2005 Texas Health & Safety Code CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT

HEALTH & SAFETY CODE

CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT

SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN


	§ 32.001. SHORT TITLE.  This chapter may be cited as the 
Maternal and Infant Health Improvement Act.

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


	§ 32.002. DEFINITIONS.  (a) In this chapter:                                
		(1)  "Adolescent" means an individual younger than 18 
years of age.         
		(2)  "Ancillary services" means services necessary to 
obtain timely, effective, and appropriate maternal and infant 
health improvement services, and includes prescription drugs, 
medical social services, transportation, health promotion 
services, and laboratory services.
		(3)  "Facility" includes a hospital, public health 
clinic, birthing center, outpatient clinic, or community health 
center.
		(4)  "Infant care" means maternal and infant health 
improvement services and ancillary services appropriate for an 
individual from birth to 12 months of age.
		(5)  "Intrapartum care" means maternal and infant 
health improvement services and ancillary services appropriate for 
a woman, fetus, or infant during childbirth.
		(6)  "Maternal and infant health improvement services" 
means services necessary to assure quality health care for women 
and children.
		(7)  "Medical assistance program" means the program 
administered by the single state agency under Title XIX of the 
Social Security Act (42 U.S.C. Section 1396 et seq.).
		(8)  "Other benefit" means a benefit, other than a 
benefit provided under this chapter, to which an individual is 
entitled for payment of the costs of maternal and infant health 
improvement services, ancillary services, educational services, or 
transportation services, including benefits available from:
			(A)  an insurance policy, group health plan, or 
prepaid medical care plan; 
			(B)  Title XVIII of the Social Security Act (42 
U.S.C. Section 1395 et seq.);
			(C)  the Veterans Administration;                                            
			(D)  the Civilian Health and Medical Program of 
the Uniformed Services;    
			(E)  workers' compensation or any other 
compulsory employers' insurance program;
			(F)  a public program created by federal or state 
law, other than Title XIX of the Social Security Act (42 U.S.C. 
Section 1396 et seq.), or by an ordinance or rule of a municipality 
or political subdivision of the state, excluding benefits created 
by the establishment of a municipal or county hospital, a joint 
municipal-county hospital, a county hospital authority, a hospital 
district, or the facilities of a publicly supported medical school;  
or
			(G)  a cause of action for medical, facility, or 
medical transportation expenses, or a settlement or judgment based 
on the cause of action, if the expenses are related to the need for 
services provided under this chapter.
		(9)  "Perinatal care" means maternal and infant health 
improvement services and ancillary services that are appropriate 
for women and infants during the perinatal period, which begins 
before conception and ends on the infant's first birthday.
		(10)  "Postpartum care" means maternal and infant 
health improvement services and ancillary services appropriate for 
a woman following a pregnancy.
		(11)  "Preconceptional care" means maternal and infant 
health improvement services and ancillary services appropriate for 
a woman before conception that are provided with the intent of 
planning and reducing health risks that might adversely affect her 
pregnancies.
		(12)  "Prenatal care" means maternal and infant health 
improvement services and ancillary services that are appropriate 
for a pregnant woman and the fetus during the period beginning on 
the date of conception and ending on the commencement of labor.
		(13)  "Program" means the maternal and infant health 
improvement services program authorized by this chapter.
		(14)  "Provider" means a person who, through a grant or 
a contract with the department or through other means approved by 
the department, provides maternal and infant health improvement 
services and ancillary services that are purchased by the 
department for the purposes of this chapter.
		(15)  "Support" means the contribution of money or 
services necessary for a person's maintenance, including food, 
clothing, shelter, transportation, and health care.
	(b)  The board by rule may define a word or term not defined 
by Subsection (a) as necessary to administer this chapter.  The 
board may not define a word or term so that the word or term is 
inconsistent or in conflict with the purposes of this chapter, or is 
in conflict with the definition and conditions of practice 
governing a provider who is required to be licensed, registered, 
certified, identified, or otherwise sanctioned under the laws of 
this state.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1995, 74th Leg., ch. 124, § 2, eff. Sept. 1, 1995.


	§ 32.003. MATERNAL AND INFANT HEALTH IMPROVEMENT SERVICES 
PROGRAM.  (a) The board may establish a maternal and infant health 
improvement services program in the department to provide 
comprehensive maternal and infant health improvement services and 
ancillary services to eligible women and infants.
	(b)  If the program is established, the board shall adopt 
rules relating to: 
		(1)  the type, amount, and duration of services to be 
provided under this chapter;  and
		(2)  the determination by the department of the 
services needed in each service area.
	(c)  If budgetary limitations exist, the board by rule shall 
establish a system of priorities relating to the types of services 
provided, geographic areas covered, or classes of individuals 
eligible for services.
	(d)  The board shall adopt the rules according to a statewide 
determination of the need for services.
	(e)  In structuring the program and adopting rules, the 
department and board shall attempt to maximize the amount of 
federal matching funds available for maternal and infant health 
improvement services while continuing to serve targeted 
populations.
	(f)  If necessary, the board by rule may coordinate services 
and other parts of the program with the medical assistance program.  
However, the board may not adopt rules relating to the services 
under either program that would:
		(1)  cause the program established under this chapter 
not to conform with federal law to the extent that federal matching 
funds would not be available;  or
		(2)  affect the status of the single state agency to 
administer the medical assistance program.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1995, 74th Leg., ch. 124, § 3, eff. Sept. 1, 1995.


	§ 32.005. ABORTION SERVICES RESTRICTED.  Notwithstanding 
any other provision of this chapter, funds administered under this 
chapter may not be used to provide abortion services unless the 
mother's life is in danger.

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


	§ 32.006. ADMINISTRATION.  (a) The board shall adopt 
rules necessary to administer this chapter, and the department 
shall administer the program in accordance with board rules.
	(b)  The department shall prescribe the design and content of 
all necessary forms used in the program.

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


	§ 32.011. DENIAL, MODIFICATION, SUSPENSION, OR 
TERMINATION OF SERVICES.  (a) The department may, for cause, deny, 
modify, suspend, or terminate services to an individual eligible 
for or receiving services after notice to the individual and an 
opportunity for a hearing.
	(b)  The board by rule shall provide criteria for action by 
the department under this section.
	(c)  Chapter 2001, Government Code, does not apply to the 
granting, denial, modification, suspension, or termination of 
services.  The department shall conduct hearings in accordance with 
the board's due process hearing rules.
	(d)  The department shall render the final administrative 
decision in a due process hearing to deny, modify, suspend, or 
terminate the receipt of services.
	(e)  The notice and hearing required by this section do not 
apply if the department restricts program services to conform to 
budgetary limitations that require the board to establish service 
priorities.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1995, 74th Leg., ch. 76, § 5.95(65), eff. Sept. 1, 1995;  
Acts 1995, 74th Leg., ch. 124, § 4, eff. Sept. 1, 1995.


	§ 32.012. FINANCIAL ELIGIBILITY;  OTHER BENEFITS.  (a) 
The department shall require an individual receiving services under 
this chapter, or the person with a legal obligation to support the 
individual, to pay for or reimburse the department for that part of 
the cost of the services that the individual or person is 
financially able to pay.
	(b)  Except as provided by board rules, an individual is not 
eligible to receive services under this chapter to the extent that 
the individual or a person with a legal obligation to support the 
individual is eligible for some other benefit that would pay for all 
or part of the services.
	(c)  When a determination of eligibility to receive maternal 
and infant health improvement services is made under this chapter 
or when the services are received, the individual requesting or 
receiving services shall inform the department of any other benefit 
to which the individual or a person with a legal obligation to 
support the individual may be entitled.
	(d)  An individual who has received services that are covered 
by some other benefit, or any other person with a legal obligation 
to support that individual, shall reimburse the department to the 
extent of the services provided when the other benefit is received.
	(e)  The commissioner may waive enforcement of Subsections 
(b)-(d) of this section as prescribed by board rules in certain 
individually considered cases in which enforcement will deny 
services to a class of otherwise eligible individuals because of 
conflicting federal, state, or local laws or rules.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1995, 74th Leg., ch. 124, § 5, eff. Sept. 1, 1995.


	§ 32.013. RECOVERY OF COSTS.  (a) The department may 
recover the cost of services provided under this chapter from a 
person who does not reimburse the department as required by Section 
32.012 or from any third party who has a legal obligation to pay 
other benefits and to whom notice of the department's interest has 
been given.
	(b)  At the request of the commissioner, the attorney general 
may bring suit in the appropriate court of Travis County on behalf 
of the department.
	(c)  In a judgment in favor of the department, the court may 
award attorney's fees, court costs, and interest accruing from the 
date on which the department provides the services to the date on 
which the department is reimbursed.

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


	§ 32.014. FEES.  (a) Except as prohibited by federal law 
or regulation, the board may charge fees for the services provided 
directly by the department or through approved providers in 
accordance with Subchapter D, Chapter 12.
	(b)  The board shall adopt standards and procedures to 
develop and implement a schedule of allowable charges for program 
services.

