By: Hinojosa S.R. No. 935     SENATE RESOLUTION          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.             _______________________________          President of the Senate                I hereby certify that the     above Resolution was adopted by     the Senate on May 28, 2017, by the   following vote:  Yeas 30, Nays 0.                 _______________________________          Secretary of the Senate