83R18574 JSC-D
By: Kolkhorst, Coleman, Zerwas, Geren, H.B. No. 15
Cortez, et al.
A BILL TO BE ENTITLED
AN ACT
relating to level of care designations for hospitals that provide
neonatal and maternal services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 241, Health and Safety Code, is amended
by adding Subchapter H to read as follows:
SUBCHAPTER H. HOSPITAL LEVEL OF CARE DESIGNATIONS FOR NEONATAL AND
MATERNAL CARE
Sec. 241.181. DEFINITIONS. In this subchapter:
(1) "Department" means the Department of State Health
Services.
(2) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
Sec. 241.182. LEVEL OF CARE DESIGNATIONS. (a) The
executive commissioner, in accordance with the rules adopted under
Section 241.183, shall assign level of care designations to each
hospital based on the neonatal and maternal services provided at
the hospital.
(b) A hospital may receive different level designations for
neonatal and maternal care, respectively.
Sec. 241.183. RULES. (a) The executive commissioner, in
consultation with the department, shall adopt rules:
(1) establishing the levels of care for neonatal and
maternal care to be assigned to hospitals;
(2) prescribing criteria for designating levels of
neonatal and maternal care, respectively, including specifying the
minimum requirements to qualify for each level designation;
(3) establishing a process for the assignment of
levels of care to a hospital for neonatal and maternal care,
respectively;
(4) establishing a process for amending the level of
care designation requirements, including a process for assisting
facilities in implementing any changes made necessary by the
amendments;
(5) dividing the state into neonatal and maternal care
regions;
(6) facilitating transfer agreements through regional
coordination;
(7) requiring payment, other than quality or
outcome-based funding, to be based on services provided by the
facility, regardless of the facility's level of care designation;
and
(8) prohibiting the denial of a neonatal or maternal
level of care designation to a hospital that meets the minimum
requirements for that level of care designation.
(b) The Health and Human Services Commission shall study
patient transfers that are not medically necessary but would be
cost-effective. Based on the study under this subsection, if the
executive commissioner determines that the transfers are feasible
and desirable, the executive commissioner may adopt rules
addressing those transfers.
(c) Each level of care designation must require a hospital
to regularly submit outcome and other data to the department as
required or requested.
(d) The criteria a hospital must achieve to receive each
level of care designation must be posted on the department's
Internet website.
Sec. 241.184. ASSIGNMENT OF LEVEL OF CARE DESIGNATION. (a)
The executive commissioner, in consultation with the department,
shall assign the appropriate level of care designation to each
hospital that meets the minimum standards for that level of care.
The executive commissioner shall evaluate separately the neonatal
and maternal services provided at the hospital and assign the
respective level of care designations accordingly.
(b) Every three years, the executive commissioner and the
department shall review the level of care designations assigned to
each hospital and, as necessary, assign a hospital a different
level of care designation or remove the hospital's level of care
designation.
(c) A hospital may request a change of designation at any
time. On request under this subsection, the executive commissioner
and the department shall review the hospital's request and, as
necessary, change the hospital's level of care designation.
Sec. 241.185. HOSPITAL FAILING TO ACHIEVE MINIMUM LEVELS OF
CARE. A hospital that does not meet the minimum requirements for
any level of care designation for neonatal or maternal services:
(1) may not receive a level of care designation for
those services; and
(2) is not eligible to receive reimbursement through
the Medicaid program for neonatal or maternal services, as
applicable, except emergency services required to be provided or
reimbursed under state or federal law.
Sec. 241.186. PERINATAL ADVISORY COUNCIL. (a) In this
section, "advisory council" means the Perinatal Advisory Council
established under this section.
(b) The advisory council consists of 17 members appointed by
the executive commissioner as follows:
(1) four physicians licensed to practice medicine
under Subtitle B, Title 3, Occupations Code, specializing in
neonatology:
(A) at least two of whom practice in a Level III
or IV neonatal intensive care unit; and
(B) at least one of whom practices in a neonatal
intensive care unit of a hospital located in a rural area;
(2) one physician licensed to practice medicine under
Subtitle B, Title 3, Occupations Code, specializing in general
pediatrics;
(3) two physicians licensed to practice medicine under
Subtitle B, Title 3, Occupations Code, specializing in
obstetrics-gynecology;
(4) two physicians licensed to practice medicine under
Subtitle B, Title 3, Occupations Code, specializing in maternal
fetal medicine;
(5) one physician licensed to practice medicine under
Subtitle B, Title 3, Occupations Code, specializing in family
practice who provides obstetrical care in a rural community;
(6) one registered nurse licensed under Subtitle E,
Title 3, Occupations Code, with expertise in maternal health care
delivery;
(7) one registered nurse licensed under Subtitle E,
Title 3, Occupations Code, with expertise in perinatal health care
delivery;
(8) one representative from a children's hospital;
(9) one representative from a hospital with a Level II
neonatal intensive care unit;
(10) one representative from a rural hospital;
(11) one representative from a general hospital; and
(12) one ex officio representative from the office of
the medical director of the Health and Human Services Commission.
