Author: DW Admin

In this issue:

• On Their Way to the Governor’s Desk
• Legislature Approves Extension of Cancer Prevention & Research Institute of Texas
• House Extends Health Care Coverage for Medicaid Mothers
• Bill Addressing Adverse Childhood Experiences Moves Forward
• Bill Promotes Best Practices for Physical Activity in Schools
• Senate Passes Medical Transportation Pilot Program for New Mothers

Upcoming Hearings for the week of May 20

Upcoming Events

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

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State Updates

On Their Way to the Governor’s Desk

With a little more than a week left in the 86^th Legislative Session, bills are making their way to the Governor’s desk for his signature. Here are just a few that impact the delivery of health care for the communities we serve. 

HB 125 – Prohibits the state from publishing the home address of licensed mental health professionals online.

HB 2225 – requires birthing facilities to inform parents of deaf and hard of hearing infants about public resources available to them, including early childhood intervention (ECI) services.

SB 999 – develops a state plan to identify best practices related to the awareness, treatment and prevention of Alzheimer's disease.

SB 1142 – allows the Travis County Healthcare District (Central Health) to employ physicians to better provide medical care for indigent and needy residents.

SB 1378 – requires institutions of higher education planning to increase enrollment to medical degree programs to submit a specific plan to increase the number of corresponding first-year residency positions.

SB 2132 – provides women auto-enrolled into the state’s Healthy Texas Women (HTW) program with information about the program and a list of health care providers in the woman's geographic area.

Legislature Approves Extension of Cancer Prevention & Research Institute of Texas  

Approximately half of all cancers can be prevented through evidence-based prevention intervention services. Established in 2009, the Cancer Prevention and Research Institute of Texas (CPRIT) provides an infrastructure that supports and enhances the networks delivering cancer prevention services and conducting groundbreaking research throughout the state. On May 10, the Texas Senate passed House Bill 39 and House Joint Resolution 12 which will extend the CPRIT program and ask voters to amend the Texas Constitution to authorize $3 billion in general obligation bonds.

CPRITs investment in prevention grants makes it possible for the state to fully capitalize on its longstanding investment in Texas’ fight against cancer. Since 2010, CPRIT grantees have provided nearly 251,000 prevention vaccinations, 230,000 tobacco cessation services and 1,300,000 screening and diagnostics for breast, cervical, HPV-related, liver and colorectal cancers. Additionally, CPRIT has invested nearly 11 percent of its research portfolio – twice the national average – toward more than 150 cancer research projects aimed at improving survival rates and preventing children and adolescents from developing cancer. Methodist Healthcare Ministries worked with the American Cancer Society this legislative session to secure the reauthorization of CPRIT and ensure Texans receive lifesaving prevention clinical services and expedite innovation in childhood cancer research.

House Extends Health Care Coverage for Medicaid Mothers

The 2018 Texas Maternal Mortality and Morbidity Task Force Biennial Report found that 56 percent of maternal deaths between 2012 and 2015 occurred after 60 days postpartum. The most common contributing factor to maternal mortality included underlying medical conditions, such as diabetes and heart disease, due to the lack of access to quality care during the year after pregnancy and throughout the interconception period. On May 10, the Texas House voted 87-43 to pass House Bill 744 by Representative Toni Rose, which adopts the Task Force’s number one recommendation – to extend access to health care coverage from 60 days to 12 months following delivery.

The current 60-day postpartum coverage provided by maternal Medicaid does not allow women time to secure postpartum outpatient care and ensure access to interconception care services. Enabling eligible women to access and maintain continuous healthcare coverage is essential to help women identify and address health issues early on. HB 744 aims at improving the health of women, facilitate continuity of care, enable effective care transitions and promote safe birth spacing. Methodist Healthcare Ministries supports extending Medicaid coverage for women up to 12 months postpartum to ensure continuity of care, allowing women to receive treatment services for conditions such as substance use, diabetes and hypertension. House Bill 744 moves to the Senate where it awaits referral to committee and further action.

Bill Addressing Adverse Childhood Experiences Moves Forward

Texas ranks 30th in the nation for the number of children who have experienced two or more childhood traumas. Experiencing multiple stressful or traumatic events during childhood, known as adverse childhood experiences (ACEs), have shown to have profound effects on an individual’s cognitive, social and biological development. With nearly 24 percent of Texas children having experienced multiple ACEs, the Texas House voted 131-14 in favor of House Bill 4183 by Representative Tan Parker (R- Flower Mound), directing the state to develop a five-year strategic plan to address the social, health and economic impacts of adverse childhood experiences.

Studies have found that as the number of ACEs increases so do the risks of poor physical health, mental health and behavioral health outcomes. Using a public health framework, HB 4183 develops a strategic plan that identifies best practices and promotes the development of early intervention and prevention strategies to mitigate the impact of ACEs. Methodist Health Ministries supports empowering struggling families, promoting safe relationships and environments and building resiliency in children and families. On Wednesday, May 15, HB 4183 was heard by the Senate Committee on Health and Human Services and was left pending, awaiting further action.

Bill Promotes Best Practices for Physical Activity in Schools

Texas has the seventh-highest obesity rate in the country for youths between the ages of 10 and 17, with more than 600,000 youths considered obese. Children who are overweight or obese are five times more likely to be overweight or obese as adults and have an increased likelihood of developing chronic diseases, including diabetes and heart disease. On May 9, the Senate Committee on Education heard House Bill 455 by Representative Alma Allen (D-Houston), which provides guidance to school districts on adequate recess time while maximizing the effectiveness of outdoor physical activity.

