80R2462 YDB-D

By: Janek S.B. No. 172

A BILL TO BE ENTITLED

AN ACT

relating to indigent health care.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 61.002(8), Health and Safety Code, is amended to read as follows:

(8) "Mandated provider" means a person who provides health care services, is selected by a county, public hospital, or hospital district, and agrees to provide health care services to eligible residents, including the primary teaching hospital of a state medical school located in a county which does not have a public hospital or hospital district, and the faculty members practicing in both the inpatient and outpatient care facilities affiliated with the teaching hospital. The term includes a teaching hospital that provides specialty health care services to eligible residents under Subchapter D.

SECTION 2. Subchapter A, Chapter 61, Health and Safety Code, is amended by adding Section 61.013 to read as follows:

Sec. 61.013. COMPTROLLER DUTY. (a) As soon as practicable after receiving notification under Section 61.0355(f), the comptroller shall pay a provider of health care services any amount owed to the provider by a county as determined under Section 61.0355 from any tax revenue that is not deposited to a trust fund and is allocated to that county by state law.

(b) The comptroller shall adopt rules and procedures as necessary to implement this section.

SECTION 3. Subchapter B, Chapter 61, Health and Safety Code, is amended by adding Section 61.0355 to read as follows:

Sec. 61.0355. DISPUTE CONCERNING COUNTY LIABILITY OR FAILURE TO PAY. (a) A county or a provider of health care services, including a teaching hospital, may file with the department a written request for a hearing concerning:

(1) a dispute between the county and the provider regarding the county's liability under this chapter to pay for health care services provided by the provider to an indigent person and the amount, if any, of the county's liability; or

(2) the county's failure to timely pay an amount the county owes to the provider under this chapter.

(b) The provider of health care services and the county shall submit all information relevant to a matter described by Subsection (a) to the department in accordance with department rules.

(c) As soon as practicable following receipt of the information required under Subsection (b), the department shall conduct a hearing on the matter. The hearing shall be conducted as a contested case under Chapter 2001, Government Code.

(d) Not later than the 30th day after the date of the hearing, the department shall:

(1) determine whether the county:

(A) is liable under this chapter for the cost of the health care services provided and the amount of liability, if any; or

(B) has failed to timely pay an amount the county owes to the provider under this chapter; and

(2) notify the county and the provider of health care services in writing of a determination made under Subdivision (1) and the reasons for the determination.

(e) A county or provider of health care services may appeal the department's final order under Chapter 2001, Government Code, using the substantial evidence rule on appeal.

(f) Not later than the 30th day after the date an order of the department finding a county liable under this section becomes final, including any modification of the order following a judicial determination of the matter, the department shall notify the comptroller in writing of the liability. The notice must include:

(1) the names of the provider of health care services and county; and

(2) the amount the county owes the provider.

SECTION 4. Chapter 61, Health and Safety Code, is amended by adding Subchapter D to read as follows: SUBCHAPTER D. SPECIALTY HEALTH CARE SERVICES

Sec. 61.101. DEFINITIONS. In this subchapter:

(1) "Specialty health care service" means a basic health care service a county is required to provide under Section 61.028 that requires specialized medical skill and is significantly more expensive than other basic health care services.

(2) "Teaching hospital" means a teaching hospital affiliated with a medical school that is described as a medical and dental unit under Section 61.003, Education Code.

Sec. 61.102. SPECIALTY HEALTH CARE SERVICES; MANDATED PROVIDER. A county, hospital district, or public hospital may:

(1) select as a mandated provider of a specialty health care service one or more teaching hospitals that agree to provide the service to eligible residents of the service area of the county, hospital district, or public hospital; and

(2) require an eligible resident in its service area who requires the specialty health care service to obtain the service from that mandated provider.

Sec. 61.103. STANDARDS AND PROCEDURES. The executive commissioner of the Health and Human Services Commission by rule shall:

(1) prescribe the basic health care services that constitute specialty health care services;

(2) establish the claim and verification procedures necessary to enable a teaching hospital to submit claims for reimbursement under this subchapter for the provision of specialty health care services; and

(3) establish payment standards for the categories of specialty health care services in accordance with rules relating to the Temporary Assistance for Needy Families-Medicaid program.

Sec. 61.104. LIABILITY FOR SERVICES. (a) To the extent funds are appropriated to the department for this purpose, the department, on submission of a claim, shall reimburse a teaching hospital for 50 percent of the cost for the specialty health care service provided by the teaching hospital under this subchapter to an eligible resident of the service area of a county, hospital district, or public hospital.

(b) Subject to the applicable payment limitations provided in Sections 61.035 and 61.061 and to other applicable limitations on liability provided in this chapter, the applicable county, hospital district, or public hospital is liable for the remainder of the cost of providing the specialty health care service to the eligible resident in its service area.

(c) To be reimbursable under this section, the cost of a specialty health care service may not exceed the amount allowable for the service under the payment standards established under Section 61.103.

Sec. 61.105. INDIGENT SPECIALTY HEALTH CARE SERVICES ACCOUNT. The indigent specialty health care services account is an account in the general revenue fund. Money in the account may be appropriated to the department only to provide funding for purposes consistent with this subchapter.

Sec. 61.106. SERVICES ELIGIBLE FOR STATE ASSISTANCE CREDIT. Subject to the requirements prescribed by Subchapter B, a county may credit toward eligibility for state assistance under Subchapter B an expenditure the county incurs under this subchapter to assist an eligible county resident.

SECTION 5. (a) Not later than January 1, 2008, the comptroller shall adopt the rules and procedures necessary to implement Section 61.013, Health and Safety Code, as added by this Act.

(b) Not later than January 1, 2008, the executive commissioner of the Health and Human Services Commission shall:

(1) in consultation with the Department of State Health Services adopt the rules and procedures necessary to implement Section 61.0355, Health and Safety Code, as added by this Act; and

(2) adopt the rules and procedures necessary to implement Subchapter D, Chapter 61, Health and Safety Code, as added by this Act.

SECTION 6. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2007.