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The House Committee on Public Health met on March 27 to take up the bills on the notice here. In order, this report covers HB 1771 (Price), HB 2059 (Price), HB 2727 (Price), HB 2544 (Campos), HB 1847 (Howard), HB 663 (Thierry), HB 2088 (Bucy), HB 2478 (Klick), HB 3212 (Toth), and HB 1686 (Oliverson). A video archive of the hearing is available here: Part 1 & Part 2.

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.

 

Vote Outs

HB 299 (Murr) voted out to House (9-1)

  • CS adopted, removes referral limitations and makes it applicable to NARR accredited recovery homes only

HB 576 (Raymond) voted out to House (10-0)

HB 1106 (Goodwin) voted out to House (10-0)

HB 1488 (Rose) voted out to House (10-0)

  • CS adopted, follows national guidelines, task force recommendations & extends task force for 10 years

HB 1890 (Jetton) voted out to House (9-1)

  • CS adopted, TLC draft, changes effective clause

HB 2767 (Klick) voted out to House (9-1)

  • Vote later reconsidered, voted out to House (9-0); Tinderholt was previous nay vote but was not present on the revote

 

Bills on Notice

HB 1771 (Price) Relating to certain records of a health professional providing a telemedicine medical service, teledentistry dental service, or telehealth service.

  • Price – Standardization of rules on telemedicine, telehealth, & teledentistry records; Boards to develop standard rules incl obtaining consent
  • CS coming, will address appropriate form of consent doc & consent necessary for audio-only formats

 

Nora Belcher, Texas e-Health Alliance – For

  • After COVID moved health care policy up on the clinical side, but admin side is lacking; HB 1771 addressing consent to treat and consent to share data covering remote care, incl. audio-only

 

HB 1771 left pending

 

HB 2059 (Price) Relating to mental health first aid training provided by local mental health authorities and local behavioral health authorities.

  • Price – Maximizes funds for mental health first aid program, prevents funds from lapsing
  • Funding already available for program, but lack of lapse provision, etc. prevents full use of the allocated funding
  • CS coming, will make nonsubstantive changes for clarity for participants in the program

 

HB 2059 left pending

 

HB 2727 (Price) Relating to the provision of home telemonitoring services under Medicaid.

  • Price – Addresses telemonitoring, CMS supportive of expansion of telemonitoring services
  • House Public Health identified telemonitoring services as an area to look at in the same way HB 4 codified COVID flexibilities for telehealth and telemedicine
  • Allows FQHCs and RHCs to use telemonitoring services, adds a maternal monitoring benefit
  • Simplifies eligibility criteria for telemonitoring, gives HHSC authority to add services that are clinically and cost effective
  • Surprised at fiscal note, money in the base budget allocated already; could save state costs over time, apparent reason for the fiscal note is that savings are long-term
  • Oliverson – Fiscal note?
    • Price – Expense related to equipment provision, but cost savings if you avoid worsening conditions leading to hospital visits; not calculable or calculated in fiscal note
  • Oliverson – Would this service be applicable for kids in STAR Kids?
    • Price – Yes
  • Oliverson – In that population ability to prevent hospitalizations is massive cost savings; fiscal note is wrong and frustrating there was no attempt to take this into account
    • Agrees

 

Nora Belcher, Texas e-Health Alliance – For

  • Bill came out of interim discussions from the Public Health Committee
  • Technology evolves & need to evolve benefit alongside the tech; tools different now and need to modernize
  • In section changing qualifying criteria, reminded that people needed to have already fallen down before qualifying for home monitoring; need to do risk assessment and check before they fall

 

Jennifer Mertz, Texas Association of Community Health Centers – For

  • Speaking for 73 FQHCs in TX, FQHCs provide wide range of preventative health care & 30% of patients are on Medicaid
  • Highlights Health Point, locations across the state & over 40% of patients are covered through Medicaid
  • Remote monitoring helps track high risk patients remotely, helps prevent conditions from getting worse and saves state dollars

 

Rep. Price closes

  • Win-win for the state, need to continue to lead in this area

 

HB 2727 left pending

 

HB 2544 (Campos) Relating to the physician’s assistant licensure compact; authorizing a fee.

