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SECTION 1. Chapter 241,
Health and Safety Code, is amended by adding Subchapter H to read as
follows:
SUBCHAPTER H. HOSPITAL LEVEL
OF CARE DESIGNATIONS FOR NEONATAL AND MATERNAL CARE NEONATAL
INTENSIVE CARE UNITS
Sec. 241.181. DEFINITIONS.
In this subchapter:
(1) "Department"
means the Department of State Health Services.
(2) "Executive
commissioner" means the executive commissioner of the Health and Human
Services Commission.
Sec. 241.182. LEVEL OF CARE
DESIGNATIONS. (a) The executive commissioner, in accordance with the
rules adopted under Section 241.183, shall assign level of care
designations to each hospital based on the neonatal and maternalneonatalintensive
care services provided at the hospital.
(b) A hospital may receive
different level designations for neonatal intensive care services. and
maternal care, respectively.
Sec. 241.183. RULES. (a)
The executive commissioner, in consultation with the department, shall
adopt rules:
(1) establishing the levels
of care for neonatal intensive care services. and maternal care
to be assigned to hospitals;
(2) prescribing criteria for
designating levels of neonatal intensiveand maternal care, respectively,
including specifying the minimum requirements to qualify for each level
designation;
(3) establishing a process
for the assignment of levels of care to a hospital for neonatal intensive
care.and maternal care, respectively;
(4) 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;
(5) dividing the state into recommended
neonatal and maternal care regions.
(6) facilitating transfer
agreements through regional coordination for hospitals without
transferring agreements in a manner that preserves historic or existing
patient referral patterns;
(7) 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
(8) prohibiting the denial
of a neonatal intensivecareor maternal level of care
designation to a hospital that meets the minimum requirements for that
level of care designation.
(b) The criteria for levels
one through three of neonatal intensiveand maternal care
adopted under Subsection (a)(2) may not include requirements related to the
number of patients treated at a hospital.
(c) The Health and Human
Services Commission shall study patient transfers that are not medically
necessary but would be cost-effective. Based on the study under this
subsection, if the executive commissioner determines that the transfers
are feasible and desirable, the executive commissioner may adopt rules
addressing those transfers.
(d) Each level of care
designation must require a hospital to regularly submit outcome and other
data to the department as required or requested.
(e) The criteria a hospital
must achieve to receive each level of care designation must be posted on
the department's Internet website.
Sec. 241.185. ASSIGNMENT OF
LEVEL OF CARE DESIGNATION. (a) The executive commissioner, in
consultation with the department, shall assign the appropriate level of
care designation to each hospital that meets the minimum standards for that
level of care. The executive commissioner shall evaluate separately the
neonatal intensive careand maternal services provided at the
hospital and assign the respective level of care designations accordingly.
(b) Every three years, the
executive commissioner and the department shall review the level of care
designations assigned to each hospital and, as necessary, assign a hospital
a different level of care designation or remove the hospital's level of
care designation.
(c) A hospital may request a
change of designation at any time. On request under this subsection, the
executive commissioner and the department shall review the hospital's
request and, as necessary, change the hospital's level of care designation.
Sec. 241.186. HOSPITAL NOT
DESIGNATED. A hospital that does not meet the minimum requirements for any
level of care designation for neonatal intensive care or maternal
services:
(1) may not receive a level of
care designation for those services; and
(2) is not eligible to
receive reimbursement through the Medicaid program for neonatal intensive
careor maternalservices, as applicable, except emergency
services required to be provided or reimbursed under state or federal law.
Sec. 241.187. PERINATAL
ADVISORY COUNCIL. (a) In this section, "advisory council"
means the Perinatal Advisory Council established under this section.
(b) The advisory council
consists of 17 members appointed by
the executive commissioner as follows:
(1) four physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in neonatology:
(A) at least two of whom
practice in a Level III or IV neonatal intensive care unit; and
(B) at least one of whom
practices in a neonatal intensive care unit of a hospital located in a
rural area;
(2) one physician licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in general pediatrics;
(3) two physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in obstetrics-gynecology;
(4) two physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in maternal fetal medicine;
(5) one physician licensed to practice medicine under Subtitle
B, Title 3, Occupations Code, specializing in family practice who provides
obstetrical care in a rural community;
(6) one registered nurse
licensed under Subtitle E, Title 3, Occupations Code, with expertise in
maternal health care delivery;
(7) one registered nurse
licensed under Subtitle E, Title 3, Occupations Code, with expertise in
perinatal health care delivery;
(8) one representative from
a children's hospital;
(9) one representative from
a hospital with a Level II neonatal intensive care unit;
(10) one representative from a rural hospital;
(11) one representative from
a general hospital; and
(12) one ex officio
representative from the office of the medical director of the Health and
Human Services Commission.
(c) To the extent possible,
the executive commissioner shall appoint members to the advisory council
who previously served on the Neonatal Intensive Care Unit Council
established under Chapter 818 (H.B. 2636), Acts of the 82nd Legislature,
Regular Session, 2011.
(d) Members of the advisory
council described by Subsections (b)(1)-(11) serve staggered three-year
terms, with the terms of five or six
of those members expiring September 1 of each year. A member may be
reappointed to the advisory council.
(e) 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.
(f) The department, with
recommendations from the advisory council, shall develop a process for the
designation and updates of levels of neonatal intensiveand
maternal care at hospitals in accordance with this subchapter.
(g) The advisory council
shall:
(1) develop and recommend
criteria for designating levels of neonatal intensiveand maternal
care, respectively, including specifying the minimum requirements to
qualify for each level designation;
(2) develop and recommend a
process for the assignment of levels of care to a hospital for neonatal intensiveand
maternal care, respectively;
(3) make recommendations for
the division of the state into neonatal intensiveand maternal
care regions incorporating existing patient transfer patterns and
agreements;
(4) examine utilization
trends relating to neonatal intensiveand maternal care; and
(5) make recommendations
related to improving neonatal intensive careand maternal
outcomes.
(h) In developing the
criteria for the levels of neonatal intensiveand maternal
care, the advisory council shall consider:
(1) any recommendations or
publications of the American Academy of Pediatrics and the American
Congress of Obstetricians and Gynecologists, including "Guidelines for
Perinatal Care";
(2) any guidelines developed
by the Society of Maternal-Fetal Medicine; and
(3) the geographic and
varied needs of citizens of this state.
(i) In developing the
criteria for designating levels one through three of neonatal intensiveand
maternal care, the advisory council may not consider the number of
patients treated at a hospital.
(j) The advisory council
shall submit a report detailing the advisory council's determinations and
recommendations to the department and the executive commissioner not later
than September 1, 2015 2016.
(k) The advisory council
shall continue to update its recommendations based on any relevant
scientific or medical developments.
(l) The advisory council is
subject to Chapter 325, Government Code (Texas Sunset Act). Unless
continued in existence as provided by that chapter, the advisory council
is abolished and this section expires September 1, 2025.
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SECTION 1. Sections
241.187(b), (d), and (j), Health and Safety Code, as added by Chapter 217
(H.B. 15), Acts of the 83rd Legislature, Regular Session, 2013, are amended
to read as follows:
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
(b) The advisory council
consists of 19 [17] members appointed by the
executive commissioner as follows:
(1) four physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in neonatology:
(A) at least two of whom
practice in a Level III or IV neonatal intensive care unit; and
(B) at least one of whom
practices in a neonatal intensive care unit of a hospital located in a
rural area;
(2) one physician licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in general pediatrics;
(3) two physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in obstetrics-gynecology;
(4) two physicians licensed
to practice medicine under Subtitle B, Title 3, Occupations Code,
specializing in maternal fetal medicine;
(5) two physicians [one physician] licensed to practice medicine under
Subtitle B, Title 3, Occupations Code, specializing in family practice who provide
[provides] obstetrical care in a rural community, at least one of whom must provide such care at a
hospital that has 50 or fewer patient beds and that is:
(A) located in a county with a population of 60,000 or less; or
(B) designated by the Centers for Medicare and Medicaid Services
as a critical access hospital, rural referral center, or sole community
hospital;
(6) one registered nurse
licensed under Subtitle E, Title 3, Occupations Code, with expertise in
maternal health care delivery;
(7) one registered nurse
licensed under Subtitle E, Title 3, Occupations Code, with expertise in
perinatal health care delivery;
(8) one representative from
a children's hospital;
(9) one representative from
a hospital with a Level II neonatal intensive care unit;
(10) two representatives [one representative] from a rural
hospital, at least one of whom must be
an administrative representative from a hospital that has 50 or fewer
patient beds and that is:
(A) located in a county with a population of 60,000 or less; or
(B) designated by the Centers for Medicare and Medicaid Services
as a critical access hospital, rural referral center, or sole community
hospital;
(11) one representative from
a general hospital; and
(12) one ex officio
representative from the office of the medical director of the Health and
Human Services Commission.
