### THE ATTORNEY GENERAI. OF TEXAS
May 21. 1987 .JlYl .w.mTGx A-RXEY GESERAI.

Bonorable Lowell C. Halt Criminal District Attorney P. 0. Box 730 Gilmer, Texas 75644 OpinionNo. JM-705
I&: Whether a county is required to reimburse a stare-supported public hospital for indigenthealth care of a resident of thatcounty
Dear Mr. Halt:
You ask whether a county that does not have apublichospital and isnot locatedwithin ahospital district is required to reimburseThe University of Texas Health Center at Tyler for health care of an indigent resident of the county who was treated at the Eealth Center for a heart condition. You advise us that the personwas referredby the county’s “contractdoctor* to theHealth Center forcare. Title 2 of the Indigent Health Care and Treatment Act, article 4438f, V.T.C.S., applies to and determines health care services and assistance for a personwho does not reside in the area that a public hospital or hospital district has a legal obligation to serve. Art. 4438f. 52.01. Each county shall provide the health care assistance prescribed by Title.2 to each eligible resident of that county who does nor residewithin an area servedby a public hospitalor hospital district. Id. 152.02,~3.01. A county may arrange co provide health care servicethrough a local health department, a publicly owned facility, a contractwith a private provider, or throughthe purchase of insurance for eligible residents. Id. $3.02. Also, a county may select one or more providers of health care services and, when medically appropriate, require its indigent residents to obtain care from amandated provider. Id. 03.03. Except as otherwiseprovidedby Title 2, and assuming thz there has been compliance with the requirements of that title concerning the provision of health care services by mandated providers and notification of and approval from the county for emergency and nonemergency services, a county is responsible for either paying for or for providing health care services for which payment is not otherwise available. See Id -2 513.03. 3.04, 3.05, 4.01(d).
A county is not liable under Title 2 for health care services provided by a hospital to an eligible resident of the county if the hospital providing the services has a Hill-Burton or state-mandated

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obligation to provide free services and the hospital is in noncompliancewith the obligation. Id. 14.01(c). Also, a county is not liable under Title 2 for the coTof a mandatory health service that is in excess of the payment standards for that service establishedby the Texas Department of Human Services or in excess of the limitation for each year prescribed by section 4.03 for each eligibleresidentof the county. See id. 94.02. -- In summary, and subject to the provisos and limitations In Title 2, a county is liable for payment for health care services provided under Title 2 by any provider to an eligible resident of the county who doesnot reside in an area servedby apublichospital or hospital district.
It has been suggested that heart disease is a chestdisease and, therefore, that the state. instead of the county, Is responsible by statute for the expanse of treatment of a heart conditionprovided at The University of Texas Health Center at Tyler for an indigent resident of a county that does not have a publichospital or hospital district. It is our opinion that the legislature has not provided that the medical care of indigent patients with heart disease is an expense tobe paid by theTyler Eealth Center out of state funds. The hospital in question originally was a state tuberculosis hospital which treated only tuberculosis cases. In 1977, the legislature transferred the East Texas ChestHospital to the Board of Regents of The University of Texas Systemwith authority to change its name and use it as a teaching hospital. See V.T.C.S. art. 3201a-4. 112, 5. The namewas changed to The University ofTexasHealth Center at Tyler. Sections 1 and 7 of article 3201a-4 state the legislature's intention that thehospital continue to serve as a state tuberculosis hospital under the terms and provisions of the Texas Tuberculosis Code, article 4477-11, V.T.C.S., and that The University of Texas System provide and pay for the care and treatment of tuberculosis patients in thathospital out of funds appropriatedby the legislature for the hospital to use for that purpose. Section 6 of article 32Ola-4provides also that:

It shallcontinue tobe thepolicy of the State of Texas toprovide a program of treatment of the citizensof this statewho are affectedwith chest diseases,and in pursuance of thatpolicy theEast Texas Chest Hospital shall among other functions continue to serve as the primary facility in this state to conduct research, develop diagnosticand treatment techniques and procedures, provide training and teaching programs, and provide diagnosis and treatment for both inpatients and outpatientswith respect to all chestdiseases.

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C Section 9 of theTexasTuberculosisCodeprovides inpart that: Patients admitted co state chest hospitals shallbe two (2)classes: (1) Indigentpublicpatients and (2) Non-indigentpublicpatients. (a) Indigent public patients are those who possess no property of any kind nor have anyone legallyresponsible for their support,andwho are unable to reimburse the state. This class shall be supportedat the expense of the state.

,- It is our opinion, however, that the provisions of the Texas

TuberculosisCode only apply to the care and treatmentof personswith tuberculosis. Senate Bill No. 868 of the Sixty-sixthLegislature in 1979 amended section 9 of the Code by changing the name "tuberculosis hospitals" to "chest hospitals." The caption of Senate Bill No. 868 describes that bill as "an Act relating to the diagnosis and care of parsons having tuberculosis." Section 2 of the Tuberculosis Code expressly states that "[IIt is the purpose of this Code to provide care and treatment for those afflicted with turberculosis, to facilitate theirhospitalization.and to enable them to obtain needed care.n
We conclude that the provisions of the Tuberculosis Code. including section 9, are applicable to the treatment of persons with tuberculosis and do not apply to the treatment of heart conditions, regardless of whether "heart conditions" might properly be called "chest diseases" in other contexts. Under both article 3201a-4 and the Tuberculosis Code, the treatment of tuberculosispatients in the Health Center at Tyler is an expense of the Health Center to be paid from state funds. Neither of those statutesnor any other statute of which we are aware mandates treatment at the Health Center at state expense for indigentpersons suffering from a heart condition. Hence, a county that arranges for care of a heart condition for its indigent resident at the Health Center is responsible for payment for such servicesunder Title 2 of the IndigentHealth Care and TreatmentAct.
SUMMARY
A county which Is liable for health cara assistance under Title 2 of the Indigent Health Care and Treatment Act is responsible for paying for or forprovidinghealth care servicesforwhich payment is not otherwise available. The statutes providing for careand treatmentof tuberculosisin

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--Y The University of Texas Health Center at Tyler for indigentpatients at state expense do not apply to heart conditions. A countywhich arranges forcare at the Health Center for a heart condition of an indigent residenr is responsible for paying the Health Center for treatment of theheart condition.

JIM MATTOX AttorneyGeneral of Texas
JACK HIGHTOWER First AssistantAttorneyGeneral
MARYXZLLER ExecutiveAssistantAttorney General
JUDGE ZOLLIE STEAKLET SpecialAssistantAttorneyGeneral
RICK GILPIN Chairman,OpinionCommittee PreparedbyNancy Sutton AssistantAttorneyGeneral

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