By: Martinez Fischer H.B. No. 3896
Substitute the following for H.B. No. 3896:
By: Cole C.S.H.B. No. 3896
A BILL TO BE ENTITLED
AN ACT
relating to the creation and operations of a health care provider
participation program by the Bexar County Hospital District.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle D, Title 4, Health and Safety Code, is
amended by adding Chapter 298F to read as follows:
CHAPTER 298F. BEXAR COUNTY HOSPITAL DISTRICT HEALTH CARE PROVIDER
PARTICIPATION PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 298F.001. DEFINITIONS. In this chapter:
(1) "Board" means the board of hospital managers of
the district.
(2) "District" means the Bexar County Hospital
District.
(3) "Institutional health care provider" means a
nonpublic hospital located in the district that provides inpatient
hospital services.
(4) "Paying provider" means an institutional health
care provider required to make a mandatory payment under this
chapter.
(5) "Program" means the health care provider
participation program authorized by this chapter.
Sec. 298F.002. APPLICABILITY. This chapter applies only to
the Bexar County Hospital District.
Sec. 298F.003. HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
PARTICIPATION IN PROGRAM. The board may authorize the district to
participate in a health care provider participation program on the
affirmative vote of a majority of the board, subject to the
provisions of this chapter.
Sec. 298F.004. EXPIRATION. (a) Subject to Section
298F.153(d), the authority of the district to administer and
operate a program under this chapter expires December 31, 2023.
(b) This chapter expires December 31, 2023.
SUBCHAPTER B. POWERS AND DUTIES OF BOARD
Sec. 298F.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. The board may require a mandatory payment authorized
under this chapter by an institutional health care provider in the
district only in the manner provided by this chapter.
Sec. 298F.052. RULES AND PROCEDURES. The board may adopt
rules relating to the administration of the program, including
collection of the mandatory payments, expenditures, audits, and any
other administrative aspects of the program.
Sec. 298F.053. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING. If the board authorizes the district to participate in a
program under this chapter, the board shall require each
institutional health care provider to submit to the district a copy
of any financial and utilization data reported in the provider's
Medicare cost report submitted for the previous fiscal year or for
the closest subsequent fiscal year for which the provider submitted
the Medicare cost report.
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 298F.101. HEARING. (a) In each year that the board
authorizes a program under this chapter, the board shall hold a
public hearing on the amounts of any mandatory payments that the
board intends to require during the year and how the revenue derived
from those payments is to be spent.
(b) Not later than the fifth day before the date of the
hearing required under Subsection (a), the board shall publish
notice of the hearing in a newspaper of general circulation in the
district and provide written notice of the hearing to each paying
provider in the district.
(c) A representative of a paying provider is entitled to
appear at the public hearing and be heard regarding any matter
related to the mandatory payments authorized under this chapter.
Sec. 298F.102. DEPOSITORY. (a) If the board requires a
mandatory payment authorized under this chapter, the board shall
designate one or more banks as a depository for the district's local
provider participation fund.
(b) All funds collected under this chapter shall be secured
in the manner provided for securing other district funds.
Sec. 298F.103. LOCAL PROVIDER PARTICIPATION FUND;
AUTHORIZED USES OF MONEY. (a) If the district requires a mandatory
payment authorized under this chapter, the district shall create a
local provider participation fund.
(b) The local provider participation fund consists of:
(1) all revenue received by the district attributable
to mandatory payments authorized under this chapter;
(2) money received from the Health and Human Services
Commission as a refund of an intergovernmental transfer under the
program, provided that the intergovernmental transfer does not
receive a federal matching payment; and
(3) the earnings of the fund.
(c) Money deposited to the local provider participation
fund of the district may be used only to:
(1) fund intergovernmental transfers from the
district to the state to provide the nonfederal share of Medicaid
payments for:
(A) payments to nonpublic hospitals, if those
payments are authorized under the Texas Healthcare Transformation
and Quality Improvement Program waiver issued under Section 1115 of
the federal Social Security Act (42 U.S.C. Section 1315);
(B) uniform rate enhancements for nonpublic
hospitals in the Medicaid managed care service area in which the
district is located;
(C) payments available under another waiver
program authorizing Medicaid payments to nonpublic hospitals or any
payments to Medicaid managed care organizations for the benefit of
nonpublic hospitals; or
(D) any reimbursement to nonpublic hospitals for
which federal matching funds are available;
(2) subject to Section 298F.151(d), pay the
administrative expenses of the district in administering the
program, including collateralization of deposits;
(3) refund a mandatory payment collected in error from
a paying provider;
(4) refund to paying providers a proportionate share
of the money that the district:
(A) receives from the Health and Human Services
Commission that is not used to fund the nonfederal share of Medicaid
supplemental payment program payments; or
(B) determines cannot be used to fund the
nonfederal share of Medicaid supplemental payment program
payments; and
(5) transfer funds to the Health and Human Services
Commission if the district is legally required to transfer the
funds to address a disallowance of federal matching funds with
respect to programs for which the district made intergovernmental
transfers described by Subdivision (1).
(d) Money in the local provider participation fund may not
be commingled with other district funds.
