Texas Register, Volume 5, Number 5, Pages 163-206, January 18, 1980 Page: 180
163-206 p. ; 28 cm.View a full description of this periodical.
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determine the extent to which the health care system in-
hibits or facilitates provision of appropriate services.
(c) In conducting a review to determine accessibility
the following shall be considered:
(1) the geographical areas and population groups
that will be served by the service under review;
(2) the barriers (i.e. cultural, physical, transporta-
tion, financial, etc.) that could affect the service within the
area;
(3) the current and projected utilization of the ser-
vice under review;
(4) the accessibility of the service under review to pa-
tients in the health service area.
.050. Quality Criterion.
(a) A health care service under review should be pro-
vided in a quality manner.
(b) In reviewing health care services for appropriate-
ness, the commission and the health systems agencies shall
determine the extent to which the health services delivered
meet established standards of quality.
(c) In conducting a review, the following shall be con-
sidered:
(1) the inadequacies of existing health care delivery
systems in the health service area as they relate to the ser-
vice under review;
(2) the utilization of appropriate resources, including
health manpower, facilities, and equipment for the provision
of the service under review; and
(3) the accreditation, certification, licensure, or
other established standards or mechanisms for evaluating
the provision of the service under review.
.060. Continuity Criterion.
(a) A health care service under review should be pro-
vided so that continuity of care is available.
(b) In reviewing health care services for appropriate-
ness, the commission and the health systems agency shall
determine the extent of effective linkages and coordination
in providing a succession of appropriate services over time.
(c) In conducting a review to determine continuity, the
following shall be considered:
(1) the coordination agreements for shared services
as they relate to the service under review;
(2) how the service under review accomplishes effec-
tive integration with other services and elements of the
health care system; and
(3) the availability and proximity of appropriate
health manpower, facilities, and equipment required to sup-
port the service under review.
.070. Cost Criterion.
(a) A health care service under review should be pro-
vided in a cost effective manner.
(b) In reviewing health care services for appropriate-
ness, the commission and the health systems agencies shall
determine the cost to the patient for procedures encountered
in the service category and the extent to which health ser-
vices are delivered in a cost effective manner.
(c) In conducting a review to determine cost effective-
ness, the following shall be considered:
(1) the availability of less costly or more effective
alternative methods of providing such service;
(2) the total economic value of resources required to
provide services, including all financial expenditures..080. Acceptability Criterion.
(a) A health care service under review should be accep-
table 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 agency shall
determine the measure of consumers' satisfaction with the
services they receive, the manner in which the services are
delivered, the ease with which services are obtained, and
their confidence in the providers of the services.
(c) In conducting a review to determine acceptability
the following shall be considered:
(1) the barriers (i.e. cultural, physical, transporta-
tion, etc.) that could affect the service within an area;
(2) the availability of less costly or more effective
alternative methods of providing such service;
(3) the existence of mechanisms for soliciting patient
comment and existence of patient's bill of rights; and
(4) percentage of out- and in-migration for utiliza-
tion of the service under review.
.090. Other Factors Considered in Review.
(a) In considering various review criteria during review
the health systems agency and the commission shall review
and examine various other factors and information relating
to the service under review. These factors or indicators assist
the health systems agency and the commission in determin-
ing whether a service compares favorably or unfavorably
with the review criteria.
(b) In the review of a service the commission shall con-
sider the following factors:
(1) the relationship of the service under review to the
applicable health systems plan(s), and annual implementa-
tion plan(s), and the state health plan;
(2) the relationship of the service under review to the
long-range development plans (if any) of existing facilities
providing the service;
(3) the need that the population served has for the
service under review, and the extent to which low income per-
sons, racial and ethnic minorities, women, handicapped per-
sons, and other underserved groups have access to the ser-
vice;
(4) the special circumstances of providing the service
under review with respect to the need for conserving energy;
(5) the effect of competition on the supply of the
health service under review;
(6) improvements or innovations in the financing
and delivery of the service under review which foster com-
petition and serve to promote quality assurance and cost
effectiveness;
(7) the special needs and circumstances of those en-
tities which provide a substantial portion of their services or
resources to individuals not residing in the health service
area or in adjacent health service areas (these entities may
include medical and other health profession schools,
multidisciplinary clinics, and specialty centers);
(8) the special needs and curcumstances of HMOs-
the needs and circumstances shall include:
(A) the needs of enrolled members and reasonably
anticipated new members of the HMO for the existing in-
stitutional health services provided by the organization;
(B) whether the services are obtained in a reasona-
ble and cost-effective manner which is consistent with theVolume 5, Number 5, January 18, 1980
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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/m1/18/: accessed April 25, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.