Select Committee on Health Care Education & Training Interim Report

The House Select Committee on Health Care Education & Training has published their Interim Report to the 84th Legislature.
 
The committee was established by Speaker Joe Straus with the following charge:
 
The committee will assess the statewide demand for health professionals, including in the area of mental health. It will also make recommendations to better align institutions of public and higher education with the needs of health care employers. These findings will provide guidance as the Legislature seeks to strengthen the state’s health care workforce, which will lead to better care for patients and better career opportunities for many Texans.
 
The committee developed the following findings through their work in the interim:
 
Public Education

• The Legislature should establish a health professions middle and high school incubator program at the Texas Education Agency that will work with school districts to develop and establish dental and health professions pipeline programs in strategic demographic areas of the state, with priority for Hispanic majority and rural areas. An Advisory Committee should be established to oversee, advise and report on the program annually to the Legislature.
• A pilot program should be designed to allow students residing in Health Professional Shortage Areas (HPSAs) of the state and who can demonstrate proof of planning to return and practice in those areas upon graduation should be granted special admission priority status if all other admission standards are met, especially in the area of mental health and oral health.
• Expand the Early High School Initiative to increase the number of students who can obtain dental and health professional certifications and dual credit.
• Include attendance of students in approved night and summer career and technical education (CTE) programs for the purpose of computing weighted state funding under the Foundation School Program in order expand the number of opportunities for students to pursue career and technical training.
• Restore the statutory minimum cap on the percentage of school finance funds that must be spent on career and technical education (CTE) programs to maximize state investment for CTE programs.
• Establish a dedicated fund or revolving loan program specifically designed to help defray the costs for school districts to build infrastructure, buy equipment and establish clinical space needed for new and expanded health science training and programs.
• Direct the State Board for Educator Certification (SBEC) to review teacher certification requirements for high need/demand health professions and determine what is needed to better recruit and retain professionals to teach health careers at the secondary level and report statutory changes needed or take Board action on recommendations.
• The Legislature should study the effectiveness of the number of school guidance counselors as the frontline workforce to guide and direct students into high demand health care careers and determine what ratio of counseling staff is needed for success.
•  “Mental Health,” as a career, should be a clearly articulated and developed as a career cluster under the Public Service Endorsement and included with all other health professions to best capture and recruit students into the field.
• Direct the State Board of Education (SBOE) and Texas Education Agency (TEA) to collaborate with public and private mental health providers to develop standards for local school district curriculum for mental health courses and certifications.
• The Texas State Board of Education should develop standards for local school district curriculum for bilingual language programs for use in health care professions.
• A rider should be developed and added into the Article III section of the budget that would direct a percentage of Area Health Education Centers (AHEC) funds towards the support of local school districts health profession classes, training and educational programs. A report on the outcomes of AHEC efforts in school districts should be required.
• The Legislature could pass similar provisions for high performing high schools as outlined in HB 2824, 83R (vetoed) but with a more narrow and specific focus on high performing health science high schools in minority and rural school districts to foster school district innovation in health sciences and careers.
• The Texas Education Agency should provide more flexibility to the credentialing evaluations, as required by HB 5, specifically if a school district graduates a high number of students in a health science related endorsement.
• The P-16 Initiative program at the Texas Higher Education Coordinating Board (THECB) should be expanded to include evidence based and researched strategies for educating children about the health care workforce at the earliest grade level possible to generate interest in health careers and connection to academic study.

