79R1899 JTS-F

By:  West                                                         S.B. No. 230


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.