BILL ANALYSIS C.S.H.B. 2979 By: Hamric 5-3-95 Committee Report (Substituted) BACKGROUND Currently, a non-indigent prisoner in county jail is responsible for any medical services he or she receives except when they are in a hospital under guard by the county. The county is responsible for guarding an individual who is injured during the act of a crime or an arrest. Then the inmate is taken to the appropriate medical facility at the discretion of the emergency medical service. When the medical facility takes in the patient the county becomes responsible, regardless of the arresting agency or financial situation of the prisoner, for all medical costs incurred. This has created a fiscally unsound situation for Harris county. The county is exposed to unlimited liability for the costs of emergency and trauma medical care rendered by third party health care providers to indigent and non-indigent prisoners. Within the past two years there have been 31 claims totaling 4 million dollars filed against Harris County. Twenty-seven are filed by just one hospital. PURPOSE The purpose of this legislation is to ensure that laws which relate to the payment of prisoner health care are uniform in all instances. CSHB 2979 would require the prisoner, if financially able, to pay for any medical services. In addition, it would require all indigent persons who are prisoners in a county jail or kept under guard by the county to receive medical services from a county jail, county hospital, hospital district, or mandated provider as defined in Section 61.002, Health and Safety Code. This would eliminate third party health-care provider claims against the county and provide the county with cost control over all medical services for which the county is financially responsible. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 104.002, Code of Criminal Procedure, by amending Subsection (d) and adding Subsection (e). Subsection (d) is amended to require prisoners who are kept under guard by the county to be financially responsible for any medical, dental, or health related services they receive. In addition, this subsection allows any health care provider which renders services to a prisoner or person kept under guard to seek payment for those services only from the prisoner or a person or a natural person who is responsible for payment for the prisoner. This Section deletes language which provides the county with the "right of subrogation" for all prisoner health care costs. It is under this "right of subrogation" which the courts have interpreted counties liable for all health care costs for persons or prisoners under guard by the county. Subsection (e) is added to require all medical, dental, or health-related services provided to an indigent person who is in prison or under guard by the county jail system public hospital, hospital district or mandated provider. SECTION 2. Effective Date. This Act takes effect September 1, 1995. SECTION 3. Emergency Clause. COMPARISON OF ORIGINAL TO SUBSTITUTE In Subsection (d), CSHB 2979 clarifies that a non-indigent prisoner in a county jail kept under guard by the county in any medical facility is financially responsible for all health-care costs, regardless of the health care provider. In CSHB 2979, Subsection (e) is substituted to require that all indigent prisoners who are in a county jail or kept under guard by the county receive medical services from the facilities of a county jail, county hospital, hospital district, or mandated provider as defined by Health and Safety Code, Section 61.002. The original Subsection (e) did not require indigent prisoners to be treated by the county hospital, hospital district, or mandated provider, but said that the county would only pay for indigent prisoners who were treated by these providers. If third party providers treated these indigent persons then they would seek reimbursement as provided by Chapter 61, Health and Safety Code. Subsection (f) is deleted from CSHB 2979. SUMMARY OF COMMITTEE ACTION HB 2979 was considered by the County Affairs Committee in a public hearing on 4/26/95. Representative Hamric opened. The following people testified for HB 2979: Dori Wind, representing herself and Harris County and the Harris County Hospital District; and Angela Mogan, representing herself; and Virginia Scott, representing herself; and Mike Quinn, representing himself and Harris County Sheriff Klevenhagan; and Leonard Spearman, representing Harris County Judge Eckels and the commissioners court. The chair recognized the following person to testify against HB 2979: Randal Payne, representing himself and the Texas Hospital Association. Representative Hamric closed. HB 2979 was left pending. HB 2979 was considered by the County Affairs Committee in a public hearing on 5/3/95. The County Affairs Committee considered a complete committee substitute. The substitute was adopted without objection. HB 2979 was reported favorably, as substituted, with the recommendation that it do pass and be printed and be placed on the Local and Consent Calendar, by the record vote of 5 ayes, 0 nays, 0 pnv, 4 absent.