Daily recess is shown to have health, social and academic benefits for students. Currently, the state does not provide school districts with specific guidance as to the best-practices for constructive physical activity and outdoor play time. HB 455 directs the Texas School Health Advisory Committee to develop age-appropriate model recess policies that encourage constructive outdoor play time. Methodist Healthcare Ministries provided written testimony to the Senate Education Committee in support of preventing obesity early in a child’s life to improve their health and productivity into adulthood. The bill was left pending in committee and awaits further action.

Senate Passes Medical Transportation Pilot Program for New Mothers

For many mothers in rural and urban areas, transportation to medical appointments is a significant barrier resulting in forgone health care or missed appointments. Missed appointments delay care which is associated with disrupted patient care, increased medical costs and increased emergency room visits. On Thursday, May 16, the Texas Senate voted overwhelmingly in support of House Bill 25 by Representative Mary Gonzalez (D-Clint), which creates a pilot program allowing pregnant and postpartum women to ride with their children to their pregnancy-related medical appointments under the Medicaid medical transportation program.

Currently, state and federal funds are not allowed to be used to transport a person who is not a Medicaid beneficiary to a medical appointment. This results in mothers having to travel without their children if they are going to a prenatal or postpartum appointment. HB 25 would allow health plans to leverage existing partnerships with ridesharing services to arrange for transportation for mothers and their children. The pilot program seeks to determine if the program reduces pregnancy-related complications, improves access to medical care and decreases missed appointments. Methodist Healthcare Ministries supported HB 25 as it worked through the House and Senate committee process. The bill, as amended in the Senate, heads back to the House for concurrence.

Upcoming Hearings for the week of May 20

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Events

Monday, May 27 – Last day of the 86th Legislative Session (Sine Die)

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• State Trauma Program Funding Bill Moves Forward
• House Tackles Property Tax Reform
• Bexar County House Freshman Ray Lopez Files Bills Protecting Vulnerable Youths
• Adequate Physical Activity Key to Future of National Security

Upcoming Hearings for the week of May 6

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

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State Updates

State Trauma Program Funding Bill Moves Forward

Every four minutes someone in Texas is faced with an unexpected traumatic injury – annually resulting in over 130,000 trauma hospitalizations and costing designated trauma centers nearly $300 million in unreimbursed trauma care services. To help offset the unreimbursed costs and sustain the state’s trauma care system, the Texas Legislature created the Driver Responsibility Program (DRP) in 2003. Over the course of the 16-year program, however, the DRP has received growing opposition for its impact on low-income drivers and families. On May 1, Representative John Zerwas (R-Fulshear) laid out House Bill 2048 for consideration on the House floor, which repeals the DRP and proposes a new funding source for the state’s entire trauma care system.

The current DRP levies fines and surcharges over a three-year period for reckless driving and moving violations such as DWIs ($1,000 a year), driving without an insurance or valid ID ($250 a year) and driving with an expired license ($100 a year). When Texans are unable to pay the DRP fines, their driver’s licenses are revoked, resulting in more than 1.4 million drivers losing their licenses since the inception of the program. HB 2048 proposes reinstating revoked driver’s licenses due to unpaid fines, repealing the program, and replacing the funding using three different mechanisms: increasing state traffic fines from $30 to $50, imposing a $4 fee on auto insurance policies, and raising the fees for DWI to $3,000, $4,500, and $6,000 for subsequent convictions, respectively. The bill was amended on the House floor, including the addition of a provision that increases the amounts allocated to Emergency Medical Services and the Regional Advisory Councils by 2 percent and 1 percent, respectively.

House Bill 2048 received broad support from health care stakeholders, including the Texas Hospital Association, Texas Sheriff’s Association, HCA Healthcare, CHRISTUS Healthcare, University Health System, Doctors Hospital at Renaissance and the San Antonio Police Department. HB 2048 was voted out by the House on a vote of 143-0 and sent to the Senate where it awaits to be referred to committee. Methodist Healthcare Ministries supports the passage of HB 2048 and its efforts to develop a sustainable and equitable funding stream for the state’s trauma care system.

House Tackles Property Tax Reform

Property tax and education reform bills have been the top policy issues of the 2019 legislative session. Legislators have routinely heard from constituents who have voiced concerns with rising property taxes, and confusing tax systems. On April 30, the Texas House debated Senate Bill 2, sponsored in the House by Representative Dustin Burrow (R-Lubbock), who stressed to House members that the intent of SB 2 is to make the tax process more transparent, though the bill does not aim to lower property tax rates.

The House approved Senate Bill 2 by a vote of 107-40, with 20 members of the Democratic party voting in favor of the bill. As passed, the bill requires cities, counties and emergency service districts to hold an election to raise property tax revenue above 3.5 percent from the previous year, matching the version passed by the Senate last week. Both versions also allow taxing units to include indigent health care costs into their revenue growth calculations, although with slightly different mechanisms. Efforts to add amendments that would exclude flood risk mitigation, public safety expenses and economic development expenditures from the revenue growth calculations were voted down.

State leadership applauded the bill’s passage, despite strong opposition from cities and counties. Local government officials fear the unintended consequences of the reform will restrict both short term and long term growth needs without providing meaningful tax relief for its residents. Senate Bill 2 has moved to conference committee where conferees will negotiate final terms.

