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  By: Sheffield H.B. No. 3433
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to level of care designations for hospitals that provide
  neonatal intensive care services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 241, Health and Safety Code, is amended
  by adding Subchapter H to read as follows:
  SUBCHAPTER H. HOSPITAL LEVEL OF CARE DESIGNATIONS FOR NEONATAL AND
  MATERNAL CARE NEONATAL INTENSIVE CARE UNITS
         Sec. 241.181.  DEFINITIONS. In this subchapter:
               (1)  "Department" means the Department of State Health
  Services.
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
         Sec. 241.182.  LEVEL OF CARE DESIGNATIONS.  (a)  The
  executive commissioner, in accordance with the rules adopted under
  Section 241.183, shall assign level of care designations to each
  hospital based on the neonatal and maternal neonatal intensive care
  services provided at the hospital.
         (b)  A hospital may receive different level designations for
  neonatal intensive care services. and maternal care, respectively.
         Sec. 241.183.  RULES.  (a)  The executive commissioner, in
  consultation with the department, shall adopt rules:
               (1)  establishing the levels of care for neonatal
  intensive care services. and maternal care to be assigned to
  hospitals;
               (2)  prescribing criteria for designating levels of
  neonatal intensive and maternal care, respectively, including
  specifying the minimum requirements to qualify for each level
  designation;
               (3)  establishing a process for the assignment of
  levels of care to a hospital for neonatal intensive care. and
  maternal care, respectively;
               (4)  establishing a process for amending the level of
  care designation requirements, including a process for assisting
  facilities in implementing any changes made necessary by the
  amendments;
               (5)  dividing the state into recommended neonatal and
  maternal care regions.
               (6)  facilitating transfer agreements through regional
  coordination for hospitals without transferring agreements in a
  manner that preserves historic or existing patient referral
  patterns;
               (7)  requiring payment, other than quality or
  outcome-based funding, to be based on services provided by the
  facility, regardless of the facility's level of care designation;
  and
               (8)  prohibiting the denial of a neonatal intensive
  care or maternal level of care designation to a hospital that meets
  the minimum requirements for that level of care designation.
         (b)  The criteria for levels one through three of neonatal
  intensive and maternal care adopted under Subsection (a)(2) may not
  include requirements related to the number of patients treated at a
  hospital.
         (c)  The Health and Human Services Commission shall study
  patient transfers that are not medically necessary but would be
  cost-effective. Based on the study under this subsection, if the
  executive commissioner determines that the transfers are feasible
  and desirable, the executive commissioner may adopt rules
  addressing those transfers.
         (d)  Each level of care designation must require a hospital
  to regularly submit outcome and other data to the department as
  required or requested.
         (e)  The criteria a hospital must achieve to receive each
  level of care designation must be posted on the department's
  Internet website.
         Sec. 241.185.  ASSIGNMENT OF LEVEL OF CARE DESIGNATION.  (a)  
  The executive commissioner, in consultation with the department,
  shall assign the appropriate level of care designation to each
  hospital that meets the minimum standards for that level of care.
  The executive commissioner shall evaluate separately the neonatal
  intensive care and maternal services provided at the hospital and
  assign the respective level of care designations accordingly.
         (b)  Every three years, the executive commissioner and the
  department shall review the level of care designations assigned to
  each hospital and, as necessary, assign a hospital a different
  level of care designation or remove the hospital's level of care
  designation.
         (c)  A hospital may request a change of designation at any
  time. On request under this subsection, the executive commissioner
  and the department shall review the hospital's request and, as
  necessary, change the hospital's level of care designation.
         Sec. 241.186.  HOSPITAL NOT DESIGNATED.  A hospital that
  does not meet the minimum requirements for any level of care
  designation for neonatal intensive care or maternal services:
               (1)  may not receive a level of care designation for
  those services; and
               (2)  is not eligible to receive reimbursement through
  the Medicaid program for neonatal intensive care or maternal
  services, as applicable, except emergency services required to be
  provided or reimbursed under state or federal law.
         Sec. 241.187.  PERINATAL ADVISORY COUNCIL.  (a)  In this
  section, "advisory council" means the Perinatal Advisory Council
  established under this section.
         (b)  The advisory council consists of 17 members appointed by
  the executive commissioner as follows:
               (1)  four physicians licensed to practice medicine
  under Subtitle B, Title 3, Occupations Code, specializing in
  neonatology:
                     (A)  at least two of whom practice in a Level III
  or IV neonatal intensive care unit; and
                     (B)  at least one of whom practices in a neonatal
  intensive care unit of a hospital located in a rural area;
               (2)  one physician licensed to practice medicine under
  Subtitle B, Title 3, Occupations Code, specializing in general
  pediatrics;
               (3)  two physicians licensed to practice medicine under
  Subtitle B, Title 3, Occupations Code, specializing in
  obstetrics-gynecology;
               (4)  two physicians licensed to practice medicine under
  Subtitle B, Title 3, Occupations Code, specializing in maternal
  fetal medicine;
               (5)  one physician licensed to practice medicine under
  Subtitle B, Title 3, Occupations Code, specializing in family
  practice who provides obstetrical care in a rural community;
               (6)  one registered nurse licensed under Subtitle E,
  Title 3, Occupations Code, with expertise in maternal health care
  delivery;
               (7)  one registered nurse licensed under Subtitle E,
  Title 3, Occupations Code, with expertise in perinatal health care
  delivery;
               (8)  one representative from a children's hospital;
               (9)  one representative from a hospital with a Level II
  neonatal intensive care unit;
               (10)  one representative from a rural hospital;
               (11)  one representative from a general hospital; and
               (12)  one ex officio representative from the office of
  the medical director of the Health and Human Services Commission.
         (c)  To the extent possible, the executive commissioner
  shall appoint members to the advisory council who previously served
  on the Neonatal Intensive Care Unit Council established under
  Chapter 818 (H.B. 2636), Acts of the 82nd Legislature, Regular
  Session, 2011.
         (d)  Members of the advisory council described by
  Subsections (b)(1)-(11) serve staggered three-year terms, with the
  terms of five or six of those members expiring September 1 of each
  year. A member may be reappointed to the advisory council.
         (e)  A member of the advisory council serves without
  compensation but is entitled to reimbursement for actual and
  necessary travel expenses related to the performance of advisory
  council duties.
         (f)  The department, with recommendations from the advisory
  council, shall develop a process for the designation and updates of
  levels of neonatal intensive and maternal care at hospitals in
  accordance with this subchapter.
         (g)  The advisory council shall:
               (1)  develop and recommend criteria for designating
  levels of neonatal intensive and maternal care, respectively,
  including specifying the minimum requirements to qualify for each
  level designation;
               (2)  develop and recommend a process for the assignment
  of levels of care to a hospital for neonatal intensive and maternal
  care, respectively;
               (3)  make recommendations for the division of the state
  into neonatal intensive and maternal care regions incorporating
  existing patient transfer patterns and agreements;
               (4)  examine utilization trends relating to neonatal
  intensive and maternal care; and
               (5)  make recommendations related to improving
  neonatal intensive care and maternal outcomes.
         (h)  In developing the criteria for the levels of neonatal
  intensive and maternal care, the advisory council shall consider:
               (1)  any recommendations or publications of the
  American Academy of Pediatrics and the American Congress of
  Obstetricians and Gynecologists, including "Guidelines for
  Perinatal Care";
               (2)  any guidelines developed by the Society of
  Maternal-Fetal Medicine; and
               (3)  the geographic and varied needs of citizens of
  this state.
         (i)  In developing the criteria for designating levels one
  through three of neonatal intensive and maternal care, the advisory
  council may not consider the number of patients treated at a
  hospital.
         (j)  The advisory council shall submit a report detailing the
  advisory council's determinations and recommendations to the
  department and the executive commissioner not later than September
  1, 2015 2016.
         (k)  The advisory council shall continue to update its
  recommendations based on any relevant scientific or medical
  developments.
         (l)  The advisory council is subject to Chapter 325,
  Government Code (Texas Sunset Act). Unless continued in existence
  as provided by that chapter, the advisory council is abolished and
  this section expires September 1, 2025.
         SECTION 2.  (a)  Not later than December 1, 2013, the
  executive commissioner of the Health and Human Services Commission
  shall appoint the members of the Perinatal Advisory Council as
  required by Section 241.187, Health and Safety Code, as added by
  this Act. Notwithstanding Section 241.187(d), Health and Safety
  Code, as added by this Act, the executive commissioner shall
  appoint:
               (1)  two members described by Section 241.187(b)(1),
  Health and Safety Code, one member described by Section
  241.187(b)(3), Health and Safety Code, and the members described by
  Sections 241.187(b)(6) and (9), Health and Safety Code, to an
  initial term that expires September 1, 2017;
               (2)  one member described by Section 241.187(b)(1),
  Health and Safety Code, one member described by Section
  241.187(b)(3), Health and Safety Code, one member described by
  Section 241.187(b)(4), Health and Safety Code, and the members
  described by Sections 241.187(b)(2), (7), and (10), Health and
  Safety Code, to an initial term that expires September 1, 2018; and
               (3)  one member described by Section 241.187(b)(1),
  Health and Safety Code, one member described by Section
  241.187(b)(4), Health and Safety Code, and the members described by
  Sections 241.187(b)(5), (8), and (11), Health and Safety Code, to
  an initial term that expires September 1, 2019.
         (b)  Not later than March 1, 2017 2018, after consideration
  of the report of the Perinatal Advisory Council, the executive
  commissioner of the Health and Human Services Commission shall
  adopt the initial rules required by Section 241.183, Health and
  Safety Code, as added by this Act.
         (c)  The executive commissioner of the Health and Human
  Services Commission shall complete for each hospital in this state:
               (1)  the neonatal level of care designation not later
  than August 31, 2017 2018.;and
               (2)     the maternal level of care designation not later
  than August 31, 2019.
         (d)  Notwithstanding Section 241.186, Health and Safety
  Code, as added by this Act:
               (1)  a hospital is not required to have a neonatal level
  of care designation as a condition of reimbursement for neonatal
  services through the Medicaid program before September 1, 2017
  2018.;and
               (2)  a hospital is not required to have a maternal level
  of care designation as a condition of reimbursement for maternal
  services through the Medicaid program before September 1, 2019.
         SECTION 3.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 4.  This Act takes effect September 1, 2015.