Bill Text: TX SB2315 | 2019-2020 | 86th Legislature | Enrolled
Bill Title: Relating to the creation and operations of a health care provider participation program by the Nueces County Hospital District.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2019-06-10 - Effective immediately [SB2315 Detail]
Download: Texas-2019-SB2315-Enrolled.html
S.B. No. 2315 |
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relating to the creation and operations of a health care provider | ||
participation program by the Nueces County Hospital District. | ||
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 298C to read as follows: | ||
CHAPTER 298C. NUECES COUNTY HOSPITAL DISTRICT HEALTH CARE PROVIDER | ||
PARTICIPATION PROGRAM | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 298C.001. DEFINITIONS. In this chapter: | ||
(1) "Board" means the board of hospital managers of | ||
the district. | ||
(2) "District" means the Nueces County Hospital | ||
District. | ||
(3) "Institutional health care provider" means a | ||
hospital that is not owned and operated by a federal or state | ||
government and provides inpatient hospital services. | ||
(4) "Paying provider" means an institutional health | ||
care provider required to make a mandatory payment under this | ||
chapter. | ||
(5) "Program" means the health care provider | ||
participation program authorized by this chapter. | ||
Sec. 298C.002. APPLICABILITY. This chapter applies only to | ||
the Nueces County Hospital District. | ||
Sec. 298C.003. HEALTH CARE PROVIDER PARTICIPATION PROGRAM; | ||
PARTICIPATION IN PROGRAM. The board may authorize the district to | ||
participate in a health care provider participation program on the | ||
affirmative vote of a majority of the board, subject to the | ||
provisions of this chapter. | ||
Sec. 298C.004. EXPIRATION. (a) Subject to Section | ||
298C.153(d), the authority of the district to administer and | ||
operate a program under this chapter expires December 31, 2021. | ||
(b) This chapter expires December 31, 2021. | ||
SUBCHAPTER B. POWERS AND DUTIES OF BOARD | ||
Sec. 298C.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY | ||
PAYMENT. The board may require a mandatory payment authorized | ||
under this chapter by an institutional health care provider located | ||
in the district only in the manner provided by this chapter. | ||
Sec. 298C.052. RULES AND PROCEDURES. The board may adopt | ||
rules relating to the administration of the program, including | ||
collection of the mandatory payments, expenditures, audits, and any | ||
other administrative aspects of the program. | ||
Sec. 298C.053. INSTITUTIONAL HEALTH CARE PROVIDER | ||
REPORTING. If the board authorizes the district to participate in a | ||
program under this chapter, the board shall require each | ||
institutional health care provider located in the district to | ||
submit to the district 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. 298C.101. HEARING. (a) In each fiscal year that the | ||
board authorizes a program under this chapter, the board shall hold | ||
a public hearing on the amounts of any mandatory payments that the | ||
board 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 board shall publish | ||
notice of the hearing in a newspaper of general circulation in the | ||
district and provide written notice of the hearing to each | ||
institutional health care provider located in the district. | ||
Sec. 298C.102. DEPOSITORY. (a) If the board requires a | ||
mandatory payment authorized under this chapter, the board shall | ||
designate one or more banks as a depository for the district's local | ||
provider participation fund. | ||
(b) All funds collected under this chapter shall be secured | ||
in the manner provided for securing other district funds. | ||
Sec. 298C.103. LOCAL PROVIDER PARTICIPATION FUND; | ||
AUTHORIZED USES OF MONEY. (a) If the district requires a | ||
mandatory payment authorized under this chapter, the district shall | ||
create a local provider participation fund. | ||
(b) The local provider participation fund consists of: | ||
(1) all revenue received by the district attributable | ||
to mandatory payments authorized under this chapter; | ||
(2) money received from the Health and Human Services | ||
Commission as a refund of an intergovernmental transfer under the | ||
program, 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 of the district may be used only to: | ||
(1) fund intergovernmental transfers from the | ||
district to the state to provide the nonfederal share of Medicaid | ||
payments for: | ||
(A) uncompensated care payments to hospitals in | ||
the Medicaid managed care service area in which the district is | ||
located, 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); | ||
(B) delivery system reform incentive payments, | ||
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); | ||
(C) uniform rate enhancements for hospitals in | ||
the Medicaid managed care service area in which the district is | ||
located; | ||
(D) payments available under another waiver | ||
program authorizing payments that are substantially similar to | ||
Medicaid payments to hospitals described by Paragraph (A), (B), or | ||
(C); or | ||
(E) any reimbursement to hospitals for which | ||
federal matching funds are available; | ||
(2) subject to Section 298C.151(d), pay the | ||
administrative expenses of the district in administering the | ||
program, including collateralization of deposits; | ||
(3) refund a mandatory payment collected in error from | ||
a paying provider; | ||
(4) refund to paying providers a proportionate share | ||
of the money that the district: | ||
(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 uniform rate enhancements | ||
described by Subdivision (1)(C); or | ||
(B) determines cannot be used to fund the | ||
nonfederal share of Medicaid supplemental payment program payments | ||
or uniform rate enhancements described by Subdivision (1)(C); | ||
(5) transfer funds to the Health and Human Services | ||
Commission if the district is legally required to transfer the | ||
funds to address a disallowance of federal matching funds with | ||
respect to programs for which the district made intergovernmental | ||
transfers described by Subdivision (1); and | ||
(6) reimburse the district if the district is required | ||
by the rules governing the uniform rate enhancement program | ||
described by Subdivision (1)(C) 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 district 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 district, any funds received by the | ||
