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TEXAS STATUTES AND CODES

CHAPTER 46. TERTIARY MEDICAL CARE

HEALTH AND SAFETY CODE

TITLE 2. HEALTH

SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS

CHAPTER 46. TERTIARY MEDICAL CARE

Sec. 46.001. DEFINITIONS. In this chapter:

(1) "Tertiary care facility" means a:

(A) primary teaching hospital of a medical school;

(B) level I trauma center;

(C) level II trauma center; or

(D) level III trauma center.

(2) "Tertiary medical services" includes, but is not limited to,

services provided by state-designated trauma centers, burn center

treatment, neonatology level III unit services, pediatric

surgery, trauma surgery, neurosurgery, cardiothoracic and

vascular surgery, organ transplant, services provided for a

life-threatening dermatologic illness, services provided to a

person with a high-risk pregnancy or cancer, and radiation

oncology.

(3) "Stabilization services" means services provided by a

tertiary care facility or a level IV designated trauma center

that are necessary to assure, within reasonable medical

probability, that no material deterioration of a patient's

medical condition is likely to result from or occur during the

transfer of the patient to a tertiary care facility.

(4) "Unreimbursed stabilization services" means stabilization

services for which a tertiary care facility or level IV

designated trauma facility has not received full payment from any

public or private source.

(5) "Unreimbursed tertiary medical services" means tertiary

care medical services for which a tertiary care facility has not

received full payment from any public or private source.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

Sec. 46.002. RULES. (a) The board may adopt rules to implement

a system that encourages hospitals to provide tertiary medical

services and stabilization services.

(b) The rules must address:

(1) coordination of tertiary medical services and stabilization

services among health care facilities in the delivery area;

(2) pre-hospital care management guidelines for triage,

transfer, and transportation of patients and periodic evaluation

of tertiary care facilities' and level IV trauma facilities'

compliance with the guidelines and the trauma facility rules, as

appropriate;

(3) requirements for data collection, including patient

outcomes;

(4) assurances that tertiary care facilities will not refuse to

accept the transfer of a 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; and

(5) enforcement of the rules.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

Sec. 46.003. TERTIARY CARE ACCOUNT. (a) The tertiary care

account is an account in the state treasury. Except as by

Subsection (e), money in the account may be appropriated only to

the department for the purposes of this chapter.

(b) The account is composed of money appropriated to the account

and any other funds required to be put in the account.

(c) The department may seek and accept gifts, grants, and

donations from any public or private entity on behalf of the

account.

(d) Section 403.095, Government Code, does not apply to the

account.

(e) For each fiscal year, five percent of the total amount in

the account shall be held in reserve and may be used only for

reimbursement of unpaid tertiary medical services and

stabilization services provided as a result of extraordinary

emergencies occurring during that year. Of the amount remaining:

(1) not more than five percent may be used for the costs of

administering the account;

(2) five percent shall be allocated for the payment of state

assistance under Chapter 61; and

(3) the remaining amount shall be allocated as provided by

Subsection (f).

(f) Except as provided by Subsection (e), the account shall be

allocated for payment to tertiary care facilities and level IV

trauma centers for unreimbursed tertiary medical services and

stabilization services, as provided for in Sections 46.005 and

46.006.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999. Amended by Acts 2001, 77th Leg., ch. 1128, Sec. 5, eff.

June 15, 2001.

Sec. 46.004. COLLECTION OF INFORMATION. (a) Each tertiary care

facility or level IV trauma facility that seeks payment under

this chapter shall submit to the department, in the manner and at

the time required by the department, information that relates to

the unreimbursed tertiary medical services or stabilization

services provided to persons who reside outside the service area

of the county, public hospital, or hospital district that is

responsible for indigent health care under Chapter 61 in the area

in which the tertiary care facility or level IV trauma facility

is located.

(b) The board shall adopt rules governing the collection of the

information under Subsection (a).

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

Sec. 46.005. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED

TERTIARY MEDICAL SERVICES. (a) The department shall certify to

the comptroller for each tertiary care facility the cost of

unreimbursed tertiary medical services provided to persons who

reside outside the service area of the county, public hospital,

or hospital district that is responsible for indigent health care

under Chapter 61 in the area in which the tertiary care facility

is located.

(b) In each fiscal year the department shall use at least 86

percent of the appropriated money in the tertiary care account to

compensate tertiary care facilities for unreimbursed tertiary

medical services.

(c) Each year the department shall make, for a facility that

operated as a tertiary care facility during the previous year, an

initial certification to the comptroller under Subsection (a) in

an amount that equals 80 percent of the amount certified under

this section for the facility in the previous year. The

department shall make a subsequent certification of the cost of

additional unreimbursed tertiary medical services provided by the

facility on receipt from the facility of the information required

to be submitted under Section 46.004.

(d) Except as provided by Subsection (e), each year the

comptroller shall pay a tertiary care facility the certified

amount determined under Subsection (a) from the funds specified

under Section 46.003(f).

Text of subsec. (e) as added by Acts 1999, 76th Leg., ch. 969,

Sec. 1

(e) If in any year the total cost of unreimbursed tertiary

medical services certified under Subsection (a) for all tertiary

care facilities exceeds the amount available for payment to the

facilities under Section 46.003(f), the department shall allocate

the amount available under Section 46.003(f) to each facility

based on the percentages computed by dividing the cost of the

facility's unreimbursed services by the total cost of all

facilities' unreimbursed services. The comptroller shall pay each

tertiary care facility based on the allocation made under this

subsection.

