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HomeMy WebLinkAboutRES 15-152RESOLUTION NO. 15-152 Resolution Implementing Requirements of the City of Beaumont's Participation in a Municipal Health Care Provider Participation Program WHEREAS, the Texas Legislature enacted by unanimous consent Senate Bill 1387, which added Chapter 295 to the Health and Safety Code and which went into effect immediately upon being signed by the Governor; WHEREAS, pursuant to new Section 295.003 of the Health and Safety Code, the governing body of a municipality may by order authorize the municipality to participate in a municipal health care provider participation program and establish a Local Provider Participation Fund; WHEREAS, the purpose of participation in a municipal health care provider participation program is to help local providers gain access to the Texas Transformation & Quality Improvement 1115 Medicaid Waiver; WHEREAS, the funding for the Local Provider Participation Fund is generated from revenue from a mandatory payment that may be required by the municipality from an institutional health care provider to fund certain intergovernmental transfers and indigent care programs; WHEREAS, pursuant to Section 295.003 of the Health and Safety Code, the City Council of the City of Beaumont on June 9, 2015, authorized the municipality to participate in a municipal health care provider participation program and establish a Local Provider Participation Fund; WHEREAS, the purpose of participation in a municipal health care provider participation program is to generate revenue from a mandatory payment that may be required by the municipality from an institutional health care provider to fund certain intergovernmental transfers and indigent care programs; WHEREAS, pursuant to Section 295.052 of the Health and Safety Code, the City Council of the City of Beaumont on July 9, 2015, authorized the municipality to collect a mandatory payment from each institutional health care provider located in the City Beaumont; WHEREAS, pursuant to Section 295.053 of the Health and Safety Code, the governing body of a municipality that collects a mandatory payment may adopt rules relating to the administration of the mandatory payment; WHEREAS, pursuant to Section 295.054 of the Health and Safety Code, the governing body of a municipality that collects a mandatory payment must require each institutional health care provider to submit to the municipality a copy of any financial and utilization data required by and reported to the Department of State Health Services under Texas Health & Safety Code 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; WHEREAS, pursuant to Section 295.102 of the Health and Safety Code, the governing body of a municipality that collects a mandatory payment must designate one or more banks WHEREAS, pursuant to Section 295.151 of the Health and Safety Code, the governing body of a municipality that collects a mandatory payment must set the amount of the mandatory payment; NOW THEREFORE, BE IT ORDERED that the City Council of the City of Beaumont: Adopts the Municipal Health Care Participation Program Model Rules and Procedures attached to this ORDER and identified as Exhibit A Municipal Health Care Participation Program Model Rules and Procedures; 2. Requires each institutional health care provider to submit to the City of Beaumont a copy of any financial and utilization data required by and reported to the Department of State Health Services under Texas Health & Safety Code 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; 3. Designates Wells Fargo Bank, N.A., located at 6250 Delaware, Beaumont, Texas, 77706, as the depository for mandatory payments received by the City of Beaumont; 4. Sets the amount of the mandatory payment for the fiscal year ending in 2015 as 1.2% percent of the net patient revenue of an institutional health care provider located in the City of Beaumont; and 5. Authorizes the City Council of the City of Beaumont to take all other actions necessary to meet the requirements of Chapter 295. Passed and approved this 28th day of July, 2015. rjeCKy Hmlayor t st:- U111, Tina Broussard, City Clerk Approved as to form: ° ---------------- Tyr n E. Co , ity Attorney MUNICIPAL HEALTH CARE PROVIDER PARTICIPATION PROGRAM MODEL RULES AND PROCEDURES General Provisions Rule 1. Definitions. In these rules and procedures: (a) "Mandatory payment" means a mandatory payment authorized under Subtitle D of Title 4 of the Texas Health & Safety Code, (b) "Institutional health care provider' means a nonpublic hospital that provides inpatient hospital services. (c) "Paying hospital" means an institutional health care provider required to make a mandatory payment. (d) "Program" means a municipal health care provider participation program authorized under Subtitle D of Title 4 of the Texas Health & Safety Code. Rule 2. Municipal Health Care Provider Participation Program; Participation in Program. (a) A municipal health care provider participation program authorizes a municipality to collect a mandatory payment from each institutional health care provider located in the municipality to be deposited in a local provider participation fund established by the municipality. Money in the local provider participation fund may be used by the municipality to fund certain intergovernmental transfers and indigent care programs as provided by these rules and procedures. (b) The governing body of a municipality may adopt an order authorizing a municipality to participate in the program, subject to the limitations provided by these rules and procedures. (c) To the extent any provision or procedure under Subtitle D of Title 4 of the Texas Health & Safety Code causes a mandatory payment to be ineligible for federal matching funds, the municipality may provide by rule for an alternative provision or procedure that conforms to the requirements of the federal Centers for Medicare and Medicaid Services. Powers and Duties of Governing- Bodyof Municipality Rule 3. Limitation on Authority to Require Mandatory Payment. The municipality may require a mandatory payment from an institutional health care provider only in the manner provided in these rules and procedures. Rule 4. Majority Vote Required Prior to Mandatory Payment. The municipality may not collect a mandatory payment without an affirmative vote of a majority of the members of the governing body. Rule S. Institutional Health Care Provider Reporting; Inspection of Records. (a) The municipality shall require each institutional health care provider to submit to the municipality a copy of any financial and utilization data required by and 1 EXHIBIT "All reported to the Department of State Health Services under Texas Health & Safety Code 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 municipality may inspect the records of an institutional health care provider to the extent necessary to ensure that the provider has submitted all required data under this Rule. General Financing Provisions Rule 6. Hearing. (a) Each year, the governing body of he municipality shall hold a public hearing on the amounts of any mandatory payments that the governing body intends to require during the year and how the revenue derived from those payments is to be