Texas 2019 - 86th Regular

Texas Senate Bill SB2134 Compare Versions

Only one version of the bill is available at this time.

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1	1	86R3614 KFF-F
2	2	By: Powell S.B. No. 2134
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to establishing supplemental payment programs for the
8	8	reimbursement of certain ambulance providers under Medicaid.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 32, Human Resources Code, is amended by
11	11	adding Subchapter H to read as follows:
12	12	SUBCHAPTER H. SUPPLEMENTAL PAYMENT PROGRAM FOR CERTAIN AMBULANCE
13	13	PROVIDERS
14	14	Sec. 32.351. DEFINITIONS. In this subchapter:
15	15	(1) "Participating provider" means an ambulance
16	16	provider that participates in a supplemental payment program.
17	17	(2) "Supplemental payment program" means a
18	18	supplemental payment program implemented under Section 32.352.
19	19	Sec. 32.352. AMBULANCE PROVIDER SUPPLEMENTAL PAYMENT
20	20	PROGRAMS. The commission shall:
21	21	(1) develop and implement two programs, one under the
22	22	Medicaid fee-for-service delivery model and one under the Medicaid
23	23	managed care delivery model, designed to provide supplemental
24	24	payments to eligible ambulance providers; and
25	25	(2) apply for and actively pursue from the federal
26	26	Centers for Medicare and Medicaid Services or other appropriate
27	27	federal agency any waiver or other authorization necessary to
28	28	implement the programs required by this section.
29	29	Sec. 32.353. PROVIDER ELIGIBILITY. (a) An ambulance
30	30	provider is eligible to participate in a supplemental payment
31	31	program if the provider:
32	32	(1) provides ground emergency medical transportation
33	33	services to Medicaid recipients;
34	34	(2) is enrolled as a Medicaid provider at the time
35	35	services are provided; and
36	36	(3) meets one of the following conditions:
37	37	(A) is a state or local governmental entity,
38	38	including a state or local governmental entity that employs or
39	39	contracts with persons who are licensed to provide emergency
40	40	medical services in this state; or
41	41	(B) contracts, under an interlocal agreement,
42	42	with a local governmental entity, including a local fire protection
43	43	district, to provide emergency medical services in this state.
44	44	(b) Participation by a governmental entity in a
45	45	supplemental payment program is voluntary.
46	46	Sec. 32.354. MEDICAID FEE-FOR-SERVICE SUPPLEMENTAL PAYMENT
47	47	PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) This
48	48	section applies only to a supplemental payment program implemented
49	49	under the Medicaid fee-for-service delivery model.
50	50	(b) A governmental entity that is a participating provider
51	51	or contracts with a participating provider as described by Section
52	52	32.353(a)(3)(B) shall:
53	53	(1) certify that the expenditures claimed for the
54	54	provision of ground emergency medical transportation services to
55	55	Medicaid recipients are public funds eligible for federal financial
56	56	participation in accordance with the requirements of 42 C.F.R.
57	57	Section 433.51;
58	58	(2) provide evidence supporting the certification of
59	59	public funds in the manner determined by the commission;
60	60	(3) submit data required by the commission for
61	61	purposes of determining the amounts the commission may claim as
62	62	expenditures qualifying for federal financial participation; and
63	63	(4) maintain and have readily available for the
64	64	commission any records related to the expenditure.
65	65	(c) Under the supplemental payment program, the commission
66	66	shall claim federal financial participation for expenditures
67	67	described by Subsection (b)(1) that are allowable costs under the
68	68	authorization to implement the supplemental payment program
69	69	obtained under Section 32.352(2).
70	70	(d) A provider participating in the supplemental payment
71	71	program shall receive, in addition to the rate of payment that the
72	72	provider would otherwise receive for the provision of ground
73	73	emergency medical transportation services to a Medicaid recipient,
74	74	a supplemental reimbursement payment. The payment must:
75	75	(1) except as provided by Subsection (e), be equal to
76	76	the amount of federal financial participation received by the
77	77	commission for the service provided and claimed; and
78	78	(2) be paid on a per-transport basis or other
79	79	federally permissible basis.
80	80	(e) The amount certified under Subsection (b)(1), when
81	81	combined with the amount received by a participating provider from
82	82	all sources of reimbursement under Medicaid, may not exceed 100
83	83	percent of the provider's actual costs for the provision of
84	84	services. The commission shall reduce a payment to a participating
85	85	provider to ensure compliance with this subsection.
86	86	Sec. 32.355. MEDICAID MANAGED CARE SUPPLEMENTAL PAYMENT
87	87	PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) In this
88	88	section:
89	89	(1) "Managed care organization" has the meaning
90	90	assigned by Section 533.001, Government Code.
91	91	(2) "Medicaid managed care organization" means a
92	92	managed care organization that contracts with the commission under
93	93	Chapter 533, Government Code, to provide health care services to
94	94	Medicaid recipients.
95	95	(b) This section applies only to a supplemental payment
96	96	program implemented under the Medicaid managed care delivery model.
97	97	(c) The commission shall develop the supplemental payment
98	98	program under the Medicaid managed care delivery model in
99	99	consultation with providers eligible to participate in the
100	100	supplemental payment program. The supplemental payment program
101	101	must use intergovernmental transfers to finance increased
102	102	capitation payments for the purpose of supplementing the
103	103	reimbursement amount paid to participating providers.
104	104	(d) To the extent intergovernmental transfers are
105	105	voluntarily made by, and accepted from, a governmental entity that
106	106	is a participating provider or contracts with a participating
107	107	provider as described by Section 32.353(a)(3)(B), and the
108	108	participating provider is a provider under a Medicaid managed care
109	109	delivery model, the commission shall make increased capitation
110	110	payments to the requisite Medicaid managed care organizations to be
111	111	used to pay the participating provider in accordance with an
112	112	enhanced fee schedule that establishes a minimum reimbursement
113	113	rate.
114	114	(e) The executive commissioner by rule shall adopt the
115	115	enhanced fee schedule described by Subsection (d). The commission
116	116	shall include a provision in each contract with a Medicaid managed
117	117	care organization that requires the organization to pay
118	118	reimbursement rates to participating providers in accordance with
119	119	that schedule.
120	120	(f) The increased capitation payments made under the
121	121	supplemental payment program and the enhanced fee schedule adopted
122	122	under Subsection (e) must allow for a supplemental payment to a
123	123	participating provider that is at least comparable in amount to the
124	124	supplemental payment the provider would receive if providing the
125	125	same service under the supplemental payment program implemented
126	126	under the Medicaid fee-for-service delivery model under Section
127	127	32.354.
128	128	(g) A managed care organization that receives an increased
129	129	capitation payment under the supplemental payment program shall pay
130	130	100 percent of the increase to the participating provider in
131	131	accordance with the enhanced fee schedule adopted under Subsection
132	132	(e).
133	133	(h) All federal matching money obtained as a result of an
134	134	intergovernmental transfer under the supplemental payment program
135	135	must be used to pay increased capitation payments and provide
136	136	supplemental payments to participating providers.
137	137	(i) To the extent that the commission determines that an
138	138	intergovernmental transfer does not comply with the authorization
139	139	obtained by the commission under Section 32.352(2), the commission
140	140	may return the transfer, refuse to accept the transfer, or adjust
141	141	the amount of the transfer as necessary to comply with the
142	142	authorization.
143	143	(j) A participating provider and governmental entity that
144	144	contracts with a participating provider must agree to comply with
145	145	any requests for information or data requirements imposed by the
146	146	commission for purposes of obtaining supporting documentation
147	147	necessary to claim federal financial participation or obtain
148	148	federal approval for implementation of the supplemental payment
149	149	program.
150	150	(k) The commission shall ensure a Medicaid managed care
151	151	organization complies with any request for information or similar
152	152	requirements necessary to implement the supplemental payment
153	153	program.
154	154	Sec. 32.356. FUNDING; USE OF GENERAL REVENUE PROHIBITED.
155	155	(a) The commission may not use general revenue to:
156	156	(1) administer a supplemental payment program; or
157	157	(2) provide reimbursements under a supplemental
158	158	payment program.
159	159	(b) A governmental entity that is a participating provider
160	160	or contracts with a participating provider as described by Section
161	161	32.353(a)(3)(B), as a condition of participating providers
162	162	receiving supplemental payments under Section 32.354, must enter
163	163	into and maintain an agreement with the commission to provide:
164	164	(1) the nonfederal share of the supplemental payments
165	165	by certifying expenditures to the commission in accordance with
166	166	Section 32.354(b); and
167	167	(2) funding necessary to pay the cost of administering
168	168	the supplemental payment program under Section 32.354.
169	169	(c) A governmental entity that is a participating provider
170	170	or contracts with a participating provider as described by Section
171	171	32.353(a)(3)(B), as a condition of participating providers
172	172	receiving supplemental payments under Section 32.355, must enter
173	173	into and maintain an agreement with the commission to provide:
174	174	(1) the nonfederal share of the increased capitation
175	175	payments by making intergovernmental transfers as provided by
176	176	Section 32.355; and
177	177	(2) funding necessary to pay the cost of administering
178	178	the supplemental payment program under Section 32.355.
179	179	SECTION 2. (a) As soon as possible after the effective date
180	180	of this Act, the Health and Human Services Commission shall seek any
181	181	waiver or other authorization necessary to implement the
182	182	supplemental payment programs required by Subchapter H, Chapter 32,
183	183	Human Resources Code, as added by this Act.
184	184	(b) To the extent permitted by the waiver or other
185	185	authorization necessary to implement the supplemental payment
186	186	programs required by Subchapter H, Chapter 32, Human Resources
187	187	Code, as added by this Act, the Health and Human Services Commission
188	188	shall implement the supplemental payment program implemented under
189	189	the Medicaid managed care program on a retroactive basis.
190	190	SECTION 3. This Act takes effect September 1, 2019.