79R1899 JTS-F
By: Branch H.B. No. 930
A BILL TO BE ENTITLED
AN ACT
relating to regional funding of indigent health care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 61.002(4), Health and Safety Code, is
amended to read as follows:
(4) "Emergency services" has the meaning assigned to
"emergency medical services" by Chapter 773.
SECTION 2. Section 61.004(b), Health and Safety Code, is
amended to read as follows:
(b) If a matter is submitted to the department under
Subsection (a), the [The] provider of assistance and the
governmental entity or hospital district shall submit promptly to
the department all relevant information regarding the person's
residence and eligibility for assistance, and services rendered by
the provider [to the department] in accordance with the
application, documentation, and verification procedures
established by the department under Section 61.006.
SECTION 3. Sections 61.006(b) and (c), Health and Safety
Code, are amended to read as follows:
(b) The minimum eligibility standards must incorporate a
net income eligibility level equal to 200 [21] percent of the
federal poverty level based on the federal Office of Management and
Budget poverty index.
(c) The department shall also define the services and
establish the payment standards for the categories of services
listed in Sections 61.028(a) and 61.0285 in accordance with
applicable [Texas Department of Human Services] rules relating to
the Temporary Assistance for Needy Families-Medicaid program. The
payment standards must be based on reasonable and customary charges
for the services.
SECTION 4. Section 61.022(b), Health and Safety Code, is
amended to read as follows:
(b) The county is the payor of last resort and shall provide
assistance only if other adequate public or private sources of
payment do not reimburse a provider for services rendered [are not
available].
SECTION 5. Subchapter B, Chapter 61, Health and Safety
Code, is amended by adding Section 61.0222 to read as follows:
Sec. 61.0222. MANDATORY MINIMUM BUDGET. (a) Each county
that provides health care assistance under this subchapter shall
set aside annually an amount equal to not less than eight percent of
its general revenue levy to pay for health care assistance under
this subchapter. The county annually shall report to the
department the amount set aside under this section.
(b) At the end of each fiscal year the county shall remit to
the comptroller any unused portion of the amount set aside under
this section for deposit in the tertiary care account under Section
46.003.
SECTION 6. Sections 61.023(a), (b), and (d), Health and
Safety Code, are amended to read as follows:
(a) A person is eligible for assistance under this
subchapter if:
(1) the person does not reside in the service area of a
public hospital or hospital district;
(2) the person meets the basic income and resources
requirements established by the department under Sections 61.006
and 61.008 and in effect when the assistance is requested; and
(3) no other adequate source of payment exists to
reimburse a provider for services rendered.
(b) A county may use a less restrictive standard of
eligibility for residents than prescribed by Subsection (a). [A
county may credit toward eligibility for state assistance under
this subchapter the services provided to each person who is an
eligible resident under a standard that incorporates a net income
eligibility level that is less than 50 percent of the federal
poverty level based on the federal Office of Management and Budget
poverty index.]
(d) Not later than the beginning of a state fiscal year, the
county shall adopt the eligibility standards it will use during
that fiscal year and shall make a reasonable effort to notify the
public of the standards. The county may change the eligibility
standards [to make them more or less restrictive than the preceding
standards], but the standards may not be more restrictive than the
standards under Subsection (a) [established by the department under
Section 61.006].
SECTION 7. Section 61.027, Health and Safety Code, is
amended by amending Subsection (b) and adding Subsection (c) to
read as follows:
(b) If an eligible resident fails to report a change in
income or resources as prescribed by this section and the change has
made the resident ineligible for assistance under the standards
adopted by the county, the resident is liable for any benefits
received while ineligible.
(c) This section does not affect:
(1) a person's criminal liability under any relevant
statute; or
(2) the liability of a county under Section 61.033.
SECTION 8. Section 61.028(a), Health and Safety Code, is
amended to read as follows:
(a) A county shall, in accordance with department rules
adopted under Section 61.006, provide the following basic health
care services:
(1) primary and preventative services designed to meet
the needs of the community, including:
(A) immunizations;
(B) medical screening services; and
(C) annual physical examinations;
(2) inpatient and outpatient hospital services;
(3) rural health clinics;
(4) laboratory and X-ray services;
(5) family planning services;
(6) physician services;
(7) payment for not more than three prescription drugs
a month; [and]
(8) skilled nursing facility services, regardless of
the patient's age;
(9) emergency services; and
(10) tertiary medical services, as defined by Section
46.001.
