Texas 2009 - 81st Regular

Texas House Bill HB3233 Compare Versions

Only one version of the bill is available at this time.

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1	1	81R2124 CLG-D
2	2	By: Davis of Harris H.B. No. 3233
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to nonpayment of hospitals under the state Medicaid
8	8	program for certain preventable adverse events and to the reporting
9	9	of occurrences of those events at certain health care facilities.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
12	12	is amended by adding Section 32.02805 to read as follows:
13	13	Sec. 32.02805. NONPAYMENT OF HOSPITALS FOR PREVENTABLE
14	14	ADVERSE EVENTS. (a) In this section:
15	15	(1) "Infant" means a child younger than one year of
16	16	age.
17	17	(2) "Serious disability" means:
18	18	(A) a physical or mental impairment that
19	19	substantially limits one or more major life activities of an
20	20	individual such as seeing, hearing, speaking, walking, or
21	21	breathing, or a loss of a bodily function, if the impairment or loss
22	22	lasts more than seven days or is still present at the time of
23	23	discharge from a hospital; or
24	24	(B) loss of a body part.
25	25	(3) "Serious injury" means a bodily injury that
26	26	results in:
27	27	(A) death;
28	28	(B) permanent and serious impairment of an
29	29	important bodily function; or
30	30	(C) permanent and significant disfigurement.
31	31	(b) The department, in its adoption of reasonable rules and
32	32	standards governing the determination of rates paid for inpatient
33	33	hospital services on a prospective payment basis, shall assure that
34	34	a hospital may not receive additional payment associated with a
35	35	preventable adverse event that occurred during the recipient's
36	36	hospitalization.
37	37	(c) For purposes of this section, a preventable adverse
38	38	event is any of the following events involving a recipient of
39	39	medical assistance:
40	40	(1) surgery performed on the wrong body part;
41	41	(2) surgery performed on the wrong person;
42	42	(3) the wrong surgical procedure performed on the
43	43	recipient;
44	44	(4) the unintended retention of a foreign object in
45	45	the recipient after surgery or another procedure;
46	46	(5) death during or immediately after surgery if the
47	47	recipient would be classified as a normal, healthy patient under
48	48	guidelines published by a national association of
49	49	anesthesiologists;
50	50	(6) death or serious disability caused by the use of a
51	51	contaminated drug, device, or biologic provided by a health care
52	52	provider if the contamination is the result of a generally
53	53	detectable contaminant in drugs, devices, or biologics regardless
54	54	of the source of the contamination or product;
55	55	(7) death or serious disability caused by the use or
56	56	function of a device during the recipient's care in which the device
57	57	is used for a function other than as intended;
58	58	(8) death or serious disability caused by an
59	59	intravascular air embolism, excluding a death associated with a
60	60	neurological procedure known to present a high risk of
61	61	intravascular air embolism;
62	62	(9) an infant being discharged to the wrong person;
63	63	(10) death or serious disability associated with the
64	64	recipient's disappearance for more than four hours, excluding the
65	65	death or serious disability of an adult recipient who has
66	66	decision-making capacity;
67	67	(11) suicide or attempted suicide resulting in serious
68	68	disability while the recipient was receiving care at the hospital
69	69	if the suicide or attempted suicide was due to the recipient's
70	70	actions after admission to the hospital, excluding a death
71	71	resulting from a self-inflicted injury that was the reason for the
72	72	recipient's admission to the hospital;
73	73	(12) death or serious disability caused by a
74	74	medication error, including an error involving the wrong drug,
75	75	wrong dose, wrong patient, wrong time, wrong rate, wrong
76	76	preparation, or wrong route of administration;
77	77	(13) death or serious disability caused by a hemolytic
78	78	reaction resulting from the administration of ABO- or
79	79	HLA-incompatible blood or blood products;
80	80	(14) death or serious disability caused by labor or
81	81	delivery in a low-risk pregnancy while the recipient was receiving
82	82	care at the hospital, including death or serious disability that
83	83	occurred not later than 42 days after the delivery date;
84	84	(15) death or serious disability directly related to
85	85	the following manifestations of poor glycemic control, the onset of
