By Hawley H.B. No. 2426
77R6552 YDB-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to disbursements to rural hospitals from the tertiary care
1-3 account.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 46.001, Health and Safety Code, as added
1-6 by Chapters 969 and 1377, Acts of the 76th Legislature, Regular
1-7 Session, 1999, is amended by adding Subdivisions (6), (7), and (8)
1-8 to read as follows:
1-9 (6) "Rural emergency medical services" means services
1-10 provided by a rural hospital to respond to an individual's
1-11 perceived need for immediate medical care or to prevent death or
1-12 aggravation of physiological or psychological illness or injury.
1-13 (7) "Rural hospital" means a general acute care
1-14 hospital licensed under Chapter 241 that is located in a county:
1-15 (A) with a population of 35,000 or less; or
1-16 (B) with a population of more than 35,000, but
1-17 that has fewer than 101 licensed hospital beds and is not in an
1-18 urbanized area as determined by the United States Census Bureau.
1-19 (8) "Unreimbursed rural emergency medical services"
1-20 means rural emergency medical services for which a rural hospital
1-21 has not received full payment from any public or private source.
1-22 SECTION 2. Section 46.002, Health and Safety Code, as added
1-23 by Chapters 969 and 1377, Acts of the 76th Legislature, Regular
1-24 Session, 1999, is amended to read as follows:
2-1 Sec. 46.002. RULES. (a) The board may adopt rules to
2-2 implement a system that encourages hospitals to provide tertiary
2-3 medical services, [and] stabilization services, and rural emergency
2-4 medical services.
2-5 (b) The rules must address:
2-6 (1) coordination of tertiary medical services, [and]
2-7 stabilization services, and rural emergency medical services among
2-8 health care facilities in the delivery area;
2-9 (2) pre-hospital care management guidelines for
2-10 triage, transfer, and transportation of patients and periodic
2-11 evaluation of tertiary care facilities', [and] level IV trauma
2-12 facilities', and rural hospitals' compliance with the guidelines
2-13 and the trauma facility rules, as appropriate;
2-14 (3) requirements for data collection, including
2-15 patient outcomes;
2-16 (4) assurances that tertiary care facilities will not
2-17 refuse to accept the transfer of a patient solely because of the
2-18 person's inability to pay for services or because of the person's
2-19 age, sex, race, religion, or national origin; and
2-20 (5) enforcement of the rules.
2-21 SECTION 3. Sections 46.003(e) and (f), Health and Safety
2-22 Code, as added by Chapters 969 and 1377, Acts of the 76th
2-23 Legislature, Regular Session, 1999, are amended to read as follows:
2-24 (e) For each fiscal year, five percent of the total amount
2-25 in the account shall be held in reserve and may be used only for
2-26 reimbursement of unpaid tertiary medical services, [and]
2-27 stabilization services, and rural emergency medical services
3-1 provided as a result of extraordinary emergencies occurring during
3-2 that year. Of the amount remaining, not more than five percent may
3-3 be used for the costs of administering the account.
3-4 (f) Except as provided by Subsection (e), the account shall
3-5 be allocated for payment to tertiary care facilities and level IV
3-6 trauma centers for unreimbursed tertiary medical services, [and]
3-7 stabilization services, and rural emergency medical services, as
3-8 provided for in Sections 46.005 and 46.006.
3-9 SECTION 4. Section 46.004(a), Health and Safety Code, as
3-10 added by Chapters 969 and 1377, Acts of the 76th Legislature,
3-11 Regular Session, 1999, is amended to read as follows:
3-12 (a) Each tertiary care facility, [or] level IV trauma, or
3-13 rural hospital facility that seeks payment under this chapter shall
3-14 submit to the department, in the manner and at the time required by
3-15 the department, information that relates to the unreimbursed
3-16 tertiary medical services, [or] stabilization services, or rural
3-17 emergency medical services provided to persons who reside outside
3-18 the service area of the county, public hospital, or hospital
3-19 district that is responsible for indigent health care under Chapter
3-20 61 in the area in which the tertiary care facility, [or] level IV
3-21 trauma facility, or rural hospital is located.
3-22 SECTION 5. Section 46.005(b), Health and Safety Code, as
3-23 added by Chapters 969 and 1377, Acts of the 76th Legislature,
3-24 Regular Session, 1999, is amended to read as follows:
3-25 (b) In each fiscal year the department shall use at least 80
3-26 [86] percent of the appropriated money in the tertiary care account
3-27 to compensate tertiary care facilities for unreimbursed tertiary
4-1 medical services.
