H.B. No. 4835
AN ACT
relating to the creation and operations of certain health care
provider participation programs.
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 292D to read as follows:
CHAPTER 292D. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
CERTAIN COUNTIES BORDERING NECHES RIVER
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 292D.001. 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 the county health care provider
participation program authorized by this chapter.
Sec. 292D.002. APPLICABILITY. This chapter applies only to
a county that:
(1) is not served by a hospital district;
(2) has a population of more than 250,000; and
(3) borders the Neches River.
Sec. 292D.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION
PROGRAM; PARTICIPATION IN PROGRAM. (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 as provided by Section 292D.103(c).
(b) The commissioners court may adopt an order authorizing a
county to participate in the program, subject to the limitations
provided by this chapter.
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT
Sec. 292D.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENTS. 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. 292D.052. MAJORITY VOTE REQUIRED. The commissioners
court of a county may not authorize the county to collect a
mandatory payment authorized under this chapter without an
affirmative vote of a majority of the members of the commissioners
court.
Sec. 292D.053. RULES AND PROCEDURES. The commissioners
court may adopt rules relating to the administration of the
program, including the collection of a mandatory payment,
expenditures, an audit, and any other administrative aspect of the
program.
Sec. 292D.054. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING; INSPECTION OF RECORDS. (a) If the commissioners court
of a county authorizes the county to participate in a 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.
(b) The commissioners court of a county that collects a
mandatory payment authorized under this chapter may inspect the
records of an institutional health care provider to the extent
necessary to ensure compliance with the requirements of Subsection
(a).
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 292D.101. HEARING. (a) In each year that the
commissioners court of a county authorizes a 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 of
the county shall publish notice of the hearing in a newspaper of
general circulation in the county and provide written notice of the
hearing to each institutional health care provider located in the
county.
(c) A representative of a paying hospital is entitled to
appear at the public hearing and be heard regarding any matter
related to the mandatory payments authorized under this chapter.
Sec. 292D.102. DEPOSITORY. (a) The commissioners court of
each county that collects a mandatory payment authorized under this
chapter by resolution shall designate one or more banks located in
the county as the depository for mandatory payments received by the
county.
(b) All income received by a county under this chapter,
including the revenue from mandatory payments remaining after
discounts and fees for assessing and collecting the payments are
deducted, shall be deposited with the county depository in the
county's local provider participation fund and may be withdrawn
only as provided by this chapter.
(c) All funds under this chapter shall be secured in the
manner provided for securing county funds.
Sec. 292D.103. LOCAL PROVIDER PARTICIPATION FUND;
AUTHORIZED USES OF MONEY. (a) Each county that collects a
mandatory payment authorized under this chapter shall create a
local provider participation fund.
(b) The local provider participation fund of a county
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.
(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 the nonfederal share of Medicaid 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), or a successor waiver program authorizing
similar Medicaid supplemental payment programs;
(B) uniform rate enhancements for nonpublic
hospitals in the Medicaid managed care service area in which the
county 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);
(D) payments to Medicaid managed care
organizations that are dedicated for payment to hospitals; or
(E) any reimbursement to nonpublic hospitals for
which federal matching funds are available;
(2) subject to Section 292D.151(d), pay the
administrative expenses of the county in administering the program,
including collateralization of deposits;
(3) refund all or a portion of a mandatory payment
collected in error from a paying hospital;
(4) refund to paying hospitals a proportionate share
of the money attributable to mandatory payments collected under
this chapter that the county:
(A) receives from the Health and Human Services
Commission 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;
(5) transfer funds to the Health and Human Services
Commission if the county is legally required to transfer the funds
to address a disallowance of federal matching funds with respect to
payments, rate enhancements, and reimbursements for which the
county made intergovernmental transfers described by Subdivision
(1); and
(6) reimburse the county if the county is required by
the rules governing the uniform rate enhancement program described
by Subdivision (1)(B) to incur an expense or forego Medicaid
reimbursements from the state because the balance of the local
provider participation fund is not sufficient to fund that rate
enhancement program.
