Bill Text: TX SB1073 | 2021-2022 | 87th Legislature | Introduced


Bill Title: Relating to the operations of health care provider participation programs in certain counties.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2021-03-18 - Referred to Local Government [SB1073 Detail]

Download: Texas-2021-SB1073-Introduced.html
  87R4842 JCG-F
 
  By: Hughes S.B. No. 1073
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the operations of health care provider participation
  programs in certain counties.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 291A.001, Health and Safety Code, is
  amended by amending Subdivisions (1) and (2) and adding Subdivision
  (4) to read as follows:
               (1)  "Institutional health care provider" means a
  [nonpublic] hospital that is not owned and operated by a federal or
  state government and provides inpatient hospital services. The term
  includes a hospital that is owned and operated by a municipality or
  county and provides inpatient hospital services.
               (2)  "Paying provider [hospital]" means an
  institutional health care provider required to make a mandatory
  payment under this chapter.
               (4)  "Qualifying assessment basis" means the health
  care item, health care service, or other health care-related basis
  consistent with 42 U.S.C. Section 1396b(w) on which a commissioners
  court requires mandatory payments to be assessed under this
  chapter.
         SECTION 2.  Section 291A.003(a), Health and Safety Code, is
  amended to read as follows:
         (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 to fund certain
  intergovernmental transfers [and indigent care programs] as
  provided by this chapter.
         SECTION 3.  Section 291A.054(a), Health and Safety Code, is
  amended to read as follows:
         (a)  The commissioners court of a county that collects a
  mandatory payment authorized under this chapter may [shall] require
  each institutional health care provider to submit to the county a
  copy of any financial and utilization data as [required by and]
  reported in:
               (1)  the provider's Medicare cost report for the most
  recent fiscal year for which the provider submitted the Medicare
  cost report; or
               (2)  a report other than the report described by
  Subdivision (1) that the commissioners court considers reliable and
  is submitted by or to the provider for the most recent fiscal year
  [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].
         SECTION 4.  Section 291A.101, Health and Safety Code, is
  amended to read as follows:
         Sec. 291A.101.  HEARING. (a) Each year, the commissioners
  court of a county that collects a mandatory payment authorized
  under this chapter shall hold at least one [a] public hearing on the
  amounts of the [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 a [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.
         (c)  A representative of a paying provider [hospital] is
  entitled to appear at the time and place designated in the public
  notice and to be heard regarding any matter related to the mandatory
  payments authorized under this chapter.
         SECTION 5.  Section 291A.103(c), Health and Safety Code, is
  amended to read as follows:
         (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:
                     (A)  the nonfederal share of [a] Medicaid
  supplemental payment program payments 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)  [subsidize indigent programs;
               [(3)]  pay the administrative expenses of the county
  solely for activities under this chapter;
               (3) [(4)]  refund a portion of a mandatory payment
  collected in error from a paying provider [hospital]; and
               (4) [(5)]  refund to a paying provider, in an amount
  that is proportionate to the mandatory payments made under this
  chapter by the provider during the 12 months preceding the date of
  the refund, the [hospitals the proportionate share of] money
  attributable to mandatory payments collected under this chapter
  that the county:
                     (A)  receives from the Health and Human Services
  Commission [received by the county] 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.
         SECTION 6.  Section 291A.151, Health and Safety Code, is
  amended to read as follows:
         Sec. 291A.151.  MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL
  NET PATIENT REVENUE]. (a)  The [Except as provided by Subsection
  (e), the] commissioners court of a county that authorizes a county
  health care provider participation program [collects a mandatory
  payment authorized] under this chapter may require [an annual]
  mandatory payments [payment] to be assessed against [on the net
  patient revenue of] each institutional health care provider located
  in the county, either annually or periodically throughout the year
  at the discretion of the commissioners court, on the basis of a
  health care item, health care service, or other health care-related
  basis that is consistent with the requirements of 42 U.S.C. Section
  1396b(w). The commissioners court shall provide an institutional
  health care provider written notice of each assessment under this
  section not later than 30 days before the date the assessment is
  due. The qualifying assessment basis must be the same for each
  institutional health care provider in the county.
         (a-1)  Except as otherwise provided by this subsection, the
  qualifying assessment basis must be determined by the commissioners
  court using information contained in an institutional health care
  provider's Medicare cost report for the most recent fiscal year for
  which the provider submitted the report. If the provider is not
  required to submit a Medicare cost report, or if the Medicare cost
  report submitted by the provider does not contain information
  necessary to determine the qualifying assessment basis, the
  qualifying assessment basis may be determined by the commissioners
  court using information contained in another report the
  commissioners court considers reliable that is submitted by or to
  the provider for the most recent fiscal year. To the extent
  practicable, the commissioners court shall use the same type of
  report to determine the qualifying assessment basis for each paying
  provider in the county.
