CHAPTER 61. INDIGENT HEALTH CARE AND TREATMENT ACT - Texas Statutes

HEALTH AND SAFETY CODE

TITLE 2. HEALTH

SUBTITLE C. PROGRAMS PROVIDING HEALTH CARE BENEFITS AND SERVICES

CHAPTER 61. INDIGENT HEALTH CARE AND TREATMENT ACT

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 61.001. SHORT TITLE. This chapter may be cited as the

Indigent Health Care and Treatment Act.

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

Sec. 61.002. DEFINITIONS. In this chapter:

(1) "Department" means the Texas Department of Health.

(2) "Eligible county resident" means an eligible resident of a

county who does not reside in the service area of a public

hospital or hospital district.

(3) "Eligible resident" means a person who meets the income and

resources requirements established by this chapter or by the

governmental entity, public hospital, or hospital district in

whose jurisdiction the person resides.

(4) "Emergency services" has the meaning assigned by Chapter

773.

(5) "General revenue levy" means:

(A) the property taxes imposed by a county that are not

dedicated to the construction and maintenance of farm-to-market

roads or to flood control under Article VIII, Section 1-a, of the

Texas Constitution or that are not dedicated to the further

maintenance of the public roads under Article VIII, Section 9, of

the Texas Constitution; and

(B) the sales and use tax revenue to be received by the county

during the calendar year in which the state fiscal year begins

under Chapter 323, Tax Code, as determined under Section

26.041(d), Tax Code.

(6) "Governmental entity" includes a county, municipality, or

other political subdivision of the state, but does not include a

hospital district or hospital authority.

(7) "Hospital district" means a hospital district created under

the authority of Article IX, Sections 4-11, of the Texas

Constitution.

(8) "Mandated provider" means a person who provides health care

services, is selected by a county, public hospital, or hospital

district, and agrees to provide health care services to eligible

residents, including the primary teaching hospital of a state

medical school located in a county which does not have a public

hospital or hospital district, and the faculty members practicing

in both the inpatient and outpatient care facilities affiliated

with the teaching hospital.

(9) "Medicaid" means the medical assistance program provided

under Chapter 32, Human Resources Code.

(10) "Public hospital" means a hospital owned, operated, or

leased by a governmental entity, except as provided by Section

61.051.

(11) "Service area" means the geographic region in which a

governmental entity, public hospital, or hospital district has a

legal obligation to provide health care services.

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

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 14, eff. Sept. 1,

1991; Acts 1995, 74th Leg., ch. 76, Sec. 8.119, eff. Sept. 1,

1995; Acts 1999, 76th Leg., ch. 1377, Sec. 1.01, eff. Sept. 1,

1999.

Sec. 61.003. RESIDENCE. (a) For purposes of this chapter, a

person is presumed to be a resident of the governmental entity in

which the person's home or fixed place of habitation to which the

person intends to return after a temporary absence is located.

However, if a person's home or fixed place of habitation is

located in a hospital district, the person is presumed to be a

resident of that hospital district.

(b) If a person does not have a residence, the person is a

resident of the governmental entity or hospital district in which

the person intends to reside.

(c) Intent to reside may be evidenced by any relevant

information, including:

(1) mail addressed to the person or to the person's spouse or

children if the spouse or children live with the person;

(2) voting records;

(3) automobile registration;

(4) Texas driver's license or other official identification;

(5) enrollment of children in a public or private school; or

(6) payment of property tax.

(d) A person is not considered a resident of a governmental

entity or hospital district if the person attempted to establish

residence solely to obtain health care assistance.

(e) The burden of proving intent to reside is on the person

requesting assistance.

(f) For purposes of this chapter, a person who is an inmate or

resident of a state school or institution operated by the Texas

Department of Criminal Justice, Department of Aging and

Disability Services, Department of State Health Services, Texas

Youth Commission, Texas School for the Blind, Texas School for

the Deaf, or any other state agency or who is an inmate, patient,

or resident of a school or institution operated by a federal

agency is not considered a resident of a hospital district or of

any governmental entity except the state or federal government.

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

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

87, Sec. 25.091, eff. September 1, 2009.

Sec. 61.004. RESIDENCE OR ELIGIBILITY DISPUTE. (a) If a

provider of assistance and a governmental entity or hospital

district cannot agree on a person's residence or whether a person

is eligible for assistance under this chapter, the provider or

the governmental entity or hospital district may submit the

matter to the department.

(b) The provider of assistance and the governmental entity or

hospital district shall submit all relevant information to the

department in accordance with the application, documentation, and

verification procedures established by the department under

Section 61.006.

(c) If the department determines that another governmental

entity or hospital district may be involved in the dispute, the

department shall notify the governmental entity or hospital

district and allow the governmental entity or hospital district

to respond.

(d) From the information submitted, the department shall

determine the person's residence or whether the person is

eligible for assistance under this chapter, as appropriate, and

shall notify each governmental entity or hospital district and

the provider of assistance of the decision and the reasons for

the decision.

(e) If a governmental entity, hospital district, or provider of

assistance does not agree with the department's decision, the

governmental entity, hospital district, or provider of assistance

may file an appeal with the department. The appeal must be filed

not later than the 30th day after the date on which the

governmental entity, hospital district, or provider of assistance

receives notice of the decision.

(f) The department shall issue a final decision not later than

the 45th day after the date on which the appeal is filed.

(g) A governmental entity, hospital district, or provider of

assistance may appeal the final order of the department under

Chapter 2001, Government Code, using the substantial evidence

rule on appeal.

(h) Service may not be denied pending an administrative or

judicial review of residence.

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

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff.

Sept. 1, 1995; Acts 1999, 76th Leg., ch. 1377, Sec. 1.02, eff.

Sept. 1, 1999.

Sec. 61.0045. INFORMATION NECESSARY TO DETERMINE ELIGIBILITY.

(a) Any provider, including a mandated provider, public

hospital, or hospital district, that delivers health care

services to a patient who the provider suspects is an eligible

resident of the service area of a county, hospital district, or

public hospital under this chapter may require the patient to:

(1) provide any information necessary to establish that the

patient is an eligible resident of the service area of the

county, hospital district, or public hospital; and

(2) authorize the release of any information relating to the

patient, including medical information and information obtained

under Subdivision (1), to permit the provider to submit a claim

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

liable for payment for the services as described by Section

61.033 or 61.060.

(b) A county, hospital district, or public hospital that

receives information obtained under Subsection (a) shall use the

information to determine whether the patient to whom services

were provided is an eligible resident of the service area of the

county, hospital district, or public hospital and, if so, shall

pay the claim made by the provider to the extent that the county,

hospital district, or public hospital is liable under Section

61.033 or 61.060.

(c) The application, documentation, and verification procedures

established by the department for counties under Section 61.006

may include a standard format for obtaining information under

Subsection (a) to facilitate eligibility and residence

determinations.

Added by Acts 1999, 76th Leg., ch. 1377, Sec. 1.03, eff. Sept. 1,

1999.

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

916, Sec. 1, eff. September 1, 2009.

Sec. 61.005. CONTRIBUTION TOWARD COST OF ASSISTANCE. (a) A

county, public hospital, or hospital district may request an

eligible resident receiving health care assistance under this

chapter to contribute a nominal amount toward the cost of the

assistance.

(b) The county, public hospital, or hospital district may not

deny or reduce assistance to an eligible resident who cannot or

refuses to contribute.

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

Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department

shall establish minimum eligibility standards and application,

documentation, and verification procedures for counties to use in

determining eligibility under this chapter.

(b) The minimum eligibility standards must incorporate a net

income eligibility level equal to 21 percent of the federal

poverty level based on the federal Office of Management and

Budget poverty index.

(b-1) Expired.

(b-2) Repealed by Acts 2001, 77th Leg., ch. 1128, Sec. 7, eff.

Sept. 1, 2001.

(c) The department shall also define the services and establish

the payment standards for the categories of services listed in

Sections 61.028(a) and 61.0285 in accordance with Texas

Department of Human Services rules relating to the Temporary

Assistance for Needy Families-Medicaid program.

(d) The department shall establish application, documentation,

and verification procedures that are consistent with the

analogous procedures used to determine eligibility in the

Temporary Assistance for Needy Families-Medicaid program. The

department may not adopt a standard or procedure that is more

restrictive than the Temporary Assistance for Needy

Families-Medicaid program or procedures.

(e) The department shall ensure that each person who meets the

basic income and resources requirements for Temporary Assistance

for Needy Families program payments but who is categorically

ineligible for Temporary Assistance for Needy Families will be

eligible for assistance under Subchapter B. Except as provided by

Section 61.023(b), the department by rule shall also provide that

a person who receives or is eligible to receive Temporary

Assistance for Needy Families, Supplemental Security Income, or

Medicaid benefits is not eligible for assistance under Subchapter

B even if the person has exhausted a part or all of that person's

benefits.

(f) The department shall notify each county and public hospital

of any change to department rules that affect the provision of

services under this chapter.

(g) Notwithstanding Subsection (a), (b), or (c) or any other

provision of law, the department shall permit payment to a

licensed dentist for services provided under Sections

61.028(a)(4) and (6) if the dentist can provide those services

within the scope of the dentist's license.

(h) Notwithstanding Subsection (a), (b), or (c), the department

shall permit payment to a licensed podiatrist for services

provided under Sections 61.028(a)(4) and (6), if the podiatrist

can provide the services within the scope of the podiatrist's

license.

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

Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.09(a), eff.

Sept. 1, 1989; Acts 1991, 72nd Leg., ch. 14, Sec. 15, eff. Sept.

1, 1991; Acts 1995, 74th Leg., ch. 76, Sec. 8.120, eff. Sept. 1,

1995; Acts 1999, 76th Leg., ch. 1377, Sec. 1.04, eff. Sept. 1,

1999; Acts 2001, 77th Leg., ch. 1128, Sec. 1, 7 eff. Sept. 1,

2001.

Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The department

by rule shall require each applicant to provide at least the

following information:

(1) the applicant's full name and address;

(2) the applicant's social security number, if available;

(3) the number of persons in the applicant's household,

excluding persons receiving Temporary Assistance for Needy

Families, Supplemental Security Income, or Medicaid benefits;

(4) the applicant's county of residence;

(5) the existence of insurance coverage or other hospital or

health care benefits for which the applicant is eligible;

(6) any transfer of title to real property that the applicant

has made in the preceding 24 months;

(7) the applicant's annual household income, excluding the

income of any household member receiving Temporary Assistance for

Needy Families, Supplemental Security Income, or Medicaid

benefits; and

(8) the amount of the applicant's liquid assets and the equity

value of the applicant's car and real property.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.04, eff. Sept.

1, 1999.

Sec. 61.008. ELIGIBILITY RULES. (a) The department by rule

shall provide that in determining eligibility:

(1) a county may not consider the value of the applicant's

homestead;

(2) a county must consider the equity value of a car that is in

excess of the amount exempted under department guidelines as a

resource;

(3) a county must subtract the work-related and child care

expense allowance allowed under department guidelines;

(4) a county must consider as a resource real property other

than a homestead and, except as provided by Subsection (b), must

count that property in determining eligibility; and

(5) if an applicant transferred title to real property for less

than market value to become eligible for assistance under this

chapter, the county may not credit toward eligibility for state

assistance an expenditure for that applicant made during a

two-year period beginning on the date on which the property is

transferred.

(b) A county may disregard the applicant's real property if the

applicant agrees to an enforceable obligation to reimburse the

county for all or part of the benefits received under this

chapter. The county and the applicant may negotiate the terms of

the obligation.

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

Sec. 61.009. REPORTING REQUIREMENTS. (a) The department shall

establish uniform reporting requirements for governmental

entities that own, operate, or lease public hospitals providing

assistance under this chapter and for counties.

(b) The reports must include information relating to:

(1) expenditures for and nature of hospital and health care

provided to eligible residents;

(2) eligibility standards and procedures established by counties

and governmental entities that own, operate, or lease public

hospitals; and

(3) relevant characteristics of eligible residents.

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

Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.121, eff. Sept.

1, 1995.

Sec. 61.010. DEDICATED TAX REVENUES. If the governing body of a

governmental entity adopts a property tax rate that exceeds the

rate calculated under Section 26.04, Tax Code, by more than eight

percent, and if a portion of the tax rate was designated to

provide revenue for indigent health care services required by

this chapter, the revenue produced by the portion of the tax rate

designated for that purpose may be spent only to provide indigent

health care services.

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

Sec. 61.011. SERVICES BY STATE HOSPITAL OR CLINIC. A state

hospital or clinic shall be entitled to payment for services

rendered to an eligible resident under the provisions of this

chapter applicable to other providers. The department may adopt

rules as necessary to implement this section.

Added by Acts 1999, 76th Leg., ch. 1377, Sec. 1.05, eff. Sept. 1,

1999.

SUBCHAPTER B. COUNTY RESPONSIBILITY FOR PERSONS NOT RESIDING IN

AN AREA SERVED BY A PUBLIC HOSPITAL OR HOSPITAL DISTRICT

Sec. 61.021. APPLICATION OF SUBCHAPTER. This subchapter applies

to health care services and assistance provided to a person who

does not reside in the service area of a public hospital or

hospital district.

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

Sec. 61.022. COUNTY OBLIGATION. (a) A county shall provide

health care assistance as prescribed by this subchapter to each

of its eligible county residents.

(b) The county is the payor of last resort and shall provide

assistance only if other adequate public or private sources of

payment are not available.

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

Sec. 61.0221. AUTHORITY RELATING TO OTHER ASSISTANCE PROGRAMS.

This subchapter does not affect the authority of the

commissioners court of a county to provide eligibility standards

or other requirements relating to assistance programs or services

that are not covered by this subchapter.

Added by Acts 1999, 76th Leg., ch. 62, Sec. 13.11(g), eff. Sept.

1, 1999.

Sec. 61.023. GENERAL ELIGIBILITY PROVISIONS. (a) A person is

eligible for assistance under this subchapter if:

(1) the person does not reside in the service area of a public

hospital or hospital district;

(2) the person meets the basic income and resources requirements

established by the department under Sections 61.006 and 61.008

and in effect when the assistance is requested; and

(3) no other adequate source of payment exists.

(b) A county may use a less restrictive standard of eligibility

for residents than prescribed by Subsection (a). A county may

credit toward eligibility for state assistance under this

subchapter the services provided to each person who is an

eligible resident under a standard that incorporates a net income

eligibility level that is less than 50 percent of the federal

poverty level based on the federal Office of Management and

Budget poverty index.

(c) A county may contract with the department to perform

eligibility determination services.

(d) Not later than the beginning of a state fiscal year, the

county shall adopt the eligibility standards it will use during

that fiscal year and shall make a reasonable effort to notify the

public of the standards. The county may change the eligibility

standards to make them more or less restrictive than the

preceding standards, but the standards may not be more

restrictive than the standards established by the department

under Section 61.006.

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

Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.10(a), eff.

Sept. 1, 1989; Acts 1999, 76th Leg., ch. 1377, Sec. 1.06, eff.

Sept. 1, 1999.

Sec. 61.024. COUNTY APPLICATION PROCEDURE. (a) A county shall

adopt an application procedure.

(b) The county may use the application, documentation, and

verification procedures established by the department under

Sections 61.006 and 61.007 or may use a less restrictive

application, documentation, or verification procedure.

(c) Not later than the beginning of a state fiscal year, the

county shall specify the procedure it will use during that fiscal

year to verify eligibility and the documentation required to

support a request for assistance and shall make a reasonable

effort to notify the public of the application procedure.

(d) The county shall furnish an applicant with written

application forms.

(e) On request of an applicant, the county shall assist the

applicant in filling out forms and completing the application

process. The county shall inform an applicant of the availability

of assistance.

(f) The county shall require an applicant to sign a written

statement in which the applicant swears to the truth of the

information supplied.

(g) The county shall explain to the applicant that if the

application is approved, the applicant must report to the county

any change in income or resources that might affect the

applicant's eligibility. The report must be made not later than

the 14th day after the date on which the change occurs. The

county shall explain the possible penalties for failure to report

a change.

(h) The county shall review each application and shall accept or

deny the application not later than the 14th day after the date

on which the county receives the completed application.

(i) The county shall provide a procedure for reviewing

applications and for allowing an applicant to appeal a denial of

assistance.

(j) The county shall provide an applicant written notification

of the county's decision. If the county denies assistance, the

written notification shall include the reason for the denial and

an explanation of the procedure for appealing the denial.

(k) The county shall maintain the records relating to an

application at least until the end of the third complete state

fiscal year following the date on which the application is

submitted.

(l) If an applicant is denied assistance, the applicant may

resubmit an application at any time circumstances justify a

redetermination of eligibility.

