By Coleman, Farabee, et al. H.B. No. 1398
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to indigent health care.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. DELIVERY OF INDIGENT HEALTH CARE BY COUNTIES, PUBLIC
1-5 HOSPITALS, AND HOSPITAL DISTRICTS
1-6 SECTION 1.01. Section 61.002, Health and Safety Code, is
1-7 amended to read as follows:
1-8 Sec. 61.002. DEFINITIONS. In this chapter:
1-9 (1) ["AFDC" means the Aid to Families with Dependent
1-10 Children program administered by the Texas Department of Human
1-11 Services under Chapter 31, Human Resources Code.]
1-12 [(2)] "Department" means the Texas Department of
1-13 Health.
1-14 (2) [(3)] "Eligible county resident" means an eligible
1-15 resident of a county who does not reside in the service area of a
1-16 public hospital or hospital district.
1-17 (3) [(4)] "Eligible resident" means a person who meets
1-18 the income and resources requirements established by this chapter
1-19 or by the governmental entity, public hospital, or hospital
1-20 district in whose jurisdiction the person resides.
1-21 (4) [(5)] "Emergency services" has the meaning
1-22 assigned by Chapter 773.
1-23 (5) [(6)] "General revenue levy" means:
1-24 (A) the property taxes imposed by a county that
2-1 are not dedicated to the construction and maintenance of
2-2 farm-to-market roads or to flood control under Article VIII,
2-3 Section 1-a, of the Texas Constitution or that are not dedicated to
2-4 the further maintenance of the public roads under Article VIII,
2-5 Section 9, of the Texas Constitution; and
2-6 (B) the sales and use tax revenue to be received
2-7 by the county during the calendar year in which the state fiscal
2-8 year begins under Chapter 323, Tax Code, as determined under
2-9 Section 26.041(d), Tax Code.
2-10 (6) [(7)] "Governmental entity" includes a county,
2-11 municipality, or other political subdivision of the state, but does
2-12 not include a hospital district or hospital authority.
2-13 (7) [(8)] "Hospital district" means a hospital
2-14 district created under the authority of Article IX, Sections 4-11,
2-15 of the Texas Constitution.
2-16 (8) [(9)] "Mandated provider" means a person who
2-17 provides health care services, is selected by a county, public
2-18 hospital, or hospital district, and agrees to provide health care
2-19 services to eligible residents.
2-20 (9) [(10)] "Medicaid" means the medical assistance
2-21 program provided under Chapter 32, Human Resources Code.
2-22 (10) [(11)] "Public hospital" means a hospital owned,
2-23 operated, or leased by a governmental entity, except as provided by
2-24 Section 61.051.
2-25 (11) [(12)] "Service area" means the geographic region
2-26 in which a governmental entity, public hospital, or hospital
2-27 district has a legal obligation to provide health care services.
3-1 SECTION 1.02. Section 61.004, Health and Safety Code, is
3-2 amended to read as follows:
3-3 Sec. 61.004. RESIDENCE OR ELIGIBILITY DISPUTE. (a) If a
3-4 provider of assistance and a governmental entity or hospital
3-5 district cannot agree on a person's residence or whether a person
3-6 is eligible for assistance under this chapter, the provider or the
3-7 governmental entity or hospital district may submit the matter to
3-8 the department.
3-9 (b) The provider of assistance and the governmental entity
3-10 or hospital district shall submit all relevant information to the
3-11 department in accordance with the application, documentation, and
3-12 verification procedures established by the department under Section
3-13 61.006.
3-14 (c) If the department determines that another governmental
3-15 entity or hospital district may be involved in the dispute, the
3-16 department shall notify the governmental entity or hospital
3-17 district and allow the governmental entity or hospital district to
3-18 respond.
3-19 (d) From the information submitted, the department shall
3-20 determine the person's residence or whether the person is eligible
3-21 for assistance under this chapter, as appropriate, and shall notify
3-22 each governmental entity or hospital district and the provider of
3-23 assistance of the decision and the reasons for the decision.
3-24 (e) If a governmental entity, hospital district, or provider
3-25 of assistance does not agree with the department's decision, the
3-26 governmental entity, hospital district, or provider of assistance
3-27 may file an appeal with the department. The appeal must be filed
4-1 not later than the 30th day after the date on which the
4-2 governmental entity, hospital district, or provider of assistance
4-3 receives notice of the decision.
4-4 (f) The department shall issue a final decision not later
4-5 than the 45th [21st] day after the date on which the appeal is
4-6 filed.
4-7 (g) A governmental entity, hospital district, or provider of
4-8 assistance may appeal the final order of the department under
4-9 Chapter 2001, Government Code, using the substantial evidence rule
4-10 on appeal.
4-11 (h) Service may not be denied pending an administrative or
4-12 judicial review of residence.
4-13 SECTION 1.03. Subchapter A, Chapter 61, Health and Safety
4-14 Code, is amended by adding Section 61.0045 to read as follows:
4-15 Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE
4-16 ELIGIBILITY. (a) Any provider, including a mandated provider,
4-17 public hospital, or hospital district, that delivers health care
4-18 services to a patient who the provider suspects is an eligible
4-19 resident of the service area of a county, hospital district, or
4-20 public hospital under this chapter may require the patient to:
4-21 (1) provide any information necessary to establish
4-22 that the patient is an eligible resident of the service area of the
4-23 county, hospital district, or public hospital; and
4-24 (2) authorize the release of any information relating
4-25 to the patient, including medical information and information
4-26 obtained under Subdivision (1), to permit the provider to submit a
4-27 claim to the county, hospital district, or public hospital that is
5-1 liable for payment for the services as described by Section 61.033
5-2 or 61.060.
5-3 (b) A county, hospital district, or public hospital that
5-4 receives information obtained under Subsection (a) shall use the
5-5 information to determine whether the patient to whom services were
5-6 provided is an eligible resident of the service area of the county,
5-7 hospital district, or public hospital and, if so, shall pay the
5-8 claim made by the provider in accordance with this chapter.
5-9 (c) The application, documentation, and verification
5-10 procedures established by the department for counties under Section
5-11 61.006 may include a standard format for obtaining information
5-12 under Subsection (a) to facilitate eligibility and residence
5-13 determinations.
5-14 SECTION 1.04. Sections 61.006 and 61.007, Health and Safety
5-15 Code, are amended to read as follows:
5-16 Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department
5-17 shall establish minimum eligibility standards and application,
5-18 documentation, and verification procedures for counties to use in
5-19 determining eligibility under this chapter.
5-20 (b) The minimum eligibility standards must incorporate a net
5-21 income eligibility level equal to 25 percent of the federal poverty
5-22 level based on the federal Office of Management and Budget poverty
5-23 index [and procedures must be consistent with the standards and
5-24 procedures used by the Texas Department of Human Services to
5-25 determine eligibility in the AFDC-Medicaid program].
5-26 (b-1) Notwithstanding Subsection (b), effective January 1,
5-27 2000, the minimum eligibility standards must incorporate a net
6-1 income eligibility level equal to 17 percent of the federal poverty
6-2 level based on the federal Office of Management and Budget poverty
6-3 index. This subsection expires December 31, 2000.
6-4 (b-2) Notwithstanding Subsection (b), effective January 1,
6-5 2001, the minimum eligibility standards must incorporate a net
6-6 income eligibility level equal to 21 percent of the federal poverty
6-7 level based on the federal Office of Management and Budget poverty
6-8 index. This subsection expires December 31, 2001.
6-9 (c) The department shall also define the services and
6-10 establish the payment standards for the categories of services
6-11 listed in Sections [Section] 61.028(a) and 61.0285 in accordance
6-12 with Texas Department of Human Services rules relating to the
6-13 Temporary Assistance for Needy Families-Medicaid [AFDC-Medicaid]
6-14 program.
6-15 (d) The department shall establish application,
6-16 documentation, and verification procedures that are consistent with
6-17 the analogous procedures used to determine eligibility in the
6-18 Temporary Assistance for Needy Families-Medicaid program. The
6-19 [(b) The department may simplify the AFDC-Medicaid standards
6-20 and procedures used by the Texas Department of Human Services as
6-21 necessary to provide efficient county administration. In
6-22 establishing simplified standards and procedures for county
6-23 administration, the] department may not adopt a standard or
6-24 procedure that is more restrictive than the Temporary Assistance
6-25 for Needy Families-Medicaid program [AFDC-Medicaid standards] or
6-26 procedures.
6-27 (e) [(c)] The department shall ensure that each person who
7-1 meets the basic income and resources requirements for Temporary
7-2 Assistance for Needy Families program [AFDC] payments but who is
7-3 categorically ineligible for Temporary Assistance for Needy
7-4 Families [AFDC] will be eligible for assistance under Subchapter
7-5 B. Except as provided by Section 61.023(b), the [The] department by
7-6 rule shall also provide that a person who receives or is eligible
7-7 to receive Temporary Assistance for Needy Families, Supplemental
7-8 Security Income [AFDC, SSI], or Medicaid benefits is not eligible
7-9 for assistance under Subchapter B even if the person has exhausted
7-10 a part or all of that person's [AFDC, SSI, or Medicaid] benefits.
7-11 (f) [(d)] The department shall notify each county and public
7-12 hospital of any change to department rules [AFDC or Medicaid
7-13 guidelines] that affect the provision of services under this
7-14 chapter [and shall amend the rules adopted under this chapter to
7-15 reflect the changes made in the AFDC or Medicaid programs].
7-16 (g) [(e)] Notwithstanding Subsection (a), (b), or (c) or any
7-17 other provision of law, the department shall permit payment to a
7-18 licensed dentist for services provided under Sections 61.028(a)(4)
7-19 and (6) [61.028(a)(3) and (a)(5) to the extent that these services
7-20 are required by Section 61.028(a)(5)] if the dentist can provide
7-21 those services within the scope of the dentist's license.
7-22 (h) [(f)] Notwithstanding Subsection (a), (b), or (c), the
7-23 department shall permit payment to a licensed podiatrist for
7-24 services provided under Sections 61.028(a)(4) and (6) [61.028(a)(3)
7-25 and (a)(5) to the extent that the services are required by Section
7-26 61.028(a)(5)], if the podiatrist can provide the services within
7-27 the scope of the podiatrist's license.
8-1 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
8-2 department by rule shall require each applicant to provide at least
8-3 the following information:
8-4 (1) the applicant's full name and address;
8-5 (2) the applicant's social security number, if
8-6 available;
8-7 (3) the number of persons in the applicant's
8-8 household, excluding persons receiving Temporary Assistance for
8-9 Needy Families, Supplemental Security Income [AFDC, SSI], or
8-10 Medicaid benefits;
8-11 (4) the applicant's county of residence;
8-12 (5) the existence of insurance coverage or other
8-13 hospital or health care benefits for which the applicant is
8-14 eligible;
8-15 (6) any transfer of title to real property that the
8-16 applicant has made in the preceding 24 months;
8-17 (7) the applicant's annual household income, excluding
8-18 the income of any household member receiving Temporary Assistance
8-19 for Needy Families, Supplemental Security Income [AFDC, SSI], or
8-20 Medicaid benefits; and
8-21 (8) the amount of the applicant's liquid assets and
8-22 the equity value of the applicant's car and real property.
8-23 SECTION 1.05. Section 61.023(b), Health and Safety Code, is
8-24 amended to read as follows:
8-25 (b) A county may use a less restrictive standard of
8-26 eligibility for residents than prescribed by Subsection (a). A
8-27 county may credit toward eligibility for state assistance under
9-1 this subchapter the services provided to each person who is an
9-2 eligible resident under a standard that incorporates a net income
9-3 eligibility level that is less than 50 percent of the federal
9-4 poverty level based on the federal Office of Management and Budget
9-5 poverty index.
9-6 SECTION 1.06. Section 61.025(d), Health and Safety Code, is
9-7 amended to read as follows:
9-8 (d) Expenditures made by the county under Subsection (b) may
9-9 be credited toward eligibility for state assistance under this
9-10 subchapter if the person who received the health care services
9-11 meets the eligibility standards established under Section 61.052
9-12 [Sections 61.006 and 61.008] and would have been eligible for
9-13 assistance under the county program if the person had not resided
9-14 in a public hospital's service area.
9-15 SECTION 1.07. Section 61.028, Health and Safety Code, is
9-16 amended to read as follows:
9-17 Sec. 61.028. BASIC [MANDATORY] HEALTH CARE SERVICES. (a) A
9-18 county shall, in accordance with department rules adopted under
9-19 Section 61.006, provide the following basic health care services:
9-20 (1) primary and preventative services designed to meet
9-21 the needs of the community, including:
9-22 (A) immunizations;
9-23 (B) medical screening services; and
9-24 (C) annual physical examinations;
9-25 (2) inpatient and outpatient hospital services;
9-26 (3) [(2)] rural health clinics;
9-27 (4) [(3)] laboratory and X-ray services;
10-1 (5) [(4)] family planning services;
10-2 (6) [(5)] physician services;
10-3 (7) [(6)] payment for not more than three prescription
10-4 drugs a month; and
10-5 (8) [(7)] skilled nursing facility services,
10-6 regardless of the patient's age.
10-7 (b) The county may provide additional health care services,
10-8 but may not credit the assistance toward eligibility for state
10-9 assistance, except as provided by Section 61.0285.
10-10 SECTION 1.08. Subchapter B, Chapter 61, Health and Safety
10-11 Code, is amended by adding Section 61.0285 to read as follows:
10-12 Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In
10-13 addition to basic health care services provided under Section
10-14 61.028, a county may, in accordance with department rules adopted
10-15 under Section 61.006, provide other medically necessary services or
10-16 supplies that the county determines to be cost-effective,
10-17 including:
10-18 (1) ambulatory surgical center services;
10-19 (2) diabetic and colostomy medical supplies and
10-20 equipment;
10-21 (3) durable medical equipment;
10-22 (4) home and community health care services;
10-23 (5) services provided by licensed master medical
10-24 social workers--advanced clinical practitioners;
10-25 (6) psychological counseling services;
10-26 (7) services provided by physician assistants, nurse
10-27 practitioners, certified nurse midwives, clinical nurse
11-1 specialists, and certified registered nurse anesthetists;
11-2 (8) dental care;
11-3 (9) vision care, including eyeglasses; and
11-4 (10) any other appropriate health care service
11-5 identified by board rule that may be determined to be
11-6 cost-effective.
11-7 (b) A county must notify the department of the county's
11-8 intent to provide services specified by Subsection (a). If the
11-9 services are approved by the department under Section 61.006, or if
11-10 the department fails to notify the county of the department's
11-11 disapproval before the 31st day after the date the county notifies
11-12 the department of its intent to provide the services, the county
11-13 may credit the services toward eligibility for state assistance
11-14 under this subchapter.
11-15 (c) A county may provide health care services that are not
11-16 specified in Subsection (a), or may provide the services specified
11-17 in Subsection (a) without actual or constructive approval of the
11-18 department, but may not credit the services toward eligibility for
11-19 state assistance.
11-20 SECTION 1.09. Section 61.031(b), Health and Safety Code, is
11-21 amended to read as follows:
11-22 (b) If the county does not require prior approval and a
11-23 provider delivers or will deliver nonemergency health care services
11-24 to a patient who the provider suspects may be eligible for
11-25 assistance under this subchapter, the provider shall notify the
11-26 patient's county of residence that health care services have been
11-27 or will be provided to the patient. The notice shall be made:
12-1 (1) by telephone not later than the 72nd hour [as soon
12-2 as possible] after the provider determines the patient's county of
12-3 residence; and
12-4 (2) by mail postmarked not later than the fifth
12-5 [third] working day after the date on which the provider determines
12-6 the patient's county of residence.
12-7 SECTION 1.10. Section 61.032(a), Health and Safety Code, is
12-8 amended to read as follows:
12-9 (a) If a nonmandated provider delivers emergency services to
12-10 a patient who the provider suspects might be eligible for
12-11 assistance under this subchapter, the provider shall notify the
12-12 patient's county of residence that emergency services have been or
12-13 will be provided to the patient. The notice shall be made:
12-14 (1) by telephone not later than the 72nd hour [as soon
12-15 as possible] after the provider determines the patient's county of
12-16 residence; and
12-17 (2) by mail postmarked not later than the fifth
12-18 [third] working day after the date on which the provider determines
12-19 the patient's county of residence.
12-20 SECTION 1.11. Section 61.034, Health and Safety Code, is
12-21 amended to read as follows:
12-22 Sec. 61.034. PAYMENT STANDARDS FOR [MANDATORY] HEALTH CARE
12-23 SERVICES. (a) A county is not liable for the cost of a
12-24 [mandatory] health care service provided under Section 61.028 or
12-25 61.0285 that is in excess of the payment standards for that service
12-26 established by the department under Section 61.006.
12-27 (b) A county may contract with a provider of assistance to
13-1 provide a health care service at a rate below the payment standard
13-2 set by the department.
13-3 SECTION 1.12. Section 61.036(b), Health and Safety Code, is
13-4 amended to read as follows:
13-5 (b) Except as provided by Section 61.023(b), a [A] county
13-6 may not credit an expenditure for an applicant toward eligibility
13-7 for state assistance if the applicant does not meet the
13-8 department's eligibility standards.
13-9 SECTION 1.13. Sections 61.037, 61.038, and 61.039, Health
13-10 and Safety Code, are amended to read as follows:
13-11 Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a)
13-12 The department may distribute funds as provided by this subchapter
13-13 to eligible counties to assist the counties in providing
13-14 [mandatory] health care services under Sections 61.028 and 61.0285
13-15 to their eligible county residents.