         (a-2)  If mandatory payments are required, the [The]
  commissioners court [may provide for the mandatory payment to be
  assessed 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 fiscal year
  ending in 2015 or, if the institutional health care provider did not
  report any data under those sections in that fiscal year, as
  determined by the institutional health care provider's Medicare
  cost report submitted for the 2015 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 payments periodically [payment on an annual basis].
         (b)  The amount of a mandatory payment authorized under this
  chapter must be determined in a manner that ensures the revenue
  generated qualifies for federal matching funds under federal law,
  consistent with [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
  county health care provider participation program [collects a
  mandatory payment authorized] under this chapter shall set the
  amount of the mandatory payment. The amount of the mandatory
  payment required of each paying provider [hospital] may not exceed
  an amount that, when added to the amount of the mandatory payments
  required from all other paying providers in the county, equals an
  amount of revenue that exceeds six percent of the aggregate net
  patient revenue of all paying providers in the county [hospital's
  net patient revenue].
         (d)  Subject to the maximum amount prescribed by 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 the nonfederal share
  of Medicaid supplemental payment program payments [an
  intergovernmental transfer described by Section 291A.103(c)(1),
  and to pay for indigent programs], except that the amount of revenue
  from mandatory payments used for administrative expenses of the
  county for activities under this chapter in a year may not exceed
  the lesser of four percent of the total revenue generated from the
  mandatory payment or $20,000.
         (e)  A paying provider [hospital] may not add a mandatory
  payment required under this section as a surcharge to a patient.
         SECTION 7.  Section 291A.154, Health and Safety Code, is
  amended to read as follows:
         Sec. 291A.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 [a] Medicaid
  supplemental payment program payments.
         (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, a [the] county that
  authorizes a county health care provider participation program
  under this chapter 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 to adopt a rule. 
         (c)  This chapter does not authorize a county that authorizes
  a county health care provider participation program under this
  chapter to collect mandatory payments for the purpose of raising
  general revenue or any amount in excess of the amount reasonably
  necessary for the purposes described by Sections 291A.103(c)(1) and
  (2).
         SECTION 8.  Section 292.001, Health and Safety Code, is
  amended by amending Subdivisions (1) and (2) and adding Subdivision
  (4) to read as follows:
               (1)  "Institutional health care provider" means a
  [nonpublic] hospital that is not owned and operated by a federal or
  state government and provides inpatient hospital services. The term
  includes a hospital that is owned and operated by a municipality or
  county and provides inpatient hospital services.
               (2)  "Paying provider [hospital]" means an
  institutional health care provider required to make a mandatory
  payment under this chapter.
               (4)  "Qualifying assessment basis" means the health
  care item, health care service, or other health care-related basis
  consistent with 42 U.S.C. Section 1396b(w) on which a commissioners
  court requires mandatory payments to be assessed under this
  chapter.
         SECTION 9.  Section 292.003(a), Health and Safety Code, is
  amended to read as follows:
         (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 to fund certain
  intergovernmental transfers [and indigent care programs] as
  provided by this chapter.
         SECTION 10.  Section 292.054(a), Health and Safety Code, is
  amended to read as follows:
         (a)  The commissioners court of a county that collects a
  mandatory payment authorized under this chapter may [shall] require
  each institutional health care provider to submit to the county a
  copy of any financial and utilization data as [required by and]
  reported in:
               (1)  the provider's Medicare cost report for the most
  recent fiscal year for which the provider submitted the Medicare
  cost report; or
               (2)  a report other than the report described by
  Subdivision (1) that the commissioners court considers reliable and
  is submitted by or to the provider for the most recent fiscal year
  [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].
         SECTION 11.  Section 292.101, Health and Safety Code, is
  amended to read as follows:
         Sec. 292.101.  HEARING. (a) Each year, the commissioners
  court of a county that collects a mandatory payment authorized
  under this chapter shall hold at least one [a] public hearing on the
  amounts of the [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 a [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.
         (c)  A representative of a paying provider [hospital] is
  entitled to appear at the time and place designated in the public
  notice and to be heard regarding any matter related to the mandatory
  payments authorized under this chapter.
