HEALTH & SAFETY CODE
SUBTITLE C. INDIGENT HEALTH CARE
CHAPTER 61. INDIGENT HEALTH CARE AND TREATMENT ACT
SUBCHAPTER A. GENERAL PROVISIONS
§ 61.001. SHORT TITLE. This chapter may be cited as the
Indigent Health Care and Treatment Act.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., ch. 14, § 14, eff. Sept. 1, 1991; Acts
1995, 74th Leg., ch. 76, § 8.119, eff. Sept. 1, 1995; Acts 1999,
76th Leg., ch. 1377, § 1.01, eff. Sept. 1, 1999.
§ 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 Corrections, Texas Department of Mental Health and
Mental Retardation, 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1995, 74th Leg., ch. 76, § 5.95(49), eff. Sept. 1, 1995;
Acts 1999, 76th Leg., ch. 1377, § 1.02, eff. Sept. 1, 1999.
§ 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 in accordance with this chapter.
(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, § 1.03, eff. Sept. 1,
1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1989, 71st Leg., ch. 1100, § 5.09(a), eff. Sept. 1, 1989;
Acts 1991, 72nd Leg., ch. 14, § 15, eff. Sept. 1, 1991; Acts
1995, 74th Leg., ch. 76, § 8.120, eff. Sept. 1, 1995; Acts 1999,
76th Leg., ch. 1377, § 1.04, eff. Sept. 1, 1999; Acts 2001, 77th
Leg., ch. 1128, § 1, 7 eff. Sept. 1, 2001.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.04, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1995, 74th Leg., ch. 76, § 8.121, eff. Sept. 1, 1995.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 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
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 13.11(g), eff. Sept. 1,
1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1989, 71st Leg., ch. 1100, § 5.10(a), eff. Sept. 1, 1989;
Acts 1999, 76th Leg., ch. 1377, § 1.06, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1997, 75th Leg., ch. 1103, § 1, eff. Sept. 1, 1997; Acts
1999, 76th Leg., ch. 1377, § 1.07, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.08, eff. Sept. 1, 1999.
§ 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, § 1.09, eff. Sept. 1,
1999. Amended by Acts 2001, 77th Leg., ch. 874, § 9, eff. Sept.
1, 2001; Acts 2003, 78th Leg., ch. 892, § 24, eff. Sept. 1, 2003.
§ 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.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.10, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.11, eff. Sept. 1, 1999;
Acts 2001, 77th Leg., ch. 1128, § 2, eff. Sept. 1, 2001.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.12, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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 a hospital maintained or operated by a state agency that
has a contract with the county to provide health care services.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1989, 71st Leg., ch. 1100, § 5.10(b), eff. Sept. 1, 1989;
Acts 1999, 76th Leg., ch. 1377, § 1.13, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1997, 75th Leg., ch. 651, § 1, eff. June 11, 1997; Acts
1999, 76th Leg., ch. 272, § 1, eff. May 28, 1999; Acts 1999, 76th
Leg., ch. 1377, § 1.14, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 272, § 2, eff. May 28, 1999; Acts
1999, 76th Leg., ch. 1377, § 1.14, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.14, eff. Sept. 1, 1999.
§ 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, § 1.15, eff. Sept. 1,
1999. Amended by Acts 2001, 77th Leg., ch. 1128, § 3, eff. Sept.
1, 2001.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., 2nd C.S., ch. 6, § 64, eff. Sept. 1,
1991.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.16, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, § 8.122, eff. Sept. 1,
1995.
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993.
SUBCHAPTER C. PERSONS WHO RESIDE IN AN AREA SERVED BY A PUBLIC
HOSPITAL OR HOSPITAL DISTRICT
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., ch. 14, § 16, eff. Sept. 1, 1991.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.17, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.18, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.19, eff. Sept. 1, 1999.
§ 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.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
§ 61.057. MANDATED PROVIDER. A public hospital may
select one or more providers of health care services. A public
hospital may require eligible 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, § 1, eff. Sept. 1, 1989.
