Texas 2019 - 86th Regular

Texas House Bill HB4289 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 4289
	1	+	By: Coleman, et al. (Senate Sponsor - Kolkhorst) H.B. No. 4289
	2	+	(In the Senate - Received from the House May 8, 2019;
	3	+	May 10, 2019, read first time and referred to Committee on Health &
	4	+	Human Services; May 17, 2019, reported favorably by the following
	5	+	vote: Yeas 9, Nays 0; May 17, 2019, sent to printer.)
	6	+	Click here to see the committee vote
2	7
3	8
	9	+	A BILL TO BE ENTITLED
4	10		AN ACT
5	11		relating to the authority of certain local governments to create
6	12		and operate health care provider participation programs.
7	13		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	14		SECTION 1. Subtitle D, Title 4, Health and Safety Code, is
9	15		amended by adding Chapter 300 to read as follows:
10	16		CHAPTER 300. HEALTH CARE PROVIDER PARTICIPATION PROGRAMS IN CERTAIN
11	17		POLITICAL SUBDIVISIONS IN THIS STATE
12	18		SUBCHAPTER A. GENERAL PROVISIONS
13	19		Sec. 300.0001. PURPOSE. The purpose of this chapter is to
14	20		authorize a hospital district, county, or municipality in this
15	21		state to administer a health care provider participation program to
16	22		provide additional compensation to certain hospitals located in the
17	23		hospital district, county, or municipality by collecting mandatory
18	24		payments from each of those hospitals to be used to provide the
19	25		nonfederal share of a Medicaid supplemental payment program and for
20	26		other purposes as authorized under this chapter.
21	27		Sec. 300.0002. DEFINITIONS. In this chapter:
22	28		(1) "Institutional health care provider" means a
23	29		nonpublic hospital that provides inpatient hospital services.
24	30		(2) "Local government" means a hospital district,
25	31		county, or municipality to which this chapter applies.
26	32		(3) "Paying hospital" means an institutional health
27	33		care provider required to make a mandatory payment under this
28	34		chapter.
29	35		(4) "Program" means a health care provider
30	36		participation program authorized by this chapter.
31	37		Sec. 300.0003. APPLICABILITY. This chapter applies only
32	38		to:
33	39		(1) a hospital district that is not participating in a
34	40		health care provider participation program authorized by another
35	41		chapter of this subtitle; and
36	42		(2) a county or municipality that:
37	43		(A) is not participating in a health care
38	44		provider participation program authorized by another chapter of
39	45		this subtitle; and
40	46		(B) is not served by a hospital district or a
41	47		public hospital.
42	48		Sec. 300.0004. LOCAL JURISDICTION HEALTH CARE PROVIDER
43	49		PARTICIPATION PROGRAM; ORDER REQUIRED FOR PARTICIPATION. The
44	50		governing body of a local government may only adopt an order or
45	51		ordinance authorizing that local government to participate in a
46	52		health care provider participation program after an affirmative
47	53		vote of the majority of the governing body.
48	54		SUBCHAPTER B. POWERS AND DUTIES OF GOVERNING BODY
49	55		Sec. 300.0051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
50	56		PAYMENT. The governing body of a local government may require a
51	57		mandatory payment authorized under this chapter by an institutional
52	58		health care provider located in that hospital district, county, or
53	59		municipality, as applicable, only in the manner provided by this
54	60		chapter.
55	61		Sec. 300.0052. RULES AND PROCEDURES. The governing body of
56	62		a local government may adopt rules relating to the administration
57	63		of the health care provider participation program in the local
58	64		government, including collection of the mandatory payments,
59	65		expenditures, audits, and any other administrative aspects of the
60	66		program.
61	67		Sec. 300.0053. INSTITUTIONAL HEALTH CARE PROVIDER
62	68		REPORTING. If the governing body of a local government authorizes
63	69		the local government to participate in a health care provider
64	70		participation program under this chapter, the governing body shall
65	71		require each institutional health care provider to submit to the
66	72		local government a copy of any financial and utilization data
67	73		required by and reported to the Department of State Health Services
68	74		under Sections 311.032 and 311.033 and any rules adopted by the
69	75		executive commissioner of the Health and Human Services Commission
70	76		to implement those sections.
71	77		SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
72	78		Sec. 300.0101. HEARING. (a) In each year that the
73	79		governing body of a local government authorizes a health care
74	80		provider participation program under this chapter, the governing
75	81		body shall hold a public hearing on the amounts of any mandatory
76	82		payments that the governing body intends to require during the year
77	83		and how the revenue derived from those payments is to be spent.
78	84		(b) Not later than the fifth day before the date of the
79	85		hearing required under Subsection (a), the governing body shall
80	86		publish notice of the hearing in a newspaper of general circulation
81	87		in the hospital district, county, or municipality, as applicable,
82	88		and provide written notice of the hearing to the chief operating
83	89		officer of each institutional health care provider located in the
84	90		hospital district, county, or municipality, as applicable.