13-16 (b) Except as provided by Subsection (c), (d), [or] (e), or
13-17 (g), to be eligible for state assistance, a county must:
13-18 (1) spend in a state fiscal year at least eight [10]
13-19 percent of the county general revenue levy for that year to provide
13-20 [mandatory] health care services described by Subsection (a) to its
13-21 eligible county residents who qualify for assistance under Section
13-22 61.023 [61.006]; and
13-23 (2) notify the department, not later than the seventh
13-24 day after the date on which the county reaches the expenditure
13-25 level, that the county has spent at least six [eight] percent of
13-26 the applicable county general revenue levy for that year to provide
13-27 [mandatory] health care services described by Subsection (a) to its
14-1 eligible county residents who qualify for assistance under Section
14-2 61.023 [61.006].
14-3 (c) If a county and a health care provider signed a contract
14-4 on or before January 1, 1985, under which the provider agrees to
14-5 furnish a certain level of health care services to indigent
14-6 persons, the value of services furnished in a state fiscal year
14-7 under the contract is included as part of the computation of a
14-8 county expenditure under this section if the value of services does
14-9 not exceed the payment rate established by the department under
14-10 Section 61.006.
14-11 (d) If a hospital district is located in part but not all of
14-12 a county, that county's appraisal district shall determine the
14-13 taxable value of the property located inside the county but outside
14-14 the hospital district. In determining eligibility for state
14-15 assistance, that county shall consider only the county general
14-16 revenue levy resulting from the property located outside the
14-17 hospital district. A county is eligible for state assistance if:
14-18 (1) the county spends in a state fiscal year at least
14-19 eight [10] percent of the county general revenue levy for that year
14-20 resulting from the property located outside the hospital district
14-21 to provide [mandatory] health care services described by Subsection
14-22 (a) to its eligible county residents who qualify for assistance
14-23 under Section 61.023 [61.006]; and
14-24 (2) the county complies with the other requirements of
14-25 this subchapter.
14-26 (e) A county that provides [mandatory] health care services
14-27 described by Subsection (a) to its eligible residents through a
15-1 hospital established by a board of managers jointly appointed by a
15-2 county and a municipality under Section 265.011 is eligible for
15-3 state assistance if:
15-4 (1) the county spends in a state fiscal year at least
15-5 eight [10] percent of the county general revenue levy for the year
15-6 to provide the [mandatory] health care services to its eligible
15-7 county residents who qualify for assistance under Section 61.052
15-8 [61.006]; and
15-9 (2) the county complies with the requirements of this
15-10 subchapter.
15-11 (f) If a county anticipates that it will reach the eight
15-12 [10] percent expenditure level, the county must notify the
15-13 department as soon as possible before the anticipated date on which
15-14 the county will reach the level.
15-15 (g) The department may waive the requirement that the county
15-16 meet the minimum expenditure level imposed by Subsection (b), (d),
15-17 or (e) and provide state assistance under this chapter at a lower
15-18 level determined by the department if the county demonstrates,
15-19 through an appropriate actuarial analysis, that the county is
15-20 unable to satisfy the eight percent expenditure level:
15-21 (1) because, although the county's general revenue tax
15-22 levy has increased significantly, expenditures for health care
15-23 services described by Subsection (a) have not increased by the same
15-24 percentage;
15-25 (2) because the county is at the maximum allowable ad
15-26 valorem tax rate, has a small population, or has insufficient
15-27 taxable property; or
16-1 (3) because of a similar reason.
16-2 (h) The department shall adopt rules governing the
16-3 circumstances under which a waiver may be granted under Subsection
16-4 (g) and the procedures to be used by a county to apply for the
16-5 waiver. The procedures must provide that the department shall make
16-6 a determination with respect to an application for a waiver not
16-7 later than the 90th day after the date the application is submitted
16-8 to the department in accordance with the procedures established by
16-9 the department. To be eligible for state assistance under
16-10 Subsection (g), a county must submit monthly financial reports, in
16-11 the form required by the department, covering the 12-month period
16-12 preceding the date on which the assistance is sought.
16-13 (i) The county must give the department all necessary
16-14 information so that the department can determine if the county
16-15 meets the requirements of Subsection (b), (d), [or] (e), or (g).
16-16 (j) Notwithstanding Subsections (b), (d), (e), and (f), the
16-17 minimum expenditure level imposed under those subsections is 10
16-18 percent of the county general revenue levy for the year and the
16-19 notice required to be made to the department under Subsection
16-20 (b)(2) is not required to be made before the county has spent at
16-21 least eight percent of the applicable county general revenue for
16-22 that year. The department may adopt rules as necessary to implement
16-23 the transition contemplated by this subsection. This subsection
16-24 expires August 31, 2001.
16-25 Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the
16-26 department determines that a county is eligible for assistance, the
16-27 department shall distribute funds appropriated to the department
17-1 from the indigent health care assistance fund or any other
17-2 available fund to the county to assist the county in providing
17-3 [mandatory] health care services under Sections 61.028 and 61.0285
17-4 to its eligible county residents who qualify for assistance as
17-5 described by Section 61.037 [under Section 61.006].
17-6 (b) State funds provided under this section to a county must
17-7 be equal to at least 90 [80] percent of the actual payment for the
17-8 [mandatory] health care services for the county's eligible
17-9 residents during the remainder of the state fiscal year after the
17-10 eight [10] percent expenditure level is reached.
17-11 Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the
17-12 department fails to provide assistance to an eligible county as
17-13 prescribed by Section 61.038, the county is not liable for payments
17-14 for health care services provided to its eligible county residents
17-15 after the county reaches the eight [10] percent expenditure level.
17-16 SECTION 1.14. Section 61.041, Health and Safety Code, is
17-17 amended by amending Subsections (a) and (b) and adding Subsection
17-18 (d) to read as follows:
17-19 (a) The department shall establish monthly reporting
17-20 requirements for a county seeking state assistance and establish
17-21 procedures necessary to determine if the county is eligible for
17-22 state assistance.
