BILL ANALYSIS C.S.H.B. 2212 By: Berlanga 04-04-95 Committee Report (Substituted) BACKGROUND In 1985, the Texas Legislature passed the Maternal and Infant Health Improvement Act (MIHIA) to "reduce the occurrence of maternal, fetal and infant deaths, low birth weight infants, handicapping conditions, unplanned adolescent pregnancies and births without appropriate intrapartum care...." Another purpose of MIHIA was to increase cooperation and coordination between the Texas Department of Human Services (DHS) and the Texas Department of Health (TDH) in areas of joint responsibility. Changes in federal and state policies since 1985, however, have rendered the key functions of MIHIA obsolete. When MIHIA was passed, the responsibility for maternal and child health policy was in two agencies, and less than half of pregnant women and infants in Texas had Medicaid coverage. Today, the purchased health services portion of the Medicaid program is the TDH's responsibility and pregnant women and infants, up to 185 percent of the federal poverty level, are covered. The current statute should be updated to delete unnecessary references to the DHS and to reflect the broader responsibilities of the TDH in planning, policy development and the assurance of the delivery of health and medical services to women and children. PURPOSE H.B. 2212, as substituted, would amend the MIHIA to reflect recent changes in state and federal laws and regulations, and add a new Subchapter B, relating to the authority of the TDH to develop and implement voluntary perinatal health care systems. RULEMAKING AUTHORITY It is the committee's opinion that this bill expressly grants additional rulemaking authority to the Texas Board of Health in SECTION 7 (Sec. 32.042(a) and Sec. 32.045(b) and (c) of the Health and Safety Code). SECTION BY SECTION ANALYSIS SECTION 1. Designates Sections 32.001 through 32.021, Health and Safety Code, as Subchapter A and adds a new heading as follows: SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN. SECTION 2. Amends Section 32.002(a), Health and Safety Code as follows: (3) Deletes "ambulatory surgical center" from the definition of "facility." (4) Replaces the definition of "infant" with a definition of "infant care." (6) Modifies the definition of "maternal and infant health improvement services" to mean services necessary to assure quality health care for women and children. (7) Deletes reference to administration by DHS in the definition of "medical assistance program" and adds a reference to administration by the "single state agency under Title XIX of the Social Security Act, (42 United States Code, Sec. 1396 et. seq.). (9) Modifies the definition of "perinatal care" to expand the period of time such services are deemed appropriate. (10) Adds definition of "postpartum care." (11) Adds definition of "preconceptional care," and the remaining subsections are relettered accordingly. SECTION 3. Amends Section 32.003(f), Health and Safety Code, by removing a reference to the DHS. SECTION 4. Amends Section 32.011, Health and Safety Code, as follows: Sec. 32.011. (a) Deletes existing Subsection (a) relating to denial of an application for services and adds "for cause, deny" to the permitted actions under existing Subsection (b); reletters the remaining subsections accordingly. (c) Establishes that Chapter 2001 of the Government Code, instead of Sections 12-20 of the Administrative Procedure and Texas Register Act, does not apply to certain TDH actions affecting services. SECTION 5. Amends Section 32.012(c), Health and Safety Code, by requiring an individual requesting services to notify TDH, at the time the eligibility determination is made, of other benefits to which the person may be entitled; deletes previous reference to an application for services. SECTION 6. Amends Section 32.015(c), Health and Safety Code, to delete the Texas Department of Human Services from the reference to funds appropriated to administer this chapter. SECTION 7. Adds Subchapter B, "PERINATAL HEALTH CARE SYSTEM," to Chapter 32, Health and Safety Code, as follows: Sec. 32.041. LEGISLATIVE FINDINGS. (a) States that the legislature finds that the perinatal period poses unique challenges for the health care system and that the development of a coordinated, cooperative system of perinatal care within a geographic area will reduce unnecessary mortality and morbidity for women and infants. (b) States that in order to improve the health of women and infants, it is necessary to promote health education, provide assurance of access to quality services and improve quality of care by encouraging optimal usage of health care personnel. Sec. 32.042. DUTIES OF BOARD; RULES. (a) Requires the Texas Board of Health (TBH) by rule to adopt minimum standards and objectives to implement voluntary perinatal health care systems, and to adopt by rule policies for health promotion and education, risk assessment, access to care and perinatal system structure, including transportation. (b) Specifies that the rules must reflect all geographic areas of the state, must provide requirements for appropriate care of perinatal patients and must facilitate coordination among all perinatal service providers and facilities in the delivery area. (c) Establishes what the rules must include. Sec. 32.043. DUTIES OF THE DEPARTMENT. Requires the TDH to develop and monitor a statewide network of voluntary perinatal health care systems, develop and maintain a reporting and analysis system to monitor and evaluate patient care within the systems in Texas, and provide for coordination and cooperation within Texas and between Texas and adjoining states. Sec. 32.044. SYSTEM REQUIREMENTS. (a) Establishes requirements for each voluntary perinatal health care system. (b) Clarifies that the subchapter does not prohibit a health care facility from providing any services it is licensed and authorized to provide. Sec. 32.045. GRANT PROGRAM. (a) Allows the TDH to establish a grant program to initiate, expand, maintain and improve voluntary perinatal health care systems. (b) Requires the TBH by rule to establish eligibility criteria and sets forth the rule requirements for the TDH when considering the grant awards. (c) Allows the TDH to approve grants in accordance with the TBH rules and establishes that grants awarded are governed by the Uniform Grant and Contract Management Act of 1981 and the rules adopted under that Act. SECTION 8. Repeals the following sections of the Health and Safety Code: Sections 32.004, 32.007, 32.008, 32.009, 32.010, 32.019, and 32.020. SECTION 9. Effective date: September 1, 1995. SECTION 10. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute for H.B. 2212 contains nonsubstantive language and format changes, as recommended by the Legislative Council. SUMMARY OF COMMITTEE ACTION H.B. 2212 was considered by the committee in a public hearing April 4, 1995. The committee considered a complete substitute for the bill. The substitute was adopted without objection. The following persons testified in favor of the bill: Jacob L. Kay, M.D., representing self. Audelio Rivera, Jr., representing self. The bill was reported favorably as substituted, with the recommendation that it do pass and be printed, by the record vote of 5 Ayes, 0 Nays, 0 PNV, and 4 Absent.