House Public Health met on March 6 to take up HB 49 (Klick), HB 112 (Howard et al.), HB 173 (Klick), HB 233 (Murr), HB 576 (Raymond), HB 624 (Harris). An archive of the hearing can be found 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.
HB 173 (Klick) Relating to the licensing and regulation of genetic counselors; requiring an occupational license; authorizing a fee
- Klick – Creates a licensing process for genetic counselors; are no enforceable standards for this practice
- Provides accountability and enforceable standards
- Defines GC, who can practice, and requires those seeing licensure to obtain master’s degree
- 35 states license genetic counselors and 12 are considering licensure
- Establishes clear/accountable framework
- Not excited about creating a new license, but need the means to take care of bad actors
- Jones – Asks about bad actors
- Can be held accountable if they do not meet professional standards
Carla McGruder, Texas Society of Genetic Councilors
- Are recognized federally and certified by American Board of Genetic Counselors
- Overviews field of genetic medicine; are over 50k genetic tests and is impossible to keep up
- Over 33% of genetic tests are ordered when they are not needed
- Want to bring more qualified genetic counselors into the state and save health care dollars
- Is a great bill that would establish a clear framework
- Collier – Other states that have a license requirement, how much do they charge?
- Some are low at $5, but most range from $100-$300
- Are over 200 genetic counselors in the state
- Collier – Health insurance cover the related genetic testing costs?
- Have to work collaboratively with doctors; wait times could be longer since we need to schedule with a doctor; wait times could push out treatment
- Collier – No direct access currently?
- Correct
- Collier – Are genetic counselors in any other settings like schools?
- Are in all fields of medicine, but telemedicine or clinic or healthcare setting
- Collier – Bill would be a path to reimbursement?
- Correct
- Jones – Seems like these are services that are not covered by insurance?
- Is a big cost currently due to unneeded tests being ordered
- The service does have a reimbursement code; genetic tests are needed to provide documentation for certain procedures
- Jones – Would a visit to a genetic counselor be included as a specialty provider visit?
- Correct; is generally how it is now
- Johnson – Family members have benefitted from this; thanks Klick for this bill
- Collier – Notes during her BRCA test doctors were careful to inform on the increased costs; are tests for those with diabetes?
- Yes for those who are young and other factors; things like high blood pressure and other diseases we cannot test for yet
- Oliverson – Concerned this would limit a physician or APRN from doing this?
- No; doctors/nurses or those who have been doing this would be grandfathered in
- Oliverson – Are just creating a new sandbox for people to be genetic counselors?
- Yes
- Oliverson – Nothing in this bill that would compel an insurance company to contract or pay a genetic counselor? Licensing someone does not guarantee payment?
- That would be another bill; most likely from the federal CMS level
- Correct; it opens up access
- Oliverson – If bill passes would make genetic counselors cost more?
- No
- Oliverson – Bill would create a licensure with certain standards, but does not guarantee insurance payment
- Correct; is not a requirement covered benefit
- Oliverson – Wanted to clarify this bill does not guarantee payment
- Jones – Asks about if the bill prohibits doctors/nurses from doing this?
- Is a clause that should include that we are not the only ones who can do this such as doctors, nurses, other practitioners
- Jones – Will need to get signed off by a doctor?
- Right now yes; bill changes this
- Jones – Why so few genetic counselors in Texas?
- Depending on the state, GCs have more freedom like having their own practices
- Have issues providing services to rural areas
- Smith – How many GCs in Texas?
- A little over 200
- Smith – Education required?
- Yes, a Master’s degree in genetic counseling and then board certified
- Smith – Have a genetic counseling board in the state?
- Currently under the national board
- Smith – Educational requirements would be the same under this bill?
- Yes; would help ensure people are continuing education
Kevin Hale, Self and Libertarian Party of Texas – Neutral
- Understand why this bill was offered up; Libertarians are typically against licensing laws as they create barriers of entry
- Bill is redundant as there are already national requirements/laws
- Oliverson – Against licensing at all levels?
- Medical is more of a grey area, but typically do
- Oliverson – Believe architects should be licensed?
- No; already have to go through education
- Oliverson – What happens in the event of a building collapses?
- Would be dealt with within that company
- Oliverson – This is about creating health and safety regulations
- Bill is redundant as there are national standards
- Jones – Why specifically are you against this bill?