17-23 (b) The department shall establish requirements relating to:
17-24 (1) documentation required to verify the eligibility
17-25 of residents to whom the county provides assistance; and
17-26 (2) county expenditures for [mandatory] health care
17-27 services under Sections 61.028 and 61.0285.
18-1 (d) The department shall establish annual reporting
18-2 requirements for each county that is required to provide indigent
18-3 health care under this chapter but that is not required to report
18-4 under Subsection (a). A county satisfies the annual reporting
18-5 requirement of this subsection if the county submits information to
18-6 the department as required by law to obtain an annual distribution
18-7 under the Agreement Regarding Disposition of Settlement Proceeds
18-8 filed on July 24, 1998, in the United States District Court,
18-9 Eastern District of Texas, in the case styled The State of Texas v.
18-10 The American Tobacco Co., et al., No. 5-96CV-91.
18-11 SECTION 1.15. Section 61.052, Health and Safety Code, is
18-12 amended by adding Subsection (g) to read as follows:
18-13 (g) A county that provides health care services to its
18-14 eligible residents through a hospital established by a board of
18-15 managers jointly appointed by a county and a municipality under
18-16 Section 265.011 and that establishes an income and resources
18-17 standard in accordance with Subsection (a)(2) may credit the
18-18 services provided to all persons who are eligible under that
18-19 standard toward eligibility for state assistance as described by
18-20 Section 61.037(e).
18-21 SECTION 1.16. Section 61.054, Health and Safety Code, is
18-22 amended to read as follows:
18-23 Sec. 61.054. BASIC [MANDATORY] HEALTH CARE SERVICES PROVIDED
18-24 BY A PUBLIC HOSPITAL. (a) Except as provided by Subsection (c), a
18-25 [A] public hospital shall endeavor to provide the basic health care
18-26 [inpatient and outpatient hospital] services a county is required
18-27 to provide under Section 61.028 [61.028(a)(1)].
19-1 (b) If a public hospital provided additional health care
19-2 services to eligible residents during the operating year that ended
19-3 before January 1, 1985, the hospital shall continue to provide
19-4 those services.
19-5 (c) A public hospital shall coordinate the delivery of basic
19-6 health care services to eligible residents and may provide any
19-7 basic health care services the hospital was not providing on
19-8 January 1, 1999, but only to the extent the hospital is financially
19-9 able to do so.
19-10 (d) A public hospital may provide [additional] health care
19-11 services in addition to basic health care services.
19-12 SECTION 1.17. Section 61.055, Health and Safety Code, is
19-13 amended to read as follows:
19-14 Sec. 61.055. BASIC HEALTH CARE SERVICES PROVIDED BY HOSPITAL
19-15 DISTRICTS. (a) Except as provided by Subsection (b), a [A]
19-16 hospital district shall endeavor to provide the basic health care
19-17 services a county is required to provide under Section 61.028,
19-18 together with any other services required under the Texas
19-19 Constitution and the statute creating the district.
19-20 (b) A hospital district shall coordinate the delivery of
19-21 basic health care services to eligible residents and may provide
19-22 any basic health care services the district was not providing on
19-23 January 1, 1999, but only to the extent the district is financially
19-24 able to do so.
19-25 (c) This section may not be construed to discharge a
19-26 hospital district from its obligation to provide the health care
19-27 services required under the Texas Constitution and the statute
20-1 creating the district.
20-2 SECTION 1.18. Section 61.058(b), Health and Safety Code, is
20-3 amended to read as follows:
20-4 (b) If the public hospital does not require prior approval
20-5 and a provider delivers or will deliver nonemergency health care
20-6 services to a patient who the provider suspects might be eligible
20-7 for assistance under this subchapter, the provider shall notify the
20-8 hospital that health care services have been or will be provided to
20-9 the patient. The notice shall be made:
20-10 (1) by telephone not later than the 72nd hour [as soon
20-11 as possible] after the provider determines that the patient resides
20-12 in the hospital's service area; and
20-13 (2) by mail postmarked not later than the fifth
20-14 [third] working day after the date on which the provider determines
20-15 that the patient resides in the hospital's service area.
20-16 SECTION 1.19. Section 61.059(a), Health and Safety Code, is
20-17 amended to read as follows:
20-18 (a) If a nonmandated provider delivers emergency services to
20-19 a patient who the provider suspects might be eligible for
20-20 assistance under this subchapter, the provider shall notify the
20-21 hospital that emergency services have been or will be provided to
20-22 the patient. The notice shall be made:
20-23 (1) by telephone not later than the 72nd hour [as soon
20-24 as possible] after the provider determines that the patient resides
20-25 in the hospital's service area; and
20-26 (2) by mail postmarked not later than the fifth
20-27 [third] working day after the date on which the provider determines
21-1 that the patient resides in the hospital's service area.
21-2 SECTION 1.20. Section 61.062, Health and Safety Code, is
21-3 amended to read as follows:
21-4 Sec. 61.062. RESPONSIBILITY OF GOVERNMENTAL ENTITY. A
21-5 governmental entity that owns, operates, or leases a public
21-6 hospital shall provide sufficient funding to the hospital to
21-7 provide basic [mandatory] health care services [assistance].
21-8 SECTION 1.21. Section 61.064(a), Health and Safety Code, is
21-9 amended to read as follows:
21-10 (a) A governmental entity that owns, operates, or leases a
21-11 public hospital and that closes, sells, or leases the hospital:
21-12 (1) has the obligation to provide basic [mandatory]
21-13 health care services [assistance] under this chapter;
21-14 (2) shall adopt the eligibility standards that the
21-15 hospital was or would have been required to adopt; and
21-16 (3) shall provide the same services the hospital was
21-17 or would have been required to provide under this chapter on the
21-18 date of the closing, sale, or lease.
