86R5582 JCG-D
By: Kolkhorst S.B. No. 2257
A BILL TO BE ENTITLED
AN ACT
relating to the authority of certain entities to create and operate
health care provider participation programs in counties not served
by a hospital district or a public hospital.
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. HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
MULTI-COUNTY DISTRICT
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 299.0001. PURPOSE. The purpose of this chapter is to
authorize certain counties not served by a hospital district or a
public hospital to create a district to administer a health care
provider participation program to provide additional compensation
to hospitals in the district by collecting mandatory payments from
each 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. 299.0002. DEFINITIONS. In this chapter:
(1) "Board" means the board of directors of a
district.
(2) "Director" means a member of the board.
(3) "District" means a health care provider
participation district created under this chapter.
(4) "Institutional health care provider" means a
nonpublic hospital that provides inpatient hospital services.
(5) "Paying hospital" means an institutional health
care provider required to make a mandatory payment under this
chapter.
(6) "Program" means a health care provider
participation program authorized by this chapter.
Sec. 299.0003. APPLICABILITY. This chapter applies only to
a county that:
(1) is not participating in a health care provider
participation program authorized under this subtitle;
(2) is not served by a hospital district or public
hospital; and
(3) has only one hospital that is located in the
county.
SUBCHAPTER B. CREATION, OPERATION, AND DISSOLUTION OF DISTRICT
Sec. 299.0021. CREATION BY CONCURRENT ORDERS. (a) Except
as provided by Subsection (b), a county and one or more other
counties may create a district by adopting concurrent orders.
(b) A county or portion of a county that is in the boundaries
of a hospital district may not be a party to the creation of a
district.
(c) A concurrent order to create a district must:
(1) be approved by the governing body of each creating
county;
(2) contain identical provisions; and
(3) define the boundaries of the district to be
coextensive with the combined boundaries of each creating county.
Sec. 299.0022. POWERS. A district may authorize and
administer a health care provider participation program in
accordance with this chapter.
Sec. 299.0023. BOARD OF DIRECTORS. (a) If three or more
counties create a district, the county judge of each county that
creates the district shall appoint one director.
(b) If two counties create a district:
(1) the county judge of the most populous county shall
appoint two directors; and
(2) the county judge of the other county shall appoint
one director.
(c) Directors serve staggered two-year terms, with as near
as possible to one-half of the directors' terms expiring each year.
(d) A vacancy in the office of director shall be filled for
the unexpired term in the same manner as the original appointment.
(e) The board shall elect from among its members a
president. The president may vote and may cast an additional vote
to break a tie.
(f) The board shall also elect from among its members a vice
president.
(g) The board shall appoint a secretary, who need not be a
director.
(h) Each officer of the board serves for a term of one year.
(i) The board shall fill a vacancy in a board office for the
unexpired term.
(j) A majority of the members of the board voting must
concur in a matter relating to the business of the district.
Sec. 299.0024. QUALIFICATIONS FOR OFFICE. (a) To be
eligible to serve as a director, a person must be a resident of the
county that appoints the person under Section 299.0023.
(b) An employee of the district may not serve as a director.
Sec. 299.0025. COMPENSATION. (a) Directors and officers
serve without compensation but may be reimbursed for actual
expenses incurred in the performance of official duties.
(b) Expenses reimbursed under this section must be:
(1) reported in the district's minute book or other
district records; and
(2) approved by the board.
Sec. 299.0026. AUTHORITY TO SUE AND BE SUED. The board may
sue and be sued on behalf of the district.
Sec. 299.0027. DISTRICT FINANCES. Subchapter F, Chapter
287, other than Sections 287.129 and 287.130, applies to the
district in the same manner that those provisions apply to a health
services district created under Chapter 287. This section does not
authorize the district to issue bonds.
Sec. 299.0028. DISSOLUTION. A district shall be dissolved
if the counties that created the district adopt concurrent orders
to dissolve the district and the concurrent orders contain
identical provisions.
Sec. 299.0029. ADMINISTRATION OF PROPERTY, DEBTS, AND
ASSETS AFTER DISSOLUTION. (a) After dissolution of a district
under Section 299.0028, the board shall continue to control and
administer any property, debts, and assets of the district until
all funds have been disposed of and all district debts have been
paid or settled.
(b) As soon as practicable after the dissolution of the
district, the board shall transfer to each institutional health
care provider in the district the provider's proportionate share of
any remaining funds in any local provider participation fund
created by the district under Section 299.0102.