86	86	which occurred while the recipient was receiving care at the
87	87	hospital:
88	88	(A) diabetic ketoacidosis;
89	89	(B) nonketotic hyperosmolar coma;
90	90	(C) hypoglycemic coma;
91	91	(D) secondary diabetes with ketoacidosis; and
92	92	(E) secondary diabetes with hyperosmolarity;
93	93	(16) death or serious disability, including
94	94	kernicterus, caused by failure to identify and treat
95	95	hyperbilirubinemia in a neonate before discharge from the hospital;
96	96	(17) stage three or four pressure ulcers acquired
97	97	after admission to the hospital;
98	98	(18) death or serious disability resulting from spinal
99	99	manipulative therapy;
100	100	(19) death or serious disability caused by an electric
101	101	shock while the recipient was receiving care at the hospital,
102	102	excluding an event involving a planned treatment such as electric
103	103	countershock;
104	104	(20) an incident in which a line designated for oxygen
105	105	or other gas to be delivered to the recipient contains the wrong gas
106	106	or is contaminated by a toxic substance;
107	107	(21) death or serious disability caused by a burn
108	108	incurred from any source while the recipient was receiving care at
109	109	the hospital;
110	110	(22) death or serious disability caused by a fall or
111	111	trauma while the recipient was receiving care at the hospital,
112	112	including death or serious disability from a fracture, dislocation,
113	113	intracranial injury, or crushing injury;
114	114	(23) death or serious disability caused by the use of a
115	115	restraint or bed rail while the recipient was receiving care at the
116	116	hospital;
117	117	(24) an instance of care for the recipient ordered or
118	118	provided by an individual impersonating a physician, nurse,
119	119	pharmacist, or other licensed health care professional;
120	120	(25) abduction of the recipient from the hospital;
121	121	(26) sexual assault of the recipient within or on the
122	122	grounds of the hospital;
123	123	(27) death or serious injury resulting from a physical
124	124	assault of the recipient that occurred within or on the grounds of
125	125	the hospital;
126	126	(28) artificial insemination with the wrong donor
127	127	sperm or implantation with the wrong donor egg;
128	128	(29) death or serious disability caused by a urinary
129	129	tract infection resulting from the insertion of a catheter by an
130	130	individual health care provider;
131	131	(30) death or serious disability caused by an
132	132	infection resulting from the insertion of a vascular catheter by an
133	133	individual health care provider;
134	134	(31) death or serious disability caused by a surgical
135	135	site infection occurring as a result of the following procedures:
136	136	(A) a coronary artery bypass graft;
137	137	(B) bariatric surgery such as laparoscopic
138	138	gastric bypass surgery, gastroenterostomy, and laparoscopic
139	139	gastric restrictive surgery; and
140	140	(C) orthopedic procedures involving the spine,
141	141	neck, shoulder, or elbow; and
142	142	(32) death or serious disability caused by a pulmonary
143	143	embolism or deep vein thrombosis that occurred while the recipient
144	144	was receiving care at the hospital following a total knee
145	145	arthroplasty or hip arthroplasty.
146	146	(d) The executive commissioner of the Health and Human
147	147	Services Commission may adopt rules to define additional
148	148	preventable adverse events for which a hospital shall be denied
149	149	additional payment under this section. In adopting rules under
150	150	this subsection, the executive commissioner may consider only the
151	151	same types of health care-associated adverse conditions or events
152	152	for which the Medicare program will not provide additional payment
153	153	under a policy adopted by the Centers for Medicare and Medicaid
154	154	Services.
155	155	(e) The department's nonpayment of a hospital under this
156	156	section does not in itself create civil liability and is not subject
157	157	to discovery or admissible in any civil action against the
158	158	hospital.
159	159	(f) A hospital may not charge a recipient of medical
160	160	assistance for the hospital service for which the hospital is
161	161	denied payment under this section.
162	162	(g) The executive commissioner of the Health and Human
163	163	Services Commission shall adopt rules necessary to implement this
164	164	section, including procedures for:
165	165	(1) identifying a preventable adverse event;
166	166	(2) verifying the occurrence of a preventable adverse
167	167	event;
168	168	(3) administering denials of payment; and
169	169	(4) managing hospitals' appeals relating to denials of
170	170	payment.
