Bill Text: TX HB2409 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to establishing supplemental payment programs for the reimbursement of certain ambulance providers under Medicaid.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-04-30 - Committee report sent to Calendars [HB2409 Detail]

Download: Texas-2019-HB2409-Introduced.html
  86R3614 KFF-F
 
  By: Klick H.B. No. 2409
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to establishing supplemental payment programs for the
  reimbursement of certain ambulance providers under Medicaid.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 32, Human Resources Code, is amended by
  adding Subchapter H to read as follows:
  SUBCHAPTER H. SUPPLEMENTAL PAYMENT PROGRAM FOR CERTAIN AMBULANCE
  PROVIDERS
         Sec. 32.351.  DEFINITIONS. In this subchapter:
               (1)  "Participating provider" means an ambulance
  provider that participates in a supplemental payment program.
               (2)  "Supplemental payment program" means a
  supplemental payment program implemented under Section 32.352. 
         Sec. 32.352.  AMBULANCE PROVIDER SUPPLEMENTAL PAYMENT
  PROGRAMS. The commission shall:
               (1)  develop and implement two programs, one under the
  Medicaid fee-for-service delivery model and one under the Medicaid
  managed care delivery model, designed to provide supplemental
  payments to eligible ambulance providers; and
               (2)  apply for and actively pursue from the federal
  Centers for Medicare and Medicaid Services or other appropriate
  federal agency any waiver or other authorization necessary to
  implement the programs required by this section.
         Sec. 32.353.  PROVIDER ELIGIBILITY. (a) An ambulance
  provider is eligible to participate in a supplemental payment
  program if the provider:
               (1)  provides ground emergency medical transportation
  services to Medicaid recipients;
               (2)  is enrolled as a Medicaid provider at the time
  services are provided; and
               (3)  meets one of the following conditions:
                     (A)  is a state or local governmental entity,
  including a state or local governmental entity that employs or
  contracts with persons who are licensed to provide emergency
  medical services in this state; or
                     (B)  contracts, under an interlocal agreement,
  with a local governmental entity, including a local fire protection
  district, to provide emergency medical services in this state.
         (b)  Participation by a governmental entity in a
  supplemental payment program is voluntary.
         Sec. 32.354.  MEDICAID FEE-FOR-SERVICE SUPPLEMENTAL PAYMENT
  PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) This
  section applies only to a supplemental payment program implemented
  under the Medicaid fee-for-service delivery model.
         (b)  A governmental entity that is a participating provider
  or contracts with a participating provider as described by Section
  32.353(a)(3)(B) shall:
               (1)  certify that the expenditures claimed for the
  provision of ground emergency medical transportation services to
  Medicaid recipients are public funds eligible for federal financial
  participation in accordance with the requirements of 42 C.F.R.
  Section 433.51;
               (2)  provide evidence supporting the certification of
  public funds in the manner determined by the commission;
               (3)  submit data required by the commission for
  purposes of determining the amounts the commission may claim as
  expenditures qualifying for federal financial participation; and
               (4)  maintain and have readily available for the
  commission any records related to the expenditure.
         (c)  Under the supplemental payment program, the commission
  shall claim federal financial participation for expenditures
  described by Subsection (b)(1) that are allowable costs under the
  authorization to implement the supplemental payment program
  obtained under Section 32.352(2).
         (d)  A provider participating in the supplemental payment
  program shall receive, in addition to the rate of payment that the
  provider would otherwise receive for the provision of ground
  emergency medical transportation services to a Medicaid recipient,
  a supplemental reimbursement payment. The payment must:
               (1)  except as provided by Subsection (e), be equal to
  the amount of federal financial participation received by the
  commission for the service provided and claimed; and
               (2)  be paid on a per-transport basis or other
  federally permissible basis.
         (e)  The amount certified under Subsection (b)(1), when
  combined with the amount received by a participating provider from
  all sources of reimbursement under Medicaid, may not exceed 100
  percent of the provider's actual costs for the provision of
  services. The commission shall reduce a payment to a participating
  provider to ensure compliance with this subsection.
         Sec. 32.355.  MEDICAID MANAGED CARE SUPPLEMENTAL PAYMENT
  PROGRAM: REIMBURSEMENT REQUIREMENTS AND METHODOLOGY. (a) In this
  section:
               (1)  "Managed care organization" has the meaning
  assigned by Section 533.001, Government Code.
               (2)  "Medicaid managed care organization" means a
  managed care organization that contracts with the commission under
  Chapter 533, Government Code, to provide health care services to
  Medicaid recipients.
