86R31292 JG-D
 
  By: Kolkhorst S.B. No. 749
 
  (Price, et al.)
 
  Substitute the following for S.B. No. 749:  No.
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to level of care designations for hospitals that provide
  neonatal and maternal care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 241.183(a), Health and Safety Code, is
  amended to read as follows:
         (a)  The executive commissioner, in consultation with the
  department, shall adopt rules:
               (1)  establishing the levels of care for neonatal and
  maternal care to be assigned to hospitals;
               (2)  prescribing criteria for designating levels of
  neonatal and 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 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 neonatal and maternal care
  regions;
               (6)  facilitating transfer agreements through regional
  coordination;
               (7)  requiring payment, other than quality or
  outcome-based funding, to be based on services provided by the
  facility, regardless of the hospital's [facility's] level of care
  designation; [and]
               (8)  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 designation;
               (9)  establishing a process through which a hospital
  may obtain a limited follow-up survey by an independent third party
  to appeal the level of care designation assigned to the hospital;
               (10)  permitting a hospital to satisfy any requirement
  for a Level I or II level of care designation that relates to an
  obstetrics or gynecological physician by:
                     (A)  granting maternal care privileges to a family
  physician with obstetrics training or experience; and
                     (B)  developing and implementing a plan for
  responding to obstetrical emergencies that require services or
  procedures outside the scope of privileges granted to the family
  physician described by Paragraph (A);
               (11)  clarifying that, regardless of a hospital's level
  of care designation, a health care provider at a designated
  facility or hospital may provide the full range of health care
  services:
                     (A)  that the provider is authorized to provide
  under state law; and
                     (B)  for which the hospital has granted privileges
  to the provider; and
               (12)  requiring the department to provide to each
  hospital that receives a level of care designation a written
  explanation of the basis for the designation, including, as
  applicable, specific reasons that prevented the hospital from
  receiving a higher level of care designation.
         SECTION 2.  Subchapter H, Chapter 241, Health and Safety
  Code, is amended by adding Sections 241.1835, 241.1836, and
  241.1865 to read as follows:
         Sec. 241.1835.  USE OF TELEMEDICINE MEDICAL SERVICES.
  (a)  In this section, "telemedicine medical service" has the
  meaning assigned by Section 111.001, Occupations Code.
         (b)  The rules adopted under Section 241.183 must allow the
  use of telemedicine medical services by a physician providing
  on-call services to satisfy certain requirements identified by the
  executive commissioner in the rules for a Level I, II, or III level
  of care designation.
         (c)  In identifying a requirement for a level of care
  designation that may be satisfied through the use of telemedicine
  medical services under Subsection (b), the executive commissioner,
  in consultation with the department, physicians of appropriate
  specialties, statewide medical, nursing, and hospital
  associations, and other appropriate interested persons, must
  ensure that the provision of a service or procedure through the use
  of telemedicine medical services is in accordance with the standard
  of care applicable to the provision of the same service or procedure
  in an in-person setting.
         (d)  Telemedicine medical services must be administered
  under this section by a physician licensed to practice medicine
  under Subtitle B, Title 3, Occupations Code.
         (e)  This section does not waive other requirements for a
  level of care designation.
         Sec. 241.1836.  APPEAL PROCESS. (a)  The rules adopted
  under Section 241.183 establishing level of care designations for
  hospitals must allow a hospital to appeal a level of care
  designation to a three-person panel that includes:
               (1)  a representative of the department;
               (2)  a representative of the commission; and
               (3)  an independent person who:
                     (A)  has expertise in the specialty area for which
  the hospital is seeking a level of care designation;
                     (B)  is not an employee of or affiliated with
  either the department or the commission; and
                     (C)  does not have a conflict of interest with the
  hospital, department, or commission.
         (b)  The independent person on the panel described by
  Subsection (a) must rotate after each appeal from a list of five to
  seven similarly qualified persons. The department shall solicit
  persons to be included on the list. A person must apply to the
  department on a form prescribed by the department and be approved by
  the commissioner to be included on the list.
         Sec. 241.1865.  WAIVER FROM LEVEL OF CARE DESIGNATION
  REQUIREMENTS; CONDITIONAL DESIGNATION. (a)  The department shall
  develop and implement a process through which a hospital may
  request and enter into an agreement with the department to:
               (1)  receive or maintain a level of care designation
  for which the hospital does not meet all requirements conditioned
