86R7215 JG-D
By: Kolkhorst S.B. No. 749
A BILL TO BE ENTITLED
AN ACT
relating to level of care designations for hospitals that provide
neonatal and maternal care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 241.183, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsection (f) to
read as follows:
(a) The executive commissioner, in consultation with the
commission [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;
(9) establishing a process through which a hospital
may appeal to an independent third party regarding the level of care
designation assigned to the hospital;
(10) permitting a health care provider who provides
care at a hospital assigned a Level I or II level of care
designation to provide each health care service for which the
provider is licensed if the hospital demonstrates a need for the
service; and
(11) specifying the situations in which a hospital can
receive off-site medical consulting or services to meet the
requirements for a level of care designation.
(f) In adopting rules under Subsection (a), the executive
commissioner shall ensure that any requirement for a level of care
designation related to care for patients of a particular
gestational age or for a specified number of patients of a
particular gestational age provides flexibility based on the
geographic area in which the hospital is located and the hospital's
capabilities for providing care.
SECTION 2. Subchapter H, Chapter 241, Health and Safety
Code, is amended by adding Sections 241.1835 and 241.1865 to read as
follows:
Sec. 241.1835. USE OF TELEHEALTH SERVICES AND TELEMEDICINE
MEDICAL SERVICES AT CERTAIN HOSPITALS. (a) In this section,
"telehealth service" and "telemedicine medical service" have the
meanings assigned by Section 111.001, Occupations Code.
(b) In adopting rules under Section 241.183, the executive
commissioner may not exclude or prohibit the use of telehealth
services or telemedicine medical services by a physician providing
on-call services at a hospital located in a rural area of this
state, as defined by executive commissioner rule, that is assigned
a Level I, II, or III level of care designation. This section
applies only to on-call services provided:
(1) at a hospital with a local medical staff
consisting of not more than four physicians; and
(2) for a hospital assigned a Level II or III level of
care designation, by a physician licensed to practice medicine
under Subtitle B, Title 3, Occupations Code, and board certified in
obstetrics or gynecology.
(c) This section does not waive the requirements for a level
of care designation.
Sec. 241.1865. WAIVER FROM LEVEL OF CARE DESIGNATION
REQUIREMENTS. (a) The executive commissioner by rule shall
develop and implement a process through which a hospital may enter
into an agreement with the commission to waive one or more
requirements for a level of care designation.
(b) The executive commissioner by rule shall adopt
requirements to enter into a waiver agreement under Subsection (a)
and specify the type of designation requirements that may be
waived.
(c) A waiver agreement entered into under Subsection (a):
(1) must expire at the end of each designation cycle
but may be renewed by the commission under the same or different
terms; and
(2) may require a hospital to meet the requirements
for a level of care designation within the period specified under
the agreement.
(d) A hospital that enters into a waiver agreement under
Subsection (a) is required to satisfy all other requirements for a
level of care designation that are not waived in the agreement.
SECTION 3. Section 241.187, Health and Safety Code, is
amended by amending Subsection (l) and adding Subsection (m) to
read as follows:
(l) The advisory council is subject to Chapter 325,
Government Code (Texas Sunset Act). The advisory council shall be
reviewed during the period in which the Department of State Health
Services is reviewed [Unless continued in existence as provided by
that chapter, the advisory council is abolished and this section
expires September 1, 2025].
(m) The executive commissioner, in consultation with the
commission and the advisory council, shall:
(1) conduct a strategic review of the practical
implementation of rules adopted by the executive commissioner under
this subchapter that at a minimum identifies:
(A) barriers to a hospital obtaining the
hospital's preferred level of care designation; and
(B) whether the barriers identified under
Paragraph (A) are appropriate;
(2) based on the review conducted under Subdivision
(1), modify rules adopted under this subchapter, as appropriate, to
improve the process and methodology of assigning level of care
designations; and
(3) prepare and submit to the legislature each
biennium a written report that summarizes:
(A) the review conducted under Subdivision (1);
and
(B) actions taken by the executive commissioner
based on the review.
SECTION 4. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall adopt rules as necessary to implement the
changes in law made by this Act.
SECTION 5. This Act takes effect September 1, 2019.