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.