spent. (b) Not later than the 10th day before the date of the hearing required under Rule 6(a), the governing body of the municipality shall publish notice of the hearing in a newspaper of general circulation in the municipality. (c) A representative of an institutional health care provider that is or may be designated as a paying hospital is entitled to appear at the time and place designated in the public notice and to be heard regarding any matter related to the mandatory payments. Rule 7. Depository. (a) The municipality shall designate one or more banks located in the municipality as the depository for mandatory payments received by the municipality. A bank designated as a depository serves for two years or until a successor is designated. (b) All income received by a municipality under these rules and procedures, including the revenue from mandatory payments remaining after fees for assessing and collecting the mandatory payments are deducted, shall be deposited with the municipality depository in the municipality's local provider participation fund and may be withdrawn only as provided by these rules and procedures. (c) All deposits into the municipality's local provider participation fund shall be secured in the manner provided for securing municipal funds. Rule B. Local Provider Participation Fund; Authorized Uses of Money. (a) Each municipality that collects a mandatory payment shall create a local provider participation fund. (b) The local provider participation fund of a municipality consists of: (1) all revenue received by the municipality attributable to mandatory payments, 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 municipality 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 local provider participation fund. (c) Money deposited to the local provider participation fund may be used only to: (1) fund intergovernmental transfers from the municipality to the state to provide the nonfederal share of a Medicaid supplemental payment program authorized under the state Medicaid plan, 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; (2) subsidize indigent programs; (3) pay the administrative expenses of the municipality solely for activities under these rules. and procedures, - . (4) refund a portion of a mandatory payment collected in error from a paying hospital; and 1 (5) refund to paying hospitals the proportionate share of money received by the municipality from the Health and Human Services Commission that is not used to fund the nonfederal share of Medicaid supplemental payment program payments. (d) Money in the local provider participation fund may not be commingled with other municipal funds. (e) An intergovernmental transfer of funds described by Rule 8(c)(1) and any funds received by the municipality as a result of an intergovernmental transfer described by that rule may not be used by the municipality or any other entity to 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). Mandatory Payments Rule 9., Mandatory. Payrneirift, Based on Paying Hospital Net Patient Revenue. (a) Except as provided by Rule 11, the governing body of a municipality that collects a mandatory payment may require an annual mandatory payment to be assessed on the net patient revenue of each institutional health care provider located in the municipality. (b) The governing body of a municipality may provide for the mandatory payment to be assessed quarterly. Mandatory payments are typically due no later than 90 days after such payment is assessed, (c) In the first year in which the mandatory payment is required, the mandatory payment is assessed based on the data for 2013 collected pursuant to Section 5(a), If no such data are available for an institutional health care provider, the mandatory payment may be calculated based on the institutional health care provider's Medicare cost report submitted for the 2013 fiscal year or for the closest subsequent fiscal year for which the provider submitted the Medicare cost report. (d) The municipality shall update the amount of the mandatory payment on an annual basis. 3 Rule 10. Mandatory Payment Requirements (a) The amount of a mandatory payment must be uniformly proportionate with the amount of net patient revenue generated by each paying hospital in the municipality. (b) The governing body of a municipality that collects a mandatory payment shall set the amount of the mandatory payment. (c) Subject to the maximum amount prescribed by Rule 11(a), the governing body of a municipality that collects a mandatory payment shall set the mandatory payments in amounts that in the aggregate will generate sufficient revenue to cover the administrative expenses of the municipality for activities under these rules and procedures and to fund purposes described in Rule 8(c). (d) The annual amount of revenue from mandatory payments used for administrative expenses of the municipality for activities under these rules and procedures may not exceed the lesser of four percent of the total revenue generated from the mandatory payment or $20,000. Rule 11. Mandatory Payment Prohibitions. (a) The amount of the mandatory payment required of each paying hospital may not exceed an amount that, when added to the amount of the mandatory payments required from all other paying hospitals in the municipality, equals an amount of revenue that exceeds six percent of the aggregate net patient revenue of all paying hospitals in the municipality. (b) A mandatory payment may not hold harmless any institutional health care provider, as required under 42 U.S.C. Section 1396b(w). (c) A paying hospital may not add a mandatory payment required under this section as a surcharge to a patient. (d) If a municipality determines that administration of mandatory payments is increasing the costs of health care to the residents of the municipality, the governing body of the municipality may rescind participation in the program and refund to each paying hospital the proportionate share of any money remaining in the local provider participation fund at the time the municipality's participation is rescinded. Rule 12. Assessment and Collection of Mandatory Payments. (a) Except as provided by Rule 12(b), the municipal tax assessor -collector shall collect the mandatory payment. The municipal tax assessor -collector shall charge and deduct from mandatory payments collected for the municipality a fee for collecting the mandatory payment in an amount determined by the governing body of the municipality, not to exceed the municipal tax assessor -collector's usual and customary charges or the amount specified in Rule 10(d). (b) The governing body of a municipality may contract for the assessment and collection of mandatory payments in the manner provided by Title 1, Tax Code, for the assessment and collection of ad valorem taxes. - (c) Revenue from a fee charged by a municipal tax assessor -collector for collecting the mandatory payment shall be deposited in the municipal general fund and, if appropriate, shall be reported as fees of the municipal tax assessor -collector. 4 Rule 13. Interest and Penalties. Any interest and penalties on mandatory payments are governed by the law applicable to municipal ad valorem taxes. Discounts applicable to municipal ad valorem taxes do not apply, 5