87R4842 JCG-F
By: Hughes S.B. No. 1073
A BILL TO BE ENTITLED
AN ACT
relating to the operations of health care provider participation
programs in certain counties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 291A.001, Health and Safety Code, is
amended by amending Subdivisions (1) and (2) and adding Subdivision
(4) to read as follows:
(1) "Institutional health care provider" means a
[nonpublic] hospital that is not owned and operated by a federal or
state government and provides inpatient hospital services. The term
includes a hospital that is owned and operated by a municipality or
county and provides inpatient hospital services.
(2) "Paying provider [hospital]" means an
institutional health care provider required to make a mandatory
payment under this chapter.
(4) "Qualifying assessment basis" means the health
care item, health care service, or other health care-related basis
consistent with 42 U.S.C. Section 1396b(w) on which a commissioners
court requires mandatory payments to be assessed under this
chapter.
SECTION 2. Section 291A.003(a), Health and Safety Code, is
amended to read as follows:
(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.
SECTION 3. Section 291A.054(a), Health and Safety Code, is
amended to read as follows:
(a) The commissioners court of a county that collects a
mandatory payment authorized under this chapter may [shall] require
each institutional health care provider to submit to the county a
copy of any financial and utilization data as [required by and]
reported in:
(1) the provider's Medicare cost report for the most
recent fiscal year for which the provider submitted the Medicare
cost report; or
(2) a report other than the report described by
Subdivision (1) that the commissioners court considers reliable and
is submitted by or to the provider for the most recent fiscal year
[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].
SECTION 4. Section 291A.101, Health and Safety Code, is
amended to read as follows:
Sec. 291A.101. HEARING. (a) Each year, the commissioners
court of a county that collects a mandatory payment authorized
under this chapter shall hold at least one [a] public hearing on the
amounts of the [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 a [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 provider [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.
SECTION 5. Section 291A.103(c), Health and Safety Code, is
amended to read as follows:
(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 payments 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;
[(3)] pay the administrative expenses of the county
solely for activities under this chapter;
(3) [(4)] refund a portion of a mandatory payment
collected in error from a paying provider [hospital]; and
(4) [(5)] refund to a paying provider, in an amount
that is proportionate to the mandatory payments made under this
chapter by the provider during the 12 months preceding the date of
the refund, the [hospitals the proportionate share of] money
attributable to mandatory payments collected under this chapter
that the county:
(A) receives from the Health and Human Services
Commission [received by the county] that is not used to fund the
nonfederal share of Medicaid supplemental payment program
payments; or
(B) determines cannot be used to fund the
nonfederal share of Medicaid supplemental payment program
payments.
SECTION 6. Section 291A.151, Health and Safety Code, is
amended to read as follows:
Sec. 291A.151. MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL
NET PATIENT REVENUE]. (a) The [Except as provided by Subsection
(e), the] commissioners court of a county that authorizes a county
health care provider participation program [collects a mandatory
payment authorized] under this chapter may require [an annual]
mandatory payments [payment] to be assessed against [on the net
patient revenue of] each institutional health care provider located
in the county, either annually or periodically throughout the year
at the discretion of the commissioners court, on the basis of a
health care item, health care service, or other health care-related
basis that is consistent with the requirements of 42 U.S.C. Section
1396b(w). The commissioners court shall provide an institutional
health care provider written notice of each assessment under this
section not later than 30 days before the date the assessment is
due. The qualifying assessment basis must be the same for each
institutional health care provider in the county.
(a-1) Except as otherwise provided by this subsection, the
qualifying assessment basis must be determined by the commissioners
court using information contained in an institutional health care
provider's Medicare cost report for the most recent fiscal year for
which the provider submitted the report. If the provider is not
required to submit a Medicare cost report, or if the Medicare cost
report submitted by the provider does not contain information
necessary to determine the qualifying assessment basis, the
qualifying assessment basis may be determined by the commissioners
court using information contained in another report the
commissioners court considers reliable that is submitted by or to
the provider for the most recent fiscal year. To the extent
practicable, the commissioners court shall use the same type of
report to determine the qualifying assessment basis for each paying
provider in the county.
(a-2) If mandatory payments are required, the [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 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 2015 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 2015 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 payments periodically [payment on an annual basis].
(b) The amount of a mandatory payment authorized under this
chapter must be determined in a manner that ensures the revenue
generated qualifies for federal matching funds under federal law,
consistent with [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 authorizes a
county health care provider participation program [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 provider [hospital] may not exceed
an amount that, when added to the amount of the mandatory payments
required from all other paying providers in the county, equals an
amount of revenue that exceeds six percent of the aggregate net
patient revenue of all paying providers in the county [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 and [,] to fund the nonfederal share
of Medicaid supplemental payment program payments [an
intergovernmental transfer described by Section 291A.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.
(e) A paying provider [hospital] may not add a mandatory
payment required under this section as a surcharge to a patient.
SECTION 7. Section 291A.154, Health and Safety Code, is
amended to read as follows:
Sec. 291A.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 payments.
(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, a [the] county that
authorizes a county health care provider participation program
under this chapter 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 county or an
institutional health care provider in the county beyond the
provisions of this chapter. This section does not require the
commissioners court to adopt a rule.
