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The House Committee on Public Health has released its interim report to the 86th Legislature.

The report addresses multiple issues, including women’s health services, maternal mortality, traumatic brain injury, services for children with mental illness, housing instability and homelessness, rural health care, telemedicine, children involved in CPS with substance abuse and mental health conditions, tissue donation, and a review of legislation under the committee’s jurisdiction. For full details, analysis, and conclusions from the committee, please see the complete report.

Spotlight on Recommendations
Charge 1 – Women’s Health Services and the Texas Maternal Mortality and Morbidity Task Force

  • Promote implementation of maternal safety initiatives statewide by encouraging hospital participation in new TexasAIM maternal safety bundles. Consider including stipends for hospitals that may need additional resources to implement AIM, for a culture of safety and high reliability through application of best practices in birthing facilities.
  • Promote care coordination and management for pregnant women and postpartum women through education, screening and appropriate referrals for maternal risk conditions, targeting high-risk populations, and championing integrated care models for services.
  • Promote the use of risk assessment tools for identification of maternal risk factors during routine prenatal care.
  • Promote awareness campaigns to enhance provider and community understanding about maternal risk factors, particularly for the highest at-risk population, and related preventative measures to promote healthy behaviors and prenatal care, and to emphasize the dangers of abusing opioids and other substances including alcohol and illicit drugs while pregnant and in caretaking of a child.
  • Enhance outreach to eligible new mothers regarding their auto enrollment in HTW once maternal Medicaid coverage expires; women are currently notified of enrollment through a letter sent through the US Postal Service.
  • Consider establishing auto-enrollment for eligible young women aging out of Children’s Medicaid and Children’s Health Insurance Program into Healthy Texas Women.
  • Continue to support tobacco prevention and cessation programs to reduce tobacco-related healthcare costs.
  • Support strategies to improve the maternal death review process.
  • For accuracy in correct cause of death declarations, require training programs for anyone who has the authority to issue a death certificate’s cause of death but is not a medical professional to ensure the person knows what the symptoms and conditions are in an overdose fatality and determination of pregnancy.

Charge 2 – Traumatic Brain Injury, Alzheimer’s, and Dementia
Alzheimer’s Disease and Dementia:

  • Encourage more medical professionals, including nurses, doctors, and social workers, to specialize in neurology, behavioral neurology, or dementia.
  • Encourage more medical professionals to specialize in geriatrics.
  • Require the inclusion of dementia symptoms in primary care education of medical professions.
  • Continue to investigate and implement telemedicine services to provide access to care for the elderly and Alzheimer’s populations living in rural or medically underserved areas.
  • Encourage DSHS to send “Dear Colleague” letters to physicians, nurse practitioners, and physician assistants about the importance of early detection and disclosure of an Alzheimer’s diagnosis.
  • Review benefits of a new Medicaid billing code in Texas modeled after the new CMS Cognitive Impairment Care Planning billing code.
  • Incorporate brain health messaging into existing public health campaigns, for example the anti-tobacco, obesity, and diabetes campaigns, to reach large, at risk populations.
  • Consider funding the two optional Alzheimer’s disease and dementia modules of the Behavioral Risk Factor Surveillance System (BRFSS) to provide more state-specific data regarding Alzheimer’s and dementia.
  • Consider expanding successful programs like GamePlan4Care and Texas Talks to increase caregiver capacity.
  • Encourage the Texas Alzheimer’s Disease Partnership to develop the new Alzheimer’s Disease State Plan after the first State Plan expired in 2015.

Traumatic Brain Injury:

  • Continue to fund the Comprehensive Rehabilitation Services program.
  • Require “Return to Learn” and “Return to Play” protocol statewide.
  • Encourage participation in the ConTex Statewide Concussion Registry by all school districts.
  • Promote campaigns to educate the public about prevention and recognition of concussions and traumatic brain injury.

