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 a public
hospital is required to provide obstetrical and post-natal services to
eligible persons.
Public hospitals must provide, to eligible residents. the
Inpatient and outpatient services that a county is ropuired to provide
to indigents under section 3.01(a)(l) of the act. See also art.
4430f. $11.03(a) (a public hospital may provide required services
through other health-care providers); art. 4438f, 112.01 (a public
hospital is liable for required servicer provided by other entities).
Section 3.01.(a)(l) requires that counties provide “inpatient end
outpatient hospital services as limited by this title.” It does ndt
list specific services. gather, the Departmsnt of Realth is required
to define the required services. V.T.C.S. ert. 4438f. 11.06(a). To
fulfill that obligation. the department has promulgated rules
governing required inpatient and outpatient hospital 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” services are required. 40 T.A.C.
914.201(l). Medically necessary services for an eligible pregnant
woman would unquestionably include some obstetrical and post-natal
1. A county subject to the act must provide not only inpatient
and outpatient hospital services but also other services including
physician services. Art. 443gf. $3.01.
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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 of the task force); see also art. 4438f, 81.06(a) (department
is to define services in accordance with department rules relating to
Medicaid progrsm): 40 T.A.C. 94.1804 (1985) (pregnint women who meet
other applicable eligibility 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 to eligible
residents during the operating period that ended
prior to January 1. 1985. violate section 11.01(b)
of the act if the hospital does not continue to
provide thoss services?
Section 11.01 of the ect provides, in part:
(a) Each public hospital shall provide the
inpatient end outpatient hospital 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) A public hospital may provide additional
health care sarvices.
If the obstetrical and post-natal services in question were
medically necessary services required under the Indigent Realth Care
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
hospital provided obstetrical end post-natal services during the
operating year that ended before January 1. 1985. subsection (b) of
section 11.01 would require the 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.
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Eionorable Chet Brooks - Page 3 (JM-746)
Your third question is:
Does section 13.02 of the act require a public
hospital to make public notice and hold a public
hearing before the hospital can reduce the scope
of its services or further restrict eligibility
for services?
Section 13.02 of the act provides:
(a) A public hospital may not change its
eligibility standards to make the standards more
restrictive and may not reduce the health car.
services it offers unless it complies with the
requirements of this section.
(b) Not later then the 90th dey before a change
would take effect, the public hospital must
publish notice of the proposed change in a
newspaper of general circulation in the area
served by the hospital 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. This notice does not replace the notice
required by the open meetings law. Chapter 271,
Acts of the 60th Legislature. Regular Session,
1967 (Article 6252-17, Vernon's Texas Civil
Statutes).
(c) Not later than the 30th day before the date
on which the change would take effect, the public
hospital shall conduct a public meeting to discuss
the change. The maeting shall be held et a
convenient time in a convenient location within
the area the hospital has e legal obligation to
serve. Members of the general public may testify
at the meeting.
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Bonoreble Chet Brooks - Page 4 (JI-746)
(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 to
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 to reduce services 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 that 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
eligible for assistance from a public hospital if that persdn meets
the basic income and resources requirements established by the
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
public hospital. Section 10.02(f) provides es follows:
A 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
hospital becomes stricter than the requirements
established by the department, the hospital shall
change its stendard to et leest comply with the
requirements established by the department.
The act does not permit a public hospital to set eligibility standards
that are more restrictive than those set by the Department of Health.
Also. if the Department of Eealth changes its standards to make them
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 to
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
the 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.
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honorable Chet Brooks - Page 5 (JM-746)
n
SUMHARY
Under the Indigent Eealth Care Act, article
4438f. V.T.C.S.. a public hospitelmust provide to
eligible residents madically secassary inpatient
end outpatient health-care sarv1c.s. The
determination of whet specific services era
medically necessary is a question of 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 the
services it offers or to make its -eligibility
standards more restrictive, a public hospital must
give notice and hold a public hearing in
accordance with section 13.02 of the act.
Attorney General of Texas
MARY KELLRR
Executive Assistant Attorney General
JUDGEZOLLIE STBABUT
Special Assistant Attorney Generel
RICII GILPIN
Chairman, Opinion Committee
Prepared by Sarah Woalk
Assistant Attorney General
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