Bill Text: TX SB170 | 2019-2020 | 86th Legislature | Enrolled

Texas Senate Bill 170 (Prior Session Legislation)

Bill Title: Relating to reimbursement of rural hospitals under Medicaid.

Sponsorship: Moderate Partisan Bill (Republican 8-1)

Status: (Passed) 2019-06-04 - Effective on 9/1/19 [SB170 Detail]

Download: Texas-2019-SB170-Enrolled.html



	S.B. No. 170




	AN ACT
	relating to reimbursement of rural hospitals under Medicaid.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Subchapter B, Chapter 531, Government Code, is
	amended by adding Section 531.02194 to read as follows:
	Sec. 531.02194. REIMBURSEMENT METHODOLOGY FOR RURAL
	HOSPITALS. (a) In this section, "rural hospital" has the meaning
	assigned by commission rules for purposes of the reimbursement of
	hospitals for providing inpatient or outpatient services under
	Medicaid.
	(b) To the extent allowed by federal law and subject to
	limitations on appropriations, the executive commissioner by rule
	shall adopt a prospective reimbursement methodology for the payment
	of rural hospitals participating in Medicaid that ensures the rural
	hospitals are reimbursed on an individual basis for providing
	inpatient and general outpatient services to Medicaid recipients by
	using the hospitals' most recent cost information concerning the
	costs incurred for providing the services. The commission shall
	calculate the prospective cost-based reimbursement rates once
	every two years.
	(c) In adopting rules under Subsection (b), the executive
	commissioner may:
	(1) adopt a methodology that requires:
	(A) a managed care organization to reimburse
	rural hospitals for services delivered through the Medicaid managed
	care program using a minimum fee schedule or other method for which
	federal matching money is available; or
	(B) both the commission and a managed care
	organization to share in the total amount of reimbursement paid to
	rural hospitals; and
	(2) require that the amount of reimbursement paid to a
	rural hospital is subject to any applicable adjustments made by the
	commission for payments to or penalties imposed on the rural
	hospital that are based on a quality-based or performance-based
	requirement under the Medicaid managed care program.
	(d) Not later than September 1 of each even-numbered year,
	the commission shall, for purposes of Subsection (b), determine the
	allowable costs incurred by a rural hospital participating in the
	Medicaid managed care program based on the rural hospital's cost
	reports submitted to the federal Centers for Medicare and Medicaid
	Services and other available information that the commission
	considers relevant in determining the hospital's allowable costs.
	(e) Notwithstanding Subsection (b) and subject to
	Subsection (f), the executive commissioner shall adopt and the
	commission shall implement, beginning with the state fiscal year
	ending August 31, 2022, a true cost-based reimbursement methodology
	for inpatient and general outpatient services provided to Medicaid
	recipients at rural hospitals that provides:
	(1) prospective payments during a state fiscal year to
	the hospitals using the reimbursement methodology adopted under
	Subsection (b); and
	(2) to the extent allowed by federal law, in the
	subsequent state fiscal year a cost settlement to provide
	additional reimbursement as necessary to reimburse the hospitals
	for the true costs incurred in providing inpatient and general
	outpatient services to Medicaid recipients during the previous
	state fiscal year.
	(f) Notwithstanding Subsection (e), if federal law does not
	permit the use of a true cost-based reimbursement methodology
	described by that subsection, the commission shall continue to use
	the prospective cost-based reimbursement methodology adopted under
	Subsection (b) for the payment of rural hospitals for providing
	inpatient and general outpatient services to Medicaid recipients.
	SECTION 2. The Health and Human Services Commission is
	required to implement a provision of this Act only if the
	legislature appropriates money specifically for that purpose. If
	the legislature does not appropriate money specifically for that
	purpose, the commission may, but is not required to, implement a
	provision of this Act using other appropriations available for that
	purpose.
	SECTION 3. Not later than September 1, 2020, the Health and
	Human Services Commission shall determine the allowable costs
	incurred by a rural hospital participating in the Medicaid managed
	care program before that date as required by Section 531.02194(d),
	Government Code, as added by this Act.
	SECTION 4. 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 5. This Act takes effect September 1, 2019.





	______________________________	______________________________
	President of the Senate	Speaker of the House

	I hereby certify that S.B. No. 170 passed the Senate on
	April 17, 2019, by the following vote: Yeas 31, Nays 0.


	______________________________
	Secretary of the Senate

	I hereby certify that S.B. No. 170 passed the House on
	May 17, 2019, by the following vote: Yeas 140, Nays 6,
	one present not voting.


	______________________________
	Chief Clerk of the House



	Approved:

	______________________________
	Date


	______________________________
	Governor