By: Wray H.B. No. 4548
A BILL TO BE ENTITLED
AN ACT
relating to the creation and operations of health care provider
participation programs in certain counties.
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 299 to read as follows:
CHAPTER 299. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
CERTAIN COUNTIES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 299.001. DEFINITIONS. In this chapter:
(1) "Institutional health care provider" means a
nonpublic hospital that provides inpatient hospital services.
(2) "Paying hospital" means an institutional health
care provider required to make a mandatory payment under this
chapter.
(3) "Program" means the county health care provider
participation program authorized by this chapter.
Sec. 299.002. APPLICABILITY. This chapter applies only to
a county that:
(1) is adjacent to two counties with a population of
1,000,000 or more; and
(2) borders the Trinity River.
Sec. 299.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION
PROGRAM; PARTICIPATION IN PROGRAM. (a) A county health care
provider participation program authorizes a county to collect a
mandatory payment from each institutional health care provider
located in the county to be deposited in a local provider
participation fund established by the county. Money in the fund may
be used by the county to fund certain intergovernmental transfers
and indigent care programs as provided by this chapter.
(b) The commissioners court may adopt an order authorizing a
county to participate in the program, subject to the limitations
provided by this chapter.
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT
Sec. 299.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. The commissioners court of a county may require a
mandatory payment authorized under this chapter by an institutional
health care provider in the county only in the manner provided by
this chapter.
Sec. 299.052. MAJORITY VOTE REQUIRED. The commissioners
court of a county may not authorize the county to collect a
mandatory payment authorized under this chapter without an
affirmative vote of a majority of the members of the commissioners
court.
Sec. 299.053. RULES AND PROCEDURES. After the
commissioners court has voted to require a mandatory payment
authorized under this chapter, the commissioners court may adopt
rules relating to the administration of the mandatory payment.
Sec. 299.054. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING; INSPECTION OF RECORDS. (a) The commissioners court of a
county that collects a mandatory payment authorized under this
chapter shall require each institutional health care provider to
submit to the county a copy of any financial and utilization data
required by and reported to the Department of State Health Services
under Sections 311.032 and 311.033 and any rules adopted by the
executive commissioner of the Health and Human Services Commission
to implement those sections.
(b) The commissioners court of a county that collects a
mandatory payment authorized under this chapter may inspect the
records of an institutional health care provider to the extent
necessary to ensure compliance with the requirements of Subsection
(a).
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 299.101. HEARING. (a) Each year, the commissioners
court of a county that collects a mandatory payment authorized
under this chapter shall hold a public hearing on the amounts of any
mandatory payments that the commissioners court intends to require
during the year and how the revenue derived from those payments is
to be spent.
(b) Not later than the 10th day before the date of the
hearing required under Subsection (a), the commissioners court of
the county shall publish notice of the hearing in a newspaper of
general circulation in the county.
(c) A representative of a paying hospital is entitled to
appear at the time and place designated in the public notice and to
be heard regarding any matter related to the mandatory payments
authorized under this chapter.
Sec. 299.102. DEPOSITORY. (a) The commissioners court of
each county that collects a mandatory payment authorized under this
chapter by resolution shall designate one or more banks located in
the county as the depository for mandatory payments received by the
county. A bank designated as a depository serves for two years or
until a successor is designated.
(b) All income received by a county under this chapter,
including the revenue from mandatory payments remaining after
discounts and fees for assessing and collecting the payments are
deducted, shall be deposited with the county depository in the
county's local provider participation fund and may be withdrawn
only as provided by this chapter.
(c) All funds under this chapter shall be secured in the
manner provided for securing county funds.
Sec. 299.103. LOCAL PROVIDER PARTICIPATION FUND;
AUTHORIZED USES OF MONEY. (a) Each county shall create a local
provider participation fund.
