81R9142 CLG-D
By: Smith of Tarrant H.B. No. 852
Substitute the following for H.B. No. 852:
By: Coleman C.S.H.B. No. 852
A BILL TO BE ENTITLED
AN ACT
relating to nonpayment of hospitals under the state Medicaid
program for certain preventable adverse conditions.
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 32.02805 to read as follows:
Sec. 32.02805. NONPAYMENT OF HOSPITALS FOR PREVENTABLE
ADVERSE CONDITIONS. (a) The department in its adoption of
reasonable rules and standards governing the determination of rates
paid for inpatient hospital services on a prospective payment basis
shall assure that a hospital may not receive additional payment
associated with any of the following preventable adverse conditions
involving a recipient of medical assistance during the recipient's
hospitalization:
(1) a foreign object retained after surgery;
(2) surgery performed on the wrong body part;
(3) surgery performed on the wrong person;
(4) the wrong surgical procedure performed on the
recipient;
(5) intravascular air embolism;
(6) blood or blood product incompatibility;
(7) a stage three or four pressure ulcer;
(8) a fall or trauma resulting in a fracture,
dislocation, intracranial injury, or crushing injury;
(9) a burn or electric shock;
(10) a catheter-associated urinary tract infection;
(11) a vascular catheter-associated infection;
(12) a manifestation of poor glycemic control,
including diabetic ketoacidosis, nonketotic hyperosmolar coma,
hypoglycemic coma, secondary diabetes with ketoacidosis, and
secondary diabetes with hyperosmolarity;
(13) a surgical site infection or mediastinitis
following a coronary artery bypass graft;
(14) a surgical site infection following certain
orthopedic procedures of the spine, neck, shoulder, or elbow;
(15) a surgical site infection following bariatric
surgery for obesity, including laparoscopic gastric bypass
surgery, gastroenterostomy, and laparoscopic gastric restrictive
surgery; and
(16) deep vein thrombosis and pulmonary embolism
following certain orthopedic procedures, including total knee
replacement or hip replacement.
(b) The executive commissioner of the Health and Human
Services Commission may adopt rules to define additional
preventable adverse conditions for which a hospital shall be denied
additional payment under this section. In adopting rules under
this subsection, the executive commissioner may consider only the
same types of health care-associated adverse conditions or events
for which the Medicare program will not provide additional payment
under a policy adopted by the Centers for Medicare and Medicaid
Services.
(c) The department's nonpayment of a hospital under this
section does not in itself create civil liability and is not subject
to discovery or admissible in any civil action against the
hospital.
(d) The Health and Human Services Commission shall compile
information regarding the denial of payment to hospitals under this
section.
(e) The Health and Human Services Commission shall make
statistical information derived from the data compiled under
Subsection (d) readily available in a user-friendly format on the
commission's website.
(f) The Health and Human Services Commission may not provide
information under Subsection (e) in a manner that identifies a
recipient of medical assistance.
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 32.02805, Human
Resources Code, as added by this Act.
SECTION 3. Section 32.02805, Human Resources Code, as added
by this Act, applies only to a preventable adverse condition
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.