CHAPTER 281. HOSPITAL DISTRICTS IN COUNTIES OF AT LEAST 190,000
HEALTH AND SAFETY CODE
TITLE 4. HEALTH FACILITIES
SUBTITLE D. HOSPITAL DISTRICTS
CHAPTER 281. HOSPITAL DISTRICTS IN COUNTIES OF AT LEAST 190,000
SUBCHAPTER A. CREATION OF DISTRICT
Sec. 281.001. DEFINITIONS. In this chapter:
(1) "Board" means the board of hospital managers of a district.
(2) "District" means a hospital district created under this
chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.002. DISTRICT AUTHORIZATION. (a) A county with at
least 190,000 inhabitants that does not own or operate a hospital
system for indigent or needy persons may create a countywide
hospital district and provide for the establishment of a hospital
or hospital system to furnish medical aid and hospital care to
indigent and needy persons residing in the district.
(b) A county with at least 190,000 inhabitants that owns and
operates a hospital or hospital system for indigent or needy
persons, separately or jointly with a municipality, may create a
countywide hospital district and take over the hospital or
hospital system to furnish medical aid and hospital care to
indigent and needy persons residing in the district.
(c) A county with at least 190,000 inhabitants that has within
its boundaries a municipality that owns a hospital or hospital
system for indigent or needy persons that is operated by or on
behalf of the municipality may create a countywide hospital
district to assume ownership of the hospital or hospital system
and to furnish medical aid and hospital care to indigent and
needy persons residing in the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.208, eff. Sept.
1, 2003.
Sec. 281.003. CREATION ELECTION REQUIRED. (a) The district may
be created only if the creation is approved by a majority of the
qualified voters of the county in which the proposed district is
to be located who vote at an election called and held for that
purpose.
(b) The commissioners court may order a creation election to be
held on its own motion and shall order the election on the
presentation of a petition for a creation election signed by at
least 100 qualified property taxpaying voters of the county.
(c) The election shall be held on the first authorized uniform
election date prescribed by the Election Code that allows
sufficient time to comply with other requirements of law.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.004. BALLOT PROPOSITIONS. (a) Except as provided by
Subsection (a-1) or (b), the ballot for an election under this
chapter shall be printed to provide for voting for or against the
proposition: "The creation of a hospital district and the levy of
a tax not to exceed 75 cents on each $100 of the taxable value of
property taxable by the district."
(a-1) The ballot for an election under this chapter held in a
county with a population of more than 800,000 that is not
included in the boundaries of a hospital district before
September 1, 2003, shall be printed to provide for voting for or
against the proposition: "The creation of a hospital district and
the levy of a tax not to exceed 25 cents on each $100 of the
taxable value of property taxable by the district."
(b) If the county or a municipality in the county has any
outstanding bonds issued for hospital purposes, the ballot for an
election under this chapter shall contain the proposition
prescribed by Subsection (a) or (a-1), as appropriate, followed
by ", and the assumption by the district of all outstanding bonds
previously issued for hospital purposes by __________ County and
by any municipality in the county."
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.209, eff. Sept.
1, 2003.
SUBCHAPTER B. DISTRICT ADMINISTRATION
Sec. 281.021. APPOINTMENT OF BOARD. (a) The commissioners
court of a county in which a district is created under this
chapter shall appoint a board of hospital managers composed of
not less than five or more than seven members.
(b) The commissioners court of a county with a population of
more than 1.4 million but less than 1.5 million in which a
district is created under this chapter shall appoint a board
composed of not less than five or more than 15 members.
(c) The Harris County Commissioners Court shall appoint a board
composed of not less than seven or more than nine members.
(d) If a district is created under this chapter in a county with
a population of more than 800,000 that was not included in the
boundaries of a hospital district before September 1, 2003, the
district shall be governed by a nine-member board of hospital
managers, appointed as follows:
(1) the commissioners court of the county shall appoint four
members;
(2) the governing body of the municipality with the largest
population in the county shall appoint four members; and
(3) the commissioners court and the governing body of the
municipality described by Subdivision (2) shall jointly appoint
one member.
(e) The El Paso County Commissioners Court shall appoint a board
composed of seven members.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 597, Sec. 72, eff. Sept. 1,
1991; Acts 2001, 77th Leg., ch. 669, Sec. 36, eff. Sept. 1, 2001;
Acts 2003, 78th Leg., ch. 198, Sec. 2.210, eff. Sept. 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
206, Sec. 1, eff. September 1, 2009.
Sec. 281.022. TERM. (a) A board member serves a two-year term,
except that the commissioners court may make some initial
appointments for one year in order to stagger terms.
(b) The members of the board of hospital managers of the Nueces
County Hospital District serve staggered three-year terms, with
as near as possible to one-third of the members' terms expiring
each year.
(c) The members of a board of hospital managers appointed under
Section 281.021(d) serve staggered four-year terms, with as near
as possible to one-fourth of the members' terms expiring each
year. The terms of the members appointed under that section are
as follows:
(1) the members appointed solely by the governing body of the
municipality with the largest population in the county shall draw
lots to determine which member serves a one-year term, which
member serves a two-year term, which member serves a three-year
term, and which member serves a four-year term;
(2) the members appointed solely by the commissioners court of
the county shall draw lots to determine which member serves a
one-year term, which member serves a two-year term, which member
serves a three-year term, and which member serves a four-year
term; and
(3) the member appointed jointly by the governing body of the
municipality described by Subdivision (1) and the commissioners
court serves a four-year term.
(d) The members of the board of hospital managers of the El Paso
County Hospital District serve staggered three-year terms, with
as near as possible to one-third of the members' terms expiring
each year.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 212, Sec. 1, eff. Sept. 1,
1995; Acts 2003, 78th Leg., ch. 198, Sec. 2.211, eff. Sept. 1,
2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
206, Sec. 2, eff. September 1, 2009.
