86R26244 KFF-D
By: Klick, Deshotel, Clardy, Hinojosa, H.B. No. 2798
et al.
Substitute the following for H.B. No. 2798:
By: Clardy C.S.H.B. No. 2798
A BILL TO BE ENTITLED
AN ACT
relating to the reimbursement of certain urban teaching hospitals
for the provision of inpatient hospital care under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0285 to read as follows:
Sec. 32.0285. CALCULATION OF MEDICAL EDUCATION ADD-ON FOR
REIMBURSEMENT OF CERTAIN URBAN TEACHING HOSPITALS. (a) In this
section:
(1) "Base standard dollar amount" means the
standardized payment amount calculated by the commission for costs
incurred by prospectively paid hospitals in this state for
providing inpatient hospital care under Medicaid.
(2) "Children's hospital" means a hospital designated
by the Centers for Medicare and Medicaid Services as a children's
hospital.
(3) "Medical education add-on" means an adjustment to
the base standard dollar amount for an urban teaching hospital to
reflect higher patient care costs relative to nonteaching urban
hospitals.
(4) "Rural hospital" means a hospital enrolled as a
Medicaid provider that:
(A) is located in a county with a population of
not more than 60,000;
(B) is designated by the Centers for Medicare and
Medicaid Services as a critical access hospital, sole community
hospital, or rural referral center and is not located in an area
defined by the United States Office of Management and Budget as a
metropolitan statistical area; or
(C) meets all of the following criteria:
(i) has 100 or fewer beds;
(ii) is designated by the Centers for
Medicare and Medicaid Services as a critical access hospital, sole
community hospital, or rural referral center; and
(iii) is located in an area defined by the
United States Office of Management and Budget as a metropolitan
statistical area.
(5) "State-owned teaching hospital" means:
(A) The University of Texas Medical Branch at
Galveston;
(B) The University of Texas Health Science Center
at Tyler; and
(C) The University of Texas M.D. Anderson Cancer
Center.
(6) "Teaching hospital" means a hospital that incurs
indirect costs for operating graduate medical education programs
and for which the Centers for Medicare and Medicaid Services has
calculated and assigned a percentage Medicare education adjustment
factor under 42 C.F.R. Section 412.105.
(7) "Urban hospital" means a hospital that:
(A) is located in an area defined by the United
States Office of Management and Budget as a metropolitan
statistical area; and
(B) is not a rural hospital, children's hospital,
state-owned teaching hospital, or freestanding psychiatric
facility.
(b) To the extent permitted by federal law, in order to
ensure that urban teaching hospitals are accurately reimbursed for
the provision of inpatient hospital care to recipients under
Medicaid, the commission shall at least annually update the
education adjustment factor used to calculate the medical education
add-on using the most current data available, including:
(1) data related to the number of interns and
residents enrolled in a hospital's approved teaching program; and
(2) the Medicare education adjustment factor assigned
under 42 C.F.R. Section 412.105 in effect at the time the commission
makes the update.
SECTION 2. (a) In this section:
(1) "Medicaid" has the meaning assigned by Section
531.001, Government Code.
(2) "Medical education add-on," "teaching hospital,"
and "urban hospital" have the meanings assigned by Section 32.0285,
Human Resources Code, as added by this Act.
(b) As soon as practicable after the effective date of this
Act, the Health and Human Services Commission shall conduct a study
to evaluate the impacts and effectiveness of using the Medicare
education adjustment factor assigned under 42 C.F.R. Section
412.105 in effect on the effective date of this Act to calculate the
medical education add-on used to reimburse teaching hospitals for
the provision of inpatient hospital care under Medicaid. The
commission shall develop and make recommendations on alternative
factors and methodologies for calculating and annually updating the
medical education add-on that:
(1) best recognize the higher costs incurred by
teaching hospitals; and
(2) mitigate issues identified with using the Medicare
education adjustment factor without reducing reimbursements to
urban teaching hospitals that have maintained or increased the
number of interns and residents enrolled in the hospitals' approved
teaching programs.
(c) Not later than December 1, 2020, the Health and Human
Services Commission shall report its findings and recommendations
under Subsection (b) of this section to the governor, the standing
committees of the senate and house of representatives having
primary jurisdiction over matters relating to state finance and
appropriations from the state treasury, the standing committees of
the senate and house of representatives having primary jurisdiction
over Medicaid, and the Legislative Budget Board.
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 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.