By Wolens H.B. No. 2573 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to tertiary medical care. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Subtitle B, Title 2, Health and Safety Code, is 1-5 amended by adding Chapter 46 to read as follows: 1-6 CHAPTER 46. TERTIARY MEDICAL CARE 1-7 Sec. 46.001. DEFINITIONS. In this chapter: 1-8 (1) "Tertiary care facility" means a: 1-9 (A) primary teaching hospital of a medical 1-10 school; 1-11 (B) level 1 trauma center; 1-12 (C) level 2 trauma center; 1-13 (D) level 3 trauma center that is more than 100 1-14 miles from a level 1 or level 2 trauma center; or 1-15 (E) level 4 trauma center. 1-16 (2) "Tertiary medical services" includes services 1-17 provided by burn centers and neonatology Level III units, pediatric 1-18 and trauma surgery, neurosurgery, cardiothoracic and vascular 1-19 surgery, organ transplant, services provided for a life threatening 1-20 dermatologic illness, services provided to a person with a high 1-21 risk pregnancy or cancer, and radiation oncology. 1-22 Sec. 46.002. DESIGNATION OF FACILITIES. The department 1-23 shall designate tertiary care facilities that meet the requirements 1-24 of this chapter to provide tertiary medical services. 2-1 Sec. 46.003. DUTIES OF BOARD; RULES. (a) The board by rule 2-2 shall adopt minimum standards and objectives to implement a system 2-3 that encourages hospitals to provide tertiary medical services and 2-4 increases the availability of tertiary medical services. 2-5 (b) The rules must: 2-6 (1) provide for service to all geographic areas of the 2-7 state, considering time and distance to the tertiary care 2-8 facilities; 2-9 (2) provide specific requirements for appropriate care 2-10 of patients; and 2-11 (3) facilitate coordination among all health care 2-12 facilities in the delivery area. 2-13 (c) The rules must include: 2-14 (1) pre-hospital care management guidelines for 2-15 triage, transfer, and transportation of patients; 2-16 (2) criteria for determining geographic boundaries of 2-17 tertiary care facilities; 2-18 (3) minimum requirements for resources and equipment 2-19 needed by a health care facility to treat patients; 2-20 (4) standards for the availability and qualifications 2-21 of the health care personnel, including each specialist treating a 2-22 patient in a tertiary care facility; 2-23 (5) requirements for data collection, including 2-24 operation of the tertiary care facility and patient outcomes; 2-25 (6) requirements for periodic performance evaluation 2-26 of the tertiary care facility; and 2-27 (7) assurances that designated tertiary care 3-1 facilities will not refuse to accept the transfer of a patient 3-2 solely because of the person's inability to pay for services or 3-3 because of the person's age, sex, race, religion, or national 3-4 origin. 3-5 Sec. 46.004. DENIAL, SUSPENSION, OR REVOCATION OF 3-6 DESIGNATION. (a) The department may deny, suspend, or revoke a 3-7 designation as a tertiary care facility if the facility fails to 3-8 comply with the rules adopted under this chapter. 3-9 (b) The denial, suspension, or revocation of a designation 3-10 by the department and the appeal from that action are governed by 3-11 the board's rules for a contested case hearing and by Chapter 2001, 3-12 Government Code. 3-13 Sec. 46.005. TERTIARY CARE FACILITY ACCOUNT. (a) The 3-14 tertiary care facility account is an account in the state treasury. 3-15 Money in the account may be appropriated only to the department for 3-16 the purposes of this chapter. 3-17 (b) The account is composed of money appropriated to the 3-18 account and any other funds required to be put in the account. 3-19 (c) The department may seek and accept gifts, grants, and 3-20 donations from any public or private entity on behalf of the 3-21 account. 3-22 (d) Section 403.095, Government Code, does not apply to the 3-23 account. 3-24 (e) For each fiscal year, five percent of the total amount 3-25 in the account shall be held in reserve and may be used only for 3-26 reimbursement of unpaid tertiary medical services provided as a 3-27 result of extraordinary emergencies occurring during that year. Of 4-1 the amount remaining, not more than five percent may be used for 4-2 the costs of administering the account. 4-3 Sec. 46.006. COLLECTION OF INFORMATION. (a) Each 4-4 designated tertiary care facility shall submit to the department, 4-5 in the manner and at the time required by the department, 4-6 information that relates to the unreimbursed tertiary medical 4-7 services provided to persons who reside outside the service area of 4-8 the county, public hospital, or hospital district that is 4-9 responsible for indigent health care under Chapter 61 in the area 4-10 in which the tertiary care facility is located. 4-11 (b) The board shall adopt rules governing the collection of 4-12 the information under Subsection (a). 4-13 Sec. 46.007. CERTIFICATION TO COMPTROLLER. (a) The 4-14 department shall certify to the comptroller for each designated 4-15 tertiary care facility the cost of unreimbursed tertiary medical 4-16 services provided by the facility to persons who reside outside the 4-17 service area of the county, public hospital, or hospital district 4-18 that is responsible for indigent health care under Chapter 61 in 4-19 the area in which the tertiary care facility is located. 4-20 (b) Each year the department shall make, for a facility that 4-21 was a designated tertiary care facility during the previous year, 4-22 an initial certification to the comptroller under Subsection (a) in 4-23 an amount that equals 80 percent of the amount certified under this 4-24 section for the facility in the previous year. The department shall 4-25 make a subsequent certification of the cost of additional 4-26 unreimbursed tertiary medical services provided by the facility on 4-27 receipt from the facility of the information required to be 5-1 submitted under Section 46.006. 5-2 (c) If in any year the total cost of unreimbursed tertiary 5-3 medical services certified under Subsection (a) for all designated 5-4 tertiary care facilities exceeds the amount available for payment 5-5 to the facilities under Section 46.005(e), the department shall 5-6 allocate the amount available under Section 46.005(e) to each 5-7 facility based on the percentages computed by dividing the cost of 5-8 the facility's unreimbursed tertiary medical services by the total 5-9 cost of all facilities' unreimbursed tertiary medical services. 5-10 (d) For purposes of this section and Section 46.008, the 5-11 cost of each service provided is the average amount payable under 5-12 Medicare for services for the Medicare diagnosis related groups 5-13 that must be provided by a tertiary care facility to qualify for 5-14 designation under the minimum standards adopted under this chapter. 5-15 Sec. 46.008. CERTIFICATION OF EMERGENCIES. (a) For 5-16 purposes of reimbursing extraordinary emergencies under this 5-17 chapter, the department shall certify an extraordinary emergency: 5-18 (1) if the governor issues an executive order or a 5-19 proclamation under Chapter 418, Government Code; 5-20 (2) if a disaster is declared by the president of the 5-21 United States under the Robert T. Stafford Disaster Relief and 5-22 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or 5-23 (3) for another similar disaster the department finds 5-24 has resulted in an extraordinary cost to a designated tertiary care 5-25 facility. 5-26 (b) If an extraordinary emergency is declared under 5-27 Subsection (a), the department shall certify to the comptroller the 6-1 amount of unreimbursed tertiary medical services incurred by a 6-2 designated tertiary care facility during the emergency. 6-3 (c) The comptroller shall pay the tertiary care facility. 6-4 SECTION 2. This Act takes effect September 1, 1999. 6-5 SECTION 3. The importance of this legislation and the 6-6 crowded condition of the calendars in both houses create an 6-7 emergency and an imperative public necessity that the 6-8 constitutional rule requiring bills to be read on three several 6-9 days in each house be suspended, and this rule is hereby suspended.