Bexar County House Freshman Ray Lopez Files Bills Protecting Vulnerable Youths

Newly sworn-in House member, Representative Ray Lopez (D-San Antonio), was given the opportunity to debate his bill, House Bill 4753, last week in the House Committee on International Relations and Economic Development. The bill calls for a study to examine the growing cost of child care affecting hard-working families throughout the state. Lopez, a former member of the San Antonio City Council, won a special election runoff to replace former state Representative Justin Rodriguez, who gave up his seat to accept an appointment as Bexar County Commissioner.

Lopez shared with committee members that some families are forced to spend up to 30 percent of their annual income on child care, much higher than the 7 percent level recommended by financial analysts. The disparity, disproportionately affecting single-family households with low incomes, recognizes that children of parents with limited incomes consequently lack access to child care resources. Representative Lopez stressed that investing in child care was the first step toward ensuring a child’s success and healthy development. HB 4753 was left pending in committee, where it will likely remain due to legislative session deadlines.

Representative Lopez also introduced House Bill 4757 which looks to improve access to healthcare coverage for youths in foster care. Under current law, youths aging out of foster care have access to state healthcare coverage until the age of 26, however many lose their coverage after they age out due to the difficult renewal processes and application forms that must be submitted annually. HB 4757 would streamline the redetermination process and create an auto-renewal process for youths after leaving state conservatorship to prevent any disruption in services, treatment or medication. Methodist Healthcare Ministries supports Representative Lopez’s initiative to protect the underserved and ensure access to healthcare coverage for all vulnerable populations.

Adequate Physical Activity Key to Future of National Security

Nearly 33 percent of youths in Texas are too overweight to serve in the military, and obesity is one of the leading reasons why 73 percent of young adults in Texas are ineligible to serve in the military. On May 1, Methodist Healthcare Ministries’ advocacy partners, Mission: Readiness and the Partnership for a Healthy Texas, held a press conference highlighting the importance of increasing physical activity in schools to curb the obesity epidemic. Senator Campbell (R-San Antonio) and Senator Kirk Watson (D-Austin) noted in their comments that this was a national security concern and both supported the implementation of obesity prevention strategies, such as the passage of Senate Bill 364 to ensure recess policies are adopted in all schools.

Dr. Deanna Hoelscher, Regional Dean of the UTHealth School of Public Health at Austin, explained that childhood obesity is estimated to cost an additional $12,900 in medical care per overweight child, placing a significant burden on the healthcare system. Retired U.S. Army Major General Rick Noriega added that engaging in meaningful recess and physical activity in schools would ensure Texas develops a healthy workforce and strong military. With the obesity rate of fourth-grade students in Texas currently 44 percent higher than the national average, the time to act is now.

Methodist Healthcare Ministries remains a staunch advocate in preventing childhood obesity. It supports an upstream approach which includes supporting the Partnership for a Healthy Texas’ Senate Bill 1834, which creates a pilot program to incentivize the purchasing of healthy foods for individuals using SNAP benefits and Senate Bill 952, which creates standards for nutrition, physical activity and screen time in licensed child care facilities. Both bills have passed the Senate and are waiting to be heard in the House Committee on Human Services.

Upcoming Hearings for the week of May 6

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

 

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• Knowing the Immunization Status of Students in a School Campus Matters

• Increasing the Physician Loan Repayment CapHelps Rural and Underserved Areas

• APRNs and PAs Prescribing Authority Improves Access to Care

• State Property Tax Cap Bill Weakens Local Health Care Safety Net Systems

Upcoming Hearings for the week of April 29

Upcoming Meetings & Events

 

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

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State Updates

Knowing the Immunization Status of Students in a School Campus Matters

Texas has seen a twentyfold increase since 2003 in the number of nonmedical exemptions for school vaccination requirements. Vaccination exemptions tend to cluster geographically, create pockets of under-vaccinated children, and leave communities vulnerable to disease outbreaks, such as measles and whooping cough. On April 23, Senator Kel Seliger (R-Midland) laid out Senate Bill 329, also known as the “Parent’s Right to Know Bill,” in the Senate Health and Human Services Committee. The bill aims to improve community awareness on the importance of vaccinations and improve the state’s ability to identify pockets of disease and implement timely public health interventions.

Immunization exemption data currently collected by the state of Texas is aggregated at the school district level. Parents in support of SB 329 contend that sharing the data at the local campus level will improve community awareness and allow families to make informed decisions when enrolling their children in school. Testimony shared with committee members pointed out that parents of children with compromised immune systems need access to the data collected by the government on their child’s immediate surroundings so that they can make decisions related to their child’s health and well-being. Rekha Lakshmanan, with The Immunization Partnership, testified in support of SB 329, noting the bill ultimately seeks to provide greater transparency regarding the number of immunization exemptions which puts Texans unnecessarily at risk of vaccine-preventable diseases. Witnesses opposed to the bill claimed improving transparency would result in a backlash against unvaccinated individuals.

Organizations signing up in support of SB 329 included the Texas PTA, Williamson County Health District, Texas Public Health Coalition and Texas Medical Association, which explained how the school campus data would be invaluable in responding quickly to disease outbreaks. Methodist Healthcare Ministries supports SB 329 and is a longtime advocate of immunization policies that protect children and their families. The bill was left pending in committee.