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


	§ 32.015. FUNDING.  (a) Except as provided by this 
chapter or by other law, the board may seek, receive, and spend 
funds received through an appropriation, grant, donation, or 
reimbursement from any public or private source to administer this 
chapter.
	(b)  Notwithstanding other law, the department's authority 
to spend funds appropriated for the program established by this 
chapter is not affected by the amount of federal funds the 
department receives.
	(c)  The department is not required to provide maternal and 
infant health improvement services unless funds are appropriated to 
the department to administer this chapter.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.  Amended 
by Acts 1995, 74th Leg., ch. 124, § 6, eff. Sept. 1, 1995.


	§ 32.016. CONTRACTS.  The department shall enter into 
contracts and agreements or award grants necessary to facilitate 
the efficient and economical provision of services under this 
chapter, including contracts and grants for the purchase of 
services, equipment, and supplies from approved providers.

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


	§ 32.017. RECORDS AND REVIEW.  (a) The department shall 
require each provider receiving reimbursement under this chapter to 
maintain records and information for each applicant for or 
recipient of services.
	(b)  The board shall adopt rules relating to the information 
a provider is required to report to the department and shall adopt 
procedures to prevent unnecessary and duplicative reporting of 
data.
	(c)  The department shall review records, information, and 
reports prepared by program providers and shall annually prepare a 
report for submission to the governor and the legislature relating 
to the status of the program.  The department shall make the report 
available to the public.
	(d)  The report required under Subsection (c) must include:                    
		(1)  the number of individuals receiving care under 
this chapter;           
		(2)  the total cost of the program, including a 
delineation of the total administrative costs and the total cost 
for each service authorized under Section 32.004(d); 
		(3)  the average cost per recipient of services;                              
		(4)  the number of individuals who received services in 
each public health region;  and
		(5)  any other information required by the board.                             
	(e)  In computing the number of individuals to be reported 
under Subsection (d)(1), the department shall ensure that no 
individual is counted more than once.

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


	§ 32.018. PROGRAM PLANS.  (a) The department shall have a 
long-range plan covering at least six years that includes at least 
the following elements:
		(1)  quantifiable indicators of effort and success;                           
		(2)  identification of priority client population and 
the minimum types of services necessary for that population; 
		(3)  a description of the appropriate use of providers, 
including the role of providers and considering the type, location, 
and specialization of the providers; 
		(4)  criteria for phasing out unnecessary services;                           
		(5)  a comprehensive assessment of needs and inventory 
of resources;  and   
		(6)  coordination of administration and service 
provision with federal, state, and local public and private 
programs that provide similar services.
	(b)  The department shall revise the plan by January 1 of 
each even-numbered year.
	(c)  The department shall develop a short-range plan that is 
derived from the long-range plan and that identifies and projects 
the costs relating to implementing the short-range plan.
	(d)  As part of the department's budget preparation process, 
the department shall biennially assess its achievement of the goals 
identified in each plan.  The department's biennial budget shall be 
made according to the results of the assessment and the short-range 
plan.  The department shall make its requests for new program 
funding and for continued funding according to demonstrated need.
	(e)  The department shall use the information collected 
under Section 32.017 to develop the long-range and short-range 
plans.

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


	§ 32.021. REQUIREMENTS REGARDING THE WOMEN, INFANTS AND 
CHILDREN PROGRAM.  (a) An agency, organization, or other entity 
that contracts with the Special Supplemental Nutrition Program for 
Women, Infants and Children shall each month provide the clinical 
and nutritional services supported by that program during extended 
hours, as defined by the department.
	(b)  Each agency, organization, or other entity that 
contracts with the program to provide clinical or nutritional 
services shall include in its annual plan submitted to the 
department a plan to expand client access to services through 
extended hours, the schedule for each site that provides services, 
and the reasons for each site's schedule.  An agency, organization, 
or other entity that contracts with the program is not required to 
offer extended hours at each of its service sites. 
	(c)  The department shall adopt guidelines for extended 
hours and waivers from the requirement of Subsection (a).
	(d)  To obtain a waiver, an agency, organization, or other 
entity shall submit a written justification to the department 
explaining the extraordinary circumstances involved and 
identifying the time frame needed for their resolution.
	(e)  The department may not grant a waiver to an agency, 
organization, or other entity for a period of more than two years.
	(f)  If an agency, organization, or other entity required by 
this section to maintain extended hours provides other maternal and 
child health services, that entity shall also make those services 
available during the extended hours.

