Bill Text: TX HB651 | 2019-2020 | 86th Legislature | Enrolled

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Bill Title: Relating to the creation and operations of health care provider participation programs in counties not served by a hospital district or a public hospital.

Sponsorship: Moderate Partisan Bill (Republican 4-1)

Status: (Vetoed) 2019-06-15 - Vetoed by the Governor [HB651 Detail]

Download: Texas-2019-HB651-Enrolled.html

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H.B. No. 651

AN ACT
relating to the creation and operations of health care provider
participation programs in counties not served by a hospital
district or a public hospital.
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 299 to read as follows:
CHAPTER 299. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
COUNTY NOT SERVED BY HOSPITAL DISTRICT OR PUBLIC HOSPITAL
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 299.0001. PURPOSE. The purpose of this chapter is to
authorize a county not served by a hospital district or a public
hospital to administer a county health care provider participation
program to provide additional compensation to hospitals in the
county by collecting mandatory payments from each hospital in the
county to be used to provide the nonfederal share of a Medicaid
supplemental payment program and for other purposes as authorized
under this chapter.
Sec. 299.0002. 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 a county health care provider
participation program authorized by this chapter.
Sec. 299.0003. APPLICABILITY. This chapter applies only to
a county that is not served by a hospital district or a public
hospital.
Sec. 299.0004. COUNTY HEALTH CARE PROVIDER PARTICIPATION
PROGRAM; COUNTY ORDER REQUIRED FOR PARTICIPATION. The
commissioners court of a county may adopt an order authorizing the
county to participate in a health care provider participation
program, subject to the limitations provided by this chapter.
SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT
Sec. 299.0051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
PAYMENT. 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. 299.0052. RULES AND PROCEDURES. The commissioners
court of a county may adopt rules relating to the administration of
the health care provider participation program in the county,
including collection of the mandatory payments, expenditures,
audits, and any other administrative aspects of the program.
Sec. 299.0053. INSTITUTIONAL HEALTH CARE PROVIDER
REPORTING. If the commissioners court of a county authorizes the
county to participate in a health care provider participation
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.
SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
Sec. 299.0101. HEARING. (a) In each year that the
commissioners court of a county authorizes a health care provider
participation 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
shall publish notice of the hearing in a newspaper of general
circulation in the county and provide written notice of the hearing
to the chief operating officer of each institutional health care
provider in the county.
Sec. 299.0102. LOCAL PROVIDER PARTICIPATION FUND;
DEPOSITORY. (a) Each commissioners court of a county that collects
a mandatory payment authorized under this chapter shall create a
local provider participation fund in one or more banks designated
by the county as a depository for the mandatory payments received by
the county.
(b) The commissioners court of a county may withdraw or use
money in the local provider participation fund of the county only
for a purpose authorized under this chapter.
(c) All funds collected under this chapter shall be secured
in the manner provided for securing other county funds.
Sec. 299.0103. DEPOSITS TO FUND; AUTHORIZED USES OF MONEY.
(a) The local provider participation fund established by a county
under Section 299.0102 consists of:
(1) all mandatory payments authorized under this
chapter and received by the county;
(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.
(b) Money deposited to the local provider participation
fund of a county may be used only to:
(1) fund intergovernmental transfers from the county
to the state to provide:
(A) the nonfederal share of a Medicaid
supplemental payment program authorized under the state Medicaid
plan, 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; or
(B) payments to Medicaid managed care
organizations that are dedicated for payment to hospitals;
(2) pay costs associated with indigent care provided
by institutional health care providers in the county;
(3) pay the administrative expenses of the county in
administering the program, including collateralization of
deposits;
(4) refund a portion of a mandatory payment collected
in error from a paying hospital; and
(5) refund to paying hospitals a proportionate share
of the money 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.
(c) Money in the local provider participation fund of a
county may not be commingled with other county funds.
(d) An intergovernmental transfer of funds described by
Subsection (b)(1) and any funds received by the county as a result
of an intergovernmental transfer described by that subsection may
not be used by the county or any other entity 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).
SUBCHAPTER D. MANDATORY PAYMENTS
Sec. 299.0151. MANDATORY PAYMENTS. (a) Except as provided
by Subsection (e), if the commissioners court of a county
authorizes a health care provider participation program under this
chapter, the commissioners court shall 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 collected 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 located in the county 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 county
shall update the amount of the mandatory payment on an annual basis.
(b) The amount of a mandatory payment authorized under this
chapter for a county 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 authorizes a
program under this chapter shall set the amount of the mandatory
payment. The amount of the mandatory payment required of each
paying hospital in the county may not exceed six percent of the
hospital's net patient revenue.
(d) Subject to the maximum amount prescribed by Subsection
(c), the commissioners court of a county that authorizes a program
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, fund an
intergovernmental transfer described by Section 299.0103(b)(1), or
make other payments authorized under this chapter. The amount of
revenue from mandatory payments that may be used for administrative
expenses by the county in a year may not exceed $25,000, plus the
cost of collateralization of deposits. If the commissioners court
demonstrates to the paying hospitals in the county that the costs of
administering the health care provider participation program under
this chapter, excluding those costs associated with the
collateralization of deposits, exceed $25,000 in any year, on
consent of all of the paying hospitals in the county, the county may
use additional revenue from mandatory payments received under this
chapter to compensate the county for its administrative expenses. A
paying hospital may not unreasonably withhold consent to compensate
the county for administrative expenses.
(e) A paying hospital may not add a mandatory payment
required under this section as a surcharge to a patient or insurer.
(f) A mandatory payment under this chapter is not a tax for
purposes of Section 5(a), Article IX, Texas Constitution.
Sec. 299.0152. ASSESSMENT AND COLLECTION OF MANDATORY
PAYMENTS. A county may collect or contract for the assessment and
collection of mandatory payments authorized under this chapter.
Sec. 299.0153. CORRECTION OF INVALID PROVISION OR
PROCEDURE. 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 county 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 in the county beyond the provisions of this chapter. This
section does not require the commissioners court of a county to
adopt a rule.
SECTION 2. 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 may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. 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.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 651 was passed by the House on April
10, 2019, by the following vote: Yeas 135, Nays 9, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 651 was passed by the Senate on May
22, 2019, by the following vote: Yeas 30, Nays 1.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor