86R3614 KFF-F
By: Powell S.B. No. 2134
A BILL TO BE ENTITLED
AN ACT
relating to establishing supplemental payment programs for the
reimbursement of certain ambulance providers under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 32, Human Resources Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H. SUPPLEMENTAL PAYMENT PROGRAM FOR CERTAIN AMBULANCE
PROVIDERS
Sec. 32.351. DEFINITIONS. In this subchapter:
(1) "Participating provider" means an ambulance
provider that participates in a supplemental payment program.
(2) "Supplemental payment program" means a
supplemental payment program implemented under Section 32.352.
Sec. 32.352. AMBULANCE PROVIDER SUPPLEMENTAL PAYMENT
PROGRAMS. The commission shall:
(1) develop and implement two programs, one under the
Medicaid fee-for-service delivery model and one under the Medicaid
managed care delivery model, designed to provide supplemental
payments to eligible ambulance providers; and
(2) apply for and actively pursue from the federal
Centers for Medicare and Medicaid Services or other appropriate
federal agency any waiver or other authorization necessary to
implement the programs required by this section.
Sec. 32.353. PROVIDER ELIGIBILITY. (a) An ambulance
provider is eligible to participate in a supplemental payment
program if the provider:
(1) provides ground emergency medical transportation
services to Medicaid recipients;
(2) is enrolled as a Medicaid provider at the time
services are provided; and
(3) meets one of the following conditions:
(A) is a state or local governmental entity,
including a state or local governmental entity that employs or
contracts with persons who are licensed to provide emergency
medical services in this state; or
(B) contracts, under an interlocal agreement,
with a local governmental entity, including a local fire protection
district, to provide emergency medical services in this state.
(b) Participation by a governmental entity in a
supplemental payment program is voluntary.
Sec. 32.354. MEDICAID FEE-FOR-SERVICE SUPPLEMENTAL PAYMENT
PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) This
section applies only to a supplemental payment program implemented
under the Medicaid fee-for-service delivery model.
(b) A governmental entity that is a participating provider
or contracts with a participating provider as described by Section
32.353(a)(3)(B) shall:
(1) certify that the expenditures claimed for the
provision of ground emergency medical transportation services to
Medicaid recipients are public funds eligible for federal financial
participation in accordance with the requirements of 42 C.F.R.
Section 433.51;
(2) provide evidence supporting the certification of
public funds in the manner determined by the commission;
(3) submit data required by the commission for
purposes of determining the amounts the commission may claim as
expenditures qualifying for federal financial participation; and
(4) maintain and have readily available for the
commission any records related to the expenditure.
(c) Under the supplemental payment program, the commission
shall claim federal financial participation for expenditures
described by Subsection (b)(1) that are allowable costs under the
authorization to implement the supplemental payment program
obtained under Section 32.352(2).
(d) A provider participating in the supplemental payment
program shall receive, in addition to the rate of payment that the
provider would otherwise receive for the provision of ground
emergency medical transportation services to a Medicaid recipient,
a supplemental reimbursement payment. The payment must:
(1) except as provided by Subsection (e), be equal to
the amount of federal financial participation received by the
commission for the service provided and claimed; and
(2) be paid on a per-transport basis or other
federally permissible basis.
(e) The amount certified under Subsection (b)(1), when
combined with the amount received by a participating provider from
all sources of reimbursement under Medicaid, may not exceed 100
percent of the provider's actual costs for the provision of
services. The commission shall reduce a payment to a participating
provider to ensure compliance with this subsection.
Sec. 32.355. MEDICAID MANAGED CARE SUPPLEMENTAL PAYMENT
PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) In this
section:
(1) "Managed care organization" has the meaning
assigned by Section 533.001, Government Code.
(2) "Medicaid managed care organization" means a
managed care organization that contracts with the commission under
Chapter 533, Government Code, to provide health care services to
Medicaid recipients.
(b) This section applies only to a supplemental payment
program implemented under the Medicaid managed care delivery model.
