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.