Are court-cost refunds to mental health facilities under Texas law limited to patients who were actually committed?

Plain-English summary

State Senator Charles Perry asked the Attorney General whether the court-cost refund required by Health and Safety Code subsection 571.018(j) is limited to mental health hearings that end in commitment. The Senator said some local authorities were trying to limit refunds to people who were actually committed to a mental health facility, and thought that limitation might be coming from a nearby subsection, 571.018(h).

The AG read the statute closely and concluded there is no commitment requirement in subsection 571.018(j). That subsection tells a judge to order the clerk to refund court costs that certain inpatient mental health facilities paid or advanced for "a person," once the facility files an affidavit certifying one of three things (it got no compensation, it treated the person under a contract with a local mental health authority, or it was only reimbursed under Medicaid). Nothing in that text says the person had to be committed; it speaks of "a person" who received "treatment." The AG noted that courts must take the Legislature at its word and not add missing words, so it would not read in a commitment limit that the statute does not contain.

The AG then explained why the "committed" language in subsection 571.018(h) does not bleed into (j). Subsection (h) does something different: it prohibits the state or a county from paying certain costs for "a patient committed to a private mental hospital," unless conditions are met. The word "committed" there defines the scope of a prohibition on payments, not a limit on the refunds that (j) requires. On top of that, (h) expressly excepts "a filing fee or other cost associated with a hearing or proceeding," which includes the court costs that (j) refunds. So (h)'s prohibition does not even touch (j)'s refunds. For both reasons, the AG concluded subsection 571.018(h) does not limit subsection 571.018(j) to commitment cases.

The AG also brushed aside a briefer's argument that the word "treatment" in (j) implies commitment, pointing out that voluntary patients under chapter 572 also receive "treatment," and a separate argument that the reading might conflict with the federal EMTALA statute, finding no direct conflict that would matter.

What this means for you

If you run or advise an inpatient mental health facility

Based on this opinion, your right to a refund of court costs you paid or advanced under subsection 571.018(j) does not depend on whether the patient was committed. The AG concluded the refund turns on the affidavit conditions in (j) (no compensation received, treatment under a contract with a local mental health authority, or Medicaid-only reimbursement), not on commitment. If a county or clerk is denying refunds solely because the person was not committed, this opinion is directly on point.

If you are a county official or court clerk handling these refunds

The opinion concludes that subsection 571.018(j) requires the refund for "a person" who received treatment, regardless of commitment, and that the "committed" language in subsection 571.018(h) does not narrow (j). Subsection (h) restricts certain county or state payments and even carves out the court costs that (j) refunds, so it provides no basis for a commitment-only refund rule.

If you advise on the interplay of these subsections

The AG's method is worth noting: it read (h) as defining the reach of a payment prohibition (a "patient committed to a private mental hospital"), not as a definition that travels to (j). It also treated (h)'s express exception for "a filing fee or other cost associated with a hearing or proceeding" as confirming that (j)'s court-cost refunds sit outside (h)'s prohibition entirely.

Common questions

Q: Do mental health facilities only get a court-cost refund when the patient was committed?
A: No. The AG concluded subsection 571.018(j) requires the refund for "a person" who received treatment, with no commitment requirement.

Q: Where did the commitment idea come from?
A: From subsection 571.018(h), which mentions "a patient committed to a private mental hospital." The AG concluded that language defines the scope of a payment prohibition, not a limit on the refunds required by subsection 571.018(j).

Q: What does a facility have to show to get the refund?
A: Under subsection 571.018(j), the facility files an affidavit certifying one of three things: it received no compensation or reimbursement, it treated the person under a contract with a local mental health authority, or it was only reimbursed under Medicaid.

Q: Does the word 'treatment' in the statute imply the person was committed?
A: No. The AG noted that voluntary patients under chapter 572 also receive "treatment," so the word does not limit the refund to commitment cases.

Q: Does federal EMTALA law change the answer?
A: No. The AG concluded the briefer did not show how refunding costs for non-committed patients "directly conflicts" with EMTALA, and EMTALA's preemption clause only displaces directly conflicting state law.

Background and statutory framework

Health and Safety Code section 571.018, part of the Texas Mental Health Code (subtitle C, chapters 571-579), allocates the costs of mental health hearings and proceedings. Counties bear many costs (id. § 571.018(a), (b), (f)), the State bears certain transport costs (id. § 571.018(e)), and counties may seek reimbursement in some cases (id. § 571.018(d)). Subsection 571.018(j) directs a judge to order a refund of court costs paid or advanced by certain inpatient mental health facilities (defined in section 571.003(9)) when the facility files an affidavit meeting one of three conditions.

The dispute centered on whether the word "committed" in subsection 571.018(h) limits subsection 571.018(j). Subsection (h) prohibits the state or a county from paying costs for "a patient committed to a private mental hospital," other than a filing fee or other cost associated with a hearing or proceeding, unless conditions are met. The AG concluded (h)'s "committed" language defines the scope of a payment prohibition, not the refunds in (j), and that (h) even excepts the court costs (j) refunds (reading "costs" consistently across the section per Horseshoe Bay Resort, Ltd. v. CRVI CDP Portfolio, LLC). Refusing to add words the Legislature omitted (citing Christus Health Gulf Coast v. Aetna, Inc., 397 S.W.3d 651 (Tex. 2013), and In re Ford Motor Co., 442 S.W.3d 265 (Tex. 2014), quoting Iselin v. United States, 270 U.S. 245 (1926)), the AG concluded (j)'s refunds are not limited to commitment cases. It rejected the "treatment"-implies-commitment argument (noting voluntary patients under chapter 572 receive treatment) and an EMTALA argument (citing BankDirect Capital Finance, LLC v. Plasma Fab, LLC, 519 S.W.3d 76 (Tex. 2017), and 42 U.S.C. § 1395dd(f)).

Citations and references

Statutes:

• Tex. Health & Safety Code § 571.018 — payment and refund of costs in mental health proceedings
• Tex. Health & Safety Code § 571.003 — definitions, including inpatient mental health facility
• 42 U.S.C. § 1395dd — EMTALA and its preemption clause

Key cases:

• In re Green Oaks Hosp. Subsidiary, L.P., 297 S.W.3d 452 (Tex. App.—Dallas 2009) — a private facility may advance court costs and seek reimbursement
• Christus Health Gulf Coast v. Aetna, Inc., 397 S.W.3d 651 (Tex. 2013) — courts take the Legislature at its word and do not revise statutes
• In re Ford Motor Co., 442 S.W.3d 265 (Tex. 2014) — supplying statutory omissions transcends the judicial function

Source

• Landing page: https://www.texasattorneygeneral.gov/opinions/ken-paxton/kp-0460
• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/2024/kp-0460.pdf

Original opinion text

KEN PAXTON
ATTORNEY GENERAL OF TEXAS

March 8, 2024

The Honorable Charles Perry
Chair, Senate Committee on Water, Agriculture, & Rural Affairs
Texas State Senate
Post Office Box 12068
Austin, Texas 78711-2068

Opinion No. KP-0460

Re: Whether the refund of court costs required by Health and Safety Code subsection 571.018(j) is limited to patients who are committed to a mental health facility (RQ-0515-KP)

Dear Senator Perry:

You inquire whether the refund of court costs under Health and Safety Code subsection 571.018(j) is limited to hearings and proceedings involving commitment.¹ You tell us "that some local authorities are attempting to limit the scope of refunds to only those persons who are committed to a mental health facility." Request Letter at 1. You suggest this perceived limitation may stem from subsection 571.018(h). Id. To address the proper scope of subsection 571.018(j), we begin by reviewing the overall statutory framework in which section 571.018 is situated.

Health and Safety Code section 571.018 sets out the procedures to pay for costs under the Texas Mental Health Code.

Section 571.018 is located in subtitle C of Title 7 of the Health and Safety Code, which is the Texas Mental Health Code (the "Code"). TEX. HEALTH & SAFETY CODE § 571.001 (establishing a short title for subtitle C). The Code consists of chapters 571–579 and is intended "to provide to each person having severe mental illness access to humane care and treatment . . . ." Id. § 571.002. Chapter 571 contains the Code's general provisions. See generally id. §§ 571.001–.026. Within chapter 571, section 571.018 provides a framework for the payment of certain costs.² Id. § 571.018. In general, counties bear many of the costs for such hearings and proceedings. Id. § 571.018(a)–(b), (f); but see id. § 571.018(d) (entitling counties to reimbursement from a patient or those liable for the patient's support in a Department of State Health Services mental health facility), 571.018(e) (assigning responsibility to the State for paying certain costs related to patient transport).

Where its conditions are met, subsection 571.018(j) also requires payment from a county. See In re Green Oaks Hosp. Subsidiary, L.P., 297 S.W.3d 452, 456–57 (Tex. App.—Dallas 2009, no pet.) (stating that the predecessor to subsection 571.018(j) "recognizes that a private facility may well choose to pay or 'advance'" court costs and "allows it to seek reimbursement from the County under limited circumstances" (emphasis added)). Specifically, subsection 571.018(j) directs a judge to order the refund of court costs paid or advanced by certain inpatient mental health facilities:

(j) The judge of a court conducting a hearing or proceeding under this subtitle shall order the clerk of the court to refund court costs paid or advanced for a person by an inpatient mental health facility as defined under Section 571.003(9)(A), (B), (D), or (E) on the filing of an affidavit with the clerk of the court certifying that:

(1) the facility has received no compensation or reimbursement for the treatment of the person;

(2) the facility provided treatment for the person under a contract with a local mental health authority; or

(3) the facility provided treatment for the person and only received reimbursement under Medicaid.

TEX. HEALTH & SAFETY CODE § 571.018(j). Relevant to your inquiry, one category of "inpatient mental health facility" that is subject to subsection 571.018(j) is "a private mental hospital licensed by the [Department of State Health Services][.]" Id. §§ 571.018(j), .003(9)(B).

Subsection 571.018(h) prohibits making certain payments to private mental hospitals,³ as follows:

(h) The state or a county may not pay any costs for a patient committed to a private mental hospital, other than a filing fee or other cost associated with a hearing or proceeding under this subtitle, unless:

(1) a public facility is not available; and

(2) the commissioners court of the county authorizes the payment, if appropriate.

Id. § 571.018(h). There is thus some overlap between subsection 571.018(h) and subsection 571.018(j), as a county paying for costs that involve a private mental hospital could implicate both subsections. See id. § 571.018(h), (j).

Nothing in subsection 571.018(j) limits the refunds of court costs to hearings and proceedings involving commitment.

Where its other requirements are met, subsection 571.018(j) requires that "court costs" be refunded. Id. § 571.018(j). Subsection 571.018(j) contains no language providing that an individual be "committed." Id. Rather, the provision directs the refund of "court costs paid or advanced for a person" without regard to commitment. Id. (emphasis added). Similarly, subsection 571.018(j) requires an affidavit certifying that "the person" received treatment. Id. Again, that requirement does not stipulate that "the person" must have been committed. A court "must take the Legislature at its word, respect its policy choices, and resist revising a statute under the guise of interpreting it." Christus Health Gulf Coast v. Aetna, Inc., 397 S.W.3d 651, 654 (Tex. 2013). When a provision is silent, courts have long recognized that "[t]o supply omissions transcends the judicial function." In re Ford Motor Co., 442 S.W.3d 265, 281 (Tex. 2014) (quoting Iselin v. United States, 270 U.S. 245, 250 (1926)). Accordingly, a court would be unlikely to construe subsection 571.018(j) to limit the refund of court costs to only committed persons.⁴

The reference to committed patients in subsection 571.018(h) does not limit the scope of refunds under subsection 571.018(j).

As previously noted, you presume that interpretations limiting the application of subsection 571.018(j) to instances involving committed persons derive from importing the limitation found in subsection 571.018(h).⁵ Request Letter at 1. Indeed, subsection 571.018(h) features the only mention of an individual being "committed" in the whole of section 571.018. See TEX. HEALTH & SAFETY CODE § 571.018(h). We thus examine subsection 571.018(h) to determine whether the phrase "a patient committed" serves to limit the scope of subsection 571.018(j).

While other portions of section 571.018—including subsection 571.018(j)—require a county to pay costs, subsection 571.018(h) instead prohibits certain payments. Specifically, "a county may not pay any costs" that fall within the scope of the prohibition "unless" two specific requirements are met. Id. (emphasis added). The phrase "a patient committed to a private mental hospital" thus establishes the scope of the prohibition against payments. To be prohibited, a payment must involve both a private mental hospital and a committed patient. Subsection 571.018(h) has no application where other medical facility types are involved or if commitment is not implicated. Because this language in subsection 571.018(h) limits the scope of prohibited payments, it provides no textual support for limiting the scope of required payments under subsection 571.018(j).

Moreover, subsection 571.018(h) excepts "a filing fee or other cost associated with a hearing or proceeding under" the Code from its payment prohibition. Id. Such costs include the "court costs" to be refunded pursuant to subsection 571.018(j). See id. § 571.018(i) (expressly stating that "costs associated with a hearing or proceeding under this subtitle" include "court costs"); see also Horseshoe Bay Resort, Ltd. v. CRVI CDP Portfolio, LLC, 415 S.W.3d 370, 384 n.7 (Tex. App.—Eastland 2013, no pet.) (stating that, when construing statutes, "a word or phrase is presumed to bear the same meaning throughout a text"). Therefore, subsection 571.018(h)'s prohibition against payment does not apply to "court costs" refunded under subsection 571.018(j). That subsection 571.018(h) does not prohibit the refund of court costs under subsection 571.018(j) lends further support to the conclusion that any limiting language in the former does not apply to the latter. Accordingly, a court would likely conclude that subsection 571.018(h) does not limit the scope of subsection 571.018(j) to hearings and proceedings involving commitment.

SUMMARY

Health and Safety Code subsection 571.018(j) requires court costs paid or advanced by certain inpatient mental health facilities to be refunded where its statutory requirements are met. Health and Safety Code subsection 571.018(h) generally prohibits the State and counties from paying costs for a patient committed to a private mental hospital unless its statutory requirements are met. Subsection 571.018(h) excepts some costs associated with certain hearings and proceedings from its general prohibition against payment. Nothing in either subsection limits the scope of subsection 571.018(j) to only court costs concerning individuals that have been committed. Accordingly, refunds under subsection 571.018(j) are not limited to only those hearings or proceedings involving commitment.

Very truly yours,

KEN PAXTON
Attorney General of Texas

BRENT WEBSTER
First Assistant Attorney General

LESLEY FRENCH
Chief of Staff

D. FORREST BRUMBAUGH
Deputy Attorney General for Legal Counsel

AUSTIN KINGHORN
Chair, Opinion Committee

J. AARON BARNES
Assistant Attorney General, Opinion Committee

Footnotes:

¹ See Letter from Honorable Charles Perry, Chair, Senate Comm. on Water, Agric., & Rural Affairs, to Honorable Ken Paxton, Tex. Att'y Gen. at 1 (Oct. 5, 2023), https://www.texasattorneygeneral.gov/sites/default/files/request-files/request/2023/RQ0515KP.pdf ("Request Letter").

² Subsection 571.018(c) provides several examples of what constitutes "costs" under section 571.018. TEX. HEALTH & SAFETY CODE § 571.018(c).

³ For purposes of the Code, a "[p]rivate mental hospital" is "a mental hospital operated by a person or political subdivision." TEX. HEALTH & SAFETY CODE § 571.003(20). A "[m]ental hospital" is either "operated primarily to provide inpatient care and treatment for persons with mental illness" or "operated by a federal agency that is equipped to provide inpatient care and treatment for persons with mental illness." Id. § 571.003(13).

⁴ Relying on Government Code subsection 311.023(5), briefing received by our office cautions that our construction may contravene the federal Emergency Medical Treatment and Active Labor Act ("EMTALA"). Brief from Max Renea Hicks, Att'y at Law at 6–7 (Oct. 25, 2023) (on file with the Op. Comm.). Specifically, the briefer questions "whether it would be consistent with EMTALA for the inpatient facility to receive payment" for treating individuals that are not committed and "whether the county would be acting consistently with EMTALA in making the payments." Id. at 6. EMTALA features an express preemption provision that states it "do[es] not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section." 42 U.S.C. § 1395dd(f). The briefer does not explain how a county refunding costs for treating non-committed individuals "directly conflicts" with EMTALA. Furthermore, when, as here, the statute's text is unambiguous, the Texas Supreme Court has cautioned against "nontextual purposivism and consequentialism winked at in [subsection 311.023(5) of] the Code Construction Act." BankDirect Cap. Fin., LLC v. Plasma Fab, LLC, 519 S.W.3d 76, 85 (Tex. 2017). Accordingly, EMTALA provides no assistance in construing Health and Safety Code section 571.018.

⁵ You do not identify any other basis for construing subsection 571.018(j) to be limited to hearings and proceedings involving commitment. See generally Request Letter at 1–2. One brief we received contends that subsection 571.018(j)'s requirement that the inpatient mental health facility's affidavit state that it provided "treatment" serves to impose such limitations. See Brief from John B. Dahill, Exec. Dir. & Gen. Couns., Tex. Conf. of Urban Counties at 1 (Nov. 2, 2023) (on file with the Op. Comm.). However, not all hearings and proceedings conducted under the Code involve commitment. For example, "a proceeding" may be conducted under chapter 572, which pertains to voluntary mental health services. See TEX. HEALTH & SAFETY CODE § 571.0165(a) (referring to "a proceeding" under various chapters, including chapter 572). A person voluntarily admitted under chapter 572 may receive "treatment." See id. §§ 572.001(e) (requiring a request for admission to include consent for "treatment"), 572.0025(f) (setting forth limitations for a prospective voluntary patient's "treatment"), 572.003(b)(1) (providing a voluntarily admitted person the right "to be reviewed periodically to determine the person's need for continued inpatient treatment"). We therefore cannot construe the use of the word "treatment" in subsection 571.018(j) to limit that provision's application to only those hearings and proceedings involving commitment.