Texas 2019 - 86th Regular

Texas Senate Bill SB749 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 749
	1	+	86R31292 JG-D
	2	+	By: Kolkhorst S.B. No. 749
	3	+	(Price, et al.)
	4	+	Substitute the following for S.B. No. 749: No.
2	5
3	6
	7	+	A BILL TO BE ENTITLED
4	8		AN ACT
5	9		relating to level of care designations for hospitals that provide
6	10		neonatal and maternal care.
7	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	12		SECTION 1. Section 241.183(a), Health and Safety Code, is
9	13		amended to read as follows:
10	14		(a) The executive commissioner, in consultation with the
11	15		department, shall adopt rules:
12	16		(1) establishing the levels of care for neonatal and
13	17		maternal care to be assigned to hospitals;
14	18		(2) prescribing criteria for designating levels of
15	19		neonatal and maternal care, respectively, including specifying the
16	20		minimum requirements to qualify for each level designation;
17	21		(3) establishing a process for the assignment of
18	22		levels of care to a hospital for neonatal and maternal care,
19	23		respectively;
20	24		(4) establishing a process for amending the level of
21	25		care designation requirements, including a process for assisting
22	26		facilities in implementing any changes made necessary by the
23	27		amendments;
24	28		(5) dividing the state into neonatal and maternal care
25	29		regions;
26	30		(6) facilitating transfer agreements through regional
27	31		coordination;
28	32		(7) requiring payment, other than quality or
29	33		outcome-based funding, to be based on services provided by the
30	34		facility, regardless of the hospital's [facility's] level of care
31	35		designation; [and]
32	36		(8) prohibiting the denial of a neonatal or maternal
33	37		level of care designation to a hospital that meets the minimum
34	38		requirements for that level of care designation;
35	39		(9) establishing a process through which a hospital
36	40		may obtain a limited follow-up survey by an independent third party
37	41		to appeal the level of care designation assigned to the hospital;
38	42		(10) permitting a hospital to satisfy any requirement
39	43		for a Level I or II level of care designation that relates to an
40	44		obstetrics or gynecological physician by:
41	45		(A) granting maternal care privileges to a family
42	46		physician with obstetrics training or experience; and
43	47		(B) developing and implementing a plan for
44	48		responding to obstetrical emergencies that require services or
45	49		procedures outside the scope of privileges granted to the family
46	50		physician described by Paragraph (A);
47	51		(11) clarifying that, regardless of a hospital's level
48	52		of care designation, a health care provider at a designated
49	53		facility or hospital may provide the full range of health care
50	54		services:
51	55		(A) that the provider is authorized to provide
52	56		under state law; and
53	57		(B) for which the hospital has granted privileges
54	58		to the provider; and
55	59		(12) requiring the department to provide to each
56	60		hospital that receives a level of care designation a written
57	61		explanation of the basis for the designation, including, as
58	62		applicable, specific reasons that prevented the hospital from
59	63		receiving a higher level of care designation.
60	64		SECTION 2. Subchapter H, Chapter 241, Health and Safety
61	65		Code, is amended by adding Sections 241.1835, 241.1836, and
62	66		241.1865 to read as follows:
63	67		Sec. 241.1835. USE OF TELEMEDICINE MEDICAL SERVICES.
64	68		(a) In this section, "telemedicine medical service" has the
65	69		meaning assigned by Section 111.001, Occupations Code.
66	70		(b) The rules adopted under Section 241.183 must allow the
67	71		use of telemedicine medical services by a physician providing
68	72		on-call services to satisfy certain requirements identified by the
69	73		executive commissioner in the rules for a Level I, II, or III level
70	74		of care designation.
71	75		(c) In identifying a requirement for a level of care
72	76		designation that may be satisfied through the use of telemedicine
73	77		medical services under Subsection (b), the executive commissioner,
74	78		in consultation with the department, physicians of appropriate
75	79		specialties, statewide medical, nursing, and hospital
76	80		associations, and other appropriate interested persons, must
77	81		ensure that the provision of a service or procedure through the use
78	82		of telemedicine medical services is in accordance with the standard
79	83		of care applicable to the provision of the same service or procedure
80	84		in an in-person setting.
81	85		(d) Telemedicine medical services must be administered
82	86		under this section by a physician licensed to practice medicine
83	87		under Subtitle B, Title 3, Occupations Code.
