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