81R440 CLG-D
By: Leibowitz H.B. No. 344
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement under the state Medicaid program for
health care services associated with certain adverse events.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0312 to read as follows:
Sec. 32.0312. REIMBURSEMENT PROHIBITED FOR SERVICES
ASSOCIATED WITH PREVENTABLE ADVERSE EVENTS. (a) In this section:
(1) "Health care facility" means a hospital or
ambulatory surgical center.
(2) "Health care provider" means a physician or health
care facility.
(3) "Infant" means a child younger than one year of
age.
(4) "Serious disability" means:
(A) a physical or mental impairment that
substantially limits one or more major life activities of an
individual such as seeing, hearing, speaking, walking, or
breathing, or a loss of a bodily function, if the impairment or loss
lasts more than seven days or is still present at the time of
discharge from an inpatient health care facility; or
(B) loss of a body part.
(5) "Serious injury" means a bodily injury that
results in:
(A) death;
(B) permanent and serious impairment of an
important bodily function; or
(C) permanent and significant disfigurement.
(b) The department may not provide reimbursement under the
medical assistance program to a health care provider for a health
care service provided in association with a preventable adverse
event involving a recipient of medical assistance while in the
provider's care, including a health care service provided as a
result of or to correct the consequences of a preventable adverse
event.
(c) For purposes of this section, a preventable adverse
event is any of the following events involving a recipient of
medical assistance:
(1) surgery performed on the wrong body part that is
not consistent with the documented informed consent for that
recipient, excluding a situation requiring prompt action that
occurs in the course of surgery or an urgent situation that
precludes obtaining informed consent;
(2) surgery performed on the wrong person;
(3) the wrong surgical procedure performed on the
recipient that is not consistent with the documented informed
consent for that recipient, excluding a situation requiring prompt
action that occurs in the course of surgery or an urgent situation
that precludes obtaining informed consent;
(4) the unintended retention of a foreign object in
the recipient after surgery or another procedure;
(5) death during or immediately after surgery if the
recipient would be classified as a normal, healthy patient under
guidelines published by a national association of
anesthesiologists;
(6) death or serious disability caused by the use of a
contaminated drug, device, or biologic provided by a health care
provider if the contamination is the result of a generally
detectable contaminant in drugs, devices, or biologics regardless
of the source of the contamination or product;
(7) death or serious disability caused by the use or
function of a device during the recipient's care in which the device
is used for a function other than as intended;
(8) death or serious disability caused by an
intravascular air embolism that occurs while the recipient is
receiving care in a health care facility, excluding a death
associated with a neurological procedure known to present a high
risk of intravascular air emoblism;
(9) an infant being discharged to the wrong person;
(10) death or serious disability associated with the
recipient's disappearance for more than four hours, excluding the
death or serious disability of an adult recipient who has
decision-making capacity;
(11) suicide or attempted suicide resulting in serious
disability while the recipient is receiving care in a health care
facility if the suicide or attempted suicide is due to the
recipient's actions after admission to the facility, excluding a
death resulting from a self-inflicted injury that was the reason
for the recipient's admission to the facility;
(12) death or serious disability caused by a
medication error, including an error involving the wrong drug,
wrong dose, wrong patient, wrong time, wrong rate, wrong
preparation, or wrong route of administration;
(13) death or serious disability caused by a hemolytic
reaction resulting from the administration of ABO- or
HLA-incompatible blood or blood products;
(14) subject to Subsection (d), death or serious
disability caused by labor or delivery in a low-risk pregnancy
while the recipient is receiving care in a health care facility,
including death or serious disability occurring not later than 42
days after the delivery date;
(15) death or serious disability directly related to
hypoglycemia, the onset of which occurs while the recipient is
receiving care in a health care facility;
(16) death or serious disability, including
kernicterus, caused by failure to identify and treat
hyperbilirubinemia in a neonate before discharge from a health care
facility;
(17) stage three or four pressure ulcers acquired
after admission to a health care facility, excluding progression
from stage two to stage three if stage two was recognized on
admission;
(18) death or serious disability resulting from spinal
manipulative therapy;
(19) death or serious disability caused by an electric
shock while the recipient is receiving care in a health care
facility, excluding an event involving a planned treatment such as
electric countershock;
(20) an incident in which a line designated for oxygen
or other gas to be delivered to the recipient contains the wrong gas
or is contaminated by a toxic substance;
(21) death or serious disability caused by a burn
incurred from any source while the recipient is receiving care in a
health care facility;
(22) death or serious disability caused by a fall
while the recipient is receiving care in a health care facility;
(23) death or serious disability caused by the use of a
restraint or bed rail while the recipient is receiving care in a
health care facility;
(24) an instance of care for the recipient ordered or
provided by an individual impersonating a physician, nurse,
pharmacist, or other licensed health care professional;
(25) abduction of the recipient from a health care
facility;
(26) sexual assault of the recipient within or on the
grounds of a health care facility;
(27) death or significant injury resulting from a
physical assault of the recipient that occurs within or on the
grounds of a health care facility; and
(28) artificial insemination with the wrong donor
sperm or donor egg.
(d) For purposes of Subsection (c)(14), the death of a
recipient of medical assistance resulting from pulmonary or
amniotic fluid embolism, acute fatty liver of pregnancy, or
cardiomyopathy during the course of labor or delivery is not
considered a preventable adverse event.
(e) The department's refusal to reimburse a health care
provider under this section does not in itself create civil
liability and is not subject to discovery or admissible in any civil
action against the provider.
SECTION 2. Not later than November 1, 2009, the executive
commissioner of the Health and Human Services Commission shall
adopt rules necessary to implement Section 32.0312, Human Resources
Code, as added by this Act.
SECTION 3. Section 32.0312, Human Resources Code, as added
by this Act, applies only to a preventable adverse event occurring
on or after the effective date of the rules adopted by the executive
commissioner of the Health and Human Services Commission under
Section 2 of this Act.
SECTION 4. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2009.