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

Sec. 61.025. COUNTY AGREEMENT WITH MUNICIPALITY. (a) This

section applies to a municipality that has a population of less

than 15,000, that owns, operates, or leases a hospital, and that

has made a transfer agreement before August 31, 1989, by the

adoption of an ordinance, resolution, or order by the

commissioners court and the governing body of the municipality.

(b) The transfer agreement may transfer partial responsibility

to the county under which the municipal hospital continues to

provide health care services to eligible residents of the

municipality, but the county agrees to assume the hospital's

responsibility to reimburse other providers who provide:

(1) mandatory inpatient or outpatient services to eligible

residents that the municipal hospital cannot provide; or

(2) emergency services to eligible residents.

(c) The hospital is a public hospital for the purposes of this

chapter, but it does not have a responsibility to provide

reimbursement for services it cannot provide or for emergency

services provided in another facility.

(d) Expenditures made by the county under Subsection (b) may be

credited toward eligibility for state assistance under this

subchapter if the person who received the health care services

meets the eligibility standards established under Section 61.052

and would have been eligible for assistance under the county

program if the person had not resided in a public hospital's

service area.

(e) The agreement to transfer partial responsibility to a county

under this section must take effect on a September 1 that occurs

not later than two years after the date on which the county and

municipality agree to the transfer. A county and municipality may

not revoke or amend an agreement made under this section, except

that the county may revoke or amend the agreement if a hospital

district is created after the effective date of the agreement and

the boundaries of the district cover all or part of the county.

(f) The county, the hospital, and any other entity in the county

that provides services under this chapter shall adopt coordinated

application and eligibility verification procedures. In

establishing the coordinated procedures, the county and other

entities shall focus on facilitating the efficient and timely

referral of residents to the proper entity in the county. In

addition, the procedures must comply with the requirements of

Sections 61.024 and 61.053. Expenditures made by a county in

establishing the coordinated procedures prescribed by this

section may not be credited toward eligibility for state

assistance under this subchapter.

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

Amended by Acts 1997, 75th Leg., ch. 1103, Sec. 1, eff. Sept. 1,

1997; Acts 1999, 76th Leg., ch. 1377, Sec. 1.07, eff. Sept. 1,

1999.

Sec. 61.026. REVIEW OF ELIGIBILITY. A county shall review at

least once every six months the eligibility of a resident for

whom an application for assistance has been granted and who has

received assistance under this chapter.

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

Sec. 61.027. CHANGE IN ELIGIBILITY STATUS. (a) An eligible

resident must report any change in income or resources that might

affect the resident's eligibility. The report must be made not

later than the 14th day after the date on which the change

occurs.

(b) If an eligible resident fails to report a change in income

or resources as prescribed by this section and the change has

made the resident ineligible for assistance under the standards

adopted by the county, the resident is liable for any benefits

received while ineligible. This section does not affect a

person's criminal liability under any relevant statute.

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

Sec. 61.028. BASIC HEALTH CARE SERVICES. (a) A county shall,

in accordance with department rules adopted under Section 61.006,

provide the following basic health care services:

(1) primary and preventative services designed to meet the needs

of the community, including:

(A) immunizations;

(B) medical screening services; and

(C) annual physical examinations;

(2) inpatient and outpatient hospital services;

(3) rural health clinics;

(4) laboratory and X-ray services;

(5) family planning services;

(6) physician services;

(7) payment for not more than three prescription drugs a month;

and

(8) skilled nursing facility services, regardless of the

patient's age.

(b) The county may provide additional health care services, but

may not credit the assistance toward eligibility for state

assistance, except as provided by Section 61.0285.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.08, eff. Sept.

1, 1999.

Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In addition

to basic health care services provided under Section 61.028, a

county may, in accordance with department rules adopted under

Section 61.006, provide other medically necessary services or

supplies that the county determines to be cost-effective,

including:

(1) ambulatory surgical center services;

(2) diabetic and colostomy medical supplies and equipment;

(3) durable medical equipment;

(4) home and community health care services;

(5) social work services;

(6) psychological counseling services;

(7) services provided by physician assistants, nurse

practitioners, certified nurse midwives, clinical nurse

specialists, and certified registered nurse anesthetists;

(8) dental care;

(9) vision care, including eyeglasses;

(10) services provided by federally qualified health centers, as

defined by 42 U.S.C. Section 1396d(l)(2)(B);

(11) emergency medical services; and

(12) any other appropriate health care service identified by

board rule that may be determined to be cost-effective.

(b) A county must notify the department of the county's intent

to provide services specified by Subsection (a). If the services

are approved by the department under Section 61.006, or if the

department fails to notify the county of the department's

disapproval before the 31st day after the date the county

notifies the department of its intent to provide the services,

the county may credit the services toward eligibility for state

assistance under this subchapter.

(c) A county may provide health care services that are not

specified in Subsection (a), or may provide the services

specified in Subsection (a) without actual or constructive

approval of the department, but may not credit the services

toward eligibility for state assistance.

Added by Acts 1999, 76th Leg., ch. 1377, Sec. 1.09, eff. Sept. 1,

1999. Amended by Acts 2001, 77th Leg., ch. 874, Sec. 9, eff.

Sept. 1, 2001; Acts 2003, 78th Leg., ch. 892, Sec. 24, eff. Sept.

1, 2003.

Sec. 61.029. PROVISION OF HEALTH CARE SERVICES. (a) A county

may arrange to provide health care services through a local

health department, a publicly owned facility, or a contract with

a private provider regardless of the provider's location, or

through the purchase of insurance for eligible residents.

(b) The county may affiliate with other governmental entities or

with a public hospital or hospital district to provide regional

administration and delivery of health care services.

(c) A county may provide or arrange to provide health care

services for eligible county residents through the purchase of

health coverage or other health benefits, including benefits

described by Chapter 75.

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

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

916, Sec. 2, eff. September 1, 2009.

Sec. 61.030. MANDATED PROVIDER. A county may select one or more

providers of health care services. The county may require

eligible county residents to obtain care from a mandated provider

except:

(1) in an emergency;

(2) when medically inappropriate; or

(3) when care is not available.

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

Sec. 61.031. NOTIFICATION OF PROVISION OF NONEMERGENCY SERVICES.

(a) A county may require any provider, including a mandated

provider, to obtain approval from the county before providing

nonemergency health care services to an eligible county resident.

(b) If the county does not require prior approval and a provider

delivers or will deliver nonemergency health care services to a

patient who the provider suspects may be eligible for assistance

under this subchapter, the provider shall notify the patient's

county of residence that health care services have been or will

be provided to the patient. The notice shall be made:

(1) by telephone not later than the 72nd hour after the provider

determines the patient's county of residence; and

(2) by mail postmarked not later than the fifth working day

after the date on which the provider determines the patient's

county of residence.

(c) If the provider knows that the patient's county of residence

has selected a mandated provider or if, after contacting the

patient's county of residence, that county requests that the

patient be transferred to a mandated provider, the provider shall

transfer the patient to the mandated provider unless it is

medically inappropriate to do so.

(d) Not later than the 14th day after the date on which the

patient's county of residence receives sufficient information to

determine eligibility, the county shall determine if the patient

is eligible for assistance from that county. If the county does

not determine the patient's eligibility within that period, the

patient is considered to be eligible. The county shall notify the

provider of its decision.

(e) If a provider delivers nonemergency health care services to

a patient who is eligible for assistance under this subchapter

and fails to comply with this section, the provider is not

eligible for payment for the services from the patient's county

of residence.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.10, eff. Sept.

1, 1999.

Sec. 61.032. NOTIFICATION OF PROVISION OF EMERGENCY SERVICES.

(a) If a nonmandated provider delivers emergency services to a

patient who the provider suspects might be eligible for

assistance under this subchapter, the provider shall notify the

patient's county of residence that emergency services have been

or will be provided to the patient. The notice shall be made:

(1) by telephone not later than the 72nd hour after the provider

determines the patient's county of residence; and

(2) by mail postmarked not later than the fifth working day

after the date on which the provider determines the patient's

county of residence.

(b) The provider shall attempt to determine the patient's county

of residence when the patient first receives services.

(c) The provider, the patient, and the patient's family shall

cooperate with the county of which the patient is presumed to be

a resident in determining if the patient is an eligible resident

of that county.

(d) Not later than the 14th day after the date on which the

patient's county of residence receives notification and

sufficient information to determine eligibility, the county shall

determine if the patient is eligible for assistance from that

county. If the county does not determine the patient's

eligibility within that period, the patient is considered to be

eligible. The county shall notify the provider of its decision.

(e) If the county and the provider disagree on the patient's

residence or eligibility, the county or the provider may submit

the matter to the department as provided by Section 61.004.

(f) If a provider delivers emergency services to a patient who

is eligible for assistance under this subchapter and fails to

comply with this section, the provider is not eligible for

payment for the services from the patient's county of residence.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.11, eff. Sept.

1, 1999; Acts 2001, 77th Leg., ch. 1128, Sec. 2, eff. Sept. 1,

2001.

Sec. 61.033. PAYMENT FOR SERVICES. (a) To the extent

prescribed by this chapter, a county is liable for health care

services provided under this subchapter by any provider,

including a public hospital or hospital district, to an eligible

county resident. A county is not liable for payment for health

care services provided:

(1) by any provider, including a public hospital or hospital

district, to a resident of that county who resides in the service

area of a public hospital or hospital district; or

(2) to an eligible resident of that county who does not reside

within the service area of a public hospital or hospital district

by a hospital having a Hill-Burton or state-mandated obligation

to provide free services and considered to be in noncompliance

with the requirements of the Hill-Burton or state-mandated

obligation.

(b) To the extent prescribed by this chapter, if another source

of payment does not adequately cover a health care service a

county provides to an eligible county resident, the county shall

pay for or provide the health care service for which other

payment is not available.

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

Sec. 61.034. PAYMENT STANDARDS FOR HEALTH CARE SERVICES. (a) A

county is not liable for the cost of a health care service

provided under Section 61.028 or 61.0285 that is in excess of the

payment standards for that service established by the department

under Section 61.006.

(b) A county may contract with a provider of assistance to

provide a health care service at a rate below the payment

standard set by the department.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.12, eff. Sept.

1, 1999.

Sec. 61.035. LIMITATION OF COUNTY LIABILITY. The maximum county

liability for each state fiscal year for health care services

provided by all assistance providers, including a hospital and a

skilled nursing facility, to each eligible county resident is:

(1) $30,000; or

(2) the payment of 30 days of hospitalization or treatment in a

skilled nursing facility, or both, or $30,000, whichever occurs

first, if the county provides hospital or skilled nursing

facility services to the resident.

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

Sec. 61.036. DETERMINATION OF ELIGIBILITY FOR PURPOSES OF STATE

ASSISTANCE. (a) A county may not credit an expenditure made to

assist an eligible county resident toward eligibility for state

assistance under this subchapter unless the county complies with

the department's application, documentation, and verification

procedures.

(b) Except as provided by Section 61.023(b), a county may not

credit an expenditure for an applicant toward eligibility for

state assistance if the applicant does not meet the department's

eligibility standards.