(d) Money in the local provider participation fund may not
be commingled with other county 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 county, any funds received by the
state or county as a result of the transfer may not be used by the
state, county, or any other entity to:
(1) 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); or
(2) fund the nonfederal share of payments to nonpublic
hospitals available through the Medicaid disproportionate share
hospital program.
SUBCHAPTER D. MANDATORY PAYMENTS
Sec. 292D.151. 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 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 shall provide that the mandatory payment is to
be assessed at least annually, but not more often than
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 most recent fiscal year for
which that data was reported. If the institutional health care
provider did not report any data under those sections, the
provider's net patient revenue is the amount of that revenue as
contained in the provider's Medicare cost report submitted for the
previous fiscal year or for the closest subsequent fiscal year for
which the provider submitted the Medicare cost report. The
commissioners court 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 aggregate amount of the
mandatory payment required of all paying hospitals may not exceed
six percent of the aggregate net patient revenue from hospital
services provided by all paying hospitals in the county.
(d) Subject to 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 an intergovernmental transfer described by
Section 292D.103(c)(1). The annual amount of revenue from mandatory
payments that may be used to pay the administrative expenses of the
county for activities under this chapter may not exceed $150,000,
plus the cost of collateralization of deposits, regardless of
actual expenses.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient.
Sec. 292D.152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. (a) The county may collect or, using a competitive
bidding process, contract for the assessment and collection of
mandatory payments authorized under this chapter.
(b) The person charged by the county with the assessment and
collection of mandatory payments shall charge and deduct from the
mandatory payments collected for the county 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 mandatory payments is an official of the county, any revenue from
a collection fee charged under Subsection (b) shall be deposited in
the county general fund and, if appropriate, shall be reported as
fees of the county.
Sec. 292D.153. 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. 292D.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 certain
Medicaid programs as described by Section 292D.103(c)(1).
(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, the commissioners court
of the county administering the program 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 located in the county beyond the provisions of this
chapter. This section does not require the commissioners court of a
county to adopt a rule.
(c) The county may only assess and collect a mandatory
payment authorized under this chapter if a waiver program, uniform
rate enhancement, or reimbursement described by Section
292D.103(c)(1) is available to the county.
SECTION 2. Section 300.0003, Health and Safety Code, is
amended to read as follows:
Sec. 300.0003. APPLICABILITY. (a) Except as provided by
Subsection (b), this [This] chapter applies only to:
(1) a hospital district that is not participating in a
health care provider participation program authorized by another
chapter of this subtitle; and
(2) a county or municipality that:
(A) is not participating in a health care
provider participation program authorized by another chapter of
this subtitle; and
(B) is not served by a hospital district or a
public hospital.
(b) This chapter does not apply to a municipality that is
located in a county described by Section 292D.002.
SECTION 3. Chapter 295, Health and Safety Code, is
repealed.
SECTION 4. (a) In this section, "paying hospital" has the
meaning assigned by Section 295.001, Health and Safety Code.
(b) If on the date Chapter 295, Health and Safety Code, is
repealed by this Act a municipality to which that chapter applies
has not transferred any remaining amount of mandatory payments
assessed and collected by the municipality under that chapter
before its repeal to the Health and Human Services Commission, the
municipality shall refund to each paying hospital in the
municipality that hospital's proportionate share of the remaining
amount of mandatory payments.
(c) This section expires September 1, 2025.
SECTION 5. (a) Except as provided by Subsection (b) of this
section, this Act takes effect September 1, 2023.
(b) The section of this Act adding Chapter 292D, Health and
Safety Code, takes effect September 1, 2025.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 4835 was passed by the House on May 2,
2023, by the following vote: Yeas 141, Nays 4, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 4835 was passed by the Senate on May
23, 2023, by the following vote: Yeas 30, Nays 1.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor