H.B. No. 4835

	AN ACT
	relating to the creation and operations of certain health care
	provider participation programs.
	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 292D to read as follows:
	CHAPTER 292D. COUNTY HEALTH CARE PROVIDER PARTICIPATION PROGRAM IN
	CERTAIN COUNTIES BORDERING NECHES RIVER
	SUBCHAPTER A. GENERAL PROVISIONS
	Sec. 292D.001.  DEFINITIONS. In this chapter:
	(1)  "Institutional health care provider" means a
	nonpublic hospital that provides inpatient hospital services.
	(2)  "Paying hospital" means an institutional health
	care provider required to make a mandatory payment under this
	chapter.
	(3)  "Program" means the county health care provider
	participation program authorized by this chapter.
	Sec. 292D.002.  APPLICABILITY. This chapter applies only to
	a county that:
	(1)  is not served by a hospital district;
	(2)  has a population of more than 250,000; and
	(3)  borders the Neches River.
	Sec. 292D.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 292D.103(c).
	(b)  The commissioners court may adopt an order authorizing a
	county to participate in the program, subject to the limitations
	provided by this chapter.
	SUBCHAPTER B. POWERS AND DUTIES OF COMMISSIONERS COURT
	Sec. 292D.051.  LIMITATION ON AUTHORITY TO REQUIRE MANDATORY
	PAYMENTS. The commissioners court of a county may require a
	mandatory payment authorized under this chapter by an institutional
	health care provider in the county only in the manner provided by
	this chapter.
	Sec. 292D.052.  MAJORITY VOTE REQUIRED.  The commissioners
	court of a county may not authorize the county to collect a
	mandatory payment authorized under this chapter without an
	affirmative vote of a majority of the members of the commissioners
	court.
	Sec. 292D.053.  RULES AND PROCEDURES. 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. 292D.054.  INSTITUTIONAL HEALTH CARE PROVIDER
	REPORTING; INSPECTION OF RECORDS.  (a)  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.
	(b)  The commissioners court of a county that collects a
	mandatory payment authorized under this chapter may inspect the
	records of an institutional health care provider to the extent
	necessary to ensure compliance with the requirements of Subsection
	(a).
	SUBCHAPTER C. GENERAL FINANCIAL PROVISIONS
	Sec. 292D.101.  HEARING.  (a)  In each year that the
	commissioners court of a county authorizes a program under this
	chapter, the commissioners court shall hold a public hearing on the
	amounts of 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 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 and provide written notice of the
	hearing to each institutional health care provider located in the
	county.
	(c)  A representative of a paying hospital is entitled to
	appear at the public hearing and be heard regarding any matter
	related to the mandatory payments authorized under this chapter.
	Sec. 292D.102.  DEPOSITORY. (a)  The commissioners court of
	each county that collects a mandatory payment authorized under this
	chapter by resolution shall designate one or more banks located in
	the county as the depository for mandatory payments received by the
	county.
	(b)  All income received by a county under this chapter,
	including the revenue from mandatory payments remaining after
	discounts and fees for assessing and collecting the payments are
	deducted, shall be deposited with the county depository in the
	county's local provider participation fund and may be withdrawn
	only as provided by this chapter.
	(c)  All funds under this chapter shall be secured in the
	manner provided for securing county funds.
	Sec. 292D.103.  LOCAL PROVIDER PARTICIPATION FUND;
	AUTHORIZED USES OF MONEY.  (a)  Each county that collects a
	mandatory payment authorized 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, including any
	penalties and interest attributable to delinquent payments;
	(2)  money received from the Health and Human Services
	Commission as a refund of an intergovernmental transfer from the
	county to the state for the purpose of providing the nonfederal
	share of Medicaid supplemental payment program payments, 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 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, 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), or a successor waiver program authorizing
	similar Medicaid supplemental payment programs;
	(B)  uniform rate enhancements for nonpublic
	hospitals in the Medicaid managed care service area in which the
	county is located;
	(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);
	(D)  payments to Medicaid managed care
	organizations that are dedicated for payment to hospitals; or
	(E)  any reimbursement to nonpublic hospitals for
	which federal matching funds are available;
	(2)  subject to Section 292D.151(d), 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 hospital;
	(4)  refund to paying hospitals a proportionate share
	of the money attributable to mandatory payments collected under
	this chapter 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;
	(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
	payments, rate enhancements, and reimbursements for which the
	county made intergovernmental transfers described by Subdivision
	(1); and
	(6)  reimburse the county if the county is required by
	the rules governing the uniform rate enhancement program described
	by Subdivision (1)(B) 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 county 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 county, any funds received by the
	state or county as a result of the transfer may not be used by the
	state, county, or any other entity to:
	(1)  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); or
	(2)  fund the nonfederal share of payments to nonpublic
	hospitals available through the Medicaid disproportionate share
	hospital program.
