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, including the primary teaching
2-20 hospital of a state medical school located in a county which does
2-21 not have a public hospital or hospital district, and the faculty
2-22 members practicing in both the inpatient and outpatient care
2-23 facilities affiliated with the teaching hospital.
2-24 (9) [(10)] "Medicaid" means the medical assistance
2-25 program provided under Chapter 32, Human Resources Code.
2-26 (10) [(11)] "Public hospital" means a hospital owned,
2-27 operated, or leased by a governmental entity, except as provided by
3-1 Section 61.051.
3-2 (11) [(12)] "Service area" means the geographic region
3-3 in which a governmental entity, public hospital, or hospital
3-4 district has a legal obligation to provide health care services.
3-5 SECTION 1.02. Section 61.004, Health and Safety Code, is
3-6 amended to read as follows:
3-7 Sec. 61.004. RESIDENCE OR ELIGIBILITY DISPUTE. (a) If a
3-8 provider of assistance and a governmental entity or hospital
3-9 district cannot agree on a person's residence or whether a person
3-10 is eligible for assistance under this chapter, the provider or the
3-11 governmental entity or hospital district may submit the matter to
3-12 the department.
3-13 (b) The provider of assistance and the governmental entity
3-14 or hospital district shall submit all relevant information to the
3-15 department in accordance with the application, documentation, and
3-16 verification procedures established by the department under Section
3-17 61.006.
3-18 (c) If the department determines that another governmental
3-19 entity or hospital district may be involved in the dispute, the
3-20 department shall notify the governmental entity or hospital
3-21 district and allow the governmental entity or hospital district to
3-22 respond.
3-23 (d) From the information submitted, the department shall
3-24 determine the person's residence or whether the person is eligible
3-25 for assistance under this chapter, as appropriate, and shall notify
3-26 each governmental entity or hospital district and the provider of
3-27 assistance of the decision and the reasons for the decision.
4-1 (e) If a governmental entity, hospital district, or provider
4-2 of assistance does not agree with the department's decision, the
4-3 governmental entity, hospital district, or provider of assistance
4-4 may file an appeal with the department. The appeal must be filed
4-5 not later than the 30th day after the date on which the
4-6 governmental entity, hospital district, or provider of assistance
4-7 receives notice of the decision.
4-8 (f) The department shall issue a final decision not later
4-9 than the 45th [21st] day after the date on which the appeal is
4-10 filed.
4-11 (g) A governmental entity, hospital district, or provider of
4-12 assistance may appeal the final order of the department under
4-13 Chapter 2001, Government Code, using the substantial evidence rule
4-14 on appeal.
4-15 (h) Service may not be denied pending an administrative or
4-16 judicial review of residence.
4-17 SECTION 1.03. Subchapter A, Chapter 61, Health and Safety
4-18 Code, is amended by adding Section 61.0045 to read as follows:
4-19 Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE
4-20 ELIGIBILITY. (a) Any provider, including a mandated provider,
4-21 public hospital, or hospital district, that delivers health care
4-22 services to a patient who the provider suspects is an eligible
4-23 resident of the service area of a county, hospital district, or
4-24 public hospital under this chapter may require the patient to:
4-25 (1) provide any information necessary to establish
4-26 that the patient is an eligible resident of the service area of the
4-27 county, hospital district, or public hospital; and
5-1 (2) authorize the release of any information relating
5-2 to the patient, including medical information and information
5-3 obtained under Subdivision (1), to permit the provider to submit a
5-4 claim to the county, hospital district, or public hospital that is
5-5 liable for payment for the services as described by Section 61.033
5-6 or 61.060.
5-7 (b) A county, hospital district, or public hospital that
5-8 receives information obtained under Subsection (a) shall use the
5-9 information to determine whether the patient to whom services were
5-10 provided is an eligible resident of the service area of the county,
5-11 hospital district, or public hospital and, if so, shall pay the
5-12 claim made by the provider in accordance with this chapter.
5-13 (c) The application, documentation, and verification
5-14 procedures established by the department for counties under Section
5-15 61.006 may include a standard format for obtaining information
5-16 under Subsection (a) to facilitate eligibility and residence
5-17 determinations.
5-18 SECTION 1.04. Sections 61.006 and 61.007, Health and Safety
5-19 Code, are amended to read as follows:
5-20 Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department
5-21 shall establish minimum eligibility standards and application,
5-22 documentation, and verification procedures for counties to use in
5-23 determining eligibility under this chapter.
5-24 (b) The minimum eligibility standards must incorporate a net
5-25 income eligibility level equal to 25 percent of the federal poverty
5-26 level based on the federal Office of Management and Budget poverty
5-27 index [and procedures must be consistent with the standards and
6-1 procedures used by the Texas Department of Human Services to
6-2 determine eligibility in the AFDC-Medicaid program].
6-3 (b-1) Notwithstanding Subsection (b), effective January 1,
6-4 2000, the minimum eligibility standards must incorporate a net
6-5 income eligibility level equal to 17 percent of the federal poverty
6-6 level based on the federal Office of Management and Budget poverty
6-7 index. This subsection expires December 31, 2000.
6-8 (b-2) Notwithstanding Subsection (b), effective January 1,
6-9 2001, the minimum eligibility standards must incorporate a net
6-10 income eligibility level equal to 21 percent of the federal poverty
6-11 level based on the federal Office of Management and Budget poverty
6-12 index. This subsection expires December 31, 2001.
6-13 (c) The department shall also define the services and
6-14 establish the payment standards for the categories of services
6-15 listed in Sections [Section] 61.028(a) and 61.0285 in accordance
6-16 with Texas Department of Human Services rules relating to the
6-17 Temporary Assistance for Needy Families-Medicaid [AFDC-Medicaid]
6-18 program.
6-19 (d) The department shall establish application,
6-20 documentation, and verification procedures that are consistent with
6-21 the analogous procedures used to determine eligibility in the
6-22 Temporary Assistance for Needy Families-Medicaid program. The
6-23 [(b) The department may simplify the AFDC-Medicaid standards
6-24 and procedures used by the Texas Department of Human Services as
6-25 necessary to provide efficient county administration. In
6-26 establishing simplified standards and procedures for county
6-27 administration, the] department may not adopt a standard or
7-1 procedure that is more restrictive than the Temporary Assistance
7-2 for Needy Families-Medicaid program [AFDC-Medicaid standards] or
7-3 procedures.
7-4 (e) [(c)] The department shall ensure that each person who
7-5 meets the basic income and resources requirements for Temporary
7-6 Assistance for Needy Families program [AFDC] payments but who is
7-7 categorically ineligible for Temporary Assistance for Needy
7-8 Families [AFDC] will be eligible for assistance under Subchapter
7-9 B. Except as provided by Section 61.023(b), the [The] department by
7-10 rule shall also provide that a person who receives or is eligible
7-11 to receive Temporary Assistance for Needy Families, Supplemental
7-12 Security Income [AFDC, SSI], or Medicaid benefits is not eligible
7-13 for assistance under Subchapter B even if the person has exhausted
7-14 a part or all of that person's [AFDC, SSI, or Medicaid] benefits.