(b) The local provider participation fund of a county
consists of:
(1) all revenue received by the county attributable to
mandatory payments authorized under this chapter, including any
amounts received attributable to a suit to enforce liability for
and collect a delinquent mandatory payment;
(2) money received from the Health and Human Services
Commission as a refund of an intergovernmental transfer from the
county to the state for the purpose of providing the nonfederal
share of Medicaid supplemental payment program payments, 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 may be used only to:
(1) fund intergovernmental transfers from the county
to the state to provide:
(A) the nonfederal share of a Medicaid
supplemental payment program authorized under the state Medicaid
plan, 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), or under a successor
waiver program authorizing similar Medicaid supplemental payment
programs; or
(B) payments to Medicaid managed care
organizations that are dedicated for payment to hospitals;
(2) subsidize indigent programs;
(3) pay the administrative expenses of the county;
(4) refund a portion of a mandatory payment collected
in error from a paying hospital; and
(5) refund to paying hospitals the proportionate share
of money received by the county from the Health and Human Services
Commission that is not used to fund the nonfederal share of Medicaid
supplemental payment program payments;
(6) refund to paying hospitals the proportionate share
of money that the county determines cannot be used to fund the
nonfederal share of Medicaid supplemental payment program payment;
and
(7) pay for any reasonable expenses the county incurs
in order to collect delinquent mandatory payments, including any
attorney's fees incurred as a result of contracting with an
attorney to represent the county in seeking and enforcing the
collection of delinquent mandatory payments.
(d) Money in the local provider participation fund may not
be commingled with other county funds.
(e) An intergovernmental transfer of funds described by
Subsection (c)(1) and any funds received by the county as a result
of an intergovernmental transfer described by that subsection may
not be used by the county or any other entity to 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).
SUBCHAPTER D. MANDATORY PAYMENTS
Sec. 299.151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), the
commission of a county may require an annual mandatory payment to be
assessed quarterly on the net patient revenue of an institutional
health care provider located in the county. 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 as determined by the data reported to the Department of
State Health Services under Sections 311.032 and 311.033 in the
fiscal year ending in 2010. The county may 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 hospital in the county. A
mandatory payment authorized under this chapter may not hold
harmless any institutional health care provider, as required under
42 U.S.C. Section 1396b(w).
(c) The commissioners court of a county that collects a
mandatory payment authorized under this chapter shall set the
amount of the mandatory payment. The amount of the mandatory
payment required of each paying hospital may not exceed an amount
that, when added to the amount of the mandatory payments required
from all other paying hospitals in the county, equals an amount of
revenue that exceeds six percent of the aggregate net patient
revenue of all paying hospitals in the county.
(d) Subject to the maximum amount prescribed by Subsection
(c), the commissioners court of a county that collects a mandatory
payment authorized under this chapter shall set the mandatory
payments in amounts that in the aggregate will generate sufficient
revenue to cover the administrative expenses of the county for
activities under this chapter, to fund the nonfederal share of a
Medicaid supplemental payment program as described by Section
299.103(c)(1), and to pay for indigent programs, except that the
amount of revenue from mandatory payments used for administrative
expenses of the county for activities under this chapter in a year
may not exceed the lesser of four percent of the total revenue
generated from the mandatory payment or $20,000. Any reasonable
expenses the commission incurs in order to collect delinquent
mandatory payments, including any attorney's fees incurred as a
result of contracting with an attorney to represent the commission
in seeking and enforcing the collection of delinquent mandatory
payments, are not subject to the limitation described in this
subsection.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient.
Sec. 299.152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. The county may collect or contract for the assessment and
collection of mandatory payments authorized under this chapter.
Sec. 299.153. INSTALLMENT PAYMENTS; ATTORNEY FOR
COLLECTION ACTIVITIES; SUIT. (a) A mandatory payment is
considered to be delinquent if it is not fully paid within 60 days
of the due date set by the county. The county may enter into an
agreement with an institutional health care provider that allows
payment in installments of a delinquent mandatory payment.
(b) The commission may contract with any competent attorney
to represent the county to seek and enforce the collection of
delinquent mandatory payments. The attorney's compensation is set
in the contract, but the total amount of compensation provided may
not exceed the lesser of (1) 20 percent of the amount of delinquent
mandatory payments collected and (2) $200,000.
(c) At any time after a mandatory payment becomes
delinquent, the county may file suit in a court of competent
jurisdiction to enforce liability for and collect the mandatory
payment. The county may recover attorney's fees in a suit to enforce
liability for and collect a delinquent mandatory payment. Any
amounts recovered or otherwise received as a result of a suit to
enforce liability for and collect a delinquent mandatory payment
shall be deposited into the local provider participation fund.
Sec. 299.154. PURPOSE; CORRECTION OF INVALID PROVISION OR
PROCEDURE. (a) The purpose of this chapter is to generate revenue
by collecting from institutional health care providers a mandatory
payment to be used to provide the nonfederal share of a Medicaid
supplemental payment program.
(b) 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 county may provide by
rule for an alternative provision or procedure that conforms to the
requirements of the federal Centers for Medicare and Medicaid
Services.
SECTION 2. 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 3. 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.