85	91		(c) A representative of a paying hospital is entitled to
86	92		appear at the time and place designated in the public notice and to
87	93		be heard regarding any matter related to the mandatory payments
88	94		authorized under this chapter.
89	95		Sec. 300.0102. LOCAL PROVIDER PARTICIPATION FUND;
90	96		DEPOSITORY. (a) Each governing body of a local government that
91	97		collects a mandatory payment authorized under this chapter shall
92	98		create a local provider participation fund.
93	99		(b) If a governing body of a local government creates a
94	100		local provider participation fund, the governing body shall
95	101		designate one or more banks as a depository for the mandatory
96	102		payments received by the local government.
97	103		(c) The governing body of a local government may withdraw or
98	104		use money in the local provider participation fund of the local
99	105		government only for a purpose authorized under this chapter.
100	106		(d) All funds collected under this chapter shall be secured
101	107		in the manner provided for securing other funds of the local
102	108		government.
103	109		Sec. 300.0103. LOCAL PROVIDER PARTICIPATION FUND;
104	110		AUTHORIZED USES OF MONEY. (a) The local provider participation
105	111		fund established by a local government under Section 300.0102
106	112		consists of:
107	113		(1) all revenue received by the local government
108	114		attributable to mandatory payments authorized under this chapter;
109	115		(2) money received from the Health and Human Services
110	116		Commission as a refund of an intergovernmental transfer from the
111	117		local government to the state for the purpose of providing the
112	118		nonfederal share of Medicaid supplemental payment program
113	119		payments, provided that the intergovernmental transfer does not
114	120		receive a federal matching payment; and
115	121		(3) the earnings of the fund.
116	122		(b) Money deposited to the local provider participation
117	123		fund of a local government may be used only to:
118	124		(1) fund intergovernmental transfers from the local
119	125		government to the state to provide the nonfederal share of Medicaid
120	126		payments for:
121	127		(A) uncompensated care payments to nonpublic
122	128		hospitals, if those payments are authorized under the Texas
123	129		Healthcare Transformation and Quality Improvement Program waiver
124	130		issued under Section 1115 of the federal Social Security Act (42
125	131		U.S.C. Section 1315);
126	132		(B) uniform rate enhancements for nonpublic
127	133		hospitals in the Medicaid managed care service area in which the
128	134		local government is located;
129	135		(C) payments available under another waiver
130	136		program authorizing payments that are substantially similar to
131	137		Medicaid payments to nonpublic hospitals described by Paragraph (A)
132	138		or (B); or
133	139		(D) any reimbursement to nonpublic hospitals for
134	140		which federal matching funds are available;
135	141		(2) subject to Section 300.0151(d), pay the
136	142		administrative expenses of the local government in administering
137	143		the program, including collateralization of deposits;
138	144		(3) refund all or a portion of a mandatory payment
139	145		collected in error from a paying hospital;
140	146		(4) refund to paying hospitals a proportionate share
141	147		of the money that the local government:
142	148		(A) receives from the Health and Human Services
143	149		Commission that is not used to fund the nonfederal share of Medicaid
144	150		supplemental payment program payments; or
145	151		(B) determines cannot be used to fund the
146	152		nonfederal share of Medicaid supplemental payment program
147	153		payments;
148	154		(5) transfer funds to the Health and Human Services
149	155		Commission if the local government is required by law to transfer
150	156		the funds to address a disallowance of federal matching funds with
151	157		respect to payments, rate enhancements, and reimbursements for
152	158		which the local government made intergovernmental transfers
153	159		described by Subdivision (1); and
154	160		(6) reimburse the local government if the local
155	161		government is required by the rules governing the uniform rate
156	162		enhancement program described by Subdivision (1)(B) to incur an
157	163		expense or forego Medicaid reimbursements from the state because
158	164		the balance of the local provider participation fund is not
159	165		sufficient to fund that rate enhancement program.
160	166		(c) Money in the local provider participation fund of a
161	167		local government may not be commingled with other funds of the local
162	168		government.
163	169		(d) Notwithstanding any other provision of this chapter,
164	170		with respect to an intergovernmental transfer of funds described by
165	171		Subsection (b)(1) made by the local government, any funds received
166	172		by the state, local government, or other entity as a result of that
167	173		transfer may not be used by the state, local government, or any
168	174		other entity to:
169	175		(1) expand Medicaid eligibility under the Patient
170	176		Protection and Affordable Care Act (Pub. L. No. 111-148) as amended
171	177		by the Health Care and Education Reconciliation Act of 2010 (Pub. L.
172	178		No. 111-152); or
173	179		(2) fund the nonfederal share of payments to nonpublic
174	180		hospitals available through the Medicaid disproportionate share
175	181		hospital program or the delivery system reform incentive payment
176	182		program.
