86R6626 KFF-D
	By: Kolkhorst	S.B. No. 2238

	A BILL TO BE ENTITLED
	AN ACT
	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.  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 3.  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.