Sec. 281.0221. TERM LIMIT. A member of the board of hospital
managers of the El Paso County Hospital District may not serve
more than two consecutive three-year terms and is not eligible
for reappointment to the board until the second anniversary of
the date the member's eligibility expires under this section.
Added by Acts 2009, 81st Leg., R.S., Ch.
206, Sec. 3, eff. September 1, 2009.
Sec. 281.023. OFFICERS. (a) The board shall elect from among
its members:
(1) a chairman; and
(2) a vice-chairman to preside in the chairman's absence.
(b) The board shall appoint a board member or the administrator
to serve as secretary.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.024. COMPENSATION. A board member serves without
compensation.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.025. RECORD OF BOARD MEETING. (a) The board shall
require the secretary to keep a suitable record of each board
meeting.
(b) The presiding member shall read and sign the record after
the meeting, and the secretary shall attest to the record.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.026. ADMINISTRATOR; DUTIES. (a) The board shall
appoint a person qualified by training and experience as the
administrator for the district.
(b) The administrator serves at the will of the board and for
terms of not more than four years.
(c) The administrator is entitled to compensation as determined
by the board.
(d) Before assuming duties, the administrator shall execute a
bond payable to the district in the amount of not less than
$10,000, conditioned on the faithful performance of the
administrator's duties and any other requirements determined by
the board.
(e) Subject to the limitations prescribed by the board, the
administrator shall:
(1) perform duties required by the board;
(2) supervise the work and activities of the district; and
(3) generally direct the affairs of the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by:
Acts 2005, 79th Leg., Ch.
424, Sec. 1, eff. June 17, 2005.
Sec. 281.027. ASSISTANT ADMINISTRATOR. (a) If the
administrator is incapacitated, absent, or unable to perform the
administrator's duties, the board may designate an assistant
administrator to perform any of the administrator's powers or
duties, subject to limitations prescribed by board order.
(b) The assistant administrator or other persons shall execute a
bond as required by board order.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.028. STAFF. (a) The board may appoint doctors to the
district's staff and hire technicians, nurses, and other
employees the board considers advisable for the district's
efficient operation.
(b) An employment contract of a person appointed or hired under
this section may not exceed four years.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 110, Sec. 1, eff. Aug. 26,
1991.
Sec. 281.0281. EMPLOYMENT OF HEALTH CARE PROVIDERS. (a) This
section applies only to a district created in a county with a
population of more than 800,000 that was not included in the
boundaries of a hospital district before September 1, 2003.
(b) The board, as it considers necessary for the efficient
operation of the district, may employ:
(1) physicians as provided in this section and Sections
162.001(c-4) and (c-5), Occupations Code; and
(2) dentists or other health care providers.
(c) The board may employ a licensed physician as a medical
director if the physician:
(1) provides only policy, administrative, and managerial
services; and
(2) does not provide direct patient care or otherwise practice
medicine, as defined by Section 151.002, Occupations Code, at or
for the district.
(d) This section does not authorize the board to supervise or
control the practice of medicine or permit the unauthorized
practice of medicine, as prohibited by Subtitle B, Title 3,
Occupations Code.
Added by Acts 2007, 80th Leg., R.S., Ch.
164, Sec. 4, eff. September 1, 2007.
Sec. 281.0282. DALLAS COUNTY HOSPITAL DISTRICT; EMPLOYMENT OF
HEALTH CARE PROVIDERS AND PHYSICIANS. (a) The board of the
Dallas County Hospital District may appoint, contract for, or
employ physicians, dentists, and other health care providers as
the board considers necessary for the efficient operation of the
district.
(b) The term of an employment contract entered into under this
section may not exceed four years.
(c) This section may not be construed as authorizing the board
of the Dallas County Hospital District to supervise or control
the practice of medicine, as prohibited by Subtitle B, Title 3,
Occupations Code.
(d) The authority granted to the board of the Dallas County
Hospital District under Subsection (a) to employ physicians shall
apply only as necessary for the district to fulfill the
district's statutory mandate to provide medical and dental care
for the indigent and needy residents of the district as provided
by Section 281.046.
(e) The Dallas County Hospital District shall establish a
committee consisting of at least five actively practicing
physicians who provide care in the district. The committee shall
approve existing policies or adopt new policies, if no policies
exist, to ensure that a physician who is employed by the district
is exercising the physician's independent medical judgment in
providing care to patients.
(f) The chair of the committee must be a member of the executive
committee of the Dallas County Hospital District's medical staff.
(g) The policies adopted or approved by the committee shall
include policies relating to credentialing, quality assurance,
utilization review, peer review, medical decision-making,
governance of the committee, and due process.
(h) Each member of a committee shall provide biennially to the
chief medical officer of the Dallas County Hospital District a
signed, verified statement indicating that the committee member:
(1) is licensed by the Texas Medical Board;
(2) will exercise independent medical judgment in all committee
matters, including matters relating to credentialing, quality
assurance, utilization review, peer review, medical
decision-making, and due process;
(3) will exercise the committee member's best efforts to ensure
compliance with the Dallas County Hospital District's policies
that are adopted or established by the committee; and
(4) will report immediately to the Texas Medical Board any
action or event that the committee member reasonably and in good
faith believes constitutes a compromise of the independent
medical judgment of a physician in caring for a patient.
(i) The committee shall adopt rules requiring the disclosure of
financial conflicts of interest by a committee member.
(j) For all matters relating to the practice of medicine, each
physician employed by the board shall ultimately report to the
chief medical officer of the Dallas County Hospital District.
Added by Acts 2009, 81st Leg., R.S., Ch.
823, Sec. 1, eff. June 19, 2009.
Sec. 281.029. RETIREMENT PROGRAMS. (a) With the approval of
the commissioners court, the board may contract with the state or
the federal government as necessary to establish or continue a
retirement program for the benefit of district employees.
(b) In addition to the retirement programs authorized by
Subsection (a), the board may establish a retirement program the
board considers necessary and advisable for the benefit of
district employees.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.030. SEAL. The board shall have a seal engraved with
the district's name. The seal shall be kept by the secretary and
used to authenticate the board's acts.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.031. REMOVAL OF BOARD MEMBER. (a) A member of the
board of hospital managers of the El Paso County Hospital
District is considered to have resigned the member's position if
the member:
(1) is absent from all the regularly scheduled board and
committee meetings that the member is eligible to attend during a
90-day period; or
(2) is absent from more than half of the regularly scheduled
board and committee meetings that the member is eligible to
attend during a 12-month period.
(b) A resignation under Subsection (a) is effective immediately
on the date the absence or refusal prescribed by Subsection (a)
occurs.
Added by Acts 2009, 81st Leg., R.S., Ch.
206, Sec. 3, eff. September 1, 2009.
SUBCHAPTER C. GENERAL POWERS AND DUTIES
Sec. 281.041. TRANSFER OF COUNTY AND MUNICIPAL HOSPITAL PROPERTY
AND FUNDS. (a) Except as provided by Subsection (e), on the
creation of a district under this chapter and the appointment and
qualification of the district board, the county owning the
hospital or hospital system, the county and municipality jointly
operating a hospital or hospital system, or the municipality
owning a hospital or hospital system shall execute and deliver to
the district board a written instrument conveying to the district
the title to land, buildings, and equipment jointly or separately
owned by the county and municipality and used to provide medical
services or hospital care, including geriatric care, to indigent
or needy persons of the county or municipality.
(b) On the creation of a district under this chapter and the
appointment and qualification of the district board, the county
owning the hospital or hospital system, the county and
municipality jointly operating a hospital or hospital system, or
the municipality owning a hospital or hospital system shall, on
the receipt of a certificate executed by the board's chairman
stating that a depository for the district has been chosen and
qualified, transfer to the district:
(1) all joint or separate county and municipal funds that are
the proceeds of any bonds assumed by the district under Section
281.044; and
(2) all unexpended joint or separate county and municipal funds
that have been established or appropriated by the county or
municipality to support and maintain the hospital facilities for
the year in which the district is created, to be used by the
district to operate and maintain those facilities for the
remainder of the year.
(c) Funds transferred to the district under this section may be
used only for a purpose for which the county or the municipality
that transferred the funds could lawfully have used the funds if
the funds had remained the property and funds of the county or
municipality.
(d) On the creation of the district, the board of managers of
the county or municipal hospital system shall continue to manage
and control the property and affairs of that system until the
board of the district is appointed and organized. At that time,
the county or municipal board of managers shall transfer to the
district board all county and municipal hospital system records,
property, and affairs and shall cease to exist.
(e) A county or municipality transferring property or funds
under this section is not required to transfer to the district:
(1) a medical facility used primarily for the treatment of
inmates of a jail or any other correctional facilities, including
juvenile justice facilities;
(2) property owned by the municipality that is used in
connection with the provision of utility services, including
electricity, water, wastewater, and sewer services;
(3) any real property or other assets related to a medical
clinic facility on which construction has begun, but has not been
completed, by the date on which the board members have been
appointed and qualified to serve;
(4) a building and related land owned by the county or
municipality that are used for purposes related or unrelated to
the hospital or hospital system, except that:
(A) if the county or municipality retains ownership of the
building and related land, the county or municipality shall lease
the space used for hospital or hospital system purposes to the
district for an initial term of three years unless a shorter term
is otherwise agreed to by the district and the transferring
entity; or
(B) if the county or municipality transfers the building and
related land to the district, the district shall lease to the
transferring entity the space not used for hospital or hospital
system purposes for an initial term of three years unless a
shorter term is otherwise agreed to by the district and the
transferring entity;
(5) any or all of the public health services and related
facilities of the county or municipality, other than a hospital
or hospital district, unless the transfer of the public health
services or a related facility to the district is mutually agreed
to by the district and the transferring entity; or
(6) an ambulance service, emergency medical service, search and
rescue service, or medical transport service that is owned or
operated by the county or municipality, unless the transfer of
all or part of the service and related buildings and equipment to
the district is mutually agreed to by the district and the
transferring entity.
(f) A transfer of an asset under this section, including a
federally qualified health center, that would violate federal or
state law unless a waiver or other authorization or approval is
granted by a federal or state agency may not occur until the
required waiver, authorization, or approval is obtained. A
facility designated as a federally qualified health center under
42 U.S.C. Section 1396d(l)(2)(B), as amended, may not be
transferred to the district until the district board has
confirmed that the transfer will not jeopardize the federal
designation of that facility.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.212, eff. Sept.
1, 2003.
Sec. 281.042. RETURN OF TRANSFERRED PROPERTY TO COUNTY OR
MUNICIPALITY. (a) The board by deed may transfer to the county
or a municipality any property that:
(1) was transferred to the district by that county or
municipality under Section 281.041; and
(2) the board considers is not and will not be useful for the
purposes for which the property was originally transferred to the
district.
(b) The transfer may be made on terms determined suitable by the
board and the commissioners court.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.043. ASSUMPTION OF CONTRACT OBLIGATIONS. On the
creation of the district, the district assumes, without prejudice
to the rights of third parties, any outstanding contract
obligations legally incurred by the county or municipality, or
both, for the construction, support, maintenance, or operation of
hospital facilities and the provision of health care services or
hospital care, including mental health care, to indigent
residents of the county or municipality before the creation of
the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.213, eff. Sept.
1, 2003.
Sec. 281.044. ASSUMPTION OF BONDED INDEBTEDNESS; CANCELLATION OF
UNSOLD MUNICIPAL OR COUNTY BONDS. (a) On the creation of the
district, the district assumes:
(1) any outstanding bonded indebtedness incurred by the county
or municipality, or both, in the acquisition of land, buildings,
and equipment transferred to the district or in the construction
and equipping of hospital facilities; and
(2) any other outstanding bonds issued by the county or
municipality for hospital purposes, the proceeds of which are in
whole or in part unexpended.
(b) On the creation of the district, the county or a
municipality in the district that issued bonds for hospital
purposes is no longer liable for the payment of the bonds or for
providing interest and sinking fund requirements on those bonds.
(c) This section does not limit or affect the rights of a
bondholder against the county or municipality if there is a
default in payment of the principal or interest on the bonds in
accordance with their terms.
(d) If the issuance of bonds by the county or municipality, or
both, to provide hospital facilities was approved at a bond
election but the bonds have not been sold on the date on which
the hospital district is created under this chapter, the bond
authority is canceled and the county or municipality, or both,
may not sell the bonds.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.045. LIMITATION ON TAXING POWER BY GOVERNMENTAL ENTITY;
DISPOSITION OF DELINQUENT TAXES. (a) On or after the creation
of the district, the county or a municipality located in the
district may not levy taxes for hospital purposes.
(b) The county or a municipality located in the district that
collects delinquent taxes owed to the county or municipality on
levies for county and municipal hospital systems under Chapter
265 shall pay the amount of the collected delinquent taxes to the
district, and the district shall apply that money to the purposes
for which the taxes were originally levied.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.046. DISTRICT RESPONSIBILITY FOR MEDICAL AID AND
HOSPITAL CARE. Beginning on the date on which taxes are
collected for the district, the district assumes full
responsibility for furnishing medical and hospital care for
indigent and needy persons residing in the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.0465. NURSING SERVICES FOR SCHOOL DISTRICTS. A
hospital district may contract with a school district included in
the hospital district to provide nursing services and assistance
to employees or students of the school district.
Added by Acts 1995, 74th Leg., ch. 260, Sec. 38, eff. May 30,
1995.
Sec. 281.047. MANAGEMENT, CONTROL, AND ADMINISTRATION. The
board shall manage, control, and administer the hospital or
hospital system of the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.0475. RENAMING DISTRICT. (a) This section applies
only to a district created in a county with a population of more
than 800,000 that was not included in the boundaries of a
hospital district before September 1, 2003.
(b) With the approval of the commissioners court, the board may
rename the district.
Added by Acts 2005, 79th Leg., Ch.
1094, Sec. 10, eff. September 1, 2005.
Sec. 281.048. DISTRICT RULES. The board may adopt rules
governing the operation of the hospital or hospital system.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.049. PURCHASING AND ACCOUNTING METHODS AND PROCEDURES.
(a) The commissioners court may prescribe:
(1) the method of making purchases and expenditures by and for
the district; and
(2) accounting and control procedures for the district.
(b) The commissioners court by resolution or order may delegate
its powers under Subsection (a) to the board.
(c) A county officer, employee, or agent shall perform any
function or service required by the commissioners court under
this section.
(d) The district shall pay salaries and expenses necessarily
incurred by the county or by a county officer or agent in
performing a duty prescribed or required under this section.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.050. POWERS RELATING TO DISTRICT PROPERTY, FACILITIES,
AND EQUIPMENT. (a) With the approval of the commissioners
court, the board may construct, condemn, acquire, lease, add to,
maintain, operate, develop, regulate, sell, exchange, and convey
any property, property right, equipment, hospital facility, or
system to maintain a hospital, building, or other facility or to
provide a service required by the district. Approval of the
commissioners court shall be required for the sale or lease of a
hospital facility regardless of the provisions of Section
285.051.
(b) Notwithstanding any other law, the board may, with the
approval of the commissioners court, lease undeveloped real
property for not more than 50 years to provide for the
development and construction of facilities designed to generate
revenue for the financial benefit of the district. The board,
directly or through a nonprofit corporation, may contract or
enter into a joint venture with a public or private entity as
necessary to enter into a lease under this subsection.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1997, 75th Leg., ch. 137, Sec. 1, eff. Sept. 1,
1997.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
535, Sec. 1, eff. June 19, 2009.
Sec. 281.051. CONTRACTING AUTHORITY. (a) With the approval of
the commissioners court, the board may, in performing its powers
under Section 281.050, contract or cooperate with:
(1) the federal government;
(2) this state;
(3) another governmental entity; or
(4) a privately owned or operated hospital.
(b) With the approval of the commissioners court, the board may
contract with:
(1) a county for care and treatment of the county's sick,
diseased, or injured persons; and
(2) this state or the federal government for care and treatment
of sick, diseased, or injured persons for whom the state or
federal government is responsible.
(c) The board shall encourage and promote participation by all
sectors of the business community, including small businesses and
businesses owned by members of a minority group or by women, in
the process by which the district enters into contracts. The
board shall develop a plan for the district to identify and
remove barriers that do not have a definite or objective
relationship to quality or competence and that unfairly
discriminate against small businesses and businesses owned by
members of a minority or by women. These barriers may include
contracting procedures and contract specifications or conditions.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1993, 73rd Leg., ch. 996, Sec. 1, eff. Aug. 30,
1993; Acts 1997, 75th Leg., ch. 137, Sec. 2, eff. Sept. 1, 1997.
Sec. 281.0511. CONTRACTING AUTHORITY OF CERTAIN DISTRICTS. (a)
This section applies only to a district created in a county with
a population of more than 800,000 that was not included in the
boundaries of a hospital district before September 1, 2003.
(b) Notwithstanding Sections 281.050 and 281.051, the board may
contract with any person, including a private or public entity or
a political subdivision of this state, to provide or assist in
the provision of services.
Added by Acts 2007, 80th Leg., R.S., Ch.
