1-1 By: Coleman, Farabee, et al. H.B. No. 1398
1-2 (Senate Sponsor - Zaffirini)
1-3 (In the Senate - Received from the House May 7, 1999;
1-4 May 10, 1999, read first time and referred to Committee on Finance;
1-5 May 13, 1999, reported favorably, as amended, by the following
1-6 vote: Yeas 9, Nays 0; May 13, 1999, sent to printer.)
1-7 COMMITTEE AMENDMENT NO. 1 By: Lindsay
1-8 Amend H.B. 1398, Subchapter C, Chapter 281, Health and Safety Code,
1-9 Section 281.0514(a) on page 9, line 34, by deleting "shall" and
1-10 inserting "may"
1-11 COMMITTEE AMENDMENT NO. 2 By: Truan
1-12 Amend H.B. 1398 as follows:
1-13 (1) On page 5, line 20, strike "and".
1-14 (2) On page 5, between lines 20 and 21, insert:
1-15 (10) services provided by federally qualified health
1-16 centers, as defined by 42 U.S.C. Section 1396d(l)(2)(B); and
1-17 (3) On page 5, line 21, strike "(10)" and substitute "(11)".
1-18 A BILL TO BE ENTITLED
1-19 AN ACT
1-20 relating to indigent health care.
1-21 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-22 ARTICLE 1. DELIVERY OF INDIGENT HEALTH CARE BY COUNTIES, PUBLIC
1-23 HOSPITALS, AND HOSPITAL DISTRICTS
1-24 SECTION 1.01. Section 61.002, Health and Safety Code, is
1-25 amended to read as follows:
1-26 Sec. 61.002. DEFINITIONS. In this chapter:
1-27 (1) ["AFDC" means the Aid to Families with Dependent
1-28 Children program administered by the Texas Department of Human
1-29 Services under Chapter 31, Human Resources Code.]
1-30 [(2)] "Department" means the Texas Department of
1-31 Health.
1-32 (2) [(3)] "Eligible county resident" means an eligible
1-33 resident of a county who does not reside in the service area of a
1-34 public hospital or hospital district.
1-35 (3) [(4)] "Eligible resident" means a person who meets
1-36 the income and resources requirements established by this chapter
1-37 or by the governmental entity, public hospital, or hospital
1-38 district in whose jurisdiction the person resides.
1-39 (4) [(5)] "Emergency services" has the meaning
1-40 assigned by Chapter 773.
1-41 (5) [(6)] "General revenue levy" means:
1-42 (A) the property taxes imposed by a county that
1-43 are not dedicated to the construction and maintenance of
1-44 farm-to-market roads or to flood control under Article VIII,
1-45 Section 1-a, of the Texas Constitution or that are not dedicated to
1-46 the further maintenance of the public roads under Article VIII,
1-47 Section 9, of the Texas Constitution; and
1-48 (B) the sales and use tax revenue to be received
1-49 by the county during the calendar year in which the state fiscal
1-50 year begins under Chapter 323, Tax Code, as determined under
1-51 Section 26.041(d), Tax Code.
1-52 (6) [(7)] "Governmental entity" includes a county,
1-53 municipality, or other political subdivision of the state, but does
1-54 not include a hospital district or hospital authority.
1-55 (7) [(8)] "Hospital district" means a hospital
1-56 district created under the authority of Article IX, Sections 4-11,
1-57 of the Texas Constitution.
1-58 (8) [(9)] "Mandated provider" means a person who
1-59 provides health care services, is selected by a county, public
1-60 hospital, or hospital district, and agrees to provide health care
1-61 services to eligible residents.
2-1 (9) [(10)] "Medicaid" means the medical assistance
2-2 program provided under Chapter 32, Human Resources Code.
2-3 (10) [(11)] "Public hospital" means a hospital owned,
2-4 operated, or leased by a governmental entity, except as provided by
2-5 Section 61.051.
2-6 (11) [(12)] "Service area" means the geographic region
2-7 in which a governmental entity, public hospital, or hospital
2-8 district has a legal obligation to provide health care services.
2-9 SECTION 1.02. Section 61.004, Health and Safety Code, is
2-10 amended to read as follows:
2-11 Sec. 61.004. RESIDENCE OR ELIGIBILITY DISPUTE. (a) If a
2-12 provider of assistance and a governmental entity or hospital
2-13 district cannot agree on a person's residence or whether a person
2-14 is eligible for assistance under this chapter, the provider or the
2-15 governmental entity or hospital district may submit the matter to
2-16 the department.
2-17 (b) The provider of assistance and the governmental entity
2-18 or hospital district shall submit all relevant information to the
2-19 department in accordance with the application, documentation, and
2-20 verification procedures established by the department under Section
2-21 61.006.
2-22 (c) If the department determines that another governmental
2-23 entity or hospital district may be involved in the dispute, the
2-24 department shall notify the governmental entity or hospital
2-25 district and allow the governmental entity or hospital district to
2-26 respond.
2-27 (d) From the information submitted, the department shall
2-28 determine the person's residence or whether the person is eligible
2-29 for assistance under this chapter, as appropriate, and shall notify
2-30 each governmental entity or hospital district and the provider of
2-31 assistance of the decision and the reasons for the decision.
2-32 (e) If a governmental entity, hospital district, or provider
2-33 of assistance does not agree with the department's decision, the
2-34 governmental entity, hospital district, or provider of assistance
2-35 may file an appeal with the department. The appeal must be filed
2-36 not later than the 30th day after the date on which the
2-37 governmental entity, hospital district, or provider of assistance
2-38 receives notice of the decision.
2-39 (f) The department shall issue a final decision not later
2-40 than the 45th [21st] day after the date on which the appeal is
2-41 filed.
2-42 (g) A governmental entity, hospital district, or provider of
2-43 assistance may appeal the final order of the department under
2-44 Chapter 2001, Government Code, using the substantial evidence rule
2-45 on appeal.
2-46 (h) Service may not be denied pending an administrative or
2-47 judicial review of residence.
