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 I trauma center;
1-12 (C) level II trauma center; or
1-13 (D) level III trauma center.
1-14 (2) "Tertiary medical services" includes, but is not
1-15 limited to, services provided by state-designated trauma centers,
1-16 burn center treatment, neonatology Level III unit services,
1-17 pediatric surgery, trauma surgery, neurosurgery, cardiothoracic and
1-18 vascular surgery, organ transplant, services provided for a
1-19 life-threatening dermatologic illness, services provided to a
1-20 person with a high-risk pregnancy or cancer, and radiation
1-21 oncology.
1-22 (3) "Stabilization services" means services provided
1-23 by a tertiary care facility or a level IV designated trauma center
1-24 that are necessary to assure, within reasonable medical
2-1 probability, that no material deterioration of a patient's medical
2-2 condition is likely to result from or occur during the transfer of
2-3 the patient to a tertiary care facility.
2-4 (4) "Unreimbursed tertiary medical services" means
2-5 tertiary care medical services for which a tertiary care facility
2-6 has not received full payment from any public or private source.
2-7 (5) "Unreimbursed stabilization services" means
2-8 stabilization services for which a tertiary care facility or level
2-9 IV designated trauma facility has not received full payment from
2-10 any public or private source.
2-11 Sec. 46.002. RULES. (a) The board may adopt rules to
2-12 implement a system that encourages hospitals to provide tertiary
2-13 medical services and stabilization services.
2-14 (b) The rules must address:
2-15 (1) coordination of tertiary medical services and
2-16 stabilization services among health care facilities in the
2-17 delivery area;
2-18 (2) pre-hospital care management guidelines for
2-19 triage, transfer, and transportation of patients and periodic
2-20 evaluation of tertiary care facilities' and level IV trauma
2-21 facilities' compliance with the guidelines and the trauma facility
2-22 rules, as appropriate;
2-23 (3) requirements for data collection, including
2-24 patient outcomes;
2-25 (4) assurances that tertiary care facilities will not
2-26 refuse to accept the transfer of a patient solely because of the
2-27 person's inability to pay for services or because of the person's
3-1 age, sex, race, religion, or national origin; and
3-2 (5) enforcement of the rules.
3-3 Sec. 46.003. TERTIARY CARE ACCOUNT. (a) The tertiary care
3-4 account is an account in the state treasury. Money in the account
3-5 may be appropriated only to the department for the purposes of this
3-6 chapter.
3-7 (b) The account is composed of money appropriated to the
3-8 account and any other funds required to be put in the account.
3-9 (c) The department may seek and accept gifts, grants, and
3-10 donations from any public or private entity on behalf of the
3-11 account.
3-12 (d) Section 403.095, Government Code, does not apply to the
3-13 account.
3-14 (e) For each fiscal year, five percent of the total amount
3-15 in the account shall be held in reserve and may be used only for
3-16 reimbursement of unpaid tertiary medical services and stabilization
3-17 services provided as a result of extraordinary emergencies
3-18 occurring during that year. Of the amount remaining, not more than
3-19 five percent may be used for the costs of administering the
3-20 account.
3-21 (f) Except as provided by Subsection (e), the account shall
3-22 be allocated for payment to tertiary care facilities and level IV
3-23 trauma centers for unreimbursed tertiary medical services and
3-24 stabilization services, as provided for in Sections 46.005 and
3-25 46.006.
3-26 Sec. 46.004. COLLECTION OF INFORMATION. (a) Each tertiary
3-27 care facility or level IV trauma facility that seeks payment under
4-1 this chapter shall submit to the department, in the manner and at
4-2 the time required by the department, information that relates to
4-3 the unreimbursed tertiary medical services or stabilization
4-4 services provided to persons who reside outside the service area of
4-5 the county, public hospital, or hospital district that is
4-6 responsible for indigent health care under Chapter 61 in the area
4-7 in which the tertiary care facility or level IV trauma facility is
4-8 located.
4-9 (b) The board shall adopt rules governing the collection of
4-10 the information under Subsection (a).
4-11 Sec. 46.005. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED
4-12 TERTIARY MEDICAL SERVICES. (a) The department shall certify to
4-13 the comptroller for each tertiary care facility the cost of
4-14 unreimbursed tertiary medical services provided to persons who
4-15 reside outside the service area of the county, public hospital, or
4-16 hospital district that is responsible for indigent health care
4-17 under Chapter 61 in the area in which the tertiary care facility is
4-18 located.
4-19 (b) In each fiscal year the department shall use at least 86
4-20 percent of the appropriated money in the tertiary care account to
4-21 compensate tertiary care facilities for unreimbursed tertiary
4-22 medical services.
4-23 (c) Each year the department shall make, for a facility that
4-24 operated as a tertiary care facility during the previous year, an
4-25 initial certification to the comptroller under Subsection (a) in an
4-26 amount that equals 80 percent of the amount certified under this
4-27 section for the facility in the previous year. The department
5-1 shall make a subsequent certification of the cost of additional
5-2 unreimbursed tertiary medical services provided by the facility on
5-3 receipt from the facility of the information required to be
5-4 submitted under Section 46.004.
5-5 (d) Except as provided by Subsection (e), each year the
5-6 comptroller shall pay a tertiary care facility the certified amount
5-7 determined under Subsection (a) from the funds specified under
5-8 Section 46.003(f).
5-9 (e) If in any year the total cost of unreimbursed tertiary
5-10 medical services certified under Subsection (a) for all tertiary
5-11 care facilities exceeds the amount available for payment to the
5-12 facilities under Section 46.003(f), the department shall allocate
5-13 the amount available under Section 46.003(f) to each facility based
5-14 on the percentages computed by dividing the cost of the facility's
5-15 unreimbursed services by the total cost of all facilities'
5-16 unreimbursed services. The comptroller shall pay each tertiary
5-17 care facility based on the allocation made under this subsection.
5-18 (f) For purposes of this section and Section 46.007, the
5-19 cost of each service provided by a tertiary care facility is the
5-20 average amount payable under Medicare reimbursement policies for
5-21 that service.
5-22 Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED
5-23 STABILIZATION SERVICES. (a) The department shall certify to the
5-24 comptroller for each tertiary care facility or level IV trauma
5-25 facility the cost of unreimbursed stabilization services provided
5-26 to persons who reside outside the service area of the county,
5-27 public hospital, or hospital district that is responsible for
6-1 indigent health care under Chapter 61 in the area in which the
6-2 tertiary care facility or level IV trauma facility is located.
6-3 (b) In each fiscal year the department shall use no more
6-4 than four percent of the appropriated money in the tertiary care
6-5 account to compensate tertiary care facilities and level IV trauma
6-6 facilities for unreimbursed stabilization services.
6-7 (c) Each year the department shall make, for a facility that
6-8 operated as a tertiary care facility or level IV trauma facility
6-9 during the previous year, an initial certification to the
6-10 comptroller under Subsection (a) in an amount that equals 80
6-11 percent of the amount certified under this section for the facility
6-12 in the previous year. The department shall make a subsequent
6-13 certification of the cost of additional unreimbursed stabilization
6-14 services provided by the facility on receipt from the facility of
6-15 the information required to be submitted under Section 46.004.
6-16 (d) Except as provided by Subsection (e), each year the
6-17 comptroller shall pay a tertiary care facility or level IV trauma
6-18 facility the certified amount determined under Subsection (a) from
6-19 the funds specified under Section 46.003(f).
6-20 (e) If in any year the total cost of unreimbursed
6-21 stabilization services certified under Subsection (a) for all
6-22 tertiary care facilities or level IV trauma facilities exceeds the
6-23 amount available for payment to the facilities under Section
6-24 46.003(f), the department shall allocate the amount available under
6-25 Section 46.003(f) to each facility based on the percentages
6-26 computed by dividing the cost of the facility's unreimbursed
6-27 stabilization services by the total cost of all facilities'
7-1 unreimbursed stabilization services. The comptroller shall pay
7-2 each tertiary care facility or level IV trauma facility based on
7-3 the allocation made under this subsection.
7-4 (f) For purposes of this section and Section 46.007, the
7-5 cost of each service provided by a tertiary care facility or level
7-6 IV trauma facility is the average amount payable under Medicare
7-7 reimbursement policies for that service.
7-8 Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) For
7-9 purposes of reimbursing extraordinary emergencies under this
7-10 chapter, the department shall certify an extraordinary emergency:
7-11 (1) if the governor issues an executive order or a
7-12 proclamation under Chapter 418, Government Code;
7-13 (2) if a disaster is declared by the president of the
7-14 United States under the Robert T. Stafford Disaster Relief and
7-15 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
7-16 (3) for another similar disaster the department finds
7-17 has resulted in an extraordinary cost to a tertiary care facility
7-18 or level IV trauma facility.
7-19 (b) If an extraordinary emergency is certified under
7-20 Subsection (a), the department shall certify to the comptroller the
7-21 amount of unreimbursed tertiary medical services or stabilization
7-22 services or transportation services incurred by a tertiary care
7-23 facility or level IV trauma facility, as appropriate, during the
7-24 emergency.
7-25 (c) Except as provided by Subsection (d), each year the
7-26 comptroller shall pay a tertiary care facility or level IV trauma
7-27 facility the certified amount determined under Subsection (b) from
8-1 the funds specified under Section 46.003(e).
8-2 (d) If in any year the total cost of unreimbursed tertiary
8-3 medical services or stabilization services certified under
8-4 Subsection (b) for all facilities exceeds the amount available for
8-5 payment to the facilities under Section 46.003(e), the department
8-6 shall allocate the amount available under Section 46.003(e) to each
8-7 facility based on the percentages computed by dividing the cost of
8-8 the facility's or provider's unreimbursed services by the total
8-9 cost of all facilities' unreimbursed services. The comptroller
8-10 shall pay each tertiary care facility or level IV trauma facility
8-11 based on the allocation made under this subsection.
8-12 SECTION 2. This Act takes effect September 1, 1999.
8-13 SECTION 3. This Act takes effect only if a specific
8-14 appropriation for the implementation of this Act is provided in
8-15 H.B. No. 1 (General Appropriations Act), Acts of the 76th
8-16 Legislature, Regular Session, 1999. If no specific appropriation
8-17 is provided in H.B. No. 1, the General Appropriations Act, this Act
8-18 has no effect.
8-19 SECTION 4. The importance of this legislation and the
8-20 crowded condition of the calendars in both houses create an
8-21 emergency and an imperative public necessity that the
8-22 constitutional rule requiring bills to be read on three several
8-23 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2573 was passed by the House on April
27, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 2573 on May 26, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 2573 was passed by the Senate, with
amendments, on May 24, 1999, by the following vote: Yeas 30, Nays
0.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor