86R13354 JCG-D
By: Price H.B. No. 4077
A BILL TO BE ENTITLED
AN ACT
relating to rural hospitals and similar facilities; requiring a
license; authorizing fees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 531, Government Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G. RURAL HOSPITALS
Sec. 531.201. STRATEGIC PLAN; REPORT. (a) The commission
shall develop and implement a strategic plan to ensure that the
citizens of this state residing in rural areas have access to
hospital services.
(b) The strategic plan must include:
(1) a proposal for using at least one of the following
methods to ensure access to hospital services in the rural areas of
this state:
(A) an enhanced cost reimbursement methodology
for the payment of rural hospitals participating in the Medicaid
managed care program in conjunction with a supplemental payment
program for rural hospitals to cover costs incurred in providing
services to recipients;
(B) a hospital rate enhancement program that
applies only to rural hospitals;
(C) a reduction of punitive actions under the
Medicaid program that require reimbursement for Medicaid payments
made to the provider, if the provider is a rural hospital, a
reduction of the frequency of payment reductions under the Medicaid
program made to rural hospitals, and an enhancement of payments
made under merit-based programs or similar programs for rural
hospitals;
(D) a reduction of state regulatory-related
costs related to the commission's review of rural hospitals; or
(E) in accordance with rules adopted by the
Centers for Medicare and Medicaid Services, the establishment of a
minimum fee schedule that applies to payments made by managed care
organizations to rural hospitals; and
(2) target dates for achieving goals related to the
proposal described by Subdivision (1).
(c) Not later than January 1, 2020, the commission shall
submit the strategic plan developed under Subsection (b) to the
Legislative Budget Board for comment and review. The commission
may not begin implementation of the proposal contained in the
strategic plan until the strategic plan is approved by the
Legislative Budget Board.
(d) Not later than November 1 of each even-numbered year,
the commission shall submit a report regarding the commission's
development and implementation of the strategic plan described by
Subsection (b) to:
(1) the legislature;
(2) the governor; and
(3) the Legislative Budget Board.
Sec. 531.202. ADVISORY COMMITTEE ON RURAL HOSPITALS. (a)
The commission shall establish the Rural Hospital Advisory
Committee, either as another advisory committee or as a
subcommittee of the Hospital Payment Advisory Committee, to advise
the commission on issues relating specifically to rural hospitals.
(b) The Rural Hospital Advisory Committee is composed of
interested persons appointed by the executive commissioner.
Section 2110.002 does not apply to the advisory committee.
(c) A member of the advisory committee serves without
compensation.
Sec. 531.203. COLLABORATION WITH OFFICE OF RURAL AFFAIRS.
The commission shall collaborate with the Office of Rural Affairs
to ensure that this state is pursuing to the fullest extent possible
federal grants, funding opportunities, and support programs
available to rural hospitals as administered by the Health
Resources and Services Administration and the Office of Minority
Health in the United States Department of Health and Human
Services.
SECTION 2. Subchapter A, Chapter 533, Government Code, is
amended by adding Section 533.0041 to read as follows:
Sec. 533.0041. REIMBURSEMENT METHODOLOGY FOR RURAL
HOSPITALS. To the extent allowed by federal law and
notwithstanding any state law, the executive commissioner shall by
rule adopt a reimbursement methodology for the payment of rural
hospitals participating in the Medicaid managed care program that
ensures the rural hospitals are reimbursed on an individual basis
that allows the rural hospitals to fully recover allowable costs
incurred in providing services to recipients. In adopting rules
under this section, the executive commissioner:
(1) may adopt a methodology that requires:
(A) the commission to directly reimburse rural
hospitals for allowable costs; or
(B) a managed care organization to reimburse
rural hospitals; and
(2) shall define "allowable costs" and "rural
hospital" for purposes of this section.
SECTION 3. Chapter 241, Health and Safety Code, is amended
by adding Subchapter K to read as follows:
SUBCHAPTER K. LIMITED SERVICES RURAL HOSPITAL
Sec. 241.301. DEFINITION. In this subchapter, "limited
services rural hospital" means a general or special hospital that
is or was licensed under this chapter and that:
(1) is:
(A) located in a rural area, as defined by:
(i) commission rule; or
(ii) 42 U.S.C. Section 1395ww(d)(2)(D); or
(B) designated by the Centers for Medicare and
Medicaid Services as a critical access hospital, rural referral
center, or sole community hospital; and
(2) otherwise meets the requirements to be designated
as a limited services rural hospital or a similarly designated
hospital under federal law.
Sec. 241.302. LICENSE REQUIRED; FEES. (a) A person may not
establish, conduct, or maintain a limited services rural hospital
unless:
(1) the United States Congress passes a bill creating
a payment program specifically for limited services rural hospitals
or similarly designated hospitals that becomes law; and
(2) the commission issues a license to the person to
establish, conduct, or maintain a limited services rural hospital
under this subchapter.
(b) If the United States Congress enacts a bill described by
Subsection (a)(1) that becomes law, the commission shall adopt
rules:
(1) establishing minimum standards for the
facilities; and
(2) implementing this section.
(c) The standards adopted under Subsection (b) must be at
least as stringent as the standards established in the law
described by Subsection (a) for eligibility to qualify for a
payment program established by the law.
(d) An applicant for a license under this section must:
(1) submit an application for the license to the
commission in a form and manner prescribed by the commission; and
(2) pay any required fee.
(e) The commission shall issue a license to act as a limited
services rural hospital under this subchapter if the applicant
complies with the rules and standards adopted under this section.
(f) The commission by order may waive or modify the
requirement of a particular provision of this chapter or a standard
adopted under this section if the commission determines that the
waiver or modification will facilitate the creation or operation of
the facility and that the waiver or modification is in the best
interests of the individuals served or to be served by the facility.
Sections 241.026(d) and (e) apply to a waiver or modification under
this section for a limited services rural hospital in the same
manner as the subsections apply to a waiver or modification for a
hospital.
(g) A provision of this chapter related to the enforcement
authority of the commission applies to a limited services rural
hospital.
SECTION 4. This Act takes effect September 1, 2019.