84	88		(e) This section does not waive other requirements for a
85	89		level of care designation.
86	90		Sec. 241.1836. APPEAL PROCESS. (a) The rules adopted
87	91		under Section 241.183 establishing level of care designations for
88	92		hospitals must allow a hospital to appeal a level of care
89	93		designation to a three-person panel that includes:
90	94		(1) a representative of the department;
91	95		(2) a representative of the commission; and
92	96		(3) an independent person who:
93	97		(A) has expertise in the specialty area for which
94	98		the hospital is seeking a level of care designation;
95	99		(B) is not an employee of or affiliated with
96	100		either the department or the commission; and
97	101		(C) does not have a conflict of interest with the
98	102		hospital, department, or commission.
99	103		(b) The independent person on the panel described by
100	104		Subsection (a) must rotate after each appeal from a list of five to
101	105		seven similarly qualified persons. The department shall solicit
102	106		persons to be included on the list. A person must apply to the
103	107		department on a form prescribed by the department and be approved by
104	108		the commissioner to be included on the list.
105	109		Sec. 241.1865. WAIVER FROM LEVEL OF CARE DESIGNATION
106	110		REQUIREMENTS; CONDITIONAL DESIGNATION. (a) The department shall
107	111		develop and implement a process through which a hospital may
108	112		request and enter into an agreement with the department to:
109	113		(1) receive or maintain a level of care designation
110	114		for which the hospital does not meet all requirements conditioned
111	115		on the hospital, in accordance with a plan approved by the
112	116		department and outlined under the agreement, satisfying all
113	117		requirements for the level of care designation within a time
114	118		specified under the agreement, which may not exceed the first
115	119		anniversary of the effective date of the agreement; or
116	120		(2) waive one specific requirement for a level of care
117	121		designation in accordance with Subsection (c).
118		-	(b) The process developed and implemented under this
119		-	section must:
120		-	(1) subject to Subdivision (2), allow a hospital to
121		-	submit a written request under Subsection (a) at any time;
122		-	(2) require a hospital to:
123		-	(A) before submitting the request, provide
124		-	notice of the hospital's intention to seek a waiver under this
125		-	section to the hospital's medical staff who practice in a specialty
126		-	service area affected by the waiver;
127		-	(B) provide the notice required by Paragraph (A)
128		-	in accordance with the hospital's process for communicating
129		-	information to medical staff; and
130		-	(C) document the provision of the notice required
131		-	by Paragraph (A); and
132		-	(3) allow the department to make a determination on
133		-	the request at any time.
	122	+	(b) A hospital may submit a written request under Subsection
	123	+	(a) at any time. The department may make a determination on a
	124	+	request submitted under that subsection at any time.
134	125		(c) The department may enter into an agreement with a
135	126		hospital to waive a requirement under Subsection (a)(2) only if the
136		-	department determines the waiver is justified after considering:
137		-	(1) the expected impact on:
138		-	(A) the accessibility of care in the geographical
139		-	area served by the hospital if the waiver is not granted; and
140		-	(B) quality of care and patient safety; or
141		-	(2) whether health care services related to the
	127	+	department determines the waiver is justified considering:
	128	+	(1) the expected impact on the accessibility of care
	129	+	in the geographical area served by the hospital if the waiver is not
	130	+	granted;
	131	+	(2) the expected impact on quality of care;
	132	+	(3) the expected impact on patient safety; or
	133	+	(4) whether health care services related to the
142	134		requirement can be provided through telemedicine medical services
143	135		under Section 241.1835.
144	136		(d) A waiver agreement entered into under Subsection (a):
145	137		(1) must expire not later than at the end of each
146	138		designation cycle but may be renewed on expiration by the
147	139		department under the same or different terms; and
148	140		(2) may specify any conditions for ongoing reporting
149	141		and monitoring during the agreement.
150	142		(e) A hospital that enters into a waiver agreement under
151	143		Subsection (a) is required to satisfy all other requirements for a
152	144		level of care designation that are not waived in the agreement.
153	145		(f) The department shall post on the department's Internet
154	146		website and periodically update:
155	147		(1) a list of hospitals that enter into an agreement
156	148		with the department under this section; and
157	149		(2) an aggregated list of the requirements
158	150		conditionally met or waived in agreements entered into under this
159	151		section.
