HEALTH & SAFETY CODE
CHAPTER 46. TERTIARY MEDICAL CARE
§ 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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
Amended by Acts 2001, 77th Leg., ch. 1128, § 5, eff. June 15,
2001.
§ 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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
§ 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, § 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, §
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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
§ 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, § 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, §
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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
§ 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, § 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, §
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, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1377, § 2.01, eff. Sept. 1, 1999.