2-48 SECTION 1.03. Subchapter A, Chapter 61, Health and Safety
2-49 Code, is amended by adding Section 61.0045 to read as follows:
2-50 Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE
2-51 ELIGIBILITY. (a) Any provider, including a mandated provider,
2-52 public hospital, or hospital district, that delivers health care
2-53 services to a patient who the provider suspects is an eligible
2-54 resident of the service area of a county, hospital district, or
2-55 public hospital under this chapter may require the patient to:
2-56 (1) provide any information necessary to establish
2-57 that the patient is an eligible resident of the service area of the
2-58 county, hospital district, or public hospital; and
2-59 (2) authorize the release of any information relating
2-60 to the patient, including medical information and information
2-61 obtained under Subdivision (1), to permit the provider to submit a
2-62 claim to the county, hospital district, or public hospital that is
2-63 liable for payment for the services as described by Section 61.033
2-64 or 61.060.
2-65 (b) A county, hospital district, or public hospital that
2-66 receives information obtained under Subsection (a) shall use the
2-67 information to determine whether the patient to whom services were
2-68 provided is an eligible resident of the service area of the county,
2-69 hospital district, or public hospital and, if so, shall pay the
3-1 claim made by the provider in accordance with this chapter.
3-2 (c) The application, documentation, and verification
3-3 procedures established by the department for counties under Section
3-4 61.006 may include a standard format for obtaining information
3-5 under Subsection (a) to facilitate eligibility and residence
3-6 determinations.
3-7 SECTION 1.04. Sections 61.006 and 61.007, Health and Safety
3-8 Code, are amended to read as follows:
3-9 Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department
3-10 shall establish minimum eligibility standards and application,
3-11 documentation, and verification procedures for counties to use in
3-12 determining eligibility under this chapter.
3-13 (b) The minimum eligibility standards must incorporate a net
3-14 income eligibility level equal to 25 percent of the federal poverty
3-15 level based on the federal Office of Management and Budget poverty
3-16 index [and procedures must be consistent with the standards and
3-17 procedures used by the Texas Department of Human Services to
3-18 determine eligibility in the AFDC-Medicaid program].
3-19 (b-1) Notwithstanding Subsection (b), effective January 1,
3-20 2000, the minimum eligibility standards must incorporate a net
3-21 income eligibility level equal to 17 percent of the federal poverty
3-22 level based on the federal Office of Management and Budget poverty
3-23 index. This subsection expires December 31, 2000.
3-24 (b-2) Notwithstanding Subsection (b), effective January 1,
3-25 2001, the minimum eligibility standards must incorporate a net
3-26 income eligibility level equal to 21 percent of the federal poverty
3-27 level based on the federal Office of Management and Budget poverty
3-28 index. This subsection expires December 31, 2001.
3-29 (c) The department shall also define the services and
3-30 establish the payment standards for the categories of services
3-31 listed in Sections [Section] 61.028(a) and 61.0285 in accordance
3-32 with Texas Department of Human Services rules relating to the
3-33 Temporary Assistance for Needy Families-Medicaid [AFDC-Medicaid]
3-34 program.
3-35 (d) The department shall establish application,
3-36 documentation, and verification procedures that are consistent with
3-37 the analogous procedures used to determine eligibility in the
3-38 Temporary Assistance for Needy Families-Medicaid program. The
3-39 [(b) The department may simplify the AFDC-Medicaid standards
3-40 and procedures used by the Texas Department of Human Services as
3-41 necessary to provide efficient county administration. In
3-42 establishing simplified standards and procedures for county
3-43 administration, the] department may not adopt a standard or
3-44 procedure that is more restrictive than the Temporary Assistance
3-45 for Needy Families-Medicaid program [AFDC-Medicaid standards] or
3-46 procedures.
3-47 (e) [(c)] The department shall ensure that each person who
3-48 meets the basic income and resources requirements for Temporary
3-49 Assistance for Needy Families program [AFDC] payments but who is
3-50 categorically ineligible for Temporary Assistance for Needy
3-51 Families [AFDC] will be eligible for assistance under Subchapter
3-52 B. Except as provided by Section 61.023(b), the [The] department by
3-53 rule shall also provide that a person who receives or is eligible
3-54 to receive Temporary Assistance for Needy Families, Supplemental
3-55 Security Income [AFDC, SSI], or Medicaid benefits is not eligible
3-56 for assistance under Subchapter B even if the person has exhausted
3-57 a part or all of that person's [AFDC, SSI, or Medicaid] benefits.
3-58 (f) [(d)] The department shall notify each county and public
3-59 hospital of any change to department rules [AFDC or Medicaid
3-60 guidelines] that affect the provision of services under this
3-61 chapter [and shall amend the rules adopted under this chapter to
3-62 reflect the changes made in the AFDC or Medicaid programs].
3-63 (g) [(e)] Notwithstanding Subsection (a), (b), or (c) or any
3-64 other provision of law, the department shall permit payment to a
3-65 licensed dentist for services provided under Sections 61.028(a)(4)
3-66 and (6) [61.028(a)(3) and (a)(5) to the extent that these services
3-67 are required by Section 61.028(a)(5)] if the dentist can provide
3-68 those services within the scope of the dentist's license.
3-69 (h) [(f)] Notwithstanding Subsection (a), (b), or (c), the
4-1 department shall permit payment to a licensed podiatrist for
4-2 services provided under Sections 61.028(a)(4) and (6) [61.028(a)(3)
4-3 and (a)(5) to the extent that the services are required by Section
4-4 61.028(a)(5)], if the podiatrist can provide the services within
4-5 the scope of the podiatrist's license.
4-6 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
4-7 department by rule shall require each applicant to provide at least
4-8 the following information:
4-9 (1) the applicant's full name and address;
4-10 (2) the applicant's social security number, if
4-11 available;
4-12 (3) the number of persons in the applicant's
4-13 household, excluding persons receiving Temporary Assistance for
4-14 Needy Families, Supplemental Security Income [AFDC, SSI], or
4-15 Medicaid benefits;
4-16 (4) the applicant's county of residence;
4-17 (5) the existence of insurance coverage or other
4-18 hospital or health care benefits for which the applicant is
4-19 eligible;
4-20 (6) any transfer of title to real property that the
4-21 applicant has made in the preceding 24 months;
4-22 (7) the applicant's annual household income, excluding
4-23 the income of any household member receiving Temporary Assistance
4-24 for Needy Families, Supplemental Security Income [AFDC, SSI], or
4-25 Medicaid benefits; and
4-26 (8) the amount of the applicant's liquid assets and
4-27 the equity value of the applicant's car and real property.