(c) Regardless of the application, documentation, and

verification procedures or eligibility standards established by

the department under Subchapter A, a county may credit an

expenditure for an eligible resident toward eligibility for state

assistance if the eligible resident received the health care

services at:

(1) a hospital maintained or operated by a state agency that has

a contract with the county to provide health care services; or

(2) a federally qualified health center delivering federally

qualified health center services, as those terms are defined in

42 U.S.C. Sections 1396d(l)(2)(A) and (B), that has a contract

with the county to provide health care services.

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

Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.10(b), eff.

Sept. 1, 1989; Acts 1999, 76th Leg., ch. 1377, Sec. 1.13, eff.

Sept. 1, 1999.

Amended by:

Acts 2005, 79th Leg., Ch.

1133, Sec. 1, eff. September 1, 2005.

Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a) The

department may distribute funds as provided by this subchapter to

eligible counties to assist the counties in providing health care

services under Sections 61.028 and 61.0285 to their eligible

county residents.

(b) Except as provided by Subsection (c), (d), (e), or (g), to

be eligible for state assistance, a county must:

(1) spend in a state fiscal year at least eight percent of the

county general revenue levy for that year to provide health care

services described by Subsection (a) to its eligible county

residents who qualify for assistance under Section 61.023; and

(2) notify the department, not later than the seventh day after

the date on which the county reaches the expenditure level, that

the county has spent at least six percent of the applicable

county general revenue levy for that year to provide health care

services described by Subsection (a) to its eligible county

residents who qualify for assistance under Section 61.023.

(c) If a county and a health care provider signed a contract on

or before January 1, 1985, under which the provider agrees to

furnish a certain level of health care services to indigent

persons, the value of services furnished in a state fiscal year

under the contract is included as part of the computation of a

county expenditure under this section if the value of services

does not exceed the payment rate established by the department

under Section 61.006.

(d) If a hospital district is located in part but not all of a

county, that county's appraisal district shall determine the

taxable value of the property located inside the county but

outside the hospital district. In determining eligibility for

state assistance, that county shall consider only the county

general revenue levy resulting from the property located outside

the hospital district. A county is eligible for state assistance

if:

(1) the county spends in a state fiscal year at least eight

percent of the county general revenue levy for that year

resulting from the property located outside the hospital district

to provide health care services described by Subsection (a) to

its eligible county residents who qualify for assistance under

Section 61.023; and

(2) the county complies with the other requirements of this

subchapter.

(e) A county that provides health care services described by

Subsection (a) to its eligible residents through a hospital

established by a board of managers jointly appointed by a county

and a municipality under Section 265.011 is eligible for state

assistance if:

(1) the county spends in a state fiscal year at least eight

percent of the county general revenue levy for the year to

provide the health care services to its eligible county residents

who qualify for assistance under Section 61.052; and

(2) the county complies with the requirements of this

subchapter.

(f) If a county anticipates that it will reach the eight percent

expenditure level, the county must notify the department as soon

as possible before the anticipated date on which the county will

reach the level.

(g) The department may waive the requirement that the county

meet the minimum expenditure level imposed by Subsection (b),

(d), or (e) and provide state assistance under this chapter at a

lower level determined by the department if the county

demonstrates, through an appropriate actuarial analysis, that the

county is unable to satisfy the eight percent expenditure level:

(1) because, although the county's general revenue tax levy has

increased significantly, expenditures for health care services

described by Subsection (a) have not increased by the same

percentage;

(2) because the county is at the maximum allowable ad valorem

tax rate, has a small population, or has insufficient taxable

property; or

(3) because of a similar reason.

(h) The department shall adopt rules governing the circumstances

under which a waiver may be granted under Subsection (g) and the

procedures to be used by a county to apply for the waiver. The

procedures must provide that the department shall make a

determination with respect to an application for a waiver not

later than the 90th day after the date the application is

submitted to the department in accordance with the procedures

established by the department. To be eligible for state

assistance under Subsection (g), a county must submit monthly

financial reports, in the form required by the department,

covering the 12-month period preceding the date on which the

assistance is sought.

(i) The county must give the department all necessary

information so that the department can determine if the county

meets the requirements of Subsection (b), (d), (e), or (g).

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

Amended by Acts 1997, 75th Leg., ch. 651, Sec. 1, eff. June 11,

1997; Acts 1999, 76th Leg., ch. 272, Sec. 1, eff. May 28, 1999;

Acts 1999, 76th Leg., ch. 1377, Sec. 1.14, eff. Sept. 1, 1999.

Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the

department determines that a county is eligible for assistance,

the department shall distribute funds appropriated to the

department from the indigent health care assistance fund or any

other available fund to the county to assist the county in

providing health care services under Sections 61.028 and 61.0285

to its eligible county residents who qualify for assistance as

described by Section 61.037.

(b) State funds provided under this section to a county must be

equal to at least 90 percent of the actual payment for the health

care services for the county's eligible residents during the

remainder of the state fiscal year after the eight percent

expenditure level is reached.

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

Amended by Acts 1999, 76th Leg., ch. 272, Sec. 2, eff. May 28,

1999; Acts 1999, 76th Leg., ch. 1377, Sec. 1.14, eff. Sept. 1,

1999.

Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the

department fails to provide assistance to an eligible county as

prescribed by Section 61.038, the county is not liable for

payments for health care services provided to its eligible county

residents after the county reaches the eight percent expenditure

level.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.14, eff. Sept.

1, 1999.

Sec. 61.0395. LIMITED TO APPROPRIATED FUNDS. (a) The total

amount of state assistance provided to counties under this

chapter for a fiscal year may not exceed the amount appropriated

for that purpose for that fiscal year.

(b) The department may adopt rules governing the distribution of

state assistance under this chapter that establish a maximum

annual allocation for each county eligible for assistance under

this chapter in compliance with Subsection (a).

(c) The rules adopted under this section:

(1) may consider the relative populations of the service areas

of eligible counties and other appropriate factors; and

(2) notwithstanding Subsection (b), may provide for, at the end

of each state fiscal year, the reallocation of all money that is

allocated to a county under Subsection (b) but that the county is

not eligible to receive and the distribution of that money to

other eligible counties.

Added by Acts 1999, 76th Leg., ch. 1377, Sec. 1.15, eff. Sept. 1,

1999. Amended by Acts 2001, 77th Leg., ch. 1128, Sec. 3, eff.

Sept. 1, 2001.

Sec. 61.040. TAX INFORMATION. The comptroller shall give the

department information relating to:

(1) the taxable value of property taxable by each county and

each county's applicable general revenue tax levy for the

relevant period; and

(2) the amount of sales and use tax revenue received by each

county for the relevant period.

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

Amended by Acts 1991, 72nd Leg., 2nd C.S., ch. 6, Sec. 64, eff.

Sept. 1, 1991.

Sec. 61.041. COUNTY REPORTING. (a) The department shall

establish monthly reporting requirements for a county seeking

state assistance and establish procedures necessary to determine

if the county is eligible for state assistance.

(b) The department shall establish requirements relating to:

(1) documentation required to verify the eligibility of

residents to whom the county provides assistance; and

(2) county expenditures for health care services under Sections

61.028 and 61.0285.

(c) The department may audit county records to determine if the

county is eligible for state assistance.

(d) The department shall establish annual reporting requirements

for each county that is required to provide indigent health care

under this chapter but that is not required to report under

Subsection (a). A county satisfies the annual reporting

requirement of this subsection if the county submits information

to the department as required by law to obtain an annual

distribution under the Agreement Regarding Disposition of

Settlement Proceeds filed on July 24, 1998, in the United States

District Court, Eastern District of Texas, in the case styled The

State of Texas v. The American Tobacco Co., et al., No.

5-96CV-91.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.16, eff. Sept.

1, 1999.

Sec. 61.042. EMPLOYMENT SERVICES PROGRAM. (a) A county may

establish procedures consistent with those used by the Texas

Department of Human Services under Chapter 31, Human Resources

Code, for administering an employment services program and

requiring an applicant or eligible resident to register for work

with the Texas Employment Commission.

(b) The county shall notify all persons with pending

applications and eligible residents of the employment service

program requirements not less than 30 days before the program is

established.

Added by Acts 1993, 73rd Leg., ch. 880, Sec. 1, eff. Sept. 1,

1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.122, eff.

Sept. 1, 1995.

Sec. 61.043. PREVENTION AND DETECTION OF FRAUD. (a) The county

shall adopt reasonable procedures for minimizing the opportunity

for fraud, for establishing and maintaining methods for detecting

and identifying situations in which a question of fraud may

exist, and for administrative hearings to be conducted on

disqualifying persons in cases where fraud appears to exist.

(b) Procedures established by a county for administrative

hearings conducted under this section shall provide for

appropriate due process, including procedures for appeals.

Added by Acts 1993, 73rd Leg., ch. 880, Sec. 1, eff. Sept. 1,

1993.

Sec. 61.044. SUBROGATION. (a) The filing of an application for

or receipt of services constitutes an assignment of the

applicant's or recipient's right of recovery from:

(1) personal insurance;

(2) other sources; or

(3) another person for personal injury caused by the other

person's negligence or wrong.

(b) A person who applies for or receives services shall inform

the county, at the time of application or at any time during

eligibility, of any unsettled tort claim that may affect medical

needs and of any private accident or sickness insurance coverage

that is or may become available. An applicant or eligible

resident shall inform the county of any injury that is caused by

the act or failure to act of some other person. An applicant or

eligible resident shall inform the county as required by this

subsection within 10 days of the date the person learns of the

person's insurance coverage, tort claim, or potential cause of

action.

(c) A claim for damages for personal injury does not constitute

grounds for denying or discontinuing services under this chapter.

(d) A separate and distinct cause of action in favor of the

county is hereby created, and the county may, without written

consent, take direct civil action in any court of competent

jurisdiction. A suit brought under this section need not be

ancillary to or dependent on any other action.

(e) The county's right of recovery is limited to the amount of

the cost of services paid by the county. Other subrogation rights

granted under this section are limited to the cost of the

services provided.

(f) An applicant or eligible resident who knowingly and

intentionally fails to disclose the information required by

Subsection (b) commits a Class C misdemeanor.

(g) An applicant or eligible resident is subject to denial of

services under this chapter following an administrative hearing.

Added by Acts 1993, 73rd Leg., ch. 880, Sec. 1, eff. Sept. 1,

1993.

SUBCHAPTER C. PERSONS WHO RESIDE IN AN AREA SERVED BY A PUBLIC

HOSPITAL OR HOSPITAL DISTRICT

Sec. 61.051. APPLICATION OF SUBCHAPTER. (a) This subchapter

applies to health care services and assistance provided to a

person who resides in the service area of a public hospital or

hospital district.

(b) For the purposes of this subchapter, a hospital is not

considered to be a public hospital and is not responsible for

providing care under this subchapter if the hospital:

(1) is owned, operated, or leased by a municipality with a

population of less than 5,500;

(2) was leased before January 1, 1981, by a municipality that at

the time of the lease did not have a legal obligation to provide

indigent health care; or

(3) was established under Section 265.031.

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

Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 16, eff. Sept. 1,

1991.

Sec. 61.052. GENERAL ELIGIBILITY PROVISIONS. (a) A public

hospital or hospital district shall provide health care

assistance to each eligible resident in its service area who

meets:

(1) the basic income and resources requirements established by

the department under Sections 61.006 and 61.008 and in effect

when the assistance is requested; or

(2) a less restrictive income and resources standard adopted by

the hospital or hospital district serving the area in which the

person resides.

