Bill Text: TX HB1576 | 2019-2020 | 86th Legislature | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the delivery of certain transportation services under Medicaid and certain other health and human services programs.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-14 - Effective immediately [HB1576 Detail]
Download: Texas-2019-HB1576-Engrossed.html
Bill Title: Relating to the delivery of certain transportation services under Medicaid and certain other health and human services programs.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-14 - Effective immediately [HB1576 Detail]
Download: Texas-2019-HB1576-Engrossed.html
By: Phelan, Paddie, Springer, | H.B. No. 1576 | |
González of El Paso, Rose, et al. |
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relating to the delivery of certain medical transportation | ||
services, including under Medicaid and certain other health and | ||
human services programs; imposing a mandatory payment; authorizing | ||
an administrative penalty. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 531.02414(a), Government Code, is | ||
amended by amending Subdivision (1) and adding Subdivisions (1-a) | ||
and (3) to read as follows: | ||
(1) "Medical transportation program" means the | ||
program that provides nonemergency transportation services [ |
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recipients under Medicaid, the children with special health care | ||
needs program, and the transportation for indigent cancer patients | ||
program, who have no other means of transportation. | ||
(1-a) "Nonemergency transportation service" means a | ||
service provided to transport a person to or from medically | ||
necessary services covered under a health care program in which the | ||
person is enrolled. The term does not include a nonmedical | ||
transportation service as defined by Section 531.024142. | ||
(3) "Transportation network company" has the meaning | ||
assigned by Section 2402.001, Occupations Code. | ||
SECTION 2. Section 531.02414, Government Code, is amended | ||
by amending Subsection (f) and adding Subsections (i), (j), (k), | ||
(l), and (m) to read as follows: | ||
(f) Except as provided by Subsection (j), the [ |
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commission shall require compliance with the rules adopted under | ||
Subsection (e) in any contract entered into with a regional | ||
contracted broker to provide nonemergency transportation services | ||
under the medical transportation program. | ||
(i) Emergency medical services personnel and emergency | ||
medical services vehicles, as those terms are defined by Section | ||
773.003, Health and Safety Code, may not provide nonemergency | ||
transportation services under the medical transportation program. | ||
(j) A regional contracted broker may subcontract with a | ||
transportation network company to provide services under this | ||
section. A rule or other requirement adopted by the executive | ||
commissioner under Subsection (e) does not apply to the | ||
subcontracted transportation network company or a motor vehicle | ||
operator who is part of the company's network. The commission or | ||
the regional contracted broker may not require a motor vehicle | ||
operator who is part of the subcontracted transportation network | ||
company's network to enroll as a Medicaid provider to provide | ||
services under this section. | ||
(k) The commission or a regional contracted broker that | ||
subcontracts with a transportation network company under | ||
Subsection (j) may require the transportation network company or a | ||
motor vehicle operator who provides services under this section to | ||
be periodically screened against the list of excluded individuals | ||
and entities maintained by the Office of Inspector General of the | ||
United States Department of Health and Human Services. | ||
(l) Notwithstanding any other law, a motor vehicle operator | ||
who is part of the network of a transportation network company that | ||
subcontracts with a regional contracted broker under Subsection (j) | ||
and who satisfies the driver requirements in Section 2402.107, | ||
Occupations Code, is qualified to provide services under this | ||
section. The commission and the regional contracted broker may not | ||
impose any additional requirements on a motor vehicle operator who | ||
satisfies the driver requirements in Section 2402.107, Occupations | ||
Code, to provide services under this section. | ||
(m) For purposes of this section and notwithstanding | ||
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle | ||
operator who provides services under this section may use a | ||