21-19 SECTION 1.22. Subchapter C, Chapter 281, Health and Safety
21-20 Code, is amended by adding Section 281.0514 to read as follows:
21-21 Sec. 281.0514. HARRIS COUNTY HOSPITAL DISTRICT; CONTRACT
21-22 WITH CERTAIN HOSPITALS. (a) The Harris County Hospital District
21-23 shall contract for indigent health care services with at least one
21-24 hospital that is:
21-25 (1) located in the district;
21-26 (2) exempt from federal income tax under Section
21-27 501(a), Internal Revenue Code of 1986, and its subsequent
22-1 amendments, by being listed as an exempt entity under any
22-2 subdivision of Section 501(c) of that code; and
22-3 (3) substantially devoted to providing hospital
22-4 services to socially and economically disadvantaged individuals in
22-5 the geographical area of the district.
22-6 (b) A contract under this section is subject to Section
22-7 281.051(a).
22-8 SECTION 1.23. Section 531.204(b), Government Code, is
22-9 amended to read as follows:
22-10 (b) The report must include:
22-11 (1) identification of significant problems in the
22-12 Texas Integrated Enrollment Services, with recommendations for
22-13 action by the commissioner;
22-14 (2) the status of the effectiveness of the Texas
22-15 Integrated Enrollment Services in providing necessary services to
22-16 the people of this state, with recommendations for any necessary
22-17 research;
22-18 (3) an analysis of the feasibility of including
22-19 indigent health care programs provided by counties, public
22-20 hospitals, and hospital districts in the Texas Integrated
22-21 Enrollment Services, a schedule for inclusion of these programs,
22-22 and a statement of how the Texas Integrated Enrollment Services may
22-23 be structured to address the wide variation in information systems
22-24 used by counties, public hospitals, and hospital districts; and
22-25 (4) [(3)] recommendations for legislative action.
22-26 SECTION 1.24. Chapter 26, Tax Code, is amended by adding
22-27 Section 26.0441 to read as follows:
23-1 Sec. 26.0441. TAX RATE ADJUSTMENT FOR INDIGENT HEALTH CARE.
23-2 (a) In the first tax year in which a taxing unit adopts a tax rate
23-3 after January 1, 2000, and in which the enhanced minimum
23-4 eligibility standards for indigent health care established under
23-5 Section 61.006, Health and Safety Code, apply to the taxing unit,
23-6 the effective maintenance and operations rate for the taxing unit
23-7 is increased by the rate computed according to the following
23-8 formula:
23-9 Enhanced Indigent Health Care Expenditures
23-10 Amount of Increase = __________________________________________
23-11 (Current Total Value - New Property Value)
23-12 (b) In each subsequent tax year, if the taxing unit's
23-13 enhanced indigent health care expenses exceed the amount of those
23-14 expenses for the preceding year, the effective maintenance and
23-15 operations rate for the taxing unit is increased by the rate
23-16 computed according to the following formula:
23-17 (Current Tax Year's Enhanced Indigent
23-18 Health Care Expenditures - Preceding Tax
23-19 Year's Indigent Health Care Expenditures)
23-20 Amount of Increase = __________________________________________
23-21 (Current Total Value - New Property Value)
23-22 (c) The taxing unit shall include a notice of the increase
23-23 in its effective maintenance and operations rate provided by this
23-24 section, including a brief description and the amount of the
23-25 enhanced indigent health care expenditures, in the information
23-26 published under Section 26.04(e) and, if applicable, Section
23-27 26.06(b).
24-1 (d) In this section, "enhanced indigent health care
24-2 expenditures" for a tax year means the amount spent by the taxing
24-3 unit for the maintenance and operation costs of providing indigent
24-4 health care at the increased minimum eligibility standards
24-5 established under Section 61.006, Health and Safety Code, effective
24-6 on or after January 1, 2000, in the period beginning on July 1 of
24-7 the year preceding the tax year for which the tax is adopted and
24-8 ending on June 30 of the tax year for which the tax is adopted,
24-9 less the amount of state assistance received by the taxing unit in
24-10 accordance with Chapter 61, Health and Safety Code, that is
24-11 attributable to those costs.
24-12 (e) In the 2000 and 2001 tax years, a taxing unit's enhanced
24-13 indigent health care expenditures for the 2000 tax year are
24-14 computed under Subsection (d) using the taxing unit's expenditures
24-15 for the maintenance and operation costs of providing indigent
24-16 health care at the increased minimum eligibility standards
24-17 described by Subsection (d) for the period beginning on January 1,
24-18 2000, and ending on June 30, 2000, instead of for the period
24-19 described by Subsection (d). This subsection expires January 1,
24-20 2002.
24-21 SECTION 1.25. (a) The change in law made by this article to
24-22 Chapter 61, Health and Safety Code, applies only to:
24-23 (1) health care services under Chapter 61, Health and
24-24 Safety Code, as amended by this article, that are delivered on or
24-25 after January 1, 2000; and
24-26 (2) state assistance under Chapter 61, Health and
24-27 Safety Code, as amended by this article, for the services described
25-1 by Subdivision (1) of this subsection.
25-2 (b) Health care services under Chapter 61, Health and Safety
25-3 Code, as amended by this article, that are delivered before January
25-4 1, 2000, and state assistance for those services are governed by
25-5 the law as it existed immediately before that date and that law is
25-6 continued in effect for this purpose.
25-7 SECTION 1.26. The Texas Department of Health shall study the
25-8 feasibility of requiring or permitting a county, public hospital,
25-9 and hospital district to issue a uniform identification card to an
25-10 eligible county resident or eligible service area resident, as
25-11 appropriate, that identifies the resident as eligible for health
25-12 care assistance under Chapter 61, Health and Safety Code. Not
25-13 later than December 15, 2000, the department shall report the
25-14 results of its study to the governor, lieutenant governor, and
25-15 speaker of the house of representatives.
25-16 ARTICLE 2. TERTIARY CARE
25-17 SECTION 2.01. Subtitle B, Title 2, Health and Safety Code,
25-18 is amended by adding Chapter 46 to read as follows:
25-19 CHAPTER 46. TERTIARY MEDICAL CARE
25-20 Sec. 46.001. DEFINITIONS. In this chapter:
25-21 (1) "Tertiary care facility" means a:
25-22 (A) primary teaching hospital of a medical
25-23 school;
25-24 (B) level 1 trauma center;
25-25 (C) level 2 trauma center; or
25-26 (D) level 3 trauma center.