7-15 (f) [(d)] The department shall notify each county and public
7-16 hospital of any change to department rules [AFDC or Medicaid
7-17 guidelines] that affect the provision of services under this
7-18 chapter [and shall amend the rules adopted under this chapter to
7-19 reflect the changes made in the AFDC or Medicaid programs].
7-20 (g) [(e)] Notwithstanding Subsection (a), (b), or (c) or any
7-21 other provision of law, the department shall permit payment to a
7-22 licensed dentist for services provided under Sections 61.028(a)(4)
7-23 and (6) [61.028(a)(3) and (a)(5) to the extent that these services
7-24 are required by Section 61.028(a)(5)] if the dentist can provide
7-25 those services within the scope of the dentist's license.
7-26 (h) [(f)] Notwithstanding Subsection (a), (b), or (c), the
7-27 department shall permit payment to a licensed podiatrist for
8-1 services provided under Sections 61.028(a)(4) and (6) [61.028(a)(3)
8-2 and (a)(5) to the extent that the services are required by Section
8-3 61.028(a)(5)], if the podiatrist can provide the services within
8-4 the scope of the podiatrist's license.
8-5 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
8-6 department by rule shall require each applicant to provide at least
8-7 the following information:
8-8 (1) the applicant's full name and address;
8-9 (2) the applicant's social security number, if
8-10 available;
8-11 (3) the number of persons in the applicant's
8-12 household, excluding persons receiving Temporary Assistance for
8-13 Needy Families, Supplemental Security Income [AFDC, SSI], or
8-14 Medicaid benefits;
8-15 (4) the applicant's county of residence;
8-16 (5) the existence of insurance coverage or other
8-17 hospital or health care benefits for which the applicant is
8-18 eligible;
8-19 (6) any transfer of title to real property that the
8-20 applicant has made in the preceding 24 months;
8-21 (7) the applicant's annual household income, excluding
8-22 the income of any household member receiving Temporary Assistance
8-23 for Needy Families, Supplemental Security Income [AFDC, SSI], or
8-24 Medicaid benefits; and
8-25 (8) the amount of the applicant's liquid assets and
8-26 the equity value of the applicant's car and real property.
8-27 SECTION 1.05. Chapter 61, Health and Safety Code, is amended
9-1 by adding Section 61.011 to read as follows:
9-2 Sec. 61.011. SERVICES BY STATE HOSPITAL OR CLINIC. A state
9-3 hospital or clinic shall be entitled to payment for services
9-4 rendered to an eligible resident under the provisions of this
9-5 chapter applicable to other providers. The department may adopt
9-6 rules as necessary to implement this section.
9-7 SECTION 1.06. Section 61.023(b), Health and Safety Code, is
9-8 amended to read as follows:
9-9 (b) A county may use a less restrictive standard of
9-10 eligibility for residents than prescribed by Subsection (a). A
9-11 county may credit toward eligibility for state assistance under
9-12 this subchapter the services provided to each person who is an
9-13 eligible resident under a standard that incorporates a net income
9-14 eligibility level that is less than 50 percent of the federal
9-15 poverty level based on the federal Office of Management and Budget
9-16 poverty index.
9-17 SECTION 1.07. Section 61.025(d), Health and Safety Code, is
9-18 amended to read as follows:
9-19 (d) Expenditures made by the county under Subsection (b) may
9-20 be credited toward eligibility for state assistance under this
9-21 subchapter if the person who received the health care services
9-22 meets the eligibility standards established under Section 61.052
9-23 [Sections 61.006 and 61.008] and would have been eligible for
9-24 assistance under the county program if the person had not resided
9-25 in a public hospital's service area.
9-26 SECTION 1.08. Section 61.028, Health and Safety Code, is
9-27 amended to read as follows:
10-1 Sec. 61.028. BASIC [MANDATORY] HEALTH CARE SERVICES. (a) A
10-2 county shall, in accordance with department rules adopted under
10-3 Section 61.006, provide the following basic health care services:
10-4 (1) primary and preventative services designed to meet
10-5 the needs of the community, including:
10-6 (A) immunizations;
10-7 (B) medical screening services; and
10-8 (C) annual physical examinations;
10-9 (2) inpatient and outpatient hospital services;
10-10 (3) [(2)] rural health clinics;
10-11 (4) [(3)] laboratory and X-ray services;
10-12 (5) [(4)] family planning services;
10-13 (6) [(5)] physician services;
10-14 (7) [(6)] payment for not more than three prescription
10-15 drugs a month; and
10-16 (8) [(7)] skilled nursing facility services,
10-17 regardless of the patient's age.
10-18 (b) The county may provide additional health care services,
10-19 but may not credit the assistance toward eligibility for state
10-20 assistance, except as provided by Section 61.0285.
10-21 SECTION 1.09. Subchapter B, Chapter 61, Health and Safety
10-22 Code, is amended by adding Section 61.0285 to read as follows:
10-23 Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In
10-24 addition to basic health care services provided under Section
10-25 61.028, a county may, in accordance with department rules adopted
10-26 under Section 61.006, provide other medically necessary services or
10-27 supplies that the county determines to be cost-effective,
11-1 including:
11-2 (1) ambulatory surgical center services;
11-3 (2) diabetic and colostomy medical supplies and
11-4 equipment;
11-5 (3) durable medical equipment;
11-6 (4) home and community health care services;
11-7 (5) services provided by licensed master medical
11-8 social workers--advanced clinical practitioners;
11-9 (6) psychological counseling services;
11-10 (7) services provided by physician assistants, nurse
11-11 practitioners, certified nurse midwives, clinical nurse
11-12 specialists, and certified registered nurse anesthetists;
11-13 (8) dental care;
11-14 (9) vision care, including eyeglasses;
11-15 (10) services provided by federally qualified health
11-16 centers, as defined by 42 U.S.C. Section 1396d(l)(2)(B); and
11-17 (11) any other appropriate health care service
11-18 identified by board rule that may be determined to be
11-19 cost-effective.
11-20 (b) A county must notify the department of the county's
11-21 intent to provide services specified by Subsection (a). If the
11-22 services are approved by the department under Section 61.006, or if
11-23 the department fails to notify the county of the department's
11-24 disapproval before the 31st day after the date the county notifies
11-25 the department of its intent to provide the services, the county
11-26 may credit the services toward eligibility for state assistance
11-27 under this subchapter.
12-1 (c) A county may provide health care services that are not
12-2 specified in Subsection (a), or may provide the services specified
12-3 in Subsection (a) without actual or constructive approval of the
12-4 department, but may not credit the services toward eligibility for
12-5 state assistance.
12-6 SECTION 1.10. Section 61.031(b), Health and Safety Code, is
12-7 amended to read as follows:
12-8 (b) If the county does not require prior approval and a
12-9 provider delivers or will deliver nonemergency health care services
12-10 to a patient who the provider suspects may be eligible for
12-11 assistance under this subchapter, the provider shall notify the
12-12 patient's county of residence that health care services have been
12-13 or 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 61.032(a), Health and Safety Code, is
12-21 amended to read as follows:
12-22 (a) If a nonmandated provider delivers emergency services to
12-23 a patient who the provider suspects might be eligible for
12-24 assistance under this subchapter, the provider shall notify the
12-25 patient's county of residence that emergency services have been or
12-26 will be provided to the patient. The notice shall be made:
12-27 (1) by telephone not later than the 72nd hour [as soon
13-1 as possible] after the provider determines the patient's county of
13-2 residence; and
13-3 (2) by mail postmarked not later than the fifth
13-4 [third] working day after the date on which the provider determines
13-5 the patient's county of residence.