wheelchair-accessible vehicle equipped with a lift or ramp that is | ||
capable of transporting passengers using a fixed-frame wheelchair | ||
in the cabin of the vehicle if the vehicle otherwise meets the | ||
requirements of Section 2402.111, Occupations Code. | ||
SECTION 3. Subchapter B, Chapter 531, Government Code, is | ||
amended by adding Section 531.024142 to read as follows: | ||
Sec. 531.024142. NONMEDICAL TRANSPORTATION SERVICES UNDER | ||
MEDICAID. (a) In this section: | ||
(1) "Managed care organization" means a managed care | ||
organization that contracts with the commission to provide health | ||
care services to Medicaid recipients under Chapter 533. | ||
(2) "Nonmedical transportation service" means: | ||
(A) curb-to-curb transportation in a standard | ||
passenger vehicle to and from a medically necessary, nonemergency | ||
covered health care service of a Medicaid recipient enrolled in a | ||
managed care plan that the managed care organization that provides | ||
health care services to the recipient determines meets the level of | ||
care that is medically appropriate for the recipient and that is | ||
scheduled not more than 48 hours before the transportation occurs, | ||
including transportation related to: | ||
(i) discharge of a recipient from a health | ||
care facility; | ||
(ii) receipt of urgent care; and | ||
(iii) obtaining pharmacy services and | ||
prescription drugs; and | ||
(B) any other transportation to or from a | ||
medically necessary, nonemergency covered health care service the | ||
commission considers appropriate to be provided by a transportation | ||
vendor, as determined by commission rule or policy. | ||
(3) "Transportation network company" has the meaning | ||
assigned by Section 2402.001, Occupations Code. | ||
(4) "Transportation vendor" means an entity, | ||
including a transportation network company, that contracts with a | ||
managed care organization to provide nonmedical transportation | ||
services. | ||
(b) The executive commissioner shall adopt rules regarding | ||
the manner in which nonmedical transportation services may be | ||
arranged and provided. | ||
(c) The rules must require a managed care organization to | ||
create a process to: | ||
(1) verify that a passenger is eligible to receive | ||
nonmedical transportation services; | ||
(2) ensure that nonmedical transportation services | ||
are provided only to and from covered health care services in areas | ||
in which a transportation network company operates; | ||
(3) refer a Medicaid recipient enrolled in a managed | ||
care plan offered by the managed care organization to the medical | ||
transportation program described by Section 531.02414 if: | ||
(A) by rule the managed care organization is not | ||
responsible for providing transportation services; or | ||
(B) the recipient requires an accessible or | ||
specialized vehicle that is not available through a transportation | ||
vendor; and | ||
(4) ensure the timely delivery of nonmedical | ||
transportation services to a Medicaid recipient, including by | ||
setting reasonable service response goals. | ||
(d) A rule adopted in accordance with Subsection (c)(4) may | ||
not penalize a managed care organization that contracts with a | ||
transportation vendor under this section if the vendor is unable to | ||
provide nonmedical transportation services to a Medicaid recipient | ||
after the managed care organization has made a specific request for | ||
those services. | ||
(e) The rules must require a transportation vendor to, | ||
before permitting a motor vehicle operator to provide nonmedical | ||
transportation services: | ||
(1) confirm that the operator: | ||
(A) is at least 18 years of age; | ||
(B) maintains a valid driver's license issued by | ||
this state, another state, or the District of Columbia; and | ||
(C) possesses proof of registration and | ||
automobile financial responsibility for each motor vehicle to be | ||
used to provide nonmedical transportation services; | ||
(2) conduct, or cause to be conducted, a local, state, | ||
and national criminal background check for the operator that | ||
includes the use of: | ||
(A) a commercial multistate and | ||
multijurisdiction criminal records locator or other similar | ||
commercial nationwide database; and | ||
(B) the national sex offender public website | ||
maintained by the United States Department of Justice or a | ||
successor agency; | ||
(3) confirm that any vehicle to be used to provide | ||
nonmedical transportation services: | ||
(A) meets the applicable requirements of Chapter | ||
548, Transportation Code; and | ||
(B) except as provided by Subsection (j), has at | ||
least four doors; and | ||
(4) obtain and review the operator's driving record. | ||
(f) The rules may not permit a motor vehicle operator to | ||
provide nonmedical transportation services if the operator: | ||
(1) has been convicted in the three-year period | ||
preceding the issue date of the driving record obtained under | ||
Subsection (e)(4) of: | ||
(A) more than three offenses classified by the | ||
Department of Public Safety as moving violations; or | ||
(B) one or more of the following offenses: | ||
(i) fleeing or attempting to elude a police | ||
officer under Section 545.421, Transportation Code; | ||
(ii) reckless driving under Section | ||
545.401, Transportation Code; | ||
(iii) driving without a valid driver's | ||
license under Section 521.025, Transportation Code; or | ||
(iv) driving with an invalid driver's | ||
license under Section 521.457, Transportation Code; | ||
(2) has been convicted in the preceding seven-year | ||
period of any of the following: | ||
(A) driving while intoxicated under Section | ||
49.04 or 49.045, Penal Code; | ||
(B) use of a motor vehicle to commit a felony; | ||
(C) a felony crime involving property damage; | ||
(D) fraud; | ||
(E) theft; | ||
(F) an act of violence; or | ||
(G) an act of terrorism; or | ||
(3) is found to be registered in the national sex | ||
offender public website maintained by the United States Department | ||
of Justice or a successor agency. | ||
(g) The commission may not require: | ||
(1) a motor vehicle operator to enroll as a Medicaid | ||
provider to provide nonmedical transportation services; or | ||
(2) a managed care organization to credential a motor | ||
vehicle operator to provide nonmedical transportation services. | ||
(h) The commission or a managed care organization that | ||
contracts with a transportation vendor may require the | ||
transportation vendor or a motor vehicle operator who provides | ||
services under this section to be periodically screened against the | ||
list of excluded individuals and entities maintained by the Office | ||
of Inspector General of the United States Department of Health and | ||
Human Services. | ||
(i) Notwithstanding any other law, a motor vehicle operator | ||
who is part of a transportation network company's network and who | ||
satisfies the driver requirements in Section 2402.107, Occupations | ||
Code, is qualified to provide nonmedical transportation services. | ||
The commission and a managed care organization may not impose any | ||
additional requirements on a motor vehicle operator who satisfies | ||
the driver requirements in Section 2402.107, Occupations Code, to | ||
provide nonmedical transportation services. | ||
(j) For purposes of this section and notwithstanding | ||
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle | ||
operator who provides services under this section may use a | ||
wheelchair-accessible vehicle equipped with a lift or ramp that is | ||
capable of transporting passengers using a fixed-frame wheelchair | ||
in the cabin of the vehicle if the vehicle otherwise meets the | ||
requirements of Section 2402.111, Occupations Code. | ||
SECTION 4. Section 533.00257(a), Government Code, is | ||
amended by adding Subdivision (2-a) to read as follows: | ||
(2-a) "Transportation network company" has the | ||
meaning assigned by Section 2402.001, Occupations Code. | ||
SECTION 5. Section 533.00257, Government Code, is amended | ||
by amending Subsections (d) and (g) and adding Subsections (k), | ||
(l), (m), and (n) to read as follows: | ||
(d) Except as provided by Subsections (k) and (m), a [ |
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managed transportation organization that participates in the | ||
medical transportation program must attempt to contract with | ||
medical transportation providers that: | ||
(1) are considered significant traditional providers, | ||
as defined by rule by the executive commissioner; | ||
(2) meet the minimum quality and efficiency measures | ||
required under Subsection (g) and other requirements that may be | ||
imposed by the managed transportation organization; and | ||
(3) agree to accept the prevailing contract rate of | ||
the managed transportation organization. | ||
(g) Except as provided by Subsections (k) and (m), the [ |
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commission shall require that managed transportation organizations | ||
and providers participating in the medical transportation program | ||
meet minimum quality and efficiency measures as determined by the | ||
commission. | ||
(k) A managed transportation organization may subcontract | ||
with a transportation network company to provide services under | ||
this section. A rule or other requirement adopted by the executive | ||
commissioner under this section or Section 531.02414 does not apply | ||
to the subcontracted transportation network company or a motor | ||
vehicle operator who is part of the company's network. The | ||
commission or the managed transportation organization may not | ||
require a motor vehicle operator who is part of the subcontracted | ||
transportation network company's network to enroll as a Medicaid | ||
provider to provide services under this section. | ||
(l) The commission or a managed transportation organization | ||
that subcontracts with a transportation network company under | ||
Subsection (k) may require the transportation network company or a | ||
motor vehicle operator who provides services under this section to | ||
be periodically screened against the list of excluded individuals | ||
and entities maintained by the Office of Inspector General of the | ||
United States Department of Health and Human Services. | ||
(m) Notwithstanding any other law, a motor vehicle operator | ||
who is part of the network of a transportation network company that | ||
subcontracts with a managed transportation organization under | ||
Subsection (k) and who satisfies the driver requirements in Section | ||
2402.107, Occupations Code, is qualified to provide services under | ||
this section. The commission and the managed transportation | ||
organization may not impose any additional requirements on a motor | ||
vehicle operator who satisfies the driver requirements in Section | ||
2402.107, Occupations Code, to provide services under this section. | ||
(n) For purposes of this section and notwithstanding | ||
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle | ||
operator who provides services under this section may use a | ||
wheelchair-accessible vehicle equipped with a lift or ramp that is | ||
capable of transporting passengers using a fixed-frame wheelchair | ||
in the cabin of the vehicle if the vehicle otherwise meets the | ||
requirements of Section 2402.111, Occupations Code. | ||
SECTION 6. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Section 533.00259 to read as follows: | ||
Sec. 533.00259. DELIVERY OF NONMEDICAL TRANSPORTATION | ||
SERVICES. (a) In this section, "nonmedical transportation | ||
service" and "transportation vendor" have the meanings assigned by | ||
Section 531.024142. | ||
(b) The commission shall: | ||
(1) not later than January 1, 2020, designate at least | ||
four managed care service areas, two of which must be urban service | ||
areas, and require each managed care organization that contracts | ||
with the commission to provide health care services to recipients | ||
in those areas to arrange for the provision of nonmedical | ||
transportation services; | ||
(2) not later than July 1, 2020, designate at least | ||
eight managed care service areas, four of which must be urban | ||
service areas, and require each managed care organization that | ||
contracts with the commission to provide health care services to | ||
recipients in those areas to arrange for the provision of | ||
nonmedical transportation services; and | ||
(3) not later than January 1, 2021, require each | ||
managed care organization that contracts with the commission to | ||
provide health care services to recipients to arrange for the | ||
provision of nonmedical transportation services. | ||
(b-1) A managed care organization may contract with a | ||
transportation vendor or other third party to arrange for the | ||
provision of nonmedical transportation services. If a managed care | ||
organization contracts with a third party that is not a | ||
transportation vendor to arrange for the provision of nonmedical | ||
transportation services, the third party shall contract with a | ||
transportation vendor to deliver the nonmedical transportation | ||
services. | ||
(c) A managed care organization that contracts with a | ||
transportation vendor or other third party to arrange for the | ||
provision of nonmedical transportation services shall ensure the | ||
effective sharing and integration of service coordination, service | ||
authorization, and utilization management data between the managed | ||
care organization and the transportation vendor or third party. | ||
(d) A managed care organization may not require: | ||
(1) a motor vehicle operator to enroll as a Medicaid | ||
provider to provide nonmedical transportation services; or | ||
(2) the credentialing of a motor vehicle operator to | ||
provide nonmedical transportation services. | ||
(e) For purposes of this section and notwithstanding | ||
Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle | ||
operator who provides services under this section may use a | ||
wheelchair-accessible vehicle equipped with a lift or ramp that is | ||
capable of transporting passengers using a fixed-frame wheelchair | ||
in the cabin of the vehicle if the vehicle otherwise meets the | ||
requirements of Section 2402.111, Occupations Code. | ||
SECTION 7. Section 773.003, Health and Safety Code, is | ||
amended by adding Subdivision (5) to read as follows: | ||
(5) "Commission" means the Health and Human Services | ||
Commission. | ||
SECTION 8. Chapter 773, Health and Safety Code, is amended | ||
by adding Subchapter J to read as follows: | ||
SUBCHAPTER J. TEXAS AMBULANCE RESPONSE SAFETY NET PROGRAM | ||
Sec. 773.301. PURPOSE. The purpose of this subchapter is to | ||
authorize the commission to establish and administer the Texas | ||
ambulance response safety net program as a self-funded ground | ||
ambulance service provider participation program for ground | ||
ambulance service providers in accordance with this subchapter. | ||
Sec. 773.302. DEFINITIONS. In this subchapter: | ||
(1) "Average commercial rate" means the average amount | ||
payable by commercial payors for the same service. The rate is | ||
calculated by: | ||
(A) aligning the paid Medicaid claims with the | ||
Medicare fees for each Healthcare Common Procedure Coding System | ||
code or Current Procedural Terminology code for a ground ambulance | ||
service provider; | ||
(B) calculating the Medicare payment for the | ||
claims described in Paragraph (A); | ||
(C) calculating a commercial-to-Medicare | ||
conversion factor for each ground ambulance service provider by | ||
dividing the total amount of the average commercial payments for | ||
the claims by the total Medicare payments for the claims; and | ||
(D) recalculating at least once every three years | ||
the commercial-to-Medicare ratio for ground ambulance service | ||
providers. | ||
(2) "Net patient revenue" means a ground ambulance | ||
service provider's estimated net realizable revenue from patients, | ||
third-party payors, and other entities for ground ambulance | ||
services rendered, including estimated retroactive adjustments | ||
required by reimbursement agreements with third-party payors. The | ||
term does not include: | ||
(A) the amounts the provider reduces for payors | ||
who have a fee schedule established by federal or state statute or a | ||
contractual agreement; | ||
(B) Medicaid payments received by the provider, | ||
including any payments for individuals who are dually eligible for | ||
Medicaid and Medicare; | ||
(C) amounts the provider reduces to zero as an | ||
uncollectible payment from any payor that are not contractual | ||
allowances, provided that the provider attempted to collect the | ||
payment; or | ||
(D) amounts related to ground ambulance services | ||
that are waived or forgiven by a paying entity due to the financial | ||
hardship of the patient, provided that the waiver or forgiveness is | ||
implemented in accordance with a written policy of the entity that | ||
is consistent with national standards adopted by the Healthcare | ||
Financial Management Association or a similar organization. | ||
Sec. 773.303. APPLICABILITY. (a) This subchapter applies | ||
only to a ground ambulance service provider that is: | ||
(1) an emergency medical services provider as defined | ||
by Section 773.003 and licensed under this chapter; | ||
(2) a nonpublic, nonfederal provider of ground | ||
ambulance services; and | ||
(3) a participant in the state Medicaid program. | ||
(b) This subchapter does not apply to: | ||
(1) an entity that provides only nonemergency ground | ||
ambulance services; | ||
(2) a state or local governmental entity that provides | ||
ground ambulance services; or | ||
(3) an entity that is required to hold a license under | ||
Section 773.045(b). | ||
(c) The executive commissioner may not modify the | ||
applicability of this subchapter in an effort to comply with the | ||
requirements of 42 C.F.R. Section 433.68. | ||
Sec. 773.304. MANDATORY PAYMENTS BASED ON NET PATIENT | ||
REVENUE. (a) Except as otherwise provided by this subchapter, the | ||
commission shall require an annual mandatory payment to be assessed | ||
on each ground ambulance service provider's net patient revenue | ||
related to the provision of emergency ground ambulance services. | ||
The mandatory payment is to be collected quarterly. The commission | ||
shall update the amount of the mandatory payment at least annually. | ||
(b) The commission shall uniformly and consistently impose | ||
the mandatory payment on each ground ambulance service provider and | ||
