The budget will dominate much of the discussion in health and human services. Lawmakers may prioritize consideration of proposals designed to make health care delivery more efficient. Other issues may include preparing for changes necessitated by federal health care reform.
Health care reform issues
While most of the broader changes related to federal health care reform legislation will not be implemented until 2014, the Legislature is likely to address some questions to prepare for implementing changes. Federal legislation requires states to establish a health insurance exchange that uninsured people can use to purchase appropriate health coverage. The federal government will conduct a readiness check for these exchanges on January 1, 2013. This session, the Legislature will need to decide if the exchanges will be run by the state or the federal government. If the exchange is state-run, TDI, HHSC, or another entity, such as a nonprofit established for that purpose, could be selected to run the exchange. Many other decisions related to the exchange, including its governance, regulatory authority, and the consumer information and help it will provide, will need to be decided.
People with incomes at or below 400 percent of the federal poverty level will be eligible for subsidies to help buy insurance. The Legislature may consider whether eligibility determination for subsidies should be added to the state’s existing eligibility system for programs like Medicaid and CHIP or whether a new eligibility system should be established.
With estimates of about 2 million more enrollees in Medicaid and CHIP by 2014, as well as many more people likely to obtain private insurance, the need for health care providers will increase. Lawmakers may consider increasing the number of graduate medical education slots for physicians and increasing physician student loan repayment rates. Scope of practice issues may also come up for discussion during this session.
Legislators are likely to consider any necessary changes to existing state statutes to conform to federal health care reform changes that took effect in September 2010. Such changes include the requirement that young adults be allowed to remain covered by their parents’ health insurance policy until the age of 26. Federal health care reform also authorized grants for states that propose pilot programs to address issues such as care coordination and improving health outcomes. Lawmakers may consider which, if any, of these pilots should be pursued.
Other legislation may be considered that would seek to allow Texas to opt out of certain parts of federal health care changes, such as mandatory participation, or attempt to nullify application of the federal law in Texas.
Spotlight on bills filed:
HB 393 – Gonzales, Veronica – Relating to physician shortage residency training programs.
HB 124 – Legler, Ken – Relating to payment for health care services and participation in a health care system.
HB 144 – Laubenberg, Jodie – Identical to HB 124.
HB 203 – Hughes, Bryan – Identical to HB 124.
Medicaid managed care
The Legislature may consider several options for expanding managed care in the Texas Medicaid program. It could be expanded to 10 counties in South Texas or to counties contiguous to areas that already are under Medicaid capitated managed care, including Lubbock, San Antonio, Austin, Houston, Corpus Christi, and El Paso. The Legislature also may hear proposals to bring particular services, such as the vendor drug program and dental services, under managed care.
Spotlight on bills filed:
HB 28 – Guillen, Ryan – Relating to reimbursement for health care services provided at certain times to persons enrolled in the Medicaid managed care program.
Withdrawal from Medicaid
Another proposal that was being discussed is for the state to opt out of the federal Medicaid program and create its own insurance program. A more specific proposal would be to opt out of acute-care coverage while maintaining participation in long-term care services.
The publication of HB 497 report on the impact to the state if Medicaid were eliminated stated:
Opting out of Medicaid means giving up federal tax dollars paid by the state’s residents to provide health care for our most vulnerable residents. Staying in the program forces states to pay for a federally-mandated expansion of Medicaid with little control over the program’s ever-rising costs, exacerbating an already unsound financial situation.
In response to the report, Health and Humans Services Commissioner Tom Suehs said all the talk about opting out should really be talk about reinventing Medicaid — changing the fundamentals of the system to give states more flexibility.
Alternative payment initiatives for Medicaid and CHIP
Legislators may consider a number of payment initiatives intended to improve the quality of care and efficiency of services in the Medicaid program and Children’s Health Insurance Program (CHIP). Proposals could include pay-for-performance initiatives that provide incentive payments to health care providers or facilities for services that meet or exceed defined performance measures. Other initiatives could include providing higher reimbursement rates for providers or entities that provide a better quality of care, such as hospitals with low readmission rates for potentially preventable conditions.
Spotlight on bills filed:
HB 198 – Parker, Tan – Relating to the use of private procurement specialists for certain state agency contracts.
Accountable Care Organizations
Accountable Care Organizations (ACOs) are groups of providers who agree to be accountable for the cost and quality of the health care provided to a given population. Lawmakers may consider whether such organizations need to be licensed and whether they will be able to directly employ doctors. Potential legal concerns in establishing ACOs, such as anti-trust issues or defining possible jury penalties for lawsuits, may be addressed. The state also could consider establishing pilot programs for ACOs for certain Medicaid populations or for state employee group health benefits.
Health information technology
Proposals could emerge to clarify how much control patients can exercise over the use of their electronic health information and how and what information may be exchanged among providers and facilities. Proposals may focus on protecting patient privacy and how patients consent to the use of their information in an electronic health information exchange.
Corporate practice of medicine
Lawmakers may debate whether Texas should allow the corporate practice of medicine, which is when hospitals directly employ physicians. Proposals may focus on eliminating state prohibitions on this practice at all hospitals or only at certain rural hospitals.
State-supported living centers
State-supported living centers (SSLCs), formerly called state schools, are state-run facilities that provide residential care and treatment for people with cognitive or developmental disabilities. The 81st Legislature in 2009 made major revisions to these care facilities in response to allegations and incidents of abuse and neglect within them that had prompted investigation by the U.S. Department of Justice. Proposals may emerge to limit admission to SSLCs, citing continued reports of abuse, or to consolidate some SSLCs and move more residents to community care settings.
Spotlight on bills filed:
SB 41 – Zaffirini, Judith – Relating to the use of restraints in state supported living centers.
SB 30 – Zaffirini, Judith – Relating to a pilot project to establish a comprehensive single point of entry for long-term services and supports provided to the aged and physically disabled individuals.
SB 222 – Nelson, Jane – Relating to access to certain long-term care services and supports under the medical assistance program.
Public health and wellness
Lawmakers may seek to enhance tobacco prevention and general wellness programs and consider ways to address health problems associated with obesity. Debate may continue on whether to institute a statewide ban on smoking in workplaces and certain public areas.
Spotlight on bills filed:
SB 204 – Zaffirini, Judith – Relating to insurance coverage for certain devices used in the treatment of diabetes.
HB 123 – Veasey, Marc – Relating to an adult diabetes education program in certain county hospital systems and hospital districts
SB 224 – Nelson, Jane – Relating to a program to recognize public schools with successful student health and fitness programs.
SB 225 – Nelson, Jane — Relating to including in public school campus improvement plans and in local school health advisory council reports to school district boards of trustees certain goals and objectives or information in order to promote improved student health.