74R8472 KLL-F
By Berlanga H.B. No. 2212
Substitute the following for H.B. No. 2212:
By McDonald C.S.H.B. No. 2212
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the Maternal and Infant Health Improvement Act and to
1-3 the development of a perinatal health care system.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Sections 32.001 through 32.021, Health and Safety
1-6 Code, are designated as Subchapter A and a new heading is added to
1-7 read as follows:
1-8 SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN
1-9 SECTION 2. Section 32.002(a), Health and Safety Code, is
1-10 amended to read as follows:
1-11 (a) In this chapter:
1-12 (1) "Adolescent" means an individual younger than 18
1-13 years of age.
1-14 (2) "Ancillary services" means services necessary to
1-15 obtain timely, effective, and appropriate maternal and infant
1-16 health improvement services, and includes prescription drugs,
1-17 medical social services, transportation, health promotion services,
1-18 and laboratory services.
1-19 (3) "Facility" includes a hospital, <ambulatory
1-20 surgical center,> public health clinic, birthing center, outpatient
1-21 clinic, or community health center.
1-22 (4) "Infant care" means maternal and infant health
1-23 improvement services and ancillary services appropriate for an
2-1 individual from birth to 12 months of age <or younger>.
2-2 (5) "Intrapartum care" means maternal and infant
2-3 health improvement services and ancillary services appropriate for
2-4 a woman, fetus, or infant during childbirth.
2-5 (6) "Maternal and infant health improvement services"
2-6 means services necessary to assure quality health care for women
2-7 and children <prevent or reduce the occurrence of maternal, fetal,
2-8 and infant deaths, low birth-weight infants, handicapping
2-9 conditions, unplanned adolescent pregnancies, and births without
2-10 appropriate intrapartum care, and includes preventive, health,
2-11 medical, assessment, nursing, and facility care services>.
2-12 (7) "Medical assistance program" means the program
2-13 administered by the single state agency under Title XIX of the
2-14 Social Security Act (42 U.S.C. Section 1396 et seq.) <Texas
2-15 Department of Human Services under Chapter 32, Human Resources
2-16 Code>.
2-17 (8) "Other benefit" means a benefit, other than a
2-18 benefit provided under this chapter, to which an individual is
2-19 entitled for payment of the costs of maternal and infant health
2-20 improvement services, ancillary services, educational services, or
2-21 transportation services, including benefits available from:
2-22 (A) an insurance policy, group health plan, or
2-23 prepaid medical care plan;
2-24 (B) Title XVIII of the Social Security Act (42
2-25 U.S.C. Section 1395 et seq.);
3-1 (C) the Veterans Administration;
3-2 (D) the Civilian Health and Medical Program of
3-3 the Uniformed Services;
3-4 (E) workers' compensation or any other
3-5 compulsory employers' insurance program;
3-6 (F) a public program created by federal or state
3-7 law, other than Title XIX of the Social Security Act (42 U.S.C.
3-8 Section 1396 et seq.), or by an ordinance or rule of a municipality
3-9 or political subdivision of the state, excluding benefits created
3-10 by the establishment of a municipal or county hospital, a joint
3-11 municipal-county hospital, a county hospital authority, a hospital
3-12 district, or the facilities of a publicly supported medical school;
3-13 or
3-14 (G) a cause of action for medical, facility, or
3-15 medical transportation expenses, or a settlement or judgment based
3-16 on the cause of action, if the expenses are related to the need for
3-17 services provided under this chapter.
3-18 (9) "Perinatal care" means maternal and infant health
3-19 improvement services and ancillary services that are appropriate
3-20 for women and infants during the perinatal period, which begins
3-21 before conception and ends on the infant's first birthday <a
3-22 pregnant woman and the fetus during the period beginning on the
3-23 20th complete week of gestation and ending on the infant's 28th
3-24 completed day of life>.
3-25 (10) "Postpartum care" means maternal and infant
4-1 health improvement services and ancillary services appropriate for
4-2 a woman following a pregnancy.
4-3 (11) "Preconceptional care" means maternal and infant
4-4 health improvement services and ancillary services appropriate for
4-5 a woman before conception that are provided with the intent of
4-6 planning and reducing health risks that might adversely affect her
4-7 pregnancies.
4-8 (12) <(10)> "Prenatal care" means maternal and infant
4-9 health improvement services and ancillary services that are
4-10 appropriate for a pregnant woman and the fetus during the period
4-11 beginning on the date of conception and ending on the commencement
4-12 of labor.
4-13 (13) <(11)> "Program" means the maternal and infant
4-14 health improvement services program authorized by this chapter.
4-15 (14) <(12)> "Provider" means a person who, through a
4-16 grant or a contract with the department or through other means
4-17 approved by the department, provides maternal and infant health
4-18 improvement services and ancillary services that are purchased by
4-19 the department for the purposes of this chapter.
4-20 (15) <(13)> "Support" means the contribution of money
4-21 or services necessary for a person's maintenance, including food,
4-22 clothing, shelter, transportation, and health care.
4-23 SECTION 3. Section 32.003(f), Health and Safety Code, is
4-24 amended to read as follows:
4-25 (f) If necessary, the board by rule may coordinate services
5-1 and other parts of the program with the medical assistance program.
5-2 However, the board may not adopt rules relating to the services
5-3 under either program that would:
5-4 (1) cause the program established under this chapter
5-5 not to conform with federal law to the extent that federal matching
5-6 funds would not be available; or
5-7 (2) affect the status of the <Texas Department of
5-8 Human Services as the> single state agency to administer the
5-9 medical assistance program.
5-10 SECTION 4. Section 32.011, Health and Safety Code, is
5-11 amended to read as follows:
5-12 Sec. 32.011. Denial, Modification, Suspension, or
5-13 Termination of Services. (a) <The department may, for cause, deny
5-14 an application for services after notice to the applicant and an
5-15 opportunity for a hearing.>
5-16 <(b)> The department may, for cause, deny, modify, suspend,
5-17 or terminate services to an individual eligible for or receiving
5-18 services after notice to the individual and an opportunity for a
5-19 hearing.
5-20 (b) <(c)> The board by rule shall provide criteria for
5-21 action by the department under this section.
5-22 (c) Chapter 2001, Government Code, does <(d) Sections
5-23 12-20, Administrative Procedure and Texas Register Act (Article
5-24 6252-13a, Vernon's Texas Civil Statutes), do> not apply to the
5-25 granting, denial, modification, suspension, or termination of
6-1 services. The department shall conduct hearings in accordance with
6-2 the board's due process hearing rules.
6-3 (d) <(e)> The department shall render the final
6-4 administrative decision in a due process hearing to deny, modify,
6-5 suspend, or terminate the receipt of services.
6-6 (e) <(f)> The notice and hearing required by this section do
6-7 not apply if the department restricts program services to conform
6-8 to budgetary limitations that require the board to establish
6-9 service priorities.
6-10 SECTION 5. Section 32.012(c), Health and Safety Code, is
6-11 amended to read as follows:
6-12 (c) When a determination of eligibility to receive maternal
6-13 and infant health improvement services <the application> is made
6-14 under this chapter or when the services are received, the
6-15 individual requesting <applying for> or receiving services shall
6-16 inform the department of any other benefit to which the individual
6-17 or a person with a legal obligation to support the individual may
6-18 be entitled.
6-19 SECTION 6. Section 32.015(c), Health and Safety Code, is
6-20 amended to read as follows:
6-21 (c) The department is not required to provide maternal and
6-22 infant health improvement services unless funds are appropriated to
6-23 the department <or to the Texas Department of Human Services> to
6-24 administer this chapter.
6-25 SECTION 7. Chapter 32, Health and Safety Code, is amended by
7-1 adding Subchapter B to read as follows:
7-2 SUBCHAPTER B. PERINATAL HEALTH CARE SYSTEM
7-3 Sec. 32.041. LEGISLATIVE FINDINGS. (a) The legislature
7-4 finds that the perinatal period beginning before conception and
7-5 continuing through the first year of life poses unique challenges
7-6 for the health care system. The development of a coordinated,
7-7 cooperative system of perinatal health care within a geographic
7-8 area will reduce unnecessary mortality and morbidity for women and
7-9 infants.
7-10 (b) In order to improve the health of women and infants, it
7-11 is necessary to promote health education, to provide assurance of
7-12 reasonable access to safe and appropriate perinatal services, and
7-13 to improve the quality of perinatal care by encouraging optimal use
7-14 of health care personnel.
7-15 Sec. 32.042. DUTIES OF BOARD; RULES. (a) The board by rule
7-16 shall adopt:
7-17 (1) minimum standards and objectives to implement
7-18 voluntary perinatal health care systems; and
7-19 (2) policies for health promotion and education, risk
7-20 assessment, access to care, and perinatal system structure,
7-21 including the transfer and transportation of pregnant women and
7-22 infants.
7-23 (b) The rules must:
7-24 (1) reflect all geographic areas of the state,
7-25 considering time and distance;
8-1 (2) provide specific requirements for appropriate care
8-2 of perinatal patients; and
8-3 (3) facilitate coordination among all perinatal
8-4 service providers and health care facilities in the delivery area.
8-5 (c) The rules must include:
8-6 (1) risk reduction guidelines for preconceptional,
8-7 prenatal, intrapartum, postpartum, and infant care, including
8-8 guidelines for the transfer and transportation of perinatal
8-9 patients;
8-10 (2) criteria for determining geographic boundaries of
8-11 perinatal health care systems;
8-12 (3) minimum requirements of health promotion and
8-13 education, risk assessment, access to care, and coordination of
8-14 services that must be present in a perinatal health care system;
8-15 (4) minimum requirements for resources and equipment
8-16 needed by a health care facility to treat perinatal patients;
8-17 (5) standards for the availability and qualifications
8-18 of the health care personnel treating perinatal patients in a
8-19 facility;
8-20 (6) requirements for data collection, including
8-21 operation of the perinatal health care system and patient outcomes;
8-22 (7) requirements for periodic performance evaluation
8-23 of the system and its components; and
8-24 (8) assurances that health care facilities will not
8-25 refuse to accept the transfer of a perinatal patient solely because
9-1 of the person's inability to pay for services or because of the
9-2 person's age, sex, race, religion, or national origin.
9-3 Sec. 32.043. DUTIES OF DEPARTMENT. The department shall:
9-4 (1) develop and monitor a statewide network of
9-5 voluntary perinatal health care systems;
9-6 (2) develop and maintain a perinatal reporting and
9-7 analysis system to monitor and evaluate perinatal patient care in
9-8 the perinatal health care systems in this state; and
9-9 (3) provide for coordination and cooperation in this
9-10 state and among this state and adjoining states.
9-11 Sec. 32.044. SYSTEM REQUIREMENTS. (a) Each voluntary
9-12 perinatal health care system must have:
9-13 (1) a coordinating board responsible for ensuring,
9-14 providing, or coordinating planning access to services, data
9-15 collection, and provider education;
9-16 (2) access to appropriate emergency medical services;
9-17 (3) risk assessment, transport, and transfer protocols
9-18 for perinatal patients;
9-19 (4) one or more health care facilities categorized
9-20 according to perinatal care capabilities using standards adopted by
9-21 board rule; and
9-22 (5) documentation of broad-based participation in
9-23 planning by providers of perinatal services and community
9-24 representatives throughout the defined geographic region.
9-25 (b) This subchapter does not prohibit a health care facility
10-1 from providing services that it is authorized to provide under a
10-2 license issued to the facility by the department.
10-3 Sec. 32.045. GRANT PROGRAM. (a) The department may
10-4 establish a program to award grants to initiate, expand, maintain,
10-5 and improve voluntary perinatal health care systems.
10-6 (b) The board by rule shall establish eligibility criteria
10-7 for awarding the grants. The rules must require the department to
10-8 consider:
10-9 (1) the need of an area and the extent to which the
10-10 grant would meet the identified need;
10-11 (2) the availability of personnel and training
10-12 programs;
10-13 (3) the availability of other funding sources;
10-14 (4) the assurance of providing quality services;
10-15 (5) the need for emergency transportation of perinatal
10-16 patients and the extent to which the system meets the identified
10-17 needs; and
10-18 (6) the stage of development of a perinatal health
10-19 care system.
10-20 (c) The department may approve grants according to rules
10-21 adopted by the board. A grant awarded under this section is
10-22 governed by Chapter 783, Government Code, and rules adopted under
10-23 that chapter.
10-24 SECTION 8. The following sections of the Health and Safety
10-25 Code are repealed:
11-1 (1) Section 32.004;
11-2 (2) Section 32.007;
11-3 (3) Section 32.008;
11-4 (4) Section 32.009;
11-5 (5) Section 32.010;
11-6 (6) Section 32.019; and
11-7 (7) Section 32.020.
11-8 SECTION 9. This Act takes effect September 1, 1995.
11-9 SECTION 10. The importance of this legislation and the
11-10 crowded condition of the calendars in both houses create an
11-11 emergency and an imperative public necessity that the
11-12 constitutional rule requiring bills to be read on three several
11-13 days in each house be suspended, and this rule is hereby suspended.