Healthcare Financial Management
64	64	Association or a similar organization.
65	65	Sec. 773.303. APPLICABILITY. (a) This subchapter applies
66	66	only to a ground transport emergency medical services provider that
67	67	is:
68	68	(1) licensed as an emergency medical services provider
69	69	under this chapter;
70	70	(2) a private, nonfederal provider of ground transport
71	71	emergency medical services; and
72	72	(3) a participant in the state Medicaid program.
73	73	(b) This subchapter does not apply to an entity that:
74	74	(1) provides only nonemergency ground transport
75	75	ambulance services; or
76	76	(2) is required to hold a license under Section
77	77	773.045(b).
78	78	Sec. 773.304. MANDATORY PAYMENTS BASED ON NET PATIENT
79	79	REVENUE. (a) Except as otherwise provided by this subchapter, the
80	80	commission shall require an annual mandatory payment to be assessed
81	81	on each ground transport emergency medical services provider's net
82	82	patient revenue related to the provision of ground transport
83	83	emergency medical services. The mandatory payment is to be
84	84	collected quarterly. The commission shall update the amount of the
85	85	mandatory payment at least annually.
86	86	(b) The commission shall uniformly and consistently impose
87	87	the mandatory payment on each ground transport emergency medical
88	88	services provider and use the same formula for each provider in
89	89	calculating the mandatory payment.
90	90	(c) The total amount of all mandatory payments for the state
91	91	fiscal year in which the mandatory payments are imposed may not
92	92	exceed:
93	93	(1) the state portion, excluding any federal financial
94	94	participation, of the cost of reimbursement enhancements provided
95	95	in this subchapter that are directly attributable to reimbursements
96	96	to ground transport emergency medical services providers; or
97	97	(2) an amount equal to six percent of the net operating
98	98	revenue of all ground transport emergency medical services
99	99	providers for the provision of emergency ground transport ambulance
100	100	services, or a greater amount as permitted by federal law, provided
101	101	that the maximum mandatory payment for a provider in any year may
102	102	not exceed the provider's net patient revenue, as reported by the
103	103	provider, subject to Section 773.306(b).
104	104	(d) Subject to the maximum amount prescribed by Subsection
105	105	(c), the commission shall set the mandatory payment in an amount
106	106	that in the aggregate generates sufficient revenue to cover the
107	107	administrative expenses of the commission for activities under this
108	108	subchapter.
109	109	(e) Not later than the 30th day before the end of each
110	110	quarter, the commission shall issue to each ground transport
111	111	emergency medical services provider a notice of the amount of the
112	112	mandatory payment required to be paid by the provider in the next
113	113	quarter.
114	114	(f) A ground transport emergency medical services provider
115	115	may not add a mandatory payment required under this subchapter as a
116	116	surcharge to a patient or a third-party payor.
117	117	(g) A ground transport emergency medical services provider
118	118	shall make mandatory payments only in the manner provided by this
119	119	subchapter.
120	120	Sec. 773.305. ASSESSMENT AND COLLECTION OF MANDATORY
121	121	PAYMENTS. (a) Subject to Subsection (b), the commission shall
122	122	collect a mandatory payment required under this subchapter.
123	123	(b) The commission may contract for the assessment and
124	124	collection of mandatory payments under this subchapter.
125	125	Sec. 773.306. REPORT; INSPECTION OF RECORDS. (a) The
126	126	commission shall require a ground transport emergency medical
127	127	services provider to submit a report at least annually, but not more
128	128	than quarterly, that includes information necessary to assist the
129	129	commission in making a determination on mandatory payments under
130	130	this subchapter.
131	131	(b) The executive commissioner may audit or inspect the
132	132	records of a ground transport emergency medical services provider
133	133	to the extent necessary to ensure the accuracy of any data submitted
134	134	to the commission under this subchapter.
135	135	Sec. 773.307. FAILURE TO SUBMIT TIMELY OR ACCURATE REPORT
136	136	OR PAYMENT; AUDIT; ADMINISTRATIVE PENALTY. (a) The commission may
137	137	assess a reasonable penalty against a ground transport emergency
138	138	medical services provider, not to exceed 15 percent of the
139	139	quarterly portion of the provider's mandatory payment, for failure
140	140	to timely submit the quarterly portion of a mandatory payment or a
141	141	report required under this subchapter.