(c) This chapter does not authorize a county that authorizes
a county health care provider participation program under this
chapter to collect mandatory payments for the purpose of raising
general revenue or any amount in excess of the amount reasonably
necessary for the purposes described by Sections 291A.103(c)(1) and
(2).
SECTION 8. Section 292.001, Health and Safety Code, is
amended by amending Subdivisions (1) and (2) and adding Subdivision
(4) to read as follows:
(1) "Institutional health care provider" means a
[nonpublic] hospital that is not owned and operated by a federal or
state government and provides inpatient hospital services. The term
includes a hospital that is owned and operated by a municipality or
county and provides inpatient hospital services.
(2) "Paying provider [hospital]" means an
institutional health care provider required to make a mandatory
payment under this chapter.
(4) "Qualifying assessment basis" means the health
care item, health care service, or other health care-related basis
consistent with 42 U.S.C. Section 1396b(w) on which a commissioners
court requires mandatory payments to be assessed under this
chapter.
SECTION 9. Section 292.003(a), Health and Safety Code, is
amended to read as follows:
(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.
SECTION 10. Section 292.054(a), Health and Safety Code, is
amended to read as follows:
(a) The commissioners court of a county that collects a
mandatory payment authorized under this chapter may [shall] require
each institutional health care provider to submit to the county a
copy of any financial and utilization data as [required by and]
reported in:
(1) the provider's Medicare cost report for the most
recent fiscal year for which the provider submitted the Medicare
cost report; or
(2) a report other than the report described by
Subdivision (1) that the commissioners court considers reliable and
is submitted by or to the provider for the most recent fiscal year
[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].
SECTION 11. Section 292.101, Health and Safety Code, is
amended to read as follows:
Sec. 292.101. HEARING. (a) Each year, the commissioners
court of a county that collects a mandatory payment authorized
under this chapter shall hold at least one [a] public hearing on the
amounts of the [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 a [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 provider [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.
SECTION 12. Section 292.103(c), Health and Safety Code, is
amended to read as follows:
(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 payments 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;
[(3)] pay the administrative expenses of the county
solely for activities under this chapter;
(3) [(4)] refund a portion of a mandatory payment
collected in error from a paying provider [hospital]; and
(4) [(5)] refund to a paying provider, in an amount
that is proportionate to the mandatory payments made under this
chapter by the provider during the 12 months preceding the date of
the refund, the [hospitals the proportionate share of] money
attributable to mandatory payments collected under this chapter
that the county:
(A) receives [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; or [and]
(B) [(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 payments.
SECTION 13. Section 292.151, Health and Safety Code, is
amended to read as follows:
Sec. 292.151. MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL
NET PATIENT REVENUE]. (a) The [Except as provided by Subsection
(e), the] commissioners court of a county that authorizes a county
health care provider participation program [collects a mandatory
payment authorized] under this chapter may require [an annual]
mandatory payments [payment] to be assessed against [on the net
patient revenue of] each institutional health care provider located
in the county, either annually or periodically throughout the year
at the discretion of the commissioners court, on the basis of a
health care item, health care service, or other health care-related
basis that is consistent with the requirements of 42 U.S.C. Section
1396b(w). The commissioners court shall provide an institutional
health care provider written notice of each assessment under this
section not later than 30 days before the date the assessment is
due. The qualifying assessment basis must be the same for each
institutional health care provider in the county.
(a-1) Except as otherwise provided by this subsection, the
qualifying assessment basis must be determined by the commissioners
court using information contained in an institutional health care
provider's Medicare cost report for the most recent fiscal year for
which the provider submitted the report. If the provider is not
required to submit a Medicare cost report, or if the Medicare cost
report submitted by the provider does not contain information
necessary to determine the qualifying assessment basis, the
qualifying assessment basis may be determined by the commissioners
court using information contained in another report the
commissioners court considers reliable that is submitted by or to
the provider for the most recent fiscal year. To the extent
practicable, the commissioners court shall use the same type of
report to determine the qualifying assessment basis for each paying
provider in the county.
(a-2) If mandatory payments are required, the [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 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 2013 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 2013 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 payments periodically [payment on an annual basis].
(b) The amount of a mandatory payment authorized under this
chapter must be determined in a manner that ensures the revenue
generated qualifies for federal matching funds under federal law,
consistent with [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 authorizes a
county health care provider participation program [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 provider [hospital] may not exceed
an amount that, when added to the amount of the mandatory payments
required from all other paying providers [hospitals] in the county,
equals an amount of revenue that exceeds six percent of the
aggregate net patient revenue of all paying providers [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 and [,] to fund the nonfederal share
of [a] Medicaid supplemental payment program payments, [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.
(e) A paying provider [hospital] may not add a mandatory
payment required under this section as a surcharge to a patient.
SECTION 14. Section 292.154, Health and Safety Code, is
amended to read as follows:
Sec. 292.154. 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 payments.
(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, a [the] county that
authorizes a county health care provider participation program
under this chapter 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 county or an
institutional health care provider in the county beyond the
provisions of this chapter. This section does not require the
commissioners court to adopt a rule.
(c) This chapter does not authorize a county that authorizes
a county health care provider participation program under this
chapter to collect mandatory payments for the purpose of raising
general revenue or any amount in excess of the amount reasonably
necessary for the purposes described by Sections 292.103(c)(1) and
(2).
SECTION 15. 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, 2021.