13-6 SECTION 1.12. Section 61.034, Health and Safety Code, is
13-7 amended to read as follows:
13-8 Sec. 61.034. PAYMENT STANDARDS FOR [MANDATORY] HEALTH CARE
13-9 SERVICES. (a) A county is not liable for the cost of a
13-10 [mandatory] health care service provided under Section 61.028 or
13-11 61.0285 that is in excess of the payment standards for that service
13-12 established by the department under Section 61.006.
13-13 (b) A county may contract with a provider of assistance to
13-14 provide a health care service at a rate below the payment standard
13-15 set by the department.
13-16 SECTION 1.13. Section 61.036(b), Health and Safety Code, is
13-17 amended to read as follows:
13-18 (b) Except as provided by Section 61.023(b), a [A] county
13-19 may not credit an expenditure for an applicant toward eligibility
13-20 for state assistance if the applicant does not meet the
13-21 department's eligibility standards.
13-22 SECTION 1.14. Sections 61.037, 61.038, and 61.039, Health
13-23 and Safety Code, are amended to read as follows:
13-24 Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a)
13-25 The department may distribute funds as provided by this subchapter
13-26 to eligible counties to assist the counties in providing
13-27 [mandatory] health care services under Sections 61.028 and 61.0285
14-1 to their eligible county residents.
14-2 (b) Except as provided by Subsection (c), (d), [or] (e), or
14-3 (g), to be eligible for state assistance, a county must:
14-4 (1) spend in a state fiscal year at least eight [10]
14-5 percent of the county general revenue levy for that year to provide
14-6 [mandatory] health care services described by Subsection (a) to its
14-7 eligible county residents who qualify for assistance under Section
14-8 61.023 [61.006]; and
14-9 (2) notify the department, not later than the seventh
14-10 day after the date on which the county reaches the expenditure
14-11 level, that the county has spent at least six [eight] percent of
14-12 the applicable county general revenue levy for that year to provide
14-13 [mandatory] health care services described by Subsection (a) to its
14-14 eligible county residents who qualify for assistance under Section
14-15 61.023 [61.006].
14-16 (c) If a county and a health care provider signed a contract
14-17 on or before January 1, 1985, under which the provider agrees to
14-18 furnish a certain level of health care services to indigent
14-19 persons, the value of services furnished in a state fiscal year
14-20 under the contract is included as part of the computation of a
14-21 county expenditure under this section if the value of services does
14-22 not exceed the payment rate established by the department under
14-23 Section 61.006.
14-24 (d) If a hospital district is located in part but not all of
14-25 a county, that county's appraisal district shall determine the
14-26 taxable value of the property located inside the county but outside
14-27 the hospital district. In determining eligibility for state
15-1 assistance, that county shall consider only the county general
15-2 revenue levy resulting from the property located outside the
15-3 hospital district. A county is eligible for 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 that year
15-6 resulting from the property located outside the hospital district
15-7 to provide [mandatory] health care services described by Subsection
15-8 (a) to its eligible county residents who qualify for assistance
15-9 under Section 61.023 [61.006]; and
15-10 (2) the county complies with the other requirements of
15-11 this subchapter.
15-12 (e) A county that provides [mandatory] health care services
15-13 described by Subsection (a) to its eligible residents through a
15-14 hospital established by a board of managers jointly appointed by a
15-15 county and a municipality under Section 265.011 is eligible for
15-16 state assistance if:
15-17 (1) the county spends in a state fiscal year at least
15-18 eight [10] percent of the county general revenue levy for the year
15-19 to provide the [mandatory] health care services to its eligible
15-20 county residents who qualify for assistance under Section 61.052
15-21 [61.006]; and
15-22 (2) the county complies with the requirements of this
15-23 subchapter.
15-24 (f) If a county anticipates that it will reach the eight
15-25 [10] percent expenditure level, the county must notify the
15-26 department as soon as possible before the anticipated date on which
15-27 the county will reach the level.
16-1 (g) The department may waive the requirement that the county
16-2 meet the minimum expenditure level imposed by Subsection (b), (d),
16-3 or (e) and provide state assistance under this chapter at a lower
16-4 level determined by the department if the county demonstrates,
16-5 through an appropriate actuarial analysis, that the county is
16-6 unable to satisfy the eight percent expenditure level:
16-7 (1) because, although the county's general revenue tax
16-8 levy has increased significantly, expenditures for health care
16-9 services described by Subsection (a) have not increased by the same
16-10 percentage;
16-11 (2) because the county is at the maximum allowable ad
16-12 valorem tax rate, has a small population, or has insufficient
16-13 taxable property; or
16-14 (3) because of a similar reason.
16-15 (h) The department shall adopt rules governing the
16-16 circumstances under which a waiver may be granted under Subsection
16-17 (g) and the procedures to be used by a county to apply for the
16-18 waiver. The procedures must provide that the department shall make
16-19 a determination with respect to an application for a waiver not
16-20 later than the 90th day after the date the application is submitted
16-21 to the department in accordance with the procedures established by
16-22 the department. To be eligible for state assistance under
16-23 Subsection (g), a county must submit monthly financial reports, in
16-24 the form required by the department, covering the 12-month period
16-25 preceding the date on which the assistance is sought.
16-26 (i) The county must give the department all necessary
16-27 information so that the department can determine if the county
17-1 meets the requirements of Subsection (b), (d), [or] (e), or (g).
17-2 Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the
17-3 department determines that a county is eligible for assistance, the
17-4 department shall distribute funds appropriated to the department
17-5 from the indigent health care assistance fund or any other
17-6 available fund to the county to assist the county in providing
17-7 [mandatory] health care services under Sections 61.028 and 61.0285
17-8 to its eligible county residents who qualify for assistance as
17-9 described by Section 61.037 [under Section 61.006].
17-10 (b) State funds provided under this section to a county must
17-11 be equal to at least 90 [80] percent of the actual payment for the
17-12 [mandatory] health care services for the county's eligible
17-13 residents during the remainder of the state fiscal year after the
17-14 eight [10] percent expenditure level is reached.
17-15 Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the
17-16 department fails to provide assistance to an eligible county as
17-17 prescribed by Section 61.038, the county is not liable for payments
17-18 for health care services provided to its eligible county residents
17-19 after the county reaches the eight [10] percent expenditure level.
17-20 SECTION 1.15. Subchapter B, Chapter 61, Health and Safety
17-21 Code, is amended by adding Section 61.0395 to read as follows:
17-22 Sec. 61.0395. LIMITED TO APPROPRIATED FUNDS. (a) The total
17-23 amount of state assistance provided to counties under this chapter
17-24 for a fiscal year may not exceed the amount appropriated for that
17-25 purpose for that fiscal year.