         (b)  This section applies only to a supplemental payment
  program implemented under the Medicaid managed care delivery model.
         (c)  The commission shall develop the supplemental payment
  program under the Medicaid managed care delivery model in
  consultation with providers eligible to participate in the
  supplemental payment program. The supplemental payment program
  must use intergovernmental transfers to finance increased
  capitation payments for the purpose of supplementing the
  reimbursement amount paid to participating providers.
         (d)  To the extent intergovernmental transfers are
  voluntarily made by, and accepted from, a governmental entity that
  is a participating provider or contracts with a participating
  provider as described by Section 32.353(a)(3)(B), and the
  participating provider is a provider under a Medicaid managed care
  delivery model, the commission shall make increased capitation
  payments to the requisite Medicaid managed care organizations to be
  used to pay the participating provider in accordance with an
  enhanced fee schedule that establishes a minimum reimbursement
  rate.
         (e)  The executive commissioner by rule shall adopt the
  enhanced fee schedule described by Subsection (d). The commission
  shall include a provision in each contract with a Medicaid managed
  care organization that requires the organization to pay
  reimbursement rates to participating providers in accordance with
  that schedule.
         (f)  The increased capitation payments made under the
  supplemental payment program and the enhanced fee schedule adopted
  under Subsection (e) must allow for a supplemental payment to a
  participating provider that is at least comparable in amount to the
  supplemental payment the provider would receive if providing the
  same service under the supplemental payment program implemented
  under the Medicaid fee-for-service delivery model under Section
  32.354. 
         (g)  A managed care organization that receives an increased
  capitation payment under the supplemental payment program shall pay
  100 percent of the increase to the participating provider in
  accordance with the enhanced fee schedule adopted under Subsection
  (e).
         (h)  All federal matching money obtained as a result of an
  intergovernmental transfer under the supplemental payment program
  must be used to pay increased capitation payments and provide
  supplemental payments to participating providers.
         (i)  To the extent that the commission determines that an
  intergovernmental transfer does not comply with the authorization
  obtained by the commission under Section 32.352(2), the commission
  may return the transfer, refuse to accept the transfer, or adjust
  the amount of the transfer as necessary to comply with the
  authorization.
         (j)  A participating provider and governmental entity that
  contracts with a participating provider must agree to comply with
  any requests for information or data requirements imposed by the
  commission for purposes of obtaining supporting documentation
  necessary to claim federal financial participation or obtain
  federal approval for implementation of the supplemental payment
  program.
         (k)  The commission shall ensure a Medicaid managed care
  organization complies with any request for information or similar
  requirements necessary to implement the supplemental payment
  program.
         Sec. 32.356.  FUNDING; USE OF GENERAL REVENUE PROHIBITED.
  (a) The commission may not use general revenue to:
               (1)  administer a supplemental payment program; or
               (2)  provide reimbursements under a supplemental
  payment program.
         (b)  A governmental entity that is a participating provider
  or contracts with a participating provider as described by Section
  32.353(a)(3)(B), as a condition of participating providers
  receiving supplemental payments under Section 32.354, must enter
  into and maintain an agreement with the commission to provide:
               (1)  the nonfederal share of the supplemental payments
  by certifying expenditures to the commission in accordance with
  Section 32.354(b); and
               (2)  funding necessary to pay the cost of administering
  the supplemental payment program under Section 32.354.
         (c)  A governmental entity that is a participating provider
  or contracts with a participating provider as described by Section
  32.353(a)(3)(B), as a condition of participating providers
  receiving supplemental payments under Section 32.355, must enter
  into and maintain an agreement with the commission to provide:
               (1)  the nonfederal share of the increased capitation
  payments by making intergovernmental transfers as provided by
  Section 32.355; and
               (2)  funding necessary to pay the cost of administering
  the supplemental payment program under Section 32.355.
         SECTION 2.  (a) As soon as possible after the effective date
  of this Act, the Health and Human Services Commission shall seek any
  waiver or other authorization necessary to implement the
  supplemental payment programs required by Subchapter H, Chapter 32,
  Human Resources Code, as added by this Act.
         (b)  To the extent permitted by the waiver or other
  authorization necessary to implement the supplemental payment
  programs required by Subchapter H, Chapter 32, Human Resources
  Code, as added by this Act, the Health and Human Services Commission
  shall implement the supplemental payment program implemented under
  the Medicaid managed care program on a retroactive basis.
         SECTION 3.  This Act takes effect September 1, 2019.
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