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The committee met to take up and consider bills. This report focuses only on the bills listed below:
 
Pending Business
 
SB 622 – Uresti, Relating to the physician assistant board.

  • Reported favorably
  • Sent to local calendar

 
SB 760 – Schwertner, Relating to provider access requirements for a Medicaid managed care organization.

  • Withdrew previously laid out committee substitute
  • New committee substitute:
    • Allows providers to utilize the MCO assistance phone number posted on the MCo’s online directory
    • Allows “substantial effort” exception to apply to all penalties and removes the withhold penalty
    • Allows MCOS to recover the difference between in-network and out-of-network payments from providers who do not meet the full credentialing requirements
    • Allows MCOs to recover the entire payment from providers whose credentialing application is fraudulent
  • Committee substitute adopted
  • Reported favorably

 
New Business
 
SB 195 – Schwertner, Relating to information relating to prescriptions for certain controlled substances.

  • Deals with Prescription Drug Monitoring program
  • Pharmacists are required to enter data when filling prescriptions for schedule 2-5 drugs
  • Bill transfers program from DPS to Pharmacy Board
  • Authorizes board to enter into an interoperability agreement with other agencies
    • Including a similar program that covers the US
  • Empowers board to auto-enroll practitioners into the program upon renewal of their license
  • Committee substitute changes:
    • Removes provision that might have been construed as limiting DPS access
    • Guarantees DPS has secure and confidential access to the database
    • Removes DPS from work group
    • Grants database access to medical examiners
    • Eliminates controlled substance registration
      • All entities that deal with controlled substances currently register; duplicative of DEA registration program
    • Authorizes each Art. 8 agency with database access to charge fees
  • Will improve the program
  • Campbell believes this bill is relevant and appropriate

 
Kathy DeWitt, Texas Association of Business

  • In support of the bill
  • Prescription drug abuse has a high cost to employers
  • DPS did a great job getting the program on line and with this bill the program can go even further

 
Dr. Richard Hurley, Texas Pain Society

  • In support of the bill
  • The pharmacy board is the right place for this program and can help make it more efficient for physicians, which is necessary
  • Approve of the provision allowing access to the national database

 
Dr. Dwayne Wolf, Harris County Medical Examiner

  • In support of the bill
  • Over 10% of caseload is from drug deaths
  • This bill will streamline medical examiner processes

 
Dr. CM Shada, Texas Medical Association, Texas Pain Society

  • In support of the bill
  • The bill is an important step forward for the program
  • Because reporting is required for the program to work it is appropriate for the Pharmacy Board to control the program because they can enforce the reporting requirements

 
AJ Patel, Texas Federation of Drug Stores, Walgreens

  • In support of the bill
  • Pharmacy Board is the best entity to facilitate this program

 
Schwertner closed

  • The bill is about streamlining the program and cutting some red tape
  • Allows DPS to focus on their core mission

 
SB 1385 – Schwertner, Relating to the authorization of the imposition of administrative penalties on providers participating in certain Medicaid waiver programs.

  • Would allow DADS to assess administrative penalties for violations for Home & Community Based Services and Texas Home Living waiver programs
  • Both help individuals with IDD live in the community instead of institutions
  • If a provider is not in compliance with their contract there are limited sanctions available currently
    • Vendor hold
    • Complete contract termination
  • Administrative penalties would allow DADS an intermediate action when vendor holds are too light and contract terminations are too severe of a penalty
  • Kolkhorst asked about the bill
    • DADS only has two options currently; this bill allows an intermediate action between a vendor hold an a termination

 
Carol Smith, Private Providers Association of Texas

  • In support of the bill
  • No provider is excited about the possibility of an adverse action but this bill will preserve the integrity of services provided
  • This bill is an incentive to achieving the goal of provider integrity
  • Concerned about lack of consistency in the survey process, lack of timely notification when expectations regarding rules are changed, lack of oversight by DADS oversight division regarding surveyors

 
Kyle Hannah, Community Living Concepts

  • Provides services to IDD community under the HCS waiver program
  • Supports appropriate disciplinary action
  • New regulations related to nursing requirements for IDD populations, fire sprinkler issues, etc. place financial burdens on the business
  • Must ensure any administrative penalties are only implemented in a way that makes sense and not done in a way to put quality providers out of business
  • Provide services to a very complex population
  • DADS surveys providers based on outcomes and not in a way that is uniform across all surveys
  • Bill does not give parameters to DADS regarding minimum and maximum penalties

 
Danette Castle, Texas Council of Community Centers

  • In support of the bill
  • Support strengthening community based services by ensuring providers are paid rates that match services
  • The bill describes the establishment of rules identifying actions that would justify a penalty; believe this will bring fairness to providers
  • Believe the bill provides the agency with a tool necessary to provide safe services to the community

 
Kathy Griffith, Premiant

  • Service provider to the IDD community
  • Support DADS taking appropriate action against providers
  • Surveys can be subjective; surveys are inconsistently applied
  • Would like more uniformity in the survey process
  • Believe the bill must address these issues to prevent good providers from having penalties assessed

 
Chris Adams, Deputy Commissioner, DADS

  • Kolkhorst asked what happens in cases where serious injury or death are the outcome
    • If a serious concern is identified the agency measures whether that concern extends to all clients being served by the provider then determines what enforcement action needs to be imposed; may also require a corrective action plan in addition to the tools listed previously
  • Kolkhorst asked about surveys
    • Annual reviews are in relation to all services provided by a provider; residential visits may also be executed
    • Encourage law enforcement agencies to identify concerns or patterns of calls received to DADS; if it is a provider regulated by DADS the agency will investigate those concerns and identify what the provider is doing to address those concerns and determine if corrective action is necessary

 
Bill left pending
 
SB 1406 – Schwertner, Relating to the protection of certain children through the operation of the child safety check alert list.