(e) Notwithstanding any other provision of this chapter,
with respect to an intergovernmental transfer of funds described by
Subsection (c)(1) made by the district, any funds received by the
state, district, or other entity as a result of that transfer may
not be used by the state, district, or any other entity to:
(1) 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); or
(2) fund the nonfederal share of payments to nonpublic
hospitals available through the Medicaid disproportionate share
hospital payment program.
SUBCHAPTER D. MANDATORY PAYMENTS
Sec. 298F.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER
NET PATIENT REVENUE. (a) If the board authorizes a health care
provider participation program under this chapter, the board may
require a mandatory payment to be assessed on the net patient
revenue of each institutional health care provider located in the
district. The board may provide for the mandatory payment to be
assessed periodically throughout the year. The board shall provide
an institutional health care provider written notice of each
assessment under this subsection, and the provider has 30 calendar
days following the date of receipt of the notice to pay the
assessment. In the first year in which the mandatory payment is
required, the mandatory payment is assessed on the net patient
revenue of an institutional health care provider, which is the
amount of that revenue as reported in the provider's Medicare cost
report submitted for the previous fiscal year or for the closest
subsequent fiscal year for which the provider submitted the
Medicare cost report. If the mandatory payment is required, the
district shall update the amount of the mandatory payment on an
annual basis.
(b) The amount of a mandatory payment authorized under this
chapter must be uniformly proportionate with the amount of net
patient revenue generated by each paying provider in the district
as permitted under federal law. A health care provider
participation program authorized under this chapter may not hold
harmless any institutional health care provider, as required under
42 U.S.C. Section 1396b(w).
(c) If the board requires a mandatory payment authorized
under this chapter, the board shall set the amount of the mandatory
payment, subject to the limitations of this chapter. The aggregate
amount of the mandatory payments required of all paying providers
in the district may not exceed six percent of the aggregate net
patient revenue from hospital services provided by all paying
providers in the district.
(d) Subject to Subsection (c), if the board requires a
mandatory payment authorized under this chapter, the board shall
set the mandatory payments in amounts that in the aggregate will
generate sufficient revenue to cover the administrative expenses of
the district for activities under this chapter and to fund an
intergovernmental transfer described by Section 298F.103(c)(1).
The annual amount of revenue from mandatory payments that shall be
paid for administrative expenses of the program by the district may
not exceed 2.5 percent of the total revenue generated from the
mandatory payments, regardless of actual expenses.
(e) A paying provider may not add a mandatory payment
required under this section as a surcharge to a patient.
(f) A mandatory payment assessed under this chapter is not a
tax for hospital purposes for purposes of Section 4, Article IX,
Texas Constitution, or Section 281.045 of this code.
Sec. 298F.152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. (a) The district may designate an official of the
district or contract with another person to assess and collect the
mandatory payments authorized under this chapter.
(b) The person charged by the district with the assessment
and collection of mandatory payments shall charge and deduct from
the mandatory payments collected for the district a collection fee
in an amount not to exceed the person's usual and customary charges
for like services.
(c) If the person charged with the assessment and collection
of mandatory payments is an official of the district, any revenue
from a collection fee charged under Subsection (b) shall be
deposited in the district general fund and, if appropriate, shall
be reported as fees of the district.
Sec. 298F.153. PURPOSE; CORRECTION OF INVALID PROVISION OR
PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this
chapter is to authorize the district to establish a program to
enable the district to collect mandatory payments from
institutional health care providers to fund the nonfederal share of
a Medicaid supplemental payment program or the Medicaid managed
care rate enhancements for nonpublic hospitals to support the
provision of health care by institutional health care providers to
district residents in need of health care.
(b) This chapter does not authorize the district to collect
mandatory payments for the purpose of raising general revenue or
any amount in excess of the amount reasonably necessary to fund the
nonfederal share of a Medicaid supplemental payment program or
Medicaid managed care rate enhancements for nonpublic hospitals and
to cover the administrative expenses of the district associated
with activities under this chapter and other amounts for which the
fund may be used as described by Section 298F.103(c).
(c) To the extent any provision or procedure under this
chapter causes a mandatory payment authorized under this chapter to
be ineligible for federal matching funds, the board may provide by
rule for an alternative provision or procedure that conforms to the
requirements of the federal Centers for Medicare and Medicaid
Services. A rule adopted under this section may not create, impose,
or materially expand the legal or financial liability or
responsibility of the district or an institutional health care
provider in the district beyond the provisions of this chapter.
This section does not require the board to adopt a rule.
(d) The district may only assess and collect a mandatory
payment authorized under this chapter if a waiver program, uniform
rate enhancement, or reimbursement described by Section
298F.103(c)(1) is available to the district.
SECTION 2. As soon as practicable after the expiration of
the authority of the Bexar County Hospital District to administer
and operate a health care provider participation program under
Chapter 298F, Health and Safety Code, as added by this Act, the
board of hospital managers of the Bexar County Hospital District
shall transfer to each institutional health care provider in the
district that provider's proportionate share of any remaining funds
in any local provider participation fund created by the district
under Section 298F.103, Health and Safety 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 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.