4-28 SECTION 1.05. Section 61.023(b), Health and Safety Code, is
4-29 amended to read as follows:
4-30 (b) A county may use a less restrictive standard of
4-31 eligibility for residents than prescribed by Subsection (a). A
4-32 county may credit toward eligibility for state assistance under
4-33 this subchapter the services provided to each person who is an
4-34 eligible resident under a standard that incorporates a net income
4-35 eligibility level that is less than 50 percent of the federal
4-36 poverty level based on the federal Office of Management and Budget
4-37 poverty index.
4-38 SECTION 1.06. Section 61.025(d), Health and Safety Code, is
4-39 amended to read as follows:
4-40 (d) Expenditures made by the county under Subsection (b) may
4-41 be credited toward eligibility for state assistance under this
4-42 subchapter if the person who received the health care services
4-43 meets the eligibility standards established under Section 61.052
4-44 [Sections 61.006 and 61.008] and would have been eligible for
4-45 assistance under the county program if the person had not resided
4-46 in a public hospital's service area.
4-47 SECTION 1.07. Section 61.028, Health and Safety Code, is
4-48 amended to read as follows:
4-49 Sec. 61.028. BASIC [MANDATORY] HEALTH CARE SERVICES. (a) A
4-50 county shall, in accordance with department rules adopted under
4-51 Section 61.006, provide the following basic health care services:
4-52 (1) primary and preventative services designed to meet
4-53 the needs of the community, including:
4-54 (A) immunizations;
4-55 (B) medical screening services; and
4-56 (C) annual physical examinations;
4-57 (2) inpatient and outpatient hospital services;
4-58 (3) [(2)] rural health clinics;
4-59 (4) [(3)] laboratory and X-ray services;
4-60 (5) [(4)] family planning services;
4-61 (6) [(5)] physician services;
4-62 (7) [(6)] payment for not more than three prescription
4-63 drugs a month; and
4-64 (8) [(7)] skilled nursing facility services,
4-65 regardless of the patient's age.
4-66 (b) The county may provide additional health care services,
4-67 but may not credit the assistance toward eligibility for state
4-68 assistance, except as provided by Section 61.0285.
4-69 SECTION 1.08. Subchapter B, Chapter 61, Health and Safety
5-1 Code, is amended by adding Section 61.0285 to read as follows:
5-2 Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In
5-3 addition to basic health care services provided under Section
5-4 61.028, a county may, in accordance with department rules adopted
5-5 under Section 61.006, provide other medically necessary services or
5-6 supplies that the county determines to be cost-effective,
5-7 including:
5-8 (1) ambulatory surgical center services;
5-9 (2) diabetic and colostomy medical supplies and
5-10 equipment;
5-11 (3) durable medical equipment;
5-12 (4) home and community health care services;
5-13 (5) services provided by licensed master medical
5-14 social workers--advanced clinical practitioners;
5-15 (6) psychological counseling services;
5-16 (7) services provided by physician assistants, nurse
5-17 practitioners, certified nurse midwives, clinical nurse
5-18 specialists, and certified registered nurse anesthetists;
5-19 (8) dental care;
5-20 (9) vision care, including eyeglasses; and
5-21 (10) any other appropriate health care service
5-22 identified by board rule that may be determined to be
5-23 cost-effective.
5-24 (b) A county must notify the department of the county's
5-25 intent to provide services specified by Subsection (a). If the
5-26 services are approved by the department under Section 61.006, or if
5-27 the department fails to notify the county of the department's
5-28 disapproval before the 31st day after the date the county notifies
5-29 the department of its intent to provide the services, the county
5-30 may credit the services toward eligibility for state assistance
5-31 under this subchapter.
5-32 (c) A county may provide health care services that are not
5-33 specified in Subsection (a), or may provide the services specified
5-34 in Subsection (a) without actual or constructive approval of the
5-35 department, but may not credit the services toward eligibility for
5-36 state assistance.
5-37 SECTION 1.09. Section 61.031(b), Health and Safety Code, is
5-38 amended to read as follows:
5-39 (b) If the county does not require prior approval and a
5-40 provider delivers or will deliver nonemergency health care services
5-41 to a patient who the provider suspects may be eligible for
5-42 assistance under this subchapter, the provider shall notify the
5-43 patient's county of residence that health care services have been
5-44 or will be provided to the patient. The notice shall be made:
5-45 (1) by telephone not later than the 72nd hour [as soon
5-46 as possible] after the provider determines the patient's county of
5-47 residence; and
5-48 (2) by mail postmarked not later than the fifth
5-49 [third] working day after the date on which the provider determines
5-50 the patient's county of residence.
5-51 SECTION 1.10. Section 61.032(a), Health and Safety Code, is
5-52 amended to read as follows:
5-53 (a) If a nonmandated provider delivers emergency services to
5-54 a patient who the provider suspects might be eligible for
5-55 assistance under this subchapter, the provider shall notify the
5-56 patient's county of residence that emergency services have been or
5-57 will be provided to the patient. The notice shall be made:
5-58 (1) by telephone not later than the 72nd hour [as soon
5-59 as possible] after the provider determines the patient's county of
5-60 residence; and
5-61 (2) by mail postmarked not later than the fifth
5-62 [third] working day after the date on which the provider determines
5-63 the patient's county of residence.
5-64 SECTION 1.11. Section 61.034, Health and Safety Code, is
5-65 amended to read as follows:
5-66 Sec. 61.034. PAYMENT STANDARDS FOR [MANDATORY] HEALTH CARE
5-67 SERVICES. (a) A county is not liable for the cost of a
5-68 [mandatory] health care service provided under Section 61.028 or
5-69 61.0285 that is in excess of the payment standards for that service
6-1 established by the department under Section 61.006.
6-2 (b) A county may contract with a provider of assistance to
6-3 provide a health care service at a rate below the payment standard
6-4 set by the department.
