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 - Dead) 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 |
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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. |