HB18 - Relating to the establishment and administration of certain programs and services providing health care services to rural counties.

      H.B. No. 18         AN ACT   relating to the establishment and administration of certain   programs and services providing health care services to rural   counties.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  This Act may be cited as the Rural Health   Stabilization and Innovation Act.          SECTION 2.  Sections 526.0301(b) and (c), Government Code,   are amended to read as follows:          (b)  The strategic plan must include:                (1)  a proposal for using at least one of the following   methods to ensure access to hospital services in the rural areas of   this state:                      (A)  an enhanced cost reimbursement methodology   for the payment of rural hospitals participating in the Medicaid   managed care program in conjunction with a supplemental payment   program for rural hospitals to cover costs incurred in providing   services to recipients;                      (B)  a hospital rate enhancement program   applicable only to rural hospitals;                      (C)  a reduction of punitive actions under   Medicaid that require reimbursement for Medicaid payments made to a   rural hospital provider, a reduction of the frequency of payment   reductions under Medicaid made to rural hospitals, and an   enhancement of payments made under merit-based programs or similar   programs for rural hospitals;                      (D)  a reduction of state regulatory-related   costs related to the commission's review of rural hospitals; or                      (E)  in accordance with rules the Centers for   Medicare and Medicaid Services adopts, the establishment of a   minimum fee schedule that applies to payments made to rural   hospitals by Medicaid managed care organizations; [ and ]                (2)  target dates for achieving goals related to the   proposal described by Subdivision (1) ; and                 (3)     a rural hospital financial needs assessment and   financial vulnerability index quantifying the likelihood that a   rural hospital, during the next two-year period, will be able to:                       (A)     maintain the types of patient services the   hospital currently offers at the same level of service;                       (B)     meet the hospital's current financial   obligations; and                       (C)  remain operational .          (c)  Not later than December [ November ] 1 of each   even-numbered year, the State Office of Rural Hospital Finance   established under Section 526.0304 [ commission ] shall submit a   report regarding the [ commission's ] development and implementation   of the strategic plan to:                (1)  the legislature;                (2)  the governor; and                (3)  the Legislative Budget Board.          SECTION 3.  Subchapter G, Chapter 526, Government Code, is   amended by adding Sections 526.0304 and 526.0305 to read as   follows:           Sec.   526.0304.     STATE OFFICE OF RURAL HOSPITAL FINANCE. The   commission shall establish and maintain the State Office of Rural   Hospital Finance within the commission to provide technical   assistance for rural hospitals and health care systems in rural   areas of this state that participate or are seeking to participate   in state or federal financial programs, including Medicaid.           Sec.   526.0305.     TEXAS RURAL HOSPITAL OFFICERS ACADEMY. (a)   In this section:                 (1)     "Institution of higher education" has the meaning   assigned by Section 61.003, Education Code.                 (2)     "Rural county" means a county with a population of   68,750 or less.                 (3)     "Rural hospital" has the meaning assigned by   Section 548.0351.           (b)     To the extent money is appropriated to the commission   for the purpose, the commission shall contract with at least two but   not more than four institutions of higher education to administer   an academy to provide professional development and continuing   education programs for the officers of rural hospitals and other   health care providers located in rural counties.   The academy must   offer at least 100 hours of coursework each year that consists of   courses and technical training on matters that impact the financial   stability of rural hospitals and rural health care systems,   including:                 (1)  relevant state and federal regulations;                 (2)  relevant state and federal financial programs;                 (3)     business administration, including revenue   maximization;                 (4)  organizational management; and                 (5)     other topics applicable to the financial stability   of rural hospitals and rural health care systems.           (b-1)     The commission shall establish an interagency   advisory committee to oversee the development of the academy's   curriculum. The advisory committee is composed of the following   members appointed by the executive commissioner:                 (1)  a representative of the commission;                 (2)     a representative of two or more institutions of   higher education;                 (3)     a representative of the Department of State Health   Services;                 (4)     a representative of the Texas Department of   Insurance;                 (5)  a representative of the state auditor's office;                 (6)  a representative of a rural hospital; and                 (7)     a representative of any state agency the executive   commissioner determines is appropriate.           (b-2)     The advisory committee established under Subsection   (b-1) is abolished on the earlier of:                 (1)     the date the advisory committee adopts a   curriculum; or                 (2)  September 1, 2027.           (b-3)     This subsection and Subsections (b-1) and (b-2)   expire September 1, 2028.           (c)     The commission shall establish criteria for the   screening and selection of applicants for admission to an academy   and include the criteria in each contract entered into under   Subsection (b).   An institution of higher education that receives a   contract to administer an academy under Subsection (b) shall notify   the commission when the institution completes the applicant   selection process and provide information to the commission   regarding the qualifications of the applicants.           (d)     Participation in an academy is limited to individuals   who are responsible for, or who anticipate becoming responsible   for, the financial stability of a rural hospital or rural health   care system in this state.           (e)     An institution of higher education that receives a   contract to administer an academy under Subsection (b):                 (1)     shall accept new participants for the academy each   year;                 (2)     shall offer to reimburse academy participants for   travel and related expenses; and                 (3)     may not claim or charge a participant for   admission to or participation in the academy or any associated   services.          SECTION 4.  Chapter 526, Government Code, as effective April   1, 2025, is amended by adding Subchapter G-1 to read as follows:   SUBCHAPTER G-1. GRANT PROGRAMS FOR RURAL HOSPITALS, HOSPITAL   DISTRICTS, AND HOSPITAL AUTHORITIES           Sec. 526.0321.  DEFINITIONS. In this subchapter:                 (1)     "Hospital district" means a hospital district   created under the authority of Sections 4 through 11, Article IX,   Texas Constitution.                 (2)     "Office" means the State Office of Rural Hospital   Finance established under Section 526.0304.                 (3)     "Rural county" means a county with a population of   68,750 or less.                 (4)     "Rural hospital" has the meaning assigned by   Section 548.0351.                 (5)     "Rural hospital authority" means a hospital   authority located in a rural county.                 (6)     "Rural hospital district" means a hospital   district located in a rural county.                 (7)     "Rural hospital organization" means a statewide   nonprofit organization that provides services to rural hospitals.           Sec.   526.0322.     FINANCIAL STABILIZATION GRANT PROGRAM. (a)   The commission shall establish a financial stabilization grant   program to award grants to support and improve the financial   stability of rural hospitals, rural hospital districts, and rural   hospital authorities that are determined to be at a moderate or high   risk of financial instability.           (b)     The determination of whether a grant applicant is at a   moderate or high risk of financial instability shall be made using   the hospital financial needs assessment and financial   vulnerability index developed as part of the strategic plan   required under Section 526.0301.           (b-1)     Notwithstanding Subsection (b), for a grant   application received before December 1, 2026, the office shall   determine whether the applicant is at a moderate or high risk of   financial instability by evaluating data published by the   commission regarding the financial stability of rural hospitals,   rural hospital districts, and rural hospital authorities.   This   subsection expires September 1, 2027.           (c)     The office shall develop a formula to allocate the money   available to the commission for grants under this section to rural   hospitals, rural hospital districts, and rural hospital   authorities that are determined to be at a moderate or high risk of   financial instability.   The formula may consider:                 (1)     the degree of financial vulnerability of the   applicant as determ [Text truncated for display. 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