164, Sec. 5, eff. September 1, 2007.
Sec. 281.0514. HARRIS COUNTY HOSPITAL DISTRICT; CONTRACT WITH
CERTAIN HOSPITALS. (a) The Harris County Hospital District may
contract for indigent health care services with at least one
hospital that is:
(1) located in the district;
(2) exempt from federal income tax under Section 501(a),
Internal Revenue Code of 1986, and its subsequent amendments, by
being listed as an exempt entity under any subdivision of Section
501(c) of that code; and
(3) substantially devoted to providing hospital services to
socially and economically disadvantaged individuals in the
geographical area of the district.
(b) A contract under this section is subject to Section
281.051(a).
Added by Acts 1999, 76th Leg., ch. 1377, Sec. 1.24, eff. Sept. 1,
1999.
Sec. 281.0515. PROCEDURES FOR HEALTH MAINTENANCE ORGANIZATION.
A district may establish a health maintenance organization in
accordance with the Texas Health Maintenance Organization Act
(Chapter 20A, Vernon's Texas Insurance Code) to provide or
arrange for health care services for the residents of the
district.
Added by Acts 1993, 73rd Leg., ch. 908, Sec. 2, eff. Aug. 30,
1993.
Sec. 281.0517. INTEGRATED HEALTH CARE SYSTEM. (a) In this
section:
(1) "Integrated health care system" means a nonprofit
corporation established and operated by a district and a medical
school to provide or arrange for comprehensive health care
services for residents of the district.
(2) "Provider" means a physician or a provider as defined under
Section 843.002, Insurance Code.
(3) "Medical school" means a medical school governed by Chapter
110, Education Code.
(b) The El Paso County Hospital District and a medical school
may establish and operate an integrated health care system.
(c) To provide or arrange for comprehensive health care
services, an integrated health care system created under this
section may:
(1) own, acquire, lease, or contract for all necessary assets;
(2) enter into contracts with providers for the provision of
health care services directly or indirectly through subcontract;
(3) provide or enter into a contract with an individual or
business entity under which the individual or entity provides
necessary management or administrative services for the system
and the system's providers;
(4) enter into a contract or other agreement with a business or
governmental entity under which the system is paid to provide
health care services; and
(5) enter into a fee-for-service, capitated, or risk-sharing
health care service arrangement.
(d) An integrated health care system that recites in its
articles of incorporation that it is created under this section
is:
(1) subject to:
(A) Chapter 551, Government Code;
(B) Chapter 552, Government Code;
(C) Chapter 843, Insurance Code;
(D) Chapter 844, Insurance Code; and
(E) Chapter 262, Local Government Code; and
(2) a unit of local government for the purposes of Chapter 101,
Civil Practice and Remedies Code.
(e) Notwithstanding Subsection (d)(1)(A), an integrated health
care system created under this section may hold a closed meeting
to deliberate:
(1) pricing or financial planning relating to a bid or
negotiation for a contract to provide a service or product line,
if an open meeting would have a detrimental effect on the
position of the system in the bid or negotiation process; or
(2) a proposed new service or product line, if the meeting is
held before public announcement of the service or product line.
(f) Notwithstanding Subsection (d)(1)(B), information relating
to the following is confidential and not subject to disclosure:
(1) pricing or financial planning relating to a bid or
negotiation for a contract to provide a service or product line,
if disclosure would have a detrimental effect on the position of
the integrated health care system in the bid or negotiation
process; or
(2) a proposed new service or product line, if disclosure is
requested before public announcement of the service or product
line.
(g) Subject to the requirements and limitations of the local
health care market, an integrated health care system created
under this section shall make reasonable efforts to include in
its provider group community providers other than the medical
school and a hospital of the El Paso County Hospital District.
Added by Acts 1997, 75th Leg., ch. 947, Sec. 1, eff. Sept. 1,
1997. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.528,
10A.529, eff. Sept. 1, 2003.
Sec. 281.052. COUNTY AUTHORITY TO SELL, LEASE, AND PURCHASE
FACILITIES FOR DISTRICT PURPOSES. (a) The commissioners court
of a county in which a district is created under this chapter may
sell real or personal property in order to enter into a contract
to:
(1) lease or rent buildings, land, facilities, equipment, or
services from others for district purposes;
(2) construct, repair, renovate, improve, or enlarge buildings,
land, facilities, or equipment for district purposes; and
(3) pay regular monthly utility bills, including electricity,
gas, and water bills, for the leased or rented buildings, land,
facilities, equipment, or services.
(b) The commissioners court may pay for the facilities,
equipment, and services and for the regular monthly utility bills
for those facilities, equipment, and services from the county's
general fund if a majority of the commissioners court considers
the facilities, equipment, and services essential to the proper
administration of the county.
(c) A construction project under this section shall be let by
contract. The contract must contain the prevailing wage for
mechanics, laborers, and other persons employed in the project.
The Tarrant County Commissioners Court shall set the prevailing
wage in the amount set by the commissioners court for all
construction projects involving the expenditure of county funds.
(d) On or before the expiration of the lease or rental contract,
the county may purchase the facilities with county general funds
if a majority of the commissioners court considers the purchase
price reasonable.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.053. DISTRICT INSPECTIONS. (a) The district may be
inspected by a representative of the commissioners court, the
Texas Board of Health, or the Texas Department of Human Services.
(b) A district officer shall:
(1) admit an inspector into the district facilities; and
(2) on demand give the inspector access to records, reports,
books, papers, and accounts related to the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.054. EMINENT DOMAIN. (a) The district has the power
of eminent domain to acquire any interest in real, personal, or
mixed property located in the district if the property interest
is necessary or convenient for the exercise of the rights or
authority conferred on the district by this chapter.
(b) The district must exercise the power of eminent domain in
the manner provided by Chapter 21, Property Code, but the
district is not required to deposit with the trial court money or
a bond as provided by Section 21.021(a), Property Code.
(c) In a condemnation proceeding brought by the district, the
district is not required to:
(1) pay in advance or give bond or other security for costs in
the trial court;
(2) give bond for the issuance of a temporary restraining order
or a temporary injunction; or
(3) give bond for costs or supersedeas on an appeal or writ of
error.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.055. GIFTS AND ENDOWMENTS. On behalf of the district,
the board may accept gifts and endowments to be held in trust and
administered by the board for the purposes and under the
directions, limitations, or provisions prescribed in writing by
the donor that are consistent with the proper management of the
district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.056. AUTHORITY TO SUE AND BE SUED; LEGAL
REPRESENTATION. (a) The board may sue and be sued. A health
care liability claim, as defined by Section 74.001, Civil
Practice and Remedies Code, may be brought against the district
only in the county in which the district is established.
(b) Except as provided by Subsection (b-1), a district may
employ or contract with private legal counsel to represent the
district on any legal matter. If the district does not employ or
contract with private legal counsel on a legal matter, the county
attorney, district attorney, or criminal district attorney, as
appropriate, with the duty to represent the county in civil
matters shall represent the district.
(b-1) The county attorney, district attorney, or criminal
district attorney, as appropriate, with the duty to represent the
county in civil matters shall, in all legal matters, represent a
district located in:
(1) a county with a population of 650,000 or more that borders
the United Mexican States;
(2) a county with a population of 3.4 million or more; or
(3) a county with a population of more than 800,000 that was not
included in the boundaries of a hospital district before
September 1, 2003.
(c) A board that receives legal services from a county attorney,
district attorney, or criminal district attorney may employ
additional private legal counsel when the board determines that
additional counsel is advisable. A board that contracts or
employs private legal counsel under Subsection (b) may request
and receive additional legal services from the county attorney,
district attorney, or criminal district attorney, as appropriate,
with the duty to represent the county in civil matters when the
board determines that additional counsel is necessary.
(d) If the district receives legal services from a county
attorney, district attorney, or criminal district attorney, the
district shall contribute sufficient funds to the general fund of
the county for the account of the budget of the county attorney,
district attorney, or criminal district attorney, as appropriate,
to pay all additional salaries and expenses incurred by that
officer in performing the duties required by the district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2003, 78th Leg., ch. 204, Sec. 3.08, eff. Sept.
1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
1094, Sec. 11, eff. September 1, 2005.
Sec. 281.0565. CHARITABLE ORGANIZATIONS. (a) In this section,
"charitable organization" means an organization that is exempt
from federal income tax under Section 501(a) of the Internal
Revenue Code of 1986 by being listed as an exempt organization in
Section 501(c)(3) or 501(c)(4) of the code.
(b) A district may create a charitable organization to
facilitate the management of a district health care program by
providing or arranging health care services, developing resources
for health care services, or providing ancillary support services
for the district.
(c) A charitable organization created by a district under this
section is a unit of local government for purposes of Chapter
101, Civil Practice and Remedies Code.
(d) A district created in a county with a population of more
than 800,000 that was not included in the boundaries of a
hospital district before September 1, 2003, may make a capital or
other financial contribution to a charitable organization created
by the district to provide regional administration and delivery
of health care services to or for the district.
Added by Acts 1997, 75th Leg., ch. 104, Sec. 1, eff. Sept. 1,
1997.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
164, Sec. 6, eff. September 1, 2007.
Sec. 281.057. EMPLOYMENT OF DISTRICT PEACE OFFICERS. (a) The
board of the Dallas County Hospital District, the Tarrant County
Hospital District, or the Bexar County Hospital District may
employ and commission peace officers for the district.
(b) The jurisdiction of a peace officer commissioned under this
section includes the property owned or controlled by the district
that employs the peace officer and any street abutting,
right-of-way over or through, or easement in the property.
(c) In a district peace officer's jurisdiction, the peace
officer has the authority granted by Chapter 14, Code of Criminal
Procedure. The peace officer may also make an arrest without a
warrant in the officer's jurisdiction if the offense involves
injury or harm to any property owned or controlled by the
district.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 853, Sec. 1, eff. Sept. 1,
1991; Acts 2003, 78th Leg., ch. 888, Sec. 1, eff. June 20, 2003.
SUBCHAPTER D. MEDICAL TREATMENT AND CARE
Sec. 281.071. PAYMENT AND SUPPORT. (a) The administrator shall
inquire into a patient's circumstances and the circumstances of
the patient's relatives legally responsible for the patient's
support if the patient is admitted to district facilities from
the county in which the hospital is located. If the administrator
finds that the patient or the patient's relatives are liable for
the patient's care and treatment in whole or in part, the
administrator shall issue an order directing the patient or the
patient's relatives to pay to the district treasurer a specified
amount each week in proportion to the financial ability of the
patient or the patient's relatives to pay.
(b) A patient or the patient's relatives may not be required to
pay an amount greater than the actual per capita cost of
maintenance.
(c) An administrator may collect an amount owed under this
section from the estate of a patient, or the relatives legally
responsible for the patient's support, in the manner provided by
law for the collection of expenses of the last illness of a
deceased person.
(d) If the administrator finds that the patient and the
patient's relatives are not able to pay in whole or in part, the
district shall without charge supply the care and treatment to
the patient.
(e) A county court of the county in which a patient's hospital
is located shall hear and determine the ability of the patient or
the patient's relatives to pay under this section if there is a
dispute over this ability or if there is doubt in the mind of the
administrator over this ability. The court shall hear witnesses
and issue any order that may be proper.
