| 1 | 1 | | 81R3551 CLG-F |
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| 2 | 2 | | By: Shapleigh S.B. No. 353 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to nonpayment of hospitals under the state Medicaid |
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| 8 | 8 | | program for certain preventable adverse conditions. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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| 11 | 11 | | is amended by adding Section 32.02805 to read as follows: |
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| 12 | 12 | | Sec. 32.02805. NONPAYMENT OF HOSPITALS FOR PREVENTABLE |
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| 13 | 13 | | ADVERSE CONDITIONS. (a) The department in its adoption of |
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| 14 | 14 | | reasonable rules and standards governing the determination of rates |
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| 15 | 15 | | paid for inpatient hospital services on a prospective payment basis |
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| 16 | 16 | | shall assure that a hospital may not receive additional payment |
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| 17 | 17 | | associated with any of the following preventable adverse conditions |
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| 18 | 18 | | if acquired by a recipient of medical assistance during the |
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| 19 | 19 | | recipient's hospitalization: |
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| 20 | 20 | | (1) a foreign object retained after surgery; |
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| 21 | 21 | | (2) intravascular air embolism; |
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| 22 | 22 | | (3) blood or blood product incompatibility; |
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| 23 | 23 | | (4) a stage three or four pressure ulcer; |
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| 24 | 24 | | (5) a fall or trauma resulting in a fracture, |
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| 25 | 25 | | dislocation, intracranial injury, or crushing injury; |
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| 26 | 26 | | (6) a burn or electric shock; |
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| 27 | 27 | | (7) a catheter-associated urinary tract infection; |
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| 28 | 28 | | (8) a vascular catheter-associated infection; |
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| 29 | 29 | | (9) a manifestation of poor glycemic control, |
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| 30 | 30 | | including diabetic ketoacidosis, nonketotic hyperosmolar coma, |
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| 31 | 31 | | hypoglycemic coma, secondary diabetes with ketoacidosis, and |
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| 32 | 32 | | secondary diabetes with hyperosmolarity; |
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| 33 | 33 | | (10) a surgical site infection or mediastinitis |
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| 34 | 34 | | following a coronary artery bypass graft; |
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| 35 | 35 | | (11) a surgical site infection following certain |
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| 36 | 36 | | orthopedic procedures of the spine, neck, shoulder, or elbow; |
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| 37 | 37 | | (12) a surgical site infection following bariatric |
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| 38 | 38 | | surgery for obesity, including laparoscopic gastric bypass |
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| 39 | 39 | | surgery, gastroenterostomy, and laparoscopic gastric restrictive |
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| 40 | 40 | | surgery; and |
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| 41 | 41 | | (13) deep vein thrombosis and pulmonary embolism |
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| 42 | 42 | | following certain orthopedic procedures, including total knee |
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| 43 | 43 | | replacement or hip replacement. |
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| 44 | 44 | | (b) The department's nonpayment of a hospital under this |
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| 45 | 45 | | section does not in itself create civil liability and is not subject |
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| 46 | 46 | | to discovery or admissible in any civil action against the |
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| 47 | 47 | | hospital. |
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| 48 | 48 | | (c) The Health and Human Services Commission shall compile |
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| 49 | 49 | | information regarding the denial of payment to hospitals under this |
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| 50 | 50 | | section. |
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| 51 | 51 | | (d) The Health and Human Services Commission shall make |
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| 52 | 52 | | statistical information derived from the data compiled under |
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| 53 | 53 | | Subsection (c) readily available in a user-friendly format on the |
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| 54 | 54 | | commission's website. |
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| 55 | 55 | | (e) The Health and Human Services Commission may not provide |
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| 56 | 56 | | information under Subsection (d) in a manner that identifies a |
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| 57 | 57 | | recipient of medical assistance. |
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| 58 | 58 | | SECTION 2. Not later than November 1, 2009, the executive |
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| 59 | 59 | | commissioner of the Health and Human Services Commission shall |
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| 60 | 60 | | adopt rules necessary to implement Section 32.02805, Human |
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| 61 | 61 | | Resources Code, as added by this Act. |
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| 62 | 62 | | SECTION 3. Section 32.02805, Human Resources Code, as added |
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| 63 | 63 | | by this Act, applies only to a preventable adverse condition |
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| 64 | 64 | | occurring on or after the effective date of the rules adopted by the |
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| 65 | 65 | | executive commissioner of the Health and Human Services Commission |
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| 66 | 66 | | under Section 2 of this Act. |
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| 67 | 67 | | SECTION 4. If before implementing any provision of this Act |
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| 68 | 68 | | a state agency determines that a waiver or authorization from a |
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| 69 | 69 | | federal agency is necessary for implementation of that provision, |
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| 70 | 70 | | the agency affected by the provision shall request the waiver or |
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| 71 | 71 | | authorization and may delay implementing that provision until the |
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| 72 | 72 | | waiver or authorization is granted. |
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| 73 | 73 | | SECTION 5. This Act takes effect September 1, 2009. |
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