17-26 (b) The department shall adopt rules governing the
17-27 distribution of state assistance under this chapter that establish
18-1 a maximum annual allocation for each county eligible for assistance
18-2 under this chapter in compliance with Subsection (a).
18-3 (c) The rules adopted under this section:
18-4 (1) may consider the relative populations of the
18-5 service areas of eligible counties and other appropriate factors;
18-6 and
18-7 (2) notwithstanding Subsection (b), may provide for,
18-8 at the end of each state fiscal year, the reallocation of all money
18-9 that is allocated to a county under Subsection (b) but that the
18-10 county is not eligible to receive and the distribution of that
18-11 money to other eligible counties.
18-12 SECTION 1.16. Section 61.041, Health and Safety Code, is
18-13 amended by amending Subsections (a) and (b) and adding Subsection
18-14 (d) to read as follows:
18-15 (a) The department shall establish monthly reporting
18-16 requirements for a county seeking state assistance and establish
18-17 procedures necessary to determine if the county is eligible for
18-18 state assistance.
18-19 (b) The department shall establish requirements relating to:
18-20 (1) documentation required to verify the eligibility
18-21 of residents to whom the county provides assistance; and
18-22 (2) county expenditures for [mandatory] health care
18-23 services under Sections 61.028 and 61.0285.
18-24 (d) The department shall establish annual reporting
18-25 requirements for each county that is required to provide indigent
18-26 health care under this chapter but that is not required to report
18-27 under Subsection (a). A county satisfies the annual reporting
19-1 requirement of this subsection if the county submits information to
19-2 the department as required by law to obtain an annual distribution
19-3 under the Agreement Regarding Disposition of Settlement Proceeds
19-4 filed on July 24, 1998, in the United States District Court,
19-5 Eastern District of Texas, in the case styled The State of Texas v.
19-6 The American Tobacco Co., et al., No. 5-96CV-91.
19-7 SECTION 1.17. Section 61.052, Health and Safety Code, is
19-8 amended to read as follows:
19-9 Sec. 61.052. GENERAL ELIGIBILITY PROVISIONS. (a) A public
19-10 hospital or hospital district shall provide health care assistance
19-11 to each eligible resident in its service area who meets:
19-12 (1) the basic income and resources requirements
19-13 established by the department under Sections 61.006 and 61.008 and
19-14 in effect when the assistance is requested; or
19-15 (2) a less restrictive income and resources standard
19-16 adopted by the hospital or hospital district serving the area in
19-17 which the person resides.
19-18 (b) If a public hospital used an income and resources
19-19 standard during the operating year that ended before January 1,
19-20 1985, that was less restrictive than the income and resources
19-21 requirements established by the department under Section 61.006,
19-22 the hospital shall adopt that standard to determine eligibility
19-23 under this subchapter.
19-24 (c) If a public hospital did not use an income and resources
19-25 standard during the operating year that ended before January 1,
19-26 1985, but had a Hill-Burton obligation during part of that year,
19-27 the hospital shall adopt the standard the hospital used to meet the
20-1 Hill-Burton obligation to determine eligibility under this
20-2 subchapter.
20-3 (d) A public hospital established after September 1, 1985,
20-4 shall provide health care services to each resident who meets the
20-5 income and resources requirements established by the department
20-6 under Sections 61.006 and 61.008, or the hospital may adopt a less
20-7 restrictive income and resources standard. The hospital may adopt
20-8 a less restrictive income and resources standard at any time.
20-9 (e) If because of a change in the income and resources
20-10 requirements established by the department under Sections 61.006
20-11 and 61.008 the standard adopted by a public hospital or hospital
20-12 district becomes stricter than the requirements established by the
20-13 department, the hospital or hospital district shall change its
20-14 standard to at least comply with the requirements established by
20-15 the department.
20-16 (f) A public hospital or hospital district may contract with
20-17 the department to perform eligibility determination services.
20-18 (g) A county that provides health care services to its
20-19 eligible residents through a hospital established by a board of
20-20 managers jointly appointed by a county and a municipality under
20-21 Section 265.011 and that establishes an income and resources
20-22 standard in accordance with Subsection (a)(2) may credit the
20-23 services provided to all persons who are eligible under that
20-24 standard toward eligibility for state assistance as described by
20-25 Section 61.037(e).
20-26 SECTION 1.18. Section 61.054, Health and Safety Code, is
20-27 amended to read as follows:
21-1 Sec. 61.054. BASIC [MANDATORY] HEALTH CARE SERVICES PROVIDED
21-2 BY A PUBLIC HOSPITAL. (a) Except as provided by Subsection (c), a
21-3 [A] public hospital shall endeavor to provide the basic health care
21-4 [inpatient and outpatient hospital] services a county is required
21-5 to provide under Section 61.028 [61.028(a)(1)].
21-6 (b) If a public hospital provided additional health care
21-7 services to eligible residents during the operating year that ended
21-8 before January 1, 1985, the hospital shall continue to provide
21-9 those services.
21-10 (c) A public hospital shall coordinate the delivery of basic
21-11 health care services to eligible residents and may provide any
21-12 basic health care services the hospital was not providing on
21-13 January 1, 1999, but only to the extent the hospital is financially
21-14 able to do so.
21-15 (d) A public hospital may provide [additional] health care
21-16 services in addition to basic health care services.
21-17 SECTION 1.19. Section 61.055, Health and Safety Code, is
21-18 amended to read as follows:
21-19 Sec. 61.055. BASIC HEALTH CARE SERVICES PROVIDED BY HOSPITAL
21-20 DISTRICTS. (a) Except as provided by Subsection (b), a [A]
21-21 hospital district shall endeavor to provide the basic health care
21-22 services a county is required to provide under Section 61.028,
21-23 together with any other services required under the Texas
21-24 Constitution and the statute creating the district.
21-25 (b) A hospital district shall coordinate the delivery of
21-26 basic health care services to eligible residents and may provide
21-27 any basic health care services the district was not providing on
22-1 January 1, 1999, but only to the extent the district is financially
22-2 able to do so.
22-3 (c) This section may not be construed to discharge a
22-4 hospital district from its obligation to provide the health care
22-5 services required under the Texas Constitution and the statute
22-6 creating the district.
22-7 SECTION 1.20. Section 61.058(b), Health and Safety Code, is
22-8 amended to read as follows:
22-9 (b) If the public hospital does not require prior approval
22-10 and a provider delivers or will deliver nonemergency health care
22-11 services to a patient who the provider suspects might be eligible
22-12 for assistance under this subchapter, the provider shall notify the
22-13 hospital that health care services have been or will be provided to
22-14 the patient. The notice shall be made:
22-15 (1) by telephone not later than the 72nd hour [as soon
22-16 as possible] after the provider determines that the patient resides
22-17 in the hospital's service area; and
22-18 (2) by mail postmarked not later than the fifth
22-19 [third] working day after the date on which the provider determines
22-20 that the patient resides in the hospital's service area.
