Sec. 61.058. NOTIFICATION OF PROVISION OF NONEMERGENCY SERVICES. (a) A public hospital may require any provider, including a mandated provider, to obtain approval from the hospital before providing nonemergency health care services to an eligible resident in the hospital's service area.
(b) If the public hospital does not require prior approval and a provider delivers or will deliver nonemergency health care services to a patient who the provider suspects might be eligible for assistance under this subchapter, the provider shall notify the hospital that health care services have been or will be provided to the patient. The notice shall be made:
(1) by telephone not later than the 72nd hour after the provider determines that the patient resides in the hospital's service area; and
(2) by mail postmarked not later than the fifth working day after the date on which the provider determines that the patient resides in the hospital's service area.
(c) If the provider knows that the public hospital serving the area in which the patient resides has selected a mandated provider or if, after contacting the hospital, the hospital requests that the patient be transferred to a mandated provider, the provider shall transfer the patient to the mandated provider unless it is medically inappropriate to do so.
(d) Not later than the 14th day after the date on which the public hospital receives sufficient information to determine eligibility, the hospital shall determine if the patient is eligible for assistance from the hospital. If the hospital does not determine the patient's eligibility within that period, the patient is considered to be eligible. The hospital shall notify the provider of its decision.
(e) If a provider delivers nonemergency health care services to a patient who is eligible for assistance under this subchapter and fails to comply with this section, the provider is not eligible for payment for the services from the public hospital serving the area in which the patient resides.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989. Amended by Acts 1999, 76th Leg., ch. 1377, Sec. 1.20, eff. Sept. 1, 1999.
Structure Texas Statutes
Subtitle C - Programs Providing Health Care Benefits and Services
Chapter 61 - Indigent Health Care and Treatment Act
Subchapter C. Persons Who Reside in an Area Served by a Public Hospital or Hospital District
Section 61.051. Application of Subchapter
Section 61.052. General Eligibility Provisions
Section 61.053. Application Procedure
Section 61.054. Basic Health Care Services Provided by a Public Hospital
Section 61.055. Basic Health Care Services Provided by Hospital Districts
Section 61.056. Provision of Health Care Services
Section 61.057. Mandated Provider
Section 61.058. Notification of Provision of Nonemergency Services
Section 61.059. Notification of Provision of Emergency Services
Section 61.060. Payment for Services
Section 61.061. Payment Rates and Limits
Section 61.062. Responsibility of Governmental Entity
Section 61.063. Procedure to Change Eligibility Standards or Services Provided
Section 61.064. Transfer of a Public Hospital
Section 61.065. County Responsibility for Hospital Sold on or After January 1, 1988
Section 61.066. Prevention and Detection of Fraud