Case Information
*1 July 14, 1987 Iionorabl. Chet Brooks Opinion No. JM-746 Chairman Committee on Eealth and R.: Obstetrical and post-natal
Elman services services under the Indigent liaalth Texas State Senate Care Act
P. 0. Box 12068
Austin, Texas 78711
Dear Senator Brooks:
You ask several questions about the Indigent FIealth Care Ate [hereinafter the act]. article 443gf. V.T.C.S. See art. 443af. 91.02(10) (defining “public hospital”); see also Attorney General opinion m-626 (1987). Your first question is whether hospital is required to provide obstetrical and post-natal services eligible persons.
Public hospitals must provide, residents. Inpatient and outpatient services that a county is ropuired to provide indigents under section 3.01(a)(l) the act. See also art. $11.03(a) (a public hospital may provide required services 4430f. through other health-care providers); art. 4438f, 112.01 (a public is liable for required servicer provided by other entities). “inpatient end Section 3.01.(a)(l) requires that counties outpatient hospital services as limited by this title.” It does ndt list specific services. gather, Departmsnt of Realth is required V.T.C.S. ert. 4438f. 11.06(a). To to define the required services. fulfill obligation. the department has promulgated rules governing required inpatient and outpatient services. 40 T.A.C. 914.201(l). (2) (1986). Those rules are general, and do not list specific types of required medicel care. The rules do provide, however. that “msdicelly necessary” are required. 40 T.A.C. 914.201(l). Medically necessary for an eligible pregnant woman would unquestionably include some obstetrical and post-natal
1. A county subject to the act must provide not only and outpatient hospital services but also other services including physician services. Art. 443gf. $3.01.
p. 3467
Bouorable Chat Brooks - Page 2 (J&746)
services. See Final Report of the Tesk Force on Indigent Health Care (December 19m (indiceting that maternity care was one of the main concerns the task force); see also art. 4438f, 81.06(a) (department is to define services in accordance with department rules relating Medicaid progrsm): 40 T.A.C. 94.1804 (1985) (pregnint women who meet other applicable standards are eligible for Medicaid); V.T.C.8. art. 4447~ (Haternal and Infant Eealth Improvement Act). The dateruination of what specific services era medically necessary is a question of fact and cannot be resolved in the opinion process.
Your second question is: Does a public hospital thet provided obstet-
rical and post-natel s.rvic.s residents during the operating period ended prior January 1. 1985. violate section 11.01(b) of the act if does not continue thoss services? Section 11.01 of the ect provides, in part:
(a) Each public hospital shall provide the end outpatient services a county is required to provide under Subdivision (1) of Subsection (a) of Section 3.01 of this Act.
(b) If a public hospital provided edditionel health care services to eligible residents during the operating year that ended before January 1, 1985. the hospital shall continue to provide those s.rvic.s.
(c) public hospital may provide additional health care sarvices.
If the obstetrical and post-natal services in question were required under the Indigent Realth Care medically necessary Act, a public hospital would violate section 11.01(a), not section 11.01(b). if it discontinued provision of such services. If a public provided obstetrical end post-natal during operating year that ended before January 1. 1985. subsection (b) section 11.01 would require public hospital to continue to provide those services, even if those services would not otherwise be required under section 11.01(e) of the act.
Eionorable Chet Brooks - Page 3 (JM-746)
Your third question is:
Does section 13.02 of the act require a public to make public notice and hold a public hearing before the hospital can reduce the scope of its restrict eligibility or further for services?
Section 13.02 of the act provides:
(a) public hospital may not change its standards to make the standards more restrictive and may not reduce the health car. it offers unless it complies with
requirements of this section.
(b) Not later then the 90th dey before a change would the public hospital must take effect, publish notice of the proposed change in a newspaper of general circulation in the area served by the hospital and set a date for hearing on the change. The published notice must include the date. time. and place the public meeting. This notice does not replace the notice required by the open meetings law. Chapter 271, Acts the 60th Legislature. Regular Session, 1967 6252-17, Vernon's Texas Civil (Article Statutes).
(c) Not later than the 30th day before the date on which the change would take effect, the public shall conduct a public meeting to discuss change. The maeting shall be held et a convenient time in a convenient location within the area has e legal obligation serve. Members of the general public may testify at the meeting. *4 (JI-746)
Bonoreble Chet Brooks - Page 4 (0) The commissioners court, city council, or board of -gers or other governing body of the hospital must formally adopt the finding that the change does not have a detrimental impact on access to health care. (Bmphasis added).
Section 13.02 of the act sxplicitly requires a public hospital give notice and hold a public hearing before the hoapitel may reduce the services it offers or before the hospitel may make its eligibility standards more restrictive. In order reduce the appropriate governmental body must determine that "the change would not have a detrimentel impact on access to health care for the residents the hospital serves." V.T.C.S. art. 4438f. 813.02(d).
Also in regard to section 13.02. we caution its provisions do not allow a public hospital to make its eligibility standards more restrictive than those established by the Department of Health under section 1.06 of the act. Section 10.02(b) provides that a person is for assistance from if that persdn meets the basic income and resources requirements established by Departmane of Eealth under section 1.06 of the act or if that person meets a lass restrictive income and resources standard adopted by the Section 10.02(f) provides es follows: public hospital. public hospital may adopt a less restrictive
incoma end resources standard at any time. If because of a change in the income and resources requirements established by the department under Section 1.06 of this Act the standerd adopted by a becomes stricter than the requirements established by the department, shall change its stendard to et leest comply with the requirements established by the department.
The act does not permit a public hospital set standards that are more restrictive than those set by the Department of Health. if the Department of Eealth changes its standards to make them Also. less restrictive, a public hospical must also change its standards if they are more restrictive than the new standards established by the department. See Bill Analysis to S.B. No. 1, 69th Leg.. prepared for Senate Commit= on Eeelth and Buman Services, filed in Bill File S.B. No. 1, Legislative Reference Library (one purpose of Indigent Eealth Care Act was to define "indigency"). Thus, a public hospital may make its eligibility standards more restrictive in accordance with procedures set out in section 13.02 only if the new standards set are no more restrictive than those established by the Department of Health.
honorable Chet Brooks - Page 5 (JM-746)
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SUMHARY Under the Indigent Eealth Care Act, article 4438f. V.T.C.S.. a public hospitelmust residents madically secassary end outpatient health-care sarv1c.s. The determination of whet specific era medically necessary is a question fact. A public hospital must continue to provide services it provided during the operating year that ended before January 1, 1985. In order to reduce offers or make its -eligibility it standards more restrictive, a public hospital must give notice and hold hearing in accordance with section 13.02 the act.
Attorney General of Texas MARY KELLRR Executive Assistant Attorney General
JUDGE ZOLLIE STBABUT
Special Assistant Attorney Generel
RICII GILPIN
Chairman, Opinion Committee
Prepared by Sarah Woalk
Assistant Attorney General