22-21 SECTION 1.21. Section 61.059(a), Health and Safety Code, is
22-22 amended to read as follows:
22-23 (a) If a nonmandated provider delivers emergency services to
22-24 a patient who the provider suspects might be eligible for
22-25 assistance under this subchapter, the provider shall notify the
22-26 hospital that emergency services have been or will be provided to
22-27 the patient. The notice shall be made:
23-1 (1) by telephone not later than the 72nd hour [as soon
23-2 as possible] after the provider determines that the patient resides
23-3 in the hospital's service area; and
23-4 (2) by mail postmarked not later than the fifth
23-5 [third] working day after the date on which the provider determines
23-6 that the patient resides in the hospital's service area.
23-7 SECTION 1.22. Section 61.062, Health and Safety Code, is
23-8 amended to read as follows:
23-9 Sec. 61.062. RESPONSIBILITY OF GOVERNMENTAL ENTITY. A
23-10 governmental entity that owns, operates, or leases a public
23-11 hospital shall provide sufficient funding to the hospital to
23-12 provide basic [mandatory] health care services [assistance].
23-13 SECTION 1.23. Section 61.064(a), Health and Safety Code, is
23-14 amended to read as follows:
23-15 (a) A governmental entity that owns, operates, or leases a
23-16 public hospital and that closes, sells, or leases the hospital:
23-17 (1) has the obligation to provide basic [mandatory]
23-18 health care services [assistance] under this chapter;
23-19 (2) shall adopt the eligibility standards that the
23-20 hospital was or would have been required to adopt; and
23-21 (3) shall provide the same services the hospital was
23-22 or would have been required to provide under this chapter on the
23-23 date of the closing, sale, or lease.
23-24 SECTION 1.24. Subchapter C, Chapter 281, Health and Safety
23-25 Code, is amended by adding Section 281.0514 to read as follows:
23-26 Sec. 281.0514. HARRIS COUNTY HOSPITAL DISTRICT; CONTRACT
23-27 WITH CERTAIN HOSPITALS. (a) The Harris County Hospital District
24-1 may contract for indigent health care services with at least one
24-2 hospital that is:
24-3 (1) located in the district;
24-4 (2) exempt from federal income tax under Section
24-5 501(a), Internal Revenue Code of 1986, and its subsequent
24-6 amendments, by being listed as an exempt entity under any
24-7 subdivision of Section 501(c) of that code; and
24-8 (3) substantially devoted to providing hospital
24-9 services to socially and economically disadvantaged individuals in
24-10 the geographical area of the district.
24-11 (b) A contract under this section is subject to Section
24-12 281.051(a).
24-13 SECTION 1.25. Section 531.047, Government Code, as added by
24-14 Chapter 1251, Acts of the 75th Legislature, Regular Session, 1997,
24-15 is amended by amending Subsection (a) and adding Subsection (h) to
24-16 read as follows:
24-17 (a) In this section:
24-18 (1) "Health professional" means an advanced nurse
24-19 practitioner, an allied health professional, a mental health
24-20 professional, a physician, or a physician assistant who is licensed
24-21 in this state.
24-22 (2) "Rural county" means a county that:
24-23 (A) has [with] a population of [less than]
24-24 50,000 or less; or
24-25 (B) contains an area that was not designated as
24-26 an urban area by the United States Bureau of the Census according
24-27 to the 1990 federal census and does not have within the boundaries
25-1 of the county a hospital that:
25-2 (i) is licensed under Chapter 241, Health
25-3 and Safety Code; and
25-4 (ii) has more than 100 beds.
25-5 (3) "Rural health facility" means a health facility
25-6 that is located in a rural county and at least 30 miles from any
25-7 accredited medical school or any teaching hospital affiliated with
25-8 an accredited medical school and that is:
25-9 (A) a licensed, nonprofit hospital; [or]
25-10 (B) a health clinic that is affiliated with:
25-11 (i) an accredited medical school; [or]
25-12 (ii) a teaching hospital that is
25-13 affiliated with an accredited medical school;
25-14 (iii) a hospital described by Paragraph
25-15 (C); or
25-16 (iv) a federally qualified health center,
25-17 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or
25-18 (C) a hospital that:
25-19 (i) is licensed under Chapter 241, Health
25-20 and Safety Code;
25-21 (ii) is owned or operated by a
25-22 municipality, county, hospital district, or hospital authority; and
25-23 (iii) provides inpatient or outpatient
25-24 services.
25-25 (4) "Telemedical consultation" means a medical
25-26 consultation for purposes of patient diagnosis or treatment that
25-27 requires the use of advanced telecommunications technology,
26-1 including:
26-2 (A) compressed digital interactive video, audio,
26-3 or data transmission;
26-4 (B) clinical data transmission via computer
26-5 imaging for teleradiology or telepathology; and
26-6 (C) other technology that facilitates access in
26-7 rural counties to health care services or medical specialty
26-8 expertise.
26-9 (h) The commissioner shall establish an advisory committee
26-10 to assist the commission in developing policies for telemedical
26-11 consultations under this section.
26-12 SECTION 1.26. Section 531.204(b), Government Code, is
26-13 amended to read as follows:
26-14 (b) The report must include:
26-15 (1) identification of significant problems in the
26-16 Texas Integrated Enrollment Services, with recommendations for
26-17 action by the commissioner;
26-18 (2) the status of the effectiveness of the Texas
26-19 Integrated Enrollment Services in providing necessary services to
26-20 the people of this state, with recommendations for any necessary
26-21 research;
26-22 (3) an analysis of the feasibility of including
26-23 indigent health care programs provided by counties, public
26-24 hospitals, and hospital districts in the Texas Integrated
26-25 Enrollment Services, a schedule for inclusion of these programs,
26-26 and a statement of how the Texas Integrated Enrollment Services may
26-27 be structured to address the wide variation in information systems
27-1 used by counties, public hospitals, and hospital districts; and
27-2 (4) [(3)] recommendations for legislative action.
27-3 SECTION 1.27. Chapter 26, Tax Code, is amended by adding
27-4 Section 26.0441 to read as follows:
27-5 Sec. 26.0441. TAX RATE ADJUSTMENT FOR INDIGENT HEALTH CARE.
27-6 (a) In the first tax year in which a taxing unit adopts a tax rate
27-7 after January 1, 2000, and in which the enhanced minimum
27-8 eligibility standards for indigent health care established under
27-9 Section 61.006, Health and Safety Code, apply to the taxing unit,
27-10 the effective maintenance and operations rate for the taxing unit
27-11 is increased by the rate computed according to the following
27-12 formula:
27-13 Enhanced Indigent Health Care Expenditures
27-14 Amount of Increase = __________________________________________
27-15 (Current Total Value - New Property Value)
27-16 (b) In each subsequent tax year, if the taxing unit's
27-17 enhanced indigent health care expenses exceed the amount of those
27-18 expenses for the preceding year, the effective maintenance and
27-19 operations rate for the taxing unit is increased by the rate
27-20 computed according to the following formula:
27-21 (Current Tax Year's Enhanced Indigent
27-22 Health Care Expenditures - Preceding Tax
27-23 Year's Indigent Health Care Expenditures)
27-24 Amount of Increase = __________________________________________
27-25 (Current Total Value - New Property Value)
27-26 (c) The taxing unit shall include a notice of the increase
27-27 in its effective maintenance and operations rate provided by this
28-1 section, including a brief description and the amount of the
28-2 enhanced indigent health care expenditures, in the information
28-3 published under Section 26.04(e) and, if applicable, Section
28-4 26.06(b).