Added by Acts 1993, 73rd Leg., ch. 328, § 1, eff. Aug. 30, 1993.  
Amended by Acts 1997, 75th Leg., ch. 1317, § 1, eff. Sept. 1, 
1997.

SUBCHAPTER B. PERINATAL HEALTH CARE SYSTEM


	§ 32.041. LEGISLATIVE FINDINGS.  (a) The legislature 
finds that the perinatal period beginning before conception and 
continuing through the first year of life poses unique challenges 
for the health care system.  The development of a coordinated, 
cooperative system of perinatal health care within a geographic 
area will reduce unnecessary mortality and morbidity for women and 
infants.
	(b)  In order to improve the health of women and infants, it 
is necessary to promote health education, to provide assurance of 
reasonable access to safe and appropriate perinatal services, and 
to improve the quality of perinatal care by encouraging optimal use 
of health care personnel.

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


	§ 32.042. DUTIES OF BOARD;  RULES.  (a) The board by rule 
shall adopt:    
		(1)  minimum standards and objectives to implement 
voluntary perinatal health care systems;  and
		(2)  policies for health promotion and education, risk 
assessment, access to care, and perinatal system structure, 
including the transfer and transportation of pregnant women and 
infants.
	(b)  The rules must:                                                           
		(1)  reflect all geographic areas of the state, 
considering time and distance;
		(2)  provide specific requirements for appropriate 
care of perinatal patients;  and
		(3)  facilitate coordination among all perinatal 
service providers and health care facilities in the delivery area.
	(c)  The rules must include:                                                   
		(1)  risk reduction guidelines for preconceptional, 
prenatal, intrapartum, postpartum, and infant care, including 
guidelines for the transfer and transportation of perinatal 
patients;
		(2)  criteria for determining geographic boundaries of 
perinatal health care systems;
		(3)  minimum requirements of health promotion and 
education, risk assessment, access to care, and coordination of 
services that must be present in a perinatal health care system;
		(4)  minimum requirements for resources and equipment 
needed by a health care facility to treat perinatal patients;
		(5)  standards for the availability and qualifications 
of the health care personnel treating perinatal patients in a 
facility;
		(6)  requirements for data collection, including 
operation of the perinatal health care system and patient outcomes;
		(7)  requirements for periodic performance evaluation 
of the system and its components;  and
		(8)  assurances that health care facilities will not 
refuse to accept the transfer of a perinatal patient solely because 
of the person's inability to pay for services or because of the 
person's age, sex, race, religion, or national origin.

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


	§ 32.043. DUTIES OF DEPARTMENT.  The department shall:                      
		(1)  develop and monitor a statewide network of 
voluntary perinatal health care systems;
		(2)  develop and maintain a perinatal reporting and 
analysis system to monitor and evaluate perinatal patient care in 
the perinatal health care systems in this state;  and
		(3)  provide for coordination and cooperation in this 
state and among this state and adjoining states.

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


	§ 32.044. SYSTEM REQUIREMENTS.  (a) Each voluntary 
perinatal health care system must have:
		(1)  a coordinating board responsible for ensuring, 
providing, or coordinating planning access to services, data 
collection, and provider education;
		(2)  access to appropriate emergency medical services;                        
		(3)  risk assessment, transport, and transfer 
protocols for perinatal patients;
		(4)  one or more health care facilities categorized 
according to perinatal care capabilities using standards adopted by 
board rule;  and
		(5)  documentation of broad-based participation in 
planning by providers of perinatal services and community 
representatives throughout the defined geographic region.
	(b)  This subchapter does not prohibit a health care facility 
from providing services that it is authorized to provide under a 
license issued to the facility by the department.

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


	§ 32.045. GRANT PROGRAM.  (a) The department may 
establish a program to award grants to initiate, expand, maintain, 
and improve voluntary perinatal health care systems.
	(b)  The board by rule shall establish eligibility criteria 
for awarding the grants.  The rules must require the department to 
consider:
		(1)  the need of an area and the extent to which the 
grant would meet the identified need;
		(2)  the availability of personnel and training 
programs;                   
		(3)  the availability of other funding sources;                               
		(4)  the assurance of providing quality services;                             
		(5)  the need for emergency transportation of perinatal 
patients and the extent to which the system meets the identified 
needs;  and
		(6)  the stage of development of a perinatal health 
care system.            
	(c)  The department may approve grants according to rules 
adopted by the board.  A grant awarded under this section is 
governed by Chapter 783, Government Code, and rules adopted under 
that chapter.

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