160	152		(g) A hospital that enters into an agreement with the
161	153		department under this section shall post on the hospital's Internet
162	154		website the nature and general terms of the agreement.
163	155		SECTION 3. Section 241.187, Health and Safety Code, is
164	156		amended by amending Subsection (l) and adding Subsections (m) and
165	157		(n) to read as follows:
166	158		(l) The advisory council is subject to Chapter 325,
167	159		Government Code (Texas Sunset Act). The advisory council shall be
168	160		reviewed during the period in which the Department of State Health
169	161		Services is reviewed [Unless continued in existence as provided by
170	162		that chapter, the advisory council is abolished and this section
171	163		expires September 1, 2025].
172	164		(m) The department, in consultation with the advisory
173	165		council, shall:
174	166		(1) conduct a strategic review of the practical
175	167		implementation of rules adopted in consultation with the department
176	168		under this subchapter that at a minimum identifies:
177	169		(A) barriers to a hospital obtaining its
178	170		requested level of care designation;
179	171		(B) whether the barriers identified under
180	172		Paragraph (A) are appropriate to ensure and improve neonatal and
181	173		maternal care;
182	174		(C) requirements for a level of care designation
183	175		that relate to gestational age; and
184	176		(D) whether, in making a level of care
185	177		designation for a hospital, the department or the perinatal
186	178		advisory council should consider:
187	179		(i) the geographic area in which the
188	180		hospital is located; and
189	181		(ii) regardless of the number of patients
190	182		of a particular gestational age treated by the hospital, the
191	183		hospital's capabilities in providing care to patients of a
192	184		particular gestational age as determined by the hospital;
193	185		(2) based on the review conducted under Subdivision
194	186		(1), recommend a modification of rules adopted under this
195	187		subchapter, as appropriate, to improve the process and methodology
196	188		of assigning level of care designations; and
197	189		(3) prepare and submit to the legislature:
198	190		(A) not later than December 31, 2019, a written
199	191		report that summarizes the department's review of neonatal care
200	192		conducted under Subdivision (1) and on actions taken by the
201	193		department and executive commissioner based on that review; and
202	194		(B) not later than December 31, 2020, a written
203	195		report that summarizes the department's review of maternal care
204	196		conducted under Subdivision (1) and on actions taken by the
205	197		department and executive commissioner based on that review.
206	198		(n) Subsection (m) and this subsection expire September 1,
207	199		2021.
208	200		SECTION 4. (a) The executive commissioner of the Health
209	201		and Human Services Commission shall complete for each hospital in
210	202		this state the maternal level of care designation not later than
211	203		August 31, 2021.
212	204		(b) Notwithstanding Section 241.186, Health and Safety
213	205		Code, a hospital is not required to have a maternal level of care
214	206		designation as a condition of reimbursement for maternal services
215	207		through the Medicaid program before September 1, 2021.
216	208		(c) A hospital that submits an application to the Department
217	209		of State Health Services for a maternal level of care designation
218	210		under Subchapter H, Chapter 241, Health and Safety Code, before the
219	211		effective date of this Act may amend the application to reflect the
220	212		applicable changes in law made by this Act.
221	213		SECTION 5. As soon as practicable after the effective date
222	214		of this Act, the executive commissioner of the Health and Human
223	215		Services Commission shall adopt rules as necessary to implement the
224	216		changes in law made by this Act.
225	217		SECTION 6. This Act takes effect immediately if it receives
226	218		a vote of two-thirds of all the members elected to each house, as
227	219		provided by Section 39, Article III, Texas Constitution. If this
228	220		Act does not receive the vote necessary for immediate effect, this
229	221		Act takes effect September 1, 2019.
230		-	______________________________ ______________________________
231		-	President of the Senate Speaker of the House
232		-	I hereby certify that S.B. No. 749 passed the Senate on
233		-	April 1, 2019, by the following vote: Yeas 31, Nays 0; and that
234		-	the Senate concurred in House amendments on May 23, 2019, by the
235		-	following vote: Yeas 31, Nays 0.
236		-	______________________________
237		-	Secretary of the Senate
238		-	I hereby certify that S.B. No. 749 passed the House, with
239		-	amendments, on May 21, 2019, by the following vote: Yeas 146,
240		-	Nays 0, one present not voting.
241		-	______________________________
242		-	Chief Clerk of the House
243		-	Approved:
244		-	______________________________
245		-	Date
246		-	______________________________
247		-	Governor