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The House Appropriations S/C on Art. VI, VII, & VIII met on February 22nd to here LBB and agency presentations on health-related agencies in Article VIII. This report covers the following topics:

  • LBB Presentation on Article VIII Health-Related Agencies
  • Behavioral Health Executive Council
  • Texas State Dental Examiners
  • Health Professions Council
  • Texas Medical Board
  • Texas Board of Nursing
  • Board of Pharmacy
  • Board of Veterinary Medical Examiners

A video archive of the hearing is available here.

This report is intended to give you an overview and highlight the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

LBB Presentation

  • $120.2m for all agencies under Art. VIII, $9m increase from previous budgets
  • $10.8m for the PMP, participating agencies are required to pay for $3m through fee revenue
  • TBVME is administratively attached to TDLR,
  • Costs associated with new complaints reqs under SB 993
  • TMB recs include replacing $600k typically from GR to a GR-D account
  • C Bell – Sunset rec to move TBVME over to TDLR for 4 years, is this cost neutral?
    • LBB Staff – Still waiting for bill to filed and further details from Sunset, but Sunset may be able to speak to that

 

Behavioral Health Executive Council

John Bielamowicz, Behavioral Health Executive Council

  • Provides overview of BHEC, after Uvalde started to look at rules, procedures, and licensure of professionals

 

Darrell Spinks, Behavioral Health Executive Council

  • Thanks legislature for moving BHEC to Bush Building, staff base salary increase, and support for BHEC to clean up
  • Doing very well overall, which is why the only exceptional item is for additional staff salary funding and training, totaling $353k
  • Salary exceptional item calculated to overcome turnover rate
  • E Thompson – What staff are you losing? Other agencies say they are losing staff to other agencies, seems like we’re competing against ourselves
    • Spinks – This is part of it, have lost attorneys to Travis County
    • Vast majority that have left voluntarily have gone to another agency
  • Toth – Who are we losing?
    • Licensing and permit specialists, staff attorneys, admins
  • Toth – What do staff attorneys do?
    • Complaints, handle prosecutions against providers
  • Toth – What do they prosecute?
    • Non-release of records up to sexual impropriety
    • Bielamowicz – Staff attorneys also help BHEC decide path forward in legal matters
  • Martinez Fischer – Should the exceptional item be higher?
    • Spinks – Ideally, yes; adjusted based on finite resources
  • Martinez Fischer – Finite resources, but also tremendous need; highlights staffing issue in facilities like Kerrville
  • Martinez Fischer – Getting people to work for agencies will be difficult due to supply & demand, what else can we do?
    • Need to have discussions among the professions themselves about limitations & what is needed to ensure minimum competency among providers
    • Hiring people in Austin is difficult, capitalizing on telework can help us recruit outside of Austin
  • Martinez Fischer – So like a telemedicine or TCHATT?
    • Yes, with the exception of the marriage & family board, boards are very able to do this
    • Trying to maximize use of teletherapy
  • Martinez Fischer – Topic is being discussed in multiple committees, now is the time to focus on this & guidance to the legislature would be helpful
    • Spinks – Understood
    • Bielamowicz – Big difference from professional members and public members on BHEC, BHEC is willing to have the hard conversations in ways other boards would not in the past
  • Walle – Asks about process and interaction of boards in BHEC
    • Spinks – Took experience from psychology board and tried to duplicate with other boards in BHEC
    • Exam approval process is antiquated, but BHEC doesn’t own the exams so doesn’t have control over how that happens
  • Walle – Timeline from the time someone applies to the time they get licensed?
    • Average is 37 days, more simple stuff is 24 hours, out of state tends to take the longest because we have to wait on documents
    • Out of state is something to look at, vetting someone who has already been vetted
    • MFT is different, small and not sure they will have a compact
  • Walle – What were the problems surrounding Uvalde for BHEC? Costs?
    • Had two LSSPs in the entire county, big problem is getting providers in there
    • Have been discussing CE credits for psychologists providing services
  • Walle – There have been discussions talking about more beds, do we have the structure in place to get these staffed with existing resources? Does it need more resources?
    • Bielamowicz – Needs more resources, have a finite amount of applicants
    • Have the regulatory infrastructure to license, bigger question is getting people to enter pathway
  • Walle – Committee discussions on mental health have been extensive
  • Walle – Salary increase are on top of the two 5% increases?
    • Spinks – Correct
  • Walle – Typical salary?
    • Can get back to you
  • Toth – What metrics do we have in place to look retrospectively at success?
    • Need to look at complaint drivers
  • Toth – This just tells you have complaints, not if you’re helping anyone
    • It is some indicator of whether we’re helping people
    • Need to look at qualifications
  • Toth – Should take a look at the VA Suicide Report; want to make sure BHEC has metrics to see if we’re helping or hurting
    • Asked ARC to conduct a study on empirical licensing standards
  • Toth – Looking at LPCs, they don’t have to go through a lot of the same education requirements; should be based on actual results
    • Exams out there are not predictive
  • Toth – But should look backwards to see if what we’re doing is successful
    • Bielamowicz – Metrics focused on application processing and time, that is how agency is run
    • Board is looking at results
  • Toth – Looking at the VA report, it tracks those helped and not
  • Walle – On CE for social workers, was there a removal of field req?
    • Just overhauled CE rules for all boards to standardize
    • Social work board recently discussed removing CE credit for practicum, but coming back before the board for discussion

