HBA-MPM H.B. 2573 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2573 By: Wolens Public Health 3/30/1999 Introduced BACKGROUND AND PURPOSE The Indigent Health Care and Treatment Act, enacted in 1985, has not addressed all out-of-county issues impacting reimbursement of facilities for care provided to indigent patients. Tertiary medical centers, which provide and coordinate care for trauma and seriously ill patients, as well as injury prevention, research, public education, and continuing education for rural providers, have experienced increased costs for care provided to out-of-county indigent residents. Currently, taxpayers of the county bear the added costs incurred by the centers to provide health care to these indigent residents. H.B. 2573 requires the Texas Board of Health (board) to adopt minimum standards and objectives to implement a system that encourages hospitals to provide tertiary medical services and increases the availability of these services. This bill also provides for funding for these services. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health (board) in SECTION 1 (Sections 46.003 and 46.006, Health and Safety Code)of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subtitle B, Title 2, Health and Safety Code, by adding Chapter 46, as follows: CHAPTER 46. TERTIARY MEDICAL CARE Sec. 46.001. DEFINITIONS. Defines "tertiary medical care" and "tertiary medical services." Sec. 46.002. DESIGNATION OF FACILITIES. Requires the Texas Department of Health (department) to designate tertiary care facilities (facilities) that meet this chapter's requirements to provide tertiary medical services. Sec. 46.003. DUTIES OF BOARD; RULES. (a) Requires the Texas Board of Health (board), by rule, to adopt minimum standards and objectives to implement a system that encourages hospitals to provide tertiary medical services and increases the availability of these services. (b) Provides that the rules must make certain provisions with respect to geographic areas services by facilities and the patients they serve. (c) Provides that the rules must include certain guidelines, criteria, requirements, standards, and assurances regarding facilities and the population they service. Sec. 46.004. DENIAL, SUSPENSION, OR REVOCATION OF DESIGNATION. Authorizes the department to deny, suspend, or revoke a designation as a facility if it does not comply with rules adopted under this chapter. Provides that the denial, suspension, or revocation of a designation by the department and the appeal from that action are governed by the board's rules for a contested case hearing and by Chapter 2001 (Administrative Procedure), Government Code. Sec. 46.005. TERTIARY CARE FACILITY ACCOUNT. Provides that the facility account is an account in the state treasury. Authorizes money in the account to be appropriated only to the department for the purposes of this chapter. Provides that the account is composed of money appropriated to the account and any other funds required to be put in the account. Authorizes the department to seek and accept gifts, grants, and donations from any public or private entity on behalf of the account. Makes Section 403.095 (Use of Dedicated Revenue), Government Code, inapplicable to the account. Requires five percent of the total amount in the account to be held in reserve for each fiscal year and authorizes it to be used only for reimbursement of unpaid tertiary medical services provided as a result of extraordinary emergencies occurring during that year. Provides that of the amount remaining, no more than five percent may be used for the costs of administering the account. Sec. 46.006. COLLECTION OF INFORMATION. (a) Requires each facility to submit to the department, in the manner and time required, information relating to unreimbursed tertiary medical services provided to persons residing outside the service area of the county, public hospital, or hospital district that is responsible for indigent health care under Chapter 61 (Indigent Health Care and Treatment Act), Health and Safety Code, in which the facility is located. Requires the board to adopt rules governing the collection of this information. Sec. 46.007. CERTIFICATION TO COMPTROLLER. (a) Requires the department to certify to the comptroller of public accounts (comptroller) for each facility the cost of unreimbursed tertiary medical services it provides to persons residing outside the service area of the county, public hospital, or hospital district responsible for indigent health care under Chapter 61, Health and Safety Code, in the area where the facility is located. (b) Requires the department, on a yearly basis, to make for a facility that was designated as a tertiary care facility during the previous year, an initial certification to the comptroller under Subsection (a) in an amount equaling 80 percent of that certified under this section for a facility in the previous year. Requires the department to make a subsequent certification of the cost of additional unreimbursed tertiary medical services provided by the facility on receipt from the facility of the information required under Section 46.006, Health and Safety Code. (c) Requires the department to allocate the amount available under Section 46.005, Health and Safety Code, to each facility based on the percentages computed by dividing the cost of the facility's unreimbursed tertiary medical services by the total cost of its unreimbursed tertiary medical services, if in any year, the cost of services certified under Subsection (a) for all designated facilities exceeds the amount available for payment to the facilities under that section. (d) Provides that the cost of each service provided is the average amount payable under Medicare for services for the Medicare diagnosis related groups that must be provided by a facility to qualify for designation under the minimum standards adopted under this chapter for purposes of this section and Section 46.008, Health and Safety Code. Sec. 46.008. CERTIFICATION OF EMERGENCIES. (a) Requires the department, for purposes of reimbursement under this chapter, to certify an extraordinary emergency under certain conditions. (b) Requires the department to certify to the comptroller the amount of unreimbursed tertiary medical services incurred by a facility during an emergency if one is declared under Subsection (a). SECTION 2. Effective date: September 1, 1999. SECTION 3. Emergency clause.