SECTION 354.1077. Provider Participation Requirements

(a) A hospital must comply with each of the following requirements to qualify for participation as a hospital in the Texas Medical Assistance (Medicaid) Program. A hospital must:

(1) be licensed by the Department of State Health Services (department) as a general or special hospital, unless exempt from licensure by the appropriate licensing authority. This requirement does not apply to military hospitals providing inpatient emergency hospital services;

(2) be enrolled and participating in the Medicare Program as a hospital;

(3) sign a written provider agreement with the department or its designee to participate in the Medicaid program. The provider agreement requires the hospital to comply with the terms of the agreement and all requirements of the Medicaid program, including regulations, rules, handbooks, standards, and guidelines published by the department or its designee; and

(4) comply with the utilization review plan approved by the department or its designee.

(b) Effective December 1, 1991, the hospital must maintain policies and procedures regarding the following policies with respect to all adult individuals receiving inpatient services provided by the hospital:

(1) provide all adult individuals the following information regarding advance directives at the time of the individual's admission as an inpatient:

(A) the individual's rights under Texas law, whether statutory or as recognized by the courts of the state, to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives (directive to physicians/living will or durable power of attorney for health care); and

(B) the hospital's policies respecting the implementation of such rights;

(2) document in the individual's medical record whether or not the individual has executed an advance directive;

(3) not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive;

(4) ensure compliance with the requirements of Texas law, whether statutory or as recognized by the courts of Texas, respecting advance directives at facilities of the provider or organization; and

(5) provide for education for staff and the community on issues concerning advance directives.

Source Note: The provisions of this §354.1077 adopted to be effective July 1, 1986, 11 TexReg 2756; amended to be effective February 1, 1992, 17 TexReg 326; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; amended to be effective November 29, 1993, 18 TexReg 8354; amended to be effective November 22, 1996, 21 TexReg 11595; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective September 1, 2006, 31 TexReg 6630; amended to be effective July 5, 2012, 37 TexReg 4853