142	142	(b) If a ground transport emergency medical services
143	143	provider submits an inaccurate report required under this
144	144	subchapter, the commission may conduct an audit of the provider's
145	145	records and may require the provider to pay the cost of any audit
146	146	expenses and related hearings.
147	147	(c) A penalty assessed under this section is in addition to
148	148	any other penalties and remedies applicable under state or federal
149	149	law.
150	150	(d) If a ground transport emergency medical services
151	151	provider refuses to submit a quarterly portion of a mandatory
152	152	payment, the commission may suspend all Medicaid payments to the
153	153	provider until:
154	154	(1) the provider submits the quarterly portion of the
155	155	mandatory payment and any associated penalties; or
156	156	(2) the provider and the commission reach a negotiated
157	157	settlement.
158	158	Sec. 773.308. TEXAS AMBULANCE RESPONSE SAFETY NET TRUST
159	159	FUND. (a) The Texas ambulance response safety net trust fund is
160	160	established as a trust fund to be held by the comptroller outside
161	161	the state treasury and administered by the commission as trustee.
162	162	(b) The trust fund consists of:
163	163	(1) all revenue from the mandatory payments required
164	164	by this subchapter, including any administrative penalties and any
165	165	interest attributable to delinquent payments; and
166	166	(2) the earnings of the fund.
167	167	(c) Money deposited to the trust fund may be used only to:
168	168	(1) provide reimbursements for ground transport
169	169	emergency medical services delivered to Medicaid recipients based
170	170	on the provider's average commercial rate, including reimbursement
171	171	enhancements to the statewide dollar amount rate used to reimburse
172	172	ground transport emergency medical services providers;
173	173	(2) pay the administrative expenses of the commission
174	174	solely for activities under this subchapter; and
175	175	(3) refund a portion of a mandatory payment collected
176	176	in error from a provider.
177	177	(d) All revenue from the mandatory payments required by this
178	178	subchapter must be deposited in the trust fund.
179	179	(e) Money in the trust fund may not be used to expand
180	180	Medicaid eligibility under the Patient Protection and Affordable
181	181	Care Act (Pub. L. No. 111-148) as amended by the Health Care and
182	182	Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
183	183	Sec. 773.309. INVALIDITY; FEDERAL FUNDS. If any provision
184	184	of or procedure under this subchapter is held invalid by a final
185	185	court order that is not subject to appeal, or if the commission
186	186	determines that the imposition of the mandatory payment and the
187	187	expenditure of amounts collected as prescribed by this subchapter
188	188	will not entitle the state to receive federal matching funds under
189	189	the Medicaid program or will be inconsistent with the objectives
190	190	described by Section 537.002(b)(7), Government Code, the
191	191	commission shall:
192	192	(1) stop collection of the payment; and
193	193	(2) not later than the 30th day after the date
194	194	collection is stopped, return to each ground transport emergency
195	195	medical services provider, in proportion to the total amount paid
196	196	by each provider compared to the total amount paid by all providers,
197	197	any unspent money deposited to the credit of the trust fund.
198	198	Sec. 773.310. RULES. The executive commissioner shall
199	199	adopt rules necessary to implement this subchapter.
200	200	SECTION 3. As soon as practicable after the effective date
201	201	of this Act, the executive commissioner of the Health and Human
202	202	Services Commission shall:
203	203	(1) adopt the rules necessary to implement Subchapter
204	204	J, Chapter 773, Health and Safety Code, as added by this Act; and
205	205	(2) establish the amount of the initial mandatory
206	206	payment imposed under Subchapter J, Chapter 773, Health and Safety
207	207	Code, as added by this Act, based on available net patient revenue
208	208	information.
209	209	SECTION 4. If before implementing any provision of this Act
210	210	a state agency determines that a waiver or authorization from a
211	211	federal agency is necessary for implementation of that provision,
212	212	the agency affected by the provision shall request the waiver or
213	213	authorization and shall delay implementing that provision until the
214	214	waiver or authorization is granted. The agency shall begin
215	215	implementing the provision on the date the waiver or authorization
216	216	is granted.
217	217	SECTION 5. This Act takes effect immediately if it receives
218	218	a vote of two-thirds of all the members elected to each house, as
219	219	provided by Section 39, Article III, Texas Constitution. If this
220	220	Act does not receive the vote necessary for immediate effect, this
221	221	Act takes effect September 1, 2019.