85R34091 JCG-D     By: Hinojosa S.R. No. 935     R E S O L U T I O N            BE IT RESOLVED by the Senate of the State of Texas, 85th   Legislature, Regular Session, 2017, That Senate Rule 12.03 be   suspended in part as provided by Senate Rule 12.08 to enable the   conference committee appointed to resolve the differences on Senate   Bill 1462 (the creation and operation of certain local health care   provider participation programs) to consider and take action on the   following matter:          Senate Rule 12.03(4) is suspended to permit the committee to   add text on a matter not included in either the house or senate   version of the bill by adding the following SECTIONS to the bill:          SECTION 28.  Subtitle D, Title 4, Health and Safety Code, is   amended by adding Chapter 298B to read as follows:   CHAPTER 298B. TARRANT COUNTY HOSPITAL DISTRICT HEALTH CARE PROVIDER   PARTICIPATION PROGRAM   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 298B.001.  DEFINITIONS. In this chapter:                (1)  "Board" means the board of hospital managers of   the district.                (2)  "District" means the Tarrant County Hospital   District.                (3)  "Institutional health care provider" means a   nonpublic hospital located in the district that 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. 298B.002.  APPLICABILITY.  This chapter applies only to   the Tarrant County Hospital District.          Sec. 298B.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. 298B.004.  EXPIRATION OF AUTHORITY. (a) Subject to   Sections 298B.153(d) and 298B.154, the authority of the district to   administer and operate a program under this chapter expires   December 31, 2019.          (b)  Subsection (a) does not affect the authority of the   district to require and collect a mandatory payment under Section   298B.154 after December 31, 2019, if necessary.   SUBCHAPTER B. POWERS AND DUTIES OF BOARD          Sec. 298B.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 in the   district only in the manner provided by this chapter.          Sec. 298B.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. 298B.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 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. 298B.101.  HEARING. (a) In each 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 in the district.          Sec. 298B.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. 298B.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 nonpublic   hospitals affiliated with the district, 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)  uniform rate enhancements for nonpublic   hospitals in the Medicaid managed care service area in which the   district 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); or                      (D)  any reimbursement to nonpublic hospitals for   which federal matching funds are available;                (2)  subject to Section 298B.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                      (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 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)(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 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:                (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 or the delivery system reform incentive payment   program.   SUBCHAPTER D. MANDATORY PAYMENTS          Sec. 298B.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 an annual mandatory   payment to be assessed on the net patient revenue of each   institutional health care provider located in the district.  The   board 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   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 authorized under this   chapter 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 298B.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.          Sec. 298B.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. 298B.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 nonpublic hospitals to support the provision of   health care by institutional health care providers to district   residents in need of health care.          (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 nonpublic 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   298B.103(c)(1) is available to the district.          Sec. 298B.154.  FEDERAL DISALLOWANCE. Notwithstanding any   other provision of this chapter, if the Centers for Medicare and   Medicaid Services issues a disallowance of federal matching funds   for a purpose for which intergovernmental transfers described by   Section 298B.103(c)(1) were made and the Health and Human Services   Commission demands repayment from the district of federal funds   paid to the district for that purpose, the district may require and   collect mandatory payments from each paying provider that received   those federal funds in an amount sufficient to satisfy the   repayment demand made by the commission. The percentage limitation   prescribed by Section 298B.151(c) does not apply to a mandatory   payment required under this section.          SECTION 29.  As soon as practicable after the expiration of   the authority of the Tarrant County Hospital District to administer   and operate a health care provider participation program under   Chapter 298B, Health and Safety Code, as added by this Act, the   board of hospital managers of the Tarrant 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 298B.103, Health and Safety Code, as added by this   Act.          SECTION 30.  If before implementing any provision of Chapter   298B, Health and Safety Code, as added by 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.          Explanation: The added language is necessary to allow the   Tarrant County Hospital District to create and operate a health   care provider participation program in Tarrant County.