Bill Text: TX HB4835 | 2023-2024 | 88th Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the creation and operations of certain health care provider participation programs.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2023-06-11 - See remarks for effective date [HB4835 Detail]
Download: Texas-2023-HB4835-Comm_Sub.html
Bill Title: Relating to the creation and operations of certain health care provider participation programs.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2023-06-11 - See remarks for effective date [HB4835 Detail]
Download: Texas-2023-HB4835-Comm_Sub.html
By: Metcalf (Senate Sponsor - Nichols) | H.B. No. 4835 | |
(In the Senate - Received from the House May 3, 2023; | ||
May 5, 2023, read first time and referred to Committee on Local | ||
Government; May 22, 2023, reported favorably by the following | ||
vote: Yeas 9, Nays 0; May 22, 2023, sent to printer.) | ||
COMMITTEE VOTE | ||
YeaNayAbsentPNV | ||
BettencourtX | ||
SpringerX | ||
EckhardtX | ||
GutierrezX | ||
HallX | ||
NicholsX | ||
ParkerX | ||
PaxtonX | ||
WestX | ||
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relating to the creation and operations of certain health care | ||
provider participation programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle D, Title 4, Health and Safety Code, is | ||
amended by adding Chapter 292D to read as follows: | ||
CHAPTER 292D. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN | ||
CERTAIN COUNTIES BORDERING NECHES RIVER | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 292D.001. DEFINITIONS. In this chapter: | ||
(1) "Institutional health care provider" means a | ||
nonpublic hospital that provides inpatient hospital services. | ||
(2) "Paying hospital" means an institutional health | ||
care provider required to make a mandatory payment under this | ||
chapter. | ||
(3) "Program" means the county health care provider | ||
participation program authorized by this chapter. | ||
Sec. 292D.002. APPLICABILITY. This chapter applies only to | ||
a county that: | ||
(1) is not served by a hospital district; | ||
(2) has a population of more than 250,000; and | ||
(3) borders the Neches River. | ||
Sec. 292D.003. COUNTY HEALTH CARE PROVIDER PARTICIPATION | ||
PROGRAM; PARTICIPATION IN PROGRAM. (a) A county health care | ||
provider participation program authorizes a county to collect a | ||
mandatory payment from each institutional health care provider | ||
located in the county to be deposited in a local provider | ||
participation fund established by the county. Money in the fund may | ||
be used by the county as provided by Section 292D.103(c). | ||
(b) The commissioners court may adopt an order authorizing a | ||
county to participate in the program, subject to the limitations | ||
provided by this chapter. | ||
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT | ||
Sec. 292D.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY | ||
PAYMENTS. The commissioners court of a county may require a | ||
mandatory payment authorized under this chapter by an institutional | ||
health care provider in the county only in the manner provided by | ||
this chapter. | ||
Sec. 292D.052. MAJORITY VOTE REQUIRED. The commissioners | ||
court of a county may not authorize the county to collect a | ||
mandatory payment authorized under this chapter without an | ||
affirmative vote of a majority of the members of the commissioners | ||
court. | ||
Sec. 292D.053. RULES AND PROCEDURES. The commissioners | ||
court may adopt rules relating to the administration of the | ||
program, including the collection of a mandatory payment, | ||
expenditures, an audit, and any other administrative aspect of the | ||
program. | ||
Sec. 292D.054. INSTITUTIONAL HEALTH CARE PROVIDER | ||
REPORTING; INSPECTION OF RECORDS. (a) If the commissioners court | ||
of a county authorizes the county to participate in a program under | ||
this chapter, the commissioners court shall require each | ||
institutional health care provider to submit to the county a copy of | ||
any financial and utilization data required by and reported to the | ||
Department of State Health Services under Sections 311.032 and | ||
311.033 and any rules adopted by the executive commissioner of the | ||
Health and Human Services Commission to implement those sections. | ||
(b) The commissioners court of a county that collects a | ||
mandatory payment authorized under this chapter may inspect the | ||
