2019S0262-1 02/22/19
By: Burrows H.B. No. 4648
A BILL TO BE ENTITLED
AN ACT
relating to the creation and operations of a health care provider
participation program by the Lubbock 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 298C to read as follows:
CHAPTER 298C. LUBBOCK COUNTY HOSPITAL DISTRICT HEALTH CARE
PROVIDER PARTICIPATION PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 298C.001. PURPOSE. The purpose of this chapter is to
authorize the district to administer a health care provider
participation program to provide additional compensation to
nonpublic hospitals by collecting mandatory payments from each
nonpublic hospital in the district to be used to provide the
nonfederal share of a Medicaid supplemental payment program and for
other purposes as authorized under this chapter.
Sec. 298C.002. DEFINITIONS. In this chapter:
(1) "Board" means the board of hospital managers of
the district.
(2) "Commissioners court" means the Commissioners
Court of Lubbock County.
(3) "County" means Lubbock County.
(4) "District" means the Lubbock County Hospital
District of Lubbock County, Texas.
(5) "Institutional health care provider" means a
nonpublic hospital located in the district that provides inpatient
hospital services.
(6) "Paying hospital" means an institutional health
care provider required to make a mandatory payment under this
chapter.
(7) "Program" means the health care provider
participation program authorized by this chapter.
Sec. 298C.003. APPLICABILITY. This chapter applies only to
the Lubbock County Hospital District of Lubbock County, Texas.
Sec. 298C.004. 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.
SUBCHAPTER B. POWERS AND DUTIES
Sec. 298C.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. The board may authorize the collection of a mandatory
payment authorized under this chapter from an institutional health
care provider located in the district only in the manner provided by
this chapter.
Sec. 298C.052. 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 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.
Sec. 298C.053. PROGRAM ADMINISTRATION. (a) The board,
subject to the approval of the commissioners court, shall delegate
all administrative responsibilities of the program, including
collection of mandatory payments, expenditures, and audits, to the
county.
(b) The commissioners court may adopt rules relating to the
administration of the program.
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 298C.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 the chief
operating officer of each institutional health care provider in the
district.
(c) Determination of the amount of any mandatory payments to
be collected during the year shall be shown to be based on
reasonable estimates of the amount of revenue necessary to meet and
cover the nonfederal share of payments described by Section
298C.103(b)(1) that is otherwise unfunded, and is subject to the
final approval of the commissioners court.
Sec. 298C.102. LOCAL PROVIDER PARTICIPATION FUND;
DEPOSITORY. (a) If the board authorizes the collection of a
mandatory payment authorized under this chapter, and the
commissioners court approves such collection, the commissioners
court shall by resolution create a local provider participation
fund in one or more banks located in the district that are
designated by the commissioners court to serve as the depository
for mandatory payments received by the county.
(b) All income received by the 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 collected under this chapter shall be secured
in the manner provided by law for securing county funds.
Sec. 298C.103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY.
(a) The local provider participation fund established under
Section 298C.102 consists of:
(1) all mandatory payments authorized under this
chapter and received by the county;
(2) money received from the Health and Human Services
Commission as a refund of an intergovernmental transfer from the
local provider participation fund to the state as 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.
(b) 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 the nonfederal share of:
(A) uncompensated care payments for nonpublic
hospitals and delivery system reform incentive payments for
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 to nonpublic hospitals
under another waiver program authorizing payments that are
substantially similar to Medicaid payments to nonpublic hospitals
described by Paragraph (A) or (B); or
(D) any reimbursement to nonpublic hospitals for
which federal matching funds are available;
(2) subject to Section 298C.151(d), pay the
administrative expenses of the county in administering the program,
including collateralization of deposits;
(3) refund a portion of a mandatory payment collected
in error from a paying hospital; and
(4) refund to paying hospitals a proportionate share
of the money that the county:
(A) receives from the Health and Human Services
Commission that is not used to fund the nonfederal share of payments
described by Subdivision (1); or
(B) determines cannot be used to fund the
nonfederal share of payments described by Subdivision (1).
(c) Money in the local provider participation fund may not
be commingled with other county funds.
(d) An intergovernmental transfer of funds described by
Subsection (b)(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. 298C.151. MANDATORY PAYMENTS. (a) If the board
authorizes a program under this chapter, the board, subject to the
approval of the commissioners court, may require an annual
mandatory payment to be assessed on the net patient revenue of each
institutional health care provider located in the district. The
commissioners court may provide that the mandatory payment is to be
collected at least annually, but not more often than quarterly. 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 most recent fiscal year for which that
data was reported. If the institutional health care provider did
not report any data under those sections, the provider's net
patient revenue is the amount of that revenue as contained 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.
(b) The amount of a mandatory payment authorized under this
chapter must be a uniform percentage of the amount of net patient
revenue generated by each paying hospital in the district. 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 aggregate amount of the mandatory payments required
of all paying hospitals in the district may not exceed six percent
of the aggregate net patient revenue of all paying hospitals in the
district.
(d) Subject to the maximum amount prescribed by Subsection
(c), the board, with the approval of the commissioners court, 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, fund an
intergovernmental transfer described by Section 298C.103(b)(1), or
make other payments authorized under this chapter. The mandatory
payment amounts must be set based on reasonable estimates of the
amount of revenue necessary to fully meet and cover authorized
expenses under this chapter. The amount of revenue from mandatory
payments that may be used for administrative expenses by the county
in a year may not exceed $25,000, plus the cost of collateralization
of deposits. If the county demonstrates to the paying hospitals
that the costs of administering the program under this chapter,
excluding those costs associated with the collateralization of
deposits, exceed $25,000 in any year, on consent of a majority of
all of the paying hospitals, the county may use additional revenue
from mandatory payments received under this chapter to compensate
the county for its administrative expenses. A paying hospital may
not unreasonably withhold consent to compensate the county for
administrative expenses.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient or insurer.
(f) A mandatory payment under this chapter is not a tax for
purposes of Section 4, Article IX, Texas Constitution, or Chapter
1053, Special District Local Laws Code.
Sec. 298C.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. 298C.153. CORRECTION OF INVALID PROVISION OR
PROCEDURE. 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.
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.