Troxclair Bill Lets One County Charge Hospitals Up To 6%

The text as introduced · 2,205 words

89R15305 SRA-F

By: Troxclair
H.B. No. 4799

A BILL TO BE ENTITLED

AN ACT

relating to the creation and operations of a health care provider

participation program in certain counties.

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 292E to read as follows:

CHAPTER 292E. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN

CERTAIN COUNTIES

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 292E.001. DEFINITIONS. In this chapter:

(1) "Institutional health care provider" means a

nonpublic hospital that provides inpatient hospital services.

(2) "Paying provider" 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. 292E.002. APPLICABILITY. This chapter applies only to

a county that:

(1) is not served by a hospital district or a public

hospital;

(2) has a population of more than 46,000 and less than

50,000; and

(3) is adjacent to the county containing the state

capital.

Sec. 292E.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 292E.103(c).

(b) The commissioners court of a county may adopt an order

authorizing the county to participate in the program, subject to

the limitations provided by this chapter.

SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT

Sec. 292E.051. LIMITATION ON AUTHORITY TO REQUIRE MANDATORY

PAYMENTS. The commissioners court of a county may require a

mandatory payment under this chapter by an institutional health

care provider in the county only in the manner provided by this

chapter.

Sec. 292E.052. MAJORITY VOTE REQUIRED. The commissioners

court of a county may not authorize the county to collect a

mandatory payment under this chapter without an affirmative vote of

a majority of the members of the commissioners court.

Sec. 292E.053. RULES AND PROCEDURES. After the

commissioners court of a county has voted to require a mandatory

payment authorized under this chapter, 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. 292E.054. INSTITUTIONAL HEALTH CARE PROVIDER

REPORTING. 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.

SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS

Sec. 292E.101. HEARING. (a) In each year that the

commissioners court of a county authorizes a mandatory payment

under this chapter, the commissioners court shall hold a public

hearing on the amounts of any mandatory payments that the county

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 each institutional health care provider located in the county.

(c) A representative of a paying provider is entitled to

appear at the public hearing and be heard regarding any matter

related to the mandatory payments authorized under this chapter.

Sec. 292E.102. DEPOSITORY. (a) The commissioners court of

a county that requires a mandatory payment under this chapter shall

designate one or more banks as the depository for the county's local

provider participation fund.

(b) All income received by a county under this chapter shall

be deposited with the depository designated under Subsection (a) in

the county's local provider participation fund and may be withdrawn

only as provided by this chapter.

(c) All money collected under this chapter shall be secured

in the manner provided for securing other county money.

Sec. 292E.103. LOCAL PROVIDER PARTICIPATION FUND;

AUTHORIZED USES OF MONEY. (a) A county that requires a mandatory

payment 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;

(2) money received from the Health and Human Services

Commission as a refund of an intergovernmental transfer described

by Subsection (c)(1), provided that the intergovernmental transfer

does not receive a federal matching payment; and

(3) the earnings of the fund.

(c) Money deposited to a county's 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 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 or other directed

payment programs for nonpublic hospitals;

(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); or

(D) any reimbursement to nonpublic hospitals, or

that may benefit nonpublic hospitals as determined by the

commissioners court, for which federal matching funds are

available;

(2) subject to Section 292E.151(e), 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 provider;

(4) refund to paying providers 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; and

(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

any program for which intergovernmental transfers described by

Subdivision (1) were made.

(d) Money in the local provider participation fund may not

be commingled with other county money.

(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, county, or other entity as a result of the transfer may not

be used by the state, county, or 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. 292E.151. MANDATORY PAYMENTS BASED ON PAYING PROVIDER

NET PATIENT REVENUE. (a) Except as provided by Subsection (f), 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 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 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

most recent fiscal year for which the provider submitted the

Medicare cost report. If the mandatory payment is required, the

commissioners court shall update the amount of the mandatory

payment on an annual basis.

(b) The commissioners court of a county that requires a

mandatory payment under this chapter shall provide each

institutional health care provider on which the payment will be

assessed written notice of an assessment under this chapter. The

institutional health care provider must pay the assessment not

later than the 30th day after the date the provider receives the

written notice.

(c) 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 provider in the

administering county. A program may not hold harmless any

institutional health care provider, as required under 42 U.S.C.

Section 1396b(w) and 42 C.F.R. Section 433.68.

(d) The commissioners court of a county that requires a

mandatory payment under this chapter shall set the amount of the

mandatory payment. The aggregate amount of the mandatory payment

required of all paying providers in the county may not exceed six

percent of the aggregate net patient revenue from hospital services

provided by all paying providers in the county.

(e) Subject to Subsection (d), the commissioners court of a

county that requires a mandatory payment 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 292E.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 $20,000, plus the cost

of collateralization of deposits, regardless of actual expenses.

(f) A paying provider may not add a mandatory payment

required under this section as a surcharge to a patient.

(g) A mandatory payment assessed under this chapter is not a

tax for hospital purposes for purposes of Section 4, Article IX,

Texas Constitution.

Sec. 292E.152. ASSESSMENT AND COLLECTION OF MANDATORY

PAYMENTS. (a) The county may collect or 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. 292E.153. PURPOSE; CORRECTION OF INVALID PROVISION OR

PROCEDURE; LIMITATION OF AUTHORITY. (a) The purpose of this

chapter is to authorize a county to establish a program to enable

the county to collect mandatory payments from institutional health

care providers to fund the nonfederal share of certain Medicaid

programs as described by Section 292E.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) A county administering a program may only assess and

collect a mandatory payment authorized under this chapter if a

waiver program, uniform rate enhancement, or reimbursement

described by Section 292E.103(c)(1) is available to the county.

(d) This chapter does not authorize a county administering a

program 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

nonpublic hospitals and to cover the administrative expenses of the

county associated with activities under this chapter.

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, 2025.