1-1 By: Zaffirini S.B. No. 1229
1-2 (In the Senate - Filed March 10, 1995; March 16, 1995, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 April 5, 1995, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 7, Nays 0; April 5, 1995,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1229 By: Zaffirini
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the Maternal and Infant Health Improvement Act and to
1-11 the development of a perinatal health care system.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Sections 32.001 through 32.021, Health and Safety
1-14 Code, are designated as Subchapter A and a new heading is added to
1-15 read as follows:
1-16 SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN
1-17 SECTION 2. Subsection (a), Section 32.002, Health and Safety
1-18 Code, is amended to read as follows:
1-19 (a) In this chapter:
1-20 (1) "Adolescent" means an individual younger than 18
1-21 years of age.
1-22 (2) "Ancillary services" means services necessary to
1-23 obtain timely, effective, and appropriate maternal and infant
1-24 health improvement services, and includes prescription drugs,
1-25 medical social services, transportation, health promotion services,
1-26 and laboratory services.
1-27 (3) "Facility" includes a hospital, <ambulatory
1-28 surgical center,> public health clinic, birthing center, outpatient
1-29 clinic, or community health center.
1-30 (4) "Infant care" means maternal and infant health
1-31 improvement services and ancillary services appropriate for an
1-32 individual from birth to 12 months of age <or younger>.
1-33 (5) "Intrapartum care" means maternal and infant
1-34 health improvement services and ancillary services appropriate for
1-35 a woman, fetus, or infant during childbirth.
1-36 (6) "Maternal and infant health improvement services"
1-37 means services necessary to assure quality health care for women
1-38 and children <prevent or reduce the occurrence of maternal, fetal,
1-39 and infant deaths, low birth-weight infants, handicapping
1-40 conditions, unplanned adolescent pregnancies, and births without
1-41 appropriate intrapartum care, and includes preventive, health,
1-42 medical, assessment, nursing, and facility care services>.
1-43 (7) "Medical assistance program" means the program
1-44 administered by the single state agency under Title XIX of the
1-45 Social Security Act (42 U.S.C. Section 1396 et seq.) <Texas
1-46 Department of Human Services under Chapter 32, Human Resources
1-47 Code>.
1-48 (8) "Other benefit" means a benefit, other than a
1-49 benefit provided under this chapter, to which an individual is
1-50 entitled for payment of the costs of maternal and infant health
1-51 improvement services, ancillary services, educational services, or
1-52 transportation services, including benefits available from:
1-53 (A) an insurance policy, group health plan, or
1-54 prepaid medical care plan;
1-55 (B) Title XVIII of the Social Security Act (42
1-56 U.S.C. Section 1395 et seq.);
1-57 (C) the Veterans Administration;
1-58 (D) the Civilian Health and Medical Program of
1-59 the Uniformed Services;
1-60 (E) workers' compensation or any other
1-61 compulsory employers' insurance program;
1-62 (F) a public program created by federal or state
1-63 law, other than Title XIX of the Social Security Act (42 U.S.C.
1-64 Section 1396 et seq.), or by an ordinance or rule of a municipality
1-65 or political subdivision of the state, excluding benefits created
1-66 by the establishment of a municipal or county hospital, a joint
1-67 municipal-county hospital, a county hospital authority, a hospital
1-68 district, or the facilities of a publicly supported medical school;
2-1 or
2-2 (G) a cause of action for medical, facility, or
2-3 medical transportation expenses, or a settlement or judgment based
2-4 on the cause of action, if the expenses are related to the need for
2-5 services provided under this chapter.
2-6 (9) "Perinatal care" means maternal and infant health
2-7 improvement services and ancillary services that are appropriate
2-8 for women and infants during the perinatal period, which begins
2-9 before conception and ends on the infant's first birthday <a
2-10 pregnant woman and the fetus during the period beginning on the
2-11 20th complete week of gestation and ending on the infant's 28th
2-12 completed day of life>.
2-13 (10) "Postpartum care" means maternal and infant
2-14 health improvement services and ancillary services appropriate for
2-15 a woman following a pregnancy.
2-16 (11) "Preconceptional care" means maternal and infant
2-17 health improvement services and ancillary services appropriate for
2-18 a woman before conception that are provided with the intent of
2-19 planning and reducing health risks that might adversely affect her
2-20 pregnancies.
2-21 (12) "Prenatal care" means maternal and infant health
2-22 improvement services and ancillary services that are appropriate
2-23 for a pregnant woman and the fetus during the period beginning on
2-24 the date of conception and ending on the commencement of labor.
2-25 (13) <(11)> "Program" means the maternal and infant
2-26 health improvement services program authorized by this chapter.
2-27 (14) <(12)> "Provider" means a person who, through a
2-28 grant or a contract with the department or through other means
2-29 approved by the department, provides maternal and infant health
2-30 improvement services and ancillary services that are purchased by
2-31 the department for the purposes of this chapter.
2-32 (15) <(13)> "Support" means the contribution of money
2-33 or services necessary for a person's maintenance, including food,
2-34 clothing, shelter, transportation, and health care.
2-35 SECTION 3. Subsection (f), Section 32.003, Health and Safety
2-36 Code, is amended to read as follows:
2-37 (f) If necessary, the board by rule may coordinate services
2-38 and other parts of the program with the medical assistance program.
2-39 However, the board may not adopt rules relating to the services
2-40 under either program that would:
2-41 (1) cause the program established under this chapter
2-42 not to conform with federal law to the extent that federal matching
2-43 funds would not be available; or
2-44 (2) affect the status of the <Texas Department of
2-45 Human Services as the> single state agency to administer the
2-46 medical assistance program.
2-47 SECTION 4. Section 32.011, Health and Safety Code, is
2-48 amended to read as follows:
2-49 Sec. 32.011. Denial, Modification, Suspension, or
2-50 Termination of Services. (a) <The department may, for cause, deny
2-51 an application for services after notice to the applicant and an
2-52 opportunity for a hearing.>
2-53 <(b)> The department may, for cause, deny, modify, suspend,
2-54 or terminate services to an individual eligible for or receiving
2-55 services after notice to the individual and an opportunity for a
2-56 hearing.
2-57 (b) <(c)> The board by rule shall provide criteria for
2-58 action by the department under this section.
2-59 (c) Chapter 2001, Government Code, does <(d) Sections
2-60 12-20, Administrative Procedure and Texas Register Act (Article
2-61 6252-13a, Vernon's Texas Civil Statutes), do> not apply to the
2-62 granting, denial, modification, suspension, or termination of
2-63 services. The department shall conduct hearings in accordance with
2-64 the board's due process hearing rules.
2-65 (d) <(e)> The department shall render the final
2-66 administrative decision in a due process hearing to deny, modify,
2-67 suspend, or terminate the receipt of services.
2-68 (e) <(f)> The notice and hearing required by this section do
2-69 not apply if the department restricts program services to conform
2-70 to budgetary limitations that require the board to establish
3-1 service priorities.
3-2 SECTION 5. Subsection (c), Section 32.012, Health and Safety
3-3 Code, is amended to read as follows:
3-4 (c) When a determination of eligibility to receive maternal
3-5 and infant health improvement services <the application> is made
3-6 under this chapter or when the services are received, the
3-7 individual requesting <applying for> or receiving services shall
3-8 inform the department of any other benefit to which the individual
3-9 or a person with a legal obligation to support the individual may
3-10 be entitled.
3-11 SECTION 6. Subsection (c), Section 32.015, Health and Safety
3-12 Code, is amended to read as follows:
3-13 (c) The department is not required to provide maternal and
3-14 infant health improvement services unless funds are appropriated to
3-15 the department <or to the Texas Department of Human Services> to
3-16 administer this chapter.
3-17 SECTION 7. Chapter 32, Health and Safety Code, is amended by
3-18 adding Subchapter B to read as follows:
3-19 SUBCHAPTER B. PERINATAL HEALTH CARE SYSTEM
3-20 Sec. 32.041. LEGISLATIVE FINDINGS. (a) The legislature
3-21 finds that the perinatal period beginning before conception and
3-22 continuing through the first year of life poses unique challenges
3-23 for the health care system. The development of a coordinated,
3-24 cooperative system of perinatal health care within a geographic
3-25 area will reduce unnecessary mortality and morbidity for women and
3-26 infants.
3-27 (b) In order to improve the health of women and infants, it
3-28 is necessary to promote health education, to provide assurance of
3-29 reasonable access to safe and appropriate perinatal services, and
3-30 to improve the quality of perinatal care by encouraging optimal use
3-31 of health care personnel.
3-32 Sec. 32.042. DUTIES OF BOARD; RULES. (a) The board by rule
3-33 shall adopt:
3-34 (1) minimum standards and objectives to implement
3-35 voluntary perinatal health care systems; and
3-36 (2) policies for health promotion and education, risk
3-37 assessment, access to care, and perinatal system structure,
3-38 including the transfer and transportation of pregnant women and
3-39 infants.
