CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT - Texas Statutes

HEALTH AND SAFETY CODE

TITLE 2. HEALTH

SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS

CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT

SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN

Sec. 32.001. SHORT TITLE. This chapter may be cited as the

Maternal and Infant Health Improvement Act.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.002. DEFINITIONS. (a) In this chapter:

(1) "Adolescent" means an individual younger than 18 years of

age.

(2) "Ancillary services" means services necessary to obtain

timely, effective, and appropriate maternal and infant health

improvement services, and includes prescription drugs, medical

social services, transportation, health promotion services, and

laboratory services.

(3) "Facility" includes a hospital, public health clinic,

birthing center, outpatient clinic, or community health center.

(4) "Infant care" means maternal and infant health improvement

services and ancillary services appropriate for an individual

from birth to 12 months of age.

(5) "Intrapartum care" means maternal and infant health

improvement services and ancillary services appropriate for a

woman, fetus, or infant during childbirth.

(6) "Maternal and infant health improvement services" means

services necessary to assure quality health care for women and

children.

(7) "Medical assistance program" means the program administered

by the single state agency under Title XIX of the Social Security

Act (42 U.S.C. Section 1396 et seq.).

(8) "Other benefit" means a benefit, other than a benefit

provided under this chapter, to which an individual is entitled

for payment of the costs of maternal and infant health

improvement services, ancillary services, educational services,

or transportation services, including benefits available from:

(A) an insurance policy, group health plan, or prepaid medical

care plan;

(B) Title XVIII of the Social Security Act (42 U.S.C. Section

1395 et seq.);

(C) the Veterans Administration;

(D) the Civilian Health and Medical Program of the Uniformed

Services;

(E) workers' compensation or any other compulsory employers'

insurance program;

(F) a public program created by federal or state law, other than

Title XIX of the Social Security Act (42 U.S.C. Section 1396 et

seq.), or by an ordinance or rule of a municipality or political

subdivision of the state, excluding benefits created by the

establishment of a municipal or county hospital, a joint

municipal-county hospital, a county hospital authority, a

hospital district, or the facilities of a publicly supported

medical school; or

(G) a cause of action for medical, facility, or medical

transportation expenses, or a settlement or judgment based on the

cause of action, if the expenses are related to the need for

services provided under this chapter.

(9) "Perinatal care" means maternal and infant health

improvement services and ancillary services that are appropriate

for women and infants during the perinatal period, which begins

before conception and ends on the infant's first birthday.

(10) "Postpartum care" means maternal and infant health

improvement services and ancillary services appropriate for a

woman following a pregnancy.

(11) "Preconceptional care" means maternal and infant health

improvement services and ancillary services appropriate for a

woman before conception that are provided with the intent of

planning and reducing health risks that might adversely affect

her pregnancies.

(12) "Prenatal care" means maternal and infant health

improvement services and ancillary services that are appropriate

for a pregnant woman and the fetus during the period beginning on

the date of conception and ending on the commencement of labor.

(13) "Program" means the maternal and infant health improvement

services program authorized by this chapter.

(14) "Provider" means a person who, through a grant or a

contract with the department or through other means approved by

the department, provides maternal and infant health improvement

services and ancillary services that are purchased by the

department for the purposes of this chapter.

(15) "Support" means the contribution of money or services

necessary for a person's maintenance, including food, clothing,

shelter, transportation, and health care.

(b) The board by rule may define a word or term not defined by

Subsection (a) as necessary to administer this chapter. The board

may not define a word or term so that the word or term is

inconsistent or in conflict with the purposes of this chapter, or

is in conflict with the definition and conditions of practice

governing a provider who is required to be licensed, registered,

certified, identified, or otherwise sanctioned under the laws of

this state.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 124, Sec. 2, eff. Sept. 1,

1995.

Sec. 32.003. MATERNAL AND INFANT HEALTH IMPROVEMENT SERVICES

PROGRAM. (a) The board may establish a maternal and infant

health improvement services program in the department to provide

comprehensive maternal and infant health improvement services and

ancillary services to eligible women and infants.

(b) If the program is established, the board shall adopt rules

relating to:

(1) the type, amount, and duration of services to be provided

under this chapter; and

(2) the determination by the department of the services needed

in each service area.

(c) If budgetary limitations exist, the board by rule shall

establish a system of priorities relating to the types of

services provided, geographic areas covered, or classes of

individuals eligible for services.

(d) The board shall adopt the rules according to a statewide

determination of the need for services.

(e) In structuring the program and adopting rules, the

department and board shall attempt to maximize the amount of

federal matching funds available for maternal and infant health

improvement services while continuing to serve targeted

populations.

(f) If necessary, the board by rule may coordinate services and

other parts of the program with the medical assistance program.

However, the board may not adopt rules relating to the services

under either program that would:

(1) cause the program established under this chapter not to

conform with federal law to the extent that federal matching

funds would not be available; or

(2) affect the status of the single state agency to administer

the medical assistance program.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 124, Sec. 3, eff. Sept. 1,

1995.

Sec. 32.005. ABORTION SERVICES RESTRICTED. Notwithstanding any

other provision of this chapter, funds administered under this

chapter may not be used to provide abortion services unless the

mother's life is in danger.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.006. ADMINISTRATION. (a) The board shall adopt rules

necessary to administer this chapter, and the department shall

administer the program in accordance with board rules.

(b) The department shall prescribe the design and content of all

necessary forms used in the program.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.011. DENIAL, MODIFICATION, SUSPENSION, OR TERMINATION OF

SERVICES. (a) The department may, for cause, deny, modify,

suspend, or terminate services to an individual eligible for or

receiving services after notice to the individual and an

opportunity for a hearing.

(b) The board by rule shall provide criteria for action by the

department under this section.

(c) Chapter 2001, Government Code, does not apply to the

granting, denial, modification, suspension, or termination of

services. The department shall conduct hearings in accordance

with the board's due process hearing rules.

(d) The department shall render the final administrative

decision in a due process hearing to deny, modify, suspend, or

terminate the receipt of services.

(e) The notice and hearing required by this section do not apply

if the department restricts program services to conform to

budgetary limitations that require the board to establish service

priorities.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(65), eff.

Sept. 1, 1995; Acts 1995, 74th Leg., ch. 124, Sec. 4, eff. Sept.

1, 1995.

Sec. 32.012. FINANCIAL ELIGIBILITY; OTHER BENEFITS. (a) The

department shall require an individual receiving services under

this chapter, or the person with a legal obligation to support

the individual, to pay for or reimburse the department for that

part of the cost of the services that the individual or person is

financially able to pay.

(b) Except as provided by board rules, an individual is not

eligible to receive services under this chapter to the extent

that the individual or a person with a legal obligation to

support the individual is eligible for some other benefit that

would pay for all or part of the services.

(c) When a determination of eligibility to receive maternal and

infant health improvement services is made under this chapter or

when the services are received, the individual requesting or

receiving services shall inform the department of any other

benefit to which the individual or a person with a legal

obligation to support the individual may be entitled.

(d) An individual who has received services that are covered by

some other benefit, or any other person with a legal obligation

to support that individual, shall reimburse the department to the

extent of the services provided when the other benefit is

received.

(e) The commissioner may waive enforcement of Subsections

(b)-(d) of this section as prescribed by board rules in certain

individually considered cases in which enforcement will deny

services to a class of otherwise eligible individuals because of

conflicting federal, state, or local laws or rules.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 124, Sec. 5, eff. Sept. 1,

1995.

Sec. 32.013. RECOVERY OF COSTS. (a) The department may recover

the cost of services provided under this chapter from a person

who does not reimburse the department as required by Section

32.012 or from any third party who has a legal obligation to pay

other benefits and to whom notice of the department's interest

has been given.

(b) At the request of the commissioner, the attorney general may

bring suit in the appropriate court of Travis County on behalf of

the department.

(c) In a judgment in favor of the department, the court may

award attorney's fees, court costs, and interest accruing from

the date on which the department provides the services to the

date on which the department is reimbursed.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.014. FEES. (a) Except as prohibited by federal law or

regulation, the board may charge fees for the services provided

directly by the department or through approved providers in

accordance with Subchapter D, Chapter 12.

(b) The board shall adopt standards and procedures to develop

and implement a schedule of allowable charges for program

services.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.015. FUNDING. (a) Except as provided by this chapter

or by other law, the board may seek, receive, and spend funds

received through an appropriation, grant, donation, or

reimbursement from any public or private source to administer

this chapter.

(b) Notwithstanding other law, the department's authority to

spend funds appropriated for the program established by this

chapter is not affected by the amount of federal funds the

department receives.

(c) The department is not required to provide maternal and

infant health improvement services unless funds are appropriated

to the department to administer this chapter.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Amended by Acts 1995, 74th Leg., ch. 124, Sec. 6, eff. Sept. 1,

1995.

Sec. 32.016. CONTRACTS. The department shall enter into

contracts and agreements or award grants necessary to facilitate

the efficient and economical provision of services under this

chapter, including contracts and grants for the purchase of

services, equipment, and supplies from approved providers.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.017. RECORDS AND REVIEW. (a) The department shall

require each provider receiving reimbursement under this chapter

to maintain records and information for each applicant for or

recipient of services.

(b) The board shall adopt rules relating to the information a

provider is required to report to the department and shall adopt

procedures to prevent unnecessary and duplicative reporting of

data.

(c) The department shall review records, information, and

reports prepared by program providers and shall annually prepare

a report for submission to the governor and the legislature

relating to the status of the program. The department shall make

the report available to the public.

(d) The report required under Subsection (c) must include:

(1) the number of individuals receiving care under this chapter;

(2) the total cost of the program, including a delineation of

the total administrative costs and the total cost for each

service authorized under Section 32.004(d);

(3) the average cost per recipient of services;

(4) the number of individuals who received services in each

public health region; and

(5) any other information required by the board.

(e) In computing the number of individuals to be reported under

Subsection (d)(1), the department shall ensure that no individual

is counted more than once.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.018. PROGRAM PLANS. (a) The department shall have a

long-range plan covering at least six years that includes at

least the following elements:

(1) quantifiable indicators of effort and success;

(2) identification of priority client population and the minimum

types of services necessary for that population;

(3) a description of the appropriate use of providers, including

the role of providers and considering the type, location, and

specialization of the providers;

(4) criteria for phasing out unnecessary services;

(5) a comprehensive assessment of needs and inventory of

resources; and

(6) coordination of administration and service provision with

federal, state, and local public and private programs that

provide similar services.

(b) The department shall revise the plan by January 1 of each

even-numbered year.

(c) The department shall develop a short-range plan that is

derived from the long-range plan and that identifies and projects

the costs relating to implementing the short-range plan.

(d) As part of the department's budget preparation process, the

department shall biennially assess its achievement of the goals

identified in each plan. The department's biennial budget shall

be made according to the results of the assessment and the

short-range plan. The department shall make its requests for new

program funding and for continued funding according to

demonstrated need.

(e) The department shall use the information collected under

Section 32.017 to develop the long-range and short-range plans.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.

Sec. 32.021. REQUIREMENTS REGARDING THE WOMEN, INFANTS AND

CHILDREN PROGRAM. (a) An agency, organization, or other entity

that contracts with the Special Supplemental Nutrition Program

for Women, Infants and Children shall each month provide the

clinical and nutritional services supported by that program

during extended hours, as defined by the department.

(b) Each agency, organization, or other entity that contracts

with the program to provide clinical or nutritional services

shall include in its annual plan submitted to the department a

plan to expand client access to services through extended hours,

the schedule for each site that provides services, and the

reasons for each site's schedule. An agency, organization, or

other entity that contracts with the program is not required to

offer extended hours at each of its service sites.

(c) The department shall adopt guidelines for extended hours and

waivers from the requirement of Subsection (a).

(d) To obtain a waiver, an agency, organization, or other entity

shall submit a written justification to the department explaining

the extraordinary circumstances involved and identifying the time

frame needed for their resolution.

(e) The department may not grant a waiver to an agency,

organization, or other entity for a period of more than two

years.

(f) If an agency, organization, or other entity required by this

section to maintain extended hours provides other maternal and

child health services, that entity shall also make those services

available during the extended hours.

Added by Acts 1993, 73rd Leg., ch. 328, Sec. 1, eff. Aug. 30,

1993. Amended by Acts 1997, 75th Leg., ch. 1317, Sec. 1, eff.

Sept. 1, 1997.

SUBCHAPTER B. PERINATAL HEALTH CARE SYSTEM

Sec. 32.041. LEGISLATIVE FINDINGS. (a) The legislature finds

that the perinatal period beginning before conception and

continuing through the first year of life poses unique challenges

for the health care system. The development of a coordinated,

cooperative system of perinatal health care within a geographic

area will reduce unnecessary mortality and morbidity for women

and infants.

(b) In order to improve the health of women and infants, it is

necessary to promote health education, to provide assurance of

reasonable access to safe and appropriate perinatal services, and

to improve the quality of perinatal care by encouraging optimal

use of health care personnel.

Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,

1995.

Sec. 32.042. DUTIES OF BOARD; RULES. (a) The board by rule

shall adopt:

(1) minimum standards and objectives to implement voluntary

perinatal health care systems; and

(2) policies for health promotion and education, risk

assessment, access to care, and perinatal system structure,

including the transfer and transportation of pregnant women and

infants.

(b) The rules must:

(1) reflect all geographic areas of the state, considering time

and distance;

(2) provide specific requirements for appropriate care of

perinatal patients; and

(3) facilitate coordination among all perinatal service

providers and health care facilities in the delivery area.

(c) The rules must include:

(1) risk reduction guidelines for preconceptional, prenatal,

intrapartum, postpartum, and infant care, including guidelines

for the transfer and transportation of perinatal patients;

(2) criteria for determining geographic boundaries of perinatal

health care systems;

(3) minimum requirements of health promotion and education, risk

assessment, access to care, and coordination of services that

must be present in a perinatal health care system;

(4) minimum requirements for resources and equipment needed by a

health care facility to treat perinatal patients;

(5) standards for the availability and qualifications of the

health care personnel treating perinatal patients in a facility;

(6) requirements for data collection, including operation of the

perinatal health care system and patient outcomes;

(7) requirements for periodic performance evaluation of the

system and its components; and

(8) assurances that health care facilities will not refuse to

accept the transfer of a perinatal patient solely because of the

person's inability to pay for services or because of the person's

age, sex, race, religion, or national origin.

Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,

1995.

Sec. 32.043. DUTIES OF DEPARTMENT. The department shall:

(1) develop and monitor a statewide network of voluntary

perinatal health care systems;

(2) develop and maintain a perinatal reporting and analysis

system to monitor and evaluate perinatal patient care in the

perinatal health care systems in this state; and

(3) provide for coordination and cooperation in this state and

among this state and adjoining states.

Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,

1995.

Sec. 32.044. SYSTEM REQUIREMENTS. (a) Each voluntary perinatal

health care system must have:

(1) a coordinating board responsible for ensuring, providing, or

coordinating planning access to services, data collection, and

provider education;

(2) access to appropriate emergency medical services;

(3) risk assessment, transport, and transfer protocols for

perinatal patients;

(4) one or more health care facilities categorized according to

perinatal care capabilities using standards adopted by board

rule; and

(5) documentation of broad-based participation in planning by

providers of perinatal services and community representatives

throughout the defined geographic region.

(b) This subchapter does not prohibit a health care facility

from providing services that it is authorized to provide under a

license issued to the facility by the department.

Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,

1995.

Sec. 32.045. GRANT PROGRAM. (a) The department may establish a

program to award grants to initiate, expand, maintain, and

improve voluntary perinatal health care systems.

(b) The board by rule shall establish eligibility criteria for

awarding the grants. The rules must require the department to

consider:

(1) the need of an area and the extent to which the grant would

meet the identified need;

(2) the availability of personnel and training programs;

(3) the availability of other funding sources;

(4) the assurance of providing quality services;

(5) the need for emergency transportation of perinatal patients

and the extent to which the system meets the identified needs;

and

(6) the stage of development of a perinatal health care system.

(c) The department may approve grants according to rules adopted

by the board. A grant awarded under this section is governed by

Chapter 783, Government Code, and rules adopted under that

chapter.

Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,

1995.