Bill Text: TX HB2333 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the Texas ambulance response safety net program; imposing a mandatory payment; authorizing an administrative penalty.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-04-09 - Left pending in committee [HB2333 Detail]

Download: Texas-2019-HB2333-Introduced.html
  86R6969 LED-F
 
  By: Paddie H.B. No. 2333
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the Texas ambulance response safety net program;
  imposing a mandatory payment; authorizing an administrative
  penalty.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  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 2.  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
  transport emergency medical services provider participation
  program for ground transport emergency medical services 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 services.  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 transport
  emergency medical services provider;
                     (B)  calculating the Medicare payment for the
  claims described in Paragraph (A);
                     (C)  calculating a commercial-to-Medicare
  conversion factor for each ground transport emergency medical
  services 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 transport emergency
  medical services providers.
               (2)  "Net patient revenue" means a ground transport
  emergency medical services provider's estimated net realizable
  revenue from patients, third-party payors, and other entities for
  ground transport emergency medical 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 transport
  emergency medical 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 transport emergency medical services provider that
  is:
               (1)  licensed as an emergency medical services provider
  under this chapter;
               (2)  a private, nonfederal provider of ground transport
  emergency medical services; and
               (3)  a participant in the state Medicaid program.
         (b)  This subchapter does not apply to an entity that:
               (1)  provides only nonemergency ground transport
  ambulance services; or
               (2)  is required to hold a license under Section
  773.045(b).
         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 transport emergency medical services provider's net
  patient revenue related to the provision of ground transport
  emergency medical 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 transport emergency medical
  services 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 transport emergency medical services providers; or
               (2)  an amount equal to six percent of the net operating
  revenue of all ground transport emergency medical services
  providers for the provision of emergency ground transport ambulance
  services, or a greater amount as 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 transport
  emergency medical services provider a notice of the amount of the
  mandatory payment required to be paid by the provider in the next
  quarter.
         (f)  A ground transport emergency medical services 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 transport emergency medical services 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 transport emergency medical
  services 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 transport emergency medical services 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 transport emergency
  medical services 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 transport emergency medical services
  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 transport emergency medical services
  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 transport
  emergency medical services delivered to Medicaid recipients based
  on the provider's average commercial rate, including reimbursement
  enhancements to the statewide dollar amount rate used to reimburse
  ground transport emergency medical services 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. If any provision
  of or procedure under this subchapter is held invalid by a final
  court order that is not subject to appeal, or if 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, the
  commission shall:
               (1)  stop collection of the payment; and
               (2)  not later than the 30th day after the date
  collection is stopped, return to each ground transport emergency
  medical services 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.
         Sec. 773.310.  RULES. The executive commissioner shall
  adopt rules necessary to implement this subchapter.
         SECTION 3.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall:
               (1)  adopt the rules necessary to implement Subchapter
  J, Chapter 773, Health and Safety Code, as added by this Act; and
               (2)  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 4.  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 shall delay implementing that provision until the
  waiver or authorization is granted. The agency shall begin
  implementing the provision on the date the waiver or authorization
  is granted.
         SECTION 5.  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.
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