Health and Safety Code
SUBTITLE C. INDIGENT HEALTH CARE
CHAPTER 61. INDIGENT HEALTH CARE AND TREATMENT ACT
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 61.001. Short Title.
This chapter may be cited as the Indigent Health Care and
Treatment Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.002. Definitions.
In this chapter:
(1) "AFDC" means the Aid to Families with Dependent Children
program administered by the Texas Department of Human Services
under Chapter 31, Human Resources Code.
(2) "Department" means the Texas Department of Health.
(3) "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.
(4) "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.
(5) "Emergency services" has the meaning assigned by Chapter
773.
(6) "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.
(7) "Governmental entity" includes a county, municipality,
or other political subdivision of the state, but does not
include a hospital district or hospital authority.
(8) "Hospital district" means a hospital district created
under the authority of Article IX, Sections 4-11, of the Texas
Constitution.
(9) "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.
(10) "Medicaid" means the medical assistance program
provided under Chapter 32, Human Resources Code.
(11) "Public hospital" means a hospital owned, operated, or
leased by a governmental entity, except as provided by Section
61.051.
(12) "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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 14, eff. Sept. 1,
1991.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.119, eff. Sept.
1, 1995.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.004. Residence Dispute.
(a) If a provider of assistance and a governmental entity or
hospital district cannot agree on a person's residence, 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.
(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 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 21st 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff.
Sept. 1, 1995.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.006. Standards and Procedures.
(a) The department shall establish eligibility standards and
application, documentation, and verification procedures for
counties to use in determining eligibility under this chapter.
The standards and procedures must be consistent with the
standards and procedures used by the Texas Department of Human
Services to determine eligibility in the AFDC-Medicaid program.
The department shall also define the services and establish the
payment standards for the categories of services listed in
Section 61.028(a) in accordance with Texas Department of Human
Services rules relating to the AFDC-Medicaid program.
(b) The department may simplify the AFDC-Medicaid standards and
procedures used by the Texas Department of Human Services as
necessary to provide efficient county administration. In
establishing simplified standards and procedures for county
administration, the department may not adopt a standard or
procedure that is more restrictive than the AFDC-Medicaid
standards or procedures.
(c) The department shall ensure that each person who meets the
basic income and resources requirements for AFDC payments but who
is categorically ineligible for AFDC will be eligible for
assistance under Subchapter B. The department by rule shall also
provide that a person who receives or is eligible to receive
AFDC, SSI, 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 AFDC, SSI, or Medicaid benefits.
(d) The department shall notify each county and public hospital
of any change to AFDC or Medicaid guidelines that affect the
provision of services under this chapter and shall amend the
rules adopted under this chapter to reflect the changes made in
the AFDC or Medicaid programs.
(e) Notwithstanding Subsection (a) or any other provision of
law, the department shall permit payment to a licensed dentist
for services provided under Sections 61.028(a)(3) and (a)(5) to
the extent that these services are required by Section
61.028(a)(5) if the dentist can provide those services within the
scope of the dentist's license.
(f) Notwithstanding Subsection (a), the department shall permit
payment to a licensed podiatrist for services provided under
Sections 61.028(a)(3) and (a)(5) to the extent that the services
are required by Section 61.028(a)(5), if the podiatrist can
provide the services within the scope of the podiatrist's
license.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.09(a), eff.
Sept. 1, 1989; Acts 1991, 72nd Leg., ch. 14, Sec. 15, eff. Sept.
1, 1991.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.120, eff. Sept.
1, 1995.
Sec. 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 AFDC, SSI, 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 AFDC, SSI, 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.121, eff. Sept.
1, 1995.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
SUBCHAPTER B. COUNTY RESPONSIBILITY FOR PERSONS NOT RESIDING IN
AN AREA
SERVED BY A PUBLIC HOSPITAL OR HOSPITAL DISTRICT
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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).
(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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.10(a), eff.
Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 Sections 61.006
and 61.008 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1997, 75th Leg., ch. 1103, Sec. 1, eff. Sept. 1,
1997.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.028. Mandatory Health Care Services.
