The Senate Committee on Health & Human Services has released its interim report to the 89th Legislature. The report includes recommendations on children’s mental health, access to care, insurance, and cancer prevention, as well as updates on implementation of legislation from the 88th Legislature. A spotlight on recommendations from the report can be found below:
Children’s Mental Health
Under previous investments in HHSC mental health services, local community mental health services, and academic health-related institutions, Texas has created a system to screen for more serious mental health issues within the child population through the TCMHCC. This screening aims to focus needed interventions and services on a voluntary basis on those children or adolescents with higher acuity.
TCMHCC also supports efforts to train primary care physicians and other health care providers to help screen and target the mental health needs of children via the primary care system and to develop a strong workforce to address the needs of that population.
Previously funded services through the community mental health systems—including evidence-based services such as mobile youth crisis teams, multi-systemic therapy, and coordinated specialty care—are targeted and offered to both DFPS and TJJD and the general population.
Additionally, re-focusing state and local resources on the highest acuity populations, as opposed to funding a more broad-based, public health approach to mental health services, can address the pressing needs of children and avoid their entry into juvenile justice or foster care systems.
Witnesses suggested structural interventions that can provide respite for children from social media, technology devices, and other factors that are impacting rates of anxiety and depression among youth. Such interventions could include reinforcing full-day, in-person school classes, physical education, and daily recess in school and restricting access to social media apps or devices.
Finally, witnesses from HHSC, TJJD, and DFPS discussed the need for a specialized residential setting for children in conservatorship and the juvenile justice system that can fill the gap between in-patient hospitalization and community placement, as well as specific behavioral health services in the state’s mental health system reserved for youth with dual IDD and behavioral health diagnoses in the custody of DFPS or TJJD.
Access to Health Care
By 2050, Texas is projected to have more than 50 million residents but will have deficits across several healthcare provider types.
Through the three panels of invited expert witnesses, the committee heard from state regulatory boards, healthcare clinicians, and economists who identified potential costs, current gaps, and forecasted needs of the state, particularly with respect to accessing primary and mental healthcare.
Texas currently relies on the expertise of the health licensing boards to ensure the highest level of patient care is delivered to the greatest number of people. When licensed practitioners fall short of state law or board rule, the licensing boards hold their licensees accountable to the fullest extent allowed by law. Witnesses urged members to continue to invest resources to ensure all licensed healthcare professionals are providing the highest level of care and support through necessary appropriations to the regulatory licensing boards that enforce statutory requirements and professional standards
Additionally, the committee chair discussed the need for the state to maintain unified and consistent standards of care and avoid creating differing standards based on who is providing the care rather than for the care itself. Yet some committee members questioned how oversight should be administered for NPs who perform medical services, and what standard of care would be applied if delegation authority is removed. Currently, NPs would be held to complaints under the Texas Board of Nursing and not the Texas Medical Board, but the supervising physician could be held liable if the NPs invited that physician to review the case.
Several committee members expressed concerns related to the number of nurse practitioners who provide full-practice services with intermittent oversight. Witnesses acknowledged that some NPs are delegated via online supervision or once-a-month with a retrospective review in exchange for the delegation fee.
Additional policy solutions to address workforce shortages must prioritize rural and underserved areas of the state and support measures that strengthen affordability and access to care. Lawmakers could consider examining the current financial structures of delegatory agreements between nurse practitioners and physicians to ensure that delegation fees charged are not excessive and are commensurate with the level of delegation oversight provided.
New, standardized educational requirements—including a residency-like requirement—might be established to enable NPs/APRNs to practice more independently, ensuring consumers are protected and rural regions can gain additional providers.
Despite the differences of opinion expressed by the panels, one trend emerged throughout: witnessed urged continued collaboration among nurses, pharmacists, physicians, and psychologists to enhance patient care and optimize resources for healthcare services.
Additionally, while there are surpluses for the forecasted number of nurse practitioners, Texas is still in need of registered nurses and licensed vocational nurses. Lawmakers should consider measures to address those shortages and continue efforts to train more physicians.
Finally, Texas BHEC and the State Board of Psychologists should continue to prepare options to mitigate against the uncertain future availability of the sole psychology licensing examination.
