76R12234 DLF-D
By Coleman, Farabee, et al. H.B. No. 1398
Substitute the following for H.B. No. 1398:
By Coleman C.S.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.
3-12 (c) If the department determines that another governmental
3-13 entity or hospital district may be involved in the dispute, the
3-14 department shall notify the governmental entity or hospital
3-15 district and allow the governmental entity or hospital district to
3-16 respond.
3-17 (d) From the information submitted, the department shall
3-18 determine the person's residence or whether the person is eligible
3-19 for assistance under this chapter, as appropriate, and shall notify
3-20 each governmental entity or hospital district and the provider of
3-21 assistance of the decision and the reasons for the decision.
3-22 (e) If a governmental entity, hospital district, or provider
3-23 of assistance does not agree with the department's decision, the
3-24 governmental entity, hospital district, or provider of assistance
3-25 may file an appeal with the department. The appeal must be filed
3-26 not later than the 30th day after the date on which the
3-27 governmental entity, hospital district, or provider of assistance
4-1 receives notice of the decision.
4-2 (f) The department shall issue a final decision not later
4-3 than the 21st day after the date on which the appeal is filed.
4-4 (g) A governmental entity, hospital district, or provider of
4-5 assistance may appeal the final order of the department under
4-6 Chapter 2001, Government Code, using the substantial evidence rule
4-7 on appeal.
4-8 (h) Service may not be denied pending an administrative or
4-9 judicial review of residence.
4-10 SECTION 1.03. Subchapter A, Chapter 61, Health and Safety
4-11 Code, is amended by adding Section 61.0045 to read as follows:
4-12 Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE
4-13 ELIGIBILITY. (a) Any provider, including a mandated provider,
4-14 public hospital, or hospital district, that delivers health care
4-15 services to a patient who the provider suspects is an eligible
4-16 resident of the service area of a county, hospital district, or
4-17 public hospital under this chapter may require the patient to:
4-18 (1) provide any information necessary to establish
4-19 that the patient is an eligible resident of the service area of the
4-20 county, hospital district, or public hospital; and
4-21 (2) authorize the release of any information relating
4-22 to the patient, including medical information and information
4-23 obtained under Subdivision (1), to permit the provider to submit a
4-24 claim to the county, hospital district, or public hospital that is
4-25 liable for payment for the services as described by Section 61.033
4-26 or 61.060.
4-27 (b) A county, hospital district, or public hospital that
5-1 receives information obtained under Subsection (a) shall use the
5-2 information to determine whether the patient to whom services were
5-3 provided is an eligible resident of the service area of the county,
5-4 hospital district, or public hospital and, if so, shall pay the
5-5 claim made by the provider in accordance with this chapter.
5-6 (c) The application, documentation, and verification
5-7 procedures established by the department for counties under Section
5-8 61.006 may include a standard format for obtaining information
5-9 under Subsection (a) to facilitate eligibility and residence
5-10 determinations.
5-11 SECTION 1.04. Sections 61.006 and 61.007, Health and Safety
5-12 Code, are amended to read as follows:
5-13 Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department
5-14 shall establish minimum eligibility standards and application,
5-15 documentation, and verification procedures for counties to use in
5-16 determining eligibility under this chapter.
5-17 (b) The minimum eligibility standards must incorporate a net
5-18 income eligibility level equal to 25 percent of the federal poverty
5-19 level based on the federal Office of Management and Budget poverty
5-20 index [and procedures must be consistent with the standards and
5-21 procedures used by the Texas Department of Human Services to
5-22 determine eligibility in the AFDC-Medicaid program].
5-23 (b-1) Notwithstanding Subsection (b), effective January 1,
5-24 2000, the minimum eligibility standards must incorporate a net
5-25 income eligibility level equal to 22 percent of the federal poverty
5-26 level based on the federal Office of Management and Budget poverty
5-27 index. This subsection expires December 31, 2000.
6-1 (c) The department shall also define the services and
6-2 establish the payment standards for the categories of services
6-3 listed in Sections [Section] 61.028(a) and 61.0285 in accordance
6-4 with Texas Department of Human Services rules relating to the
6-5 Temporary Assistance for Needy Families-Medicaid [AFDC-Medicaid]
6-6 program.
6-7 (d) The department shall establish application,
6-8 documentation, and verification procedures that are consistent with
6-9 the analogous procedures used to determine eligibility in the
6-10 Temporary Assistance for Needy Families-Medicaid program. The
6-11 [(b) The department may simplify the AFDC-Medicaid standards
6-12 and procedures used by the Texas Department of Human Services as
6-13 necessary to provide efficient county administration. In
6-14 establishing simplified standards and procedures for county
6-15 administration, the] department may not adopt a standard or
6-16 procedure that is more restrictive than the Temporary Assistance
6-17 for Needy Families-Medicaid program [AFDC-Medicaid standards] or
6-18 procedures.
6-19 (e) [(c)] The department shall ensure that each person who
6-20 meets the basic income and resources requirements for Temporary
6-21 Assistance for Needy Families program [AFDC] payments but who is
6-22 categorically ineligible for Temporary Assistance for Needy
6-23 Families [AFDC] will be eligible for assistance under Subchapter
6-24 B. Except as provided by Section 61.023(b), the [The] department by
6-25 rule shall also provide that a person who receives or is eligible
6-26 to receive Temporary Assistance for Needy Families, Supplemental
6-27 Security Income [AFDC, SSI], or Medicaid benefits is not eligible
7-1 for assistance under Subchapter B even if the person has exhausted
7-2 a part or all of that person's [AFDC, SSI, or Medicaid] benefits.
7-3 (f) [(d)] The department shall notify each county and public
7-4 hospital of any change to department rules [AFDC or Medicaid
7-5 guidelines] that affect the provision of services under this
7-6 chapter [and shall amend the rules adopted under this chapter to
7-7 reflect the changes made in the AFDC or Medicaid programs].
7-8 (g) [(e)] Notwithstanding Subsection (a), (b), or (c) or any
7-9 other provision of law, the department shall permit payment to a
7-10 licensed dentist for services provided under Sections 61.028(a)(4)
7-11 and (6) [61.028(a)(3) and (a)(5) to the extent that these services
7-12 are required by Section 61.028(a)(5)] if the dentist can provide
7-13 those services within the scope of the dentist's license.
7-14 (h) [(f)] Notwithstanding Subsection (a), (b), or (c), the
7-15 department shall permit payment to a licensed podiatrist for
7-16 services provided under Sections 61.028(a)(4) and (6) [61.028(a)(3)
7-17 and (a)(5) to the extent that the services are required by Section
7-18 61.028(a)(5)], if the podiatrist can provide the services within
7-19 the scope of the podiatrist's license.
7-20 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
7-21 department by rule shall require each applicant to provide at least
7-22 the following information:
7-23 (1) the applicant's full name and address;
7-24 (2) the applicant's social security number, if
7-25 available;
7-26 (3) the number of persons in the applicant's
7-27 household, excluding persons receiving Temporary Assistance for
8-1 Needy Families, Supplemental Security Income [AFDC, SSI], or
8-2 Medicaid benefits;
8-3 (4) the applicant's county of residence;
8-4 (5) the existence of insurance coverage or other
8-5 hospital or health care benefits for which the applicant is
8-6 eligible;
8-7 (6) any transfer of title to real property that the
8-8 applicant has made in the preceding 24 months;
8-9 (7) the applicant's annual household income, excluding
8-10 the income of any household member receiving Temporary Assistance
8-11 for Needy Families, Supplemental Security Income [AFDC, SSI], or
8-12 Medicaid benefits; and
8-13 (8) the amount of the applicant's liquid assets and
8-14 the equity value of the applicant's car and real property.
8-15 SECTION 1.05. Section 61.023(b), Health and Safety Code, is
8-16 amended to read as follows:
8-17 (b) A county may use a less restrictive standard of
8-18 eligibility for residents than prescribed by Subsection (a) and may
8-19 credit the services provided to all persons who are eligible
8-20 residents under that standard toward eligibility for state
8-21 assistance under this subchapter.
8-22 SECTION 1.06. Subchapter B, Chapter 61, Health and Safety
8-23 Code, is amended by adding Section 61.0235 to read as follows:
8-24 Sec. 61.0235. COUNTY JAIL INMATES. (a) A county may elect
8-25 to treat as eligible county residents the inmates of a county jail
8-26 in the county who satisfy the eligibility requirements applicable
8-27 in the county under Sections 61.023(a)(2) and (3) or (b), but who:
9-1 (1) do not reside in the county; or
9-2 (2) reside in the service area of a public hospital or
9-3 hospital district in the county.
9-4 (b) A county that elects to treat inmates as eligible county
9-5 residents under Subsection (a) must waive any right to
9-6 reimbursement from other counties or from public hospitals or
9-7 hospital districts in whose service areas the inmates reside.
9-8 (c) A county may credit the services provided to each inmate
9-9 who is treated as an eligible county resident under Subsection (a)
9-10 toward eligibility for state assistance under this subchapter.
9-11 SECTION 1.07. Section 61.025(d), Health and Safety Code, is
9-12 amended to read as follows:
9-13 (d) Expenditures made by the county under Subsection (b) may
9-14 be credited toward eligibility for state assistance under this
9-15 subchapter if the person who received the health care services
9-16 meets the eligibility standards established under Section 61.052
9-17 [Sections 61.006 and 61.008] and would have been eligible for
9-18 assistance under the county program if the person had not resided
9-19 in a public hospital's service area.
9-20 SECTION 1.08. Section 61.028, Health and Safety Code, is
9-21 amended to read as follows:
9-22 Sec. 61.028. BASIC [MANDATORY] HEALTH CARE SERVICES. (a) A
9-23 county shall, in accordance with department rules adopted under
9-24 Section 61.006, provide the following basic health care services:
9-25 (1) primary and preventative services designed to meet
9-26 the needs of the community, including:
9-27 (A) immunizations;
10-1 (B) medical screening services; and
10-2 (C) annual physical examinations;
10-3 (2) inpatient and outpatient hospital services;
10-4 (3) health clinics, including [(2)] rural health
10-5 clinics, if appropriate;
10-6 (4) [(3)] laboratory and X-ray services;
10-7 (5) [(4)] family planning services;
10-8 (6) [(5)] physician services;
10-9 (7) [(6)] payment for not more than three prescription
10-10 drugs a month; and
10-11 (8) [(7)] skilled nursing facility services,
10-12 regardless of the patient's age.
10-13 (b) The county may provide additional health care services,
10-14 but may not credit the assistance toward eligibility for state
10-15 assistance, except as provided by Section 61.0285.
10-16 SECTION 1.09. Subchapter B, Chapter 61, Health and Safety
10-17 Code, is amended by adding Section 61.0285 to read as follows:
10-18 Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In
10-19 addition to basic health care services provided under Section
10-20 61.028, a county may, in accordance with department rules adopted
10-21 under Section 61.006, provide other medically necessary services or
10-22 supplies that the county determines to be cost-effective,
10-23 including:
10-24 (1) ambulatory surgical center services;
10-25 (2) diabetic and colostomy medical supplies and
10-26 equipment;
10-27 (3) durable medical equipment;
11-1 (4) home and community health care services;
11-2 (5) services provided by licensed master medical
11-3 social workers--advanced clinical practitioners;
11-4 (6) psychological counseling services;
11-5 (7) services provided by physician assistants, nurse
11-6 practitioners, certified nurse midwives, clinical nurse
11-7 specialists, and certified registered nurse anesthetists;
11-8 (8) dental care;
11-9 (9) vision care, including eyeglasses; and
11-10 (10) any other appropriate health care service
11-11 identified by board rule that may be determined to be
11-12 cost-effective.
11-13 (b) A county must notify the department of the county's
11-14 intent to provide services specified by Subsection (a). If the
11-15 services are approved by the department under Section 61.006, or if
11-16 the department fails to notify the county of the department's
11-17 disapproval before the 31st day after the date the county notifies
11-18 the department of its intent to provide the services, the county
11-19 may credit the services toward eligibility for state assistance
11-20 under this subchapter.
11-21 (c) A county may provide health care services that are not
11-22 specified in Subsection (a), or may provide the services specified
11-23 in Subsection (a) without actual or constructive approval of the
11-24 department, but may not credit the services toward eligibility for
11-25 state assistance.
11-26 SECTION 1.10. Section 61.031(b), Health and Safety Code, is
11-27 amended to read as follows:
12-1 (b) If the county does not require prior approval and a
12-2 provider delivers or will deliver nonemergency health care services
12-3 to a patient who the provider suspects may be eligible for
12-4 assistance under this subchapter, the provider shall notify the
12-5 patient's county of residence that health care services have been
12-6 or will be provided to the patient. The notice shall be made:
12-7 (1) by telephone not later than the 72nd hour [as soon
12-8 as possible] after the provider determines the patient's county of
12-9 residence; and
12-10 (2) by mail postmarked not later than the fifth
12-11 [third] working day after the date on which the provider determines
12-12 the patient's county of residence.
12-13 SECTION 1.11. Section 61.032(a), Health and Safety Code, is
12-14 amended to read as follows:
12-15 (a) If a nonmandated provider delivers emergency services to
12-16 a patient who the provider suspects might be eligible for
12-17 assistance under this subchapter, the provider shall notify the
12-18 patient's county of residence that emergency services have been or
12-19 will be provided to the patient. The notice shall be made:
12-20 (1) by telephone not later than the 72nd hour [as soon
12-21 as possible] after the provider determines the patient's county of
12-22 residence; and
12-23 (2) by mail postmarked not later than the fifth
12-24 [third] working day after the date on which the provider determines
12-25 the patient's county of residence.
12-26 SECTION 1.12. Section 61.034, Health and Safety Code, is
12-27 amended to read as follows:
13-1 Sec. 61.034. PAYMENT STANDARDS FOR [MANDATORY] HEALTH CARE
13-2 SERVICES. (a) A county is not liable for the cost of a
13-3 [mandatory] health care service provided under Section 61.028 or
13-4 61.0285 that is in excess of the payment standards for that service
13-5 established by the department under Section 61.006.
13-6 (b) A county may contract with a provider of assistance to
13-7 provide a health care service at a rate below the payment standard
13-8 set by the department.
13-9 SECTION 1.13. Section 61.036(b), Health and Safety Code, is
13-10 amended to read as follows:
13-11 (b) Except as provided by Section 61.023(b), a [A] county
13-12 may not credit an expenditure for an applicant toward eligibility
13-13 for state assistance if the applicant does not meet the
13-14 department's eligibility standards.
13-15 SECTION 1.14. Sections 61.037, 61.038, and 61.039, Health
13-16 and Safety Code, are amended to read as follows:
13-17 Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a)
13-18 The department may distribute funds as provided by this subchapter
13-19 to eligible counties to assist the counties in providing
13-20 [mandatory] health care services under Sections 61.028 and 61.0285
13-21 to their eligible county residents.
