83R4538 AED-D
By: Zerwas H.B. No. 1507
A BILL TO BE ENTITLED
AN ACT
relating to the minimum standards for birthing centers and certain
health professionals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 244.002, Health and Safety Code, is
amended by amending Subdivisions (2) and (3) and adding
Subdivisions (2-a), (2-b), (3-a), and (3-b) to read as follows:
(2) "Board" means the executive commissioner [Texas
Board of Health].
(2-a) "Certified nurse-midwife" has the meaning
assigned by Section 203.002, Occupations Code.
(2-b) "Clinical director" means the person
responsible for advising and consulting with the staff of a
birthing center on matters relating to the clinical management of
the center's patients, including developing clinical policies for
the center and supervising all persons who provide direct patient
care.
(3) "Department" means the [Texas] Department of State
Health Services.
(3-a) "Executive Commissioner" means the executive
commissioner of the Health and Human Services Commission.
(3-b) "Licensed midwife" means a midwife licensed
under Chapter 203, Occupations Code.
SECTION 2. Section 244.005(c), Health and Safety Code, is
amended to read as follows:
(c) The application must contain evidence that:
(1) the composition of the center's staff meets the
standards adopted [by the board] under this chapter for the level of
license for which the application is submitted; and
(2) the center, or each licensed or certified
professional providing services at the center, maintains liability
insurance coverage in the amount specified by and subject to the
terms required by department rules.
SECTION 3. Section 244.010, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsection (c) to
read as follows:
(a) For each level of license of a birthing center, the
rules must contain minimum standards for:
(1) the qualifications for professional and
nonprofessional personnel;
(2) the supervision of professional and
nonprofessional personnel;
(3) the provision and coordination of treatment and
services;
(4) the organizational structure, including the lines
of authority and the delegation of responsibility;
(5) the keeping of clinical records; [and]
(6) any other aspect of the operation of a birthing
center considered [that the board considers] necessary to protect
the public; and
(7) the construction and design of a birthing center.
(c) The minimum construction and design standards,
including plumbing, heating, lighting, and ventilation standards
and other design standards necessary to ensure the health and
safety of a birthing center's patients, adopted under this section
must be at least as stringent as the standards of The Joint
Commission on health care organization accreditation in effect on
January 1, 2013.
SECTION 4. Chapter 244, Health and Safety Code, is amended
by adding Sections 244.0101, 244.0102, 244.0103, and 244.0104 to
read as follows:
Sec. 244.0101. CLINICAL DIRECTOR. (a) A birthing center
shall employ a qualified clinical director.
(b) A clinical director employed under this section must be
a certified nurse-midwife or a physician licensed to practice
medicine in this state.
Sec. 244.0102. REQUIRED PATIENT TRANSFERS. A licensed
midwife who is providing care to a patient at a birthing center
shall immediately transfer the patient to a hospital located in
close proximity to the center, as established by department rule,
if the patient exhibits one or more of the following medical
conditions:
(1) a non-vertex presentation;
(2) a multiple gestation; or
(3) a previous uterine surgery, including a cesarean
delivery.
Sec. 244.0103. TRANSFER AGREEMENTS. (a) A birthing center
shall enter into a transfer agreement with a hospital located in
close proximity to the center, as established by department rule.
(b) At a minimum, a transfer agreement must:
(1) provide for the use of medically appropriate life
support measures that a reasonable and prudent physician exercising
ordinary care in the same or a similar locality would use to
stabilize the patient before the transfer and to sustain the
patient during the transfer;
(2) require the provision of appropriate personnel and
equipment that a reasonable and prudent physician exercising
ordinary care in the same or a similar locality would use for the
transfer;
(3) require the transfer of all necessary records for
continuing the care for the patient;
(4) prohibit the transfer of a patient predicated on
arbitrary, capricious, or unreasonable discrimination because of
race, religion, national origin, age, sex, physical condition, or
economic status; and
(5) prohibit the transfer or acceptance of a patient
in need of emergency care based on the individual's inability to pay
for the services rendered by the transferring birthing center or
receiving hospital.
(c) The birthing center shall submit the agreement to the
department for review. The department shall determine whether the
agreement complies with the requirements of this section and rules
adopted under this section. The department shall complete the
review not later than the 30th day after the date the agreement is
received by the department.
(d) The executive commissioner shall adopt rules governing
transfers and transfer agreements. The rules must:
(1) require that if a patient at a birthing center has
an emergency medical condition that has not been stabilized, the
center may not transfer the patient unless:
(A) the patient or a legally responsible person
acting on the patient's behalf, after being informed of the center's
obligations under this subsection and of the risk of transfer, in
writing requests transfer to another medical facility;
(B) a licensed physician has signed a
certification, which includes a summary of the risks and benefits,
that, based on the information available at the time of transfer,
the medical benefits reasonably expected from the provision of
appropriate medical treatment at another medical facility outweigh
the increased risks to the patient and, in the case of labor, to the
unborn child from effecting the transfer; or
(C) if a licensed physician is not physically
present in the birthing center at the time a patient is transferred,
a qualified medical person has signed a certification described in
Paragraph (B) after a licensed physician, in consultation with the
person, has made the determination described in that paragraph and
subsequently countersigns the certificate;
(2) authorize the birthing center to enter into
multiple transfer agreements based on the type or level of medical
services available at other hospitals;
(3) require the birthing center to recognize the right
of a patient to request transfer to the care of a physician and
hospital of the patient's choice;
(4) require the birthing center to recognize and
comply with the requirements of Chapter 61 relating to the transfer
of patients to mandated providers; and
(5) consider the availability of appropriate
facilities, services, and staff for providing care to the patient.
(e) A birthing center that transfers a patient in violation
of rules adopted under this section or provisions required in a
transfer agreement under this section violates this chapter.
Sec. 244.0104. REFERRAL AND CONSULTATION; LICENSED
MIDWIVES. (a) A birthing center may not allow a licensed midwife
to provide care to a patient at the center unless the midwife
complies with the standards for referral or consultation required
by the Texas Board of Nursing for certified nurse-midwives.
(b) A licensed midwife who provides care to a patient at a
birthing center shall enter into a referral agreement, on the form
prescribed by the department, with a licensed physician who agrees
to consult with and receive referrals from the licensed midwife.
The agreement may not be for a term that exceeds one year. Each
year, the licensed midwife shall submit a copy of the current
agreement to the department.
(c) The department shall maintain copies of the referral
agreements required under Subsection (b) until the first
anniversary of the date the agreement expires.
SECTION 5. (a) Not later than September 1, 2014, the
Department of State Health Services shall develop the form for the
referral agreement required by Section 244.0104, Health and Safety
Code, as added by this Act.
(b) The executive commissioner of the Health and Human
Services Commission shall adopt the rules required to implement
Chapter 244, Health and Safety Code, as amended by this Act.
(c) Not later than December 1, 2013, a birthing center must
comply with Section 244.005(c), Health and Safety Code, as amended
by this Act.
(d) On or after the effective date of this Act, a birthing
center may not employ or continue to employ a clinical director who
does not meet the requirements of Section 244.0101, Health and
Safety Code, as added by this Act.
SECTION 6. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2013.