88R11248 MPF-F
By: Clardy H.B. No. 4700
A BILL TO BE ENTITLED
AN ACT
relating to the creation and operations of a health care provider
participation program by the Nacogdoches 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 298H to read as follows:
CHAPTER 298H. NACOGDOCHES COUNTY HOSPITAL DISTRICT HEALTH CARE
PROVIDER PARTICIPATION PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 298H.001. DEFINITIONS. In this chapter:
(1) "Board" means the board of directors of the
district.
(2) "District" means the Nacogdoches County Hospital
District.
(3) "Institutional health care provider" means a
nonpublic hospital located in the district that provides inpatient
hospital services.
(4) "Paying provider" means an institutional health
care provider required to make a mandatory payment under this
chapter.
(5) "Program" means the health care provider
participation program authorized by this chapter.
(6) "Qualifying assessment basis" means any basis
consistent with 42 U.S.C. Section 1396b(w) on which the board
requires mandatory payments to be assessed under this chapter.
Sec. 298H.002. APPLICABILITY. This chapter applies only to
the Nacogdoches County Hospital District.
Sec. 298H.003. HEALTH CARE PROVIDER PARTICIPATION PROGRAM;
PARTICIPATION IN PROGRAM. (a) 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.
(b) The board may not authorize the district to participate
in a health care provider participation program under Chapter 300
or 300A.
Sec. 298H.004. EXPIRATION. (a) Subject to Section
298H.153(d), the authority of the district to administer and
operate a program under this chapter expires December 31, 2027.
(b) This chapter expires December 31, 2027.
SUBCHAPTER B. POWERS AND DUTIES OF BOARD
Sec. 298H.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. The board may require a mandatory payment authorized
under this chapter by an institutional health care provider located
in the district only in the manner provided by this chapter.
Sec. 298H.052. RULES AND PROCEDURES. The board may adopt
rules relating to the administration of the program, including
collection of the mandatory payments, expenditures, audits, and
other administrative aspects of the program.
Sec. 298H.053. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING. If the board authorizes the district to participate in a
program under this chapter, the board may require each
institutional health care provider to submit to the district a copy
of any financial and utilization data reported in:
(1) the provider's Medicare cost report submitted 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 board considers reliable and is submitted
by or to the provider for the most recent fiscal year.
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 298H.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.
(c) A representative of a paying provider is entitled to
appear at the public hearing and be heard regarding any matter
related to the mandatory payments authorized under this chapter.
Sec. 298H.102. DEPOSITORY. (a) If the board requires a
mandatory payment authorized under this chapter, the board shall
designate one or more banks as a depository for the district's local
provider participation fund.
(b) All funds collected under this chapter shall be secured
in the manner provided for securing other district funds.
Sec. 298H.103. LOCAL PROVIDER PARTICIPATION FUND;
AUTHORIZED USES OF MONEY. (a) If the district requires a
mandatory payment authorized under this chapter, the district shall
create a local provider participation fund.
(b) The local provider participation fund consists of:
(1) all revenue received by the district attributable
to the mandatory payments authorized under this chapter;
(2) money received from the Health and Human Services
Commission as a refund of an intergovernmental transfer under the
program, provided that the intergovernmental transfer does not
receive a federal matching payment; and
(3) the earnings of the fund.
(c) Money deposited to the local provider participation
fund of the district may be used only to:
(1) fund intergovernmental transfers from the
district to the state to provide the nonfederal share of Medicaid
supplemental payments for:
(A) uncompensated care payments to 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) rate enhancements for nonpublic hospitals in
the Medicaid managed care service area in which the district is
located;
(C) payments available 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 298H.151(f), pay the
administrative expenses of the district in administering the
program, including collateralization of deposits;
(3) refund a mandatory payment collected in error from
a paying provider;
(4) refund to paying providers a proportionate share
of the money attributable to the mandatory payments collected under
this chapter that the district:
(A) receives from the Health and Human Services
Commission that is not used to fund the nonfederal share of Medicaid
supplemental payments described by Subdivision (1); or
(B) determines cannot be used to fund the
nonfederal share of Medicaid supplemental payments or rate
enhancements described by Subdivision (1); and
(5) transfer funds to the Health and Human Services
Commission if the district is legally required to transfer the
funds to address a disallowance of federal matching funds with
respect to Medicaid supplemental payments for which the district
made intergovernmental transfers described by Subdivision (1).
(d) Money in the local provider participation fund may not
be commingled with other district funds.
(e) Notwithstanding any other provision of this chapter,
with respect to an intergovernmental transfer of funds described by
Subsection (c)(1) made by the district, any funds received by the
state, district, or other entity as a result of that transfer may
not be used by the state, district, or 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. 298H.151. MANDATORY PAYMENTS. (a) If the board
authorizes a health care provider participation program under this
chapter, the board may require a mandatory payment to be assessed
against each institutional health care provider located in the
district, either annually or periodically throughout the year at
the discretion of the board, on a qualifying assessment basis. The
qualifying assessment basis must be the same for each institutional
health care provider in the district. The board shall provide an
institutional health care provider written notice of each
assessment under this section, and the provider has 30 calendar
days following the date of receipt of the notice to make the
assessed mandatory payment.
(b) Except as otherwise provided by this subsection, the
qualifying assessment basis must be determined by the board 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 board using information
contained in another report the board considers reliable that is
submitted by or to the provider for the most recent fiscal year. To
the extent practicable, the board shall use the same type of report
to determine the qualifying assessment basis for each paying
provider in the district.
(c) If a mandatory payment is required, the district shall
periodically update the amount of the mandatory payment.
(d) 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 42 U.S.C. Section 1396b(w).
(e) If the board requires a mandatory payment authorized
under this chapter, the board shall set the amount of the mandatory
payment, subject to the limitations of this chapter. The aggregate
amount of the mandatory payments required of all paying providers
in the district may not exceed six percent of the aggregate net
patient revenue from hospital services provided in the district.
(f) Subject to Subsection (e), if the board requires a
mandatory payment authorized under this chapter, the board shall
set the mandatory payments in amounts that in the aggregate will
generate sufficient revenue to cover the administrative expenses of
the district for activities under this chapter and to fund an
intergovernmental transfer described by Section 298H.103(c)(1).
The annual amount of revenue from the mandatory payments used by the
district may not exceed $150,000, plus the cost of
collateralization of deposits, regardless of actual expenses.
(g) A paying provider may not add a mandatory payment
required under this section as a surcharge to a patient.
(h) A mandatory payment assessed under this chapter is not a
tax for hospital purposes for purposes of Section 4, Article IX,
Texas Constitution, or Section 281.045 of this code.
Sec. 298H.152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. (a) The district may designate an official of the
district or contract with another person to assess and collect the
mandatory payments authorized under this chapter.
(b) The person charged by the district with the assessment
and collection of the mandatory payments shall charge and deduct
from the mandatory payments collected for the district a collection
fee in an amount not to exceed the person's usual and customary
charges for like services.
(c) If the person charged with the assessment and collection
of the mandatory payments is an official of the district, any
revenue from a collection fee charged under Subsection (b) shall be
deposited in the district general fund and, if appropriate, shall
be reported as fees of the district.
Sec. 298H.153. PURPOSE; CORRECTION OF INVALID PROVISION OR
PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this
chapter is to authorize the district to establish a program to
enable the district to collect the mandatory payments from
institutional health care providers to fund the nonfederal share of
a Medicaid supplemental payment program or the Medicaid managed
care rate enhancements for nonpublic hospitals to support the
provision of health care by institutional health care providers to
district residents in need of health care.
(b) This chapter does not authorize the district to collect
the mandatory payments for the purpose of raising general revenue
or any amount in excess of the amount reasonably necessary to:
(1) fund the nonfederal share of a Medicaid
supplemental payment program or the Medicaid managed care rate
enhancements for nonpublic hospitals; and
(2) cover the administrative expenses of the district
associated with activities under this chapter and other uses of the
fund described by Section 298H.103(c).
(c) 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.
(d) The district may only assess and collect a mandatory
payment authorized under this chapter if a waiver program, rate
enhancement, or reimbursement described by Section 298H.103(c)(1)
is available for nonpublic hospitals located in the district.
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, 2023.