Bill Text: TX HB2798 | 2019-2020 | 86th Legislature | Comm Sub
Bill Title: Relating to the reimbursement of certain urban teaching hospitals for the provision of inpatient hospital care under Medicaid.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2019-05-09 - Placed on General State Calendar [HB2798 Detail]
Download: Texas-2019-HB2798-Comm_Sub.html
86R26244 KFF-D | |||
By: Klick, Deshotel, Clardy, Hinojosa, | H.B. No. 2798 | ||
et al. | |||
Substitute the following for H.B. No. 2798: | |||
By: Clardy | C.S.H.B. No. 2798 |
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relating to the reimbursement of certain urban teaching hospitals | ||
for the provision of inpatient hospital care under Medicaid. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter B, Chapter 32, Human Resources Code, | ||
is amended by adding Section 32.0285 to read as follows: | ||
Sec. 32.0285. CALCULATION OF MEDICAL EDUCATION ADD-ON FOR | ||
REIMBURSEMENT OF CERTAIN URBAN TEACHING HOSPITALS. (a) In this | ||
section: | ||
(1) "Base standard dollar amount" means the | ||
standardized payment amount calculated by the commission for costs | ||
incurred by prospectively paid hospitals in this state for | ||
providing inpatient hospital care under Medicaid. | ||
(2) "Children's hospital" means a hospital designated | ||
by the Centers for Medicare and Medicaid Services as a children's | ||
hospital. | ||
(3) "Medical education add-on" means an adjustment to | ||
the base standard dollar amount for an urban teaching hospital to | ||
reflect higher patient care costs relative to nonteaching urban | ||
hospitals. | ||
(4) "Rural hospital" means a hospital enrolled as a | ||
Medicaid provider that: | ||
(A) is located in a county with a population of | ||
not more than 60,000; | ||
(B) is designated by the Centers for Medicare and | ||
Medicaid Services as a critical access hospital, sole community | ||
hospital, or rural referral center and is not located in an area | ||
defined by the United States Office of Management and Budget as a | ||
metropolitan statistical area; or | ||
(C) meets all of the following criteria: | ||
(i) has 100 or fewer beds; | ||
(ii) is designated by the Centers for | ||
Medicare and Medicaid Services as a critical access hospital, sole | ||
community hospital, or rural referral center; and | ||
(iii) is located in an area defined by the | ||
United States Office of Management and Budget as a metropolitan | ||
statistical area. | ||
(5) "State-owned teaching hospital" means: | ||
(A) The University of Texas Medical Branch at | ||
Galveston; | ||
(B) The University of Texas Health Science Center | ||
at Tyler; and | ||
(C) The University of Texas M.D. Anderson Cancer | ||
Center. | ||
(6) "Teaching hospital" means a hospital that incurs | ||
indirect costs for operating graduate medical education programs | ||
and for which the Centers for Medicare and Medicaid Services has | ||
calculated and assigned a percentage Medicare education adjustment | ||
factor under 42 C.F.R. Section 412.105. | ||
(7) "Urban hospital" means a hospital that: | ||
(A) is located in an area defined by the United | ||
States Office of Management and Budget as a metropolitan | ||
statistical area; and | ||
(B) is not a rural hospital, children's hospital, | ||
state-owned teaching hospital, or freestanding psychiatric | ||
facility. | ||
(b) To the extent permitted by federal law, in order to | ||
ensure that urban teaching hospitals are accurately reimbursed for | ||
the provision of inpatient hospital care to recipients under | ||
Medicaid, the commission shall at least annually update the | ||
education adjustment factor used to calculate the medical education | ||
add-on using the most current data available, including: | ||
(1) data related to the number of interns and | ||
residents enrolled in a hospital's approved teaching program; and | ||
(2) the Medicare education adjustment factor assigned | ||
under 42 C.F.R. Section 412.105 in effect at the time the commission | ||
makes the update. | ||
SECTION 2. (a) In this section: | ||
(1) "Medicaid" has the meaning assigned by Section | ||
531.001, Government Code. | ||
(2) "Medical education add-on," "teaching hospital," | ||
and "urban hospital" have the meanings assigned by Section 32.0285, | ||
Human Resources Code, as added by this Act. | ||
(b) As soon as practicable after the effective date of this | ||
Act, the Health and Human Services Commission shall conduct a study | ||
to evaluate the impacts and effectiveness of using the Medicare | ||
education adjustment factor assigned under 42 C.F.R. Section | ||
412.105 in effect on the effective date of this Act to calculate the | ||
medical education add-on used to reimburse teaching hospitals for | ||
the provision of inpatient hospital care under Medicaid. The | ||
commission shall develop and make recommendations on alternative | ||
factors and methodologies for calculating and annually updating the | ||
medical education add-on that: | ||
(1) best recognize the higher costs incurred by | ||
teaching hospitals; and | ||
(2) mitigate issues identified with using the Medicare | ||
education adjustment factor without reducing reimbursements to | ||
urban teaching hospitals that have maintained or increased the | ||
number of interns and residents enrolled in the hospitals' approved | ||
teaching programs. | ||
(c) Not later than December 1, 2020, the Health and Human | ||
Services Commission shall report its findings and recommendations | ||
under Subsection (b) of this section to the governor, the standing | ||
committees of the senate and house of representatives having | ||
primary jurisdiction over matters relating to state finance and | ||
appropriations from the state treasury, the standing committees of | ||
the senate and house of representatives having primary jurisdiction | ||
over Medicaid, and the Legislative Budget Board. | ||
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. |