28-5 (d) In this section, "enhanced indigent health care
28-6 expenditures" for a tax year means the amount spent by the taxing
28-7 unit for the maintenance and operation costs of providing indigent
28-8 health care at the increased minimum eligibility standards
28-9 established under Section 61.006, Health and Safety Code, effective
28-10 on or after January 1, 2000, in the period beginning on July 1 of
28-11 the year preceding the tax year for which the tax is adopted and
28-12 ending on June 30 of the tax year for which the tax is adopted,
28-13 less the amount of state assistance received by the taxing unit in
28-14 accordance with Chapter 61, Health and Safety Code, that is
28-15 attributable to those costs.
28-16 (e) In the 2000 and 2001 tax years, a taxing unit's enhanced
28-17 indigent health care expenditures for the 2000 tax year are
28-18 computed under Subsection (d) using the taxing unit's expenditures
28-19 for the maintenance and operation costs of providing indigent
28-20 health care at the increased minimum eligibility standards
28-21 described by Subsection (d) for the period beginning on January 1,
28-22 2000, and ending on June 30, 2000, instead of for the period
28-23 described by Subsection (d). This subsection expires January 1,
28-24 2002.
28-25 SECTION 1.28. (a) The change in law made by this article to
28-26 Chapter 61, Health and Safety Code, applies only to:
28-27 (1) health care services under Chapter 61, Health and
29-1 Safety Code, as amended by this article, that are delivered on or
29-2 after January 1, 2000; and
29-3 (2) state assistance under Chapter 61, Health and
29-4 Safety Code, as amended by this article, for the services described
29-5 by Subdivision (1) of this subsection.
29-6 (b) Health care services under Chapter 61, Health and Safety
29-7 Code, as amended by this article, that are delivered before January
29-8 1, 2000, and state assistance for those services are governed by
29-9 the law as it existed immediately before that date and that law is
29-10 continued in effect for this purpose.
29-11 SECTION 1.29. The Texas Department of Health shall study the
29-12 feasibility of requiring or permitting a county, public hospital,
29-13 and hospital district to issue a uniform identification card to an
29-14 eligible county resident or eligible service area resident, as
29-15 appropriate, that identifies the resident as eligible for health
29-16 care assistance under Chapter 61, Health and Safety Code. Not
29-17 later than December 15, 2000, the department shall report the
29-18 results of its study to the governor, lieutenant governor, and
29-19 speaker of the house of representatives.
29-20 SECTION 1.30. For fiscal years 2000 and 2001, the rules
29-21 adopted under Section 61.0395(b), Health and Safety Code, as added
29-22 by this Act, must ensure that each county's annual allocation is
29-23 equal to at least the average estimated annual amount of state
29-24 assistance that the county would have been eligible to receive
29-25 during each of the state fiscal years ending on August 31, 1997,
29-26 August 31, 1998, and August 31, 1999, computed as if the
29-27 eligibility threshold established by Section 61.037, Health and
30-1 Safety Code, as amended by this Act, and the state match rate
30-2 established by Section 61.038, Health and Safety Code, as amended
30-3 by this Act, had applied during those fiscal years.
30-4 ARTICLE 2. TERTIARY MEDICAL CARE
30-5 SECTION 2.01. Subtitle B, Title 2, Health and Safety Code,
30-6 is amended by adding Chapter 46 to read as follows:
30-7 CHAPTER 46. TERTIARY MEDICAL CARE
30-8 Sec. 46.001. DEFINITIONS. In this chapter:
30-9 (1) "Tertiary care facility" means a:
30-10 (A) primary teaching hospital of a medical
30-11 school;
30-12 (B) level I trauma center;
30-13 (C) level II trauma center; or
30-14 (D) level III trauma center.
30-15 (2) "Tertiary medical services" includes, but is not
30-16 limited to, services provided by state-designated trauma centers,
30-17 burn center treatment, neonatology level III unit services,
30-18 pediatric surgery, trauma surgery, neurosurgery, cardiothoracic and
30-19 vascular surgery, organ transplant, services provided for a
30-20 life-threatening dermatologic illness, services provided to a
30-21 person with a high-risk pregnancy or cancer, and radiation
30-22 oncology.
30-23 (3) "Stabilization services" means services provided
30-24 by a tertiary care facility or a level IV designated trauma center
30-25 that are necessary to assure, within reasonable medical
30-26 probability, that no material deterioration of a patient's medical
30-27 condition is likely to result from or occur during the transfer of
31-1 the patient to a tertiary care facility.
31-2 (4) "Unreimbursed stabilization services" means
31-3 stabilization services for which a tertiary care facility or level
31-4 IV designated trauma facility has not received full payment from
31-5 any public or private source.
31-6 (5) "Unreimbursed tertiary medical services" means
31-7 tertiary care medical services for which a tertiary care facility
31-8 has not received full payment from any public or private source.
31-9 Sec. 46.002. RULES. (a) The board may adopt rules to
31-10 implement a system that encourages hospitals to provide tertiary
31-11 medical services and stabilization services.
31-12 (b) The rules must address:
31-13 (1) coordination of tertiary medical services and
31-14 stabilization services among health care facilities in the
31-15 delivery area;
31-16 (2) pre-hospital care management guidelines for
31-17 triage, transfer, and transportation of patients and periodic
31-18 evaluation of tertiary care facilities' and level IV trauma
31-19 facilities' compliance with the guidelines and the trauma facility
31-20 rules, as appropriate;
31-21 (3) requirements for data collection, including
31-22 patient outcomes;
31-23 (4) assurances that tertiary care facilities will not
31-24 refuse to accept the transfer of a patient solely because of the
31-25 person's inability to pay for services or because of the person's
31-26 age, sex, race, religion, or national origin; and
31-27 (5) enforcement of the rules.
32-1 Sec. 46.003. TERTIARY CARE ACCOUNT. (a) The tertiary care
32-2 account is an account in the state treasury. Money in the account
32-3 may be appropriated only to the department for the purposes of this
32-4 chapter.
32-5 (b) The account is composed of money appropriated to the
32-6 account and any other funds required to be put in the account.
32-7 (c) The department may seek and accept gifts, grants, and
32-8 donations from any public or private entity on behalf of the
32-9 account.
32-10 (d) Section 403.095, Government Code, does not apply to the
32-11 account.
32-12 (e) For each fiscal year, five percent of the total amount
32-13 in the account shall be held in reserve and may be used only for
32-14 reimbursement of unpaid tertiary medical services and stabilization
32-15 services provided as a result of extraordinary emergencies
32-16 occurring during that year. Of the amount remaining, not more than
32-17 five percent may be used for the costs of administering the
32-18 account.
32-19 (f) Except as provided by Subsection (e), the account shall
32-20 be allocated for payment to tertiary care facilities and level IV
32-21 trauma centers for unreimbursed tertiary medical services and
32-22 stabilization services, as provided for in Sections 46.005 and
32-23 46.006.