13-22 (b) Except as provided by Subsection (c), (d), [or] (e), or
13-23 (g), to be eligible for state assistance, a county must:
13-24 (1) spend in a state fiscal year at least eight [10]
13-25 percent of the county general revenue levy for that year to provide
13-26 [mandatory] health care services described by Subsection (a) to its
13-27 eligible county residents who qualify for assistance under Section
14-1 61.023 [61.006]; and
14-2 (2) notify the department, not later than the seventh
14-3 day after the date on which the county reaches the expenditure
14-4 level, that the county has spent at least six [eight] percent of
14-5 the applicable 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].
14-9 (c) If a county and a health care provider signed a contract
14-10 on or before January 1, 1985, under which the provider agrees to
14-11 furnish a certain level of health care services to indigent
14-12 persons, the value of services furnished in a state fiscal year
14-13 under the contract is included as part of the computation of a
14-14 county expenditure under this section if the value of services does
14-15 not exceed the payment rate established by the department under
14-16 Section 61.006.
14-17 (d) If a hospital district is located in part but not all of
14-18 a county, that county's appraisal district shall determine the
14-19 taxable value of the property located inside the county but outside
14-20 the hospital district. In determining eligibility for state
14-21 assistance, that county shall consider only the county general
14-22 revenue levy resulting from the property located outside the
14-23 hospital district. A county is eligible for state assistance if:
14-24 (1) the county spends in a state fiscal year at least
14-25 eight [10] percent of the county general revenue levy for that year
14-26 resulting from the property located outside the hospital district
14-27 to provide [mandatory] health care services described by Subsection
15-1 (a) to its eligible county residents who qualify for assistance
15-2 under Section 61.023 [61.006]; and
15-3 (2) the county complies with the other requirements of
15-4 this subchapter.
15-5 (e) A county that provides [mandatory] health care services
15-6 described by Subsection (a) to its eligible residents through a
15-7 hospital established by a board of managers jointly appointed by a
15-8 county and a municipality under Section 265.011 is eligible for
15-9 state assistance if:
15-10 (1) the county spends in a state fiscal year at least
15-11 eight [10] percent of the county general revenue levy for the year
15-12 to provide the [mandatory] health care services to its eligible
15-13 county residents who qualify for assistance under Section 61.052
15-14 [61.006]; and
15-15 (2) the county complies with the requirements of this
15-16 subchapter.
15-17 (f) If a county anticipates that it will reach the eight
15-18 [10] percent expenditure level, the county must notify the
15-19 department as soon as possible before the anticipated date on which
15-20 the county will reach the level.
15-21 (g) The department may waive the requirement that the county
15-22 meet the minimum expenditure level imposed by Subsection (b), (d),
15-23 or (e) and provide state assistance under this chapter at a lower
15-24 level determined by the department if the county demonstrates that
15-25 the county is unable to satisfy the eight percent expenditure
15-26 level:
15-27 (1) because, although the county's general revenue tax
16-1 levy has increased significantly, expenditures for health care
16-2 services described by Subsection (a) have not increased by the same
16-3 percentage;
16-4 (2) because the county is at the maximum allowable ad
16-5 valorem tax rate, has a small population, or has insufficient
16-6 taxable property; or
16-7 (3) because of a similar reason.
16-8 (h) The department shall adopt rules governing the
16-9 circumstances under which a waiver may be granted under Subsection
16-10 (g) and the procedures to be used by a county to apply for the
16-11 waiver. The procedures must provide that the department shall make
16-12 a determination with respect to an application for a waiver not
16-13 later than the 90th day after the date the application is submitted
16-14 to the department in accordance with the procedures established by
16-15 the department. To be eligible for state assistance under
16-16 Subsection (g), a county must submit monthly financial reports, in
16-17 the form required by the department, covering the 12-month period
16-18 preceding the date on which the assistance is sought.
16-19 (i) The county must give the department all necessary
16-20 information so that the department can determine if the county
16-21 meets the requirements of Subsection (b), (d), [or] (e), or (g).
16-22 Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the
16-23 department determines that a county is eligible for assistance, the
16-24 department shall distribute funds appropriated to the department
16-25 from the indigent health care assistance fund or any other
16-26 available fund to the county to assist the county in providing
16-27 [mandatory] health care services under Sections 61.028 and 61.0285
17-1 to its eligible county residents who qualify for assistance as
17-2 described by Section 61.037 [under Section 61.006].
17-3 (b) State funds provided under this section to a county must
17-4 be equal to at least 90 [80] percent of the actual payment for the
17-5 [mandatory] health care services for the county's eligible
17-6 residents during the remainder of the state fiscal year after the
17-7 eight [10] percent expenditure level is reached.
17-8 Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the
17-9 department fails to provide assistance to an eligible county as
17-10 prescribed by Section 61.038, the county is not liable for payments
17-11 for health care services provided to its eligible county residents
17-12 after the county reaches the eight [10] percent expenditure level.
17-13 SECTION 1.15. Section 61.041, Health and Safety Code, is
17-14 amended by amending Subsections (a) and (b) and adding Subsection
17-15 (d) to read as follows:
17-16 (a) The department shall establish monthly reporting
17-17 requirements for a county seeking state assistance and establish
17-18 procedures necessary to determine if the county is eligible for
17-19 state assistance.
17-20 (b) The department shall establish requirements relating to:
17-21 (1) documentation required to verify the eligibility
17-22 of residents to whom the county provides assistance; and
17-23 (2) county expenditures for [mandatory] health care
17-24 services under Sections 61.028 and 61.0285.
17-25 (d) The department shall establish annual reporting
17-26 requirements for each county that is required to provide indigent
17-27 health care under this chapter but that is not required to report
18-1 under Subsection (a). A county satisfies the annual reporting
18-2 requirement of this subsection if the county submits information to
18-3 the department as required by law to obtain an annual distribution
18-4 under the Agreement Regarding Disposition of Settlement Proceeds
18-5 filed on July 24, 1998, in the United States District Court,
18-6 Eastern District of Texas, in the case styled The State of Texas v.
18-7 The American Tobacco Co., et al., No. 5-96CV-91.
18-8 SECTION 1.16. Section 61.052, Health and Safety Code, is
18-9 amended by adding Subsection (g) to read as follows:
18-10 (g) A county that provides health care services to its
18-11 eligible residents through a hospital established by a board of
18-12 managers jointly appointed by a county and a municipality under
18-13 Section 265.011 and that establishes an income and resources
18-14 standard in accordance with Subsection (a)(2) may credit the
18-15 services provided to all persons who are eligible under that
18-16 standard toward eligibility for state assistance as described by
18-17 Section 61.037(e).
18-18 SECTION 1.17. Section 61.054(a), Health and Safety Code, is
18-19 amended to read as follows:
18-20 (a) A public hospital shall provide the basic health care
18-21 [inpatient and outpatient hospital] services a county is required
18-22 to provide under Section 61.028 [61.028(a)(1)].
18-23 SECTION 1.18. Section 61.055, Health and Safety Code, is
18-24 amended to read as follows:
18-25 Sec. 61.055. SERVICES PROVIDED BY HOSPITAL DISTRICTS. A
18-26 hospital district shall provide the basic health care services a
18-27 county is required to provide under Section 61.028, together with
19-1 any other services required under the Texas Constitution and the
19-2 statute creating the district.
19-3 SECTION 1.19. Section 61.058(b), Health and Safety Code, is
19-4 amended to read as follows:
19-5 (b) If the public hospital does not require prior approval
19-6 and a provider delivers or will deliver nonemergency health care
19-7 services to a patient who the provider suspects might be eligible
19-8 for assistance under this subchapter, the provider shall notify the
19-9 hospital that health care services have been or will be provided to
19-10 the patient. The notice shall be made:
19-11 (1) by telephone not later than the 72nd hour [as soon
19-12 as possible] after the provider determines that the patient resides
19-13 in the hospital's service area; and
19-14 (2) by mail postmarked not later than the fifth
19-15 [third] working day after the date on which the provider determines
19-16 that the patient resides in the hospital's service area.
19-17 SECTION 1.20. Section 61.059(a), Health and Safety Code, is
19-18 amended to read as follows:
19-19 (a) If a nonmandated provider delivers emergency services to
19-20 a patient who the provider suspects might be eligible for
19-21 assistance under this subchapter, the provider shall notify the
19-22 hospital that emergency services have been or will be provided to
19-23 the patient. The notice shall be made:
19-24 (1) by telephone not later than the 72nd hour [as soon
19-25 as possible] after the provider determines that the patient resides
19-26 in the hospital's service area; and
19-27 (2) by mail postmarked not later than the fifth
20-1 [third] working day after the date on which the provider determines
20-2 that the patient resides in the hospital's service area.
20-3 SECTION 1.21. Section 61.062, Health and Safety Code, is
20-4 amended to read as follows:
20-5 Sec. 61.062. RESPONSIBILITY OF GOVERNMENTAL ENTITY. A
20-6 governmental entity that owns, operates, or leases a public
20-7 hospital shall provide sufficient funding to the hospital to
20-8 provide basic [mandatory] health care services [assistance].
20-9 SECTION 1.22. Section 61.064(a), Health and Safety Code, is
20-10 amended to read as follows:
20-11 (a) A governmental entity that owns, operates, or leases a
20-12 public hospital and that closes, sells, or leases the hospital:
20-13 (1) has the obligation to provide basic [mandatory]
20-14 health care services [assistance] under this chapter;
20-15 (2) shall adopt the eligibility standards that the
20-16 hospital was or would have been required to adopt; and
20-17 (3) shall provide the same services the hospital was
20-18 or would have been required to provide under this chapter on the
20-19 date of the closing, sale, or lease.
20-20 SECTION 1.23. Section 531.204(b), Government Code, is
20-21 amended to read as follows:
20-22 (b) The report must include:
20-23 (1) identification of significant problems in the
20-24 Texas Integrated Enrollment Services, with recommendations for
20-25 action by the commissioner;
20-26 (2) the status of the effectiveness of the Texas
20-27 Integrated Enrollment Services in providing necessary services to
21-1 the people of this state, with recommendations for any necessary
21-2 research;
21-3 (3) an analysis of the feasibility of including
21-4 indigent health care programs provided by counties, public
21-5 hospitals, and hospital districts in the Texas Integrated
21-6 Enrollment Services, a schedule for inclusion of these programs,
21-7 and a statement of how the Texas Integrated Enrollment Services may
21-8 be structured to address the wide variation in information systems
21-9 used by counties, public hospitals, and hospital districts; and
21-10 (4) [(3)] recommendations for legislative action.
21-11 SECTION 1.24. Chapter 26, Tax Code, is amended by adding
21-12 Section 26.0441 to read as follows:
21-13 Sec. 26.0441. TAX RATE ADJUSTMENT FOR INDIGENT HEALTH CARE.
21-14 (a) In the first tax year in which a taxing unit adopts a tax rate
21-15 after January 1, 2000, and in which the enhanced minimum
21-16 eligibility standards for indigent health care established under
21-17 Section 61.006, Health and Safety Code, apply to the taxing unit,
21-18 the effective maintenance and operations rate for the taxing unit
21-19 is increased by the rate computed according to the following
21-20 formula:
21-21 Enhanced Indigent Health Care Expenditures
21-22 Amount of Increase = __________________________________________
21-23 (Current Total Value - New Property Value)
21-24 (b) In each subsequent tax year, if the taxing unit's
21-25 enhanced indigent health care expenses exceed the amount of those
21-26 expenses for the preceding year, the effective maintenance and
21-27 operations rate for the taxing unit is increased by the rate
22-1 computed according to the following formula:
22-2 (Current Tax Year's Enhanced Indigent
22-3 Health Care Expenditures - Preceding Tax
22-4 Year's Indigent Health Care Expenditures)
22-5 Amount of Increase = __________________________________________
22-6 (Current Total Value - New Property Value)
22-7 (c) The taxing unit shall include a notice of the increase
22-8 in its effective maintenance and operations rate provided by this
22-9 section, including a brief description and the amount of the
22-10 enhanced indigent health care expenditures, in the information
22-11 published under Section 26.04(e) and, if applicable, Section
22-12 26.06(b).
22-13 (d) In this section, "enhanced indigent health care
22-14 expenditures" for a tax year means the amount spent by the taxing
22-15 unit for the maintenance and operation costs of providing indigent
22-16 health care at the increased minimum eligibility standards
22-17 established under Section 61.006, Health and Safety Code, effective
22-18 on or after January 1, 2000, in the period beginning on July 1 of
22-19 the year preceding the tax year for which the tax is adopted and
22-20 ending on June 30 of the tax year for which the tax is adopted,
22-21 less the amount of state assistance received by the taxing unit in
22-22 accordance with Chapter 61, Health and Safety Code, that is
22-23 attributable to those costs.
22-24 (e) In the 2000 and 2001 tax years, a taxing unit's enhanced
22-25 indigent health care expenditures for the 2000 tax year are
22-26 computed under Subsection (d) using the taxing unit's expenditures
22-27 for the maintenance and operation costs of providing indigent
23-1 health care at the increased minimum eligibility standards
23-2 described by Subsection (d) for the period beginning on January 1,
23-3 2000, and ending on June 30, 2000, instead of for the period
23-4 described by Subsection (d). This subsection expires January 1,
23-5 2002.
23-6 SECTION 1.25. (a) The change in law made by this article to
23-7 Chapter 61, Health and Safety Code, applies only to:
23-8 (1) health care services under Chapter 61, Health and
23-9 Safety Code, as amended by this article, that are delivered on or
23-10 after January 1, 2000; and
23-11 (2) state assistance under Chapter 61, Health and
23-12 Safety Code, as amended by this article, for the services described
23-13 by Subdivision (1) of this subsection.
23-14 (b) Health care services under Chapter 61, Health and Safety
23-15 Code, as amended by this article, that are delivered before January
23-16 1, 2000, and state assistance for those services are governed by
23-17 the law as it existed immediately before that date and that law is
23-18 continued in effect for this purpose.
23-19 SECTION 1.26. The Texas Department of Health shall study the
23-20 feasibility of requiring or permitting a county, public hospital,
23-21 and hospital district to issue a uniform identification card to an
23-22 eligible county resident or eligible service area resident, as
23-23 appropriate, that identifies the resident as eligible for health
23-24 care assistance under Chapter 61, Health and Safety Code. Not
23-25 later than December 15, 2000, the department shall report the
23-26 results of its study to the governor, lieutenant governor, and
23-27 speaker of the house of representatives.
24-1 ARTICLE 2. TERTIARY CARE
24-2 SECTION 2.01. Subtitle B, Title 2, Health and Safety Code,
24-3 is amended by adding Chapter 46 to read as follows:
24-4 CHAPTER 46. TERTIARY MEDICAL CARE
24-5 Sec. 46.001. DEFINITIONS. In this chapter:
24-6 (1) "Tertiary care facility" means a:
24-7 (A) primary teaching hospital of a medical
24-8 school;
24-9 (B) level 1 trauma center;
24-10 (C) level 2 trauma center; or
24-11 (D) level 3 trauma center.