171	171	SECTION 2. The heading to Chapter 98, Health and Safety
172	172	Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
173	173	Legislature, Regular Session, 2007, is amended to read as follows:
174	174	CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
175	175	PREVENTABLE ADVERSE EVENTS
176	176	SECTION 3. Sections 98.001(1) and (11), Health and Safety
177	177	Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
178	178	Legislature, Regular Session, 2007, are amended to read as follows:
179	179	(1) "Advisory panel" means the Advisory Panel on
180	180	Health Care-Associated Infections and Preventable Adverse Events.
181	181	(11) "Reporting system" means the Texas Health
182	182	Care-Associated Infection and Preventable Adverse Events Reporting
183	183	System.
184	184	SECTION 4. Section 98.051, Health and Safety Code, as added
185	185	by Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
186	186	Session, 2007, is amended to read as follows:
187	187	Sec. 98.051. ESTABLISHMENT. The commissioner shall
188	188	establish the Advisory Panel on Health Care-Associated Infections
189	189	and Preventable Adverse Events within [the infectious disease
190	190	surveillance and epidemiology branch of] the department to guide
191	191	the implementation, development, maintenance, and evaluation of
192	192	the reporting system.
193	193	SECTION 5. Sections 98.102(a) and (c), Health and Safety
194	194	Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
195	195	Legislature, Regular Session, 2007, are amended to read as follows:
196	196	(a) The department shall establish the Texas Health
197	197	Care-Associated Infection and Preventable Adverse Events Reporting
198	198	System within the [infectious disease surveillance and
199	199	epidemiology branch of the] department. The purpose of the
200	200	reporting system is to provide for:
201	201	(1) the reporting of health care-associated
202	202	infections by health care facilities to the department;
203	203	(2) the reporting of health care-associated
204	204	preventable adverse events by health care facilities to the
205	205	department;
206	206	(3) the public reporting of information regarding the
207	207	health care-associated infections by the department;
208	208	(4) the public reporting of information regarding
209	209	health care-associated preventable adverse events by the
210	210	department; and
211	211	(5) [(3)] the education and training of health care
212	212	facility staff by the department regarding this chapter.
213	213	(c) The data reported by health care facilities to the
214	214	department must contain sufficient patient identifying information
215	215	to:
216	216	(1) avoid duplicate submission of records;
217	217	(2) allow the department to verify the accuracy and
218	218	completeness of the data reported; and
219	219	(3) for data reported under Section 98.103 or 98.104,
220	220	allow the department to risk adjust the facilities' infection
221	221	rates.
222	222	SECTION 6. Subchapter C, Chapter 98, Health and Safety
223	223	Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
224	224	Legislature, Regular Session, 2007, is amended by adding Section
225	225	98.1045 to read as follows:
226	226	Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS. (a)
227	227	In this section:
228	228	(1) "Infant" means a child younger than one year of
229	229	age.
230	230	(2) "Serious disability" means:
231	231	(A) a physical or mental impairment that
232	232	substantially limits one or more major life activities of an
233	233	individual such as seeing, hearing, speaking, walking, or
234	234	breathing, or a loss of a bodily function, if the impairment or loss
235	235	lasts more than seven days or is still present at the time of
236	236	discharge from an inpatient health care facility; or
237	237	(B) loss of a body part.
238	238	(3) "Serious injury" means a bodily injury that
239	239	results in:
240	240	(A) death;
241	241	(B) permanent and serious impairment of an
242	242	important bodily function; or
243	243	(C) permanent and significant disfigurement.
244	244	(b) A health care facility shall report to the department
245	245	the following preventable adverse events involving a patient at the
246	246	facility:
247	247	(1) surgery performed on the wrong body part;
248	248	(2) surgery performed on the wrong person;
249	249	(3) the wrong surgical procedure performed on the
250	250	patient;
251	251	(4) the unintended retention of a foreign object in
252	252	the patient after surgery or another procedure;
253	253	(5) death during or immediately after surgery if the
254	254	patient would be classified as a normal, healthy patient under
255	255	guidelines published by a national association of
256	256	anesthesiologists;
257	257	(6) death or serious disability caused by the use of a
258	258	contaminated drug, device, or biologic provided by a health care
259	259	provider if the contamination was the result of a generally
260	260	detectable contaminant in drugs, devices, or biologics regardless
261	261	of the source of the contamination or product;
262	262	(7) death or serious disability caused by the use or
263	263	function of a device during the patient's care in which the device
264	264	was used for a function other than as intended;
265	265	(8) death or serious disability caused by an
266	266	intravascular air embolism that occurred while the patient was
267	267	receiving care at the facility, excluding a death associated with a
268	268	neurological procedure known to present a high risk of
269	269	intravascular air embolism;
270	270	(9) an infant being discharged to the wrong person;
271	271	(10) death or serious disability associated with the
272	272	patient's disappearance for more than four hours, excluding the
273	273	death or serious disability of an adult patient who has
274	274	decision-making capacity;
275	275	(11) suicide or attempted suicide resulting in serious
276	276	disability while the patient was receiving care at the facility if
277	277	the suicide or attempted suicide was due to the patient's actions
278	278	after admission to the facility, excluding a death resulting from a
279	279	self-inflicted injury that was the reason for the patient's
280	280	admission to the facility;
281	281	(12) death or serious disability caused by a
282	282	medication error, including an error involving the wrong drug,
283	283	wrong dose, wrong patient, wrong time, wrong rate, wrong
284	284	preparation, or wrong route of administration;
285	285	(13) death or serious disability caused by a hemolytic
286	286	reaction resulting from the administration of ABO- or
287	287	HLA-incompatible blood or blood products;
288	288	(14) death or serious disability caused by labor or
289	289	delivery in a low-risk pregnancy while the patient was receiving
290	290	care at the facility, including death or serious disability
291	291	occurring not later than 42 days after the delivery date;
292	292	(15) death or serious disability directly related to
293	293	the following manifestations of poor glycemic control, the onset of
294	294	which occurred while the patient was receiving care at the
295	295	facility:
296	296	(A) diabetic ketoacidosis;
297	297	(B) nonketotic hyperosmolar coma;
298	298	(C) hypoglycemic coma;
299	299	(D) secondary diabetes with ketoacidosis; and
300	300	(E) secondary diabetes with hyperosmolarity;
301	301	(16) death or serious disability, including
302	302	kernicterus, caused by failure to identify and treat
303	303	hyperbilirubinemia in a neonate before discharge from the facility;
304	304	(17) stage three or four pressure ulcers acquired
305	305	after admission to the facility;
306	306	(18) death or serious disability resulting from spinal
307	307	manipulative therapy;
308	308	(19) death or serious disability caused by an electric
309	309	shock while the patient was receiving care at the facility,
310	310	excluding an event involving a planned treatment such as electric
311	311	countershock;
312	312	(20) an incident in which a line designated for oxygen
313	313	or other gas to be delivered to the patient contained the wrong gas
314	314	or was contaminated by a toxic substance;
315	315	(21) death or serious disability caused by a burn
316	316	incurred from any source while the patient was receiving care at the
317	317	facility;
318	318	(22) death or serious disability caused by a fall or
319	319	trauma while the patient was receiving care at the facility,
320	320	including death or serious disability from a fracture, dislocation,
321	321	intracranial injury, or crushing injury;
322	322	(23) death or serious disability caused by the use of a
323	323	restraint or bed rail while the patient was receiving care at the
324	324	facility;
325	325	(24) an instance of care for the patient ordered or
326	326	provided by an individual impersonating a physician, nurse,
327	327	pharmacist, or other licensed health care professional;
328	328	(25) abduction of the patient from the facility;
329	329	(26) sexual assault of the patient within or on the
330	330	grounds of the facility;
331	331	(27) death or serious injury resulting from a physical
332	332	assault of the patient that occurred within or on the grounds of the
333	333	facility;
334	334	(28) artificial insemination with the wrong donor
335	335	sperm or implantation with the wrong donor egg;
336	336	(29) death or serious disability caused by a urinary
337	337	tract infection resulting from the insertion of a catheter by an
338	338	individual health care provider;
339	339	(30) death or serious disability caused by an
340	340	infection resulting from the insertion of a vascular catheter by an
341	341	individual health care provider;
342	342	(31) death or serious disability caused by a surgical
343	343	site infection occurring as a result of the following procedures:
344	344	(A) a coronary artery bypass graft;
345	345	(B) bariatric surgery such as laparoscopic
346	346	gastric bypass surgery, gastroenterostomy, and laparoscopic
347	347	gastric restrictive surgery; and
348	348	(C) orthopedic procedures involving the spine,
349	349	neck, shoulder, or elbow;
350	350	(32) death or serious disability caused by a pulmonary
351	351	embolism or deep vein thrombosis that occurred while the patient
352	352	was receiving care at the facility following a total knee
353	353	arthroplasty or hip arthroplasty; and
354	354	(33) a health care-associated adverse condition or
355	355	event for which the Medicare program will not provide additional
356	356	payment to a health care facility under a policy adopted by the
357	357	Centers for Medicare and Medicaid Services.