use the same formula for each provider in calculating the mandatory | ||
payment. | ||
(c) The total amount of all mandatory payments for the state | ||
fiscal year in which the mandatory payments are imposed may not | ||
exceed: | ||
(1) the state portion, excluding any federal financial | ||
participation, of the cost of reimbursement enhancements provided | ||
in this subchapter that are directly attributable to reimbursements | ||
to ground ambulance service providers; or | ||
(2) an amount equal to six percent of the net operating | ||
revenue of all ground ambulance service providers for the provision | ||
of emergency ground ambulance services, or an amount otherwise | ||
permitted by federal law, provided that the maximum mandatory | ||
payment for a provider in any year may not exceed the provider's net | ||
patient revenue, as reported by the provider, subject to Section | ||
773.306(b). | ||
(d) Subject to the maximum amount prescribed by Subsection | ||
(c), the commission shall set the mandatory payment in an amount | ||
that in the aggregate generates sufficient revenue to cover the | ||
administrative expenses of the commission for activities under this | ||
subchapter. | ||
(e) Not later than the 30th day before the end of each | ||
quarter, the commission shall issue to each ground ambulance | ||
service provider a notice of the amount of the mandatory payment | ||
required to be paid by the provider in the next quarter. | ||
(f) A ground ambulance service provider may not add a | ||
mandatory payment required under this subchapter as a surcharge to | ||
a patient or a third-party payor. | ||
(g) A ground ambulance service provider shall make | ||
mandatory payments only in the manner provided by this subchapter. | ||
Sec. 773.305. ASSESSMENT AND COLLECTION OF MANDATORY | ||
PAYMENTS. (a) Subject to Subsection (b), the commission shall | ||
collect a mandatory payment required under this subchapter. | ||
(b) The commission may contract for the assessment and | ||
collection of mandatory payments under this subchapter. | ||
Sec. 773.306. REPORT; INSPECTION OF RECORDS. (a) The | ||
commission shall require a ground ambulance service provider to | ||
submit a report at least annually, but not more than quarterly, that | ||
includes information necessary to assist the commission in making a | ||
determination on mandatory payments under this subchapter. | ||
(b) The executive commissioner may audit or inspect the | ||
records of a ground ambulance service provider to the extent | ||
necessary to ensure the accuracy of any data submitted to the | ||
commission under this subchapter. | ||
Sec. 773.307. FAILURE TO SUBMIT TIMELY OR ACCURATE REPORT | ||
OR PAYMENT; AUDIT; ADMINISTRATIVE PENALTY. (a) The commission may | ||
assess a reasonable penalty against a ground ambulance service | ||
provider, not to exceed 15 percent of the quarterly portion of the | ||
provider's mandatory payment, for failure to timely submit the | ||
quarterly portion of a mandatory payment or a report required under | ||
this subchapter. | ||
(b) If a ground ambulance service provider submits an | ||
inaccurate report required under this subchapter, the commission | ||
may conduct an audit of the provider's records and may require the | ||
provider to pay the cost of any audit expenses and related hearings. | ||
(c) A penalty assessed under this section is in addition to | ||
any other penalties and remedies applicable under state or federal | ||
law. | ||
(d) If a ground ambulance service provider refuses to submit | ||
a quarterly portion of a mandatory payment, the commission may | ||
suspend all Medicaid payments to the provider until: | ||
(1) the provider submits the quarterly portion of the | ||
mandatory payment and any associated penalties; or | ||
(2) the provider and the commission reach a negotiated | ||
settlement. | ||
Sec. 773.308. TEXAS AMBULANCE RESPONSE SAFETY NET TRUST | ||
FUND. (a) The Texas ambulance response safety net trust fund is | ||
established as a trust fund to be held by the comptroller outside | ||
the state treasury and administered by the commission as trustee. | ||
(b) The trust fund consists of: | ||
(1) all revenue from the mandatory payments required | ||
by this subchapter, including any administrative penalties and any | ||
interest attributable to delinquent payments; and | ||
(2) the earnings of the fund. | ||
(c) Money deposited to the trust fund may be used only to: | ||
(1) provide reimbursements for ground ambulance | ||
services delivered to Medicaid recipients under a fee-for-service | ||
arrangement by a ground ambulance service provider to which this | ||
subchapter applies based on the provider's average commercial rate, | ||