§ 61.058. NOTIFICATION OF PROVISION OF NONEMERGENCY
SERVICES. (a) A public hospital may require any provider,
including a mandated provider, to obtain approval from the hospital
before providing nonemergency health care services to an eligible
resident in the hospital's service area.
(b) If the public hospital does not require prior approval
and a provider delivers or will deliver nonemergency health care
services to a patient who the provider suspects might be eligible
for assistance under this subchapter, the provider shall notify the
hospital 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 that the patient resides in the hospital's
service area; and
(2) by mail postmarked not later than the fifth
working day after the date on which the provider determines that the
patient resides in the hospital's service area.
(c) If the provider knows that the public hospital serving
the area in which the patient resides has selected a mandated
provider or if, after contacting the hospital, the hospital
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
public hospital receives sufficient information to determine
eligibility, the hospital shall determine if the patient is
eligible for assistance from the hospital. If the hospital does not
determine the patient's eligibility within that period, the patient
is considered to be eligible. The hospital 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 public hospital
serving the area in which the patient resides.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.20, eff. Sept. 1, 1999.
§ 61.059. 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
hospital 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 that the patient resides in the hospital's
service area; and
(2) by mail postmarked not later than the fifth
working day after the date on which the provider determines that the
patient resides in the hospital's service area.
(b) The provider shall attempt to determine if the patient
resides in a public hospital's service area when the patient first
receives services.
(c) The provider, the patient, and the patient's family
shall cooperate with the public hospital in determining if the
patient is an eligible resident of the hospital's service area.
(d) Not later than the 14th day after the date on which the
public hospital receives sufficient information to determine
eligibility, the hospital shall determine if the patient is
eligible for assistance from the hospital. If the hospital does not
determine the patient's eligibility within that period, the patient
is considered to be eligible. The hospital shall notify the
provider of its decision.
(e) If the public hospital and the provider disagree on the
patient's residence or eligibility, the hospital 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 public hospital serving the area in which
the patient resides.
(g) If emergency services are customarily available at a
facility operated by a public hospital, that hospital is not liable
for emergency services furnished to an eligible resident by another
provider in the area the hospital has a legal obligation to serve.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.21, eff. Sept. 1, 1999;
Acts 2001, 77th Leg., ch. 1128, § 4, eff. Sept. 1, 2001.
§ 61.060. PAYMENT FOR SERVICES. (a) To the extent
prescribed by this chapter, a public hospital is liable for health
care services provided under this subchapter by any provider,
including another public hospital, to an eligible resident in the
hospital's service area. A public hospital is not liable for
payment for health care services provided to:
(1) a person who does not reside in the hospital's
service area; or
(2) an eligible resident of the hospital's service
area 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) A hospital district is liable for health care services
as provided by the Texas Constitution and the statute creating the
district.
(c) A public hospital is the payor of last resort under this
subchapter and is not liable for payment or assistance to an
eligible resident in the hospital's service area if any other
public or private source of payment is available.
(d) If another source of payment does not adequately cover a
health care service a public hospital provides to an eligible
resident of the hospital's service area, the hospital shall pay for
or provide the health care service for which other payment is not
available.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
§ 61.061. PAYMENT RATES AND LIMITS. The payment rates
and limits prescribed by Sections 61.034 and 61.035 that relate to
county services apply to inpatient and outpatient hospital services
a public hospital is required to provide if:
(1) the hospital cannot provide the services or
emergency services that are required; and
(2) the services are provided by an entity other than
the hospital.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
§ 61.062. RESPONSIBILITY OF GOVERNMENTAL ENTITY. A
governmental entity that owns, operates, or leases a public
hospital shall provide sufficient funding to the hospital to
provide basic health care services.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.22, eff. Sept. 1, 1999.
