1-1 By: Wolens (Senate Sponsor - Nelson) H.B. No. 2573 1-2 (In the Senate - Received from the House April 28, 1999; 1-3 April 29, 1999, read first time and referred to Committee on Health 1-4 Services; May 13, 1999, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 5, Nays 0; 1-6 May 13, 1999, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 2573 By: Nelson 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to tertiary medical care. 1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-12 SECTION 1. Subtitle B, Title 2, Health and Safety Code, is 1-13 amended by adding Chapter 46 to read as follows: 1-14 CHAPTER 46. TERTIARY MEDICAL CARE 1-15 Sec. 46.001. DEFINITIONS. In this chapter: 1-16 (1) "Tertiary care facility" means a: 1-17 (A) primary teaching hospital of a medical 1-18 school; 1-19 (B) level I trauma center; 1-20 (C) level II trauma center; or 1-21 (D) level III trauma center. 1-22 (2) "Tertiary medical services" includes, but is not 1-23 limited to, services provided by state-designated trauma centers, 1-24 burn center treatment, neonatology Level III unit services, 1-25 pediatric surgery, trauma surgery, neurosurgery, cardiothoracic and 1-26 vascular surgery, organ transplant, services provided for a life 1-27 threatening dermatologic illness, services provided to a person 1-28 with a high risk pregnancy or cancer, and radiation oncology. 1-29 (3) "Stabilization services" means services provided 1-30 by a tertiary care facility or a level IV designated trauma center 1-31 that are necessary to assure, within reasonable medical 1-32 probability, that no material deterioration of a patient's medical 1-33 condition is likely to result from or occur during the transfer of 1-34 the patient to a tertiary care facility. 1-35 (4) "Unreimbursed tertiary medical services" means 1-36 tertiary care medical services for which a tertiary care facility 1-37 has not received full payment from any public or private source. 1-38 (5) "Unreimbursed stabilization services" means 1-39 stabilization services for which a tertiary care facility or level 1-40 IV designated trauma facility has not received full payment from 1-41 any public or private source. 1-42 Sec. 46.002. RULES. (a) The board may adopt rules to 1-43 implement a system that encourages hospitals to provide tertiary 1-44 medical services and stabilization services. 1-45 (b) The rules must address: 1-46 (1) coordination of tertiary medical services and 1-47 stabilization services among health care facilities in the 1-48 delivery area; 1-49 (2) pre-hospital care management guidelines for 1-50 triage, transfer, and transportation of patients and periodic 1-51 evaluation of tertiary care facilities' and level IV trauma 1-52 facilities' compliance with the guidelines and the trauma facility 1-53 rules, as appropriate; 1-54 (3) requirements for data collection, including 1-55 patient outcomes; 1-56 (4) assurances that tertiary care facilities will not 1-57 refuse to accept the transfer of a patient solely because of the 1-58 person's inability to pay for services or because of the person's 1-59 age, sex, race, religion, or national origin; and 1-60 (5) enforcement of the rules. 1-61 Sec. 46.003. TERTIARY CARE ACCOUNT. (a) The tertiary care 1-62 account is an account in the state treasury. Money in the account 1-63 may be appropriated only to the department for the purposes of this 1-64 chapter. 2-1 (b) The account is composed of money appropriated to the 2-2 account and any other funds required to be put in the account. 2-3 (c) The department may seek and accept gifts, grants, and 2-4 donations from any public or private entity on behalf of the 2-5 account. 2-6 (d) Section 403.095, Government Code, does not apply to the 2-7 account. 2-8 (e) For each fiscal year, five percent of the total amount 2-9 in the account shall be held in reserve and may be used only for 2-10 reimbursement of unpaid tertiary medical services and stabilization 2-11 services provided as a result of extraordinary emergencies 2-12 occurring during that year. Of the amount remaining, not more than 2-13 five percent may be used for the costs of administering the 2-14 account. 2-15 (f) Except as provided by subsection (e), the account shall 2-16 be allocated for payment to tertiary care facilities and level IV 2-17 trauma centers for unreimbursed tertiary medical services and 2-18 stabilization services, as provided for in Section 46.005 and 2-19 46.006. 2-20 Sec. 46.004. COLLECTION OF INFORMATION. (a) Each tertiary 2-21 care facility or level IV trauma facility that seeks payment under 2-22 this chapter shall submit to the department, in the manner and at 2-23 the time required by the department, information that relates to 2-24 the unreimbursed tertiary medical services or stabilization 2-25 services provided to persons who reside outside the service area of 2-26 the county, public hospital, or hospital district that is 2-27 responsible for indigent health care under Chapter 61 in the area 2-28 in which the tertiary care facility or level IV trauma facility is 2-29 located. 2-30 (b) The board shall adopt rules governing the collection of 2-31 the information under Subsection (a). 2-32 Sec. 46.005. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED 2-33 TERTIARY MEDICAL SERVICES. (a) The department shall certify to 2-34 the comptroller for each tertiary care facility the cost of 2-35 unreimbursed tertiary medical services provided to persons who 2-36 reside outside the service area of the county, public hospital, or 2-37 hospital district that is responsible for indigent health care 2-38 under Chapter 61 in the area in which the tertiary care facility is 2-39 located. 2-40 (b) In each fiscal year the department shall use at least 86 2-41 percent of the appropriated money in the tertiary care account to 2-42 compensate tertiary care facilities for unreimbursed tertiary 2-43 medical services. 2-44 (c) Each year the department shall make, for a facility that 2-45 operated as a tertiary care facility during the previous year, an 2-46 initial certification to the comptroller under Subsection (a) in an 2-47 amount that equals 80 percent of the amount certified under this 2-48 section for the facility in the previous year. The department 2-49 shall make a subsequent certification of the cost of additional 2-50 unreimbursed tertiary medical services provided by the facility on 2-51 receipt from the facility of the information required to be 2-52 submitted under Section 46.004. 