6-5 SECTION 1.12. Section 61.036(b), Health and Safety Code, is
6-6 amended to read as follows:
6-7 (b) Except as provided by Section 61.023(b), a [A] county
6-8 may not credit an expenditure for an applicant toward eligibility
6-9 for state assistance if the applicant does not meet the
6-10 department's eligibility standards.
6-11 SECTION 1.13. Sections 61.037, 61.038, and 61.039, Health
6-12 and Safety Code, are amended to read as follows:
6-13 Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a)
6-14 The department may distribute funds as provided by this subchapter
6-15 to eligible counties to assist the counties in providing
6-16 [mandatory] health care services under Sections 61.028 and 61.0285
6-17 to their eligible county residents.
6-18 (b) Except as provided by Subsection (c), (d), [or] (e), or
6-19 (g), to be eligible for state assistance, a county must:
6-20 (1) spend in a state fiscal year at least eight [10]
6-21 percent of the county general revenue levy for that year to provide
6-22 [mandatory] health care services described by Subsection (a) to its
6-23 eligible county residents who qualify for assistance under Section
6-24 61.023 [61.006]; and
6-25 (2) notify the department, not later than the seventh
6-26 day after the date on which the county reaches the expenditure
6-27 level, that the county has spent at least six [eight] percent of
6-28 the applicable county general revenue levy for that year to provide
6-29 [mandatory] health care services described by Subsection (a) to its
6-30 eligible county residents who qualify for assistance under Section
6-31 61.023 [61.006].
6-32 (c) If a county and a health care provider signed a contract
6-33 on or before January 1, 1985, under which the provider agrees to
6-34 furnish a certain level of health care services to indigent
6-35 persons, the value of services furnished in a state fiscal year
6-36 under the contract is included as part of the computation of a
6-37 county expenditure under this section if the value of services does
6-38 not exceed the payment rate established by the department under
6-39 Section 61.006.
6-40 (d) If a hospital district is located in part but not all of
6-41 a county, that county's appraisal district shall determine the
6-42 taxable value of the property located inside the county but outside
6-43 the hospital district. In determining eligibility for state
6-44 assistance, that county shall consider only the county general
6-45 revenue levy resulting from the property located outside the
6-46 hospital district. A county is eligible for state assistance if:
6-47 (1) the county spends in a state fiscal year at least
6-48 eight [10] percent of the county general revenue levy for that year
6-49 resulting from the property located outside the hospital district
6-50 to provide [mandatory] health care services described by Subsection
6-51 (a) to its eligible county residents who qualify for assistance
6-52 under Section 61.023 [61.006]; and
6-53 (2) the county complies with the other requirements of
6-54 this subchapter.
6-55 (e) A county that provides [mandatory] health care services
6-56 described by Subsection (a) to its eligible residents through a
6-57 hospital established by a board of managers jointly appointed by a
6-58 county and a municipality under Section 265.011 is eligible for
6-59 state assistance if:
6-60 (1) the county spends in a state fiscal year at least
6-61 eight [10] percent of the county general revenue levy for the year
6-62 to provide the [mandatory] health care services to its eligible
6-63 county residents who qualify for assistance under Section 61.052
6-64 [61.006]; and
6-65 (2) the county complies with the requirements of this
6-66 subchapter.
6-67 (f) If a county anticipates that it will reach the eight
6-68 [10] percent expenditure level, the county must notify the
6-69 department as soon as possible before the anticipated date on which
7-1 the county will reach the level.
7-2 (g) The department may waive the requirement that the county
7-3 meet the minimum expenditure level imposed by Subsection (b), (d),
7-4 or (e) and provide state assistance under this chapter at a lower
7-5 level determined by the department if the county demonstrates,
7-6 through an appropriate actuarial analysis, that the county is
7-7 unable to satisfy the eight percent expenditure level:
7-8 (1) because, although the county's general revenue tax
7-9 levy has increased significantly, expenditures for health care
7-10 services described by Subsection (a) have not increased by the same
7-11 percentage;
7-12 (2) because the county is at the maximum allowable ad
7-13 valorem tax rate, has a small population, or has insufficient
7-14 taxable property; or
7-15 (3) because of a similar reason.
7-16 (h) The department shall adopt rules governing the
7-17 circumstances under which a waiver may be granted under Subsection
7-18 (g) and the procedures to be used by a county to apply for the
7-19 waiver. The procedures must provide that the department shall make
7-20 a determination with respect to an application for a waiver not
7-21 later than the 90th day after the date the application is submitted
7-22 to the department in accordance with the procedures established by
7-23 the department. To be eligible for state assistance under
7-24 Subsection (g), a county must submit monthly financial reports, in
7-25 the form required by the department, covering the 12-month period
7-26 preceding the date on which the assistance is sought.
7-27 (i) The county must give the department all necessary
7-28 information so that the department can determine if the county
7-29 meets the requirements of Subsection (b), (d), [or] (e), or (g).
7-30 (j) Notwithstanding Subsections (b), (d), (e), and (f), the
7-31 minimum expenditure level imposed under those subsections is 10
7-32 percent of the county general revenue levy for the year and the
7-33 notice required to be made to the department under Subsection
7-34 (b)(2) is not required to be made before the county has spent at
7-35 least eight percent of the applicable county general revenue for
7-36 that year. The department may adopt rules as necessary to implement
7-37 the transition contemplated by this subsection. This subsection
7-38 expires August 31, 2001.
7-39 Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the
7-40 department determines that a county is eligible for assistance, the
7-41 department shall distribute funds appropriated to the department
7-42 from the indigent health care assistance fund or any other
7-43 available fund to the county to assist the county in providing
7-44 [mandatory] health care services under Sections 61.028 and 61.0285
7-45 to its eligible county residents who qualify for assistance as
7-46 described by Section 61.037 [under Section 61.006].
7-47 (b) State funds provided under this section to a county must
7-48 be equal to at least 90 [80] percent of the actual payment for the
7-49 [mandatory] health care services for the county's eligible
7-50 residents during the remainder of the state fiscal year after the
7-51 eight [10] percent expenditure level is reached.
7-52 Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the
7-53 department fails to provide assistance to an eligible county as
7-54 prescribed by Section 61.038, the county is not liable for payments
7-55 for health care services provided to its eligible county residents
7-56 after the county reaches the eight [10] percent expenditure level.
