By Berlanga                                           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 32.018, 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 auxiliary services appropriate for an
    2-1  individual from the time of 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 extends through the first year of the
   3-22  infant's life <a pregnant woman and the fetus during the period
   3-23  beginning on the 20th complete week of gestation and ending on the
   3-24  infant's 28th 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 auxiliary services appropriate for
    4-5  a woman prior to conception which are provided with the intent of
    4-6  planning and reducing health risks which might adversely effect her
    4-7  pregnancies.
    4-8              (12)  "Prenatal care" means maternal and infant health
    4-9  improvement services and ancillary services that are appropriate
   4-10  for a pregnant woman and the fetus during the period beginning on
   4-11  the date of conception and ending on the commencement of labor.
   4-12              (13) <(11)>  "Program" means the maternal and infant
   4-13  health improvement services program authorized by this chapter.
   4-14              (14) <(12)>  "Provider" means a person who, through a
   4-15  grant or a contract with the department or through other means
   4-16  approved by the department, provides maternal and infant health
   4-17  improvement services and ancillary services that are purchased by
   4-18  the department for the purposes of this chapter.
   4-19              (15) <(13)>  "Support" means the contribution of money
   4-20  or services necessary for a person's maintenance, including food,
   4-21  clothing, shelter, transportation, and health care.
   4-22        SECTION 3.  Section 32.003(f), Health and Safety Code, is
   4-23  amended to read as follows:
   4-24        (f)  If necessary, the board by rule may coordinate services
   4-25  and other parts of the program with the medical assistance program.
    5-1  However, the board may not adopt rules relating to the services
    5-2  under either program that would:
    5-3              (1)  cause the program established under this chapter
    5-4  not to conform with federal law to the extent that federal matching
    5-5  funds would not be available; or
    5-6              (2)  affect the status of the <Texas Department of
    5-7  Human Services as the> single state agency to administer the
    5-8  medical assistance program.
    5-9        SECTION 4.  Section 32.011, Health and Safety Code, is
   5-10  amended to read as follows:
   5-11        Sec. 32.011.  Denial, Modification, Suspension, or
   5-12  Termination of Services.  (a)  <The department may, for cause, deny
   5-13  an application for services after notice to the applicant and an
   5-14  opportunity for a hearing.>
   5-15        <(b)>  The department may, for cause, deny, modify, suspend,
   5-16  or terminate services to an individual eligible for or receiving
   5-17  services after notice to the individual and an opportunity for a
   5-18  hearing.
   5-19        (b) <(c)>  The board by rule shall provide criteria for
   5-20  action by the department under this section.
   5-21        (c) <(d)>  Chapter 2001, Government Code, does <Sections
   5-22  12-20, Administrative Procedure and Texas Register Act (Article
   5-23  6252-13a, Vernon's Texas Civil Statutes), do> not apply to the
   5-24  granting, denial, modification, suspension, or termination of
   5-25  services.  The department shall conduct hearings in accordance with
    6-1  the board's due process hearing rules.
    6-2        (d) <(e)>  The department shall render the final
    6-3  administrative decision in a due process hearing to deny, modify,
    6-4  suspend, or terminate receipt of services.
    6-5        (e) <(f)>  The notice and hearing required by this section do
    6-6  not apply if the department restricts program services to conform
    6-7  budgetary limitations that require the board to establish service
    6-8  priorities.
    6-9        SECTION 5.  Section 32.012(c), Health and Safety Code, is
   6-10  amended to read as follows:
   6-11        (c)  When <the application> a determination of eligibility to
   6-12  receive maternal and infant health improvement services is made
   6-13  under this chapter or when the services are received, the
   6-14  individual requesting <applying for> or receiving services shall
   6-15  inform the department of any other benefit to which the individual
   6-16  or a person with a legal obligation to support the individual may
   6-17  be entitled.
   6-18        SECTION 6.  Section 32.015(c), Health and Safety Code, is
   6-19  amended to read as follows:
   6-20        (c)  The department is not required to provide maternal and
   6-21  infant health improvement services unless funds are appropriated to
   6-22  the department <or to the Texas Department of Human Services> to
   6-23  administer this chapter.
   6-24        SECTION 7.  Chapter 32, Health and Safety Code, is amended by
   6-25  adding Subchapter B to read as follows:
    7-1              SUBCHAPTER B.  PERINATAL HEALTH CARE SYSTEM
    7-2        Sec. 32.041.  LEGISLATIVE FINDINGS.  (a)  The legislature
    7-3  finds that the perinatal period (beginning before conception and
    7-4  continuing through the first year of life) poses unique challenges
    7-5  for the health care system.  The development of a coordinated,
    7-6  cooperative system of perinatal health care within a geographic
    7-7  area will reduce unnecessary mortality and morbidity for women and
    7-8  infants.
    7-9        (b)  In order to improve the health of women and infants, it
   7-10  is necessary to promote health education, to provide assurance of
   7-11  reasonable access to safe and appropriate perinatal services and to
   7-12  improve the qualify of perinatal care by encouraging optimal
   7-13  utilization of health care personnel.
   7-14        Sec. 32.042.  DUTIES OF BOARD; RULES.  (a)  The board by rule
   7-15  shall adopt minimum standards and objectives to implement voluntary
   7-16  perinatal health care systems.  The board by rule shall adopt
   7-17  policies for health promotion and education, risk assessment,
   7-18  access to care, and perinatal system structure, including the
   7-19  transfer and transportation of pregnant women and infants.
   7-20        (b)  The rules must reflect all geographic areas of the
   7-21  state, considering time and distance, must provide specific
   7-22  requirements for appropriate care of perinatal patients, and must
   7-23  facilitate coordination among all perinatal service providers and
   7-24  health care facilities in the delivery area.
   7-25        (c)  The rules must include:
    8-1              (1)  risk reduction guidelines for preconceptional,
    8-2  prenatal, intrapartum, postpartum and infant care, including
    8-3  guidelines for transfer and transportation  of perinatal patients;
    8-4              (2)  criteria for determining geographic boundaries of
    8-5  perinatal health care systems;
    8-6              (3)  minimum requirements of health promotion and
    8-7  education, risk assessment, access to care and coordination of
    8-8  services which must be present in a perinatal health care system;
    8-9              (4)  minimum requirements for resources and equipment
   8-10  needed by a health care facility to treat perinatal patients;
   8-11              (5)  standards for the availability and qualifications
   8-12  of the health care personnel treating perinatal patients within
   8-13  facility;
   8-14              (6)  requirements for data collection, including
   8-15  operation of the perinatal health care system and patient outcomes;
   8-16              (7)  requirements for periodic performance evaluation
   8-17  of the system and its components; and
   8-18              (8)  assurances that health care facilities will not
   8-19  refuse to accept the transfer of a perinatal patient solely because
   8-20  of the person's inability to pay for services or because of the
   8-21  person's age, sex, race, religion, or national origin.
   8-22        Sec. 32.043.  DUTIES OF THE DEPARTMENT.  The department
   8-23  shall:
   8-24              (1)  develop and monitor a statewide network of
   8-25  voluntary perinatal health care systems;
    9-1              (2)  develop and maintain a perinatal reporting and
    9-2  analysis system to monitor and evaluate perinatal patient care in
    9-3  the perinatal health care systems in this state; and
    9-4              (3)  provide for coordination and cooperation within
    9-5  this state and among this state and adjoining states.
    9-6        Sec. 32.044.  SYSTEM REQUIREMENTS.  (a)  Each voluntary
    9-7  perinatal health care system must have:
    9-8              (1)  a coordinating board responsible for ensuring,
    9-9  providing or coordinating planning access to services, data
   9-10  collection and provider education;
   9-11              (2)  access to appropriate emergency medical services;
   9-12              (3)  risk assessment, transport, and transfer protocols
   9-13  for perinatal patients;
   9-14              (4)  one or more health care facilities categorized
   9-15  according to perinatal care capabilities using standards adopted by
   9-16  board rule; and
   9-17              (5)  documentation of broad based participation in
   9-18  planning by providers of perinatal services and community
   9-19  representatives throughout the defined geographic region.
   9-20        (b)  This subchapter does not prohibit a health care facility
   9-21  from providing services that it is authorized to provide under a
   9-22  license issued to the facility by the department.
   9-23        Sec. 32.045.  GRANT PROGRAM.  (a)  The department may
   9-24  establish a program to award grants to initiate, expand, maintain,
   9-25  and improve voluntary perinatal health care systems.
   10-1        (b)  The board by rule shall establish eligibility criteria
   10-2  for awarding the grants.  The rules must require the department to
   10-3  consider:
   10-4              (1)  the need of an area and the extent to which the
   10-5  grant would meet the identified need;
   10-6              (2)  the availability of personnel and training
   10-7  programs;
   10-8              (3)  the availability of other funding sources;
   10-9              (4)  the assurance of providing quality services;
  10-10              (5)  the need for emergency transportation of perinatal
  10-11  patients and the extent to which the system meets the identified
  10-12  needs; and
  10-13              (6)  the stage of development of a perinatal health
  10-14  care system.
  10-15        (c)  The department may approve grants according to the rules
  10-16  adopted by the board.  A grant awarded under this section is
  10-17  governed by the Uniform Grant and Contract Management Act of 1981
  10-18  (Chapter 783, Government Code) and by the rules adopted under that
  10-19  Act.
  10-20        SECTION 8.  (a)  Section 32.004, Health and Safety Code, is
  10-21  repealed.
  10-22        (b)  Section 32.007, Health and Safety Code, is repealed.
  10-23        (c)  Section 32.008, Health and Safety Code, is repealed.
  10-24        (d)  Section 32.009, Health and Safety Code, is repealed.
  10-25        (e)  Section 32.010, Health and Safety Code, is repealed.
   11-1        (f)  Section 32.019, Health and Safety Code, is repealed.
   11-2        (g)  Section 32.020, Health and Safety Code, is repealed.
   11-3        SECTION 9.  This Act takes effect September 1, 1995.
   11-4        SECTION 10.  The importance of this legislation and the
   11-5  crowded condition of the calendars in both houses create an
   11-6  emergency and an imperative public necessity that the
   11-7  constitutional rule requiring bills to be read on three several
   11-8  days in each house be suspended, and this rule is hereby suspended.