32-24 Sec. 46.004. COLLECTION OF INFORMATION. (a) Each tertiary
32-25 care facility or level IV trauma facility that seeks payment under
32-26 this chapter shall submit to the department, in the manner and at
32-27 the time required by the department, information that relates to
33-1 the unreimbursed tertiary medical services or stabilization
33-2 services provided to persons who reside outside the service area of
33-3 the county, public hospital, or hospital district that is
33-4 responsible for indigent health care under Chapter 61 in the area
33-5 in which the tertiary care facility or level IV trauma facility is
33-6 located.
33-7 (b) The board shall adopt rules governing the collection of
33-8 the information under Subsection (a).
33-9 Sec. 46.005. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED
33-10 TERTIARY MEDICAL SERVICES. (a) The department shall certify to
33-11 the comptroller for each tertiary care facility the cost of
33-12 unreimbursed tertiary medical services provided to persons who
33-13 reside outside the service area of the county, public hospital, or
33-14 hospital district that is responsible for indigent health care
33-15 under Chapter 61 in the area in which the tertiary care facility is
33-16 located.
33-17 (b) In each fiscal year the department shall use at least 86
33-18 percent of the appropriated money in the tertiary care account to
33-19 compensate tertiary care facilities for unreimbursed tertiary
33-20 medical services.
33-21 (c) Each year the department shall make, for a facility that
33-22 operated as a tertiary care facility during the previous year, an
33-23 initial certification to the comptroller under Subsection (a) in an
33-24 amount that equals 80 percent of the amount certified under this
33-25 section for the facility in the previous year. The department
33-26 shall make a subsequent certification of the cost of additional
33-27 unreimbursed tertiary medical services provided by the facility on
34-1 receipt from the facility of the information required to be
34-2 submitted under Section 46.004.
34-3 (d) Except as provided by Subsection (e), each year the
34-4 comptroller shall pay a tertiary care facility the certified amount
34-5 determined under Subsection (a) from the funds specified under
34-6 Section 46.003(f).
34-7 (e) If in any year the total cost of unreimbursed tertiary
34-8 medical services certified under Subsection (a) for all tertiary
34-9 care facilities exceeds the amount available for payment to all
34-10 facilities under Section 46.003(f), less the amount allocated for
34-11 stabilization services under Section 46.006(b), the department
34-12 shall allocate the amount available under Section 46.003(f) to each
34-13 facility based on the percentages computed by dividing the cost of
34-14 the facility's unreimbursed tertiary medical services by the total
34-15 cost of all facilities' unreimbursed tertiary medical services.
34-16 The comptroller shall pay each tertiary care facility based on the
34-17 allocation made under this subsection.
34-18 (f) For purposes of this section and Section 46.007, the
34-19 cost of each service provided by a tertiary care facility is the
34-20 average amount payable under Medicare reimbursement policies for
34-21 that service.
34-22 Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED
34-23 STABILIZATION SERVICES. (a) The department shall certify to the
34-24 comptroller for each tertiary care facility or level IV trauma
34-25 facility the cost of unreimbursed stabilization services provided
34-26 to persons who reside outside the service area of the county,
34-27 public hospital, or hospital district that is responsible for
35-1 indigent health care under Chapter 61 in the area in which the
35-2 tertiary care facility or level IV trauma facility is located.
35-3 (b) In each fiscal year the department shall use no more
35-4 than four percent of the appropriated money in the tertiary care
35-5 account to compensate tertiary care facilities and level IV trauma
35-6 facilities for unreimbursed stabilization services.
35-7 (c) Each year the department shall make, for a facility that
35-8 operated as a tertiary care facility or level IV trauma facility
35-9 during the previous year, an initial certification to the
35-10 comptroller under Subsection (a) in an amount that equals 80
35-11 percent of the amount certified under this section for the facility
35-12 in the previous year. The department shall make a subsequent
35-13 certification of the cost of additional unreimbursed stabilization
35-14 services provided by the facility on receipt from the facility of
35-15 the information required to be submitted under Section 46.004.
35-16 (d) Except as provided by Subsection (e), each year the
35-17 comptroller shall pay a tertiary care facility or level IV trauma
35-18 facility the certified amount determined under Subsection (a) from
35-19 the funds specified under Section 46.003(f).
35-20 (e) If in any year the total cost of unreimbursed
35-21 stabilization services certified under Subsection (a) for all
35-22 tertiary care facilities or level IV trauma facilities exceeds the
35-23 amount available for payment to the facilities under Section
35-24 46.003(f), as limited by Subsection (b), the department shall
35-25 allocate the amount available to each facility based on the
35-26 percentages computed by dividing the cost of the facility's
35-27 unreimbursed stabilization services by the total cost of all
36-1 facilities' unreimbursed stabilization services. The comptroller
36-2 shall pay each tertiary care facility or level IV trauma facility
36-3 based on the allocation made under this subsection.
36-4 (f) For purposes of this section and Section 46.007, the
36-5 cost of each service provided by a tertiary care facility or level
36-6 IV trauma facility is the average amount payable under Medicare
36-7 reimbursement policies for that service.
36-8 Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) For
36-9 purposes of reimbursing extraordinary emergencies under this
36-10 chapter, the department shall certify an extraordinary emergency:
36-11 (1) if the governor issues an executive order or a
36-12 proclamation under Chapter 418, Government Code;
36-13 (2) if a disaster is declared by the president of the
36-14 United States under the Robert T. Stafford Disaster Relief and
36-15 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
36-16 (3) for another similar disaster the department finds
36-17 has resulted in an extraordinary cost to a tertiary care facility
36-18 or level IV trauma facility.
36-19 (b) If an extraordinary emergency is certified under
36-20 Subsection (a), the department shall certify to the comptroller the
36-21 amount of unreimbursed tertiary medical services or stabilization
36-22 services incurred by a tertiary care facility or level IV trauma
36-23 facility, as appropriate, during the emergency.
36-24 (c) Except as provided by Subsection (d), each year the
36-25 comptroller shall pay a tertiary care facility or level IV trauma
36-26 facility the certified amount determined under Subsection (b) from
36-27 the funds specified under Section 46.003(e).
37-1 (d) If in any year the total cost of unreimbursed tertiary
37-2 medical services or stabilization services certified under
37-3 Subsection (b) for all facilities exceeds the amount available for
37-4 payment to the facilities under Section 46.003(e), the department
37-5 shall allocate the amount available under Section 46.003(e) to each
37-6 facility based on the percentages computed by dividing the cost of
37-7 the facility's unreimbursed services by the total cost of all
37-8 facilities' unreimbursed services. The comptroller shall pay each
37-9 tertiary care facility or level IV trauma facility based on the
37-10 allocation made under this subsection.
37-11 SECTION 2.02. Section 773.003, Health and Safety Code, is
37-12 amended by adding Subdivision (22) to read as follows:
37-13 (22) "Trauma services" includes services provided to a
37-14 severely or seriously injured patient who has a principal diagnosis
37-15 listed in the Injuries and Poisonings Chapter of the International
37-16 Classification of Diseases, Clinical Modification.
37-17 ARTICLE 3. MISCELLANEOUS PROVISIONS
37-18 FOR INDIGENT HEALTH CARE
37-19 SECTION 3.01. Subtitle C, Title 2, Health and Safety Code,
37-20 is amended by adding Chapter 64 to read as follows:
37-21 CHAPTER 64. MISCELLANEOUS PROVISIONS
37-22 Sec. 64.001. TEACHING HOSPITAL ACCOUNT. The Texas
37-23 Department of Health state-owned multi-categorical teaching
37-24 hospital account is an account in the general revenue fund. Money
37-25 in the account may be appropriated only to the department to
37-26 provide funding for indigent health care.
37-27 ARTICLE 4. DISSOLUTION OF HOSPITAL DISTRICTS
38-1 SECTION 4.01. Chapter 285, Health and Safety Code, is
38-2 amended by adding Subchapter K to read as follows:
38-3 SUBCHAPTER K. DISSOLUTION OF HOSPITAL DISTRICT
38-4 Sec. 285.151. ASSETS TRANSFERRED ON DISSOLUTION.
38-5 Notwithstanding any general or special law, if a hospital district
38-6 is dissolved and the money or other assets of the district are
38-7 transferred to a county or other governmental entity under a
38-8 process established in accordance with Section 9, Article IX, Texas
38-9 Constitution, the governmental entity shall use all transferred
38-10 assets to:
38-11 (1) pay the outstanding debts and obligations of the
38-12 district relating to the assets at the time of the transfer, if
38-13 any; and
38-14 (2) furnish medical and hospital care for indigent
38-15 persons who reside in the territory within the jurisdiction of the
38-16 governmental entity.
38-17 ARTICLE 5. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM
38-18 SECTION 5.01. FEDERAL AUTHORIZATION. It is the intent of
38-19 the 76th Legislature that:
38-20 (1) the Health and Human Services Commission or an
38-21 appropriate health and human services agency continue to pursue the
38-22 waiver or other authorization described by Section 4, Chapter 444,
38-23 Acts of the 74th Legislature, Regular Session, 1995;
38-24 (2) the waiver or other authorization apply to
38-25 expansion of Medicaid eligibility, as described by Section 532.102,
38-26 Government Code, for both children and their families and other
38-27 adults; and
39-1 (3) the Health and Human Services Commission take any
39-2 other appropriate action authorized under law to accomplish the
39-3 expansion of Medicaid eligibility, as described by Section 532.102,
39-4 Government Code, for children and their families and for other
39-5 adults.
39-6 ARTICLE 6. STUDY RELATING TO BASIC HEALTH CARE SERVICES
39-7 AND STATE ASSISTANCE
39-8 SECTION 6.01. STUDY. The Texas Department of Health shall:
39-9 (1) study the provision of basic health care services
39-10 by counties, hospital districts, and public hospitals under Chapter
39-11 61, Health and Safety Code, and the cost of providing those
39-12 services;
39-13 (2) study the threshold for eligibility for state
39-14 assistance to a county established under Section 61.037, Health and
39-15 Safety Code, and develop a threshold to replace that threshold that
39-16 is stated as a formula and that reflects:
39-17 (A) a county's fiscal capacity;
39-18 (B) a county's health care resources; and
39-19 (C) the relevant characteristics of the county's
39-20 residents, including the percentage of the county's residents
39-21 living below the federal poverty level; and
39-22 (3) study the financing of basic health care services
39-23 by counties, hospital districts, and public hospitals under Chapter
39-24 61, Health and Safety Code, including the use of:
39-25 (A) local, state, and federal funds; and
39-26 (B) the funds distributed to political
39-27 subdivisions under the Agreement Regarding Disposition of
40-1 Settlement Proceeds filed on July 24, 1998, in the United States
40-2 District Court, Eastern District of Texas, in the case styled The
40-3 State of Texas vs. The American Tobacco Co., et al., No. 5-96CV-91.
40-4 SECTION 6.02. REPORT. Not later than December 1, 2000, the
40-5 Texas Department of Health shall submit a written report of the
40-6 study conducted under this article to the governor, lieutenant
40-7 governor, and speaker of the house of representatives. The report
40-8 must include the recommendations of the department, together with
40-9 the proposed eligibility threshold described by Section 6.01(2) of
40-10 this article.
40-11 SECTION 6.03. EXPIRATION. This article expires August 31,
40-12 2001.
40-13 ARTICLE 7. PILOT PROGRAM FOR REGIONAL HEALTH CARE
40-14 DELIVERY SYSTEM
40-15 SECTION 7.01. DEFINITIONS. In this article:
40-16 (1) "Commissioner" means the commissioner of health
40-17 and human services.
40-18 (2) "Pilot program" means the regional health care
40-19 delivery system pilot program established under this article.
40-20 SECTION 7.02. PILOT PROGRAM. (a) Not later than January 1,
40-21 2000, the commissioner shall establish a regional health care
40-22 delivery system pilot program to coordinate the use of health care
40-23 resources in a region of the state. The pilot program must:
40-24 (1) emphasize prevention services, continuity of care,
40-25 and the provision of a medical home for clients;
40-26 (2) maximize the use of local and state funds by
40-27 obtaining any available federal matching funds;
41-1 (3) be designed to result in long-term cost savings to
41-2 the participating entities;
41-3 (4) simplify eligibility criteria and streamline
41-4 eligibility determinations; and
41-5 (5) improve accountability of indigent health care
41-6 dollars.
41-7 (b) The commissioner may adopt rules as necessary to
41-8 implement the pilot program. The rules may provide an alternative
41-9 funding structure to the funding structure established under
41-10 Chapter 61, Health and Safety Code.
41-11 (c) The commissioner may not require a county, public
41-12 hospital, hospital district, or other entity to participate in the
41-13 pilot program.
41-14 SECTION 7.03. REPORT. (a) Not later than January 1, 2003,
41-15 the commissioner shall submit a written report relating to the
41-16 pilot program to the governor, lieutenant governor, and speaker of
41-17 the house of representatives.
41-18 (b) The report must include:
41-19 (1) an analysis of:
41-20 (A) the quality of health care services provided
41-21 under the pilot program; and
41-22 (B) the cost-effectiveness of providing health
41-23 care services through the pilot program; and
41-24 (2) recommendations for legislation for implementing
41-25 regional health care delivery systems in this state, including
41-26 recommendations relating to:
41-27 (A) the structure of a regional entity to
42-1 administer a regional health care delivery system;
42-2 (B) the manner in which state assistance money
42-3 may most effectively be distributed to support a regional health
42-4 care delivery system; and
42-5 (C) any other matter necessary to implement
42-6 effective and efficient regional health care delivery systems in
42-7 this state.
42-8 SECTION 7.04. EXPIRATION; TERMINATION OF PILOT PROGRAM.
42-9 This section expires and the pilot program is terminated August 31,
42-10 2003.
42-11 ARTICLE 8. EFFECTIVE DATE; EMERGENCY
42-12 SECTION 8.01. EFFECTIVE DATE. This Act takes effect
42-13 September 1, 1999.
42-14 SECTION 8.02. EMERGENCY. The importance of this legislation
42-15 and the crowded condition of the calendars in both houses create an
42-16 emergency and an imperative public necessity that the
42-17 constitutional rule requiring bills to be read on three several
42-18 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1398 was passed by the House on May
6, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 1398 on May 27, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1398 was passed by the Senate, with
amendments, on May 25, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor