CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT
HEALTH AND SAFETY CODE
TITLE 2. HEALTH
SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS
CHAPTER 32. MATERNAL AND INFANT HEALTH IMPROVEMENT
SUBCHAPTER A. PROGRAM FOR WOMEN AND CHILDREN
Sec. 32.001. SHORT TITLE. This chapter may be cited as the
Maternal and Infant Health Improvement Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.002. DEFINITIONS. (a) In this chapter:
(1) "Adolescent" means an individual younger than 18 years of
age.
(2) "Ancillary services" means services necessary to obtain
timely, effective, and appropriate maternal and infant health
improvement services, and includes prescription drugs, medical
social services, transportation, health promotion services, and
laboratory services.
(3) "Facility" includes a hospital, public health clinic,
birthing center, outpatient clinic, or community health center.
(4) "Infant care" means maternal and infant health improvement
services and ancillary services appropriate for an individual
from birth to 12 months of age.
(5) "Intrapartum care" means maternal and infant health
improvement services and ancillary services appropriate for a
woman, fetus, or infant during childbirth.
(6) "Maternal and infant health improvement services" means
services necessary to assure quality health care for women and
children.
(7) "Medical assistance program" means the program administered
by the single state agency under Title XIX of the Social Security
Act (42 U.S.C. Section 1396 et seq.).
(8) "Other benefit" means a benefit, other than a benefit
provided under this chapter, to which an individual is entitled
for payment of the costs of maternal and infant health
improvement services, ancillary services, educational services,
or transportation services, including benefits available from:
(A) an insurance policy, group health plan, or prepaid medical
care plan;
(B) Title XVIII of the Social Security Act (42 U.S.C. Section
1395 et seq.);
(C) the Veterans Administration;
(D) the Civilian Health and Medical Program of the Uniformed
Services;
(E) workers' compensation or any other compulsory employers'
insurance program;
(F) a public program created by federal or state law, other than
Title XIX of the Social Security Act (42 U.S.C. Section 1396 et
seq.), or by an ordinance or rule of a municipality or political
subdivision of the state, excluding benefits created by the
establishment of a municipal or county hospital, a joint
municipal-county hospital, a county hospital authority, a
hospital district, or the facilities of a publicly supported
medical school; or
(G) a cause of action for medical, facility, or medical
transportation expenses, or a settlement or judgment based on the
cause of action, if the expenses are related to the need for
services provided under this chapter.
(9) "Perinatal care" means maternal and infant health
improvement services and ancillary services that are appropriate
for women and infants during the perinatal period, which begins
before conception and ends on the infant's first birthday.
(10) "Postpartum care" means maternal and infant health
improvement services and ancillary services appropriate for a
woman following a pregnancy.
(11) "Preconceptional care" means maternal and infant health
improvement services and ancillary services appropriate for a
woman before conception that are provided with the intent of
planning and reducing health risks that might adversely affect
her pregnancies.
(12) "Prenatal care" means maternal and infant health
improvement services and ancillary services that are appropriate
for a pregnant woman and the fetus during the period beginning on
the date of conception and ending on the commencement of labor.
(13) "Program" means the maternal and infant health improvement
services program authorized by this chapter.
(14) "Provider" means a person who, through a grant or a
contract with the department or through other means approved by
the department, provides maternal and infant health improvement
services and ancillary services that are purchased by the
department for the purposes of this chapter.
(15) "Support" means the contribution of money or services
necessary for a person's maintenance, including food, clothing,
shelter, transportation, and health care.
(b) The board by rule may define a word or term not defined by
Subsection (a) as necessary to administer this chapter. The board
may not define a word or term so that the word or term is
inconsistent or in conflict with the purposes of this chapter, or
is in conflict with the definition and conditions of practice
governing a provider who is required to be licensed, registered,
certified, identified, or otherwise sanctioned under the laws of
this state.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 124, Sec. 2, eff. Sept. 1,
1995.
Sec. 32.003. MATERNAL AND INFANT HEALTH IMPROVEMENT SERVICES
PROGRAM. (a) The board may establish a maternal and infant
health improvement services program in the department to provide
comprehensive maternal and infant health improvement services and
ancillary services to eligible women and infants.
(b) If the program is established, the board shall adopt rules
relating to:
(1) the type, amount, and duration of services to be provided
under this chapter; and
(2) the determination by the department of the services needed
in each service area.
(c) If budgetary limitations exist, the board by rule shall
establish a system of priorities relating to the types of
services provided, geographic areas covered, or classes of
individuals eligible for services.
(d) The board shall adopt the rules according to a statewide
determination of the need for services.
(e) In structuring the program and adopting rules, the
department and board shall attempt to maximize the amount of
federal matching funds available for maternal and infant health
improvement services while continuing to serve targeted
populations.
(f) If necessary, the board by rule may coordinate services and
other parts of the program with the medical assistance program.
However, the board may not adopt rules relating to the services
under either program that would:
(1) cause the program established under this chapter not to
conform with federal law to the extent that federal matching
funds would not be available; or
(2) affect the status of the single state agency to administer
the medical assistance program.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 124, Sec. 3, eff. Sept. 1,
1995.
Sec. 32.005. ABORTION SERVICES RESTRICTED. Notwithstanding any
other provision of this chapter, funds administered under this
chapter may not be used to provide abortion services unless the
mother's life is in danger.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.006. ADMINISTRATION. (a) The board shall adopt rules
necessary to administer this chapter, and the department shall
administer the program in accordance with board rules.
(b) The department shall prescribe the design and content of all
necessary forms used in the program.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.011. DENIAL, MODIFICATION, SUSPENSION, OR TERMINATION OF
SERVICES. (a) The department may, for cause, deny, modify,
suspend, or terminate services to an individual eligible for or
receiving services after notice to the individual and an
opportunity for a hearing.
(b) The board by rule shall provide criteria for action by the
department under this section.
(c) Chapter 2001, Government Code, does not apply to the
granting, denial, modification, suspension, or termination of
services. The department shall conduct hearings in accordance
with the board's due process hearing rules.
(d) The department shall render the final administrative
decision in a due process hearing to deny, modify, suspend, or
terminate the receipt of services.
(e) The notice and hearing required by this section do not apply
if the department restricts program services to conform to
budgetary limitations that require the board to establish service
priorities.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(65), eff.
Sept. 1, 1995; Acts 1995, 74th Leg., ch. 124, Sec. 4, eff. Sept.
1, 1995.
Sec. 32.012. FINANCIAL ELIGIBILITY; OTHER BENEFITS. (a) The
department shall require an individual receiving services under
this chapter, or the person with a legal obligation to support
the individual, to pay for or reimburse the department for that
part of the cost of the services that the individual or person is
financially able to pay.
(b) Except as provided by board rules, an individual is not
eligible to receive services under this chapter to the extent
that the individual or a person with a legal obligation to
support the individual is eligible for some other benefit that
would pay for all or part of the services.
(c) When a determination of eligibility to receive maternal and
infant health improvement services is made under this chapter or
when the services are received, the individual requesting or
receiving services shall inform the department of any other
benefit to which the individual or a person with a legal
obligation to support the individual may be entitled.
(d) An individual who has received services that are covered by
some other benefit, or any other person with a legal obligation
to support that individual, shall reimburse the department to the
extent of the services provided when the other benefit is
received.
(e) The commissioner may waive enforcement of Subsections
(b)-(d) of this section as prescribed by board rules in certain
individually considered cases in which enforcement will deny
services to a class of otherwise eligible individuals because of
conflicting federal, state, or local laws or rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 124, Sec. 5, eff. Sept. 1,
1995.
Sec. 32.013. RECOVERY OF COSTS. (a) The department may recover
the cost of services provided under this chapter from a person
who does not reimburse the department as required by Section
32.012 or from any third party who has a legal obligation to pay
other benefits and to whom notice of the department's interest
has been given.
(b) At the request of the commissioner, the attorney general may
bring suit in the appropriate court of Travis County on behalf of
the department.
(c) In a judgment in favor of the department, the court may
award attorney's fees, court costs, and interest accruing from
the date on which the department provides the services to the
date on which the department is reimbursed.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.014. FEES. (a) Except as prohibited by federal law or
regulation, the board may charge fees for the services provided
directly by the department or through approved providers in
accordance with Subchapter D, Chapter 12.
(b) The board shall adopt standards and procedures to develop
and implement a schedule of allowable charges for program
services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.015. FUNDING. (a) Except as provided by this chapter
or by other law, the board may seek, receive, and spend funds
received through an appropriation, grant, donation, or
reimbursement from any public or private source to administer
this chapter.
(b) Notwithstanding other law, the department's authority to
spend funds appropriated for the program established by this
chapter is not affected by the amount of federal funds the
department receives.
(c) The department is not required to provide maternal and
infant health improvement services unless funds are appropriated
to the department to administer this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 124, Sec. 6, eff. Sept. 1,
1995.
Sec. 32.016. CONTRACTS. The department shall enter into
contracts and agreements or award grants necessary to facilitate
the efficient and economical provision of services under this
chapter, including contracts and grants for the purchase of
services, equipment, and supplies from approved providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.017. RECORDS AND REVIEW. (a) The department shall
require each provider receiving reimbursement under this chapter
to maintain records and information for each applicant for or
recipient of services.
(b) The board shall adopt rules relating to the information a
provider is required to report to the department and shall adopt
procedures to prevent unnecessary and duplicative reporting of
data.
(c) The department shall review records, information, and
reports prepared by program providers and shall annually prepare
a report for submission to the governor and the legislature
relating to the status of the program. The department shall make
the report available to the public.
(d) The report required under Subsection (c) must include:
(1) the number of individuals receiving care under this chapter;
(2) the total cost of the program, including a delineation of
the total administrative costs and the total cost for each
service authorized under Section 32.004(d);
(3) the average cost per recipient of services;
(4) the number of individuals who received services in each
public health region; and
(5) any other information required by the board.
(e) In computing the number of individuals to be reported under
Subsection (d)(1), the department shall ensure that no individual
is counted more than once.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.018. PROGRAM PLANS. (a) The department shall have a
long-range plan covering at least six years that includes at
least the following elements:
(1) quantifiable indicators of effort and success;
(2) identification of priority client population and the minimum
types of services necessary for that population;
(3) a description of the appropriate use of providers, including
the role of providers and considering the type, location, and
specialization of the providers;
(4) criteria for phasing out unnecessary services;
(5) a comprehensive assessment of needs and inventory of
resources; and
(6) coordination of administration and service provision with
federal, state, and local public and private programs that
provide similar services.
(b) The department shall revise the plan by January 1 of each
even-numbered year.
(c) The department shall develop a short-range plan that is
derived from the long-range plan and that identifies and projects
the costs relating to implementing the short-range plan.
(d) As part of the department's budget preparation process, the
department shall biennially assess its achievement of the goals
identified in each plan. The department's biennial budget shall
be made according to the results of the assessment and the
short-range plan. The department shall make its requests for new
program funding and for continued funding according to
demonstrated need.
(e) The department shall use the information collected under
Section 32.017 to develop the long-range and short-range plans.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 32.021. REQUIREMENTS REGARDING THE WOMEN, INFANTS AND
CHILDREN PROGRAM. (a) An agency, organization, or other entity
that contracts with the Special Supplemental Nutrition Program
for Women, Infants and Children shall each month provide the
clinical and nutritional services supported by that program
during extended hours, as defined by the department.
(b) Each agency, organization, or other entity that contracts
with the program to provide clinical or nutritional services
shall include in its annual plan submitted to the department a
plan to expand client access to services through extended hours,
the schedule for each site that provides services, and the
reasons for each site's schedule. An agency, organization, or
other entity that contracts with the program is not required to
offer extended hours at each of its service sites.
(c) The department shall adopt guidelines for extended hours and
waivers from the requirement of Subsection (a).
(d) To obtain a waiver, an agency, organization, or other entity
shall submit a written justification to the department explaining
the extraordinary circumstances involved and identifying the time
frame needed for their resolution.
(e) The department may not grant a waiver to an agency,
organization, or other entity for a period of more than two
years.
(f) If an agency, organization, or other entity required by this
section to maintain extended hours provides other maternal and
child health services, that entity shall also make those services
available during the extended hours.
Added by Acts 1993, 73rd Leg., ch. 328, Sec. 1, eff. Aug. 30,
1993. Amended by Acts 1997, 75th Leg., ch. 1317, Sec. 1, eff.
Sept. 1, 1997.
SUBCHAPTER B. PERINATAL HEALTH CARE SYSTEM
Sec. 32.041. LEGISLATIVE FINDINGS. (a) The legislature finds
that the perinatal period beginning before conception and
continuing through the first year of life poses unique challenges
for the health care system. The development of a coordinated,
cooperative system of perinatal health care within a geographic
area will reduce unnecessary mortality and morbidity for women
and infants.
(b) In order to improve the health of women and infants, it is
necessary to promote health education, to provide assurance of
reasonable access to safe and appropriate perinatal services, and
to improve the quality of perinatal care by encouraging optimal
use of health care personnel.
Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,
1995.
Sec. 32.042. DUTIES OF BOARD; RULES. (a) The board by rule
shall adopt:
(1) minimum standards and objectives to implement voluntary
perinatal health care systems; and
(2) policies for health promotion and education, risk
assessment, access to care, and perinatal system structure,
including the transfer and transportation of pregnant women and
infants.
(b) The rules must:
(1) reflect all geographic areas of the state, considering time
and distance;
(2) provide specific requirements for appropriate care of
perinatal patients; and
(3) facilitate coordination among all perinatal service
providers and health care facilities in the delivery area.
(c) The rules must include:
(1) risk reduction guidelines for preconceptional, prenatal,
intrapartum, postpartum, and infant care, including guidelines
for the transfer and transportation of perinatal patients;
(2) criteria for determining geographic boundaries of perinatal
health care systems;
(3) minimum requirements of health promotion and education, risk
assessment, access to care, and coordination of services that
must be present in a perinatal health care system;
(4) minimum requirements for resources and equipment needed by a
health care facility to treat perinatal patients;
(5) standards for the availability and qualifications of the
health care personnel treating perinatal patients in a facility;
(6) requirements for data collection, including operation of the
perinatal health care system and patient outcomes;
(7) requirements for periodic performance evaluation of the
system and its components; and
(8) assurances that health care facilities will not refuse to
accept the transfer of a perinatal patient solely because of the
person's inability to pay for services or because of the person's
age, sex, race, religion, or national origin.
Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,
1995.
Sec. 32.043. DUTIES OF DEPARTMENT. The department shall:
(1) develop and monitor a statewide network of voluntary
perinatal health care systems;
(2) develop and maintain a perinatal reporting and analysis
system to monitor and evaluate perinatal patient care in the
perinatal health care systems in this state; and
(3) provide for coordination and cooperation in this state and
among this state and adjoining states.
Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,
1995.
Sec. 32.044. SYSTEM REQUIREMENTS. (a) Each voluntary perinatal
health care system must have:
(1) a coordinating board responsible for ensuring, providing, or
coordinating planning access to services, data collection, and
provider education;
(2) access to appropriate emergency medical services;
(3) risk assessment, transport, and transfer protocols for
perinatal patients;
(4) one or more health care facilities categorized according to
perinatal care capabilities using standards adopted by board
rule; and
(5) documentation of broad-based participation in planning by
providers of perinatal services and community representatives
throughout the defined geographic region.
(b) This subchapter does not prohibit a health care facility
from providing services that it is authorized to provide under a
license issued to the facility by the department.
Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,
1995.
Sec. 32.045. GRANT PROGRAM. (a) The department may establish a
program to award grants to initiate, expand, maintain, and
improve voluntary perinatal health care systems.
(b) The board by rule shall establish eligibility criteria for
awarding the grants. The rules must require the department to
consider:
(1) the need of an area and the extent to which the grant would
meet the identified need;
(2) the availability of personnel and training programs;
(3) the availability of other funding sources;
(4) the assurance of providing quality services;
(5) the need for emergency transportation of perinatal patients
and the extent to which the system meets the identified needs;
and
(6) the stage of development of a perinatal health care system.
(c) The department may approve grants according to rules adopted
by the board. A grant awarded under this section is governed by
Chapter 783, Government Code, and rules adopted under that
chapter.
Added by Acts 1995, 74th Leg., ch. 124, Sec. 7, eff. Sept. 1,
1995.