BILL ANALYSIS



S.B. 1229
By: Zaffirini/et al. (Berlanga)
04-26-95
Committee Report (Unamended)


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

S.B. 1229 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     renumbered 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) Sets forth 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) Sets forth 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,  (Vernon's
     Civil Statute and Codes, Government Code, Sec. 783), and the
     rules adopted under that Act.

SECTION 8. Repeals the following sections of the Health and Safety
Code: Sec. 32.004, regarding program services, Sec. 32.007,
regarding provision of program services by the TDH, Sec. 32.008,
regarding service providers, Sec. 32.009, regarding individual
referral and application for services, Sec. 32.010, regarding
eligibility for services, Sec. 32.019, regarding a memorandum of
understanding, and Sec. 32.020, regarding maternal and child health
advisory committee.

SECTION 9. Effective date: September 1, 1995.

SECTION 10.  Emergency clause.

SUMMARY OF COMMITTEE ACTION

S.B. 1229 was considered by the Public Health Committee in a formal
meeting on April 26, 1995. The bill was reported favorably without
amendment, with the recommendation that it do pass and be printed
by a record vote of 8 AYES, 0 NAYS, 0 PNV, and 1 ABSENT.