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.
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