 
Higher Education

• The Legislature should continue the process for funding an increase in Graduate Medical Education (GME) slots in the state. New slots may need to be funded based upon a regional assessment of greatest health need in the state.
• The Legislature could consider restoring the state’s Medicaid match for Graduate Medical Education (GME) to pull in additional federal funds since current funding for GME/residency slots has not increased.
• The Texas Higher Education Coordinating Board (THECB) should coordinate a statewide partnership program with medical/dental schools, institutions of higher education and health science centers in order to develop and form formal partnership programs between those entities and local school districts to help establish health professions pipeline programs at the middle and high school level.
• The Legislature should consider directing the Higher Education Coordinating Board to administer the Texas Access to Health Professionals (TAHP) loan repayment program for all critically needed dental and health professions. This program would be in addition to the Physician Loan Repayment program. The program could be paid for through a joint federal state matching program called the State Loan Repayment Program (SLRP) and by dedicating and appropriating additional tobacco tax revenues to the program.
• The Higher Education Coordinating Board should consider development of a program similar to the Iowa Practice Support Initiative, to improve the long term retention of dental and health professionals in the loan repayment program.
• The Legislature could consider authorizing a pilot program that would demonstrate the effectiveness of a program similar to Oregon's Pay It Forward Model, to increase access to higher education and incentivize study in critical health fields. The state would pay up front for a student’s education in a critical need health related field and the student would then pay the state back interest-free upon employment. This would create a revolving fund for future students and a second type of incentive.
• The Higher Education Coordinating Board should be directed to coordinate with institutions of higher education the development of expedited training programs in mental health careers that align with new curriculum for mental health that would be developed by school districts.

 
Mental Health

• Require a joint study of the mental health care system conducted by the Department of State Health Services, (DSHS), Texas Department of Insurance (TDI) and an institute of higher education to evaluate the full spectrum of payment and reimbursements for mental health services in Texas, to determine if payment reform and regulatory changes are needed to better meet the demand for services and strengthen the workforce.
• The Legislature should thoroughly review and adopt where consensus exists the recommendations offered in the mental health workforce report produced by the Department of State Health Services, (DSHS) as required by HB 1023, 83R.
• A dedicated statewide mental health internship and residency grant program should be established to provide training stipends for psychiatric trainees, licensed counselor interns and other pre-licensure positions in the mental health professions. This could be funded by federal grants (i.e. The Behavioral Health Workforce Education and Training for Professionals). A single joint and collaborative effort between the state and counties would be needed to secure increased federal funds, especially in mental health shortage areas. Currently grants received in Texas are too widely disbursed and do not have enough financial value to make the difference needed to strengthen the state’s workforce.
• The Legislature should authorize the development of a pilot program that would incentivize and reward institutes of higher education willing and able to develop and demonstrate innovative multimodal and multidisciplinary models for delivering and expanding access to mental and behavioral health services in Texas.
• The Health and Human Services Commission should develop a strategy for increasing the number of certified peer specialists in the state. The plan/strategy should also indicate ways in which certified peer specialists can help reduce costs in the Medicaid program.
• Require the Health and Human Services Commission (HHSC) to evaluate and adjust Medicaid reimbursement rates where appropriate to mental health providers to incentivize community based mental health services, increase access to mental health professionals, as well as realize cost savings from care provided by community based providers versus emergency room care or county correctional costs.
• Clarify in state law, where appropriate, that occupational therapists can be classified as mental health providers and can be reimbursed for such services when provided for individuals with a mental health diagnosis.

 
General State Workforce Regulations, Initiatives and Programs

• The Legislature should support and fund the Texas Workforce Commission’s (TWC) expansion of the Accelerate Texas Program and further require the program to include mental health technicians and other entry level dental, medical, and mental health professions as options in the program.
• The Legislature should clarify, reduce or remove barriers to adult entry into the healthcare workforce including immunization requirements, high school diploma and GED requirements and other potential barriers. A temporary task force on the issue may be needed to provide recommendations.
• The Legislature should thoughtfully review and consider reforms in the area of criminal felonies that would prevent an individual from entering a health related field.
• The Texas Workforce Commission (TWC) should deploy rapid entry level dental and health professions training programs in strategic demographic areas of the state, including Hispanic majority, rural and Health Professional Shortage Areas (HPSAs) regions of the state.
• The Texas Workforce Commission (TWC) should coordinate an initiative with the Texas Higher Education Coordinating Board (THECB) to help individuals receive the education and training necessary to move from entry level positions into critically needed dental, medical, and mental health professionals. This would also open up additional entry level health positions for job seeking individuals.
• The Texas Workforce Commission should increase the number of Adult Education and Literacy (AEL) and Self-Sufficiency Fund projects that include training in dental and health-related occupations. Consideration of new projects should be targeted in Health Professional Shortage Areas.
• The Texas Workforce Commission (TWC) should allow non-profits (in accordance with SB 307, 83R) to have access to workforce skill development funding without having to partner with a community college.
• The Texas Workforce Commission (TWC) should consider a strategic program/initiative designed to encourage and support individuals to enter dental and health professions in the TANF Choices and SNAP Employment & Training (SNAP E&T) programs.
• The Department of State Health Services (DSHS), Area Health Education Centers (AHECs), and Local Workforce Boards should in partnership create and deploy a coordinated dental, medical and mental health professions recruitment campaign designed to reach both students and young adults promoting the need and benefits of pursuing a career in a critically needed dental and health profession.
• The Higher Education Coordinating Board should evaluate all state agencies dental and health profession employment needs and determine if specific programs and curriculum could be developed to better train individuals with the right skills and credentials to fill such positions and improve employee performance and retention for the state. (i.e. CPScase workers, juvenile justice caseworkers, etc.)
• The Legislature should fund the state’s community and faith-based initiative, through the Renewing Our Communities Account (ROCA), and direct the funds specifically to help build the capacity of non-profits to partner with dental, medical and mental healthcare providers, state and local governments and other stakeholders to support and help implement key health care programs and initiatives.