- Already have a national set of standards; is additional barrier of entry
In closing, Klick
- This is an emerging field; are bad actors in the state, need regulatory framework to address that
HB 173 left pending
HB 576 (Raymond) Relating to the confidentiality of certain autopsy records
- Raymond – CS was not ready in time for this hearing, asks members to discuss with him if they have any recommendations
- Do not think the next of kin should have to go to court to get photos to get second autopsy
- A second autopsy is not mentioned in this bill, will have this in the bill’s final form
- Johnson – Concern is if there is an investigation going on, a potential perpetrator could have access to the information; concerned about “shall” wording; do not want to impede a proper investigation
- Do you still want them to go to the court or DA?
- Johnson – Will be happy to work with you; wording is concerning
- Notes there will be members who are going to present bills against certain DAs; not trying to impede investigations
- Smith – Some language on page 2 on Chapter 552; would be acceptable to have “unless” language
- Was written on legislative council without permission
- Smith – Next of kin is a defined term?
- Believe so
- Tinderholt – Notes Section 552 provides a whole list of exceptions
- Jones – Do not have the same concerns as A. Johnson; constitution guarantees your right to have information
Kevin Hale, Self and Libertarian Party of Texas – For
- In support as this is a transparency bill
Lee Spiller, Citizens Commission on Human Rights – Neutral
- Is a big public interest to get data; will consider changing position after re-reading the bill
In closing, Raymond
- Will circle back with the members of this committee; will perfect the language
- Passed this bill two years ago, will pass it ago
HB 576 left pending
HB 233 (Murr) Relating to inservice training on identifying abuse, neglect, and illegal, unprofessional, and unethical conduct in certain health care facilities
- Murr – Last session committee voted this bill out 11-0 and passed the house 138-5
- Bill clarifies initial training remains at 8 hours, but annual training can be reduced to 4 hours
Sherri Layton, La Hacienda Treatment Center and Texas Association of Addiction Professionals – For
- Patients are a vulnerable population and need to keep high standards of care; support bill
- Bill would save us $20k a year
- Collier – Would include contractors who work at facilities?
- Would apply to anyone who works at the facility
- Collier – Will also ask this to the bill author
Cynthia Humphrey, Association of Substance Abuse Providers – For
- Agree with Layton’s testimony; supports bill
Lee Spiller, Citizens Commission on Human Rights – Neutral
- If we are going to cut from 8 to 4 that is okay, but need to ensure workers get whistleblower rights, along with fraud, information
In closing, Murr
- Collier – Would apply to who?
- Bill changes from 8 hours to 4 and would apply to all that work at the facility
HB 233 left pending
HB 112 (Howard) Relating to workplace violence prevention in certain health facilities
- Howard – Bill has been heard in this committee before
- Notes she has experienced workplace violence during her career as a nurse; 50% of nurses have experienced physical violence
- HB 2696 studied the problem of violence in health care facilities; would implement recommendations from their most recent report; enacts anti-retaliation protections
- Bill clarifies law enforcement does have a role in these incidents
- Efforts to create safe working environments will help with recruitment/retention
- Price – Would be beneficial for those entering into the professional; what does enforcement provision look like
- Licensing agency can administer penalties or civil litigation against the facility
- Tinderholt – More about creating standardized policies for such events?
- Correct; includes prevention and de-escalation techniques
- In the event that things do happen, is about reporting/addressing
- Tinderholt – Would rather see standardized disciplinary actions than the appropriate licensing entities taking their own disciplinary route
- Oliverson – Have complete support on this; is about appropriate policies/procedures in place
- Oliverson – Workforce shortages are getting worse due to the violence in facilities
- Is about looking at the data to make informed decisions
- Jones – How did this not pass last session?
- This committee and house passed this unanimously; did not get to Senate
- Campbell is carrying in the Senate, so have more hope this time
- Klick – Notes her wrist was broken by a patient; many are leaving the profession due to stresses of Covid and potential of violence
Heather De La Garza, Texas Hospital Association – For
- THA has been working on this legislation for the past two years
- Would require a workplace violence committee and policy/plan that encourages ongoing education, unfettered reporting and solicits feedback on how to be safer
- Conducted a study where 61% of responding hospitals noted violence has increased
- Bill addresses violence perpetrated by patients, family, or hospital staff
Donna Beecroft, Memorial Herman Health System – For
- Workplace violence has escalated over the years; this bill will help address these issues
- Jones and A. Johnson thanks Beecroft for their testimony
Leah Blackwell, Memorial Herman Health System – For
- If we do not address workplace violence issue, will increase workforce issues
- 57k estimated shortage on registered nurses by 2032
- Nurses are being affected by workforce violence at a staggering rate
Patricia Ducayet, State Long Term Care Ombudsman – Neutral
- Was concerned at the initial bill that it might lead to more discharge of nursing facility residents from their facility; feel reassured after discussion by the author
- Feel residents can be protected in the rulemaking process
Mary Patulo, Texas Nurses Association – For
- Bill is important for the retention of nurses
Karen Garvey, Parkland Health – For
- Support this bill; have already created a workplace violence plan and an oversight committee
- Are recipients of two workplace violence grants to help purchase things like individual alarms
JD Buchert, Texas Nursing Association and Texas Collaboration of Perioperative Nurses – For
- 48 nurses are subject to acts of violence a day; numbers are frightening
- 57% increase of workplace violence from 2021
- This bill is needed for health care workers to know the legislature has their back
Ashley Albarran, Texas Nursing Association – For
- Nurses should not feel like violence should not be a part of the job
- Have given the committee letters from nurses about the things they are subjected to on the job
- Jones – If we pass this bill, more nurses want to come to Texas and work?
- Believe so,
- Jones – Some complaints that the hospital does not have sufficient policies on place; could penalize facilities if they do not have specific protections?
- Klick – Howard may be better to ask, but believe there are civil remedies
- Jones – Support this bill, but frustrated something so obvious cannot get passed
Kevin Hale, Self and Libertarian Party of Texas
- Would like de-escalation specified in the bill; would like 25% of training to be de-escalation
Jack Frazee, Texas Nurses Association – For
- Agencies can take administrative action: scales from warnings, penalties, and then civil litigation
- Jones – Bill would allow patients with prejudices to send away staff?
- Bill is to protect those providing care
In closing, Howard
- Is not about turning patients with issues away, is about creating a safe environment
HB 112 left pending
HB 624 (Harris) Relating to emergency medical transport by fire fighters of certain patients
- Harris – Bill amends health and safety code to give firefighters statutory authority to transport individuals to the hospital under certain circumstances; was done in Oklahoma before us
- Price – Would not want to see a firefighter to be held accountable for not doing it
- Have not heard concerns from stakeholders that being a concern yet
- Tinderholt – What transportation via police cars? Consider adding them
- Does not include police cars; in rural areas firefighters are typically there first
- Jones – Asks about a detail in the bill; support this bill
- Some city fire fighter departments are EMS as well, but in rural areas are typically only one
- Campos – Support this bill; thanks for bringing it
- Collier – Transportation would be via a firetruck via a car?
- Will ask resource witness; believe it is explicitly on the vehicle the firefighters are responding in
Devin Jackson, City of Palestine Fire Department – For
- This is a nation-wide issue; often firetruck is there way before an ambulance can
- Have been instances where firemen have been reprimanded for taking individuals to the hospital
HB 624 left pending
HB 49 (Klick) Relating to public access to certain hospital investigation information and materials
- Cloak state investigations in secrecy; increase transparency by making final hospital reports, number of times investigated open to the public
- Last session bill passed House and Senate committee unanimously, removed from Senate local and contested on the last day
Cesar Lopez, Texas Hospital Association – For
- Supportive of this bill both this and last session; clarifies patient records should not be impacted
- Collier – Do rehab and long-term care fall under this bill?
- Yes, applies to those under 241 and 257 licensure; general and mental hospitals
- Tinderholt – Would redact names?
- If personally identifiable, would be subject to redaction
Lee Spiller, Citizens Commission on Human Rights – For
- Support this bill, thanks Klick and THA for their support
Ware Wendell, Texas Watch – For
- Was a loophole in law; this information should come to light
- Medical errors take 250k lives per year; 1 in 5 patients will experience harm a majority of which is preventable
- Get more information on restaurants than we do hospitals
- Do not understand how this bill was a casualty of the Senate local and consent calendar
- Jones – How many lives taken by medical errors
- 250k; some estimates are 500k
Kevin Hale, Self and Libertarian Party of Texas – For
- Support the transparency bill
HB 49 left pending