	SUBCHAPTER D. MANDATORY PAYMENTS
	Sec. 292D.151.  MANDATORY PAYMENTS BASED ON PAYING HOSPITAL
	NET PATIENT REVENUE. (a)  Except as provided by Subsection (e), 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 shall provide that the mandatory payment is to
	be assessed at least annually, but not more often than
	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
	previous fiscal year or for the closest subsequent fiscal year for
	which the provider submitted the Medicare cost report.  The
	commissioners court shall update the amount of the mandatory
	payment on an annual basis.
	(b)  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 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 collects a
	mandatory payment authorized under this chapter shall set the
	amount of the mandatory payment.  The aggregate amount of the
	mandatory payment required of all paying hospitals may not exceed
	six percent of the aggregate net patient revenue from hospital
	services provided by all paying hospitals in the county.
	(d)  Subject to 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 an intergovernmental transfer described by
	Section 292D.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 $150,000,
	plus the cost of collateralization of deposits, regardless of
	actual expenses.
	(e)  A paying hospital may not add a mandatory payment
	required under this section as a surcharge to a patient.
	Sec. 292D.152.  ASSESSMENT AND COLLECTION OF MANDATORY
	PAYMENTS. (a) The county may collect or, using a competitive
	bidding process, 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. 292D.153.  INTEREST, PENALTIES, AND
	DISCOUNTS.  Interest, penalties, and discounts on mandatory
	payments required under this chapter are governed by the law
	applicable to county ad valorem taxes.
	Sec. 292D.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 certain
	Medicaid programs as described by Section 292D.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)  The county may only assess and collect a mandatory
	payment authorized under this chapter if a waiver program, uniform
	rate enhancement, or reimbursement described by Section
	292D.103(c)(1) is available to the county.
	SECTION 2.  Section 300.0003, Health and Safety Code, is
	amended to read as follows:
	Sec. 300.0003.  APPLICABILITY.  (a) Except as provided by
	Subsection (b), this [This] chapter applies only to:
	(1)  a hospital district that is not participating in a
	health care provider participation program authorized by another
	chapter of this subtitle; and
	(2)  a county or municipality that:
	(A)  is not participating in a health care
	provider participation program authorized by another chapter of
	this subtitle; and
	(B)  is not served by a hospital district or a
	public hospital.
	(b)  This chapter does not apply to a municipality that is
	located in a county described by Section 292D.002.
	SECTION 3.  Chapter 295, Health and Safety Code, is
	repealed.
	SECTION 4.  (a) In this section, "paying hospital" has the
	meaning assigned by Section 295.001, Health and Safety Code.
	(b)  If on the date Chapter 295, Health and Safety Code, is
	repealed by this Act a municipality to which that chapter applies
	has not transferred any remaining amount of mandatory payments
	assessed and collected by the municipality under that chapter
	before its repeal to the Health and Human Services Commission, the
	municipality shall refund to each paying hospital in the
	municipality that hospital's proportionate share of the remaining
	amount of mandatory payments.
	(c)  This section expires September 1, 2025.
	SECTION 5.  (a) Except as provided by Subsection (b) of this
	section, this Act takes effect September 1, 2023.
	(b)  The section of this Act adding Chapter 292D, Health and
	Safety Code, takes effect September 1, 2025.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I certify that H.B. No. 4835 was passed by the House on May 2,
	2023, by the following vote:  Yeas 141, Nays 4, 1 present, not
	voting.
	______________________________
	Chief Clerk of the House
	I certify that H.B. No. 4835 was passed by the Senate on May
	23, 2023, by the following vote:  Yeas 30, Nays 1.
	______________________________
	Secretary of the Senate
	APPROVED:  _____________________
	Date
	_____________________
	Governor