  • Expands DFPS use of the CSCAL program in certain instances
  • A means to locate a child that is being sought after by DFPS
  • Committee substitute changes
    • Ensures the program is only used to locate children in substantial probability of harm
    • Recognizes additional attorneys that may be involved in the case

 
Dean Rucker, Texas Supreme Court Children’s Commission

  • On the bill
  • Bill accomplishes the intended goal
  • The term “in home support services” used in the bill may need to be changed to align with terms currently used regarding the program “family based safety services” would be a better term

 
Johanna Scott, Parent Guidance Center

  • On the bill
  • Originally intended to testify against; now on because of substitute
  • Agree with previous witness; other terms should be included as well to reflect times in an investigation when working with a family and would need compliance
  • Sometimes families do not know the rules and do not know they cannot move without notifying the agency
    • Would like language requiring notification to parents about the rules; would help with compliance

 
Bill left pending
 
SB 359 – West, Relating to the authority of a peace officer to apprehend a person for emergency detention and the authority of certain facilities to temporarily detain a person with mental illness.

  • Perry laid out the bill for West
  • Currently ER departments in hospitals are not authorized to hold an individual who requests mental health services and then subsequently asks to leave
    • Provides hospital employees with few options aside from calling law enforcement
  • Bill provides that a hospital may detain a person for up to four hours who has voluntarily requested treatment if a physician at the facility believes that person has a mental illness and poses a risk of harm and believes there is not sufficient time to file an order for emergency detention
  • Clarifies that an officer may enter a facility to initiate an emergency detention after a four hour time limit has run

 
Dr. Leslie Seacrest, Texas Hospital Association, Texas Federation of Psychiatry, Texas Medical Association

  • In support of the bill
  • There are critical times in which ER physicians need to intervene in order to preserve the lives of those suffering from a mental disorder and the lives of others
  • Currently the only legal physical constraint is by a peace officer
  • Giving physicians four hours decreases danger and preserves liberty
  • Perry asked if this is not intended to count as involuntary commitment which would impede the possibility of a person from having a CHL
    • Believe that is correct
  • Perry noted West is drafting an amendment to clarify that this is the case
    • The only entity that can institute involuntary commitment is the mental illness court
  • Rodriguez asked if the four hours is to allow a physician time to contact law enforcement
    • Not really; the intent is to allow the physician time to perform an assessment
  • Rodriguez asked what would be done if the person was determined to be a danger to themselves or others after an assessment
    • They would address the court in order for them to review the findings and make a determination

 
Dr. Bobby Greenberg, Physician

  • In support of the bill
  • ER physicians all struggle with this issue and all need this tool to help in taking care of patients
  • Sometimes it depends on the circumstances what happens after the four hours
  • Bringing in law enforcement can cause problems with patient trust

 
Joseph Meyer, Self

  • In support of the bill
  • Adopted a child who has a psychiatric illness; when he was 10 he was hospitalized for several weeks
  • Would be afraid to call the police for an intervention
  • The Memphis model for crisis intervention began a long time ago and very few officers are trained
  • Austin Police Chief Art Acevedo has begun working with mental health agencies to put social workers on the front line with law enforcement officers available as backup

 
Dr. Sally Taylor, Psychiatrist

  • In support of the bill
  • Have seen patients voluntarily come into a hospital and then decide at some point they want to leave; puts docs in a hard position deciding what to do
  • Sometimes it is best to hold patients and decide what the best course of action is
  • Four hours is a very reasonable time for further assessment to be made
  • Rodriguez asked who pays the bill for the four hour hold
    • It is a medical stabilization issue; these patients are already in the hospital

 
Mary Lisa Jensen, National Alliance of Mental Illness

  • In support of  the bill
  • Want to ensure physicians have the ability to initiate the four hour hold

 
Richard Briscoe, Open Carry Texas

  • Presuming the clarification Perry described is agreeable the group will change their position from against to on the bill

 
Lee Spiller, Citizens Commission on Human Rights

  • Against the bill
  • Detaining patients in an ER is dangerous and degrading
  • ERs are busy, hectic, scary places; not an appropriate venue for involuntary detention
  • Believes a lot of rural hospitals will be hurt by this
  • Taylor asked what should be done
    • A lot of this problem is a capacity problem; no beds available in psychiatric facilities
  • Non-dangerous patients will get caught up in this bill; the problem is not with detaining people who represent a danger, that is already covered in the penal code

 
Justin Armand, Texans for Accountable Government

  • Against the bill
  • Those suffering need a safe place to go to help and the bill removes the sanctity of health care and trust in doctors and emergency rooms
  • This will be horrific experience for people seeking medical help
  • People will stop seeking help
  • It is not the role of government to diagnose conditions or to give authority to health care practitioners to detain people they believe to be a danger
  • The bill limits liability which causes concern; liability would cause them to exercise caution

 
CJ Grisham, Open Carry Texas

  • Met with THA and came to an agreement on how to fix the bill

 
Gerald Yezak, Robertson County Sherriff

  • In support of the bill

 
Bill left pending
 
Sunset Bill Amendments
 
Amendments laid out and withdrawn to comply with Senate rules; no amendments were detailed