  • Campos – Facilitates ability of licensed PAs to practice in multiple states, would be developed with assistance from Council of State Governments
  • TX already belongs to several other health care interstate compacts
  • Utah recently adopted compact, bills pending in Rhode Island, Minnesota, and Ohio this year
  • Will include requirements for states to adhere to on PA qualifications & ensure baseline is met
  • Oliverson – Appreciate bill and allowing health care provider to move states is useful; wants to ask resource witness about how every state regulates practice of medicine a little differently, need to make sure this isn’t a way to trample on the Medical Practice Act & requirements are maintained

 

Janith Mills, Texas Academy of PAs – For

  • Positive impact of telemedicine have left significant mark on care, but licensure has not changed to recognize remote delivery
  • HB 2544 would be a win-win, would strengthen labor markets, improve access, reduce economic burden on patients

 

Stephen Carlton, Texas Medical Board – On

  • Oliverson – Compact licenses can get dicey if you haven’t set them up properly, want to be sure that all of the Practice Act requirements are changing, correct?
    • This is brand new, Medical Compact was in place for several years before TX joined so were able to see how it worked
    • Requirements seems to be maintained
    • TMB is unclear on Commission power to create an enforceable code of ethics, not sure if this creates different standard
    • Also not sure of fee & provision allowing borrowing state employees
  • Oliverson – So the Commission would have ability to borrow employees?
    • Part of Commission powers in the language
  • Oliverson – No regulatory consistency across all 50 states
    • Understanding is they would have to follow rules in TX, gives different path to licensure, but not sure what the code of ethics would be
  • Oliverson – Reasonable idea and need more employees; how do we resolve these concerns?
    • Happy to work with author and see if further clarification is available; understanding is this is the model language
  • J Jones – Had same questions & concerns about this; lawyer sitting for the Bar has different standards in different states
    • Whatever scores they had in national exam is not a consideration for privilege to practice in other states, just qualifications and PA amendment in the target state

 

Rep. Campos closes

  • PAs will adhere to existing laws and regulations, will provide for greater in person and telehealth access

 

HB 2544 left pending

 

HB 1847 (Howard) Relating to an exception to certain reporting requirements for persons reviewing cases for the Texas Maternal Mortality and Morbidity Review Committee.

  • Howard – Report from MMRC was delayed due to redacting info
  • Reviews are not peer review, but expert review designed to improve system; bill would exempt reviewers from mandatory reporting on certain issues found during case review

 

Taylor Fuerst, First United Methodist Church of Austin – For

  • Highlights Circle Up group within the church, working on improving maternal outcomes & appreciate legislative attention focused on high rate of maternal mortality & morbidity

 

HB 1847 left pending

 

HB 663 (Thierry) Relating to the confidentiality and reporting of certain maternal mortality information to the Department of State Health Services and to a work group establishing a maternal mortality and morbidity data registry.

  • Thierry – Maternal Mortality and Morbidity Review Committee were unable to release their data findings, could not get cases in time; MMRC the committee needs more resources
  • HB 663 establishes a work group of health experts to help record information, metrics, and increase maternal care post-birth
  • Black mothers are still at higher risk for maternal mortality & morbidity; for all other groups rates went down, but for black mothers maternal mortality & morbidity went up; HB 663 would help examine the causes of maternal mortality & morbidity

 

Jody Harrison, Self – For

  • Good to see women legislators & woman chair on this committee; good questions from the committee
  • HB 663 will provide critical statistics & material to allow MMRC to help protect women’s lives

 

Dinah Waranch, Self – For

  • Grateful that members of the committee are dedicating so much time to improving outcomes for mothers; US has ever increasing rates, TX has higher rates than other developed countries
  • Equally shocking are racial inequities, black mothers die at 3x the rate
  • HB 663 covers three important topics, reimbursing basic expenses, nurse exemption from reporting requirements, and data

 