3-40 (b) The rules must:
3-41 (1) reflect all geographic areas of the state,
3-42 considering time and distance;
3-43 (2) provide specific requirements for appropriate care
3-44 of perinatal patients; and
3-45 (3) facilitate coordination among all perinatal
3-46 service providers and health care facilities in the delivery area.
3-47 (c) The rules must include:
3-48 (1) risk reduction guidelines for preconceptional,
3-49 prenatal, intrapartum, postpartum, and infant care, including
3-50 guidelines for the transfer and transportation of perinatal
3-51 patients;
3-52 (2) criteria for determining geographic boundaries of
3-53 perinatal health care systems;
3-54 (3) minimum requirements of health promotion and
3-55 education, risk assessment, access to care, and coordination of
3-56 services that must be present in a perinatal health care system;
3-57 (4) minimum requirements for resources and equipment
3-58 needed by a health care facility to treat perinatal patients;
3-59 (5) standards for the availability and qualifications
3-60 of the health care personnel treating perinatal patients in a
3-61 facility;
3-62 (6) requirements for data collection, including
3-63 operation of the perinatal health care system and patient outcomes;
3-64 (7) requirements for periodic performance evaluation
3-65 of the system and its components; and
3-66 (8) assurances that health care facilities will not
3-67 refuse to accept the transfer of a perinatal patient solely because
3-68 of the person's inability to pay for services or because of the
3-69 person's age, sex, race, religion, or national origin.
3-70 Sec. 32.043. DUTIES OF DEPARTMENT. The department shall:
4-1 (1) develop and monitor a statewide network of
4-2 voluntary perinatal health care systems;
4-3 (2) develop and maintain a perinatal reporting and
4-4 analysis system to monitor and evaluate perinatal patient care in
4-5 the perinatal health care systems in this state; and
4-6 (3) provide for coordination and cooperation in this
4-7 state and among this state and adjoining states.
4-8 Sec. 32.044. SYSTEM REQUIREMENTS. (a) Each voluntary
4-9 perinatal health care system must have:
4-10 (1) a coordinating board responsible for ensuring,
4-11 providing, or coordinating planning access to services, data
4-12 collection, and provider education;
4-13 (2) access to appropriate emergency medical services;
4-14 (3) risk assessment, transport, and transfer protocols
4-15 for perinatal patients;
4-16 (4) one or more health care facilities categorized
4-17 according to perinatal care capabilities using standards adopted by
4-18 board rule; and
4-19 (5) documentation of broad-based participation in
4-20 planning by providers of perinatal services and community
4-21 representatives throughout the defined geographic region.
4-22 (b) This subchapter does not prohibit a health care facility
4-23 from providing services that it is authorized to provide under a
4-24 license issued to the facility by the department.
4-25 Sec. 32.045. GRANT PROGRAM. (a) The department may
4-26 establish a program to award grants to initiate, expand, maintain,
4-27 and improve voluntary perinatal health care systems.
4-28 (b) The board by rule shall establish eligibility criteria
4-29 for awarding the grants. The rules must require the department to
4-30 consider:
4-31 (1) the need of an area and the extent to which the
4-32 grant would meet the identified need;
4-33 (2) the availability of personnel and training
4-34 programs;
4-35 (3) the availability of other funding sources;
4-36 (4) the assurance of providing quality services;
4-37 (5) the need for emergency transportation of perinatal
4-38 patients and the extent to which the system meets the identified
4-39 needs; and
4-40 (6) the stage of development of a perinatal health
4-41 care system.
4-42 (c) The department may approve grants according to rules
4-43 adopted by the board. A grant awarded under this section is
4-44 governed by Chapter 783, Government Code, and rules adopted under
4-45 that chapter.
4-46 SECTION 8. The following sections of the Health and Safety
4-47 Code are repealed:
4-48 (1) Section 32.004;
4-49 (2) Section 32.007;
4-50 (3) Section 32.008;
4-51 (4) Section 32.009;
4-52 (5) Section 32.010;
4-53 (6) Section 32.019; and
4-54 (7) Section 32.020.
4-55 SECTION 9. This Act takes effect September 1, 1995.
4-56 SECTION 10. The importance of this legislation and the
4-57 crowded condition of the calendars in both houses create an
4-58 emergency and an imperative public necessity that the
4-59 constitutional rule requiring bills to be read on three several
4-60 days in each house be suspended, and this rule is hereby suspended.
4-61 * * * * *