(c) The commission shall develop the supplemental payment
program under the Medicaid managed care delivery model in
consultation with providers eligible to participate in the
supplemental payment program. The supplemental payment program
must use intergovernmental transfers to finance increased
capitation payments for the purpose of supplementing the
reimbursement amount paid to participating providers.
(d) To the extent intergovernmental transfers are
voluntarily made by, and accepted from, a governmental entity that
is a participating provider or contracts with a participating
provider as described by Section 32.353(a)(3)(B), and the
participating provider is a provider under a Medicaid managed care
delivery model, the commission shall make increased capitation
payments to the requisite Medicaid managed care organizations to be
used to pay the participating provider in accordance with an
enhanced fee schedule that establishes a minimum reimbursement
rate.
(e) The executive commissioner by rule shall adopt the
enhanced fee schedule described by Subsection (d). The commission
shall include a provision in each contract with a Medicaid managed
care organization that requires the organization to pay
reimbursement rates to participating providers in accordance with
that schedule.
(f) The increased capitation payments made under the
supplemental payment program and the enhanced fee schedule adopted
under Subsection (e) must allow for a supplemental payment to a
participating provider that is at least comparable in amount to the
supplemental payment the provider would receive if providing the
same service under the supplemental payment program implemented
under the Medicaid fee-for-service delivery model under Section
32.354.
(g) A managed care organization that receives an increased
capitation payment under the supplemental payment program shall pay
100 percent of the increase to the participating provider in
accordance with the enhanced fee schedule adopted under Subsection
(e).
(h) All federal matching money obtained as a result of an
intergovernmental transfer under the supplemental payment program
must be used to pay increased capitation payments and provide
supplemental payments to participating providers.
(i) To the extent that the commission determines that an
intergovernmental transfer does not comply with the authorization
obtained by the commission under Section 32.352(2), the commission
may return the transfer, refuse to accept the transfer, or adjust
the amount of the transfer as necessary to comply with the
authorization.
(j) A participating provider and governmental entity that
contracts with a participating provider must agree to comply with
any requests for information or data requirements imposed by the
commission for purposes of obtaining supporting documentation
necessary to claim federal financial participation or obtain
federal approval for implementation of the supplemental payment
program.
(k) The commission shall ensure a Medicaid managed care
organization complies with any request for information or similar
requirements necessary to implement the supplemental payment
program.
Sec. 32.356. FUNDING; USE OF GENERAL REVENUE PROHIBITED.
(a) The commission may not use general revenue to:
(1) administer a supplemental payment program; or
(2) provide reimbursements under a supplemental
payment program.
(b) A governmental entity that is a participating provider
or contracts with a participating provider as described by Section
32.353(a)(3)(B), as a condition of participating providers
receiving supplemental payments under Section 32.354, must enter
into and maintain an agreement with the commission to provide:
(1) the nonfederal share of the supplemental payments
by certifying expenditures to the commission in accordance with
Section 32.354(b); and
(2) funding necessary to pay the cost of administering
the supplemental payment program under Section 32.354.
(c) A governmental entity that is a participating provider
or contracts with a participating provider as described by Section
32.353(a)(3)(B), as a condition of participating providers
receiving supplemental payments under Section 32.355, must enter
into and maintain an agreement with the commission to provide:
(1) the nonfederal share of the increased capitation
payments by making intergovernmental transfers as provided by
Section 32.355; and
(2) funding necessary to pay the cost of administering
the supplemental payment program under Section 32.355.
SECTION 2. (a) As soon as possible after the effective date
of this Act, the Health and Human Services Commission shall seek any
waiver or other authorization necessary to implement the
supplemental payment programs required by Subchapter H, Chapter 32,
Human Resources Code, as added by this Act.
(b) To the extent permitted by the waiver or other
authorization necessary to implement the supplemental payment
programs required by Subchapter H, Chapter 32, Human Resources
Code, as added by this Act, the Health and Human Services Commission
shall implement the supplemental payment program implemented under
the Medicaid managed care program on a retroactive basis.
SECTION 3. This Act takes effect September 1, 2019.