24-12 (2) "Tertiary medical services" includes services
24-13 provided by burn centers and neonatology Level III units, pediatric
24-14 and trauma surgery, neurosurgery, cardiothoracic and vascular
24-15 surgery, organ transplant, services provided for a life-threatening
24-16 dermatologic illness, services provided to a person with a high
24-17 risk pregnancy or cancer, and radiation oncology.
24-18 (3) "Unreimbursed tertiary medical service" means a
24-19 tertiary medical service for which a tertiary care facility has not
24-20 received from any public or private source any payment that is
24-21 directly attributable to the particular service.
24-22 Sec. 46.002. RULES. The board may adopt rules to implement
24-23 this chapter.
24-24 Sec. 46.003. TERTIARY CARE FACILITY ACCOUNT. (a) The
24-25 tertiary care facility account is an account in the state treasury.
24-26 Money in the account may be appropriated only to the department for
24-27 the purposes of this chapter.
25-1 (b) The account is composed of money appropriated to the
25-2 account and any other funds required to be put in the account.
25-3 (c) The department may seek and accept gifts, grants, and
25-4 donations from any public or private entity on behalf of the
25-5 account.
25-6 (d) Section 403.095, Government Code, does not apply to the
25-7 account.
25-8 (e) For each fiscal year, five percent of the total amount
25-9 in the account shall be held in reserve and may be used only to pay
25-10 for unreimbursed tertiary medical services provided as a result of
25-11 extraordinary emergencies occurring during that year in accordance
25-12 with this chapter. Of the amount remaining, not more than five
25-13 percent may be used for the costs of administering the account.
25-14 Sec. 46.004. COLLECTION OF INFORMATION. (a) A tertiary
25-15 care facility that seeks payment under this chapter shall submit to
25-16 the department, in the manner and at the time required by the
25-17 department, information that relates to the unreimbursed tertiary
25-18 medical services provided to persons who reside outside the service
25-19 area of the county, public hospital, or hospital district that is
25-20 responsible for indigent health care under Chapter 61 in the area
25-21 in which the tertiary care facility is located.
25-22 (b) The board shall adopt rules governing the collection of
25-23 the information under Subsection (a).
25-24 Sec. 46.005. CERTIFICATION TO COMPTROLLER. (a) The
25-25 department shall certify to the comptroller for each tertiary care
25-26 facility the cost of unreimbursed tertiary medical services
25-27 provided by the facility to persons who reside outside the service
26-1 area of the county, public hospital, or hospital district that is
26-2 responsible for indigent health care under Chapter 61 in the area
26-3 in which the tertiary care facility is located.
26-4 (b) Each year the department shall make, for a facility that
26-5 was a designated tertiary care facility during the previous year,
26-6 an initial certification to the comptroller under Subsection (a) in
26-7 an amount that equals 80 percent of the amount certified under this
26-8 section for the facility in the previous year. The department shall
26-9 make a subsequent certification of the cost of additional
26-10 unreimbursed tertiary medical services provided by the facility on
26-11 receipt from the facility of the information required to be
26-12 submitted under Section 46.004.
26-13 (c) If in any year the total cost of unreimbursed tertiary
26-14 medical services certified under Subsection (a) for all tertiary
26-15 care facilities exceeds the amount available for payment to the
26-16 facilities under Section 46.003(e), the department shall allocate
26-17 the amount available under Section 46.003(e) to each facility based
26-18 on the percentages computed by dividing the cost of the facility's
26-19 unreimbursed tertiary medical services by the total cost of all
26-20 facilities' unreimbursed tertiary medical services.
26-21 (d) For purposes of this section and Section 46.006, the
26-22 cost of each unreimbursed tertiary medical service provided is the
26-23 average amount payable under Medicare for services for the
26-24 Medicare diagnosis related groups applicable to the tertiary
26-25 medical services provided by a tertiary care facility.
26-26 Sec. 46.006. CERTIFICATION OF EMERGENCIES. (a) For
26-27 purposes of reimbursing extraordinary emergencies under this
27-1 chapter, the department shall certify an extraordinary emergency:
27-2 (1) if the governor issues an executive order or a
27-3 proclamation under Chapter 418, Government Code;
27-4 (2) if a disaster is declared by the president of the
27-5 United States under the Robert T. Stafford Disaster Relief and
27-6 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
27-7 (3) for another similar disaster the department finds
27-8 has resulted in an extraordinary cost to a tertiary care facility.
27-9 (b) If an extraordinary emergency is declared under
27-10 Subsection (a), the department shall certify to the comptroller the
27-11 amount of unreimbursed tertiary medical services incurred by a
27-12 tertiary care facility during the emergency.
27-13 (c) The comptroller shall pay the tertiary care facility.