(d) Members of the advisory
council described by Subsections (b)(1)-(11) serve staggered three-year
terms, with the terms of [five or]
six of those members expiring September 1 of each year. A member
may be reappointed to the advisory council.
(j) The advisory council
shall submit a report detailing the advisory council's determinations and
recommendations to the department and the executive commissioner not later
than September 1, 2016 [2015].
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SECTION 2. (a) Not later
than December 1, 2013, the executive commissioner of the Health and Human
Services Commission shall appoint the members of the Perinatal Advisory
Council as required by Section 241.187, Health and Safety Code, as added by
this Act. Notwithstanding Section 241.187(d), Health and Safety Code, as
added by this Act, the executive commissioner shall appoint:
(1) two members described by
Section 241.187(b)(1), Health and Safety Code, one member described by
Section 241.187(b)(3), Health and Safety Code, and the members described by
Sections 241.187(b)(6) and (9), Health and Safety Code, to an initial term
that expires September 1, 2017;
(2) one member described by
Section 241.187(b)(1), Health and Safety Code, one member described by
Section 241.187(b)(3), Health and Safety Code, one member described by
Section 241.187(b)(4), Health and Safety Code, and the members described by
Sections 241.187(b)(2), (7), and (10), Health and Safety Code, to an
initial term that expires September 1, 2018; and
(3) one member described by
Section 241.187(b)(1), Health and Safety Code, one member described by
Section 241.187(b)(4), Health and Safety Code, and the members described by
Sections 241.187(b)(5), (8), and (11), Health and Safety Code, to an
initial term that expires September 1, 2019.
(b) Not later than March 1, 2017
2018, after consideration of the report of the Perinatal
Advisory Council, the executive commissioner of the Health and Human
Services Commission shall adopt the initial rules required by Section
241.183, Health and Safety Code, as added by this Act.
(c) The executive
commissioner of the Health and Human Services Commission shall complete for
each hospital in this state:
(1) the neonatal level of
care designation not later than August 31, 2017 2018.;and
(2) the maternal level of care designation not later than August
31, 2019.
(d) Notwithstanding Section
241.186, Health and Safety Code, as added by this Act:
(1) a hospital is not
required to have a neonatal level of care designation as a condition of
reimbursement for neonatal services through the Medicaid program before
September 1, 20172018. ;and
(2) a hospital is not required to have a maternal level of care
designation as a condition of reimbursement for maternal services through
the Medicaid program before September 1, 2019.
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No
equivalent provision.
SECTION 3. Notwithstanding
Section 2, Chapter 217 (H.B. 15), Acts of the 83rd Legislature, Regular
Session, 2013:
(1) the executive
commissioner of the Health and Human Services Commission shall adopt the
initial rules required by Section 241.183, Health and Safety Code, as added
by Chapter 217 (H.B. 15), Acts of the 83rd Legislature, Regular Session,
2013, not later than March 1, 2018, after consideration of the report of
the Perinatal Advisory Council;
(2) the executive
commissioner of the Health and Human Services Commission shall complete for
each hospital in this state:
(A) the neonatal level of
care designation not later than August 31, 2018; and
(B)
the maternal level of care designation not later than August 31, 2020;
and
(3) a hospital is not
required to have:
(A) a neonatal level of care
designation as a condition of reimbursement for neonatal services through
the Medicaid program before September 1, 2018; and
(B)
a maternal level of care designation as a condition of reimbursement for
maternal services through the Medicaid program before September 1, 2020.
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