Charge 3 – Services for Children with Mental Illness

  • Require points of contact, who are trained in mental health, to be placed in each Education
  • Service Center to work with all school districts in the specified region.
  • Increase the learning opportunities regarding mental health to teachers, counselors, nurses, and administrators in proven programs, such as Mental Health First Aid, trauma-informed curricula, and social-emotional learning.
  • Require Health classes be held in elementary, middle, and high school; ensure curricula is comprehensive and age appropriate.
  • Require a list of local, evidence-based mental health programs be provided to TEA for distribution to all school districts.
  • Study the need for universal mental health screening for students entering K-12.
  • Require creation of a sub-committee of the Health and Human Services Commission based State Behavioral Health Coordinating Council to review and oversee coordination of all federal and state funding addressing mental and behavioral health of school-age children.
  • Require TEA to explore opportunities for mental health promotion, resiliency building, self-regulation, and competency skills in the Texas Essential Knowledge and Skills.
  • Review benefits of expanding first episode psychosis programs.
  • Encourage campus-based best practice integrated care programs having on-site mental and behavioral wellness therapy and treatment for students and families.
  • Ensure trauma informed care training specific to children with IDD is available to independent school districts around the state through each ESC.
  • Require HHSC to study the development of standards of care for mental health services for individuals with IDD.
  • Promote continued efforts in building mental health and integrated healthcare programs in communities, including through collaborations between LMHAs and school districts and through innovative programs by school districts.

Charge 4 – The Overlays Among Housing Instability, Homelessness and Mental Illness

  • Study the benefits of expanding permanent supportive housing site-based units and consider increasing funding.
  • Encourage local homeless service and housing initiatives following other best practices, like Haven for Hope.
  • Create a committee to include TDHCA and HHSC to oversee and coordinate state programs to ensure the greatest efficiency and effectiveness of the funds and programs, and require state agencies providing services to the homeless to report on programs and participate on the committee.
  • Consider integrating continuum of care campuses, like the one being constructed at UTHealth Harris County Psychiatric Center, into other psychiatric hospitals.
  • Consider increasing rental and utility assistance for clients of local mental health authorities.

Charge 5 – Population Health and Healthcare Delivery in Rural and Urban Medically Underserved areas, Telemedicine, and Rural Hospital Challenges and Closures

  • Continue promoting access to health services through remote treatment options, including telemedicine.
  • Study broadband access in rural areas and create a plan to ensure rural facilities can transition to e-health records and use technology for other administrative matters and to increase the availability of telemedicine services.
  • Promote joint disaster training with the local health departments especially in rural areas.
  • Encourage communities to study, identify, and address their primary public health concerns.
  • Continue to utilize, and encourage community health workers to address chronic disease, education, and referrals – these workers are especially effective because of their ability to form personal contacts with the people in their area.
  • Require HHSC to study and provide a full report and recommendations in relation to the rider information referenced in the hearings related to Medicaid reimbursement payments to rural hospitals regarding actual costs.
  • Address telemedicine barriers specific to rural hospitals including, allowing telemedicine to supplement Level 4 trauma centers (which is most rural hospitals) which by law are required to have a physician that can respond in person within 30 minutes.
  • Consider alternative hospital models in rural healthcare including, a free-standing emergency center or scaled down hospitals, with a requirement of maintaining a continuum of care, in rural communities.
  • Should Congress pass legislation creating “step-down” rural healthcare facilities as an option for a community that has a rural hospital that can no longer afford to operate, Texas should enact mirror legislation to ensure that the new step-down facility type is recognized under Medicaid and state licensing and regulations.
  • Develop and support tools that help rural hospitals to track their performance, and easily transition into a step-down hospital type facility, then provide education to rural hospital stakeholders and administrators throughout the state regarding each set of tools.
  • As DSRIP funds ($3.1 billion per year) have the potential to be phased out, the state must consider programs that are successful because of those funds and figure out how to incorporate those programs into Medicaid Managed Care in Texas.
  • Address tobacco as a primary driver of health risks in a statewide ordinance.

Charge 6 – The prevalence of children involved with Child Protective Services System who have a mental illness and/or a substance use disorder or due to their guardian’s substance abuse or an untreated mental illness 

  • Consider expansion of county-led initiatives like Family Drug Courts.
  • Review creating a family counseling program for families who have successfully completed Family Drug Treatment Courts (FDTC) programs focused on maintaining sobriety, rebuilding the family unit, and other family therapy services.
  • Encourage implementing more targeted DFPS recruiting efforts because for every 100 families that come to information sessions regarding becoming a foster parent, only a few actually become foster parents.
  • Consider increasing funding to expand the Crisis Response and Psychiatric Hospital Diversion Programs administered by HHSC.
  • Review resources for therapeutic foster care services for youth in foster care with severe mental, emotional, or behavioral health needs.
  • Consider establishing specialized caseworker units focused on families where substance abuse is present.
  • Enhance data reporting for parental substance use disorders in the CPS data management system.
  • Leverage the opportunities for funds from the federal Family First Prevention Services Act.
  • Encourage HHSC to continue to review and improve programs for network adequacy.
  • Evaluate the need for additional investment in Family Based Safety Services to address the underlying causes of substance use disorders.
  • Ensure that efforts are continued in the recruitment of homes for children in CPS conservatorship and that the right type of placements are being made for high-needs children; ensure the requirements of SB 11 (85R) regarding family based safety services are being implemented.

Charge 7 – Organ and Bone Marrow Donations

  • Consider funding organ donation education initiatives for drivers at DPS offices.
  • Add the donor registration question to hunting and fishing license applications and renewals.
  • Add the donor registration question to concealed handgun license applications and renewals.
  • Add the donor registration question to boating license applications and renewals.

Charge 8 – Oversight Jurisdiction of the Committee
The Committee was specifically charged to oversee the implementation of key pieces of public health legislation passed during the 85th Legislative Session, including House Bill 10, House Bill 13, House Bill 337, and Senate Bill 292. Please review the report for recommendations embedded in the report discussion.

Add’tl Charges – Children’s Mental Health and School Safety

  • See recommendations for Charge 3 in this report.
  • Promote school safety by increasing programs to assess and address mental health concerns of students.
  • Require HHSC review the various mental health programs available to assess students, including Mental Health First Aid, the YAM program, TWITR, CPAP, and the Trauma and Grief Center and provide information regarding best practices on the HHSC and TEA websites. Consider implementing pilots of the various programs available.
  • Consider providing funding to increase the number of school counselors and school social workers to align with the national recommended ratios.
  • Enforce implementation of Senate Bill 490 (85R) which requires TEA to collect data from all schools on the number of school counselors on each campus and require sharing the data with HHSC.
  • Require each school district to consider implementing a system of anonymous reporting for any issues, including cyberbullying or concerns being raised on social media.
  • For the purpose of intervening early, consider creating a user-friendly referral process so that everyone – teacher, friend, bus driver, etc. – knows and understands how to refer a student in need.
  • Encourage student led, school-wide mental health awareness groups.
  • Encourage collaboration with the Department of Public safety to include mental health in school safety training.
  • Evaluate whether to incorporate social-emotional learning into the Texas Essential Knowledge and Skills.
  • Consider implementing the CIS model through CIS affiliates in more schools across the state.
  • Consider following the U.S. Preventive Services Task Force and the American Academy of Pediatrics recommendation of screening in clinical settings for major depressive disorder in youth ages 12 and above.
  • Encourage HHSC collaboration with TEA, local mental and behavioral health authorities, and ESCs to create a trauma-informed culture across systems, agencies, and communities.
  • Encourage partnerships with Texas schools and colleges to develop crisis teams consisting of staff, students, and mental health professionals trained in mental health first-aid and crisis response.
  • Consider expanding prevention services to include substance abuse prevention and violence prevention programs in schools and homes.
  • Consider developing and enhancing mental health frameworks to ensure resources are deployed more quickly for the next emergency.