Health Insurance
Witnesses discussed ways that Texas can encourage additional consumer education of health care options TDI and the Office of the Public Insurance Counsel should continue their ongoing commitment to educate the public on health insurance affordability and product options, but also expand their efforts to inform the public by publishing a booklet consolidating new and existing TDI health insurance content to help inform consumers regarding the basics of health insurance.
Texas should encourage healthcare prices to be available for consumers as widely as possible, including requiring healthcare providers to make accessible list prices to incentivize consumers shopping for coverage.
Finally, efforts to increase available health insurance coverage types under innovative, alternative, private market options for healthcare services can provide options to small businesses and individuals. Texas policymakers could also encourage the federal government to enact tax policies that encourage wide use of health savings accounts and other financing options that give consumers more freedom in the healthcare markets.
Cancer Prevention
Invited witnesses provided information to the Senate panel concerning how Texas has invested in cancer research, how research is currently supporting community initiatives to increase access to cancer screening and treatment, and how state investments could be leveraged to reduce the overall incidence of cancer diagnoses among state residents. Policymakers should continue current CPRIT prevention services and maintain the current structure of funding for investments in medical devices and tests to support earlier cancer detection.
Members of the Senate committee also asked about the need for additional public awareness on the connections between diet, environmental factors and cancer incidence. Witnesses suggested that DSHS could implement additional data points for collection in its cancer registry for incidence rates for early-onset cancers with an emphasis on diet profile, lifestyle, alcohol use, and environmental exposures, including the impacts of COVID-19.
Medicaid Fraud
Texas Medicaid has a robust partnership among several state agencies to ensure fraud, waste, and abuse are identified, investigated, and eradicated across the state. The Office of Inspector General at HHSC and the Office of the Texas Attorney General testified that the current structure of enforcement enables their agencies to work in concert with the Medicaid program and managed care organizations across administrative civil and criminal arenas and hold Medicaid providers and clients accountable.
Committee members asked the panel of witnesses what other tools or penalties might be needed to ensure that Texas effectively recovers lost Medicaid funds and prevents future losses.
Winter noted that he believed the current enforcement remedies—$10,000 per violation in addition to the amount of the actual Medicaid loss, plus three times that number—are strong; however, the OIG’s primary enforcement statute has not been updated since the 1980s. “We intend to propose changes to modernize our statutory management authority, equipping us with the tools necessary to better protect this program.” The state should modernize the current fraud statutes to seek out increasingly sophisticated schemes.
Investments in technology tools and program staff can also expand the reach. The OAG’s MFCU unit garners almost $50 for every state tax dollar invested in its enforcement activities.
Dudensing testified that the committee members should expand support for tools like Artificial intelligence and other data analysis technologies to enhance fraud, waste, and abuse strategies and to expand the Texas Fraud Prevention Partnership to include private health payers as well.
Protecting Vulnerable Texans in Emergencies
Throughout the hearing, members of the Senate Committee on Health and Human Services and invited witnesses exchanged ideas on how to better address vulnerable populations and their needs in emergency events such as hurricanes, wild fires, or other disaster events.
Witnesses supported a proposal to creating a comprehensive list/registry of licensed, regulated, or certified facilities and facilities that receive compensation for taking care of individuals that can be disseminated amongst the agencies responding to emergency events. Policymakers could consider requiring certain facilities licensed, certified, or regulated by the state to pre-determine the level of back-up generators needed in an emergency, and establishing generation testing and maintenance requirements.
Several committee members suggested that entities receiving tax credits for providing certain housing to seniors have some responsibility to stay engaged and onsite for those residents during emergency disasters. Tax credit housing criteria should include such a requirement for the housing types that market and cater to elderly individuals.
However, for entities that are marketing specific residential services in multi-family buildings to senior citizens the state deceptive trade practices laws could be applied to ensure no vulnerable populations are being misled as to the housing those developments are providing the tenants.
During public testimony, the Office of the State Long-Term Care Ombudsman and advocacy organizations urged the committee to consider adding requirements for entities licensed, certified, or regulated by the state to provide backup electrical generation to support critical functions such as lighting, elevators, refrigeration for food, and temperature control.
Finally, members of the public asked the committee to pass legislation to better regulate and oversee the “certified” IDD group homes under the HCS Medicaid waiver program by establishing licensing standards and enforcement for those facilities.