(f) An appeal from an order of the county court must be made to
a district court in the county in which the district is located.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.072. REIMBURSEMENT FOR SERVICES. The board shall
require reimbursement from a county, municipality, or public
hospital located outside the boundaries of the district for the
district's care and treatment of a sick, diseased, or injured
person of that county, municipality, or public hospital as
provided by Chapter 61 (Indigent Health Care and Treatment Act).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.073. DISPOSITION OF DISTRICT RECORDS. (a) The
preservation, microfilming, destruction, or other disposition of
the records of a district is subject to Subtitle C, Title 6,
Local Government Code.
(b) The period that medical records are retained shall be in
accordance with rules relating to the retention of medical
records adopted by the Texas Department of Health and with other
applicable federal and state laws and rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 118, eff. Sept. 1,
1991.
SUBCHAPTER E. DISTRICT FINANCES
Sec. 281.091. BUDGET. (a) The administrator shall prepare an
annual budget under the board's direction.
(b) The budget and budget revisions must be approved by the
board and then shall be presented to the commissioners court for
final approval.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.092. ADMINISTRATOR'S REPORT. (a) As soon as
practicable after the close of the fiscal year, the administrator
shall make a report to the board, commissioners court, Texas
Board of Health, and comptroller.
(b) The report must:
(1) consist of a sworn statement of all money and choses in
action received by the administrator and their disposition; and
(2) show in detail the operations of the district for the fiscal
year.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.093. DEPOSITORY. (a) Not later than the 30th day
after the appointment of the board, the board shall:
(1) select a depository for district funds in the manner
provided by law for the selection of a county depository; or
(2) elect to use the depository previously selected by the
county.
(b) If the board selects a depository in accordance with
Subsection (a)(1), the depository shall serve as the district
depository for four years and until its successor is selected and
qualified.
(c) The board may extend any contract with a depository to the
next October and then select a depository for the following four
years.
(d) All income of the district shall be deposited in the
district depository.
(e) Warrants against district funds do not require the county
clerk's signature.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1993, 73rd Leg., ch. 246, Sec. 1, eff. Aug. 30,
1993.
Sec. 281.094. USE OF CERTAIN FUNDS BY THE NUECES COUNTY HOSPITAL
DISTRICT. (a) With the approval of the Nueces County
Commissioners Court, the board of the Nueces County Hospital
District may use funds made available to the district from
sources other than a tax levy to fund health care services,
including public health services, mental health and mental
retardation services, emergency medical services, health services
provided to persons confined in jail facilities, and for other
health related purposes.
(b) The board of the Nueces County Hospital District may use
funds made available to the district from any source to fund
indigent health care.
Added by Acts 1999, 76th Leg., ch. 1133, Sec. 1, eff. June 18,
1999.
Sec. 281.095. PROHIBITION AGAINST PARTICIPATION IN TAX INCREMENT
FINANCING BY CERTAIN HOSPITAL DISTRICTS. (a) In this section,
"district" means Bexar County Hospital District, Nueces County
Hospital District, El Paso County Hospital District, or Harris
County Hospital District.
(b) The district may not enter into a contract or agreement to
pay into a tax increment fund any of the district's tax increment
produced from property located in a reinvestment zone under
Chapter 311, Tax Code. This subsection does not affect the
validity of an agreement entered into by the district before
September 1, 2001, to pay a portion of the district's tax
increment into a tax increment fund under Chapter 311, Tax Code.
(c) The proceeds of a tax imposed under Section 281.121 may not
be used to make a payment into a tax increment fund under Chapter
311, Tax Code, if that payment is prohibited by this section.
(d) A project plan or reinvestment zone financing plan approved
under Section 311.011, Tax Code, on or after September 1, 2001,
may not include any of the district's tax increment or any other
funds derived from the district as a source of revenue to finance
or pay project costs.
(e) A project plan or reinvestment zone financing plan approved
under Section 311.011, Tax Code, before September 1, 2001, may
not be amended on or after September 1, 2001, to:
(1) increase the percentage of the district's tax increment to
be contributed to a tax increment fund;
(2) increase the time during which the district is to contribute
any of the district's tax increment to a tax increment fund;
(3) allow or require the district, if it was not included in the
originally approved project plan or reinvestment zone financing
plan, to contribute any of the district's tax increment or other
money to a tax increment fund; or
(4) allow the district to pay into a tax increment fund any of
the district's tax increment derived from property added to the
reinvestment zone on or after September 1, 2001.
(f) An agreement entered into by the district under Section
311.013(f), Tax Code, before September 1, 2001, may not be
amended on or after September 1, 2001, to include any of the
conditions prohibited by Subsection (e).
Added by Acts 2001, 77th Leg., ch. 588, Sec. 1, eff. Sept. 1,
2001.
Sec. 281.096. AUTHORITY TO TAKE ACTIONS RELATING TO AD VALOREM
TAXES. (a) With respect to the imposition or collection of an
ad valorem tax imposed for the benefit of a hospital district,
the commissioners court of the county in which the district is
located has the authority assigned by law to the governing body
of the hospital district, including the authority to:
(1) adopt an exemption, partial exemption, or other form of
relief from an ad valorem tax;
(2) elect to tax property that would otherwise be exempt from an
ad valorem tax; and
(3) exercise a power granted to a taxing unit under Section
6.30, Tax Code.
(b) The board of a hospital district may not exercise a power
granted by Subsection (a) to the commissioners court with respect
to the imposition or collection of an ad valorem tax imposed for
the benefit of the hospital district.
Added by Acts 2003, 78th Leg., ch. 102, Sec. 1, eff. Sept. 1,
2003.
SUBCHAPTER F. DISTRICT BONDS AND CERTIFICATES OF OBLIGATION
Sec. 281.101. GENERAL OBLIGATION BONDS. The commissioners
court, in the district's name and on the district's faith and
credit, may issue and sell bonds to acquire, construct, equip, or
enlarge the hospital or hospital system.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.102. BOND ELECTION. (a) The district may not issue
bonds, excluding refunding bonds, unless the bonds are authorized
by a majority of the qualified voters of the district voting at
an election called and held for that purpose.
(b) The commissioners court may order a bond election on its own
motion or on the board's request.
(c) The election must be:
(1) called and held in accordance with Chapter 1251, Government
Code; and
(2) conducted in the same manner as other countywide elections.
(d) The district shall pay for the cost of the election and
shall provide for payment before the commissioners court orders
the election.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 8.261, eff. Sept.
1, 2001.
Sec. 281.103. REFUNDING BONDS. (a) Refunding bonds of the
district may be issued to refund and pay any outstanding bonded
indebtedness of the district, including assumed bonded
indebtedness.
(b) The refunding bonds must be issued in the manner provided
for other bonds of the district except that an election is not
required.
(c) The refunding bonds may be:
(1) sold and the proceeds applied to the payment of outstanding
bonds; or
(2) exchanged in whole or in part for not less than a similar
principal amount of the outstanding bonds plus the unpaid,
matured interest on those bonds.
(d) The average annual interest cost on the refunding bonds,
computed in accordance with recognized standard bond interest
cost tables, may not exceed the average annual interest cost so
computed on the bonds to be discharged out of the proceeds of the
refunding bonds, unless the total interest cost on the refunding
bonds, computed to their respective maturity dates, is less than
the total interest cost so computed on the bonds to be discharged
out of those proceeds. In those computations, any premium
required to be paid on the bonds to be refunded as a condition to
payment in advance of their stated maturity dates shall be taken
into account as an addition to the net interest cost to the
district of the refunding bonds.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.104. EXECUTION OF BONDS. The county judge of the
county in which the district is created shall execute the bonds
in the name of the district, and the county clerk shall
countersign the bonds.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.105. APPROVAL AND REGISTRATION OF BONDS. (a) District
bonds are subject to the same requirements with regard to
approval by the attorney general and registration by the
comptroller as the law provides for approval and registration of
bonds issued by the county.
(b) The attorney general's approval of district bonds has the
same effect as that approval for other bonds issued by the
county.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 281.106. AUTHORITY TO ISSUE CERTIFICATES OF OBLIGATION.
With the approval of the commissioners court, the board may issue
certificates of obligation in accordance with Subchapter C,
Chapter 271, Local Government Code, for district purposes as
authorized by this chapter.
Added by Acts 2003, 78th Leg., ch. 47, Sec. 2, eff. Sept. 1,
2003.
Sec. 281.107. ALTERNATIVE FINANCING AND ELECTION PROCEDURES.
(a) This section is applicable to any hospital district that was
created pursuant to the authority granted by Section 4, Article
IX, Texas Constitution, is operating under this chapter, and has
previously held an election at which the voters approved the levy
and assessment of an ad valorem tax at a rate not greater than 75
cents per $100 of assessed valuation of taxable property within
the district.
(b) The commissioners court may, in the district's name, call,
order, and hold an election and submit thereat the proposition
and ballot prescribed in Subsections (c) and (d) if the
district's board of managers:
(1) finds that capital funds are needed to acquire, construct,
equip, and improve the district's hospital system;
(2) finds that financing such improvements through the issuance
of combination tax and revenue bonds or other obligations is the
best available method to provide the capital funds that are
needed to furnish the highest quality of medical treatment and
hospital care to persons residing in the district; and
(3) requests that the commissioners court call and hold an
election under the alternative procedures authorized by this
section.
(c) The official proposition submitted to the voters at an
election held under this section shall include, at a minimum, the
information included in the election order as prescribed by
Subsection (e).
(d) The ballot shall be arranged in a manner that will permit
the voters to vote for or against the following summary of the
proposition:
"Authorizing (insert name of district) to (insert description of
proposed district improvement) and to pledge (insert amount of
combination tax and revenue bonds or other obligations) for the
purpose of financing the proposed hospital district improvement
project."
(e) The election order shall include:
(1) a statement of the maximum aggregate principal amount of
bonds and obligations having maturities longer than five years
that will be secured by the hospital system and tax revenues
authorized by this section if approved by the voters at the
election unless another election is held and the voters approve
an increased amount; and
(2) a general description of the district's proposed financing
and improvement plans, including:
(A) the expected uses of the proposed improvements to the
hospital system according to the proposed plans;
(B) estimates of the costs of the proposed improvements,
estimates of the amount of the expected revenues that will be
received from the operation of the proposed improvements, and
estimates of the amount of revenues, including tax revenues, that
will be required to pay the long-term combination tax and revenue
bonds and other obligations when due, based on the interest rate
and other assumptions stated in the order; and
(C) any other matter deemed by the board of managers to be
appropriate to inform the voters of the details of the proposed
improvements to the district's hospital system and the financing
plans.
(f) An election conducted pursuant to this section shall be
conducted in accordance with the procedures provided in Section
281.102.
(g) If a majority of the votes received at the election favor
the proposition submitted at the election, the commissioners
court is authorized to issue and execute, on behalf and in the
name of the district, combination tax and revenue bonds and other
short-term and long-term obligations in the amounts and upon the
terms recommended and at the times requested by the board of
managers. If requested by the board of managers, the
commissioners court may also, by order, extend or confirm the
pledge to previously issued bonds and other obligations of the
district.
(h) Bonds and other short-term or long-term obligations that are
secured in the manner authorized by this section shall be payable
from and secured by the revenues of the district's hospital
system and from the ad valorem tax revenues of the district to
the extent prescribed and agreed in the orders, resolutions,
indentures, contracts, or other documents authorizing their
issuance or execution. The district, through the commissioners
court, shall annually levy, assess, and collect ad valorem taxes
on taxable property in the district, within the limited tax rate
previously authorized by the voters, when and as required by the
proceedings authorizing the bonds and other obligations.
(i) Each district that utilizes the