Increasing the Physician Education Loan Repayment Cap

Texas ranks 47th in the nation in its ratio of primary care physicians to total population. The low ratio of primary care providers impacts access to care, especially for the 6 million Texans living in 123 counties with a full primary care professional shortage area designation. To encourage new physicians to work in underserved communities, Texas currently pays up to $160,000 of a physician’s student loan in return for a four-year commitment to practice in an underserved area and care for patients enrolled in the CHIP and Medicaid programs. Over the last five years, the program, known as the Physician Education Loan Repayment Program (PELRP), has enrolled 750 physicians caring for patients in rural communities, urban community health centers and correctional facilities. On April 23, the Senate Higher Education Committee took testimony on Senate Bill 998 by Senator Chuy Hinojosa (D-McAllen), which revamps the PELRP by increasing the maximum available loan repayment amount to each participating physician by $20,000 over a four-year term for a maximum of $180,000. This increased amount more closely reflects the educational debt load of recent medical graduates.

According to the Association of American Medical Colleges, 76 percent of medical students graduate with student debt and their total debt load has increased significantly over the past decade. The average educational debt of a new physician has grown from $173,000 in 2011 to $190,000 in 2016. Testifying in support of SB 998, Alan Schalscha, Chief Medical Officer of CommUnityCare, emphasized that the increased loan repayment amount is necessary to remain competitive with actual physician debt and will assist in attracting physicians to practice in medically underserved areas. The bill received support from many stakeholders, including the Texas Association of Community Health Centers, the Teaching Hospitals of Texas and the Texas Medical Association. Methodist Healthcare Ministries works to secure physicians for rural clinics who are often unable to successfully recruit providers for their communities. Passage of SB 998 will strengthen the PELRP and allow medically underserved areas to competitively recruit physicians for necessary medical care. The bill was left pending in committee.

APRNs and PAs Prescribing Authority Improves Access to Care

In Texas today, there are 206 counties designated as a mental health professional shortage area, with 73 percent of these counties lacking a single psychiatrist. As a result, patients must often wait several weeks or drive several hours for an appointment to see a psychiatrist. Currently, only psychiatrists can prescribe schedule II controlled substances, such as ADHD medication, pain medication or even opioid treatment medications. However, 42 other states already allow advanced practice registered nurses (APRNs) and physician assistants (PAs) to prescribe these drugs under a physician’s supervision. On April 24, the House Public Health Committee heard testimony on House Bill 2250 by Representative Eddie Lucio, III (D-San Benito), which looks to improve continuity of care, increase access to care and reduce administrative burdens for hospitals.

The future of health care depends on a team-based approach to patient care. Under the current law, a supervising physician must be present for an APRN or PA to prescribe or adjust a Schedule II drug. Testifying in support of House Bill 2250, Sharon Hilgartener, with Texas Nurse Practitioners, stated that changing the dosage of pain medication while the patient is in the hospital is currently within her scope of practice. However, upon discharge, if the dosage on a patient’s prescription needs to change, a physician must sign off. The inability to reach a physician often results in delayed patient discharge, decreased throughput, decreased patient satisfaction scores and ultimately lower reimbursement rates. The Texas Medical Association also went on record in support of HB 2250. Methodist Healthcare Ministries values a patient-centered system of care that reflects the patients’ needs and improves access to health care services. The bill was left pending in committee.

State Property Tax Cap Bill Weakens Local Health Care Safety Net Systems

Texas’ rapid population increase places an unparalleled demand on its police, firefighters, paramedics and other local community services. As the cost of providing these services continues to rise, local governments rely on their ability to raise funds through property tax revenues to meet the needs of their residents. Under current law, local governments may raise property tax revenue by up to 8 percent without holding a local election. On April 15, the Texas Senate passed Senate Bill 2 by Senator Paul Bettencourt (R-Houston), which seeks to limit the capacity of local governments and special purpose districts to raise taxes by more than 3.5 percent above the previous year’s revenue and retains a 2.5 percent revenue cap for school districts. Reducing the property tax cap restricts local governments from providing necessary services, such as building and maintaining essential infrastructure, investing in schools and protecting against public health threats.

Local government officials and health care advocates from across the state are opposed to the current language in the Senate’s property tax cap legislation. The legislation threatens to weaken an already vulnerable health care safety net system, especially for providers in rural communities, who cannot rely on state and federal reimbursement to remain viable. Property tax revenues are also used to maintain the underfunded Texas trauma system as well as to offset the state’s share of Medicaid payments to hospitals.

Senate Bill 2 differs from the House’s property tax bill, House Bill 2 by Representative Dustin Burrows (R-Lubbock), which will be debated April 30 on the House floor. The current proposal places a 2.5 percent revenue cap on counties, cities and special purpose districts; however, the bill exempts local hospital districts and school districts from the revenue cap.

Methodist Healthcare Ministries remains engaged in tracking state legislation that restricts local governments from meeting their basic obligations to citizens. Texas needs a fully funded and sustainable health care safety net system to serve the uninsured and underserved of this state.

Upcoming Hearings for the week of April 29

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Meetings & Events

Saturday, May 4 at 10:30 – Minds Matter Conference; Breaking the Silence on Suicide (San Antonio College)​

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• House Passes Health Literacy Bill
• House and Senate Appoint Budget Conferees
• Improving Access to Oral Health Through Teledentistry
• Border Health Bills Get Heard in Senate Committee

Upcoming Hearings for the week of April 22

Upcoming Meetings & Events

 

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

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State Updates

House Passes Health Literacy Bill

One out of five Texans lack the knowledge to manage their health and prevent disease. Knowing how to seek medical care and take advantage of preventive services requires understanding health information to make informed decisions. Last Tuesday, Representative John Turner (D- Dallas), laid out House Bill 2032 on the House floor for consideration, where it easily passed on a vote of 101-33 and is now headed to the Senate. The bill directs the Statewide Health Coordinating Council (SHCC) to create an advisory committee that will develop a state plan to increase health literacy so that Texans are able to obtain, process and understand basic health information to make healthy decisions. 

The health impacts of low health literacy result in the reduced physical and mental health of Texans. Methodist Healthcare Ministries championed similar legislation in 2017 and returned this session to support the SHCC’s formal recommendation to establish these provisions in statute. The development of a health literacy plan will increase patient adherence, decrease hospital readmissions and increase a patient’s ability to manage medications correctly. Work continues to secure a hearing for HB 2032 in the Senate Health and Human Services Committee in the coming weeks.

House and Senate Appoint Budget Conferees

The House and Senate have completed work on their respective versions of the state’s two-year budget, the 2020-2021 General Appropriations Act, and must now come to an agreement before the legislative session officially ends on May 27. House Speaker Dennis Bonnen and Lieutenant Governor Dan Patrick each named five members to the Budget Conference Committee to iron out the differences between the House and Senate appropriation bills.

• In the House, Representative John Zerwas (R- Fulshear) will serve alongside Representatives Greg Bonnen (R-Friendswood), Sarah Davis (R-Houston), Oscar Longoria (D-Mission), and Armando Walle (D-Houston).
• In the Senate, Senator Jane Nelson (R-Grapevine) will serve alongside Senators Joan Huffman (R-Houston), Lois Kolkhorst (R-Brenham), Larry Taylor (R-Friendswood), and Robert Nichols (R-Jacksonville).

Leaders remain optimistic about reaching an agreement on the budget, however, there are significant differences between the House and Senate. The House budget appropriates $116.5 billion in state funds and $2.3 billion from the Economic Stabilization Fund (ESF), while the Senate budget appropriates $116.8 billion in state funds and no dollars from ESF. The Legislative Budget Board has released the following summaries for the House and Senate bills. Methodist Healthcare Ministries has several important issues that will be decided in conference negotiations, including funding for the reconstruction of the San Antonio State Hospital, outpatient mental health treatment, substance use treatment, women’s health programs, early childhood intervention services, and other budget items. Conferees are expected to convene for their first meeting on Tuesday, April 23.

Improving Access to Oral Health Through Teledentistry

While oral healthcare has improved across many states, Texas continues to fall behind and currently ranks 44^thin the nation for rural oral healthcare. Currently, 310,000 Texans do not have access to dental care, with 93,000 insured patients needing to travel more than 15 miles to access dental services and 411,000 people living in a designated dental health professional shortage area. As a result of the low ranking, the U.S. Rural Health Report Card for 2017 gave Texas an “F” for rural access to dental care. To improve access to dental care for underserved areas, Senator Charles Perry (R-Lubbock) filed Senate Bill 792. The bill received a hearing last week in the Senate Health & Human Services Committee and remains pending.

Of Texas’ 29 million resident’s, teledentistry stands to provide care to 3.1 million patients in rural communities. SB 792 defines teledentistry and enables dentists to supervise up to two dental hygienists at alternative sites using telemedical services, bringing care directly to patients. Witnesses in support of the bill testified that SB 792 lays the groundwork for improving access to oral healthcare and explained the need to integrate medicine and dentistry through telehealth oral consultations for effective disease prevention and identification, such as cancers.

Increasing access to routine oral health care services that prevent tooth decay and reduce the prevalence of chronic diseases is a legislative priority for Methodist Healthcare Ministries. In an effort to engage local faith communities on improving access to dental care, the Ministries providing funding to Texas Impact to develop the 2018 primer, Equipping Texas Faith Communities for Oral Health Leadership.

Border Health Bills Get Heard in Senate Committee 

In response to emerging public health threats, such as tuberculosis and Zika outbreaks, the Task Force of Border Health Officials was formed last session to identify public health priorities uniquely affecting counties on the Texas-Mexico border. Local health department officials appointed to the Task Force released a legislative report in December outlining both short-term and long-term recommendations that would aim to: improve the public health infrastructure, reduce communicable diseases, reduce chronic diseases, improve environmental health and improve maternal child health in border counties. To codify these recommendations into law, Senator Eddie Lucio, Jr (D-Brownsville) laid out the following bills in the Senate Health and Human Services Committee last week.

•  Senate Bill 1119– Establishes the border public health initiative to reduce the adverse health impacts of diabetes, hypertension, and obesity for adults and children by promoting educational resources, screenings and referrals.
• Senate Bill 1120– Provides border-specific continuing education training to community health workers, health care professionals and local public health employees to diagnose and treat communicable diseases, such as tuberculosis and increase immunization rates.
• Senate Bill 1121– Improves access to laboratory agreements for public health departments along the border so that public health departments in a short time frame can test specimens to diagnose and treat diseases.
• Senate Bill 1122– Establishes a sanitarian recruitment and retention program that would improve disease management response by controlling vector breeding of food-borne, water-borne, vector-borne and zoonotic diseases, such as Zika.
• Senate Bill 1124– Establishes the public health multidisciplinary response team (consisting of an epidemiologist, nurse, sanitarian and public health specialist) which would be deployed to assess the border health infrastructure, response capabilities and develop countermeasures to mitigate emerging public health threats.
• Senate Bill 1312– Issues restricted pesticide applicator licenses to local health departments for the sole purpose of mosquito control in border counties. The bill also directs the study of the ongoing needs of border counties related to infectious disease management.
• Senate Bill 1313– Establishes a school-based childhood obesity and other chronic disease prevention demonstration program and establishes a chronic disease prevention program for adults to serve border counties. MHM supports this bill to establish best practices to successfully address childhood obesity and chronic disease prevention.

Testifying in support of these bills were Dr. Hector Gonzales, with the City of Laredo Health Department, and Eduardo Olivarez, with the Hidalgo County Health and Human Services Department. They explained how border counties are uniquely affected by transnational diseases and public health threats and emphasized the importance of growing local health care professionals that understand the bi-cultural needs of the region. Methodist Healthcare Ministries staff attended the Task Force hearings in Austin over the interim to learn more of the health needs impacting border counties and registered in support of the Senate bills. SB 1124 and SB 1312 were unanimously voted out of the Senate Health and Human Services Committee and have been placed on the Senate Intent Calendar. The remaining bills are currently pending in committee awaiting further action.

Upcoming Hearings for the week of April 22

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Meetings & Events

Friday, April 26 at 12:00 – Texas Tribune: A Conversation on Children’s Health and Vaccines. Registration In Person / Livestream

Saturday, May 4 at 10:30 – Minds Matter Conference; Breaking the Silence on Suicide (San Antonio College)

 

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• Mental Health Grants Identified for School-Based Health Centers
• Extending Health Services for Post-Partum Moms
• Bolstering the Early Childhood Intervention Program in Texas
• Funding Recovery Community Organizations and Peer to Peer Counseling Model
• Bill Looks to Increase Telepharmacy Sites in Rural Counties

Upcoming Hearings for the week of April 15

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

___________________________________________________________________________________________

State Updates

Mental Health Grants Identified for School-Based Health Centers

One in five children experiences serious mental illness, and with the tragic school shooting at Santa Fe High School and the impact of Hurricane Harvey still being felt around the state, increasing access to mental health screening and treatment for youths has become eminent. Last Wednesday, the House Public Health Committee took testimony on House Bill 1335, authored by Rep. Four Price (R-Amarillo), which creates a behavioral health grant program for school-based health centers. School-based health centers allow school districts and community partners, such as local mental health authorities and nonprofit organizations, to develop cooperative health care programs for students and families in schools. Currently, these health centers focus on immunizations, dental health care, health education and preventive health strategies. House Bill 1335 would create a dedicated grant for behavioral health professionals in schools, integrating behavioral health services in the school environment and ultimately improving the emotional well-being and academic performance of at-risk students.

With 1.9 million youths in Texas needing behavioral health services by age 14, integrating behavioral health services in schools will increase access to care at a critical stage in youth development. Testifying in support of HB 1335, Dr. Teandra Gordon, with Legacy Community Health, spoke to the positive impact of providing mental health services in schools, especially for our uninsured or underinsured students. Joining in support were Meadows Mental Health Policy Institute, NAMI Texas, Texans Care for Children, the Hogg Foundation for Mental Health, among other health advocates. There were also witnesses who registered in opposition to the bill, arguing the program would diminish parents’ rights and distract school teachers from focusing on teaching.

Methodist Healthcare Ministries owns and operates two school-based health centers, located on the Schertz and Marion Independent School District campuses in Guadalupe County. Both offer pediatric primary care and dental services, as well as behavioral health counseling. Methodist Healthcare Ministries supports the passage of House Bill 1335 and its efforts to expand early identification and intervention of behavioral health needs for children. The bill was left pending in committee where it awaits further action.

Extending Health Services for Post-Partum Moms 

Roughly 1.8 million Texas women are in need of access to preventive health services, yet less than a quarter of these women currently receive the care they need. When women experience gaps in their healthcare coverage, it increases their risk for negative health outcomes. The Texas Maternal Mortality and Morbidity Task Force found that over one-half of pregnancy-related deaths occurred after 60 days postpartum and that 80 percent of these deaths were potentially preventable had these women received access to health care coverage. The House Human Services Committee heard from witnesses last week on House Bill 1110 by Rep. Sarah Davis (R-Houston), which seeks to maximize the utilization of services and programs in the women’s healthcare safety net, reduce the state’s maternal mortality rates and save Texas taxpayer dollars. 

As recommended by the Maternal Task Force’s Biennial Report, House Bill 1110 extends coverage for maternal Medicaid benefits from 60 days to 12 months postpartum. Signing up in support of the bill were advocates representing Healthy Futures of Texas, Texans Care for Children, Children’s Defense Fund, the Center for Public Policy Priorities, and The Texas Women’s Health Coalition. The bill was left pending in committee by Chair James Frank (R-Wichita Falls). Methodist Healthcare Ministries joined advocates in support of HB 1110 and efforts by Rep. Davis to improve access to health care services for women which will improve maternal health and reduce poor health outcomes.

Bolstering the Early Childhood Intervention Program in Texas

Annually, the Texas Health and Human Service’s Early Childhood Intervention (ECI) program serves more than 50,000 children statewide between the ages 0-3 with physical, intellectual or mental disabilities. Children in this program receive speech, occupational and in-home therapies which are instrumental to their development. On April 9, House Bill 12 by Rep. Sarah Davis (R-Houston) was heard by the House Human Services Committee. The bill establishes safeguards for the ECI program, eases the burden on providers and increases access to services for families in need.

To develop a sustainable ECI program, the bill’s committee substitute would require private insurers cover select ECI services (e.g., specialized skilled training and case management), ensure parity exists between private insurers and Medicaid, create an ombudsman for ECI providers, and establish an ECI telehealth pilot program. Noted during the hearing was the fact that parents with private insurance often opted not to secure ECI services primarily because not all services are covered by their insurers. Concern was also expressed for parents having to pay high deductibles. Christie Shaw with West Texas Centers testified in favor of the bill, noting the committee substitute would expand their current pilot program and encourage providers be reimbursed for their services.

Between 2010 and 2018 Texas lost 16 ECI providers, impacting 83 counties and more than 7,600 children statewide. Stephanie Rubin with Texans Care for Children emphasized the importance of having an adequate ECI provider network, and that with only 42 current providers for the entire state, the telehealth program would be critical in improving access to services.

Methodist Healthcare Ministries supports increasing access to ECI services which improve childhood outcomes and result in cost savings to the state by reducing the number of children who need special education services later in school. House Bill 12 was left pending in committee. The companion bill, Senate Bill 2225 by Senator Judith Zaffirini (D-Laredo), currently awaits a hearing in the Senate Health and Human Services Committee.

Funding Recovery Community Organizations and Peer to Peer Counseling Model

Substance use disorders affect 1.6 million adults and 1.1 million children in Texas, however, accessing treatment and recovery services is an ongoing challenge. Only 8.6 percent of Texans over the age of 12 who use illicit drugs receive treatment, far below the national average of 14.1 percent. Fortunately, recovery community organizations (RCOs), independent nonprofit organizations led by representatives of local communities of recovery, help connect people to treatment and fill the gap in the SUD treatment infrastructure. These unique organizations provide recovery and family supports through peer-to-peer counseling services. House Bill 1613 by Rep. Joe Moody (D-El Paso) seeks to bolster community-led efforts by RCOs that combat substance use disorder by securing reimbursement for providers who use peer-to-peer counseling services. 

RCOs participate in organizing recovery-focused community education, outreach programs and peer-based support services. HB 1613 defines the parameters, certification requirements, training requirements and the scope of RCOs to qualify for Medicaid reimbursements. Currently, RCOs are sustained through federal, state and private grants. The implementation of a billable service through the Medicaid program, however, would allow RCOs to focus on increasing the quality of long-term recovery services. Advocates of the RCO model testified on the value of the peer-to-peer model of care, the cost-effectiveness of RCOs and how the program ensures fidelity to recovery.

Increasing access to behavioral health and substance use disorder services through the peer-to-peer counseling model is a priority for Methodist Healthcare Ministries, which recognizes the vital importance in accessing treatment and saving lives. HB 1613 was left pending in committee.

Bill Looks to Increase Telepharmacy Sites in Rural Counties

The link between poor medication adherence and hospital readmissions is well documented. A single day gap in medication therapy increases the chance of hospitalization by 50 percent. By contrast, having a pharmacy located at a clinical site that provides medications to patients upon leaving a medical visit, can reduce rehospitalizations by 40 percent. On Wednesday, the House Public Health Committee took testimony on House Bill 1706 by Representative Tom Oliverson (R-Houston), which seeks to increase access to prescription medication in underserved communities by expanding the list of healthcare facilities eligible to host a telepharmacy site to include: federally qualified health centers, community health centers, birthing centers, hospitals, ambulatory surgical centers, outpatient clinics and public health clinics.

Low volume of prescriptions, notably in rural areas, prevents pharmacies from being staffed by pharmacists. Fortunately, current law allows remote pharmacies to operate in rural areas using a telepharmacy system, with the stipulation that they be located at least 22 miles from a Class A pharmacy. At these remote dispensing sites, the pharmacy technician fills the prescription, has the prescription reviewed by a pharmacist using technology, and remotely secures a 2-way HIPAA compliant consultation between the patient and pharmacist. House Bill 1706 directs telepharmacies to operate in a setting which will allow for convenient access to a pharmacist, increasing first-fill and medication adherence rates. Witnesses in support testified that the bill would allow a community mental health center to co-locate a pharmacy dispensing site at a satellite campus to reach the most vulnerable patients, namely those with mental illness.

Methodist Healthcare Ministries supports the efforts of House Bill 1706 to increase access to medications for patients in underserved and remote areas of the state, ultimately working toward improving patient outcomes, curbing hospital readmissions and decreasing overall healthcare costs. HB 1706 was left pending in committee, awaiting further action.

Upcoming Hearings for the week of April 15

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• Texas Budget Bill Moves Through House and Senate
• Committee Looks at Incentivizing Healthy Food Purchases for SNAP Families
• Nurse Practitioner Bill Aims to Increase Access to Care
• House Bill Allows Dentists to Delegate Delivery of Anesthesia to Licensed Hygienists

Upcoming Hearings for the week of April 1

Upcoming Meetings & Events

View our 2019 Legislative Agenda

Advocacy Find your Rep How the Texas Legislature Works Bill Tracking Access to Care Behavioral Health Healthcare Workforce Women & Children's Health Research 2018 State of Texas Children: The Road to a Brighter Future

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State Updates

Texas Budget Bill Moves through House and Senate 

Texas lawmakers worked until the late hours of the night on March 27 to debate the Texas budget for FY 2020-2021. As the only bill that must pass during the 140-day legislative session, lawmakers had one more opportunity to amend the proposed budget before it heads to the Senate and ultimately the conference committee negotiating process. More than 350 amendments were filed, however a large number were withdrawn by the authors or ruled out on a technicality. Ultimately, the House passed a $251 billion budget with $87.6 billion dedicated to health and human services programs.

Methodist Healthcare Ministries expresses its thanks to State Representative Roland Gutierrez (D – San Antonio) for filing an amendment to fully fund the reconstruction of the San Antonio State Hospital, estimated at $323 million for the 300-bed facility. The amendment was ultimately placed in Article XI of the House budget, essentially a wish list of proposals that are not formally adopted but do remain in play during conference committee negotiations.

House Bill 1 proceeded to the Senate Finance Committee last week and was heard Wednesday, April 4. The Senate Committee Substitute to House Bill 1 (CSHB 1) was voted out unanimously and is scheduled to be voted on by the full Senate Tuesday, April 9. CSHB 1 currently includes $248 billion with $92.2 billion allocated for health and human services. Specific initiatives in the Senate version include:

• $948 million for community mental health services for adults and children
• $315 million for Women’s Health Programs
• $313 million for early childhood intervention services
• $252 million for EMS and trauma care systems
• $167 million for immunizations initiatives for adults and children

With only seven weeks remaining in the 86^thLegislative Session, Methodist Healthcare Ministries continues its efforts to advocate for programs and funding that impact the healthcare of our neediest families.

Committee Looks at Incentivizing Healthy Food Purchases for Low-income Families 

The Senate Health and Human Services Committee heard testimony this week on legislation that would direct the state to study local programs across communities working to incentivize the purchase of fruits and vegetables through the Supplemental Nutrition Assistance Program (SNAP). Senate Bill 1834 by Representative Carol Alvarado (D – Houston) would give low-income Texans access to affordable healthy foods through a state pilot program that would stretch current SNAP benefits even further.

Passage of the federal Agricultural Improvement Act of 2018, more commonly known as the Farm Bill, appropriated roughly $250 million over five years for SNAP incentive programs to encourage fresh produce consumption. Texas has started to take steps to promote the availability of SNAP incentive programs, such as the popular Sustainable Food Center’s Double Dollars program, which provides SNAP recipients an extra dollar for every dollar of SNAP benefits spent on locally grown fresh fruits and vegetables. A number of incentive programs exist at the local level, but to date, no state-level programming or investment has been made.

Farmers, grocery store owners, local vendors, and small retail stores would also benefit from higher sales of locally grown produce. Testifying on behalf of the Sustainable Food Center, Alex Canepa spoke in favor of SB 1834, stating his farmers markets currently support incentive programs. He noted that Texas is lagging other states who are already implementing successful programs, giving Michigan as an example.

SNAP benefits are 100 percent federally funded and assist millions of low-income families with the purchase of groceries. Studies show that many of these same low-income families are disproportionately struggling with obesity and Type 2 diabetes. Nearly 30 percent of all Texas children benefit from the SNAP program and over half of SNAP recipients in Texas are under the age of 18. Methodist Healthcare Ministries joined efforts with the American Heart Association and the Partnership for a Healthy Texas coalition to support the passage of SB 1834. The bill was left pending in the Senate Health and Human Services Committee by Chair Lois Kolkhorst.

Nurse Practitioner Bill Aims to Increase Access to Care 

Access to care advocates testified before members of the House Public Health Committee in support of House Bill 1792 by Representative Stephanie Klick (R-Fort Worth) which looks to expand access to primary care by providing a pathway to full practice for nurse practitioners, certified nurse midwives and clinical nurse specialists. The bill would require at least one year of experience under a delegating physician and increase the required continuing education requirements for APRNs from 20 to 48 hours, the equivalent of physician continuing education requirements.

Current Texas law prevents advanced practice registered nurses from providing health care to the full extent of their licensure and training. Today, APRNs must sign a delegation agreement with a collaborating physician to practice, even though the partnering physician is not required to be on-site or see any of the patients. Advocates testified this delegation agreement adds to health care bureaucracy and red tape, taking time away from patients and increasing costs for businesses and providers. Twenty-four states, the Veterans Administration and all branches of military have repealed laws that include these delegation agreements to increase access to care for their patients.

Testifying in opposition were physicians representing the Texas Medical Association as well as other independent providers, who shared that the extensive level of education and experience of a medical doctor were needed to ensure the necessary oversight and safety of patients. HB 1792 was left pending in committee.

House Bill Allows Dentists to Delegate Delivery of Anesthesia to Licensed Hygienists

Members of the House Public Health Subcommittee on Health Professions also heard testimony on House Bill 2275 by Representative Stephanie Klick (R-Fort Worth). The bill, as filed, would allow dentists to delegate to a licensed hygienist the ability to deliver an anesthetic in the presence of a dentist. The delegation provision is optional and does not create a mandate.

Witnesses testifying in support noted that this practice is currently allowed in 48 other states. The Texas Dental Hygienist Association registered in support of HB 2275 and shared the different levels of training and education necessary for accreditation. Dr. David Reeves, a member of the Texas Dental Association Periodontists and an instructor at the VA testified in support of the bill, stating that local anesthesia is safe when proper dosages and techniques are utilized. Testifying in opposition to the bill was a representative of the Texas Dental Association who stated the bill lowered the standards of care and was unnecessary. HB 2275 was left pending in committee. Methodist Healthcare Ministries signed up in support of HB 2275 which increases access to oral health in Texas.

Upcoming Hearings for week of April 8

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Meetings & Events

Apr 15-16: TX Campaign to Prevent Teen Pregnancy 8^thAnnual Symposium– Sponsored by Methodist Healthcare Ministries (Austin)

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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