 
Veterans

• Evaluate and consider expanding statewide the Texas Workforce Commission’s (TWC) accelerated curriculum and training program for veterans in emergency medical services, surgical technology, respiratory therapy, dental hygiene and nursing.
• Establish in statute that a single state agency is the lead point for both veterans’ health care services and veterans' employment in health related fields.
• All state health licensing boards should establish a clear and streamlined process for a military service member or veteran to submit an application for a license or apprenticeship and consider military healthcare experience where applicable to obtain credit for verified military experience, service and training.
• Expand the number of Texas Workforce Commission’s (TWC) College Credit for Heroes partnerships and programs in community colleges and also the number and type of professionals in the program to ensure an increased focus on needed health related professions.
• Create a statewide public-private partnership to establish and expand veteran peer specialist programs for addressing veterans' mental health needs.
• Direct the Governor’s office of Economic Development to develop recruitment strategies to attract veterans with health care training and experience to Texas.
• Reform the Veteran's employment preference statute to allow state agencies to post positions to be filled by veterans only and give state agencies the authority to make direct hires without advertising the position; this could help fill critically needed health positions for the state more quickly while also increasing the percentage of veterans hired by the state.
• The Texas Veterans Commission should be given the statutory authority to require all institutions of higher education to report the academic and graduation outcomes of veterans, and specific information on veteran outcomes in all health care professional programs should be obtained and publicly reported.

 
Additional Findings

• The Department of State Health Services (DSHS) should develop a modern, more precise and Texas specific health needs assessment model, in order for the state to monitor and evaluate and report on the impact of all state programs in dental and health shortage areas to determine the effectiveness of such programs. The report should also provide specific and real time information for best strategies to reduce the number of medical and dental Health Professional Shortage Areas (HPSAs) in Texas.
• The Legislature should establish a Task Force to study and provide a full and comprehensive review of all entities that offer dental or medical health care training and determine what educational models are the best investment of state and federal tax dollars for student loan and grant assistance purposes.
• The Legislature should evaluate and determine if prerequisites for nursing programs, specifically the Certified Nursing Assistant (CNA) courses are truly a proper and necessary prerequisites for entry into nursing school and if any other barriers exist that unnecessarily restrict entry into nursing programs.
• The Legislature should expand the current Certified Nursing Assistant (CNA) certification program to allow for additional and specialized career options for certification as a nurse aide in Texas. Increased opportunities for certification would provide flexibility for employers to develop tailored job training and more appropriate continuing education standards for nursing aides across the health care sector. The state’s expansion of the CNA certification program could also provide more flexibility for instructor requirements and allow for a broader range of qualified health professionals and health science instructors to teach CNA courses.
• The Legislature should direct the Department of Aging and Disability Services (DADS) to determine the viability of establishing a quality outcome payment system for providers to reward high quality care by Certified Nurse Aides (CNA) or their equivalents that would reward providers with bonus quality payments that must be shared.