records of an institutional health care provider to the extent | ||
necessary to ensure compliance with the requirements of Subsection | ||
(a). | ||
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS | ||
Sec. 292D.101. HEARING. (a) In each year that the | ||
commissioners court of a county authorizes a program under this | ||
chapter, the commissioners court shall hold a public hearing on the | ||
amounts of any mandatory payments that the commissioners court | ||
intends to require during the year and how the revenue derived from | ||
those payments is to be spent. | ||
(b) Not later than the fifth day before the date of the | ||
hearing required under Subsection (a), the commissioners court of | ||
the county shall publish notice of the hearing in a newspaper of | ||
general circulation in the county and provide written notice of the | ||
hearing to each institutional health care provider located in the | ||
county. | ||
(c) A representative of a paying hospital is entitled to | ||
appear at the public hearing and be heard regarding any matter | ||
related to the mandatory payments authorized under this chapter. | ||
Sec. 292D.102. DEPOSITORY. (a) The commissioners court of | ||
each county that collects a mandatory payment authorized under this | ||
chapter by resolution shall designate one or more banks located in | ||
the county as the depository for mandatory payments received by the | ||
county. | ||
(b) All income received by a county under this chapter, | ||
including the revenue from mandatory payments remaining after | ||
discounts and fees for assessing and collecting the payments are | ||
deducted, shall be deposited with the county depository in the | ||
county's local provider participation fund and may be withdrawn | ||
only as provided by this chapter. | ||
(c) All funds under this chapter shall be secured in the | ||
manner provided for securing county funds. | ||
Sec. 292D.103. LOCAL PROVIDER PARTICIPATION FUND; | ||
AUTHORIZED USES OF MONEY. (a) Each county that collects a | ||
mandatory payment authorized under this chapter shall create a | ||
local provider participation fund. | ||
(b) The local provider participation fund of a county | ||
consists of: | ||
(1) all revenue received by the county attributable to | ||
mandatory payments authorized under this chapter, including any | ||
penalties and interest attributable to delinquent payments; | ||
(2) money received from the Health and Human Services | ||
Commission as a refund of an intergovernmental transfer from the | ||
county to the state for the purpose of providing the nonfederal | ||
share of Medicaid supplemental payment program payments, provided | ||
that the intergovernmental transfer does not receive a federal | ||
matching payment; and | ||
(3) the earnings of the fund. | ||
(c) Money deposited to the local provider participation | ||
fund may be used only to: | ||
(1) fund intergovernmental transfers from the county | ||
to the state to provide the nonfederal share of Medicaid payments | ||
for: | ||
(A) uncompensated care payments to nonpublic | ||
hospitals, if those payments are authorized under the Texas | ||
Healthcare Transformation and Quality Improvement Program waiver | ||
issued under Section 1115 of the federal Social Security Act (42 | ||
U.S.C. Section 1315), or a successor waiver program authorizing | ||
similar Medicaid supplemental payment programs; | ||
(B) uniform rate enhancements for nonpublic | ||
hospitals in the Medicaid managed care service area in which the | ||
county is located; | ||
(C) payments available under another waiver | ||
program authorizing payments that are substantially similar to | ||
Medicaid payments to nonpublic hospitals described by Paragraph (A) | ||
or (B); | ||
(D) payments to Medicaid managed care | ||
organizations that are dedicated for payment to hospitals; or | ||
(E) any reimbursement to nonpublic hospitals for | ||
which federal matching funds are available; | ||
(2) subject to Section 292D.151(d), pay the | ||
administrative expenses of the county in administering the program, | ||
including collateralization of deposits; | ||
(3) refund all or a portion of a mandatory payment | ||
collected in error from a paying hospital; | ||
(4) refund to paying hospitals a proportionate share | ||
of the money attributable to mandatory payments collected under | ||
this chapter that the county: | ||