Text of subsec. (e) as added by Acts 1999, 76th Leg., ch. 1377,

Sec. 2.01

(e) If in any year the total cost of unreimbursed tertiary

medical services certified under Subsection (a) for all tertiary

care facilities exceeds the amount available for payment to all

facilities under Section 46.003(f), less the amount allocated for

stabilization services under Section 46.006(b), the department

shall allocate the amount available under Section 46.003(f) to

each facility based on the percentages computed by dividing the

cost of the facility's unreimbursed tertiary medical services by

the total cost of all facilities' unreimbursed tertiary medical

services. The comptroller shall pay each tertiary care facility

based on the allocation made under this subsection.

(f) For purposes of this section and Section 46.007, the cost of

each service provided by a tertiary care facility is the average

amount payable under Medicare reimbursement policies for that

service.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

Sec. 46.006. CERTIFICATION TO COMPTROLLER OF UNREIMBURSED

STABILIZATION SERVICES. (a) The department shall certify to the

comptroller for each tertiary care facility or level IV trauma

facility the cost of unreimbursed stabilization services provided

to persons who reside outside the service area of the county,

public hospital, or hospital district that is responsible for

indigent health care under Chapter 61 in the area in which the

tertiary care facility or level IV trauma facility is located.

(b) In each fiscal year the department shall use no more than

four percent of the appropriated money in the tertiary care

account to compensate tertiary care facilities and level IV

trauma facilities for unreimbursed stabilization services.

(c) Each year the department shall make, for a facility that

operated as a tertiary care facility or level IV trauma facility

during the previous year, an initial certification to the

comptroller under Subsection (a) in an amount that equals 80

percent of the amount certified under this section for the

facility in the previous year. The department shall make a

subsequent certification of the cost of additional unreimbursed

stabilization services provided by the facility on receipt from

the facility of the information required to be submitted under

Section 46.004.

(d) Except as provided by Subsection (e), each year the

comptroller shall pay a tertiary care facility or level IV trauma

facility the certified amount determined under Subsection (a)

from the funds specified under Section 46.003(f).

Text of subsec. (e) as added by Acts 1999, 76th Leg., ch. 969,

Sec. 1

(e) If in any year the total cost of unreimbursed stabilization

services certified under Subsection (a) for all tertiary care

facilities or level IV trauma facilities exceeds the amount

available for payment to the facilities under Section 46.003(f),

the department shall allocate the amount available under Section

46.003(f) to each facility based on the percentages computed by

dividing the cost of the facility's unreimbursed stabilization

services by the total cost of all facilities' unreimbursed

stabilization services. The comptroller shall pay each tertiary

care facility or level IV trauma facility based on the allocation

made under this subsection.

Text of subsec. (e) as added by Acts 1999, 76th Leg., ch. 1377,

Sec. 2.01

(e) If in any year the total cost of unreimbursed stabilization

services certified under Subsection (a) for all tertiary care

facilities or level IV trauma facilities exceeds the amount

available for payment to the facilities under Section 46.003(f),

as limited by Subsection (b), the department shall allocate the

amount available to each facility based on the percentages

computed by dividing the cost of the facility's unreimbursed

stabilization services by the total cost of all facilities'

unreimbursed stabilization services. The comptroller shall pay

each tertiary care facility or level IV trauma facility based on

the allocation made under this subsection.

(f) For purposes of this section and Section 46.007, the cost of

each service provided by a tertiary care facility or level IV

trauma facility is the average amount payable under Medicare

reimbursement policies for that service.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

Sec. 46.007. CERTIFICATION OF EMERGENCIES. (a) For purposes of

reimbursing extraordinary emergencies under this chapter, the

department shall certify an extraordinary emergency:

(1) if the governor issues an executive order or a proclamation

under Chapter 418, Government Code;

(2) if a disaster is declared by the president of the United

States under the Robert T. Stafford Disaster Relief and Emergency

Assistance Act (42 U.S.C. Section 5121 et seq.); or

(3) for another similar disaster the department finds has

resulted in an extraordinary cost to a tertiary care facility or

level IV trauma facility.

(b) If an extraordinary emergency is certified under Subsection

(a), the department shall certify to the comptroller the amount

of unreimbursed tertiary medical services or stabilization

services or transportation services incurred by a tertiary care

facility or level IV trauma facility, as appropriate, during the

emergency.

(c) Except as provided by Subsection (d), each year the

comptroller shall pay a tertiary care facility or level IV trauma

facility the certified amount determined under Subsection (b)

from the funds specified under Section 46.003(e).

Text of subsec. (d) as added by Acts 1999, 76th Leg., ch. 969,

Sec. 1

(d) If in any year the total cost of unreimbursed tertiary

medical services or stabilization services certified under

Subsection (b) for all facilities exceeds the amount available

for payment to the facilities under Section 46.003(e), the

department shall allocate the amount available under Section

46.003(e) to each facility based on the percentages computed by

dividing the cost of the facility's or provider's unreimbursed

services by the total cost of all facilities' unreimbursed

services. The comptroller shall pay each tertiary care facility

or level IV trauma facility based on the allocation made under

this subsection.

Text of subsec. (d) as added by Acts 1999, 76th Leg., ch. 1377,

Sec. 2.01

(d) If in any year the total cost of unreimbursed tertiary

medical services or stabilization services certified under

Subsection (b) for all facilities exceeds the amount available

for payment to the facilities under Section 46.003(e), the

department shall allocate the amount available under Section

46.003(e) to each facility based on the percentages computed by

dividing the cost of the facility's unreimbursed services by the

total cost of all facilities' unreimbursed services. The

comptroller shall pay each tertiary care facility or level IV

trauma facility based on the allocation made under this

subsection.

Added by Acts 1999, 76th Leg., ch. 969, Sec. 1, eff. Sept. 1,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 2.01, eff. Sept. 1,

1999.

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