BILL ANALYSIS |
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C.S.H.B. 15 |
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By: Kolkhorst |
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Public Health |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Over the past decade, Texas has seen significant increases in the utilization of neonatal intensive care units (NICU). According to interested parties, while only a small fraction of births are low-weight births, approximately half of the costs associated with NICU care can be attributed to care of infants with very low birth weights. These parties contend that, because Medicaid covers more than half of all births in Texas, concern over the standards for operating a NICU and the Medicaid payments for services delivered in these units led to the establishment of the Neonatal Intensive Care Unit Council. It has been reported that the council has recommended defining standards for both neonatal and maternity levels of care to improve outcomes and allow the state to make effective use of the state's resources.
C.S.H.B. 15 seeks to reduce the utilization of NICUs, to improve the outcomes for both pregnant women and newborns, and to achieve cost savings for the state by providing for level of care designations for neonatal and maternal care units at hospitals.
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RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTIONS 1 and 2 of this bill.
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ANALYSIS
C.S.H.B. 15 amends the Health and Safety Code to require the executive commissioner of the Health and Human Services Commission (HHSC), in accordance with rules adopted under the bill, to assign level of care designations to each hospital based on the neonatal and maternal services provided at the hospital. The bill authorizes a hospital to receive different level designations for neonatal and maternal care, respectively.
C.S.H.B. 15 requires the executive commissioner, in consultation with the Department of State Health Services (DSHS), to adopt rules establishing the levels of care for neonatal and maternal care to be assigned to hospitals; prescribing criteria for designating levels of neonatal and maternal care, respectively, including specifying the minimum requirements to qualify for each level designation; establishing a process for the assignment of levels of care to a hospital for neonatal and maternal care, respectively; establishing a process for amending the level of care designation requirements, including a process for assisting facilities in implementing any changes made necessary by the amendments; dividing the state into neonatal and maternal care regions; facilitating transfer agreements through regional coordination; requiring payment, other than quality or outcome-based funding, to be based on services provided by the facility, regardless of the facility's level of care designation; and prohibiting the denial of a neonatal or maternal level of care designation to a hospital that meets the minimum requirements for that level of care.
C.S.H.B. 15 requires HHSC to study patient transfers that are not medically necessary but would be cost-effective. The bill authorizes the executive commissioner, based on the study, to adopt rules addressing those transfers if it is determined that the transfers are feasible and desirable. The bill requires each level of care designation to require the hospital to regularly submit outcome and other data to DSHS as required or requested. The bill requires the criteria a hospital must achieve to receive each level of care designation to be posted on DSHS's Internet website.
C.S.H.B. 15 requires the executive commissioner, in consultation with DSHS, to assign the appropriate level of care designation to each hospital that meets the minimum standards for that level of care and requires the executive commissioner to evaluate separately the neonatal and maternal services provided at the hospital and to assign the respective level of care designations accordingly. The bill requires the executive commissioner and DSHS every three years to review the levels of care designations assigned to each hospital and to assign a hospital a different level of care designation or remove the hospital's level of care designation as necessary. The bill authorizes a hospital to request a change of designation at any time and requires the executive commissioner and DSHS, on such request, to review the hospital's request and, as necessary, change the hospital's level of care designation. The bill requires the executive commissioner to complete for each hospital in Texas the neonatal level of care designation not later than August 31, 2017, and the maternal level of care designation not later than August 31, 2019.
C.S.H.B. 15 prohibits a hospital that does not meet the minimum requirements for any level of care designation for neonatal or maternal services from receiving a level of care designation for those services and specifies that such a hospital is not eligible to receive reimbursement through the Medicaid program for neonatal or maternal services, as applicable, except emergency services required to be provided or reimbursed under Texas or federal law. The bill establishes that a hospital is not required to have a neonatal level of care designation as a condition of reimbursement through the Medicaid program before September 1, 2017, or a maternal level of care designation as a condition of reimbursement through the Medicaid program before September 1, 2019.
C.S.H.B. 15 establishes the 17-member Perinatal Advisory Council, requires the members to be appointed by the executive commissioner not later than December 1, 2013, and sets out the composition of the advisory council. The bill requires the executive commissioner, to the extent possible, to appoint members to the advisory council who previously served on the Neonatal Intensive Care Unit Council. The bill establishes that members of the advisory council, with the exception of the ex officio representative from the office of the medical director of HHSC, serve staggered three-year terms, with the terms of five or six of those members expiring September 1 of each year, and sets out specific dates for the expiration of the initial terms of each of those member. The bill authorizes a member to be reappointed to the advisory council and establishes that a member of the advisory council serves without compensation but is entitled to reimbursement for actual and necessary travel expenses related to the performance of advisory council duties. The bill requires DSHS, with recommendations from the advisory council, to develop a process for the designation and updates of levels of neonatal and maternal care at hospitals in accordance with the bill's provisions.
C.S.H.B. 15 requires the advisory council to develop and recommend criteria for designating levels of neonatal and maternal care, respectively, including specifying the minimum requirements to qualify for each level designation; to develop and recommend a process for the assignment of levels of care to a hospital for neonatal and maternal care, respectively; to make recommendations for the division of the state into neonatal and maternal care regions; to examine utilization trends relating to neonatal and maternal care; and to make recommendations related to improving neonatal and maternal outcomes. The bill requires the advisory council, in developing the criteria for the levels of neonatal and maternal care, to consider any recommendations or publications of the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists, including the Guidelines for Perinatal Care; any guidelines developed by the Society of Maternal-Fetal Medicine; and the geographic and varied needs of citizens of this state. The bill requires the advisory council to submit a report detailing the advisory council's determinations and recommendations to DSHS and the executive commissioner not later than September 1, 2015, and requires the advisory council to continue to update its recommendations based on any relevant scientific or medical developments. The bill establishes that the advisory council is subject to the Texas Sunset Act and, unless continued in existence as provided by that act, provides that the advisory council is abolished and provisions relating to the advisory council expire on September 1, 2025.
C.S.H.B. 15 requires the executive commissioner, not later than March 1, 2017, and after consideration of the advisory council's report, to adopt the initial rules required by the bill.
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EFFECTIVE DATE
September 1, 2013.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 15 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and highlighted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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