(A) receives from the Health and Human Services | ||
Commission that is not used to fund the nonfederal share of Medicaid | ||
supplemental payment program payments; or | ||
(B) determines cannot be used to fund the | ||
nonfederal share of Medicaid supplemental payment program | ||
payments; | ||
(5) transfer funds to the Health and Human Services | ||
Commission if the county is legally required to transfer the funds | ||
to address a disallowance of federal matching funds with respect to | ||
payments, rate enhancements, and reimbursements for which the | ||
county made intergovernmental transfers described by Subdivision | ||
(1); and | ||
(6) reimburse the county if the county is required by | ||
the rules governing the uniform rate enhancement program described | ||
by Subdivision (1)(B) to incur an expense or forego Medicaid | ||
reimbursements from the state because the balance of the local | ||
provider participation fund is not sufficient to fund that rate | ||
enhancement program. | ||
(d) Money in the local provider participation fund may not | ||
be commingled with other county funds. | ||
(e) Notwithstanding any other provision of this chapter, | ||
with respect to an intergovernmental transfer of funds described by | ||
Subsection (c)(1) made by the county, any funds received by the | ||
state or county as a result of the transfer may not be used by the | ||
state, county, or any other entity to: | ||
(1) 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); or | ||
(2) fund the nonfederal share of payments to nonpublic | ||
hospitals available through the Medicaid disproportionate share | ||
hospital program. | ||
SUBCHAPTER D. MANDATORY PAYMENTS | ||
Sec. 292D.151. MANDATORY PAYMENTS BASED ON PAYING HOSPITAL | ||
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if | ||
the commissioners court of a county authorizes a program under this | ||
chapter, the commissioners court may require an annual mandatory | ||
payment to be assessed on the net patient revenue of each | ||
institutional health care provider located in the county. The | ||
commissioners court shall provide that the mandatory payment is to | ||
be assessed at least annually, but not more often than | ||
quarterly. In the first year in which the mandatory payment is | ||
required, the mandatory payment is assessed on the net patient | ||
revenue of an institutional health care provider as determined by | ||
the data reported to the Department of State Health Services under | ||
Sections 311.032 and 311.033 in the most recent fiscal year for | ||
which that data was reported. If the institutional health care | ||
provider did not report any data under those sections, the | ||
provider's net patient revenue is the amount of that revenue as | ||
contained in the provider's Medicare cost report submitted for the | ||
previous fiscal year or for the closest subsequent fiscal year for | ||
which the provider submitted the Medicare cost report. The | ||
commissioners court shall update the amount of the mandatory | ||
payment on an annual basis. | ||
(b) The amount of a mandatory payment authorized under this | ||
chapter must be uniformly proportionate with the amount of net | ||
patient revenue generated by each paying hospital in the county. A | ||
mandatory payment authorized under this chapter may not hold | ||
harmless any institutional health care provider, as required under | ||
42 U.S.C. Section 1396b(w). | ||
(c) The commissioners court of a county that collects a | ||
mandatory payment authorized under this chapter shall set the | ||
amount of the mandatory payment. The aggregate amount of the | ||
mandatory payment required of all paying hospitals may not exceed | ||
six percent of the aggregate net patient revenue from hospital | ||
services provided by all paying hospitals in the county. | ||
(d) Subject to Subsection (c), the commissioners court of a | ||
county that collects a mandatory payment authorized under this | ||
chapter shall set the mandatory payments in amounts that in the | ||
aggregate will generate sufficient revenue to cover the | ||
administrative expenses of the county for activities under this | ||
chapter and to fund an intergovernmental transfer described by | ||
Section 292D.103(c)(1). The annual amount of revenue from mandatory | ||
payments that may be used to pay the administrative expenses of the | ||
county for activities under this chapter may not exceed $150,000, | ||
plus the cost of collateralization of deposits, regardless of | ||
actual expenses. | ||
(e) A paying hospital may not add a mandatory payment | ||
required under this section as a surcharge to a patient. | ||
Sec. 292D.152. ASSESSMENT AND COLLECTION OF MANDATORY | ||
PAYMENTS. (a) The county may collect or, using a competitive | ||
bidding process, contract for the assessment and collection of | ||
mandatory payments authorized under this chapter. | ||
(b) The person charged by the county with the assessment and | ||
collection of mandatory payments shall charge and deduct from the | ||
mandatory payments collected for the county a collection fee in an | ||
amount not to exceed the person's usual and customary charges for | ||
like services. | ||
(c) If the person charged with the assessment and collection | ||
of mandatory payments is an official of the county, any revenue from | ||
a collection fee charged under Subsection (b) shall be deposited in | ||
the county general fund and, if appropriate, shall be reported as | ||
fees of the county. | ||
Sec. 292D.153. INTEREST, PENALTIES, AND | ||
DISCOUNTS. Interest, penalties, and discounts on mandatory | ||
payments required under this chapter are governed by the law | ||
applicable to county ad valorem taxes. | ||
Sec. 292D.154. PURPOSE; CORRECTION OF INVALID PROVISION OR | ||
PROCEDURE. (a) The purpose of this chapter is to generate revenue | ||
by collecting from institutional health care providers a mandatory | ||
payment to be used to provide the nonfederal share of certain | ||
Medicaid programs as described by Section 292D.103(c)(1). | ||
(b) To the extent any provision or procedure under this | ||
chapter causes a mandatory payment authorized under this chapter to | ||
be ineligible for federal matching funds, the commissioners court | ||
of the county administering the program may provide by rule for an | ||
alternative provision or procedure that conforms to the | ||
requirements of the federal Centers for Medicare and Medicaid | ||
Services. A rule adopted under this section may not create, impose, | ||
or materially expand the legal or financial liability or | ||
responsibility of the county or an institutional health care | ||
provider located in the county beyond the provisions of this | ||
chapter. This section does not require the commissioners court of a | ||
county to adopt a rule. | ||
(c) The county may only assess and collect a mandatory | ||
payment authorized under this chapter if a waiver program, uniform | ||
rate enhancement, or reimbursement described by Section | ||
292D.103(c)(1) is available to the county. | ||
SECTION 2. Section 300.0003, Health and Safety Code, is | ||
amended to read as follows: | ||
Sec. 300.0003. APPLICABILITY. (a) Except as provided by | ||
Subsection (b), this [ |
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(1) a hospital district that is not participating in a | ||
health care provider participation program authorized by another | ||
chapter of this subtitle; and | ||
(2) a county or municipality that: | ||
(A) is not participating in a health care | ||
provider participation program authorized by another chapter of | ||
this subtitle; and | ||
(B) is not served by a hospital district or a | ||
public hospital. | ||
(b) This chapter does not apply to a municipality that is | ||
located in a county described by Section 292D.002. | ||
SECTION 3. Chapter 295, Health and Safety Code, is | ||
repealed. | ||
SECTION 4. (a) In this section, "paying hospital" has the | ||
meaning assigned by Section 295.001, Health and Safety Code. | ||
(b) If on the date Chapter 295, Health and Safety Code, is | ||
repealed by this Act a municipality to which that chapter applies | ||
has not transferred any remaining amount of mandatory payments | ||
assessed and collected by the municipality under that chapter | ||
before its repeal to the Health and Human Services Commission, the | ||
municipality shall refund to each paying hospital in the | ||
municipality that hospital's proportionate share of the remaining | ||
amount of mandatory payments. | ||
(c) This section expires September 1, 2025. | ||
SECTION 5. (a) Except as provided by Subsection (b) of this | ||
section, this Act takes effect September 1, 2023. | ||
(b) The section of this Act adding Chapter 292D, Health and | ||
Safety Code, takes effect September 1, 2025. | ||
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