27-14 ARTICLE 3. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM
27-15 SECTION 3.01. FEDERAL AUTHORIZATION. It is the intent of
27-16 the 76th Legislature that:
27-17 (1) the Health and Human Services Commission or an
27-18 appropriate health and human services agency continue to pursue the
27-19 waiver or other authorization described by Section 4, Chapter 444,
27-20 Acts of the 74th Legislature, Regular Session, 1995;
27-21 (2) the waiver or other authorization apply to
27-22 expansion of Medicaid eligibility, as described by Section 532.102,
27-23 Government Code, for both children and their families and other
27-24 adults; and
27-25 (3) the Health and Human Services Commission take any
27-26 other appropriate action authorized under law to accomplish the
27-27 expansion of Medicaid eligibility, as described by Section 532.102,
28-1 Government Code, for children and their families and for other
28-2 adults.
28-3 ARTICLE 4. STUDY RELATING TO BASIC HEALTH CARE SERVICES
28-4 AND STATE ASSISTANCE
28-5 SECTION 4.01. STUDY. The Texas Department of Health shall:
28-6 (1) study the provision of basic health care services
28-7 by counties, hospital districts, and public hospitals under Chapter
28-8 61, Health and Safety Code, and the cost of providing those
28-9 services; and
28-10 (2) study the threshold for eligibility for state
28-11 assistance to a county established under Section 61.037, Health and
28-12 Safety Code, and develop a threshold to replace that threshold that
28-13 is stated as a formula and that reflects:
28-14 (A) a county's fiscal capacity;
28-15 (B) a county's health care resources; and
28-16 (C) the relevant characteristics of the county's
28-17 residents, including the percentage of the county's residents
28-18 living below the federal poverty level.
28-19 SECTION 4.02. REPORT. Not later than December 1, 2000, the
28-20 Texas Department of Health shall submit a written report of the
28-21 study conducted under this article to the governor, lieutenant
28-22 governor, and speaker of the house of representatives. The report
28-23 must include the recommendations of the department, together with
28-24 the proposed eligibility threshold described by Section 4.01(2) of
28-25 this article.
28-26 SECTION 4.03. EXPIRATION. This article expires August 31,
28-27 2001.
29-1 ARTICLE 5. PILOT PROGRAM FOR REGIONAL HEALTH CARE
29-2 DELIVERY SYSTEM
29-3 SECTION 5.01. DEFINITIONS. In this article:
29-4 (1) "Commissioner" means the commissioner of health
29-5 and human services.
29-6 (2) "Pilot program" means the regional health care
29-7 delivery system pilot program established under this article.
29-8 SECTION 5.02. PILOT PROGRAM. (a) Not later than January 1,
29-9 2000, the commissioner shall establish a regional health care
29-10 delivery system pilot program to coordinate the use of health care
29-11 resources in a region of the state. The pilot program must:
29-12 (1) emphasize prevention services, continuity of care,
29-13 and the provision of a medical home for clients;
29-14 (2) maximize the use of local and state funds by
29-15 obtaining any available federal matching funds;
29-16 (3) be designed to result in long-term cost savings to
29-17 the participating entities;
29-18 (4) simplify eligibility criteria and streamline
29-19 eligibility determinations; and
29-20 (5) improve accountability of indigent health care
29-21 dollars.
29-22 (b) The commissioner may adopt rules as necessary to
29-23 implement the pilot program. The rules may provide an alternative
29-24 funding structure to the funding structure established under
29-25 Chapter 61, Health and Safety Code.
29-26 (c) The commissioner may not require a county, public
29-27 hospital, hospital district, or other entity to participate in the
30-1 pilot program.
30-2 SECTION 5.03. REPORT. (a) Not later than January 1, 2003,
30-3 the commissioner shall submit a written report relating to the
30-4 pilot program to the governor, lieutenant governor, and speaker of
30-5 the house of representatives.
30-6 (b) The report must include:
30-7 (1) an analysis of:
30-8 (A) the quality of health care services provided
30-9 under the pilot program; and
30-10 (B) the cost-effectiveness of providing health
30-11 care services through the pilot program; and
30-12 (2) recommendations for legislation for implementing
30-13 regional health care delivery systems in this state, including
30-14 recommendations relating to:
30-15 (A) the structure of a regional entity to
30-16 administer a regional health care delivery system;
30-17 (B) the manner in which state assistance money
30-18 may most effectively be distributed to support a regional health
30-19 care delivery system; and
30-20 (C) any other matter necessary to implement
30-21 effective and efficient regional health care delivery systems in
30-22 this state.
30-23 SECTION 5.04. EXPIRATION; TERMINATION OF PILOT PROGRAM.
30-24 This section expires and the pilot program is terminated August 31,
30-25 2003.
30-26 ARTICLE 6. EFFECTIVE DATE; EMERGENCY
30-27 SECTION 6.01. EFFECTIVE DATE. This Act takes effect
31-1 September 1, 1999.
31-2 SECTION 6.02. EMERGENCY. The importance of this legislation
31-3 and the crowded condition of the calendars in both houses create an
31-4 emergency and an imperative public necessity that the
31-5 constitutional rule requiring bills to be read on three several
31-6 days in each house be suspended, and this rule is hereby suspended.