HBA-MPM H.B. 2573 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 2573 By: Wolens Public Health 7/19/1999 Enrolled BACKGROUND AND PURPOSE The Indigent Health Care and Treatment Act, enacted in 1985, has not addressed all out-of-county issues impacting reimbursement of facilities for care provided to indigent patients. Tertiary medical facilities and level IV trauma facilities, which provide and coordinate care for trauma and seriously ill patients, as well as injury prevention, research, public education, and continuing education for rural providers, have experienced increased costs for care provided to out-of-county indigent residents. Currently, taxpayers of the county bear the added costs incurred by the centers to provide health care to these indigent residents. H.B. 2573 requires the Texas Board of Health (board) to adopt minimum standards and objectives to implement a system that encourages hospitals to provide tertiary medical services and stabilization services, and increases the availability of the services. This bill also provides for funding for these services. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health (board) in SECTION 1 (Sections 46.002 and 46.004, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subtitle B, Title 2, Health and Safety Code, by adding Chapter 46, as follows: CHAPTER 46. TERTIARY MEDICAL CARE Sec. 46.001. DEFINITIONS. Defines "tertiary care facility," "tertiary medical services," "stabilization services," "unreimbursed tertiary medical services," and "unreimbursed stabilization services." Sec. 46.002. RULES. Authorizes the Texas Board of Health (board) to adopt rules to implement a system which encourages hospitals to provide tertiary medical services and stabilization services. Provides that these rules must address certain coordination efforts, guidelines, requirements, and assurances with respect to these services. Sec. 46.003. TERTIARY CARE ACCOUNT. Provides that the tertiary care account (account) is in the state treasury, and authorizes money in the account to be appropriated only to the Texas Department of Health (department) for tertiary medical care. Provides that the account is composed of appropriated money and other funds required to be put in the account. Authorizes the department to seek and accept gifts, grants, and donations from any public or private entity on the account's behalf. Makes Section 403.095 (Use of Dedicated Revenue), Government Code, inapplicable to the account. Requires five percent of the total amount in the account, for each fiscal year, to be reserved. Authorizes this amount to be used only for reimbursement of unpaid tertiary medical services and stabilization services provided resulting from extraordinary emergencies occurring during that year. Prohibits no more than five percent to be used for coasts of administering the account. Requires the account to be allocated for payment to tertiary care facilities and level IV trauma centers for unreimbursed tertiary medical services and stabilization services as provided for in Sections 46.005 and 46.006, Health and Safety Code, except as limited by this section. Sec. 46.004. COLLECTION OF INFORMATION. Requires each tertiary care facility or level IV trauma facility seeking payment under this chapter to submit to the department, in the manner and time required, information relating to unreimbursed tertiary medical services or stabilization services provided to persons residing outside the service area of the county, public hospital, or hospital district responsible for indigent health care under Chapter 61 (Indigent Health Care and Treatment Act), Health and Safety Code, in the area where the relevant facility is located. Requires the board to adopt rules governing the collection of this information. Sec. 46.005. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED TERTIARY MEDICAL SERVICES. (a) Requires the department to certify to the comptroller of public accounts (comptroller) for each tertiary care facility (facility) the cost of unreimbursed tertiary medical services provided to persons residing outside the service area of the county, public hospital, or hospital district responsible for indigent health care under Chapter 61, Health and Safety Code, in the area where the facility is located. (b) Requires the department, on a yearly basis, to use at least 86 percent of appropriated money in the tertiary care account to compensate facilities for unreimbursed tertiary medical services. (c) Requires the department to make, for a facility operating as a tertiary care facility during the previous year, an initial certification to the comptroller under Subsection (a) in an amount equal to 80 percent of that certified under this section for the facility in the previous year. Requires the department to submit to make a subsequent certification of the cost of additional unreimbursed tertiary medical services provided by the facility on receipt of information required to be submitted under Section 46.004, Health and Safety Code. (d) Requires the comptroller to pay a facility the certified amount determined under Subsection (a) from the funds specified under Section 46.003, Health and Safety Code, except as provided by Subsection (e) of this Section. (e) Requires the department, if in any year the total cost of unreimbursed tertiary medical services certified under Subsection (a) for all tertiary care facilities exceeds the amount available for payment to the facilities under Section 46.003, Health and Safety Code, to allocate the amount available under Section 46.003 to each facility based on the percentages computed by dividing the cost of the facility's unreimbursed services by the total cost of all facilities' unreimbursed services. Requires the comptroller to pay each tertiary care facility based on the allocation made under this subsection. (f) Provides that the cost of each service provided by a facility is the average amount payable under Medicare reimbursement policies for that service for purposes of this section and Cection 46.007, Health and Safety Code. Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED STABILIZATION SERVICES. (a) Requires the department to certify to the comptroller for each tertiary care facility or level IV trauma facility the cost of unreimbursed stabilization services provided to persons residing outside the service area of the county, public hospital, or hospital district responsible for indigent health care under Chapter 61, Health and Safety Code, in the area where the relevant facility is located. (b) Prohibits the department from using more than four percent of the appropriated money in each fiscal year in the tertiary care account to compensate tertiary care and level IV trauma facilities for unreimbursed stabilization services. (c) Requires the department to make on an annual basis, for a facility that operated as a tertiary care or level IV trauma facility during the previous year, an initial certification to the comptroller under Subsection (a) in an amount equal to 80 percent of the amount certified under this section for the facility in the previous year. Requires the department to make a subsequent certification of the cost of additional unreimbursed stabilization services provided by the facility on receipt from the facility of the information required to be submitted under Section 46.004, Health and Safety Code. (d) Requires the comptroller to pay a tertiary care or level IV trauma facility the certified amount determined under Subsection (a) from the funds specified under Section 46.003 on a yearly basis except as provided by Subsection (e). (e) Requires the department, if in any year the total cost of certified unreimbursed stabilization services exceeds the amount available for payment to a tertiary care or level IV trauma facility under Section 46.003, Health and Safety Code, to allocate the amount available under Section 46.003, Health and Safety Code, to each facility based on the percentages computed by dividing the cost of the facility's unreimbursed stabilization services by the total cost of all facilities' unreimbursed stabilization services. Requires the comptroller to pay each relevant facility based on the allocation made under this subsection. (f) Provides that for purposes of this section and Section 46.007, Health and Safety Code, the cost of each service provided by a tertiary care or level IV trauma facility is the average amount payable under Medicare reimbursement policies for that service. Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) Requires the department, for purposes of reimbursement under this chapter, to certify an extraordinary emergency under certain conditions. (b) Requires the department to certify to the comptroller the amount of unreimbursed tertiary medical services or stabilization services or transportation services incurred by a tertiary care or level IV trauma facility during an emergency if one is certified under Subsection (a). (c) Requires the comptroller to pay the certified amount determined under Subsection (b) from funds specified under Section 46.003, Health and Safety Code, on a yearly basis to a tertiary care or level IV trauma facility, except as provided by Subsection (d). (d) Requires the department, if in any year the total cost of certified unreimbursed tertiary medical or stabilization services exceeds the amount available for payment to facilities under Section 46.003, Health and Safety Code, to allocate the amount available under Section 46.003, Health and Safety Code, to each facility based on the percentages computed by dividing the cost of the facility's unreimbursed services by the total cost of all facilities' unreimbursed services. Requires the comptroller to pay each relevant facility based on the allocation made under this subsection. SECTION 2. Effective date: September 1, 1999. SECTION 3. Makes this Act applicable only if a specific appropriation is made for its implementation as provided in H.B. 1 (General Appropriations Act), Acts of the 76th Legislature, Regular Session, 1999). SECTION 4. Emergency clause.