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A BILL TO BE ENTITLED
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AN ACT
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relating to the minimum standards for birthing centers and certain |
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health professionals. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 244.002, Health and Safety Code, is |
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amended by amending Subdivisions (2) and (3) and adding |
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Subdivisions (2-a), (2-b), (3-a), and (3-b) to read as follows: |
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(2) "Board" means the executive commissioner [Texas
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Board of Health]. |
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(2-a) "Certified nurse-midwife" has the meaning |
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assigned by Section 203.002, Occupations Code. |
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(2-b) "Clinical director" means the person |
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responsible for advising and consulting with the staff of a |
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birthing center on matters relating to the clinical management of |
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the center's patients, including developing clinical policies for |
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the center and supervising all persons who provide direct patient |
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care. |
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(3) "Department" means the [Texas] Department of State |
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Health Services. |
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(3-a) "Executive Commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(3-b) "Licensed midwife" means a midwife licensed |
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under Chapter 203, Occupations Code. |
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SECTION 2. Section 244.005(c), Health and Safety Code, is |
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amended to read as follows: |
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(c) The application must contain evidence that: |
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(1) the composition of the center's staff meets the |
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standards adopted [by the board] under this chapter for the level of |
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license for which the application is submitted; and |
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(2) the center, or each licensed or certified |
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professional providing services at the center, maintains liability |
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insurance coverage in the amount specified by and subject to the |
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terms required by department rules. |
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SECTION 3. Section 244.010, Health and Safety Code, is |
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amended by amending Subsection (a) and adding Subsection (c) to |
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read as follows: |
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(a) For each level of license of a birthing center, the |
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rules must contain minimum standards for: |
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(1) the qualifications for professional and |
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nonprofessional personnel; |
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(2) the supervision of professional and |
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nonprofessional personnel; |
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(3) the provision and coordination of treatment and |
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services; |
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(4) the organizational structure, including the lines |
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of authority and the delegation of responsibility; |
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(5) the keeping of clinical records; [and] |
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(6) any other aspect of the operation of a birthing |
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center considered [that the board considers] necessary to protect |
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the public; and |
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(7) the construction and design of a birthing center. |
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(c) The minimum construction and design standards, |
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including plumbing, heating, lighting, and ventilation standards |
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and other design standards necessary to ensure the health and |
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safety of a birthing center's patients, adopted under this section |
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must be at least as stringent as the standards of The Joint |
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Commission on health care organization accreditation in effect on |
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January 1, 2013. |
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SECTION 4. Chapter 244, Health and Safety Code, is amended |
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by adding Sections 244.0101, 244.0102, 244.0103, and 244.0104 to |
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read as follows: |
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Sec. 244.0101. CLINICAL DIRECTOR. (a) A birthing center |
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shall employ a qualified clinical director. |
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(b) A clinical director employed under this section must be |
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a certified nurse-midwife or a physician licensed to practice |
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medicine in this state. |
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Sec. 244.0102. REQUIRED PATIENT TRANSFERS. A licensed |
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midwife who is providing care to a patient at a birthing center |
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shall immediately transfer the patient to a hospital located in |
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close proximity to the center, as established by department rule, |
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if the patient exhibits one or more of the following medical |
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conditions: |
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(1) a non-vertex presentation; |
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(2) a multiple gestation; or |
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(3) a previous uterine surgery, including a cesarean |
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delivery. |
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Sec. 244.0103. TRANSFER AGREEMENTS. (a) A birthing center |
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shall enter into a transfer agreement with a hospital located in |
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close proximity to the center, as established by department rule. |
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(b) At a minimum, a transfer agreement must: |
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(1) provide for the use of medically appropriate life |
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support measures that a reasonable and prudent physician exercising |
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ordinary care in the same or a similar locality would use to |
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stabilize the patient before the transfer and to sustain the |
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patient during the transfer; |
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(2) require the provision of appropriate personnel and |
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equipment that a reasonable and prudent physician exercising |
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ordinary care in the same or a similar locality would use for the |
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transfer; |
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(3) require the transfer of all necessary records for |
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continuing the care for the patient; |
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(4) prohibit the transfer of a patient predicated on |
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arbitrary, capricious, or unreasonable discrimination because of |
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race, religion, national origin, age, sex, physical condition, or |
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economic status; and |
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(5) prohibit the transfer or acceptance of a patient |
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in need of emergency care based on the individual's inability to pay |
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for the services rendered by the transferring birthing center or |
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receiving hospital. |
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(c) The birthing center shall submit the agreement to the |
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department for review. The department shall determine whether the |
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agreement complies with the requirements of this section and rules |
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adopted under this section. The department shall complete the |
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review not later than the 30th day after the date the agreement is |
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received by the department. |
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(d) The executive commissioner shall adopt rules governing |
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transfers and transfer agreements. The rules must: |
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(1) require that if a patient at a birthing center has |
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an emergency medical condition that has not been stabilized, the |
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center may not transfer the patient unless: |
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(A) the patient or a legally responsible person |
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acting on the patient's behalf, after being informed of the center's |
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obligations under this subsection and of the risk of transfer, in |
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writing requests transfer to another medical facility; |
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(B) a licensed physician has signed a |
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certification, which includes a summary of the risks and benefits, |
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that, based on the information available at the time of transfer, |
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the medical benefits reasonably expected from the provision of |
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appropriate medical treatment at another medical facility outweigh |
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the increased risks to the patient and, in the case of labor, to the |
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unborn child from effecting the transfer; or |
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(C) if a licensed physician is not physically |
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present in the birthing center at the time a patient is transferred, |
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a qualified medical person has signed a certification described in |
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Paragraph (B) after a licensed physician, in consultation with the |
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person, has made the determination described in that paragraph and |
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subsequently countersigns the certificate; |
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(2) authorize the birthing center to enter into |
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multiple transfer agreements based on the type or level of medical |
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services available at other hospitals; |
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(3) require the birthing center to recognize the right |
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of a patient to request transfer to the care of a physician and |
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hospital of the patient's choice; |
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(4) require the birthing center to recognize and |
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comply with the requirements of Chapter 61 relating to the transfer |
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of patients to mandated providers; and |
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(5) consider the availability of appropriate |
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facilities, services, and staff for providing care to the patient. |
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(e) A birthing center that transfers a patient in violation |
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of rules adopted under this section or provisions required in a |
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transfer agreement under this section violates this chapter. |
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Sec. 244.0104. REFERRAL AND CONSULTATION; LICENSED |
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MIDWIVES. (a) A birthing center may not allow a licensed midwife |
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to provide care to a patient at the center unless the midwife |
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complies with the standards for referral or consultation required |
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by the Texas Board of Nursing for certified nurse-midwives. |
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(b) A licensed midwife who provides care to a patient at a |
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birthing center shall enter into a referral agreement, on the form |
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prescribed by the department, with a licensed physician who agrees |
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to consult with and receive referrals from the licensed midwife. |
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The agreement may not be for a term that exceeds one year. Each |
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year, the licensed midwife shall submit a copy of the current |
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agreement to the department. |
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(c) The department shall maintain copies of the referral |
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agreements required under Subsection (b) until the first |
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anniversary of the date the agreement expires. |
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SECTION 5. (a) Not later than September 1, 2014, the |
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Department of State Health Services shall develop the form for the |
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referral agreement required by Section 244.0104, Health and Safety |
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Code, as added by this Act. |
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(b) The executive commissioner of the Health and Human |
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Services Commission shall adopt the rules required to implement |
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Chapter 244, Health and Safety Code, as amended by this Act. |
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(c) Not later than December 1, 2013, a birthing center must |
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comply with Section 244.005(c), Health and Safety Code, as amended |
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by this Act. |
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(d) On or after the effective date of this Act, a birthing |
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center may not employ or continue to employ a clinical director who |
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does not meet the requirements of Section 244.0101, Health and |
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Safety Code, as added by this Act. |
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SECTION 6. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2013. |