(c) If, after administering any property and assets, the
board determines that the district's property and assets are
insufficient to pay the debts of the district, the district shall
transfer the remaining debts to the counties that created the
district in proportion to the funds contributed to the district by
each county, including a paying hospital in the county.
(d) If, after complying with Subsections (b) and (c) and
administering the property and assets, the board determines that
unused funds remain, the board shall transfer the unused funds to
the counties that created the district in proportion to the funds
contributed to the district by each county, including a paying
hospital in the county.
Sec. 299.0030. ACCOUNTING AFTER DISSOLUTION. After the
district has paid all its debts and has disposed of all its assets
and funds as prescribed by Section 299.0029, the board shall
provide an accounting to each county that created the district. The
accounting must show the manner in which the assets and debts of the
district were distributed.
SUBCHAPTER C. HEALTH CARE PROVIDER PARTICIPATION PROGRAM; POWERS
AND DUTIES OF DISTRICT BOARD
Sec. 299.0051. HEALTH CARE PROVIDER PARTICIPATION 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.
Sec. 299.0052. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. The board may require a mandatory payment authorized
under this chapter by an institutional health care provider in the
district only in the manner provided by this chapter.
Sec. 299.0053. RULES AND PROCEDURES. The board may adopt
rules relating to the administration of the health care provider
participation program in the district, including collection of the
mandatory payments, expenditures, audits, and any other
administrative aspects of the program.
Sec. 299.0054. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING. If the board authorizes the district to participate in a
health care provider participation program under this chapter, the
board shall require each institutional health care provider located
in the district 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.
SUBCHAPTER D. GENERAL FINANCIAL PROVISIONS
Sec. 299.0101. HEARING. (a) In each year that the board
authorizes a health care provider participation 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 each
county that creates the district and provide written notice of the
hearing to the chief operating officer of each institutional health
care provider in the district.
Sec. 299.0102. LOCAL PROVIDER PARTICIPATION FUND;
DEPOSITORY. (a) If the board collects a mandatory payment
authorized under this chapter, the board shall create a local
provider participation fund in one or more banks designated by the
district as a depository for the mandatory payments received by the
district.
(b) The board may withdraw or use money in the local
provider participation fund of the district only for a purpose
authorized under this chapter.
(c) All funds collected under this chapter shall be secured
in the manner provided for securing county funds.
Sec. 299.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY.
(a) The local provider participation fund established under
Section 299.0102 consists of:
(1) all revenue received by the district attributable
to mandatory payments authorized under this chapter, including any
penalties and interest attributable to delinquent payments;
(2) money received from the Health and Human Services
Commission as a refund of an intergovernmental transfer from the
district 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.
(b) Money deposited to the local provider participation
fund may be used only to:
(1) fund intergovernmental transfers from the
district to the state to provide:
(A) the nonfederal share of a Medicaid
supplemental payment program authorized under the state Medicaid
plan, 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 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 in the district;
(3) pay the administrative expenses of the district
solely for activities under this chapter;
(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 district that is not used to fund the
nonfederal share of Medicaid supplemental payment program
payments.
(c) Money in the local provider participation fund may not
be commingled with other district funds or other funds of a county
that creates the district.
(d) An intergovernmental transfer of funds described by
Subsection (b)(1) and any funds received by the district as a result
of an intergovernmental transfer described by that subsection may
not be used by the district, a county that created the district, 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).
Sec. 299.0104. ACCOUNTING OF FUNDS. The district shall
maintain an accounting of the funds received from each county that
creates the district, including a paying hospital in the county.
SUBCHAPTER E. MANDATORY PAYMENTS
Sec. 299.0151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if
the board authorizes a health care provider participation program
under this chapter, the district 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
board may provide for the mandatory payment to be assessed
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 located in the
district 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 2017 or, if the institutional health care
provider did not report any data under those sections in that fiscal
year, as determined by the institutional health care provider's
Medicare cost report submitted for the 2017 fiscal year or for the
closest subsequent fiscal year for which the provider submitted the
Medicare cost report. The district shall 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 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 board shall set the amount of a mandatory payment
authorized under this chapter. The amount of the mandatory payment
required of each paying hospital may not exceed six percent of the
paying hospital's net patient revenue.
(d) Subject to the maximum amount prescribed by Subsection
(c), the board shall set a mandatory payment authorized under this
chapter in amounts that in the aggregate will generate sufficient
revenue to cover the administrative expenses of the district for
activities under this chapter, to fund an intergovernmental
transfer described by Section 299.0103(b)(1), and to pay for
indigent programs in the district, except that the amount of
revenue from mandatory payments used for administrative expenses of
the district for activities under this chapter in a year may not
exceed four percent of the total revenue generated from the
mandatory payment.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient.