7-57 SECTION 1.14. Section 61.041, Health and Safety Code, is
7-58 amended by amending Subsections (a) and (b) and adding Subsection
7-59 (d) to read as follows:
7-60 (a) The department shall establish monthly reporting
7-61 requirements for a county seeking state assistance and establish
7-62 procedures necessary to determine if the county is eligible for
7-63 state assistance.
7-64 (b) The department shall establish requirements relating to:
7-65 (1) documentation required to verify the eligibility
7-66 of residents to whom the county provides assistance; and
7-67 (2) county expenditures for [mandatory] health care
7-68 services under Sections 61.028 and 61.0285.
7-69 (d) The department shall establish annual reporting
8-1 requirements for each county that is required to provide indigent
8-2 health care under this chapter but that is not required to report
8-3 under Subsection (a). A county satisfies the annual reporting
8-4 requirement of this subsection if the county submits information to
8-5 the department as required by law to obtain an annual distribution
8-6 under the Agreement Regarding Disposition of Settlement Proceeds
8-7 filed on July 24, 1998, in the United States District Court,
8-8 Eastern District of Texas, in the case styled The State of Texas v.
8-9 The American Tobacco Co., et al., No. 5-96CV-91.
8-10 SECTION 1.15. Section 61.052, Health and Safety Code, is
8-11 amended by adding Subsection (g) to read as follows:
8-12 (g) A county that provides health care services to its
8-13 eligible residents through a hospital established by a board of
8-14 managers jointly appointed by a county and a municipality under
8-15 Section 265.011 and that establishes an income and resources
8-16 standard in accordance with Subsection (a)(2) may credit the
8-17 services provided to all persons who are eligible under that
8-18 standard toward eligibility for state assistance as described by
8-19 Section 61.037(e).
8-20 SECTION 1.16. Section 61.054, Health and Safety Code, is
8-21 amended to read as follows:
8-22 Sec. 61.054. BASIC [MANDATORY] HEALTH CARE SERVICES PROVIDED
8-23 BY A PUBLIC HOSPITAL. (a) Except as provided by Subsection (c), a
8-24 [A] public hospital shall endeavor to provide the basic health care
8-25 [inpatient and outpatient hospital] services a county is required
8-26 to provide under Section 61.028 [61.028(a)(1)].
8-27 (b) If a public hospital provided additional health care
8-28 services to eligible residents during the operating year that ended
8-29 before January 1, 1985, the hospital shall continue to provide
8-30 those services.
8-31 (c) A public hospital shall coordinate the delivery of basic
8-32 health care services to eligible residents and may provide any
8-33 basic health care services the hospital was not providing on
8-34 January 1, 1999, but only to the extent the hospital is financially
8-35 able to do so.
8-36 (d) A public hospital may provide [additional] health care
8-37 services in addition to basic health care services.
8-38 SECTION 1.17. Section 61.055, Health and Safety Code, is
8-39 amended to read as follows:
8-40 Sec. 61.055. BASIC HEALTH CARE SERVICES PROVIDED BY HOSPITAL
8-41 DISTRICTS. (a) Except as provided by Subsection (b), a [A]
8-42 hospital district shall endeavor to provide the basic health care
8-43 services a county is required to provide under Section 61.028,
8-44 together with any other services required under the Texas
8-45 Constitution and the statute creating the district.
8-46 (b) A hospital district shall coordinate the delivery of
8-47 basic health care services to eligible residents and may provide
8-48 any basic health care services the district was not providing on
8-49 January 1, 1999, but only to the extent the district is financially
8-50 able to do so.
8-51 (c) This section may not be construed to discharge a
8-52 hospital district from its obligation to provide the health care
8-53 services required under the Texas Constitution and the statute
8-54 creating the district.
8-55 SECTION 1.18. Section 61.058(b), Health and Safety Code, is
8-56 amended to read as follows:
8-57 (b) If the public hospital does not require prior approval
8-58 and a provider delivers or will deliver nonemergency health care
8-59 services to a patient who the provider suspects might be eligible
8-60 for assistance under this subchapter, the provider shall notify the
8-61 hospital that health care services have been or will be provided to
8-62 the patient. The notice shall be made:
8-63 (1) by telephone not later than the 72nd hour [as soon
8-64 as possible] after the provider determines that the patient resides
8-65 in the hospital's service area; and
8-66 (2) by mail postmarked not later than the fifth
8-67 [third] working day after the date on which the provider determines
8-68 that the patient resides in the hospital's service area.
8-69 SECTION 1.19. Section 61.059(a), Health and Safety Code, is
9-1 amended to read as follows:
9-2 (a) If a nonmandated provider delivers emergency services to
9-3 a patient who the provider suspects might be eligible for
9-4 assistance under this subchapter, the provider shall notify the
9-5 hospital that emergency services have been or will be provided to
9-6 the patient. The notice shall be made:
9-7 (1) by telephone not later than the 72nd hour [as soon
9-8 as possible] after the provider determines that the patient resides
9-9 in the hospital's service area; and
9-10 (2) by mail postmarked not later than the fifth
9-11 [third] working day after the date on which the provider determines
9-12 that the patient resides in the hospital's service area.
9-13 SECTION 1.20. Section 61.062, Health and Safety Code, is
9-14 amended to read as follows:
9-15 Sec. 61.062. RESPONSIBILITY OF GOVERNMENTAL ENTITY. A
9-16 governmental entity that owns, operates, or leases a public
9-17 hospital shall provide sufficient funding to the hospital to
9-18 provide basic [mandatory] health care services [assistance].
9-19 SECTION 1.21. Section 61.064(a), Health and Safety Code, is
9-20 amended to read as follows:
9-21 (a) A governmental entity that owns, operates, or leases a
9-22 public hospital and that closes, sells, or leases the hospital:
9-23 (1) has the obligation to provide basic [mandatory]
9-24 health care services [assistance] under this chapter;
9-25 (2) shall adopt the eligibility standards that the
9-26 hospital was or would have been required to adopt; and
9-27 (3) shall provide the same services the hospital was
9-28 or would have been required to provide under this chapter on the
9-29 date of the closing, sale, or lease.
9-30 SECTION 1.22. Subchapter C, Chapter 281, Health and Safety
9-31 Code, is amended by adding Section 281.0514 to read as follows:
9-32 Sec. 281.0514. HARRIS COUNTY HOSPITAL DISTRICT; CONTRACT
9-33 WITH CERTAIN HOSPITALS. (a) The Harris County Hospital District
9-34 shall contract for indigent health care services with at least one
9-35 hospital that is:
9-36 (1) located in the district;
9-37 (2) exempt from federal income tax under Section
9-38 501(a), Internal Revenue Code of 1986, and its subsequent
9-39 amendments, by being listed as an exempt entity under any
9-40 subdivision of Section 501(c) of that code; and
9-41 (3) substantially devoted to providing hospital
9-42 services to socially and economically disadvantaged individuals in
9-43 the geographical area of the district.
9-44 (b) A contract under this section is subject to Section
9-45 281.051(a).
9-46 SECTION 1.23. Section 531.204(b), Government Code, is
9-47 amended to read as follows:
9-48 (b) The report must include:
9-49 (1) identification of significant problems in the
9-50 Texas Integrated Enrollment Services, with recommendations for
9-51 action by the commissioner;
9-52 (2) the status of the effectiveness of the Texas
9-53 Integrated Enrollment Services in providing necessary services to
9-54 the people of this state, with recommendations for any necessary
9-55 research;
9-56 (3) an analysis of the feasibility of including
9-57 indigent health care programs provided by counties, public
9-58 hospitals, and hospital districts in the Texas Integrated
9-59 Enrollment Services, a schedule for inclusion of these programs,
9-60 and a statement of how the Texas Integrated Enrollment Services may
9-61 be structured to address the wide variation in information systems
9-62 used by counties, public hospitals, and hospital districts; and
9-63 (4) [(3)] recommendations for legislative action.
9-64 SECTION 1.24. Chapter 26, Tax Code, is amended by adding
9-65 Section 26.0441 to read as follows:
9-66 Sec. 26.0441. TAX RATE ADJUSTMENT FOR INDIGENT HEALTH CARE.
9-67 (a) In the first tax year in which a taxing unit adopts a tax rate
9-68 after January 1, 2000, and in which the enhanced minimum
9-69 eligibility standards for indigent health care established under
10-1 Section 61.006, Health and Safety Code, apply to the taxing unit,
10-2 the effective maintenance and operations rate for the taxing unit
10-3 is increased by the rate computed according to the following
10-4 formula:
10-5 Enhanced Indigent Health Care Expenditures
10-6 Amount of Increase = __________________________________________
10-7 (Current Total Value - New Property Value)
10-8 (b) In each subsequent tax year, if the taxing unit's
10-9 enhanced indigent health care expenses exceed the amount of those
10-10 expenses for the preceding year, the effective maintenance and
10-11 operations rate for the taxing unit is increased by the rate
10-12 computed according to the following formula:
10-13 (Current Tax Year's Enhanced Indigent
10-14 Health Care Expenditures - Preceding Tax
10-15 Year's Indigent Health Care Expenditures)
10-16 Amount of Increase = __________________________________________
10-17 (Current Total Value - New Property Value)
10-18 (c) The taxing unit shall include a notice of the increase
10-19 in its effective maintenance and operations rate provided by this
10-20 section, including a brief description and the amount of the
10-21 enhanced indigent health care expenditures, in the information
10-22 published under Section 26.04(e) and, if applicable, Section
10-23 26.06(b).
10-24 (d) In this section, "enhanced indigent health care
10-25 expenditures" for a tax year means the amount spent by the taxing
10-26 unit for the maintenance and operation costs of providing indigent
10-27 health care at the increased minimum eligibility standards
10-28 established under Section 61.006, Health and Safety Code, effective
10-29 on or after January 1, 2000, in the period beginning on July 1 of
10-30 the year preceding the tax year for which the tax is adopted and
10-31 ending on June 30 of the tax year for which the tax is adopted,
10-32 less the amount of state assistance received by the taxing unit in
10-33 accordance with Chapter 61, Health and Safety Code, that is
10-34 attributable to those costs.
10-35 (e) In the 2000 and 2001 tax years, a taxing unit's enhanced
10-36 indigent health care expenditures for the 2000 tax year are
10-37 computed under Subsection (d) using the taxing unit's expenditures
10-38 for the maintenance and operation costs of providing indigent
10-39 health care at the increased minimum eligibility standards
10-40 described by Subsection (d) for the period beginning on January 1,
10-41 2000, and ending on June 30, 2000, instead of for the period
10-42 described by Subsection (d). This subsection expires January 1,
10-43 2002.
10-44 SECTION 1.25. (a) The change in law made by this article to
10-45 Chapter 61, Health and Safety Code, applies only to:
10-46 (1) health care services under Chapter 61, Health and
10-47 Safety Code, as amended by this article, that are delivered on or
10-48 after January 1, 2000; and
10-49 (2) state assistance under Chapter 61, Health and
10-50 Safety Code, as amended by this article, for the services described
10-51 by Subdivision (1) of this subsection.
10-52 (b) Health care services under Chapter 61, Health and Safety
10-53 Code, as amended by this article, that are delivered before January
10-54 1, 2000, and state assistance for those services are governed by
10-55 the law as it existed immediately before that date and that law is
10-56 continued in effect for this purpose.
10-57 SECTION 1.26. The Texas Department of Health shall study the
10-58 feasibility of requiring or permitting a county, public hospital,
10-59 and hospital district to issue a uniform identification card to an
10-60 eligible county resident or eligible service area resident, as
10-61 appropriate, that identifies the resident as eligible for health
10-62 care assistance under Chapter 61, Health and Safety Code. Not
10-63 later than December 15, 2000, the department shall report the
10-64 results of its study to the governor, lieutenant governor, and
10-65 speaker of the house of representatives.
10-66 ARTICLE 2. TERTIARY CARE
10-67 SECTION 2.01. Subtitle B, Title 2, Health and Safety Code,
10-68 is amended by adding Chapter 46 to read as follows:
10-69 CHAPTER 46. TERTIARY MEDICAL CARE
11-1 Sec. 46.001. DEFINITIONS. In this chapter:
11-2 (1) "Tertiary care facility" means a:
11-3 (A) primary teaching hospital of a medical
11-4 school;
11-5 (B) level 1 trauma center;
11-6 (C) level 2 trauma center; or
11-7 (D) level 3 trauma center.
11-8 (2) "Tertiary medical services" includes services
11-9 provided by burn centers and neonatology Level III units, pediatric
11-10 and trauma surgery, neurosurgery, cardiothoracic and vascular
11-11 surgery, organ transplant, services provided for a life-threatening
11-12 dermatologic illness, services provided to a person with a high
11-13 risk pregnancy or cancer, and radiation oncology.
11-14 (3) "Unreimbursed tertiary medical service" means a
11-15 tertiary medical service for which a tertiary care facility has not
11-16 received from any public or private source any payment that is
11-17 directly attributable to the particular service.
11-18 Sec. 46.002. RULES. The board may adopt rules to implement
11-19 this chapter.
11-20 Sec. 46.003. TERTIARY CARE FACILITY ACCOUNT. (a) The
11-21 tertiary care facility account is an account in the state treasury.
11-22 Money in the account may be appropriated only to the department for
11-23 the purposes of this chapter.
11-24 (b) The account is composed of money appropriated to the
11-25 account and any other funds required to be put in the account.
11-26 (c) The department may seek and accept gifts, grants, and
11-27 donations from any public or private entity on behalf of the
11-28 account.
11-29 (d) Section 403.095, Government Code, does not apply to the
11-30 account.
11-31 (e) For each fiscal year, five percent of the total amount
11-32 in the account shall be held in reserve and may be used only to pay
11-33 for unreimbursed tertiary medical services provided as a result of
11-34 extraordinary emergencies occurring during that year in accordance
11-35 with this chapter. Of the amount remaining, not more than five
11-36 percent may be used for the costs of administering the account.
11-37 (f) Except as provided by Subsection (e), the account shall
11-38 be allocated for payment to tertiary facilities for the facilities'
11-39 unreimbursed tertiary medical services.
11-40 (g) This chapter may not be construed to authorize the
11-41 department to use funds to provide reimbursement to tertiary care
11-42 facilities under this subchapter other than funds appropriated for
11-43 that purpose in the General Appropriations Act.
11-44 Sec. 46.004. COLLECTION OF INFORMATION. (a) A tertiary
11-45 care facility that seeks payment under this chapter shall submit to
11-46 the department, in the manner and at the time required by the
11-47 department, information that relates to the unreimbursed tertiary
11-48 medical services provided to persons who reside outside the service
11-49 area of the county, public hospital, or hospital district that is
11-50 responsible for indigent health care under Chapter 61 in the area
11-51 in which the tertiary care facility is located.
11-52 (b) The board shall adopt rules governing the collection of
11-53 the information under Subsection (a).
11-54 Sec. 46.005. CERTIFICATION TO COMPTROLLER. (a) The
11-55 department shall certify to the comptroller for each tertiary care
11-56 facility the cost of unreimbursed tertiary medical services
11-57 provided by the facility to persons who reside outside the service
11-58 area of the county, public hospital, or hospital district that is
11-59 responsible for indigent health care under Chapter 61 in the area
11-60 in which the tertiary care facility is located.
11-61 (b) Each year the department shall make, for a facility that
11-62 operated as a tertiary care facility during the previous year, an
11-63 initial certification to the comptroller under Subsection (a) in an
11-64 amount that equals 80 percent of the amount certified under this
11-65 section for the facility in the previous year. The department shall
11-66 make a subsequent certification of the cost of additional
11-67 unreimbursed tertiary medical services provided by the facility on
11-68 receipt from the facility of the information required to be
11-69 submitted under Section 46.004.
12-1 (c) Except as provided by Subsection (d), each year the
12-2 comptroller shall pay a tertiary care facility the certified amount
12-3 declared under Subsection (a) from the funds specified under
12-4 Section 46.003(f).
12-5 (d) If in any year the total cost of unreimbursed tertiary
12-6 medical services certified under Subsection (a) for all tertiary
12-7 care facilities exceeds the amount available for payment to the
12-8 facilities under Section 46.003(f), the department shall allocate
12-9 the amount available under Section 46.003(f) to each facility based
12-10 on the percentages computed by dividing the cost of the facility's
12-11 unreimbursed tertiary medical services by the total cost of all
12-12 facilities' unreimbursed tertiary medical services. The
12-13 comptroller shall pay each tertiary care facility based on the
12-14 allocation made under this subsection.
12-15 (e) For purposes of this section and Section 46.006, the
12-16 cost of each unreimbursed tertiary medical service provided is the
12-17 average amount payable under Medicare for services for the
12-18 Medicare diagnosis related groups applicable to the tertiary
12-19 medical services provided by a tertiary care facility.
12-20 Sec. 46.006. CERTIFICATION OF EMERGENCIES. (a) For
12-21 purposes of reimbursing extraordinary emergencies under this
12-22 chapter, the department shall certify an extraordinary emergency:
12-23 (1) if the governor issues an executive order or a
12-24 proclamation under Chapter 418, Government Code;
12-25 (2) if a disaster is declared by the president of the
12-26 United States under the Robert T. Stafford Disaster Relief and
12-27 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
12-28 (3) for another similar disaster the department finds
12-29 has resulted in an extraordinary cost to a tertiary care facility.
12-30 (b) If an extraordinary emergency is declared under
12-31 Subsection (a), the department shall certify to the comptroller the
12-32 amount of unreimbursed tertiary medical services incurred by a
12-33 tertiary care facility during the emergency.
12-34 (c) Except as provided by Subsection (d), the comptroller
12-35 shall pay the tertiary care facility the certified amount declared
12-36 under Subsection (b) from allocated funds specified under Section
12-37 46.003(e).
12-38 (d) If in any year the total cost of unreimbursed tertiary
12-39 medical services certified under Subsection (b) for all tertiary
12-40 care facilities exceeds the amount available for payment to the
12-41 facilities under Section 46.003(e), the department shall allocate
12-42 the amount available under Section 46.003(e) to each facility based
12-43 on the percentages computed by dividing the cost of the facility's
12-44 unreimbursed tertiary medical services incurred during emergencies
12-45 by the total cost of all facilities' unreimbursed tertiary medical
12-46 services incurred during emergencies. The comptroller shall pay
12-47 each tertiary care facility based on the allocation made under this
12-48 subsection.
12-49 ARTICLE 3. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM
12-50 SECTION 3.01. FEDERAL AUTHORIZATION. It is the intent of
12-51 the 76th Legislature that:
12-52 (1) the Health and Human Services Commission or an
12-53 appropriate health and human services agency continue to pursue the
12-54 waiver or other authorization described by Section 4, Chapter 444,
12-55 Acts of the 74th Legislature, Regular Session, 1995;
12-56 (2) the waiver or other authorization apply to
12-57 expansion of Medicaid eligibility, as described by Section 532.102,
12-58 Government Code, for both children and their families and other
12-59 adults; and
12-60 (3) the Health and Human Services Commission take any
12-61 other appropriate action authorized under law to accomplish the
12-62 expansion of Medicaid eligibility, as described by Section 532.102,
12-63 Government Code, for children and their families and for other
12-64 adults.
12-65 ARTICLE 4. STUDY RELATING TO BASIC HEALTH CARE SERVICES
12-66 AND STATE ASSISTANCE
12-67 SECTION 4.01. STUDY. The Texas Department of Health shall:
12-68 (1) study the provision of basic health care services
12-69 by counties, hospital districts, and public hospitals under Chapter
13-1 61, Health and Safety Code, and the cost of providing those
13-2 services;
13-3 (2) study the threshold for eligibility for state
13-4 assistance to a county established under Section 61.037, Health and
13-5 Safety Code, and develop a threshold to replace that threshold that
13-6 is stated as a formula and that reflects:
13-7 (A) a county's fiscal capacity;
13-8 (B) a county's health care resources; and
13-9 (C) the relevant characteristics of the county's
13-10 residents, including the percentage of the county's residents
13-11 living below the federal poverty level; and
13-12 (3) study the financing of basic health care services
13-13 by counties, hospital districts, and public hospitals under Chapter
13-14 61, Health and Safety Code, including the use of:
13-15 (A) local, state, and federal funds; and
13-16 (B) the funds distributed to political
13-17 subdivisions under the Agreement Regarding Disposition of
13-18 Settlement Proceeds filed on July 24, 1998, in the United States
13-19 District Court, Eastern District of Texas, in the case styled The
13-20 State of Texas vs. The American Tobacco Co., et al., No. 5-96CV-91.
13-21 SECTION 4.02. REPORT. Not later than December 1, 2000, the
13-22 Texas Department of Health shall submit a written report of the
13-23 study conducted under this article to the governor, lieutenant
13-24 governor, and speaker of the house of representatives. The report
13-25 must include the recommendations of the department, together with
13-26 the proposed eligibility threshold described by Section 4.01(2) of
13-27 this article.
13-28 SECTION 4.03. EXPIRATION. This article expires August 31,
13-29 2001.
13-30 ARTICLE 5. PILOT PROGRAM FOR REGIONAL HEALTH CARE
13-31 DELIVERY SYSTEM
13-32 SECTION 5.01. DEFINITIONS. In this article:
13-33 (1) "Commissioner" means the commissioner of health
13-34 and human services.
13-35 (2) "Pilot program" means the regional health care
13-36 delivery system pilot program established under this article.
13-37 SECTION 5.02. PILOT PROGRAM. (a) Not later than January 1,
13-38 2000, the commissioner shall establish a regional health care
13-39 delivery system pilot program to coordinate the use of health care
13-40 resources in a region of the state. The pilot program must:
13-41 (1) emphasize prevention services, continuity of care,
13-42 and the provision of a medical home for clients;
13-43 (2) maximize the use of local and state funds by
13-44 obtaining any available federal matching funds;
13-45 (3) be designed to result in long-term cost savings to
13-46 the participating entities;
13-47 (4) simplify eligibility criteria and streamline
13-48 eligibility determinations; and
13-49 (5) improve accountability of indigent health care
13-50 dollars.
13-51 (b) The commissioner may adopt rules as necessary to
13-52 implement the pilot program. The rules may provide an alternative
13-53 funding structure to the funding structure established under
13-54 Chapter 61, Health and Safety Code.
13-55 (c) The commissioner may not require a county, public
13-56 hospital, hospital district, or other entity to participate in the
13-57 pilot program.
13-58 SECTION 5.03. REPORT. (a) Not later than January 1, 2003,
13-59 the commissioner shall submit a written report relating to the
13-60 pilot program to the governor, lieutenant governor, and speaker of
13-61 the house of representatives.
13-62 (b) The report must include:
13-63 (1) an analysis of:
13-64 (A) the quality of health care services provided
13-65 under the pilot program; and
13-66 (B) the cost-effectiveness of providing health
13-67 care services through the pilot program; and
13-68 (2) recommendations for legislation for implementing
13-69 regional health care delivery systems in this state, including
14-1 recommendations relating to:
14-2 (A) the structure of a regional entity to
14-3 administer a regional health care delivery system;
14-4 (B) the manner in which state assistance money
14-5 may most effectively be distributed to support a regional health
14-6 care delivery system; and
14-7 (C) any other matter necessary to implement
14-8 effective and efficient regional health care delivery systems in
14-9 this state.
14-10 SECTION 5.04. EXPIRATION; TERMINATION OF PILOT PROGRAM.
14-11 This section expires and the pilot program is terminated August 31,
14-12 2003.
14-13 ARTICLE 6. EFFECTIVE DATE; EMERGENCY
14-14 SECTION 6.01. EFFECTIVE DATE. This Act takes effect
14-15 September 1, 1999.
14-16 SECTION 6.02. EMERGENCY. The importance of this legislation
14-17 and the crowded condition of the calendars in both houses create an
14-18 emergency and an imperative public necessity that the
14-19 constitutional rule requiring bills to be read on three several
14-20 days in each house be suspended, and this rule is hereby suspended.
14-21 * * * * *