25-27 (2) "Tertiary medical services" includes services
26-1 provided by burn centers and neonatology Level III units, pediatric
26-2 and trauma surgery, neurosurgery, cardiothoracic and vascular
26-3 surgery, organ transplant, services provided for a life-threatening
26-4 dermatologic illness, services provided to a person with a high
26-5 risk pregnancy or cancer, and radiation oncology.
26-6 (3) "Unreimbursed tertiary medical service" means a
26-7 tertiary medical service for which a tertiary care facility has not
26-8 received from any public or private source any payment that is
26-9 directly attributable to the particular service.
26-10 Sec. 46.002. RULES. The board may adopt rules to implement
26-11 this chapter.
26-12 Sec. 46.003. TERTIARY CARE FACILITY ACCOUNT. (a) The
26-13 tertiary care facility account is an account in the state treasury.
26-14 Money in the account may be appropriated only to the department for
26-15 the purposes of this chapter.
26-16 (b) The account is composed of money appropriated to the
26-17 account and any other funds required to be put in the account.
26-18 (c) The department may seek and accept gifts, grants, and
26-19 donations from any public or private entity on behalf of the
26-20 account.
26-21 (d) Section 403.095, Government Code, does not apply to the
26-22 account.
26-23 (e) For each fiscal year, five percent of the total amount
26-24 in the account shall be held in reserve and may be used only to pay
26-25 for unreimbursed tertiary medical services provided as a result of
26-26 extraordinary emergencies occurring during that year in accordance
26-27 with this chapter. Of the amount remaining, not more than five
27-1 percent may be used for the costs of administering the account.
27-2 (f) Except as provided by Subsection (e), the account shall
27-3 be allocated for payment to tertiary facilities for the facilities'
27-4 unreimbursed tertiary medical services.
27-5 (g) This chapter may not be construed to authorize the
27-6 department to use funds to provide reimbursement to tertiary care
27-7 facilities under this subchapter other than funds appropriated for
27-8 that purpose in the General Appropriations Act.
27-9 Sec. 46.004. COLLECTION OF INFORMATION. (a) A tertiary
27-10 care facility that seeks payment under this chapter shall submit to
27-11 the department, in the manner and at the time required by the
27-12 department, information that relates to the unreimbursed tertiary
27-13 medical services provided to persons who reside outside the service
27-14 area of the county, public hospital, or hospital district that is
27-15 responsible for indigent health care under Chapter 61 in the area
27-16 in which the tertiary care facility is located.
27-17 (b) The board shall adopt rules governing the collection of
27-18 the information under Subsection (a).
27-19 Sec. 46.005. CERTIFICATION TO COMPTROLLER. (a) The
27-20 department shall certify to the comptroller for each tertiary care
27-21 facility the cost of unreimbursed tertiary medical services
27-22 provided by the facility to persons who reside outside the service
27-23 area of the county, public hospital, or hospital district that is
27-24 responsible for indigent health care under Chapter 61 in the area
27-25 in which the tertiary care facility is located.
27-26 (b) Each year the department shall make, for a facility that
27-27 operated as a tertiary care facility during the previous year, an
28-1 initial certification to the comptroller under Subsection (a) in an
28-2 amount that equals 80 percent of the amount certified under this
28-3 section for the facility in the previous year. The department shall
28-4 make a subsequent certification of the cost of additional
28-5 unreimbursed tertiary medical services provided by the facility on
28-6 receipt from the facility of the information required to be
28-7 submitted under Section 46.004.
28-8 (c) Except as provided by Subsection (d), each year the
28-9 comptroller shall pay a tertiary care facility the certified amount
28-10 declared under Subsection (a) from the funds specified under
28-11 Section 46.003(f).
28-12 (d) If in any year the total cost of unreimbursed tertiary
28-13 medical services certified under Subsection (a) for all tertiary
28-14 care facilities exceeds the amount available for payment to the
28-15 facilities under Section 46.003(f), the department shall allocate
28-16 the amount available under Section 46.003(f) to each facility based
28-17 on the percentages computed by dividing the cost of the facility's
28-18 unreimbursed tertiary medical services by the total cost of all
28-19 facilities' unreimbursed tertiary medical services. The
28-20 comptroller shall pay each tertiary care facility based on the
28-21 allocation made under this subsection.
28-22 (e) For purposes of this section and Section 46.006, the
28-23 cost of each unreimbursed tertiary medical service provided is the
28-24 average amount payable under Medicare for services for the
28-25 Medicare diagnosis related groups applicable to the tertiary
28-26 medical services provided by a tertiary care facility.
28-27 Sec. 46.006. CERTIFICATION OF EMERGENCIES. (a) For
29-1 purposes of reimbursing extraordinary emergencies under this
29-2 chapter, the department shall certify an extraordinary emergency:
29-3 (1) if the governor issues an executive order or a
29-4 proclamation under Chapter 418, Government Code;
29-5 (2) if a disaster is declared by the president of the
29-6 United States under the Robert T. Stafford Disaster Relief and
29-7 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
29-8 (3) for another similar disaster the department finds
29-9 has resulted in an extraordinary cost to a tertiary care facility.
29-10 (b) If an extraordinary emergency is declared under
29-11 Subsection (a), the department shall certify to the comptroller the
29-12 amount of unreimbursed tertiary medical services incurred by a
29-13 tertiary care facility during the emergency.
29-14 (c) Except as provided by Subsection (d), the comptroller
29-15 shall pay the tertiary care facility the certified amount declared
29-16 under Subsection (b) from allocated funds specified under Section
29-17 46.003(e).
29-18 (d) If in any year the total cost of unreimbursed tertiary
29-19 medical services certified under Subsection (b) for all tertiary
29-20 care facilities exceeds the amount available for payment to the
29-21 facilities under Section 46.003(e), the department shall allocate
29-22 the amount available under Section 46.003(e) to each facility based
29-23 on the percentages computed by dividing the cost of the facility's
29-24 unreimbursed tertiary medical services incurred during emergencies
29-25 by the total cost of all facilities' unreimbursed tertiary medical
29-26 services incurred during emergencies. The comptroller shall pay
29-27 each tertiary care facility based on the allocation made under this
30-1 subsection.