§ 61.063. PROCEDURE TO CHANGE ELIGIBILITY STANDARDS OR
SERVICES PROVIDED. (a) A public hospital may not change its
eligibility standards to make the standards more restrictive and
may not reduce the health care services it offers unless it complies
with the requirements of this section.
(b) Not later than the 90th day before the date on which a
change would take effect, the public hospital must publish notice
of the proposed change in a newspaper of general circulation in the
hospital's service area and set a date for a public hearing on the
change. The published notice must include the date, time, and place
of the public meeting. The notice is in addition to the notice
required by Chapter 551, Government Code.
(c) Not later than the 30th day before the date on which the
change would take effect, the public hospital must conduct a public
meeting to discuss the change. The meeting must be held at a
convenient time in a convenient location in the hospital's service
area. Members of the public may testify at the meeting.
(d) If, based on the public testimony and on other relevant
information, the governing body of the hospital finds that the
change would not have a detrimental effect on access to health care
for the residents the hospital serves, the hospital may adopt the
change. That finding must be formally adopted.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1995, 74th Leg., ch. 76, § 5.95(82), eff. Sept. 1, 1995.
§ 61.064. TRANSFER OF A PUBLIC HOSPITAL. (a) A
governmental entity that owns, operates, or leases a public
hospital and that closes, sells, or leases the hospital:
(1) has the obligation to provide basic health care
services under this chapter;
(2) shall adopt the eligibility standards that the
hospital was or would have been required to adopt; and
(3) shall provide the same services the hospital was
or would have been required to provide under this chapter on the
date of the closing, sale, or lease.
(b) If the governmental entity owned, operated, or leased
the public hospital before January 1, 1985, and sold or leased the
hospital on or after that date but before September 1, 1986, the
obligation retained is the obligation the hospital would have had
on September 1, 1986.
(c) Notwithstanding Subsections (a) and (b), if a hospital
district that owns, operates, or leases a public hospital
dissolves, the district has no responsibility under this chapter.
If on or before dissolution the district sold or transferred its
hospital to another governmental entity, that governmental entity
assumes the district's responsibility to provide health care
services in accordance with this subchapter. If the district did
not sell or transfer the hospital to another governmental entity,
the county shall provide health care services to the residents of
the district's service area in accordance with Subchapter B.
(d) This section does not apply to a governmental entity
that sold or leased a public hospital to a hospital district or a
hospital authority on or after January 1, 1985, but before
September 1, 1986. If a governmental entity sold or leased a
hospital as provided by this subsection, the hospital ceased being
a public hospital for the purposes of this chapter on the date it
was sold or leased, and neither the governmental entity nor the
hospital district or hospital authority has any responsibility
under this chapter.
Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1999, 76th Leg., ch. 1377, § 1.23, eff. Sept. 1, 1999.
§ 61.065. COUNTY RESPONSIBILITY FOR HOSPITAL SOLD ON OR
AFTER JANUARY 1, 1988. (a) This section applies to a county that,
on or after January 1, 1988, sells to a purchaser that is not a
governmental entity a county hospital that was leased at the time of
the sale to a person who is not a governmental entity.
(b) On the date the hospital is sold, the hospital ceases
being a public hospital for the purposes of this chapter, and the
county shall provide health care services to county residents in
accordance with Subchapter B.
(c) If the contract for the sale of the hospital provides
for the provision by the hospital of health care services to county
residents, the value of the health care services credited or paid in
a state fiscal year under the contract is included as part of the
computation of a county expenditure under Section 61.037 to the
extent that the value of the services does not exceed the payment
standard established by the department for allowed inpatient and
outpatient services.
Added by Acts 1989, 71st Leg., ch. 1100, § 5.10(c), eff. Sept. 1,
1989.
§ 61.066. PREVENTION AND DETECTION OF FRAUD. (a) A
hospital district may 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 hospital district for
administrative hearings conducted under this section shall provide
for appropriate due process, including procedures for appeals.
Added by Acts 2001, 77th Leg., ch. 563, § 1, eff. Aug. 27, 2001.