177	183		SUBCHAPTER D. MANDATORY PAYMENTS
178	184		Sec. 300.0151. MANDATORY PAYMENTS. (a) Except as provided
179	185		by Subsection (e), if the governing body of a local government
180	186		authorizes a health care provider participation program under this
181	187		chapter, the governing body shall require an annual mandatory
182	188		payment to be assessed on the net patient revenue of each
183	189		institutional health care provider located in the hospital
184	190		district, county, or municipality, as applicable. The governing
185	191		body of the local government shall provide that the mandatory
186	192		payment is to be assessed at least annually, but not more often than
187	193		quarterly. In the first year in which the mandatory payment is
188	194		required, the mandatory payment is assessed on the net patient
189	195		revenue of an institutional health care provider located in the
190	196		hospital district, county, or municipality, as applicable, as
191	197		determined by the data reported to the Department of State Health
192	198		Services under Sections 311.032 and 311.033 in the most recent
193	199		fiscal year for which that data was reported. If the institutional
194	200		health care provider did not report any data under those sections,
195	201		the provider's net patient revenue is the amount of that revenue as
196	202		contained in the provider's Medicare cost report submitted for the
197	203		previous fiscal year or for the closest subsequent fiscal year for
198	204		which the provider submitted the Medicare cost report. The local
199	205		government shall update the amount of the mandatory payment on an
200	206		annual basis.
201	207		(b) The amount of a mandatory payment authorized under this
202	208		chapter for a local government must be uniformly proportionate with
203	209		the amount of net patient revenue generated by each paying hospital
204	210		in the hospital district, county, or municipality, as applicable,
205	211		as permitted under federal law. A health care provider
206	212		participation program authorized under this chapter may not hold
207	213		harmless any institutional health care provider, as required under
208	214		42 U.S.C. Section 1396b(w).
209	215		(c) The governing body of a local government that authorizes
210	216		a program under this chapter shall set the amount of the mandatory
211	217		payment. The aggregate amount of the mandatory payments required
212	218		of all paying hospitals in the hospital district, county, or
213	219		municipality, as applicable, may not exceed six percent of the
214	220		aggregate net patient revenue from hospital services provided by
215	221		all paying hospitals in the hospital district, county, or
216	222		municipality, as applicable.
217	223		(d) Subject to Subsection (c), the governing body of a local
218	224		government shall set the mandatory payments in amounts that in the
219	225		aggregate will generate sufficient revenue to cover the
220	226		administrative expenses of the local government for activities
221	227		under this chapter and to fund an intergovernmental transfer
222	228		described by Section 300.0103(b)(1). The annual amount of revenue
223	229		from mandatory payments that shall be paid for administrative
224	230		expenses for activities under this chapter by the local government
225	231		may not exceed $150,000, plus the cost of collateralization of
226	232		deposits, regardless of actual expenses.
227	233		(e) A paying hospital may not add a mandatory payment
228	234		required under this section as a surcharge to a patient.
229	235		(f) A mandatory payment required by the governing body of a
230	236		hospital district under this chapter is not a tax for purposes of
231	237		the applicable provision of Article IX, Texas Constitution.
232	238		Sec. 300.0152. ASSESSMENT AND COLLECTION OF MANDATORY
233	239		PAYMENTS. (a) A hospital district may designate an official of the
234	240		district or contract with another person to assess and collect the
235	241		mandatory payments authorized under this chapter.
236	242		(b) A county or municipality may collect or, using a
237	243		competitive bidding process, contract for the assessment and
238	244		collection of mandatory payments authorized under this chapter.
239	245		(c) The person charged by the local government with the
240	246		assessment and collection of mandatory payments shall charge and
241	247		deduct from the mandatory payments collected for the local
242	248		government a collection fee in an amount not to exceed the person's
243	249		usual and customary charges for like services.
244	250		(d) If the person charged with the assessment and collection
245	251		of mandatory payments is an official of the local government, any
246	252		revenue from a collection fee charged under Subsection (c) shall be
247	253		deposited in the local government general fund and, if appropriate,
248	254		shall be reported as fees of the local government.
249	255		Sec. 300.0153. CORRECTION OF INVALID PROVISION OR
250	256		PROCEDURE. (a) This chapter does not authorize a local government
251	257		to collect mandatory payments for the purpose of raising general
252	258		revenue or any amount in excess of the amount reasonably necessary
253	259		to fund the nonfederal share of a Medicaid supplemental payment
254	260		program or Medicaid managed care rate enhancements for nonpublic
255	261		hospitals and to cover the administrative expenses of the local
256	262		government associated with activities under this chapter and other
257	263		uses of the fund described by Section 300.0103(b).
258	264		(b) To the extent any provision or procedure under this
259	265		chapter causes a mandatory payment authorized under this chapter to
260	266		be ineligible for federal matching funds, the local government may
261	267		provide by rule for an alternative provision or procedure that
262	268		conforms to the requirements of the federal Centers for Medicare
263	269		and Medicaid Services. A rule adopted under this section may not
264	270		create, impose, or materially expand the legal or financial
265	271		liability or responsibility of the local government or an
266	272		institutional health care provider in the local hospital district,
267	273		county, or municipality, as applicable, beyond the provisions of
268	274		this chapter. This section does not require the governing body of a
269	275		local government to adopt a rule.
270	276		(c) The local government may only assess and collect a
271	277		mandatory payment authorized under this chapter if a waiver
272	278		program, uniform rate enhancement, or reimbursement described by
273	279		Section 300.0103(b)(1) is available to the local government.
274	280		Sec. 300.0154. REPORTING REQUIREMENTS. (a) The governing
275	281		body of each local government that authorizes a program under this
276	282		chapter shall report information to the Health and Human Services
277	283		Commission regarding the program on a schedule determined by the
278	284		commission.
279	285		(b) The information must include:
280	286		(1) the amount of the mandatory payments required and
281	287		collected in each year the program is authorized;
282	288		(2) any expenditure of money attributable to mandatory
283	289		payments collected under this chapter, including:
284	290		(A) any contract with an entity for the
285	291		administration or operation of a program authorized by this
286	292		chapter; or
287	293		(B) a contract with a person for the assessment
288	294		and collection of a mandatory payment as authorized under Section
289	295		300.0152; and
290	296		(3) the amount of money attributable to mandatory
291	297		payments collected under this chapter that is used for any other
292	298		purpose.
293	299		(c) The executive commissioner of the Health and Human
294	300		Services Commission shall adopt rules to administer this section.
295	301		Sec. 300.0155. EXPIRATION OF AUTHORITY. The authority of a
296	302		local government to administer and operate a program under this
297	303		chapter expires on September 1 following the second anniversary of
298	304		the date the governing body of the local government adopted the
299	305		order or ordinance authorizing the local government to participate
300	306		in the program as provided by Section 300.0004.
301	307		Sec. 300.0156. AUTHORITY TO REFUSE FOR VIOLATION. The
302	308		Health and Human Services Commission may refuse to accept money
303	309		from a local provider participation fund established under this
304	310		chapter if the commission determines that doing so may violate
305	311		federal law.
306	312		SECTION 2. Subtitle D, Title 4, Health and Safety Code, is
307	313		amended by adding Chapter 300A to read as follows:
308	314		CHAPTER 300A. HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
309	315		DISTRICTS COMPOSED OF CERTAIN LOCAL GOVERNMENTS
310	316		SUBCHAPTER A. GENERAL PROVISIONS
311	317		Sec. 300A.0001. PURPOSE. The purpose of this chapter is to
312	318		authorize certain local governments to create a district to
313	319		administer a health care provider participation program to provide
314	320		additional compensation to certain hospitals in the district by
315	321		collecting mandatory payments from each of those hospitals in the
316	322		district to be used to provide the nonfederal share of a Medicaid
317	323		supplemental payment program and for other purposes as authorized
318	324		under this chapter.
319	325		Sec. 300A.0002. DEFINITIONS. In this chapter:
320	326		(1) "Board" means the board of directors of a
321	327		district.
322	328		(2) "Director" means a member of the board.
323	329		(3) "District" means a health care provider
324	330		participation district created under this chapter.
325	331		(4) "Institutional health care provider" means a
326	332		nonpublic hospital that provides inpatient hospital services.
327	333		(5) "Local government" means a hospital district,
328	334		county, or municipality to which this chapter applies.
329	335		(6) "Paying hospital" means an institutional health
330	336		care provider required to make a mandatory payment under this
331	337		chapter.
332	338		(7) "Program" means a health care provider
333	339		participation program authorized by this chapter.
334	340		Sec. 300A.0003. APPLICABILITY. This chapter applies only
335	341		to:
336	342		(1) a hospital district that:
337	343		(A) is not participating in a health care
338	344		provider participation program authorized by another chapter of
339	345		this subtitle; and
340	346		(B) has only one institutional health care
341	347		provider located in the district; and
342	348		(2) a county or municipality that:
343	349		(A) is not participating in a health care
344	350		provider participation program authorized by another chapter of
345	351		this subtitle;
346	352		(B) is not served by a hospital district or a
347	353		public hospital; and
348	354		(C) has only one institutional health care
349	355		provider located in the county or municipality.
350	356		SUBCHAPTER B. CREATION, OPERATION, AND DISSOLUTION OF DISTRICT
351	357		Sec. 300A.0021. CREATION BY CONCURRENT ORDERS. (a) A local
352	358		government and one or more other local governments may create a
353	359		district by adopting concurrent orders.
354	360		(b) A concurrent order to create a district must:
355	361		(1) be approved by the governing body of each creating
356	362		local government;
357	363		(2) contain identical provisions; and
358	364		(3) define the boundaries of the district to be
359	365		coextensive with the combined boundaries of each creating local
360	366		government.
