S.B. No. 2315
 
 
 
 
AN ACT
  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