2007 Legislative Compendium: EMS and Trauma Care

Detainment and Examination of the Suspected Mentally Ill
House Bill 518 by Rep. Elliott Naishtat (D-Austin) and Sen. Kenneth Brimer (R-Fort Worth) amends the Health and Safety Code to extend the amount of time a physician may detain a mentally ill patient who is considered a potential harm to himself or others, within the emergency department, without a written order of protective custody, from 24 hours to 48 hours. The bill also calls for a physician to examine the detainee as soon as possible within 24 hours of detainment instead of the previous 12 hours.

Emergency Medical Dispatch Resource Centers Program
House Bill 1412 by Rep. Jim McReynolds (D-Lufkin) and sponsored by Sen. Robert Deuell, MD (R-Greenville), makes permanent the Emergency Medical Dispatch (EMD) program, piloted initially in 2003. Under the program, life-saving information is given to caregivers prior to the arrival of emergency medical personnel.

Liability of Emergency Caregivers
House Bill 2117 by Rep. Tan Parker (R-Flower Mound) and Sen. Chris Harris (R-Arlington) clarifies liability of public safety volunteers who are often first responders in emergency situations. The language specifies that individuals who in good faith administer emergency care, including automated external defibrillators, are immune from civil damages. HB 2117 is effective immediately.

Anaphylaxis Treatment by Emergency Medical Personnel
House Bill 2827 by Rep. Larry Taylor (R-Friendswood) and Sen. Mike Jackson (R-La Porte) requires emergency medical services (EMS) vehicles to maintain epinephrine injectors (EPI) or similar anaphylaxis treatment. TMA had concerns about the bill as it was filed because it implied that EMS medical directors would not have the ability to restrict EPI pen administration to only those emergency personnel qualified and trained to use them. Representative Taylor amended the bill to address medicine's concerns by specifying that the supervising physician may establish protocols to identify who can administer the devices. The bill also sets training requirements for anaphylaxis treatment for emergency medical personnel. HB 2827 is effective immediately.

Red Light Photo Systems/New Funding of Trauma Services
Senate Bill 1119 by Sen. John Carona (R-Dallas) and Rep. Jim Murphy (R-Houston) relates to photographic traffic signal enforcement systems and the imposition of civil penalties. After collecting the penalty, local authorities may retain enough of the revenue to cover costs for purchasing, installing, and maintaining the enforcement systems. Of the remaining money, 50 percent must be deposited into the regional trauma account, while the other 50 percent must only be used to fund traffic safety programs. SB 1119 is effective Sept.1, 2007.

Trauma Funding
In 2003, the legislature passed a bill to establish the Driver's Responsibility Program. The program imposes fees on drivers for speeding or driving without a license. Fifty percent of the proceeds are used to fund transportation projects, and the balance funds uncompensated trauma care at designated trauma facilities. In 2005, the legislature reauthorized the program, but used a portion of the funds to help balance the state budget, meaning that while money accumulated in the account, the Texas Department of State Health Services (DSHS) was prevented from distributing all of it. This year, in lieu of removing those limits, the legislature used a portion of the funds to help pay for rebasing Medicaid inpatient hospital rates. Medicaid physician payment rates were increased as well. If funds in the trauma account exceed $98 million in either 2008 or 2009, DSHS may distribute the funds using the current trauma funding methodology. Texas hospitals agreed to the arrangement as part of the negotiations on SB 10, the Medicaid reform bill

Collection of Driver Responsibility Program Surcharges
Senate Bill 1723, authored by Sen. Steve Ogden (R-Bryan) and Rep. Mike Krusee (R-Round Rock), alters the collection of surcharges associated with traffic violations under the Driver Responsibility Program. Fifty percent of the surcharges fund trauma facilities and EMS. SB 1723 allows for periodic amnesty and the availability of installment plans for those who cannot pay the full surcharge. This could negatively affect the funding of critical health care facilities and access.

Post-Acute Care for Brain Injuries
House Bill 1919 by Rep. Todd Smith (R-Euless) and Sen. Leticia Van de Putte (D-San Antonio) requires health plans, other than small employer health plans, to include post-acute care coverage. This includes cognitive rehabilitation therapy for victims of traumatic brain injury. Health plans already are required to cover medical care relating to traumatic brain injury. The bill assures that patients can obtain rehabilitative services, including outpatient day treatment services or post-acute services relating to the injury. HB 1919 specifies that the health plan may not limit the number of post-acute care treatments unless separately stated. Payment limitations, deductibles, and cost-sharing must be the same as for other types of coverage. The bill also specifies that the plan must provide "reasonable expenses" related to periodic reevaluation of a covered patient who has acute brain injury and has been unresponsive to treatment, but becomes responsive to treatment at a later date. Factors that plans may consider "reasonable costs" include the cost, the time that has expired since the previous evaluation, difference in expertise of the physician or practitioner providing the care, changes in technology, and advances in medicine.

Post-acute care coverage for traumatic brain injury may not be excluded for small employer plans. The deductible, maximum limits, and cost-sharing must be consistent with similar coverage offered under a small employer plan.

The Texas Department of Insurance, in consultation with the Texas Traumatic Brain Injury Advisory Council, shall prescribe rules for the basic training of health-benefit plan personnel who conduct preauthorization review to prevent inappropriate denials of coverage. Additionally, health plans, other than small employer plans, must annually notify enrollees in writing about coverage for brain injury.

Lastly, the bill outlines requirements for determining medical necessity and prohibits health plans, other than small employer plans, from denying coverage solely because treatment was not provided within a hospital.

EMS/Trauma Near Misses

Regulation of Freestanding Emergency Departments
Senate Bill 1115 by Senator Deuell would have established a regulatory structure for freestanding emergency departments (ERs). There are only a handful of facilities operating in Texas, but the concept is popular in other states and expected to increase here. In principle, freestanding ERs are supposed to be staffed and operated like an ER. The only difference is that these facilities are not physically connected to a hospital. However, TMA fears that without regulation, ER staffing levels, equipment, and hours of operation could vary, creating confusion with the public. SB 1115 would have established state regulation of freestanding ERs and specified minimum requirements. TMA and the Texas College of Emergency Physicians (TCEP) supported the bill, but differed with the author over hours of operation of the ERs. TMA and TCEP pushed for 24/7 operations instead of a minimum 12-hour schedule as included in the legislation. The bill passed the Senate but died in the House Public Health Committee.

Booster Seat Bill
Senate Bill 60 by Sen. Judith Zaffirini (D-Laredo) and Rep. Fred Brown (R-College Station) would have raised the age that a child must be secured in a child passenger seat in a vehicle to age 8, or taller than four feet, nine inches. The bill passed the Senate 26-4 but died in the House Transportation Committee. TMA and the Texas Pediatric Society strongly supported the bill. Texas will lose $19 million in federal transportation funding for failure to adopt the legislation.

EMS and Trauma Close Calls

Motorcycle Helmet Rollback
House Bill 727 by Representative Hopson would have lowered the age requirement for wearing motorcycle helmets from 21 years to 18 years of age for both motorcycle operators and passengers. It also would have eliminated the requirement for completion of motorcycle operator training and a safety course, and would have eliminated coverage by a health plan of a least $10,000 in medical benefits incurred from an accident for operators 21 years and over. TMA strongly opposed this bill.

EMS/Trauma Staff Team:

Legislative:  Michelle Romero
Policy:  Helen Kent Davis and Gayle Love
Legal: Kelly Walla

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