361	367		Sec. 300A.0022. POWERS. A district may authorize and
362	368		administer a health care provider participation program in
363	369		accordance with this chapter.
364	370		Sec. 300A.0023. BOARD OF DIRECTORS. (a) If three or more
365	371		local governments create a district, the presiding officer of the
366	372		governing body of each local government that creates the district
367	373		shall appoint one director.
368	374		(b) If two local governments create a district:
369	375		(1) the presiding officer of the governing body of the
370	376		most populous local government shall appoint two directors; and
371	377		(2) the presiding officer of the governing body of the
372	378		other local government shall appoint one director.
373	379		(c) Directors serve staggered two-year terms, with as near
374	380		as possible to one-half of the directors' terms expiring each year.
375	381		(d) A vacancy in the office of director shall be filled for
376	382		the unexpired term in the same manner as the original appointment.
377	383		(e) The board shall elect from among its members a
378	384		president. The president may vote and may cast an additional vote
379	385		to break a tie.
380	386		(f) The board shall also elect from among its members a vice
381	387		president.
382	388		(g) The board shall appoint a secretary, who need not be a
383	389		director.
384	390		(h) Each officer of the board serves for a term of one year.
385	391		(i) The board shall fill a vacancy in a board office for the
386	392		unexpired term.
387	393		(j) A majority of the members of the board voting must
388	394		concur in a matter relating to the business of the district.
389	395		Sec. 300A.0024. QUALIFICATIONS FOR OFFICE. (a) To be
390	396		eligible to serve as a director, a person must be a resident of the
391	397		local government that appoints the person under Section 300A.0023.
392	398		(b) An employee of the district may not serve as a director.
393	399		Sec. 300A.0025. COMPENSATION. (a) Directors and officers
394	400		serve without compensation but may be reimbursed for actual
395	401		expenses incurred in the performance of official duties.
396	402		(b) Expenses reimbursed under this section must be:
397	403		(1) reported in the district's minute book or other
398	404		district records; and
399	405		(2) approved by the board.
400	406		Sec. 300A.0026. AUTHORITY TO SUE AND BE SUED. The board may
401	407		sue and be sued on behalf of the district.
402	408		Sec. 300A.0027. DISTRICT FINANCES. Subchapter F, Chapter
403	409		287, other than Sections 287.129 and 287.130, applies to the
404	410		district in the same manner that those provisions apply to a health
405	411		services district created under Chapter 287. This section does not
406	412		authorize the district to issue bonds.
407	413		Sec. 300A.0028. DISSOLUTION. A district shall be dissolved
408	414		if the local governments that created the district adopt concurrent
409	415		orders to dissolve the district and the concurrent orders contain
410	416		identical provisions.
411	417		Sec. 300A.0029. ADMINISTRATION OF PROPERTY, DEBTS, AND
412	418		ASSETS AFTER DISSOLUTION. (a) After dissolution of a district
413	419		under Section 300A.0028, the board shall continue to control and
414	420		administer any property, debts, and assets of the district until
415	421		all funds have been disposed of and all district debts have been
416	422		paid or settled.
417	423		(b) As soon as practicable after the dissolution of the
418	424		district, the board shall transfer to each institutional health
419	425		care provider in the district the provider's proportionate share of
420	426		any remaining funds in any local provider participation fund
421	427		created by the district under Section 300A.0102.
422	428		(c) If, after administering any property and assets, the
423	429		board determines that the district's property and assets are
424	430		insufficient to pay the debts of the district, the district shall
425	431		transfer the remaining debts to the local governments that created
426	432		the district in proportion to the funds contributed to the district
427	433		by each local government, including a paying hospital in the local
428	434		government.
429	435		(d) If, after complying with Subsections (b) and (c) and
430	436		administering the property and assets, the board determines that
431	437		unused funds remain, the board shall transfer the unused funds to
432	438		the local governments that created the district in proportion to
433	439		the funds contributed to the district by each local government,
434	440		including a paying hospital in the local government.
435	441		Sec. 300A.0030. ACCOUNTING AFTER DISSOLUTION. After the
436	442		district has paid all its debts and has disposed of all its assets
437	443		and funds as prescribed by Section 300A.0029, the board shall
438	444		provide an accounting to each local government that created the
439	445		district. The accounting must show the manner in which the assets
440	446		and debts of the district were distributed.
441	447		SUBCHAPTER C. HEALTH CARE PROVIDER PARTICIPATION PROGRAM; POWERS
442	448		AND DUTIES OF DISTRICT BOARD
443	449		Sec. 300A.0051. HEALTH CARE PROVIDER PARTICIPATION
444	450		PROGRAM. The board of a district may authorize the district to
445	451		participate in a health care provider participation program on the
446	452		affirmative vote of a majority of the board, subject to the
447	453		provisions of this chapter.
448	454		Sec. 300A.0052. LIMITATION ON AUTHORITY TO REQUIRE
449	455		MANDATORY PAYMENT. The board may require a mandatory payment
450	456		authorized under this chapter by an institutional health care
451	457		provider in the district only in the manner provided by this
452	458		chapter.
453	459		Sec. 300A.0053. RULES AND PROCEDURES. The board may adopt
454	460		rules relating to the administration of the health care provider
455	461		participation program in the district, including collection of the
456	462		mandatory payments, expenditures, audits, and any other
457	463		administrative aspects of the program.
458	464		Sec. 300A.0054. INSTITUTIONAL HEALTH CARE PROVIDER
459	465		REPORTING. If the board authorizes the district to participate in a
460	466		health care provider participation program under this chapter, the
461	467		board shall require each institutional health care provider located
462	468		in the district to submit to the district a copy of any financial
463	469		and utilization data required by and reported to the Department of
464	470		State Health Services under Sections 311.032 and 311.033 and any
465	471		rules adopted by the executive commissioner of the Health and Human
466	472		Services Commission to implement those sections.
467	473		SUBCHAPTER D. GENERAL FINANCIAL PROVISIONS
468	474		Sec. 300A.0101. HEARING. (a) In each year that the board
469	475		authorizes a health care provider participation program under this
470	476		chapter, the board shall hold a public hearing on the amounts of any
471	477		mandatory payments that the board intends to require during the
472	478		year and how the revenue derived from those payments is to be spent.
473	479		(b) Not later than the fifth day before the date of the
474	480		hearing required under Subsection (a), the board shall publish
475	481		notice of the hearing in a newspaper of general circulation in each
476	482		local government that creates the district and provide written
477	483		notice of the hearing to the chief operating officer of each
478	484		institutional health care provider in the district.
479	485		(c) A representative of a paying hospital is entitled to
480	486		appear at the time and place designated in the public notice and be
481	487		heard regarding any matter related to the mandatory payments
482	488		authorized under this chapter.
483	489		Sec. 300A.0102. LOCAL PROVIDER PARTICIPATION FUND;
484	490		DEPOSITORY. (a) If the board collects a mandatory payment
485	491		authorized under this chapter, the board shall create a local
486	492		provider participation fund in one or more banks designated by the
487	493		district as a depository for the mandatory payments received by the
488	494		district.
489	495		(b) The board may withdraw or use money in the local
490	496		provider participation fund of the district only for a purpose
491	497		authorized under this chapter.
492	498		(c) All funds collected under this chapter shall be secured
493	499		in the manner provided for securing public funds.
494	500		Sec. 300A.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY.
495	501		(a) The local provider participation fund established under
496	502		Section 300A.0102 consists of:
497	503		(1) all revenue received by the district attributable
498	504		to mandatory payments authorized under this chapter;
499	505		(2) money received from the Health and Human Services
500	506		Commission as a refund of an intergovernmental transfer from the
501	507		district to the state for the purpose of providing the nonfederal
502	508		share of Medicaid supplemental payment program payments, provided
503	509		that the intergovernmental transfer does not receive a federal
504	510		matching payment; and
505	511		(3) the earnings of the fund.
506	512		(b) Money deposited to the local provider participation
507	513		fund may be used only to:
508	514		(1) fund intergovernmental transfers from the
509	515		district to the state to provide the nonfederal share of Medicaid
510	516		payments for:
511	517		(A) uncompensated care payments to nonpublic
512	518		hospitals, if those payments are authorized under the Texas
513	519		Healthcare Transformation and Quality Improvement Program waiver
514	520		issued under Section 1115 of the federal Social Security Act (42
515	521		U.S.C. Section 1315);
516	522		(B) uniform rate enhancements for nonpublic
517	523		hospitals in the Medicaid managed care service area in which the
518	524		district is located;
519	525		(C) payments available under another waiver
520	526		program authorizing payments that are substantially similar to
521	527		Medicaid payments to nonpublic hospitals described by Paragraph (A)
522	528		or (B); or
523	529		(D) any reimbursement to nonpublic hospitals for
524	530		which federal matching funds are available;
525	531		(2) subject to Section 300A.0151(d), pay the
526	532		administrative expenses of the district in administering the
527	533		program, including collateralization of deposits;
528	534		(3) refund all or a portion of a mandatory payment
529	535		collected in error from a paying hospital;
530	536		(4) refund to paying hospitals a proportionate share
531	537		of the money that the district:
532	538		(A) receives from the Health and Human Services
533	539		Commission that is not used to fund the nonfederal share of Medicaid
534	540		supplemental payment program payments; or
535	541		(B) determines cannot be used to fund the
536	542		nonfederal share of Medicaid supplemental payment program
537	543		payments;
538	544		(5) transfer funds to the Health and Human Services
539	545		Commission if the district is required by law to transfer the funds
540	546		to address a disallowance of federal matching funds with respect to
541	547		payments, rate enhancements, and reimbursements for which the
542	548		district made intergovernmental transfers described by Subdivision
543	549		(1); and
544	550		(6) reimburse the district if the district is required
545	551		by the rules governing the uniform rate enhancement program
546	552		described by Subdivision (1)(B) to incur an expense or forego
547	553		Medicaid reimbursements from the state because the balance of the
548	554		local provider participation fund is not sufficient to fund that
549	555		rate enhancement program.
