2005 Texas Health & Safety Code CHAPTER 46. TERTIARY MEDICAL CARE

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.