S.B. No. 749
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(a), Health and Safety Code, is
amended to read as follows:
(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 hospital's [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 obtain a limited follow-up survey by an independent third party
to appeal the level of care designation assigned to the hospital;
(10) permitting a hospital to satisfy any requirement
for a Level I or II level of care designation that relates to an
obstetrics or gynecological physician by:
(A) granting maternal care privileges to a family
physician with obstetrics training or experience; and
(B) developing and implementing a plan for
responding to obstetrical emergencies that require services or
procedures outside the scope of privileges granted to the family
physician described by Paragraph (A);
(11) clarifying that, regardless of a hospital's level
of care designation, a health care provider at a designated
facility or hospital may provide the full range of health care
services:
(A) that the provider is authorized to provide
under state law; and
(B) for which the hospital has granted privileges
to the provider; and
(12) requiring the department to provide to each
hospital that receives a level of care designation a written
explanation of the basis for the designation, including, as
applicable, specific reasons that prevented the hospital from
receiving a higher level of care designation.
SECTION 2. Subchapter H, Chapter 241, Health and Safety
Code, is amended by adding Sections 241.1835, 241.1836, and
241.1865 to read as follows:
Sec. 241.1835. USE OF TELEMEDICINE MEDICAL SERVICES.
(a) In this section, "telemedicine medical service" has the
meaning assigned by Section 111.001, Occupations Code.
(b) The rules adopted under Section 241.183 must allow the
use of telemedicine medical services by a physician providing
on-call services to satisfy certain requirements identified by the
executive commissioner in the rules for a Level I, II, or III level
of care designation.
(c) In identifying a requirement for a level of care
designation that may be satisfied through the use of telemedicine
medical services under Subsection (b), the executive commissioner,
in consultation with the department, physicians of appropriate
specialties, statewide medical, nursing, and hospital
associations, and other appropriate interested persons, must
ensure that the provision of a service or procedure through the use
of telemedicine medical services is in accordance with the standard
of care applicable to the provision of the same service or procedure
in an in-person setting.
(d) Telemedicine medical services must be administered
under this section by a physician licensed to practice medicine
under Subtitle B, Title 3, Occupations Code.
(e) This section does not waive other requirements for a
level of care designation.
Sec. 241.1836. APPEAL PROCESS. (a) The rules adopted
under Section 241.183 establishing level of care designations for
hospitals must allow a hospital to appeal a level of care
designation to a three-person panel that includes:
(1) a representative of the department;
(2) a representative of the commission; and
(3) an independent person who:
(A) has expertise in the specialty area for which
the hospital is seeking a level of care designation;
(B) is not an employee of or affiliated with
either the department or the commission; and
(C) does not have a conflict of interest with the
hospital, department, or commission.
(b) The independent person on the panel described by
Subsection (a) must rotate after each appeal from a list of five to
seven similarly qualified persons. The department shall solicit
persons to be included on the list. A person must apply to the
department on a form prescribed by the department and be approved by
the commissioner to be included on the list.
Sec. 241.1865. WAIVER FROM LEVEL OF CARE DESIGNATION
REQUIREMENTS; CONDITIONAL DESIGNATION. (a) The department shall
develop and implement a process through which a hospital may
request and enter into an agreement with the department to:
(1) receive or maintain a level of care designation
for which the hospital does not meet all requirements conditioned
on the hospital, in accordance with a plan approved by the
department and outlined under the agreement, satisfying all
requirements for the level of care designation within a time
specified under the agreement, which may not exceed the first
anniversary of the effective date of the agreement; or
(2) waive one specific requirement for a level of care
designation in accordance with Subsection (c).
(b) The process developed and implemented under this
section must:
(1) subject to Subdivision (2), allow a hospital to
submit a written request under Subsection (a) at any time;
(2) require a hospital to:
(A) before submitting the request, provide
notice of the hospital's intention to seek a waiver under this
section to the hospital's medical staff who practice in a specialty
service area affected by the waiver;
(B) provide the notice required by Paragraph (A)
in accordance with the hospital's process for communicating
information to medical staff; and
(C) document the provision of the notice required
by Paragraph (A); and
(3) allow the department to make a determination on
the request at any time.
(c) The department may enter into an agreement with a
hospital to waive a requirement under Subsection (a)(2) only if the
department determines the waiver is justified after considering:
(1) the expected impact on:
(A) the accessibility of care in the geographical
area served by the hospital if the waiver is not granted; and
(B) quality of care and patient safety; or
(2) whether health care services related to the
requirement can be provided through telemedicine medical services
under Section 241.1835.
(d) A waiver agreement entered into under Subsection (a):
(1) must expire not later than at the end of each
designation cycle but may be renewed on expiration by the
department under the same or different terms; and
(2) may specify any conditions for ongoing reporting
and monitoring during the agreement.
(e) 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.
(f) The department shall post on the department's Internet
website and periodically update:
(1) a list of hospitals that enter into an agreement
with the department under this section; and
(2) an aggregated list of the requirements
conditionally met or waived in agreements entered into under this
section.
(g) A hospital that enters into an agreement with the
department under this section shall post on the hospital's Internet
website the nature and general terms of the agreement.
SECTION 3. Section 241.187, Health and Safety Code, is
amended by amending Subsection (l) and adding Subsections (m) and
(n) 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 department, in consultation with the advisory
council, shall:
(1) conduct a strategic review of the practical
implementation of rules adopted in consultation with the department
under this subchapter that at a minimum identifies:
(A) barriers to a hospital obtaining its
requested level of care designation;
(B) whether the barriers identified under
Paragraph (A) are appropriate to ensure and improve neonatal and
maternal care;
(C) requirements for a level of care designation
that relate to gestational age; and
(D) whether, in making a level of care
designation for a hospital, the department or the perinatal
advisory council should consider:
(i) the geographic area in which the
hospital is located; and
(ii) regardless of the number of patients
of a particular gestational age treated by the hospital, the
hospital's capabilities in providing care to patients of a
particular gestational age as determined by the hospital;
(2) based on the review conducted under Subdivision
(1), recommend a modification of 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:
(A) not later than December 31, 2019, a written
report that summarizes the department's review of neonatal care
conducted under Subdivision (1) and on actions taken by the
department and executive commissioner based on that review; and
(B) not later than December 31, 2020, a written
report that summarizes the department's review of maternal care
conducted under Subdivision (1) and on actions taken by the
department and executive commissioner based on that review.
(n) Subsection (m) and this subsection expire September 1,
2021.
SECTION 4. (a) The executive commissioner of the Health
and Human Services Commission shall complete for each hospital in
this state the maternal level of care designation not later than
August 31, 2021.
(b) Notwithstanding Section 241.186, Health and Safety
Code, a hospital is not required to have a maternal level of care
designation as a condition of reimbursement for maternal services
through the Medicaid program before September 1, 2021.
(c) A hospital that submits an application to the Department
of State Health Services for a maternal level of care designation
under Subchapter H, Chapter 241, Health and Safety Code, before the
effective date of this Act may amend the application to reflect the
applicable changes in law made by this Act.
SECTION 5. 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 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, 2019.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 749 passed the Senate on
April 1, 2019, by the following vote: Yeas 31, Nays 0; and that
the Senate concurred in House amendments on May 23, 2019, by the
following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 749 passed the House, with
amendments, on May 21, 2019, by the following vote: Yeas 146,
Nays 0, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor