House Committee on Public Health – Interim Report

The House Committee on Public Health has published its report to the 82nd Legislature. Below is a summary of the recommendations.

Interim Charge 1—Monitor implementation of legislation intended to curb rising obesity rates in Texas. Study and make recommendations regarding better coordination of prevention efforts     and evidence-based strategies to reduce the impact of obesity on health care costs. Include recommendations related to the use of federal stimulus funds targeted toward obesity prevention.

Recommendations:

1. Consider shifting all obesity prevention funding and efforts towards the prevention of early childhood obesity.
2. All state agencies that receive funding for obesity prevention or healthy nutritional outreach programs should better coordinate efforts with other state agencies, academic institutions and community based groups to achieve better results.
3. The Health and Human Services Commission (HHSC) should continue to work with the federal government on better nutritional guidelines and standards for the Supplemental Nutritional Assistance Program (SNAP).  
4. Consider utilizing the established Renewing Our Communities Account (ROCA) to direct capacity building grants to faith and community based groups that seek to prevent early childhood obesity. 
5. The state wellness program established by HB 1297, 80R should achieve higher state agency adoption rates and employee participation or be abolished. 
6. Support policies that provide better access to nutritious foods, farmer's markets and locally grown fruits and vegetables. 
7. The HHSC could study how the Nurse Family Partnership program could be enhanced to include early childhood obesity prevention education.
8. The Employees Retirement System of Texas (ERS) should report to the Legislature the health outcomes and cost savings of the bariatric surgery benefit adopted by ERS as required by SB 2577, 81R.

Interim Charge 2—Study the state's ability to respond to the H1N1 virus. Examine issues related to vaccine and antiviral distribution and capacity, disease surveillance, communication with providers and the public, intergovernmental cooperation, and medical surge capability.

Recommendations:

1. Continue to support the purchase and stockpile of antiviral medication.
2. Support the development of in-state manufacturing and distribution of the regular flu and H1N1 vaccines to ensure that shortages do not occur in this state, especially for highly vulnerable populations.
3. The Department of State Health Services (DSHS) should develop a more transparent and effective communication process with local authorities, healthcare providers and the public. 
4. The DSHS should improve collaboration with the federal government, academic partners and local communities to improve the state's preparation and response, especially along the Texas border.

Interim Charge 3—Determine how the state can best coordinate efforts to streamline health care delivery with health information technology (HIT). Identify areas in state law that affect the adoption and use of HIT. Recommend statutory changes as necessary.

Recommendations:

1. Determine clearly in law who is the owner of medical records.
2. Adopt privacy and security safeguards for the creation, storage and exchange of electronic medical records in Texas.
3. Provide ongoing guidance to the Texas Health Service Authority (THSA) and periodic review of the implementation of the strategic plan for statewide adoption of HIT in Texas.
4. The State Auditor's Office (SAO) should audit the effectiveness of the federal HIT grants awarded to the HHSC and the THSA.
5. The Electronic Health Information Exchange System Advisory Committee, created under HB 1218, 81R could be expanded to include consumer and privacy advocates and also computer security/risk assessment experts to advise all state entities involved in HIT technology.

Interim Charge 4—Identify factors influencing health care cost trends in Texas, including practices or policies that may contribute to regional variations. Investigate medical imaging utilization and its impact on the cost and quality of health care. Recommend policy changes to promote best practices, reduce costs, and improve quality within the state Medicaid program, Employees Retirement System, and Teacher Retirement System. (Joint Interim Charge with House Committee on Appropriations)

Recommendations:   

1. Review why disconnect exists between a consumer's knowledge of the cost and value of a healthcare provider's services and the healthcare provider's knowledge of the cost and value of services provided to a consumer.
2. Reconsider a consumer directed payment plan in the Medicaid program for certain populations.
3. Consider adopting a results-driven reimbursement system for the payment of medical care that is based upon health outcomes and standards of care.
4. Address the dramatic rise in premature births in Texas and the associated long term costs.
5. Require the registration and accreditation of certain imaging equipment in Texas.
6. The HHSC should review the rapid rise in home health and telemedicine services in the Medicaid program to determine if these services actually lower costs, increase quality of care and improve access to care.
7. The DSHS should improve and update the state's consumer guide website as required by SB 1731, 80R.

Interim Charge 5—Examine the need for and barriers to implementing routine HIV screenings as recommended in 2006 by the Centers for Disease Control and Prevention. Assess the impact of implementation on HIV transmission, health outcomes, clinical progression, and mortality.

Recommendations:

1. Encourage areas of the state with high HIV/AIDS infection rates to apply directly to the Centers for Disease Control and Prevention (CDC) for local funding for screening and treatment programs.
2. Encourage local health departments in areas with high HIV infection rates to work with healthcare facilities and providers to test more frequently for HIV.
3. Review the collaborative HIV prevention efforts of the DSHS with all local health authorities on HIV/AIDS prevention, screening and testing.
4. The DSHS faith and community liaison should identify faith and community based groups that currently work on HIV/AIDS related issues and coordinate state and local government efforts with those groups.
5. Review the regional variations in HIV/AIDS funding and determine if adjustments in state funds are necessary.
6. The SAO should monitor and report annually to the Legislature on all federal, state, local and private funds for HIV/AIDS prevention, testing and treatment in the State of Texas.
7. Review the HIV/AIDS testing requirements as prescribed by HB 1795, 81R to determine if these provisions need to be amended to better align with best practices for testing pregnant mothers and newborns for HIV/AIDS in Texas.

Interim Charge 6—Pursuant to HB 1672 (81R), Section 4, study the policies and procedures related to the disclosure required by Chapter 33, Health and Safety Code, to the parent, managing conservator, or guardian of a newborn child.

Recommendations:

1. Determine whether the state or the individual is the owner of blood spots and genetic material once such material is taken outside of the individual's body and also what rights parents, legal guardians and conservators have over such material.
2. Amend the statute to at minimum require the informed consent of parents, guardians, or managing conservators for the residual uses of newborn screening blood spots; disclosure procedures as defined in HB 1672 (81R) are not adequate for ensuring informed consent.
3. The DSHS should immediately distribute the updated newborn blood spot screening disclosure form as required by law to ensure that parents, guardians, or managing conservators are informed about the storage and residual uses of blood spots.
4. The DSHS should add a privacy advocate and a member of the public onto the Institutional Review Board (IRB).

Interim Charge 7—Identify any gaps in Texas laws that may prevent coordinated efforts, both statewide and on the border, to ensure a safe food supply. (Joint Interim Charge with House Committee on Border and Intergovernmental Affairs)

Recommendations:

1. 1.      Adopt the removal of the exemption to licensure for persons, firms, or corporations that ship raw fruits or vegetables as proposed by the House Committee substitute for SB 1329, 81R.
2. The DSHS should incorporate an educational component that promotes best practices in food safety into the licensure and re-licensure process for all food manufacturers and distributors. DSHS should add incentives to the licensure process to encourage the adoption of evidence based best practices in food safety.
3. Pass a resolution to Congress urging the protection of Federal Drug Administration (FDA) and United States Department of Agriculture (USDA) food safety workers and inspectors on the Texas border.
4. The DSHS should continue to seek grant funding to study food safety inspection gaps along the Texas border.
5. The DSHS should better collaborate with all academic, federal and local partners to routinely review the safety of imported food into Texas.

Interim charge 8—Monitor the agencies and programs under the committee's jurisdiction.

The report provides the implementation status of legislation passed by the 81st Legislature that pertains to the HHSC and DSHS.

A complete copy of the report can be found by visiting:

http://www.house.state.tx.us/_media/pdf/committees/reports/82interim/House-Committee-on-Public-Health-Interim-Report-2010.pdf