Madi Mason, RN – For

  • Medicaid is essential for getting coverage for pregnant women
  • Need to know in real time how COVID affected Maternal mortality
  • This bill helps get faster and more accurate data while also protecting families

 

Nakeenya Wilson, Maternal Health Equity Collaborative – For

  • Members of the MMRC receive a varying amount of information depending on what is submitted, sometimes we get certain medical records, info from family members, etc. and sometimes not; this info can fill in the gaps & help MMRC make recommendations
  • TX is the only state in the country requiring the redaction process
  • Need to know how mothers were affected by COVID, but will not get that data quickly enough
  • Collier – Appreciates this information, if we’re going to allocate resources, shouldn’t we have good data to help allocate dollars?
    • Absolutely
  • Collier – Bill would help us be more fiscally responsible to improve outcomes
    • Yes, would increase efficiency and save money

 

HB 663 left pending

 

HB 2088 (Bucy) Relating to the regulation of the practice of pharmacy.

  • Bucy – Amends the law to allow pharmacists to dispense the smallest prepackaged insulin dose as long as there is a 30-day supply
  • Cleans up the authority the bill has and cleans up standards for violations
  • Getting it the closest to the 30 days as possible

 

Aimee Lusson, Texas Federation of Drug Stores – For

  • The dosage requirements for each individual can vary drastically so what is needed over a 30-day period can be different
  • The 30-day supply can last for longer than that depending on a patient’s dosage
  • This bill helps each patient get their supply and assure pharmacies they will get reimbursed

 

HB 2088 left pending

 

HB 2478 (Klick) Relating to an annual report regarding certain newborn screening tests.

  • Chair Klick – Changes screening for newborns to be annual and some of the criteria of the reports for NPS diseases

 

Stephen Holland, Self – For

  • 33 other states already have this in their screening, and it helps save lives
  • Treatment for the disease cannot start until it is known about, and it takes years to recognize without the initial screening
  • The damage from the diseases can be mitigated if early treatment is started

 

Mercedes Johnson, Self – For

  • Shares personal story of sons born with NPS diseases
  • Families can go months or years without getting a correct diagnosis and this can be solved by adding it to the screenings
  • J Jones – Did you lose two children due to this?
    • Yes

 

HB 2478 left pending

 

HB 3212 (Toth) Relating to the duties of a birthing facility conducting newborn screening tests; creating an administrative and civil penalty.

  • Toth – Meant to increase the efficiency of the newborn screening process
  • Working on a CS for this
  • Newborn screenings are not processed on Sundays; that needs to be changed
  • Dishes needs to be open 7 days a week; working on a fiscal note for that
  • Removing the penalty
  • If a baby is born on Friday, they don’t take the sample until Saturday where it is sent to Austin, but dishes is closed on Sunday and is not tested until Sunday
  • The baby will be in distress before they find any deficiencies

 

Baylee Burns, Self – For

  • Shows picture of daughter who the bill was named after
  • Shares personal story of newborn who died due to a deficiency that was not addressed in time because the screening processing did not happen fast enough
  • J Jones – How long did it take for them to send the screening?
    • It was drawn 24 hours after the baby was born and the state lab collected it on Monday instead of Sunday
  • J Jones – So if the test had been expeditiously sent then her death was preventable?
    • Yes, it was

 

Ritch Wheeler, Self – For

  • Family member of Baylee
  • The hope for today is to let no more babies die from this problem

 

Bonnie Abram, Self – For

  • Grandmother in Baylee’s family
  • Shares story of thinking the baby had good health but the baby died without warning

 

Steve Wohleb, Texas Hospital Association – On

  • Discussed the bill with Toth and are happy with the changes that are going to be made to it

 

Rep. Toth closes

  • J Jones – What is the penalty about?
    • When the bill was first drafted, they were only aware of the Sunday testing issue but there is also a failure with the hospitals sending the samples
    • Working on getting rid of the penalty and figuring that out in the CS

 

HB 3212 left pending

 

HB 1686 (Oliverson) Relating to prohibitions on the provision to certain children of procedures and treatments for gender transitioning, gender reassignment, or gender dysphoria and on the use of public money or public assistance to provide those procedures and treatments.

