By Wolens H.B. No. 2573
76R5760 CMR-D
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; or
1-13 (D) level 3 trauma center that is more than 100
1-14 miles from a level 1 or level 2 trauma center.
1-15 (2) "Tertiary medical services" includes services
1-16 provided by burn centers and neonatology Level III units, pediatric
1-17 and trauma surgery, neurosurgery, cardiothoracic and vascular
1-18 surgery, organ transplant, services provided for a life threatening
1-19 dermatologic illness, services provided to a person with a high
1-20 risk pregnancy or cancer, and radiation oncology.
1-21 Sec. 46.002. DESIGNATION OF FACILITIES. The department
1-22 shall designate tertiary care facilities that meet the requirements
1-23 of this chapter to provide tertiary medical services.
1-24 Sec. 46.003. DUTIES OF BOARD; RULES. (a) The board by rule
2-1 shall adopt minimum standards and objectives to implement a system
2-2 that encourages hospitals to provide tertiary medical services and
2-3 increases the availability of tertiary medical services.
2-4 (b) The rules must:
2-5 (1) provide for service to all geographic areas of the
2-6 state, considering time and distance to the tertiary care
2-7 facilities;
2-8 (2) provide specific requirements for appropriate care
2-9 of patients; and
2-10 (3) facilitate coordination among all health care
2-11 facilities in the delivery area.
2-12 (c) The rules must include:
2-13 (1) pre-hospital care management guidelines for
2-14 triage, transfer, and transportation of patients;
2-15 (2) criteria for determining geographic boundaries of
2-16 tertiary care facilities;
2-17 (3) minimum requirements for resources and equipment
2-18 needed by a health care facility to treat patients;
2-19 (4) standards for the availability and qualifications
2-20 of the health care personnel, including each specialist treating a
2-21 patient in a tertiary care facility;
2-22 (5) requirements for data collection, including
2-23 operation of the tertiary care facility and patient outcomes;
2-24 (6) requirements for periodic performance evaluation
2-25 of the tertiary care facility; and
2-26 (7) assurances that designated tertiary care
2-27 facilities will not refuse to accept the transfer of a patient
3-1 solely because of the person's inability to pay for services or
3-2 because of the person's age, sex, race, religion, or national
3-3 origin.
3-4 Sec. 46.004. DENIAL, SUSPENSION, OR REVOCATION OF
3-5 DESIGNATION. (a) The department may deny, suspend, or revoke a
3-6 designation as a tertiary care facility if the facility fails to
3-7 comply with the rules adopted under this chapter.
3-8 (b) The denial, suspension, or revocation of a designation
3-9 by the department and the appeal from that action are governed by
3-10 the board's rules for a contested case hearing and by Chapter 2001,
3-11 Government Code.
3-12 Sec. 46.005. TERTIARY CARE FACILITY ACCOUNT. (a) The
3-13 tertiary care facility account is an account in the state treasury.
3-14 Money in the account may be appropriated only to the department for
3-15 the purposes of this chapter.
3-16 (b) The account is composed of money appropriated to the
3-17 account and any other funds required to be put in the account.
3-18 (c) The department may seek and accept gifts, grants, and
3-19 donations from any public or private entity on behalf of the
3-20 account.
3-21 (d) Section 403.095, Government Code, does not apply to the
3-22 account.
3-23 (e) For each fiscal year, five percent of the total amount
3-24 in the account shall be held in reserve and may be used only for
3-25 reimbursement of unpaid tertiary medical services provided as a
3-26 result of extraordinary emergencies occurring during that year. Of
3-27 the amount remaining, not more than five percent may be used for
4-1 the costs of administering the account.
4-2 Sec. 46.006. COLLECTION OF INFORMATION. (a) Each
4-3 designated tertiary care facility shall submit to the department,
4-4 in the manner and at the time required by the department,
4-5 information that relates to the unreimbursed tertiary medical
4-6 services provided to persons who reside outside the service area of
4-7 the county, public hospital, or hospital district that is
4-8 responsible for indigent health care under Chapter 61 in the area
4-9 in which the tertiary care facility is located.
4-10 (b) The board shall adopt rules governing the collection of
4-11 the information under Subsection (a).
4-12 Sec. 46.007. CERTIFICATION TO COMPTROLLER. (a) The
4-13 department shall certify to the comptroller for each designated
4-14 tertiary care facility the cost of unreimbursed tertiary medical
4-15 services provided by the facility to persons who reside outside the
4-16 service area of the county, public hospital, or hospital district
4-17 that is responsible for indigent health care under Chapter 61 in
4-18 the area in which the tertiary care facility is located.
4-19 (b) Each year the department shall make, for a facility that
4-20 was a designated tertiary care facility during the previous year,
4-21 an initial certification to the comptroller under Subsection (a) in
4-22 an amount that equals 80 percent of the amount certified under this
4-23 section for the facility in the previous year. The department shall
4-24 make a subsequent certification of the cost of additional
4-25 unreimbursed tertiary medical services provided by the facility on
4-26 receipt from the facility of the information required to be
4-27 submitted under Section 46.006.
5-1 (c) If in any year the total cost of unreimbursed tertiary
5-2 medical services certified under Subsection (a) for all designated
5-3 tertiary care facilities exceeds the amount available for payment
5-4 to the facilities under Section 46.005(e), the department shall
5-5 allocate the amount available under Section 46.005(e) to each
5-6 facility based on the percentages computed by dividing the cost of
5-7 the facility's unreimbursed tertiary medical services by the total
5-8 cost of all facilities' unreimbursed tertiary medical services.
5-9 (d) For purposes of this section and Section 46.008, the
5-10 cost of each service provided is the average amount payable under
5-11 Medicare for services for the Medicare diagnosis related groups
5-12 that must be provided by a tertiary care facility to qualify for
5-13 designation under the minimum standards adopted under this chapter.
5-14 Sec. 46.008. CERTIFICATION OF EMERGENCIES. (a) For
5-15 purposes of reimbursing extraordinary emergencies under this
5-16 chapter, the department shall certify an extraordinary emergency:
5-17 (1) if the governor issues an executive order or a
5-18 proclamation under Chapter 418, Government Code;
5-19 (2) if a disaster is declared by the president of the
5-20 United States under the Robert T. Stafford Disaster Relief and
5-21 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
5-22 (3) for another similar disaster the department finds
5-23 has resulted in an extraordinary cost to a designated tertiary care
5-24 facility.
5-25 (b) If an extraordinary emergency is declared under
5-26 Subsection (a), the department shall certify to the comptroller the
5-27 amount of unreimbursed tertiary medical services incurred by a
6-1 designated tertiary care facility during the emergency.
6-2 (c) The comptroller shall pay the tertiary care facility.
6-3 SECTION 2. This Act takes effect September 1, 1999.
6-4 SECTION 3. The importance of this legislation and the
6-5 crowded condition of the calendars in both houses create an
6-6 emergency and an imperative public necessity that the
6-7 constitutional rule requiring bills to be read on three several
6-8 days in each house be suspended, and this rule is hereby suspended.