(c) To the extent possible, the executive commissioner
shall appoint members to the advisory council who previously served
on the Neonatal Intensive Care Unit Council established under
Chapter 818 (H.B. 2636), Acts of the 82nd Legislature, Regular
Session, 2011.
(d) Members of the advisory council described by
Subsections (b)(1)-(11) serve staggered three-year terms, with the
terms of five or six of those members expiring September 1 of each
year. A member may be reappointed to the advisory council.
(e) A member of the advisory council serves without
compensation but is entitled to reimbursement for actual and
necessary travel expenses related to the performance of advisory
council duties.
(f) The department, with recommendations from the advisory
council, shall develop a process for the designation and updates of
levels of neonatal and maternal care at hospitals in accordance
with this subchapter.
(g) The advisory council shall:
(1) develop and recommend criteria for designating
levels of neonatal and maternal care, respectively, including
specifying the minimum requirements to qualify for each level
designation;
(2) develop and recommend a process for the assignment
of levels of care to a hospital for neonatal and maternal care,
respectively;
(3) make recommendations for the division of the state
into neonatal and maternal care regions;
(4) examine utilization trends relating to neonatal
and maternal care; and
(5) make recommendations related to improving
neonatal and maternal outcomes.
(h) In developing the criteria for the levels of neonatal
and maternal care, the advisory council shall consider:
(1) any recommendations or publications of the
American Academy of Pediatrics and the American Congress of
Obstetricians and Gynecologists, including "Guidelines for
Perinatal Care";
(2) any guidelines developed by the Society of
Maternal-Fetal Medicine; and
(3) the geographic and varied needs of citizens of
this state.
(i) The advisory council shall submit a report detailing the
advisory council's determinations and recommendations to the
department and the executive commissioner not later than September
1, 2015.
(j) The advisory council shall continue to update its
recommendations based on any relevant scientific or medical
developments.
(k) The advisory council is subject to Chapter 325,
Government Code (Texas Sunset Act). Unless continued in existence
as provided by that chapter, the advisory council is abolished and
this section expires September 1, 2025.
SECTION 2. (a) Not later than December 1, 2013, the
executive commissioner of the Health and Human Services Commission
shall appoint the members of the Perinatal Advisory Council as
required by Section 241.186, Health and Safety Code, as added by
this Act. Notwithstanding Section 241.186(d), Health and Safety
Code, as added by this Act, the executive commissioner shall
appoint:
(1) two members described by Section 241.186(b)(1),
Health and Safety Code, one member described by Section
241.186(b)(3), Health and Safety Code, and the members described by
Sections 241.186(b)(6) and (9), Health and Safety Code, to an
initial term that expires September 1, 2017;
(2) one member described by Section 241.186(b)(1),
Health and Safety Code, one member described by Section
241.186(b)(3), Health and Safety Code, one member described by
Section 241.186(b)(4), Health and Safety Code, and the members
described by Sections 241.186(b)(2), (7), and (10), Health and
Safety Code, to an initial term that expires September 1, 2018; and
(3) one member described by Section 241.186(b)(1),
Health and Safety Code, one member described by Section
241.186(b)(4), Health and Safety Code, and the members described by
Sections 241.186(b)(5), (8), and (11), Health and Safety Code, to
an initial term that expires September 1, 2019.
(b) Not later than March 1, 2017, after consideration of the
report of the Perinatal Advisory Council, the executive
commissioner of the Health and Human Services Commission shall
adopt the initial rules required by Section 241.183, Health and
Safety Code, as added by this Act.
(c) The executive commissioner of the Health and Human
Services Commission shall complete for each hospital in this state:
(1) the neonatal level of care designation not later
than August 31, 2017; and
(2) the maternal level of care designation not later
than August 31, 2019.
(d) Notwithstanding Section 241.185, Health and Safety
Code, as added by this Act:
(1) a hospital is not required to have a neonatal level
of care designation as a condition of reimbursement through the
Medicaid program before September 1, 2017; and
(2) a hospital is not required to have a maternal level
of care designation as a condition of reimbursement through the
Medicaid program before September 1, 2019.
SECTION 3. 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 4. This Act takes effect September 1, 2013.