  • Oliverson – No scientific evidence that hormone therapy helps children overcome gender dysphoria and suicide & the effects of the treatments are not reversible; professional counseling has been a proven option that helps adolescents with gender dysphoria
  • Prohibits the medical side for children and does not criminalize parents put in tough situations
  • Tinderholt – Was there any consideration to make it a civil cause of action like the heartbeat bill?
    • That was talked about but the appropriate way to regulate this is through the medical board and practice act
    • The real dysfunction here is the lack of convincing high-quality evidence
  • Tinderholt – Concerned that parents may consult with medical professionals across state lines and have treatments sent into the state? Does this concern that?
    • This bill contemplates the practice within Texas and cannot nor should they entertain telling another state what to do
  • Tinderholt – If someone is being counselled to do this and then they bring them across state lines to do this is it a similar answer?
    • This bill does not contemplate medical care received outside of Texas
  • Tinderholt – Does the bill discuss anything about de-transitioning?
    • This bill is a preventative measure so that people are not faced with de-transitioning
  • Tinderholt – Does the bill require insurance companies that paid for it to assist with de-transitioning?
    • No
  • Tinderholt – What about statute of limitations and they have a surgery but 15 years later realize it was wrong that is not covered?
    • It is not covered but is something important to consider for the future
  • Tinderholt – Agree that counseling has a lot of value but is concerned with therapists that try to psychologically condition the children to be the opposite sex; Does this cover that at all?
    • This bill leaves open the opportunity for therapy because there is good evidence showing the benefits of it
  • A Johnson – Is gender dysphoria a true medical diagnosis?
    • Thinks the concept is something but it has become so expansive that it is an imprecise term
  • A Johnson – Do you believe that there are physicians in Texas that are treating gender dysphoria in a true and accurate way?
    • No
  • A Johnson – Not even one?
    • Thinks that those who are prescribing hormone blockers are ignoring the science
  • A Johnson – Referring for surgery you are aware that it is not a standard of care and that there are not surgeries performed on adolescents?
    • That is incorrect
  • A Johnson – Can you give the citation?
    • In a previous hearing there was a speaker who came and said that operations were done on adolescents claiming they were reversible when they were not
  • A Johnson – Under your bill cosmetic procedures would be allowed for individuals as long as they are not claiming gender dysphoria?
    • You have to consider whether or not the procedure is removing abnormal conditions such as gynecomastia operations
  • A Johnson – Under the bill it does not contemplate if somebody under the age of 18 wishes to have cosmetic surgery? If a young girl has a breast larger than the other and has emotional distress from it wanting something done, can it be done under this bill?
    • Yes, that would be possible
  • A Johnson – As long as they are not expressing gender dysphoria then the operations can happen?
    • Examples are different
  • A Johnson – The hormone treatment can be done for precocious puberty
    • It is actually not usually done for precocious puberty because of avoiding negative consequences
  • A Johnson – So, in this circumstance the same puberty blockers could still be prescribed?
    • There is a section in the bill that specifically outlines a series of exemptions for treatments of conditions where there is an abnormal development
  • A Johnson – So it is not a complaint over the procedure or hormone, the ban is for it applying to gender dysphoria?
    • Yes, the ban has to do with conditions where the science is inconclusive and there are a growing list of harms and people who regret it
  • A Johnson – As a governing body would it be more appropriate for them to put together a compilation of scientists and doctors to begin a study on the differing testimonies?
    • Contemplated doing that but the reality is that it has already been done 5 times by countries around the world with better record keeping and data; no value add
  • A Johnson – If today there was a number of medical associations and groups with differing studies and opinions would that raise the question of creating a study?
    • This issue has been looked at exhaustively by the greater scientific community so it does not make sense that Texas doctors would find reliably different evidence
  • A Johnson – There are steps by which they could do a study and if it is a slam dunk then they would be back in two years with this exact thing; so, a study is possible?
    • It is a step that could be taken but it is a waste of resources
    • What could they possibly add to the 5 comprehensive systematic reviews?
  • A Johnson – They could put together part of the medical board and have them participate in coming up with a plan or schedule for an additional element or safeguards for this?
    • They could do all of that or they could do nothing and continue to ignore the already done reviews
  • A Johnson – This bill does not ban parents from making a decision early after birth and picking the sex of an intersex child?
    • Does not know about parents doing it
    • Knows there are conditions where it is easier to raise the child one way or the other
    • Pretty rare for a circumstance where it is 50/50 and the parent truly chooses
  • A Johnson – In the circumstance where the parents pick it may not correspond with how that individual identifies as they grow; those children don’t get to transition?
    • The more important question is how they feel when they are in their 20s instead
    • That is why this bill is only specific for adolescents
  • A Johnson – Remembers the moment they realized they were gay; kids know, and it is hard and hopes that this state finds a way to make decisions that is passionate and protective of children
  • Price – What are the differences in the studies done here and in the US vs. what that would look like in other countries?
    • By in large European countries that have been down this pathway for longer and in a more cohesive way have one by one called for stopping the treatments for adolescents; science supporting the treatment for adolescents being a good thing is not good
    • There is a growing list of harms from these treatments for adolescents that they found
    • One of the problems with the literature in this area is that there are few or no reliable trials
    • There is a lot of data that is being paraded as authoritative but then you look and find that it was based on a self-reporting survey
  • Tinderholt – Would you agree that trying to transition the children is harmful?
    • There are studies that indicate that social transitioning is not a neutral act and that children who are transitioned at a young age have a very low chance at coming to terms with their sex
  • Tinderholt – Would say it is harmful though?
    • Would just say they are not neutral acts
  • Tinderholt – Believes transitioning a child at that age should be considered child abuse, would you agree?
    • Knows there are many families where it was a decision dumped in their lap and they were given the choice of either supporting the transition or suicide
    • Does not think it is reasonable
  • Tinderholt – What about the medical professionals? People were asked if they wanted to have a dead child or a child of the opposite sex?
    • Does not know about calling it child abuse but that it would cost them their license after this bill is passed
  • V Jones – Has heard about several of the randomized trials; where are those trials from? Knows there are several Texas medical associations against this bill
    • Was talking about systematic reviews and not randomized trials
    • A systematic review helps sort out the conclusions of multiple studies
    • Specifically, Florida, the UK, Sweden, Finland, and Norway have done systematic reviews
  • V Jones – Are you saying that there is not enough data for those who have mentioned favorable outcomes towards services and healthcare for transgender youth?
    • There is data but the data is conflicting, and the quality of the studies is very low
  • J Jones – So, are you saying there is no such thing as gender dysphoria?
    • No, it is a real condition but medical treatment for adolescents is inappropriate
  • J Jones – In some legal settings such as in the middle of parents fighting children can have their say considered; you said if a trans kid is suicidal that some grownup convinced them that they were suicidal?
    • That is not what was said
  • J Jones – Is there ever a legitimate diagnosis of gender dysphoria that would allow surgery or gender affirming care of a minor? Gives example of someone who knew and stuck with their decision since pre-k
    • There is evidence showing that supportive care from a young age shows that they come to terms with their sex or become gay
    • Currently science is not good at figuring which is which and that is a problem
    • The most important thing that must be contemplated is that none of it is reversible so if it is gotten wrong then they cannot go back to square one
  • J Jones – So, if the kid is right but is never given the care then there is a person with consequences who does not look and feel how they want; so why is the one subset of people more important than the others?
    • The first rule of healthcare is first do no harm
    • The former president of WPATH who is the leading transition surgeon said the hormone blockers and gender affirming care is actually making it harder to do the transitioning surgeries
    • If you do the surgery on someone who is transitioning as an adult but never went through puberty correctly then there is not enough to work with to do the surgery correctly
  • J Jones – The expert debate can go back and forth all day and is concerned about the prioritization of some individuals over others

 

18 witness spoke For the bill, 29 witnesses spoke Against, and 2 spoke On the bill before public testimony was closed near midnight; an additional 79 witnesses registered for but did not testify, and over 2,500 witnesses registered against but did not testify.