Sec. 299.0152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. The district may collect or contract for the assessment
and collection of mandatory payments authorized under this chapter.
Sec. 299.0153. INTEREST, PENALTIES, AND DISCOUNTS.
Interest, penalties, and discounts on mandatory payments required
under this chapter are governed by the law applicable to county ad
valorem taxes.
Sec. 299.0154. 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.
SECTION 2. Subtitle D, Title 4, Health and Safety Code, is
amended by adding Chapter 299A to read as follows:
CHAPTER 299A. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
COUNTY NOT SERVED BY HOSPITAL DISTRICT OR PUBLIC HOSPITAL
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 299A.0001. PURPOSE. The purpose of this chapter is to
authorize a county not served by a hospital district or a public
hospital to administer a county health care provider participation
program to provide additional compensation to hospitals in the
county by collecting mandatory payments from each hospital in the
county to be used to provide the nonfederal share of a Medicaid
supplemental payment program and for other purposes as authorized
under this chapter.
Sec. 299A.0002. 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 a county health care provider
participation program authorized by this chapter.
Sec. 299A.0003. APPLICABILITY. This chapter applies only
to a county that is not served by a hospital district or a public
hospital.
Sec. 299A.0004. COUNTY HEALTH CARE PROVIDER PARTICIPATION
PROGRAM; COUNTY ORDER REQUIRED FOR PARTICIPATION. The
commissioners court of a county may adopt an order authorizing the
county to participate in a health care provider participation
program, subject to the limitations provided by this chapter.
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT
Sec. 299A.0051. 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. 299A.0052. RULES AND PROCEDURES. The commissioners
court of a county may adopt rules relating to the administration of
the health care provider participation program in the county,
including collection of the mandatory payments, expenditures,
audits, and any other administrative aspects of the program.
Sec. 299A.0053. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING. If the commissioners court of a county authorizes the
county to participate in a health care provider participation
program under this chapter, the commissioners court 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.
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 299A.0101. HEARING. (a) In each year that the
commissioners court of a county authorizes a health care provider
participation program under this chapter, the commissioners court
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 fifth day before the date of the
hearing required under Subsection (a), the commissioners court
shall publish notice of the hearing in a newspaper of general
circulation in the county and provide written notice of the hearing
to the chief operating officer of each institutional health care
provider in the county.
Sec. 299A.0102. LOCAL PROVIDER PARTICIPATION FUND;
DEPOSITORY. (a) Each commissioners court of a county that collects
a mandatory payment authorized under this chapter shall create a
local provider participation fund in one or more banks designated
by the county as a depository for the mandatory payments received by
the county.
(b) The commissioners court of a county may withdraw or use
money in the local provider participation fund of the county only
for a purpose authorized under this chapter.
(c) All funds collected under this chapter shall be secured
in the manner provided for securing other county funds.
Sec. 299A.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY.
(a) The local provider participation fund established by a county
under Section 299A.0102 consists of:
(1) all revenue received by the county attributable to
mandatory payments authorized under this chapter, including any
penalties and interest attributable to delinquent payments;
(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.
(b) Money deposited to the local provider participation
fund of a county 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, 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 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 in the county;
(3) pay the administrative expenses of the county
solely for activities under this chapter;
(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 that is not used to fund the
nonfederal share of Medicaid supplemental payment program
payments.
(c) Money in the local provider participation fund of a
county 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. 299A.0151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if
the commissioners court of a county authorizes a health care
provider participation program under this chapter, 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 county. The commissioners court may
provide for the mandatory payment to be assessed 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 located in the county 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 2017 or, if the institutional health care provider did not
report any data under those sections in that fiscal year, as
determined by the institutional health care provider's Medicare
cost report submitted for the 2017 fiscal year or for the closest
subsequent fiscal year for which the provider submitted the
Medicare cost report. The county shall 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 in the county may not
exceed six percent of the paying hospital's net patient revenue.
(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 an intergovernmental
transfer described by Section 299A.103(b)(1), and to pay for
indigent programs in the county, 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.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient.
Sec. 299A.0152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. A county may collect or contract for the assessment and
collection of mandatory payments authorized under this chapter.
Sec. 299A.0153. INTEREST, PENALTIES, AND DISCOUNTS.
Interest, penalties, and discounts on mandatory payments required
under this chapter are governed by the law applicable to county ad
valorem taxes.
Sec. 299A.0154. 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 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 3. 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 4. 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.