2-53 (d) Except as provided by Subsection (e), each year the 2-54 comptroller shall pay a tertiary care facility the certified amount 2-55 determined under Subsection (a) from the funds specified under 2-56 Section 46.003(f). 2-57 (e) If in any year the total cost of unreimbursed tertiary 2-58 medical services certified under Subsection (a) for all tertiary 2-59 care facilities exceeds the amount available for payment to the 2-60 facilities under Section 46.003(f), the department shall allocate 2-61 the amount available under Section 46.003(f) to each facility based 2-62 on the percentages computed by dividing the cost of the facility's 2-63 unreimbursed services by the total cost of all facilities' 2-64 unreimbursed services. The comptroller shall pay each tertiary 2-65 care facility based on the allocation made under this Subsection. 2-66 (f) For purposes of this section and Section 46.007, the 2-67 cost of each service provided by a tertiary care facility is the 2-68 average amount payable under Medicare reimbursement policies for 2-69 that service. 3-1 Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED 3-2 STABILIZATION SERVICES. (a) The department shall certify to the 3-3 comptroller for each tertiary care facility or level IV trauma 3-4 facility the cost of unreimbursed stabilization services provided 3-5 to persons who reside outside the service area of the county, 3-6 public hospital, or hospital district that is responsible for 3-7 indigent health care under Chapter 61 in the area in which the 3-8 tertiary care facility or level IV trauma facility is located. 3-9 (b) In each fiscal year the department shall use no more 3-10 than four percent of the appropriated money in the tertiary care 3-11 account to compensate tertiary care facilities and level IV trauma 3-12 facilities for unreimbursed stabilization services. 3-13 (c) Each year the department shall make, for a facility that 3-14 operated as a tertiary care facility or level IV trauma facility 3-15 during the previous year, an initial certification to the 3-16 comptroller under Subsection (a) in an amount that equals 80 3-17 percent of the amount certified under this section for the facility 3-18 in the previous year. The department shall make a subsequent 3-19 certification of the cost of additional unreimbursed stabilization 3-20 services provided by the facility on receipt from the facility of 3-21 the information required to be submitted under Section 46.004. 3-22 (d) Except as provided by Subsection (e), each year the 3-23 comptroller shall pay a tertiary care facility or level IV trauma 3-24 facility the certified amount determined under Subsection (a) from 3-25 the funds specified under Section 46.003(f). 3-26 (e) If in any year the total cost of unreimbursed 3-27 stabilization services certified under Subsection (a) for all 3-28 tertiary care facilities or level IV trauma facilities exceeds the 3-29 amount available for payment to the facilities under Section 3-30 46.003(f), the department shall allocate the amount available under 3-31 Section 46.003(f) to each facility based on the percentages 3-32 computed by dividing the cost of the facility's unreimbursed 3-33 stabilization services by the total cost of all facilities' 3-34 unreimbursed stabilization services. The comptroller shall pay 3-35 each tertiary care facility or level IV trauma facility based on 3-36 the allocation made under this Subsection. 3-37 (f) For purposes of this section and Section 46.007, the 3-38 cost of each service provided by a tertiary care facility or level 3-39 IV trauma facility is the average amount payable under Medicare 3-40 reimbursement policies for that service. 3-41 Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) For 3-42 purposes of reimbursing extraordinary emergencies under this 3-43 chapter, the department shall certify an extraordinary emergency: 3-44 (1) if the governor issues an executive order or a 3-45 proclamation under Chapter 418, Government Code; 3-46 (2) if a disaster is declared by the president of the 3-47 United States under the Robert T. Stafford Disaster Relief and 3-48 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or 3-49 (3) for another similar disaster the department finds 3-50 has resulted in an extraordinary cost to a tertiary care facility 3-51 or level IV trauma facility. 3-52 (b) If an extraordinary emergency is certified under 3-53 Subsection (a), the department shall certify to the comptroller the 3-54 amount of unreimbursed tertiary medical services or stabilization 3-55 services or transportation services incurred by a tertiary care 3-56 facility or level IV trauma facility, as appropriate, during the 3-57 emergency. 3-58 (c) Except as provided by Subsection (d), each year the 3-59 comptroller shall pay a tertiary care facility or level IV trauma 3-60 facility the certified amount determined under Subsection (b) from 3-61 the funds specified under Section 46.003(e). 3-62 (d) If in any year the total cost of unreimbursed tertiary 3-63 medical services or stabilization services certified under 3-64 Subsection (b) for all facilities exceeds the amount available for 3-65 payment to the facilities under Section 46.003(e), the department 3-66 shall allocate the amount available under Section 46.003(e) to each 3-67 facility based on the percentages computed by dividing the cost of 3-68 the facility's or provider unreimbursed services by the total cost 3-69 of all facilities' unreimbursed services. The comptroller shall 4-1 pay each tertiary care facility or level IV trauma facility based 4-2 on the allocation made under this Subsection. 4-3 SECTION 2. This Act takes effect September 1, 1999. 4-4 SECTION 3. This Act takes effect only if a specific 4-5 appropriation for the implementation of this Act is provided in 4-6 H.B. No. 1 (General Appropriations Act), Acts of the 76th 4-7 Legislature, Regular Session, 1999. If no specific appropriation 4-8 is provided in H.B. No. 1, the General Appropriations Act, this Act 4-9 has no effect. 4-10 SECTION 4. The importance of this legislation and the 4-11 crowded condition of the calendars in both houses create an 4-12 emergency and an imperative public necessity that the 4-13 constitutional rule requiring bills to be read on three several 4-14 days in each house be suspended, and this rule is hereby suspended. 4-15 * * * * *