30-2 ARTICLE 3. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM
30-3 SECTION 3.01. FEDERAL AUTHORIZATION. It is the intent of
30-4 the 76th Legislature that:
30-5 (1) the Health and Human Services Commission or an
30-6 appropriate health and human services agency continue to pursue the
30-7 waiver or other authorization described by Section 4, Chapter 444,
30-8 Acts of the 74th Legislature, Regular Session, 1995;
30-9 (2) the waiver or other authorization apply to
30-10 expansion of Medicaid eligibility, as described by Section 532.102,
30-11 Government Code, for both children and their families and other
30-12 adults; and
30-13 (3) the Health and Human Services Commission take any
30-14 other appropriate action authorized under law to accomplish the
30-15 expansion of Medicaid eligibility, as described by Section 532.102,
30-16 Government Code, for children and their families and for other
30-17 adults.
30-18 ARTICLE 4. STUDY RELATING TO BASIC HEALTH CARE SERVICES
30-19 AND STATE ASSISTANCE
30-20 SECTION 4.01. STUDY. The Texas Department of Health shall:
30-21 (1) study the provision of basic health care services
30-22 by counties, hospital districts, and public hospitals under Chapter
30-23 61, Health and Safety Code, and the cost of providing those
30-24 services;
30-25 (2) study the threshold for eligibility for state
30-26 assistance to a county established under Section 61.037, Health and
30-27 Safety Code, and develop a threshold to replace that threshold that
31-1 is stated as a formula and that reflects:
31-2 (A) a county's fiscal capacity;
31-3 (B) a county's health care resources; and
31-4 (C) the relevant characteristics of the county's
31-5 residents, including the percentage of the county's residents
31-6 living below the federal poverty level; and
31-7 (3) study the financing of basic health care services
31-8 by counties, hospital districts, and public hospitals under Chapter
31-9 61, Health and Safety Code, including the use of:
31-10 (A) local, state, and federal funds; and
31-11 (B) the funds distributed to political
31-12 subdivisions under the Agreement Regarding Disposition of
31-13 Settlement Proceeds filed on July 24, 1998, in the United States
31-14 District Court, Eastern District of Texas, in the case styled The
31-15 State of Texas vs. The American Tobacco Co., et al., No. 5-96CV-91.
31-16 SECTION 4.02. REPORT. Not later than December 1, 2000, the
31-17 Texas Department of Health shall submit a written report of the
31-18 study conducted under this article to the governor, lieutenant
31-19 governor, and speaker of the house of representatives. The report
31-20 must include the recommendations of the department, together with
31-21 the proposed eligibility threshold described by Section 4.01(2) of
31-22 this article.
31-23 SECTION 4.03. EXPIRATION. This article expires August 31,
31-24 2001.
31-25 ARTICLE 5. PILOT PROGRAM FOR REGIONAL HEALTH CARE
31-26 DELIVERY SYSTEM
31-27 SECTION 5.01. DEFINITIONS. In this article:
32-1 (1) "Commissioner" means the commissioner of health
32-2 and human services.
32-3 (2) "Pilot program" means the regional health care
32-4 delivery system pilot program established under this article.
32-5 SECTION 5.02. PILOT PROGRAM. (a) Not later than January 1,
32-6 2000, the commissioner shall establish a regional health care
32-7 delivery system pilot program to coordinate the use of health care
32-8 resources in a region of the state. The pilot program must:
32-9 (1) emphasize prevention services, continuity of care,
32-10 and the provision of a medical home for clients;
32-11 (2) maximize the use of local and state funds by
32-12 obtaining any available federal matching funds;
32-13 (3) be designed to result in long-term cost savings to
32-14 the participating entities;
32-15 (4) simplify eligibility criteria and streamline
32-16 eligibility determinations; and
32-17 (5) improve accountability of indigent health care
32-18 dollars.
32-19 (b) The commissioner may adopt rules as necessary to
32-20 implement the pilot program. The rules may provide an alternative
32-21 funding structure to the funding structure established under
32-22 Chapter 61, Health and Safety Code.
32-23 (c) The commissioner may not require a county, public
32-24 hospital, hospital district, or other entity to participate in the
32-25 pilot program.
32-26 SECTION 5.03. REPORT. (a) Not later than January 1, 2003,
32-27 the commissioner shall submit a written report relating to the
33-1 pilot program to the governor, lieutenant governor, and speaker of
33-2 the house of representatives.
33-3 (b) The report must include:
33-4 (1) an analysis of:
33-5 (A) the quality of health care services provided
33-6 under the pilot program; and
33-7 (B) the cost-effectiveness of providing health
33-8 care services through the pilot program; and
33-9 (2) recommendations for legislation for implementing
33-10 regional health care delivery systems in this state, including
33-11 recommendations relating to:
33-12 (A) the structure of a regional entity to
33-13 administer a regional health care delivery system;
33-14 (B) the manner in which state assistance money
33-15 may most effectively be distributed to support a regional health
33-16 care delivery system; and
33-17 (C) any other matter necessary to implement
33-18 effective and efficient regional health care delivery systems in
33-19 this state.
33-20 SECTION 5.04. EXPIRATION; TERMINATION OF PILOT PROGRAM.
33-21 This section expires and the pilot program is terminated August 31,
33-22 2003.
33-23 ARTICLE 6. EFFECTIVE DATE; EMERGENCY
33-24 SECTION 6.01. EFFECTIVE DATE. This Act takes effect
33-25 September 1, 1999.
33-26 SECTION 6.02. EMERGENCY. The importance of this legislation
33-27 and the crowded condition of the calendars in both houses create an
34-1 emergency and an imperative public necessity that the
34-2 constitutional rule requiring bills to be read on three several
34-3 days in each house be suspended, and this rule is hereby suspended.