including reimbursement enhancements to the statewide dollar | ||
amount rate used to reimburse ground ambulance service providers; | ||
(2) pay the administrative expenses of the commission | ||
solely for activities under this subchapter; and | ||
(3) refund a portion of a mandatory payment collected | ||
in error from a provider. | ||
(d) All revenue from the mandatory payments required by this | ||
subchapter must be deposited in the trust fund. | ||
(e) Money in the trust fund may not be used 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. 773.309. INVALIDITY; FEDERAL FUNDS. The commission | ||
shall stop collection of the mandatory payment and, not later than | ||
the 30th day after the date collection is stopped, return to each | ||
ground ambulance service provider, in proportion to the total | ||
amount paid by each provider compared to the total amount paid by | ||
all providers, any unspent money deposited to the credit of the | ||
trust fund, if: | ||
(1) any provision of or procedure under this | ||
subchapter is held invalid by a final court order that is not | ||
subject to appeal; | ||
(2) the commission determines that the imposition of | ||
the mandatory payment and the expenditure of amounts collected as | ||
prescribed by this subchapter will not entitle the state to receive | ||
federal matching funds under the Medicaid program or will be | ||
inconsistent with the objectives described by Section | ||
537.002(b)(7), Government Code; or | ||
(3) the commission determines that the amount of the | ||
mandatory payments collected would exceed the amount paid in | ||
increased Medicaid fee-for-service reimbursement rates for | ||
services provided to individuals who are dually eligible for | ||
Medicaid and Medicare. | ||
Sec. 773.310. RULES. The executive commissioner shall | ||
adopt rules necessary to implement this subchapter. | ||
SECTION 9. Subchapter B, Chapter 32, Human Resources Code, | ||
is amended by adding Section 32.080 to read as follows: | ||
Sec. 32.080. ENHANCED PAYMENT MODEL FOR CERTAIN AMBULANCE | ||
PROVIDERS. (a) The executive commissioner, in consultation with | ||
ambulance providers, by rule shall establish an enhanced payment | ||
model for reimbursing non-state operated public ambulance | ||
providers who provide ground emergency medical transportation | ||
services to recipients of medical assistance. The enhanced payment | ||
model must be implemented under the Medicaid fee-for-service | ||
delivery model through supplemental payments and the Medicaid | ||
managed care delivery model through an enhanced reimbursement or | ||
payment rate. | ||
(b) The commission may not use general revenue to reimburse | ||
non-state operated public ambulance providers under or administer | ||
the enhanced payment model. | ||
(c) Reimbursements made under the enhanced payment model | ||
must be: | ||
(1) in addition to money appropriated to the | ||
commission for reimbursing non-state operated public ambulance | ||
providers; and | ||
(2) provided in a manner that maximizes the | ||
availability of federal money. | ||
(d) Under the enhanced payment model, the commission may: | ||
(1) receive and spend money from an intergovernmental | ||
transfer on: | ||
(A) reimbursing non-state operated public | ||
ambulance providers; and | ||
(B) covering the cost of establishing and | ||
administering the enhanced payment model; and | ||
(2) as necessary, certify that reimbursements made | ||
under the enhanced payment model are public funds eligible for | ||
federal financial participation in accordance with the | ||
requirements of 42 C.F.R. Section 433.51. | ||
SECTION 10. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall establish the amount of the initial | ||
mandatory payment imposed under Subchapter J, Chapter 773, Health | ||
and Safety Code, as added by this Act, based on available net | ||
patient revenue information. | ||
SECTION 11. 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: | ||
(1) for a provision of Subchapter J, Chapter 773, | ||
Health and Safety Code, as added by this Act, shall delay | ||
implementing that provision, including the collection of a | ||
mandatory payment, until the waiver or authorization is granted and | ||
begin implementing the provision on the date the waiver or | ||
authorization is granted; and | ||
(2) for any other provision, may delay implementing | ||
the provision until the waiver or authorization is granted. | ||
SECTION 12. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall adopt rules as necessary to implement the | ||
changes in law made by this Act. | ||
SECTION 13. 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. |