  on the hospital, in accordance with a plan approved by the
  department and outlined under the agreement, satisfying all
  requirements for the level of care designation within a time
  specified under the agreement, which may not exceed the first
  anniversary of the effective date of the agreement; or
               (2)  waive one specific requirement for a level of care
  designation in accordance with Subsection (c).
         (b)  A hospital may submit a written request under Subsection
  (a) at any time. The department may make a determination on a
  request submitted under that subsection at any time.
         (c)  The department may enter into an agreement with a
  hospital to waive a requirement under Subsection (a)(2) only if the
  department determines the waiver is justified considering:
               (1)  the expected impact on the accessibility of care
  in the geographical area served by the hospital if the waiver is not
  granted;
               (2)  the expected impact on quality of care;
               (3)  the expected impact on patient safety; or
               (4)  whether health care services related to the
  requirement can be provided through telemedicine medical services
  under Section 241.1835.
         (d)  A waiver agreement entered into under Subsection (a):
               (1)  must expire not later than at the end of each
  designation cycle but may be renewed on expiration by the
  department under the same or different terms; and
               (2)  may specify any conditions for ongoing reporting
  and monitoring during the agreement.
         (e)  A hospital that enters into a waiver agreement under
  Subsection (a) is required to satisfy all other requirements for a
  level of care designation that are not waived in the agreement.
         (f)  The department shall post on the department's Internet
  website and periodically update:
               (1)  a list of hospitals that enter into an agreement
  with the department under this section; and
               (2)  an aggregated list of the requirements
  conditionally met or waived in agreements entered into under this
  section.
         (g)  A hospital that enters into an agreement with the
  department under this section shall post on the hospital's Internet
  website the nature and general terms of the agreement.
         SECTION 3.  Section 241.187, Health and Safety Code, is
  amended by amending Subsection (l) and adding Subsections (m) and
  (n) to read as follows:
         (l)  The advisory council is subject to Chapter 325,
  Government Code (Texas Sunset Act). The advisory council shall be
  reviewed during the period in which the Department of State Health
  Services is reviewed [Unless continued in existence as provided by
  that chapter, the advisory council is abolished and this section
  expires September 1, 2025].
         (m)  The department, in consultation with the advisory
  council, shall:
               (1)  conduct a strategic review of the practical
  implementation of rules adopted in consultation with the department
  under this subchapter that at a minimum identifies:
                     (A)  barriers to a hospital obtaining its
  requested level of care designation;
                     (B)  whether the barriers identified under
  Paragraph (A) are appropriate to ensure and improve neonatal and
  maternal care;
                     (C)  requirements for a level of care designation
  that relate to gestational age; and
                     (D)  whether, in making a level of care
  designation for a hospital, the department or the perinatal
  advisory council should consider:
                           (i)  the geographic area in which the
  hospital is located; and
                           (ii)  regardless of the number of patients
  of a particular gestational age treated by the hospital, the
  hospital's capabilities in providing care to patients of a
  particular gestational age as determined by the hospital;
               (2)  based on the review conducted under Subdivision
  (1), recommend a modification of rules adopted under this
  subchapter, as appropriate, to improve the process and methodology
  of assigning level of care designations; and
               (3)  prepare and submit to the legislature:
                     (A)  not later than December 31, 2019, a written
  report that summarizes the department's review of neonatal care
  conducted under Subdivision (1) and on actions taken by the
  department and executive commissioner based on that review; and
                     (B)  not later than December 31, 2020, a written
  report that summarizes the department's review of maternal care
  conducted under Subdivision (1) and on actions taken by the
  department and executive commissioner based on that review.
         (n)  Subsection (m) and this subsection expire September 1,
  2021.
         SECTION 4.  (a)  The executive commissioner of the Health
  and Human Services Commission shall complete for each hospital in
  this state the maternal level of care designation not later than
  August 31, 2021.
         (b)  Notwithstanding Section 241.186, Health and Safety
  Code, 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, 2021.
         (c)  A hospital that submits an application to the Department
  of State Health Services for a maternal level of care designation
  under Subchapter H, Chapter 241, Health and Safety Code, before the
  effective date of this Act may amend the application to reflect the
  applicable changes in law made by this Act.
         SECTION 5.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules as necessary to implement the
  changes in law made 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, 2019.