By Christian, Turner of Coleman H.B. No. 2565
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to payment for health care services provided to certain
1-3 persons by public hospitals and hospital districts.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 61.004, Health and Safety Code, is
1-6 amended to read as follows:
1-7 Sec. 61.004. RESIDENCE OR ELIGIBILITY DISPUTE. (a) If a
1-8 provider of assistance and a governmental entity or hospital
1-9 district cannot agree on a person's residence or whether a person
1-10 is eligible for assistance under this chapter, the provider or the
1-11 governmental entity or hospital district may submit the matter to
1-12 the department.
1-13 (b) The provider of assistance and the governmental entity
1-14 or hospital district shall submit all relevant information to the
1-15 department.
1-16 (c) If the department determines that another governmental
1-17 entity or hospital district may be involved in the dispute, the
1-18 department shall notify the governmental entity or hospital
1-19 district and allow the governmental entity or hospital district to
1-20 respond.
1-21 (d) From the information submitted, the department shall
1-22 determine the person's residence or whether the person is eligible
1-23 for assistance under this chapter and shall notify each
1-24 governmental entity or hospital district and the provider of
2-1 assistance of the decision and the reasons for the decision.
2-2 (e) If a governmental entity, hospital district, or provider
2-3 of assistance does not agree with the department's decision, the
2-4 governmental entity, hospital district, or provider of assistance
2-5 may file an appeal with the department. The appeal must be filed
2-6 not later than the 30th day after the date on which the
2-7 governmental entity, hospital district, or provider of assistance
2-8 receives notice of the decision.
2-9 (f) The department shall issue a final decision not later
2-10 than the 21st day after the date on which the appeal is filed.
2-11 (g) A governmental entity, hospital district, or provider of
2-12 assistance may appeal the final order of the department under
2-13 Chapter 2001, Government Code, using the substantial evidence rule
2-14 on appeal.
2-15 (h) Service may not be denied pending an administrative or
2-16 judicial review of residence.
2-17 SECTION 2. Section 61.033, Health and Safety Code, is
2-18 amended by adding Subsection (c) to read as follows:
2-19 (c) The department may enforce this section and the board
2-20 may adopt rules as necessary to enforce this section.
2-21 SECTION 3. Subchapter B, Chapter 61, Health and Safety Code,
2-22 is amended by adding Section 61.0335 to read as follows:
2-23 Sec. 61.0335. INFORMATION NECESSARY TO DETERMINE
2-24 ELIGIBILITY. (a) Any provider, including a mandated provider,
2-25 public hospital, or hospital district, that delivers health care
2-26 services to a patient who the provider suspects is an eligible
2-27 county resident under this subchapter may require the patient to:
3-1 (1) provide any information necessary to establish
3-2 that the patient is an eligible county resident; and
3-3 (2) authorize the release of any information relating
3-4 to the patient, including medical information and information
3-5 obtained under Subdivision (1), to permit the provider to submit a
3-6 claim to the county that is liable under Section 61.033.
3-7 (b) A county that receives information obtained under
3-8 Subsection (a) shall use the information to determine whether the
3-9 person to whom services were provided is an eligible county
3-10 resident of that county and, if so, shall pay the claim made by the
3-11 provider in accordance with this subchapter.
3-12 (c) The application, documentation, and verification
3-13 procedures established by the department for counties under Section
3-14 61.006 may include a standard format for obtaining information
3-15 under Subsection (a) to facilitate eligibility and residence
3-16 determinations.
3-17 SECTION 4. Section 61.031(b), Health and Safety Code, is
3-18 amended to read as follows:
3-19 (b) If the county does not require prior approval and a
3-20 provider delivers or will deliver nonemergency health care services
3-21 to a patient who the provider suspects may be eligible for
3-22 assistance under this subchapter, the provider shall notify the
3-23 patient's county of residence that health care services have been
3-24 or will be provided to the patient. The notice shall be made:
3-25 (1) by telephone not later than the 72nd hour [as soon
3-26 as possible] after the provider determines the patient's county of
3-27 residence; and
4-1 (2) by mail postmarked not later than the fifth
4-2 [third] working day after the date on which the provider determines
4-3 the patient's county of residence.
4-4 SECTION 5. Section 61.032(a), Health and Safety Code, is
4-5 amended to read as follows:
4-6 (a) If a nonmandated provider delivers emergency services to
4-7 a patient who the provider suspects might be eligible for
4-8 assistance under this subchapter, the provider shall notify the
4-9 patient's county of residence that emergency services have been or
4-10 will be provided to the patient. The notice shall be made:
4-11 (1) by telephone not later than the 72nd hour [as soon
4-12 as possible] after the provider determines the patient's county of
4-13 residence; and
4-14 (2) by mail postmarked not later than the fifth
4-15 [third] working day after the date on which the provider determines
4-16 the patient's county of residence.
4-17 SECTION 6. Section 61.058(b), Health and Safety Code, is
4-18 amended to read as follows:
4-19 (b) If the public hospital does not require prior approval
4-20 and a provider delivers or will deliver nonemergency health care
4-21 services to a patient who the provider suspects might be eligible
4-22 for assistance under this subchapter, the provider shall notify the
4-23 hospital that health care services have been or will be provided to
4-24 the patient. The notice shall be made:
4-25 (1) by telephone not later than the 72nd hour [as soon
4-26 as possible] after the provider determines that the patient resides
4-27 in the hospital's service area; and
5-1 (2) by mail postmarked not later than the fifth
5-2 [third] working day after the date on which the provider determines
5-3 that the patient resides in the hospital's service area.
5-4 SECTION 7. Section 61.059(a), Health and Safety Code, is
5-5 amended to read as follows:
5-6 (a) If a nonmandated provider delivers emergency services to
5-7 a patient who the provider suspects might be eligible for
5-8 assistance under this subchapter, the provider shall notify the
5-9 hospital that emergency services have been or will be provided to
5-10 the patient. The notice shall be made:
5-11 (1) by telephone not later than the 72nd hour [as soon
5-12 as possible] after the provider determines that the patient resides
5-13 in the hospital's service area; and
5-14 (2) by mail postmarked not later than the fifth
5-15 [third] working day after the date on which the provider determines
5-16 that the patient resides in the hospital's service area.
5-17 SECTION 8. Section 61.060, Health and Safety Code, is
5-18 amended by adding Subsection (e) to read as follows:
5-19 (e) The department may enforce this section and the board
5-20 may adopt rules as necessary to enforce this section.
5-21 SECTION 9. The Texas Department of Health shall study the
5-22 feasibility of requiring or permitting a county, public hospital,
5-23 and hospital district to issue a uniform identification card to an
5-24 eligible county resident or eligible service area resident, as
5-25 appropriate, that identifies the resident as eligible for health
5-26 care assistance under Chapter 61, Health and Safety Code. Not
5-27 later than December 15, 2000, the department shall report the
6-1 results of its study to the governor, lieutenant governor, and
6-2 speaker of the house of representatives.
6-3 SECTION 10. The importance of this legislation and the
6-4 crowded condition of the calendars in both houses create an
6-5 emergency and an imperative public necessity that the
6-6 constitutional rule requiring bills to be read on three several
6-7 days in each house be suspended, and this rule is hereby suspended,
6-8 and that this Act take effect and be in force from and after its
6-9 passage, and it is so enacted.