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Texas House Bill HB3649

Texas 2019 - 86th Regular

Texas House Bill HB3649 Compare Versions

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1-86R26747 JCG-D
1+86R10424 JCG-D
22 By: Hinojosa H.B. No. 3649
3- Substitute the following for H.B. No. 3649:
4- By: Rosenthal C.S.H.B. No. 3649
53
64
75 A BILL TO BE ENTITLED
86 AN ACT
97 relating to the creation and operations of a health care provider
108 participation program by a certain hospital district.
119 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1210 SECTION 1. Subtitle D, Title 4, Health and Safety Code, is
1311 amended by adding Chapter 298E to read as follows:
1412 CHAPTER 298E. HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN CERTAIN
1513 HOSPITAL DISTRICTS
1614 SUBCHAPTER A. GENERAL PROVISIONS
1715 Sec. 298E.001. DEFINITIONS. In this chapter:
1816 (1) "Board" means the board of hospital managers of a
1917 district.
2018 (2) "District" means a hospital district to which this
2119 chapter applies.
2220 (3) "Institutional health care provider" means a
23- hospital that is not owned and operated by a federal, state, or
24- local government and provides inpatient hospital services.
21+ nonpublic hospital that provides inpatient hospital services.
2522 (4) "Paying provider" means an institutional health
2623 care provider required to make a mandatory payment under this
2724 chapter.
2825 (5) "Program" means a health care provider
2926 participation program authorized by this chapter.
3027 Sec. 298E.002. APPLICABILITY. This chapter applies only
3128 to a hospital district created in a county with a population of more
3229 than 800,000 that was not included in the boundaries of a hospital
3330 district before September 1, 2003.
3431 Sec. 298E.003. HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
3532 PARTICIPATION IN PROGRAM. The board of a district may authorize the
3633 district to participate in a health care provider participation
3734 program on the affirmative vote of a majority of the board, subject
3835 to the provisions of this chapter.
39- Sec. 298E.004. EXPIRATION. (a) Subject to Section
40- 298E.153(d), the authority of a district to administer and operate
41- a program under this chapter expires December 31, 2023.
42- (b) This chapter expires December 31, 2023.
4336 SUBCHAPTER B. POWERS AND DUTIES OF BOARD
4437 Sec. 298E.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
4538 PAYMENT. The board of a district may require a mandatory payment
4639 authorized under this chapter by an institutional health care
4740 provider located in the district only in the manner provided by this
4841 chapter.
4942 Sec. 298E.052. RULES AND PROCEDURES. The board of a
5043 district may adopt rules relating to the administration of the
5144 program, including collection of the mandatory payments,
5245 expenditures, audits, and any other administrative aspects of the
5346 program.
5447 Sec. 298E.053. INSTITUTIONAL HEALTH CARE PROVIDER
5548 REPORTING. If the board of a district authorizes the district to
5649 participate in a program under this chapter, the board shall
5750 require each institutional health care provider located in the
5851 district to submit to the district a copy of any financial and
5952 utilization data required by and reported to the Department of
6053 State Health Services under Sections 311.032 and 311.033 and any
6154 rules adopted by the executive commissioner of the Health and Human
6255 Services Commission to implement those sections.
6356 SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
6457 Sec. 298E.101. HEARING. (a) In each year that the board of
6558 a district authorizes a program under this chapter, the board shall
6659 hold a public hearing on the amounts of any mandatory payments that
6760 the board intends to require during the year and how the revenue
6861 derived from those payments is to be spent.
6962 (b) Not later than the fifth day before the date of the
7063 hearing required under Subsection (a), the board shall publish
7164 notice of the hearing in a newspaper of general circulation in the
7265 district and provide written notice of the hearing to each
7366 institutional health care provider located in the district.
7467 Sec. 298E.102. DEPOSITORY. (a) If the board of a district
7568 requires a mandatory payment authorized under this chapter, the
7669 board shall designate one or more banks as a depository for the
7770 district's local provider participation fund.
7871 (b) All funds collected by a district under this chapter
7972 shall be secured in the manner provided for securing other funds of
8073 the district.
8174 Sec. 298E.103. LOCAL PROVIDER PARTICIPATION FUND;
8275 AUTHORIZED USES OF MONEY. (a) If a district requires a mandatory
8376 payment authorized under this chapter, the district shall create a
8477 local provider participation fund.
8578 (b) A district's local provider participation fund consists
8679 of:
8780 (1) all revenue received by the district attributable
8881 to mandatory payments authorized under this chapter;
8982 (2) money received from the Health and Human Services
9083 Commission as a refund of an intergovernmental transfer under the
9184 program, provided that the intergovernmental transfer does not
9285 receive a federal matching payment; and
9386 (3) the earnings of the fund.
9487 (c) Money deposited to the local provider participation
9588 fund of a district may be used only to:
9689 (1) fund intergovernmental transfers from the
9790 district to the state to provide the nonfederal share of Medicaid
9891 payments for:
99- (A) uncompensated care payments to hospitals in
100- the Medicaid managed care service area in which the district is
101- located, if those payments are authorized under the Texas
102- Healthcare Transformation and Quality Improvement Program waiver
103- issued under Section 1115 of the federal Social Security Act (42
104- U.S.C. Section 1315);
105- (B) uniform rate enhancements for hospitals in
106- the Medicaid managed care service area in which the district is
107- located;
92+ (A) uncompensated care payments to nonpublic
93+ hospitals affiliated with the district, if those payments are
94+ authorized under the Texas Healthcare Transformation and Quality
95+ Improvement Program waiver issued under Section 1115 of the federal
96+ Social Security Act (42 U.S.C. Section 1315);
97+ (B) uniform rate enhancements for nonpublic
98+ hospitals in the Medicaid managed care service area in which the
99+ district is located;
108100 (C) payments available under another waiver
109101 program authorizing payments that are substantially similar to
110- Medicaid payments to hospitals described by Paragraph (A) or (B);
111- or
112- (D) any reimbursement to hospitals for which
113- federal matching funds are available;
102+ Medicaid payments to nonpublic hospitals described by Paragraph (A)
103+ or (B); or
104+ (D) any reimbursement to nonpublic hospitals for
105+ which federal matching funds are available;
114106 (2) subject to Section 298E.151(d), pay the
115107 administrative expenses of the district in administering the
116108 program, including collateralization of deposits;
117109 (3) refund a mandatory payment collected in error from
118110 a paying provider;
119111 (4) refund to paying providers a proportionate share
120112 of the money that the district:
121113 (A) receives from the Health and Human Services
122114 Commission that is not used to fund the nonfederal share of Medicaid
123115 supplemental payment program payments; or
124116 (B) determines cannot be used to fund the
125117 nonfederal share of Medicaid supplemental payment program
126118 payments;
127119 (5) transfer funds to the Health and Human Services
128120 Commission if the district is legally required to transfer the
129121 funds to address a disallowance of federal matching funds with
130122 respect to programs for which the district made intergovernmental
131123 transfers described by Subdivision (1); and
132124 (6) reimburse the district if the district is required
133125 by the rules governing the uniform rate enhancement program
134126 described by Subdivision (1)(B) to incur an expense or forego
135127 Medicaid reimbursements from the state because the balance of the
136128 local provider participation fund is not sufficient to fund that
137129 rate enhancement program.
138130 (d) Money in the local provider participation fund of a
139131 district may not be commingled with other district funds.
140132 (e) Notwithstanding any other provision of this chapter,
141133 with respect to an intergovernmental transfer of funds described by
142134 Subsection (c)(1) made by a district, any funds received by the
143135 state, district, or other entity as a result of that transfer may
144136 not be used by the state, district, or any other entity to:
145137 (1) expand Medicaid eligibility under the Patient
146138 Protection and Affordable Care Act (Pub. L. No. 111-148) as amended
147139 by the Health Care and Education Reconciliation Act of 2010 (Pub. L.
148140 No. 111-152); or
149- (2) fund the nonfederal share of payments to hospitals
150- available through the Medicaid disproportionate share hospital
151- program or the delivery system reform incentive payment program.
141+ (2) fund the nonfederal share of payments to nonpublic
142+ hospitals available through the delivery system reform incentive
143+ payment program.
152144 SUBCHAPTER D. MANDATORY PAYMENTS
153145 Sec. 298E.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER
154146 NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if
155147 the board of a district authorizes a health care provider
156148 participation program under this chapter, the board may require an
157149 annual mandatory payment to be assessed on the net patient revenue
158150 of each institutional health care provider located in the district.
159151 The board may provide for the mandatory payment to be assessed
160152 quarterly. In the first year in which the mandatory payment is
161153 required, the mandatory payment is assessed on the net patient
162- revenue of an institutional health care provider as reported in the
163- provider's Medicare cost report submitted for the most recent
164- fiscal year for which the provider submitted a Medicare cost
165- report. If the mandatory payment is required, the district shall
166- update the amount of the mandatory payment on an annual basis.
154+ revenue of an institutional health care provider as determined by
155+ the data reported to the Department of State Health Services under
156+ Sections 311.032 and 311.033 in the most recent fiscal year for
157+ which that data was reported. If the institutional health care
158+ provider did not report any data under those sections, the
159+ provider's net patient revenue is the amount of that revenue as
160+ contained in the provider's Medicare cost report submitted for the
161+ previous fiscal year or for the closest subsequent fiscal year for
162+ which the provider submitted the Medicare cost report. If the
163+ mandatory payment is required, the district shall update the amount
164+ of the mandatory payment on an annual basis.
167165 (b) The amount of a mandatory payment assessed under this
168166 chapter by the board of a district must be uniformly proportionate
169167 with the amount of net patient revenue generated by each paying
170168 provider in the district as permitted under federal law. A health
171169 care provider participation program authorized under this chapter
172170 may not hold harmless any institutional health care provider
173171 located in the district, as required under 42 U.S.C. Section
174172 1396b(w).
175173 (c) If the board of a district requires a mandatory payment
176174 authorized under this chapter, the board shall set the amount of the
177175 mandatory payment, subject to the limitations of this chapter. The
178176 aggregate amount of the mandatory payments required of all paying
179177 providers in the district may not exceed six percent of the
180178 aggregate net patient revenue from hospital services provided by
181179 all paying providers in the district.
182180 (d) Subject to Subsection (c), if the board of a district
183181 requires a mandatory payment authorized under this chapter, the
184182 board shall set the mandatory payments in amounts that in the
185183 aggregate will generate sufficient revenue to cover the
186184 administrative expenses of the district for activities under this
187185 chapter and to fund an intergovernmental transfer described by
188186 Section 298E.103(c)(1). The annual amount of revenue from
189187 mandatory payments that shall be paid for administrative expenses
190188 by the district is $150,000, plus the cost of collateralization of
191189 deposits, regardless of actual expenses.
192190 (e) A paying provider may not add a mandatory payment
193191 required under this section as a surcharge to a patient.
194192 (f) A mandatory payment assessed under this chapter is not a
195193 tax for hospital purposes for purposes of Section 4, Article IX,
196194 Texas Constitution, or Section 281.045 of this code.
197195 Sec. 298E.152. ASSESSMENT AND COLLECTION OF MANDATORY
198196 PAYMENTS. (a) A district may designate an official of the district
199197 or contract with another person to assess and collect the mandatory
200198 payments authorized under this chapter.
201199 (b) The person charged by the district with the assessment
202200 and collection of mandatory payments shall charge and deduct from
203201 the mandatory payments collected for the district a collection fee
204202 in an amount not to exceed the person's usual and customary charges
205203 for like services.
206204 (c) If the person charged with the assessment and collection
207205 of mandatory payments is an official of the district, any revenue
208206 from a collection fee charged under Subsection (b) shall be
209207 deposited in the district general fund and, if appropriate, shall
210208 be reported as fees of the district.
211209 Sec. 298E.153. PURPOSE; CORRECTION OF INVALID PROVISION OR
212- PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this
213- chapter is to authorize a district to establish a program to enable
214- the district to collect mandatory payments from institutional
215- health care providers to fund the nonfederal share of a Medicaid
210+ PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this chapter
211+ is to authorize a district to establish a program to enable the
212+ district to collect mandatory payments from institutional health
213+ care providers to fund the nonfederal share of a Medicaid
216214 supplemental payment program or the Medicaid managed care rate
217- enhancements for hospitals to support the provision of health care
218- by institutional health care providers located in the district to
219- district residents in need of health care.
215+ enhancements for nonpublic hospitals to support the provision of
216+ health care by institutional health care providers located in the
217+ district to district residents in need of health care.
220218 (b) This chapter does not authorize a district to collect
221219 mandatory payments for the purpose of raising general revenue or
222220 any amount in excess of the amount reasonably necessary to fund the
223221 nonfederal share of a Medicaid supplemental payment program or
224- Medicaid managed care rate enhancements for hospitals and to cover
225- the administrative expenses of the district associated with
226- activities under this chapter.
222+ Medicaid managed care rate enhancements for nonpublic hospitals and
223+ to cover the administrative expenses of the district associated
224+ with activities under this chapter.
227225 (c) To the extent any provision or procedure under this
228226 chapter causes a mandatory payment authorized under this chapter to
229227 be ineligible for federal matching funds, the board of a district
230228 may provide by rule for an alternative provision or procedure that
231229 conforms to the requirements of the federal Centers for Medicare
232230 and Medicaid Services. A rule adopted under this section may not
233231 create, impose, or materially expand the legal or financial
234232 liability or responsibility of the district or an institutional
235233 health care provider in the district beyond the provisions of this
236234 chapter. This section does not require the board to adopt a rule.
237235 (d) A district may only assess and collect a mandatory
238236 payment authorized under this chapter if a waiver program, uniform
239237 rate enhancement, or reimbursement described by Section
240238 298E.103(c)(1) is available to the district.
241- SECTION 2. As soon as practicable after the expiration of
242- the authority of a hospital district to administer and operate a
243- health care provider participation program under Chapter 298E,
244- Health and Safety Code, as added by this Act, the board of hospital
245- managers of the hospital district shall transfer to each
246- institutional health care provider in the district that provider's
247- proportionate share of any remaining funds in any local provider
248- participation fund created by the district under Section 298E.103,
249- Health and Safety Code, as added by this Act.
250- SECTION 3. If before implementing any provision of this Act
239+ SECTION 2. If before implementing any provision of this Act
251240 a state agency determines that a waiver or authorization from a
252241 federal agency is necessary for implementation of that provision,
253242 the agency affected by the provision shall request the waiver or
254243 authorization and may delay implementing that provision until the
255244 waiver or authorization is granted.
256- SECTION 4. This Act takes effect immediately if it receives
245+ SECTION 3. This Act takes effect immediately if it receives
257246 a vote of two-thirds of all the members elected to each house, as
258247 provided by Section 39, Article III, Texas Constitution. If this
259248 Act does not receive the vote necessary for immediate effect, this
260249 Act takes effect September 1, 2019.