(b) If a public hospital used an income and resources standard

during the operating year that ended before January 1, 1985, that

was less restrictive than the income and resources requirements

established by the department under Section 61.006, the hospital

shall adopt that standard to determine eligibility under this

subchapter.

(c) If a public hospital did not use an income and resources

standard during the operating year that ended before January 1,

1985, but had a Hill-Burton obligation during part of that year,

the hospital shall adopt the standard the hospital used to meet

the Hill-Burton obligation to determine eligibility under this

subchapter.

(d) A public hospital established after September 1, 1985, shall

provide health care services to each resident who meets the

income and resources requirements established by the department

under Sections 61.006 and 61.008, or the hospital may adopt a

less restrictive income and resources standard. The hospital may

adopt a less restrictive income and resources standard at any

time.

(e) If because of a change in the income and resources

requirements established by the department under Sections 61.006

and 61.008 the standard adopted by a public hospital or hospital

district becomes stricter than the requirements established by

the department, the hospital or hospital district shall change

its standard to at least comply with the requirements established

by the department.

(f) A public hospital or hospital district may contract with the

department to perform eligibility determination services.

(g) A county that provides health care services to its eligible

residents through a hospital established by a board of managers

jointly appointed by a county and a municipality under Section

265.011 and that establishes an income and resources standard in

accordance with Subsection (a)(2) may credit the services

provided to all persons who are eligible under that standard

toward eligibility for state assistance as described by Section

61.037(e).

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.17, eff. Sept.

1, 1999.

Sec. 61.053. APPLICATION PROCEDURE. (a) A public hospital or

hospital district shall adopt an application procedure.

(b) Not later than the beginning of a public hospital's or

hospital district's operating year, the hospital or district

shall specify the procedure it will use during the operating year

to determine eligibility and the documentation required to

support a request for assistance and shall make a reasonable

effort to notify the public of the procedure.

(c) The public hospital or hospital district shall furnish an

applicant with written application forms.

(d) On request of an applicant, the public hospital or hospital

district shall assist an applicant in filling out forms and

completing the application process. The hospital or district

shall inform an applicant of the availability of assistance.

(e) The public hospital or hospital district shall require an

applicant to sign a written statement in which the applicant

swears to the truth of the information supplied.

(f) The public hospital or hospital district shall explain to

the applicant that if the application is approved, the applicant

must report to the hospital or district any change in income or

resources that might affect the applicant's eligibility. The

report must be made not later than the 14th day after the date on

which the change occurs. The hospital or district shall explain

the possible penalties for failure to report a change.

(g) The public hospital or hospital district shall review each

application and shall accept or deny the application not later

than the 14th day after the date on which the hospital or

district receives the completed application.

(h) The public hospital or hospital district shall provide a

procedure for reviewing applications and for allowing an

applicant to appeal a denial of assistance.

(i) The public hospital or hospital district shall provide an

applicant written notification of the hospital's or district's

decision. If the hospital or district denies assistance, the

written notification shall include the reason for the denial and

an explanation of the procedure for appealing the denial.

(j) The public hospital or hospital district shall maintain the

records relating to an application for at least three years after

the date on which the application is submitted.

(k) If an applicant is denied assistance, the applicant may

resubmit an application at any time circumstances justify a

redetermination of eligibility.

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

Sec. 61.054. BASIC HEALTH CARE SERVICES PROVIDED BY A PUBLIC

HOSPITAL. (a) Except as provided by Subsection (c), a public

hospital shall endeavor to provide the basic health care services

a county is required to provide under Section 61.028.

(b) If a public hospital provided additional health care

services to eligible residents during the operating year that

ended before January 1, 1985, the hospital shall continue to

provide those services.

(c) A public hospital shall coordinate the delivery of basic

health care services to eligible residents and may provide any

basic health care services the hospital was not providing on

January 1, 1999, but only to the extent the hospital is

financially able to do so.

(d) A public hospital may provide health care services in

addition to basic health care services.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.18, eff. Sept.

1, 1999.

Sec. 61.055. BASIC HEALTH CARE SERVICES PROVIDED BY HOSPITAL

DISTRICTS. (a) Except as provided by Subsection (b), a hospital

district shall endeavor to provide the basic health care services

a county is required to provide under Section 61.028, together

with any other services required under the Texas Constitution and

the statute creating the district.

(b) A hospital district shall coordinate the delivery of basic

health care services to eligible residents and may provide any

basic health care services the district was not providing on

January 1, 1999, but only to the extent the district is

financially able to do so.

(c) This section may not be construed to discharge a hospital

district from its obligation to provide the health care services

required under the Texas Constitution and the statute creating

the district.

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

Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.19, eff. Sept.

1, 1999.

Sec. 61.056. PROVISION OF HEALTH CARE SERVICES. (a) A public

hospital or hospital district may arrange to provide health care

services through a local health department, a publicly owned

facility, or a contract with a private provider regardless of the

provider's location, or through the purchase of insurance for

eligible residents.

(b) The public hospital or hospital district may affiliate with

other public hospitals or hospital districts or with a

governmental entity to provide regional administration and

delivery of health care services.

(c) A hospital district created in a county with a population of

more than 800,000 that was not included in the boundaries of a

hospital district before September 1, 2003, may affiliate with

any public or private entity to provide regional administration

and delivery of health care services. The regional affiliation,

in accordance with the affiliation agreement, shall use money

contributed by an affiliated governmental entity to provide

health care services to an eligible resident of that governmental

entity.

Text of subsection as added by Acts 2009, 81st Leg., R.S., Ch.

217, Sec. 3

(d) A hospital district created in a county with a population of

more than 800,000 that was not included in the bound