 

Texas Board of Veterinary Medical Examiners

Steven Ogle, Sunset

  • Current review is the 3rd in 6 years, agency still struggling with problems identified in the first review
  • Review found significant enforcement and data management issues; failed to contract for and implement new database
  • Also found issues with targeting resources, not enough oversight for medication diversion
  • Suggesting attaching to TDLR for 4 years, work with DIR for new database
  • C Bell – Reason to move it? Is the problem underfunding?
    • Ogle – Without additional oversight, giving them more money would likely not result in change in practice
    • Sunset recommending agency to come in for 4 years with the apparatus in place
  • C Bell – If the underfunded strategies had been funded in the past, would it have avoided the problems? Not just talking about TBVME, is historic underfunding a big driver?
    • Underfunding is a contributing factor, but Sunset has also seen failure to respond to recommendations to get on the right track & funding will not fix this
    • Failure to get expertise for database, target resources, etc.
  • Walle – So the rec is to move it to another agency?
    • 4 year attachment to TDLR, would be a separate agency after
    • TBVME needs help and TDLR has the infrastructure to help
  • Walle – What does this cost?
    • Haven’t received estimate from TDLR, but expecting this when bill is filed

 

Brittany Sharkey, TBVME

  • Provides overview of TBVME and struggles of agency
  • TBVME failed to meet targets due to poor leadership and underfunding; have been in role of Exec Dir for 5 months
  • In last 5 months, have doubled number of compliance inspections, reduced cases waiting for settlement conference by 66%, etc.
  • Asking for exceptional item requests, incl. licensing software application funding, additional targeted staff raises, funding to expand enforcement beyond current 5 investigators, and a group related to increasing case resolution capacity
  • C Bell – Not trying to defend TBVME, but seem to have a common theme of underfunding; would you be successful being moved to TDLR without the exceptional items?
    • Sharkey – Would likely be in the same position we are in currently, e.g. don’t have funding for a data system without the exceptional items
    • Need funding to run TBVME at level the public expects
  • Walle – Sunset report was not kind, found irregularities in procurement; can you talk about cultural problems at the agency?
    • Current database system had irregularities with procurement, cooperating with audit
    • Unfortunately the database has the licensing data in it, so need to maintain until new database is procured
    • Projected timeline of 1 year build out for database, 3 years out and still have only one functional module out of 6
  • Walle – Do veterinarians have to report the prescriptions they send out?
    • No reporting requirement, veterinarians are unique in that they can write and fill on site
    • No current regulation tracks in-office prescriptions
  • Walle – So basically, they self-report
    • Yes
  • E Thompson – Was DIR involved in the new database?
    • DIR was not involved until recently
  • E Thompson – Beholden to this system?
    • Without further appropriations
  • E Thompson – Would the system transfer to TDLR?
    • Depends on how the bill looks, TDLR has variety of databases and could participate in theirs, procure our own with their advice & consent, etc.
  • E Thompson – Any current database contracts state is liable for?
    • One of the benefits of the irregularities is that we don’t have an ongoing contract, currently month-to-month; intending to plan based on bills
  • C Bell – Is there software that exists you could talk to DIR about and you know will work?
    • TBVME believes there is, contract with HPC for tech support, etc., and they oversee and administer a licensing system
    • HPC believes it could stand up within 90 days, award-winning
  • C Bell – Can the existing data be ported to the new system?
    • Believe it is, also asking for one-time data entry clerks
  • C Bell – Cost-wise how does it compare?
    • Biggest cost is the buildout of $120k, but would be a savings ongoing

 

Texas State Board of Dental Examiners

Dr. David Yu, TSBDE

  • Provides overview of TSBDE rules and inspections directed under Sunset; board has operated at high level of efficiency
  • Lose of staffing is an issue, lose valuable knowledge and skills when staff leave; asking for salary adjustments above statewide raise

 

Leticia Kappel, TSBDE

  • Highlights TSBDE successes, incl. quick license processing and complaint resolution
  • Exceptional items incl. additional salary adjustments, Professional Recovery Network is asking for rate increases
  • Walle – Understand need to retain staff; how many do you have?
    • 48
  • Walle – assume some are processing applications, complaints staff, etc.
    • Yes, have investigators, attorneys, dental review staff, finance, etc.

 

Health Professions Council

John Monk, HPC

  • Thankful to be moved to the Bush Building
  • Asking for funding to retain qualified staff; have database maintenance staff in place

 

Texas Medical Board

Brint Carlton, TMB

  • Growing workload in licensing division coupled with lower than average appropriation versus what is given to GR for similar agencies; turnover rate at 21%
  • First exceptional item is for additional salary adjustments, 3rd party survey showed TMB staff is underpaid compared to other agencies, also asking for 10% to account for inflation
  • Proposed 5%+5% is based on snapshot of position filled in August 2022, does not fund unfilled positions
  • Other items include enhancements for licensing oversight and one-time items for website improvements, customer-service engagement system, scanning docs for record retention, e-file system, etc.
  • With exceptional items granted TMB would still be sending millions into GR

 

Texas Board of Nursing

Kathy Shipp, BON

  • Asking for increase in salary for the Exec Dir in exceptional item 5, want to retain current & remain competitive for these salaries

 

Katherine Thomas, BON

  • Highlights workforce shortages at BON, want to maintain quality; compensation exceptional item has been adjusted down in light of salary funding in HB 1
  •  Other staffing item relates to ability of BON to respond to customers and complaints; have had worsening metrics & need resources to be able to process these in a timely manner
  • Exceptional item 3 for IT items includes cloud services, strengthening cybersecurity, microfiche modernization, etc.
  • Anticipating being able to pay for exceptional items with fees over the next biennium
  • C Bell – Appreciates work of BON

 

Texas State Board of Pharmacy

Julie Speer, TSBP

  • Grateful for increased salaries in the base budget bill
  • Provides overview of TSBP
  • TSBP salaries are 15% below other agencies, 24% turnover in FY2022, common reason for leaving was inadequate pay
  • Previous merit increase was cut in 2020 in response to 5% decrease call, restoring this would help with high-performing staff

 

Megan Holloway, TSBP

  • Lack of funding is impacting ability to prosecute cases, also requesting funding for IT databases on pharmacy controlled substance purchases and Rx pads
  • Also asking for new FTEs incl. government relations, programmer, HR staff, data officer, PMP specialists, sterile compounding specialist, etc.

 

Julie Speer, TSBP

  • TSBP is asking Exec Dir salary be moved from Schedule 4 to 5, increasing to make salary comparable to other agency heads
  • Walle discusses sterile compounding with Speer
  • Walle – How does sterile compounding help with investigations?
    • Having staff that does it regularly allows TSBP better analyze what is going on and assess complaints
  • Walle – Your using that expertise to testify? Having to pay people to testify?
    • Holloway – Yes, need a pharmacy expert to testify before SOAH

 

Public Testimony

Duane Galligher, Texas Pharmacy Association

  • Pharmacy Recovery Network was developed in the 80s, bill passed in the 1983; eventually grew to be the Professional Recovery Network and has 4 agencies under its umbrella
  • Costs are increasing; TSBP, TSBDE, others, have exceptional items to increase funding for the PRN

 

Trent Hightower, Texas Veterinary Medical Association

  • Supporting exceptional item requests from the TBVME; problems related to stagnant funding and underfunding
  • Most pressing need is for new software system to manage data
  • New staff items would be key in improving agency operations

 

Dr. Steve Golla, Texas State Board of Veterinary Medical examiners

  • Agency shortcomings due to lack of appropriate data management system, number one need is funding for a new system
  • Agency currently using Excel spreadsheets, need funding to fix issues, cannot function without a new system; asking for funding for the $1.4m item for the new system
  • C Bell – Heard about cloud-based software in earlier testimony that was about $100k, is this where we should go?
    • Has been a lot of discussion on software, personally think it should be the software other agencies are using that works
    • Can shift to new software later, priority is getting agency functioning

 

Dr. Jimmy Widmer, Texas Medical Association

  • TX needs more physicians, new services like telemedicine placing more demand on TMB for licenses; important to have fair disciplinary procedures
  • Should give attention to TMB requests for staffing, disciplinary process, etc.; supports license fees going towards the TMB
  • TMA supports appropriation equal to at least 60% of the TMB’s revenues