SECTION 9. Section 61.0285(a), Health and Safety Code, is
amended to read as follows:
(a) In addition to basic health care services provided under
Section 61.028, a county may, in accordance with department rules
adopted under Section 61.006, provide other medically necessary
services or supplies that the county determines to be
cost-effective, including:
(1) ambulatory surgical center services;
(2) diabetic and colostomy medical supplies and
equipment;
(3) durable medical equipment;
(4) home and community health care services;
(5) social work services;
(6) psychological counseling services;
(7) services provided by physician assistants, nurse
practitioners, certified nurse midwives, clinical nurse
specialists, and certified registered nurse anesthetists;
(8) dental care;
(9) vision care, including eyeglasses;
(10) services provided by federally qualified health
centers, as defined by 42 U.S.C. Section 1396d(l)(2)(B); and
(11) [emergency medical services; and
[(12)] any other appropriate health care service
identified by board rule that may be determined to be
cost-effective.
SECTION 10. Sections 61.031(a), (b), (d), and (e), Health
and Safety Code, are amended to read as follows:
(a) A county may require any provider, including a mandated
provider, to obtain approval from the county before providing
nonemergency health care services to an eligible county resident.
A county that requires a provider to obtain approval under this
subsection may not deny a claim by a provider for failure to obtain
approval unless the county can demonstrate that the provider
received actual notice of the requirement.
(b) If the county does not require prior approval and a
provider delivers or will deliver nonemergency health care services
to a patient who the provider suspects may be eligible for
assistance under this subchapter, the provider shall notify the
patient's county of residence that health care services have been
or will be provided to the patient. The notice shall be made[:
[(1) by telephone not later than the 72nd hour after
the provider determines the patient's county of residence; and
[(2)] by mail postmarked not later than the 30th
[fifth working] day after the date on which the provider determines
the patient's county of residence. If a provider sends timely
notice under this subsection to any county that the provider
reasonably believes to be the patient's county of residence, that
notice is effective to toll the deadline for giving notice under
this subsection if another county is later determined to be the
patient's county of residence.
(d) Not later than the 14th day after the date on which the
patient's county of residence receives notification from a provider
under Subsection (b) [sufficient information to determine
eligibility], the county shall determine if the patient is eligible
for assistance from that county. If the county does not determine
the patient's eligibility within that period or does not request
supplemental information from the provider within that period, the
patient is deemed [considered] to be eligible. The county shall
notify the provider of its decision.
(e) Subject to Subsection (a), if [If] a provider delivers
nonemergency health care services to a patient who is eligible for
assistance under this subchapter and fails to comply with this
section, the provider is not eligible for payment for the services
from the patient's county of residence.
SECTION 11. Section 61.032, Health and Safety Code, is
amended by amending Subsections (a), (d), and (e) and adding
Subsections (e-1) and (e-2) to read as follows:
(a) If a nonmandated provider delivers emergency services
to a patient who the provider suspects might be eligible for
assistance under this subchapter, the provider shall notify the
patient's county of residence that emergency services have been or
will be provided to the patient. The notice shall be made[:
[(1) by telephone not later than the 72nd hour after
the provider determines the patient's county of residence; and
[(2)] by mail postmarked not later than the 30th
[fifth working] day after the date on which the provider determines
the patient's county of residence. If a provider sends timely
notice under this subsection to any county that the provider
reasonably believes to be the patient's county of residence, that
notice is effective to toll the deadline for giving notice under
this subsection if another county is later determined to be the
patient's county of residence.
(d) Not later than the 14th day after the date on which the
patient's county of residence receives notification from a provider
under Subsection (a) [and sufficient information to determine
eligibility], the county shall determine if the patient is eligible
for assistance from that county. If the county does not determine
the patient's eligibility within that period or does not request
supplemental information from the provider within that period, the
patient is deemed [considered] to be eligible. The county shall
notify the provider of its decision.
(e) If the county and the provider disagree on the patient's
residence or eligibility:
(1) [,] the county or the provider may submit the
matter to the department as provided by Section 61.004; or
(2) the provider may bring an action against one or
more counties to determine the patient's residence or eligibility
for assistance and to determine the liability of a county to pay for
services under Section 61.033.
(e-1) A provider who obtains a determination that a county
is liable to pay for services under Subsection (e)(2) may also
recover from the county court costs and reasonable attorney's fees.
(e-2) Notwithstanding Section 15.015, Civil Practice and
Remedies Code, an action under Subsection (e)(2) may be brought in a
county or district court in the provider's county of residence. A
county's sovereign immunity to suit is waived and abolished to the
extent of the liability created by Subsection (e)(2).
SECTION 12. The change in law made by this Act to Chapter
61, Health and Safety Code, applies only to assistance for health
care services rendered on or after the effective date of this Act.
Assistance for health care services rendered before the effective
date of this Act are governed by the law in effect on the date the
services were rendered, and the former law is continued in effect
for that purpose.
SECTION 13. This Act takes effect September 1, 2005.