Texas Register, Volume 5, Number 5, Pages 163-206, January 18, 1980 Page: 179
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PROPOSED RULES
179v
include an array of activities such as from birth planning, the
use of contraception, and the management of infertility to
sex education, marital counseling, and even genetic counsel-
ing. Family planning has succeeded the older term, birth
control, which is now felt to be restrictive in meaning. Birth
control can be separately defined as the prevention of preg-
nancy by contraception, abortion, sterilization, or abstinence
from coitus.
.190. Rehabilitation. A service that provides care for
coordinated multidisciplinary physical restoration of normal
form and function to a person after injury or illness, or the
development and/or restoration of a disabled (congenital or
otherwise), ill, or injured person to self-sufficiency and/or
gainful employment at his or her highest attainable skill in
the shortest possible time, but excludes any services offered
in the office(s) and/or treatment areas(s) of a physician, or
group of physicians, in private practice.
.200. Burn Unit. A discrete, self-contained unit located in
a hospital or other health care facility that is equipped,
staffed, and devoted exclusively to the provision of burn care.
.210. Burn Center. A discrete, self-contained unit located
in a hospital or a facility that is equipped, staffed, and
devoted exclusively to the provision of burn care. It has the
capacity to provide the following: emergency care and
stabilization of burn patients; evaluation of burn severity;
acute, convalescent, and rehabilitative burn care; basic and
clinical research; and education and training.
.220. Health Maintenance Organization (HMO. An entity
that undertakes to provide or arrange for the provision of one
or more health care plans, pursuant to the Texas Health
Maintenance Organization Act, Article 20A.01-20A.35,
Texas Revised Civil Statutes. A health care plan is any ar-
rangement whereby an entity undertakes to provide, arrange
for, pay for, or reimburse any part of the cost of any health
care service and at least part of such arrangements consists
of arranging for or the provision of health care services for
the purpose of preventing, alleviating, curing, or healing
human illness or injury.
Doc. No. 800247.170. Immunization Services. Those services and health-
related support activites provided by health care facilities or
other health care entities directed toward rendering in-
dividuals resistant to specific diseases by means of vaccines.
Appropriateness review will be restricted to such services
which are provided routinely for preventive purposes to the
general public or specific population groups within the
general public by agencies of federal, state, or local govern-
ment. Participation by hospitals and private physicians in
immunization programs administered by federal and state
agencies will be reviewed only to the extent that information
related to such participation is available from the ad-
ministering agency.
.180. Family Planning. A service provided by a health
care facility or other health care entity which utilizes a range
of methods of fertility regulation to help individuals or cou-
ples to avoid unwanted births; bring about wanted births;
produce a change in the number of children born; regulate
the intervals between pregnancies; and control the time at
which births occur in relation to the age of parents. It mayVolume 5, Number 5, January 18, 1980
Review Criteria Indicators and Standards
315.30.03
This subchapter describes the characteristics, criteria, and
indicators which are to be utilized in the performance of ap-
propriateness review.
The rules are proposed under the authority of Article
4418(h), Texas Revised Civil Statutes.
.010. Appropriateness Review Characteristics. The health
systems agencies and the commission in conducting ap-
propriateness review of all services shall consider certain fac-
tors or characteristics to determine the degree to which the
services meet the health care needs of the population served.
The review characteristics include the following:
(1) the availability of the service;
(2) the accessibility of the service;
(3) the quality of the service;
(4) the continuity of the service;
(5) the cost of the service; and
(6) the acceptability of the service.
.020. Review Criteria. The characteristics form the basis
of review criteria by providing specific parameters by which a
service's performance is assessed. When a service compares
favorably with all of the established review criteria against
which it is properly measured, the service shall be considered
appropriate by the health systems agency and the commis-
sion. When a service compares unfavorably with one or more
of the established review criteria against which it is properly
measured, the health systems agency and the commission
may consider the service inappropriate.
.030. Availability Criterion.
(a) A health care service under review should be
available to the population in the health service area and the
state.
(b) In reviewing health care services for appropriate-
ness, the commission and the health systems agencies shall
determine the extent to which the health care services are
available to patients in a specified area.
(c) In conducting a review to determine availability,
the following shall be considered:
(1) the geographic areas and population groups that
will be served by the service under review;
(2) the inadequacies of existing health care delivery
systems in the health service area as they relate to the ser-
vice under review;
(3) the current and '-ojected utilization for the ser-
vice under review;
(4) the population trends and vital rates for the
health service area;
(5) the availability of resources (including health
manpower, management personnel, and funds for capital and
operating need) for the provision of the service under review;
and
(6) the percentage of out- and in-migration for
utilization of the service under review.
.040. Accessibility Criterion.
(a) A health care service under review should be ac-
cessible to the population in the health service area and the
state.
(b) In reviewing health care services for appropriate-
ness, the commission and the health systems agencies shall
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Texas. Secretary of State. Texas Register, Volume 5, Number 5, Pages 163-206, January 18, 1980, periodical, January 18, 1980; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth244557/m1/17/: accessed April 25, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.