Tex.
Health & Safety Code Section 311.031
Definitions
(1)
Repealed by Acts 2015, 84th Leg., R.S., Ch. 1, Sec. 3.1639(69), eff. April 2, 2015.(2)
“Charity care” means the unreimbursed cost to a hospital of:(A)
providing, funding, or otherwise financially supporting health care services on an inpatient or outpatient basis to a person classified by the hospital as “financially indigent” or “medically indigent”; and/or(B)
providing, funding, or otherwise financially supporting health care services provided to financially indigent persons through other nonprofit or public outpatient clinics, hospitals, or health care organizations.(3)
“Contractual allowances” means the difference between revenue at established rates and amounts realizable from third-party payors under contractual agreements.(4)
“Department” means the Department of State Health Services.(5)
“Donations” means the unreimbursed costs of providing cash and in-kind services and gifts, including facilities, equipment, personnel, and programs, to other nonprofit or public outpatient clinics, hospitals, or health care organizations.(6)
“Education-related costs” means the unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting educational benefits, services, and programs including:(A)
education of physicians, nurses, technicians, and other medical professionals and health care providers;(B)
provision of scholarships and funding to medical schools, colleges, and universities for health professions education;(C)
education of patients concerning diseases and home care in response to community needs; and(D)
community health education through informational programs, publications, and outreach activities in response to community needs.(6-a)
“Executive commissioner” means the executive commissioner of the Health and Human Services Commission.(7)
“Financially indigent” means an uninsured or underinsured person who is accepted for care with no obligation or a discounted obligation to pay for the services rendered based on the hospital’s eligibility system.(8)
“Government-sponsored indigent health care” means the unreimbursed cost to a hospital of providing health care services to recipients of Medicaid and other federal, state, or local indigent health care programs, eligibility for which is based on financial need.(9)
“Health care organization” means a nonprofit or public organization that provides, funds, or otherwise financially supports health care services provided to financially indigent persons.(10)
“Hospital” means:(A)
a general or special hospital licensed under Chapter 241 (Hospitals);(B)
a private mental hospital licensed under Chapter 577 (Private Mental Hospitals and Other Mental Health Facilities); and(C)
a treatment facility licensed under Chapter 464 (Facilities Treating Persons with a Chemical Dependency).(11)
“Hospital eligibility system” means the financial criteria and procedure used by a hospital to determine if a patient is eligible for charity care. The system shall include income levels and means testing indexed to the federal poverty guidelines; provided, however, that a hospital may not establish an eligibility system which sets the income level eligible for charity care lower than that required by counties under Section 61.023 (General Eligibility Provisions) or higher, in the case of the financially indigent, than 200 percent of the federal poverty guidelines. A hospital may determine that a person is financially or medically indigent pursuant to the hospital’s eligibility system after health care services are provided.(12)
“Hospital system” means a system of local nonprofit hospitals under the common governance of a single corporate parent that are located within a radius of not more than 125 linear miles of the corporate parent.(13)
“Medically indigent” means a person whose medical or hospital bills after payment by third-party payors exceed a specified percentage of the patient’s annual gross income, determined in accordance with the hospital’s eligibility system, and the person is financially unable to pay the remaining bill.(14)
“Research-related costs” means the unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting facilities, equipment, and personnel for medical and clinical research conducted in response to community needs.(15)
“Subsidized health services” means those services provided by a hospital in response to community needs for which the reimbursement is less than the hospital’s cost for providing the services and which must be subsidized by other hospital or nonprofit supporting entity revenue sources. Subsidized health services may include but are not limited to:(A)
emergency and trauma care;(B)
neonatal intensive care;(C)
free-standing community clinics; and(D)
collaborative efforts with local government or private agencies in preventive medicine, such as immunization programs.(16)
“Unreimbursed costs” means the costs a hospital incurs for providing services after subtracting payments received from any source for such services including but not limited to the following: third-party insurance payments; Medicare payments; Medicaid payments; Medicare education reimbursements; state reimbursements for education; payments from drug companies to pursue research; grant funds for research; and disproportionate share payments. For purposes of this definition, the term “costs” shall be calculated by applying the cost to charge ratios derived in accordance with generally accepted accounting principles for hospitals to billed charges. The calculation of the cost to charge ratios shall be based on the most recently completed and audited prior fiscal year of the hospital or hospital system. Prior to January 1, 1996, for purposes of this definition, charitable contributions and grants to a hospital, including transfers from endowment or other funds controlled by the hospital or its nonprofit supporting entities, shall not be subtracted from the costs of providing services for purposes of determining unreimbursed costs. After January 1, 1996, for purposes of this definition, charitable contributions and grants to a hospital, including transfers from endowment or other funds controlled by the hospital or its nonprofit supporting entities, shall not be subtracted from the costs of providing services for purposes of determining the unreimbursed costs of charity care and government-sponsored indigent health care.
Source:
Section 311.031 — Definitions, https://statutes.capitol.texas.gov/Docs/HS/htm/HS.311.htm#311.031 (accessed May 4, 2024).