state, district, or other entity as a result of that transfer may | ||
not be used by the state, district, 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. 298C.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER | ||
NET PATIENT REVENUE. (a) Except as provided by Subsection (e), if | ||
the board authorizes a health care provider participation program | ||
under this chapter, the board may require a mandatory payment to be | ||
assessed, either annually or periodically throughout the fiscal | ||
year at the discretion of the board, on the net patient revenue of | ||
each institutional health care provider located in the district. | ||
The board shall provide an institutional health care provider | ||
written notice of each assessment under this subsection, and the | ||
provider has 30 calendar days following the date of receipt of the | ||
notice to pay the assessment. In the first fiscal 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. If the | ||
mandatory payment is required, the district shall update the amount | ||
of the mandatory payment on an annual basis. | ||
(b) The amount of a mandatory payment assessed under this | ||
chapter by the board must be uniformly proportionate with the | ||
amount of net patient revenue generated by each paying provider in | ||
the district as permitted under federal law. A health care provider | ||
participation program authorized under this chapter may not hold | ||
harmless any institutional health care provider, as required under | ||
42 U.S.C. Section 1396b(w). | ||
(c) If the board requires a mandatory payment authorized | ||
under this chapter, the board shall set the amount of the mandatory | ||
payment, subject to the limitations of this chapter. The aggregate | ||
amount of the mandatory payments required of all paying providers | ||
in the district may not exceed six percent of the aggregate net | ||
patient revenue from hospital services provided by all paying | ||
providers in the district. | ||
(d) Subject to Subsection (c), if the board requires a | ||
mandatory payment authorized under this chapter, the board shall | ||
set the mandatory payments in amounts that in the aggregate will | ||
generate sufficient revenue to cover the administrative expenses of | ||
the district for activities under this chapter and to fund an | ||
intergovernmental transfer described by Section 298C.103(c)(1). | ||
The annual amount of revenue from mandatory payments that shall be | ||
paid for administrative expenses by the district is $150,000, plus | ||
the cost of collateralization of deposits, regardless of actual | ||
expenses. | ||
(e) A paying provider may not add a mandatory payment | ||
required under this section as a surcharge to a patient. | ||
(f) A mandatory payment assessed under this chapter is not a | ||
tax for hospital purposes for purposes of Section 4, Article IX, | ||
Texas Constitution, or Section 281.045 of this code. | ||
Sec. 298C.152. ASSESSMENT AND COLLECTION OF MANDATORY | ||
PAYMENTS. (a) The district may designate an official of the | ||
district or contract with another person to assess and collect the | ||
mandatory payments authorized under this chapter. | ||
(b) The person charged by the district with the assessment | ||
and collection of mandatory payments shall charge and deduct from | ||
the mandatory payments collected for the district 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 district, any revenue | ||
from a collection fee charged under Subsection (b) shall be | ||
deposited in the district general fund and, if appropriate, shall | ||
be reported as fees of the district. | ||
Sec. 298C.153. PURPOSE; CORRECTION OF INVALID PROVISION OR | ||
PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this | ||
chapter is to authorize the district to establish a program to | ||
enable the district to collect mandatory payments from | ||
institutional health care providers to fund the nonfederal share of | ||
a Medicaid supplemental payment program or the Medicaid managed | ||
care rate enhancements for hospitals to support the provision of | ||
health care by institutional health care providers located in the | ||
district. | ||
(b) This chapter does not authorize the district to collect | ||
mandatory payments for the purpose of raising general revenue or | ||
any amount in excess of the amount reasonably necessary to fund the | ||
nonfederal share of a Medicaid supplemental payment program or | ||
Medicaid managed care rate enhancements for hospitals and to cover | ||
the administrative expenses of the district associated with | ||
activities under this chapter. | ||
(c) 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 board 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 district or an institutional health care | ||
provider in the district beyond the provisions of this chapter. | ||
This section does not require the board to adopt a rule. | ||
(d) The district may only assess and collect a mandatory | ||
payment authorized under this chapter if a waiver program, uniform | ||
rate enhancement, or reimbursement described by Section | ||
298C.103(c)(1) is available to at least one institutional health | ||
care provider located in the district. | ||
SECTION 2. As soon as practicable after the expiration of | ||
the authority of the Nueces County Hospital District to administer | ||
and operate a health care provider participation program under | ||
Chapter 298C, Health and Safety Code, as added by this Act, the | ||
board of hospital managers of the Nueces County Hospital District | ||
shall transfer to each institutional health care provider in the | ||
district that provider's proportionate share of any remaining funds | ||
in any local provider participation fund created by the district | ||
under Section 298C.103, Health and Safety Code, as added by this | ||
Act. | ||
SECTION 3. 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 4. 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 hereby certify that S.B. No. 2315 passed the Senate on | ||
April 17, 2019, by the following vote: Yeas 31, Nays 0; and that | ||
the Senate concurred in House amendment on May 23, 2019, by the | ||
following vote: Yeas 31, Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
I hereby certify that S.B. No. 2315 passed the House, with | ||
amendment, on May 17, 2019, by the following vote: Yeas 127, | ||
Nays 20, two present not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
Approved: | ||
______________________________ | ||
Date | ||
______________________________ | ||
Governor |