         SECTION 12.  Section 292.103(c), Health and Safety Code, is
  amended to read as follows:
         (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:
                     (A)  the nonfederal share of [a] Medicaid
  supplemental payment program payments 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)  [subsidize indigent programs;
               [(3)] pay the administrative expenses of the county
  solely for activities under this chapter;
               (3) [(4)]  refund a portion of a mandatory payment
  collected in error from a paying provider [hospital]; and
               (4) [(5)]  refund to a paying provider, in an amount
  that is proportionate to the mandatory payments made under this
  chapter by the provider during the 12 months preceding the date of
  the refund, the [hospitals the proportionate share of] money
  attributable to mandatory payments collected under this chapter
  that the county:
                     (A)  receives [received by the county] from the
  Health and Human Services Commission that is not used to fund the
  nonfederal share of Medicaid supplemental payment program
  payments; or [and]
                     (B)  [(6) refund to paying hospitals the
  proportionate share of money that the county] determines cannot be
  used to fund the nonfederal share of Medicaid supplemental payment
  program payments.
         SECTION 13.  Section 292.151, Health and Safety Code, is
  amended to read as follows:
         Sec. 292.151.  MANDATORY PAYMENTS [BASED ON PAYING HOSPITAL
  NET PATIENT REVENUE]. (a) The [Except as provided by Subsection
  (e), the] commissioners court of a county that authorizes a county
  health care provider participation program [collects a mandatory
  payment authorized] under this chapter may require [an annual]
  mandatory payments [payment] to be assessed against [on the net
  patient revenue of] each institutional health care provider located
  in the county, either annually or periodically throughout the year
  at the discretion of the commissioners court, on the basis of a
  health care item, health care service, or other health care-related
  basis that is consistent with the requirements of 42 U.S.C. Section
  1396b(w). The commissioners court shall provide an institutional
  health care provider written notice of each assessment under this
  section not later than 30 days before the date the assessment is
  due. The qualifying assessment basis must be the same for each
  institutional health care provider in the county.
         (a-1)  Except as otherwise provided by this subsection, the
  qualifying assessment basis must be determined by the commissioners
  court using information contained in an institutional health care
  provider's Medicare cost report for the most recent fiscal year for
  which the provider submitted the report. If the provider is not
  required to submit a Medicare cost report, or if the Medicare cost
  report submitted by the provider does not contain information
  necessary to determine the qualifying assessment basis, the
  qualifying assessment basis may be determined by the commissioners
  court using information contained in another report the
  commissioners court considers reliable that is submitted by or to
  the provider for the most recent fiscal year. To the extent
  practicable, the commissioners court shall use the same type of
  report to determine the qualifying assessment basis for each paying
  provider in the county.
         (a-2)  If mandatory payments are required, the [The]
  commissioners court [may provide for the mandatory payment to be
  assessed 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 fiscal year
  ending in 2013 or, if the institutional health care provider did not
  report any data under those sections in that fiscal year, as
  determined by the institutional health care provider's Medicare
  cost report submitted for the 2013 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 payments periodically [payment on an annual basis].
         (b)  The amount of a mandatory payment authorized under this
  chapter must be determined in a manner that ensures the revenue
  generated qualifies for federal matching funds under federal law,
  consistent with [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
  county health care provider participation program [collects a
  mandatory payment authorized] under this chapter shall set the
  amount of the mandatory payment. The amount of the mandatory
  payment required of each paying provider [hospital] may not exceed
  an amount that, when added to the amount of the mandatory payments
  required from all other paying providers [hospitals] in the county,
  equals an amount of revenue that exceeds six percent of the
  aggregate net patient revenue of all paying providers [hospitals]
  in the county.
         (d)  Subject to the maximum amount prescribed by 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 the nonfederal share
  of [a] Medicaid supplemental payment program payments, [and to pay
  for indigent programs,] except that the amount of revenue from
  mandatory payments used for administrative expenses of the county
  for activities under this chapter in a year may not exceed the
  lesser of four percent of the total revenue generated from the
  mandatory payment or $20,000.
         (e)  A paying provider [hospital] may not add a mandatory
  payment required under this section as a surcharge to a patient.
         SECTION 14.  Section 292.154, Health and Safety Code, is
  amended to read as follows:
         Sec. 292.154.  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 [a] Medicaid
  supplemental payment program payments.
         (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, a [the] county that
  authorizes a county health care provider participation program
  under this chapter 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 to adopt a rule.
         (c)  This chapter does not authorize a county that authorizes
  a county health care provider participation program under this
  chapter to collect mandatory payments for the purpose of raising
  general revenue or any amount in excess of the amount reasonably
  necessary for the purposes described by Sections 292.103(c)(1) and
  (2).
         SECTION 15.  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, 2021.
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