(a) A county shall, in accordance with department rules adopted
under Section 61.006, provide:
(1) inpatient and outpatient hospital services;
(2) rural health clinics;
(3) laboratory and X-ray services;
(4) family planning services;
(5) physician services;
(6) payment for not more than three prescription drugs a
month; and
(7) 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.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 as soon as possible after the provider
determines the patient's county of residence; and
(2) by mail postmarked not later than the third 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 as soon as possible after the provider
determines the patient's county of residence; and
(2) by mail postmarked not later than the third 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, 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.034. Payment Standards for Mandatory Health Care Services.
(a) A county is not liable for the cost of a mandatory health
care service 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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) 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1989, 71st Leg., ch. 1100, Sec. 5.10(b), eff.
Sept. 1, 1989.
Sec. 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 mandatory health care services to their eligible county
residents.
(b) Except as provided by Subsection (c), (d), or (e), to be
eligible for state assistance, a county must:
(1) spend in a state fiscal year at least 10 percent of the
county general revenue levy for that year to provide mandatory
health care services to its eligible county residents who
qualify for assistance under Section 61.006; 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 eight percent of the
applicable county general revenue levy for that year to provide
mandatory health care services to its eligible county residents
who qualify for assistance under Section 61.006.
(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 10
percent of the county general revenue levy for that year
resulting from the property located outside the hospital
district to provide mandatory health care services to its
eligible county residents who qualify for assistance under
Section 61.006; and
(2) the county complies with the other requirements of this
subchapter.
(e) A county that provides mandatory 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 is eligible for state assistance if:
(1) the county spends in a state fiscal year at least 10
percent of the county general revenue levy for the year to
provide mandatory health care services to its eligible county
residents who qualify for assistance under Section 61.006; and
(2) the county complies with the requirements of this
subchapter.
(f) If a county anticipates that it will reach the 10 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 county must give the department all necessary
information so that the department can determine if the county
meets the requirements of Subsection (b), (d), or (e).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1997, 75th Leg., ch. 651, Sec. 1, eff. June 11,
1997.
Sec. 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 mandatory health care services to its eligible county
residents who qualify for assistance under Section 61.006.
(b) State funds provided under this section to a county must be
equal to at least 80 percent of the actual payment for mandatory
health care services for the county's eligible residents during
the remainder of the state fiscal year after the 10 percent
expenditure level is reached.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 10 percent
expenditure level.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., 2nd C.S., ch. 6, Sec. 64, eff.
Sept. 1, 1991.
Sec. 61.041. County Reporting.
(a) The department shall establish 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 mandatory health care services.
(c) The department may audit county records to determine if the
county is eligible for state assistance.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1,
1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 8.122, eff.
Sept. 1, 1995.
Sec. 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, Sec. 1, eff. Sept. 1,
1993.
Sec. 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, Sec. 1, eff. Sept. 1,
1993.
SUBCHAPTER C. PERSONS WHO RESIDE IN AN AREA SERVED BY A PUBLIC
HOSPITAL
OR HOSPITAL DISTRICT
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 16, eff. Sept. 1,
1991.
Sec. 61.052. General Eligibility Provisions.
(a) A public hospital 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 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 becomes
stricter than the requirements established by the department, the
hospital shall change its standard to at least comply with the
requirements established by the department.
(f) A public hospital may contract with the department to
perform eligibility determination services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.054. Mandatory Health Care Services Provided by a Public Hospital.
(a) A public hospital shall provide the inpatient and
outpatient hospital services a county is required to provide
under Section 61.028(a)(1).
(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 may provide additional health care
services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 61.055. Services Provided by Hospital Districts.
A hospital district shall provide the health care services
required under the Texas Constitution and the statute creating
the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 as soon as possible after the provider
determines that the patient resides in the hospital's service
area; and
(2) by mail postmarked not later than the third 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 as soon as possible after the provider
determines that the patient resides in the hospital's service
area; and
(2) by mail postmarked not later than the third 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, 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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 mandatory health care assistance.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(82), eff.
Sept. 1, 1995.
Sec. 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 mandatory health care
assistance 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, Sec. 1, eff. Sept. 1, 1989.
Sec. 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, Sec. 5.10(c), eff. Sept.
1, 198