358	358	SECTION 7. Sections 98.106(a), (b), and (g), Health and
359	359	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
360	360	Legislature, Regular Session, 2007, are amended to read as follows:
361	361	(a) The department shall compile and make available to the
362	362	public a summary, by health care facility, of:
363	363	(1) the infections reported by facilities under
364	364	Sections 98.103 and 98.104; and
365	365	(2) the preventable adverse events reported by
366	366	facilities under Section 98.1045.
367	367	(b) Information included in the [The] departmental summary
368	368	with respect to infections reported by facilities under Sections
369	369	98.103 and 98.104 must be risk adjusted and include a comparison of
370	370	the risk-adjusted infection rates for each health care facility in
371	371	this state that is required to submit a report under Sections 98.103
372	372	and 98.104.
373	373	(g) The department shall make the departmental summary
374	374	available on an Internet website administered by the department and
375	375	may make the summary available through other formats accessible to
376	376	the public. The website must contain a statement informing the
377	377	public of the option to report suspected health care-associated
378	378	infections and preventable adverse events to the department.
379	379	SECTION 8. Section 98.108, Health and Safety Code, as added
380	380	by Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
381	381	Session, 2007, is amended to read as follows:
382	382	Sec. 98.108. FREQUENCY OF REPORTING. In consultation with
383	383	the advisory panel, the executive commissioner by rule shall
384	384	establish the frequency of reporting by health care facilities
385	385	required under Sections 98.103, [and] 98.104, and 98.1045.
386	386	Facilities may not be required to report more frequently than
387	387	quarterly.
388	388	SECTION 9. Section 98.109(e), Health and Safety Code, as
389	389	added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
390	390	Regular Session, 2007, is amended to read as follows:
391	391	(e) A department summary or disclosure may not contain
392	392	information identifying a facility patient, employee, contractor,
393	393	volunteer, consultant, health care professional, student, or
394	394	trainee in connection with a specific [infection] incident.
395	395	SECTION 10. Sections 98.110 and 98.111, Health and Safety
396	396	Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
397	397	Legislature, Regular Session, 2007, are amended to read as follows:
398	398	Sec. 98.110. DISCLOSURE WITHIN DEPARTMENT.
399	399	Notwithstanding any other law, the department may disclose
400	400	information reported by health care facilities under Section
401	401	98.103, [or] 98.104, or 98.1045 to other programs within the
402	402	department for public health research or analysis purposes only,
403	403	provided that the research or analysis relates to health
404	404	care-associated infections or preventable adverse events. The
405	405	privilege and confidentiality provisions contained in this chapter
406	406	apply to such disclosures.
407	407	Sec. 98.111. CIVIL ACTION. Published infection rates or
408	408	preventable adverse events may not be used in a civil action to
409	409	establish a standard of care applicable to a health care facility.
410	410	SECTION 11. (a) Not later than June 1, 2010, the executive
411	411	commissioner of the Health and Human Services Commission shall
412	412	adopt rules necessary to implement Section 32.02805, Human
413	413	Resources Code, as added by this Act.
414	414	(b) Not later than October 1, 2009, the executive
415	415	commissioner of the Health and Human Services Commission shall
416	416	adopt rules and procedures necessary to implement the reporting of
417	417	health care-associated preventable adverse events as required
418	418	under Chapter 98, Health and Safety Code, as amended by this Act.
419	419	SECTION 12. Section 32.02805, Human Resources Code, as
420	420	added by this Act, applies only to a preventable adverse event
421	421	occurring on or after the effective date of the rules adopted by the
422	422	executive commissioner of the Health and Human Services Commission
423	423	under Section 11(a) of this Act.
424	424	SECTION 13. If before implementing any provision of this
425	425	Act a state agency determines that a waiver or authorization from a
426	426	federal agency is necessary for implementation of that provision,
427	427	the agency affected by the provision shall request the waiver or
428	428	authorization and may delay implementing that provision until the
429	429	waiver or authorization is granted.
430	430	SECTION 14. This Act takes effect September 1, 2009.