550	556		(c) Money in the local provider participation fund may not
551	557		be commingled with other district funds or other funds of a local
552	558		government that creates the district.
553	559		(d) Notwithstanding any other provision of this chapter,
554	560		with respect to an intergovernmental transfer of funds described by
555	561		Subsection (b)(1) made by the district, any funds received by the
556	562		state, district, or other entity as a result of the transfer may not
557	563		be used by the state, district, or any other entity to:
558	564		(1) expand Medicaid eligibility under the Patient
559	565		Protection and Affordable Care Act (Pub. L. No. 111-148) as amended
560	566		by the Health Care and Education Reconciliation Act of 2010 (Pub. L.
561	567		No. 111-152); or
562	568		(2) fund the nonfederal share of payments to nonpublic
563	569		hospitals available through the Medicaid disproportionate share
564	570		hospital program or the delivery system reform incentive payment
565	571		program.
566	572		Sec. 300A.0104. ACCOUNTING OF FUNDS. The district shall
567	573		maintain an accounting of the funds received from each local
568	574		government that creates the district, including a paying hospital
569	575		located in a hospital district, county, or municipality that
570	576		created the district, as applicable.
571	577		SUBCHAPTER E. MANDATORY PAYMENTS
572	578		Sec. 300A.0151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL
573	579		NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if
574	580		the board authorizes a health care provider participation program
575	581		under this chapter, the district shall require an annual mandatory
576	582		payment to be assessed on the net patient revenue of each
577	583		institutional health care provider located in the district. The
578	584		board shall provide that the mandatory payment is to be assessed at
579	585		least annually, but not more often than quarterly. In the first
580	586		year in which the mandatory payment is required, the mandatory
581	587		payment is assessed on the net patient revenue of an institutional
582	588		health care provider located in the district as determined by the
583	589		data reported to the Department of State Health Services under
584	590		Sections 311.032 and 311.033 in the most recent fiscal year for
585	591		which that data was reported. If the institutional health care
586	592		provider did not report any data under those sections, the
587	593		provider's net patient revenue is the amount of that revenue as
588	594		contained in the provider's Medicare cost report submitted for the
589	595		previous fiscal year or for the closest subsequent fiscal year for
590	596		which the provider submitted the Medicare cost report. The
591	597		district shall update the amount of the mandatory payment on an
592	598		annual basis.
593	599		(b) The amount of a mandatory payment authorized under this
594	600		chapter must be uniformly proportionate with the amount of net
595	601		patient revenue generated by each paying hospital in the district
596	602		as permitted under federal law. A health care provider
597	603		participation program authorized under this chapter may not hold
598	604		harmless any institutional health care provider, as required under
599	605		42 U.S.C. Section 1396b(w).
600	606		(c) The board shall set the amount of a mandatory payment
601	607		authorized under this chapter. The aggregate amount of the
602	608		mandatory payments required of all paying hospitals in the district
603	609		may not exceed six percent of the aggregate net patient revenue from
604	610		hospital services provided by all paying hospitals in the district.
605	611		(d) Subject to Subsection (c), the board shall set the
606	612		mandatory payments in amounts that in the aggregate will generate
607	613		sufficient revenue to cover the administrative expenses of the
608	614		district for activities under this chapter and to fund an
609	615		intergovernmental transfer described by Section 300A.0103(b)(1).
610	616		The annual amount of revenue from mandatory payments that shall be
611	617		paid for administrative expenses by the district for activities
612	618		under this chapter may not exceed $150,000, plus the cost of
613	619		collateralization of deposits, regardless of actual expenses.
614	620		(e) A paying hospital may not add a mandatory payment
615	621		required under this section as a surcharge to a patient.
616	622		(f) For purposes of any hospital district that creates a
617	623		district under this chapter, a mandatory payment assessed under
618	624		this chapter is not a tax for hospital purposes for purposes of the
619	625		applicable provision of Article IX, Texas Constitution.
620	626		Sec. 300A.0152. ASSESSMENT AND COLLECTION OF MANDATORY
621	627		PAYMENTS. (a) The district may designate an official of the
622	628		district or contract with another person to assess and collect the
623	629		mandatory payments authorized under this chapter.
624	630		(b) The person charged by the district with the assessment
625	631		and collection of mandatory payments shall charge and deduct from
626	632		the mandatory payments collected for the district a collection fee
627	633		in an amount not to exceed the person's usual and customary charges
628	634		for like services.
629	635		(c) If the person charged with the assessment and collection
630	636		of mandatory payments is an official of the district, any revenue
631	637		from a collection fee charged under Subsection (b) shall be
632	638		deposited in the district general fund and, if appropriate, shall
633	639		be reported as fees of the district.