4-2 SECTION 6. Sections 46.006 and 46.007, Health and Safety
4-3 Code, as added by Chapters 969 and 1377, Acts of the 76th
4-4 Legislature, Regular Session, 1999, are amended to read as follows:
4-5 Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED
4-6 STABILIZATION SERVICES AND UNREIMBURSED RURAL EMERGENCY MEDICAL
4-7 SERVICES. (a) The department shall certify to the comptroller for
4-8 each tertiary care facility, [or] level IV trauma facility, or
4-9 rural hospital the cost of unreimbursed stabilization services or
4-10 unreimbursed rural emergency medical services provided to persons
4-11 who reside outside the service area of the county, public hospital,
4-12 or hospital district that is responsible for indigent health care
4-13 under Chapter 61 in the area in which the tertiary care facility,
4-14 [or] level IV trauma facility, or rural hospital is located.
4-15 (b) In each fiscal year the department shall use no more
4-16 than 10 [four] percent of the appropriated money in the tertiary
4-17 care account to compensate tertiary care facilities, [and] level IV
4-18 trauma facilities, or rural hospitals for unreimbursed
4-19 stabilization services or unreimbursed rural emergency medical
4-20 services.
4-21 (c) Each year the department shall make, for a facility that
4-22 operated as a tertiary care facility, [or] level IV trauma
4-23 facility, or rural hospital during the previous year, an initial
4-24 certification to the comptroller under Subsection (a) in an amount
4-25 that equals 80 percent of the amount certified under this section
4-26 for the facility in the previous year. The department shall make a
4-27 subsequent certification of the cost of additional unreimbursed
5-1 stabilization services and unreimbursed rural emergency medical
5-2 services provided by the facility on receipt from the facility of
5-3 the information required to be submitted under Section 46.004.
5-4 (d) Except as provided by Subsection (e), each year the
5-5 comptroller shall pay a tertiary care facility, [or] level IV
5-6 trauma facility, or rural hospital the certified amount determined
5-7 under Subsection (a) from the funds specified under Section
5-8 46.003(f).
5-9 (e) If in any year the total cost of unreimbursed
5-10 stabilization services and unreimbursed rural emergency medical
5-11 services certified under Subsection (a) for all tertiary care
5-12 facilities, [or] level IV trauma facilities, or rural hospitals
5-13 exceeds the amount available for payment to the facilities under
5-14 Section 46.003(f), as limited by Subsection (b), the department
5-15 shall allocate the amount available under Section 46.003(f) to each
5-16 facility based on the percentages computed by dividing the cost of
5-17 the facility's unreimbursed stabilization services and unreimbursed
5-18 rural emergency medical services by the total cost of all
5-19 facilities' unreimbursed stabilization services and unreimbursed
5-20 rural emergency medical services. The comptroller shall pay each
5-21 tertiary care facility, [or] level IV trauma facility, or rural
5-22 hospital based on the allocation made under this subsection.
5-23 (f) For purposes of this section and Section 46.007, the
5-24 cost of each service provided by a tertiary care facility, [or]
5-25 level IV trauma facility, or rural hospital is the average amount
5-26 payable under Medicare reimbursement policies for that service.
5-27 Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) For purposes
6-1 of reimbursing extraordinary emergencies under this chapter, the
6-2 department shall certify an extraordinary emergency:
6-3 (1) if the governor issues an executive order or a
6-4 proclamation under Chapter 418, Government Code;
6-5 (2) if a disaster is declared by the president of the
6-6 United States under the Robert T. Stafford Disaster Relief and
6-7 Emergency Assistance Act (42 U.S.C. Section 5121 et seq.); or
6-8 (3) for another similar disaster the department finds
6-9 has resulted in an extraordinary cost to a tertiary care facility,
6-10 [or] level IV trauma facility, or rural hospital.
6-11 (b) If an extraordinary emergency is certified under
6-12 Subsection (a), the department shall certify to the comptroller the
6-13 amount of unreimbursed tertiary medical services, [or]
6-14 stabilization services, rural emergency medical services, or
6-15 transportation services incurred by a tertiary care facility, [or]
6-16 level IV trauma facility, or rural hospital, as appropriate, during
6-17 the emergency.
6-18 (c) Except as provided by Subsection (d), each year the
6-19 comptroller shall pay a tertiary care facility, [or] level IV
6-20 trauma facility, or rural hospital the certified amount determined
6-21 under Subsection (b) from the funds specified under Section
6-22 46.003(e).
6-23 (d) If in any year the total cost of unreimbursed tertiary
6-24 medical services, [or] stabilization services, or rural emergency
6-25 medical services certified under Subsection (b) for all facilities
6-26 exceeds the amount available for payment to the facilities under
6-27 Section 46.003(e), the department shall allocate the amount
7-1 available under Section 46.003(e) to each facility based on the
7-2 percentages computed by dividing the cost of the facility's [or
7-3 provider's] unreimbursed services by the total cost of all
7-4 facilities' unreimbursed services. The comptroller shall pay each
7-5 tertiary care facility, [or] level IV trauma facility, or rural
7-6 hospital based on the allocation made under this subsection.
7-7 SECTION 7. This Act takes effect September 1, 2001.