634	640		Sec. 300A.0153. CORRECTION OF INVALID PROVISION OR
635	641		PROCEDURE; LIMITATION OF AUTHORITY. (a) This chapter does not
636	642		authorize the district to collect mandatory payments for the
637	643		purpose of raising general revenue or any amount in excess of the
638	644		amount reasonably necessary to:
639	645		(1) fund the nonfederal share of a Medicaid
640	646		supplemental payment program or Medicaid managed care rate
641	647		enhancements for nonpublic hospitals; and
642	648		(2) cover the administrative expenses of the district
643	649		associated with activities under this chapter and other uses of the
644	650		fund described by Section 300A.0103(b).
645	651		(b) To the extent any provision or procedure under this
646	652		chapter causes a mandatory payment authorized under this chapter to
647	653		be ineligible for federal matching funds, the board may provide by
648	654		rule for an alternative provision or procedure that conforms to the
649	655		requirements of the federal Centers for Medicare and Medicaid
650	656		Services. A rule adopted under this section may not create, impose,
651	657		or materially expand the legal or financial liability or
652	658		responsibility of the district or an institutional health care
653	659		provider in the district beyond the provisions of this chapter.
654	660		This section does not require the board to adopt a rule.
655	661		(c) The district may only assess and collect a mandatory
656	662		payment authorized under this chapter if a waiver program, uniform
657	663		rate enhancement, or reimbursement described by Section
658	664		300A.0103(b)(1) is available to the district.
659	665		Sec. 300A.0154. REPORTING REQUIREMENTS. (a) The board of a
660	666		district that authorizes a program under this chapter shall report
661	667		information to the Health and Human Services Commission regarding
662	668		the program on a schedule determined by the commission.
663	669		(b) The information must include:
664	670		(1) the amount of the mandatory payments required and
665	671		collected in each year the program is authorized;
666	672		(2) any expenditure of money attributable to mandatory
667	673		payments collected under this chapter, including:
668	674		(A) any contract with an entity for the
669	675		administration or operation of a program authorized by this
670	676		chapter; or
671	677		(B) a contract with a person for the assessment
672	678		and collection of a mandatory payment as authorized under Section
673	679		300A.0152; and
674	680		(3) the amount of money attributable to mandatory
675	681		payments collected under this chapter that is used for any other
676	682		purpose.
677	683		(c) The executive commissioner of the Health and Human
678	684		Services Commission shall adopt rules to administer this section.
679	685		Sec. 300A.0155. EXPIRATION OF AUTHORITY. The authority of
680	686		a district to administer and operate a program under this chapter
681	687		expires on September 1 following the second anniversary of the date
682	688		the board of the district authorized the district to participate in
683	689		the program as provided by Section 300A.0051.
684	690		Sec. 300A.0156. AUTHORITY TO REFUSE FOR VIOLATION. The
685	691		Health and Human Services Commission may refuse to accept money
686	692		from a local provider participation fund established under this
687	693		chapter if the commission determines that doing so may violate
688	694		federal law.
689	695		SECTION 3. As soon as practicable after the expiration of
690	696		the authority of a local government to administer and operate a
691	697		health care provider participation program under Chapter 300 or
692	698		300A, Health and Safety Code, as added by this Act, the governing
693	699		body of the local government shall transfer to each institutional
694	700		health care provider in the boundaries of the local government that
695	701		provider's proportionate share of any remaining funds in any local
696	702		provider participation fund created by the local government under
697	703		Chapter 300 or 300A, Health and Safety Code, as added by this Act.
698	704		SECTION 4. If before implementing any provision of this Act
699	705		a state agency determines that a waiver or authorization from a
700	706		federal agency is necessary for implementation of that provision,
701	707		the agency affected by the provision shall request the waiver or
702	708		authorization and may delay implementing that provision until the
703	709		waiver or authorization is granted.
704	710		SECTION 5. This Act takes effect immediately if it receives
705	711		a vote of two-thirds of all the members elected to each house, as
706	712		provided by Section 39, Article III, Texas Constitution. If this
707	713		Act does not receive the vote necessary for immediate effect, this
708	714		Act takes effect September 1, 2019.
709		-	______________________________ ______________________________
710		-	President of the Senate Speaker of the House
711		-	I certify that H.B. No. 4289 was passed by the House on May 8,
712		-	2019, by the following vote: Yeas 101, Nays 40, 1 present, not
713		-	voting.
714		-	______________________________
715		-	Chief Clerk of the House
716		-	I certify that H.B. No. 4289 was passed by the Senate on May
717		-	22, 2019, by the following vote: Yeas 31, Nays 0.
718		-	______________________________
719		-	Secretary of the Senate
720		-	APPROVED: _____________________
721		-	Date
722		-	_____________________
723		-	Governor
	715	+	* * * * *