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In this issue:

State Updates

• End of Session Wrap Up
• Policy Work Continues During the Legislative Interim
• We Remain Thankful to the Work and Contributions Made by All

86th Legislative Session Summary Reports

Upcoming Hearings

Upcoming Events

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State Updates

End of Session Wrap Up

The 140-day Texas legislative session came to a close over the May 27 Memorial Day holiday with Governor Greg Abbott and legislative leaders celebrating significant victories related to school finance and property tax reform. Before swinging the final gavel, lawmakers fulfilled their constitutional duty and passed a balanced budget allocating $250.7 billion for the 2020-2021 biennium, a 16 percent increase over the 2018-2019 budget. Included in the final budget is $84.4 billion for health and human services programs, up just 1 percent from the previous biennium. As has been the custom in past sessions, lawmakers included a $900 million cut to the state Medicaid program through a cost containment rider in the state budget bill. The state’s health care services agency will direct the program reductions over the next two years to achieve these savings.

A total of 7,324 bills were filed this legislative session, with 1,373 bills ultimately becoming law. In a rare move from previous governors, Governor Abbott signed the two-year budget into law without any line-item vetoes.

Working alongside lawmakers and state health advocates over the five-month session, Methodist Healthcare Ministries weighed in on more than 200 new state laws, helping deliver on a number of regional priorities important to families in our 74-county service area. Despite healthcare receiving little attention this legislative session, there were a number of notable accomplishments related to access to care, mental health and women’s and children’s health. Highlights of key bills include:

• Access to Care
  • Reducing transportation barriers to health care treatment by allow ridesharing companies to provide nonmedical transportation services under Medicaid. (HB 1576)
  • Preventing cancer by raising the statewide minimum age to purchase all tobacco products, including e-cigarettes, from 18 to 21 years of age (exempts military). (SB 21)
  • Continuing to support cancer prevention & research initiatives by passing a constitutional amendment which will ask voters on the Nov. 5 ballot for the authority to issue another $3 billion in bonds for the continuation of the Cancer Prevention & Research Institute of Texas (CPRIT). (HB 39 and HJR 12)
  • Incentivizing the purchase of fruits and vegetables by creating a SNAP pilot program and studying existing incentive programs throughout the state. (SB 1834)
  • Creating greater flexibility and efficiency for local hospital districts allowing them to better serve uninsured Texans by creating local healthcare provider participation funds programs (LPPFs) in Bexar County and Nueces County. (SB 1545 and SB 2315)
• Behavioral Health
  • Securing $190.3 million to begin construction on a new San Antonio State Hospital, a 300-bed campus that will improve care for those living in South Texas with behavioral health needs. (SB 500)
  • Improving mental health capacity in rural areas through regional coordination between local mental health authorities (LMHAs), requiring them to develop mental health service development plans. (HB 633)
  • Increasing access to intensive home-based and community-based mental health services for children enrolled in Medicaid by giving managed care organizations flexibility to provide more cost-effective and evidence-based services as deemed medically appropriate. (SB 1177)
  • Improving school safety and mental health promotion by allocating $100 million to create a Child Mental Health Consortium that will leverage the expertise of health-related educational institutions to improve the child mental health care system in Texas and increase access to child psychiatry through telemedicine, and by allocating $100M to create a School Safety Allotment to assist with school safety and security training, prevention and treatment programs related to Adverse Childhood Experiences (ACEs) and suicide prevention in school. (SB 11)
  • Increasing the capacity of school districts and school personnel to support mental health and the healthy development of students by establishing training, policy and planning requirements, use of trauma-informed practices, social and emotional skill development, and comprehensive suicide prevention. (HB 18)
• Women and Children’s Health
  • Improving access to maternal health care services by creating a pilot program that will allow children to ride with their pregnant or postpartum mothers to their medical appointments under the Medicaid Transportation Program. (HB 25)
  • Improving maternal and newborn health for women and children with a drug dependency by expanding the Texas AIM program for hospitals to include bundles for maternal opioid abuse disorder. (SB 436)
  • Increasing access to healthcare services after a women’s 60-day Medicaid for Pregnant Women coverage expires by notifying them of their eligibility for the Healthy Texas Women (HTW) program. (SB 2132)
  • Improving access to postpartum services by developing a limited postpartum care service package for women enrolled in HTW for up to 12 months postpartum (SB 750), and creating a 5-year strategic plan to improve access to postpartum screenings, treatment and support. (HB 253)
  • Helping children stay active and healthy by updating existing nutrition and active play minimum standards at daycare centers & registered family homes to align with recommendations from the American Academy of Pediatrics. (SB 952)

Policy Work Continues During the Legislative Interim

Without a doubt, there was little political will this session to address comprehensive health care for our state’s low-income families. Notably, Texas continues to have the highest number of uninsured adults and children in the country, with little talk of a permanent fix or a backup plan to protect patients if Texas succeeds in repealing the Affordable Care Act. Identifying sound proposals that aim to secure healthcare coverage for the millions of uninsured Texans remains a top priority for Methodist Healthcare Ministries as we continue to advocate on behalf of the underserved in our 74-county service region.

We Remain Thankful to the Work and Contributions Made by All

Methodist Healthcare Ministries extends a heartfelt thank you to all of our hardworking elected officials in the Texas Legislature, especially our 10 Senate and 44 House members representing MHM’s 74-county service region. We appreciate allowing us the countless office visits made with lawmakers and Capitol staff, as well as their public endorsement of legislation and policies drafted to improve the health of Texas families. Our efforts were greatly strengthened and expertly led by our funded health care advocacy partners, including The Center for Public Policy Priorities, Children’s Defense Fund, Council for a Strong America, Healthy Futures of Texas, Meadows Mental Health Policy Institute, National Alliance on Mental Illness – Texas, National Association of Social Workers – Texas, Texas Impact, Texas Doctors for Social Responsibility, Texas Pediatric Society, Texans Care for Children and The Immunization Partnership.

86th Legislative Session Summary Reports

Below are links to additional excellent summaries by our advocacy partners.

· Center for Public Policy Priorities

· National Association of Social Workers – Texas

· Texas Coalition for Healthy Minds

· Texas Pediatric Society

· Texas Hospital Association

· Texans Care for Children

· Texas Impact (Blog)

Upcoming Hearings

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Events

Sept. 19-20: Center for Public Policy Priorities & Texas Association of Community Health Plans – Texas State of Enrollment Conference (San Antonio)

Sept. 26-27: Meadows Mental Health Policy Institute – Engage & Excel Conference (Austin)

Sept. 26-28: The Texas Tribune – TribFestival (Austin)

Oct. 3-4: Health Literacy Collaborative – TX Health Literacy Conference (San Antonio)

Nov. 8-9: NAMI Texas – Road to Resilience Conference (Houston)

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• On Their Way to the Governor’s Desk
• Legislature Approves Extension of Cancer Prevention & Research Institute of Texas
• House Extends Health Care Coverage for Medicaid Mothers
• Bill Addressing Adverse Childhood Experiences Moves Forward
• Bill Promotes Best Practices for Physical Activity in Schools
• Senate Passes Medical Transportation Pilot Program for New Mothers

Upcoming Hearings for the week of May 20

Upcoming Events

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State Updates

On Their Way to the Governor’s Desk

With a little more than a week left in the 86^th Legislative Session, bills are making their way to the Governor’s desk for his signature. Here are just a few that impact the delivery of health care for the communities we serve. 

HB 125 – Prohibits the state from publishing the home address of licensed mental health professionals online.

HB 2225 – requires birthing facilities to inform parents of deaf and hard of hearing infants about public resources available to them, including early childhood intervention (ECI) services.

SB 999 – develops a state plan to identify best practices related to the awareness, treatment and prevention of Alzheimer's disease.

SB 1142 – allows the Travis County Healthcare District (Central Health) to employ physicians to better provide medical care for indigent and needy residents.

SB 1378 – requires institutions of higher education planning to increase enrollment to medical degree programs to submit a specific plan to increase the number of corresponding first-year residency positions.

SB 2132 – provides women auto-enrolled into the state’s Healthy Texas Women (HTW) program with information about the program and a list of health care providers in the woman's geographic area.

Legislature Approves Extension of Cancer Prevention & Research Institute of Texas  

Approximately half of all cancers can be prevented through evidence-based prevention intervention services. Established in 2009, the Cancer Prevention and Research Institute of Texas (CPRIT) provides an infrastructure that supports and enhances the networks delivering cancer prevention services and conducting groundbreaking research throughout the state. On May 10, the Texas Senate passed House Bill 39 and House Joint Resolution 12 which will extend the CPRIT program and ask voters to amend the Texas Constitution to authorize $3 billion in general obligation bonds.

CPRITs investment in prevention grants makes it possible for the state to fully capitalize on its longstanding investment in Texas’ fight against cancer. Since 2010, CPRIT grantees have provided nearly 251,000 prevention vaccinations, 230,000 tobacco cessation services and 1,300,000 screening and diagnostics for breast, cervical, HPV-related, liver and colorectal cancers. Additionally, CPRIT has invested nearly 11 percent of its research portfolio – twice the national average – toward more than 150 cancer research projects aimed at improving survival rates and preventing children and adolescents from developing cancer. Methodist Healthcare Ministries worked with the American Cancer Society this legislative session to secure the reauthorization of CPRIT and ensure Texans receive lifesaving prevention clinical services and expedite innovation in childhood cancer research.

House Extends Health Care Coverage for Medicaid Mothers

The 2018 Texas Maternal Mortality and Morbidity Task Force Biennial Report found that 56 percent of maternal deaths between 2012 and 2015 occurred after 60 days postpartum. The most common contributing factor to maternal mortality included underlying medical conditions, such as diabetes and heart disease, due to the lack of access to quality care during the year after pregnancy and throughout the interconception period. On May 10, the Texas House voted 87-43 to pass House Bill 744 by Representative Toni Rose, which adopts the Task Force’s number one recommendation – to extend access to health care coverage from 60 days to 12 months following delivery.

The current 60-day postpartum coverage provided by maternal Medicaid does not allow women time to secure postpartum outpatient care and ensure access to interconception care services. Enabling eligible women to access and maintain continuous healthcare coverage is essential to help women identify and address health issues early on. HB 744 aims at improving the health of women, facilitate continuity of care, enable effective care transitions and promote safe birth spacing. Methodist Healthcare Ministries supports extending Medicaid coverage for women up to 12 months postpartum to ensure continuity of care, allowing women to receive treatment services for conditions such as substance use, diabetes and hypertension. House Bill 744 moves to the Senate where it awaits referral to committee and further action.

Bill Addressing Adverse Childhood Experiences Moves Forward

Texas ranks 30th in the nation for the number of children who have experienced two or more childhood traumas. Experiencing multiple stressful or traumatic events during childhood, known as adverse childhood experiences (ACEs), have shown to have profound effects on an individual’s cognitive, social and biological development. With nearly 24 percent of Texas children having experienced multiple ACEs, the Texas House voted 131-14 in favor of House Bill 4183 by Representative Tan Parker (R- Flower Mound), directing the state to develop a five-year strategic plan to address the social, health and economic impacts of adverse childhood experiences.

Studies have found that as the number of ACEs increases so do the risks of poor physical health, mental health and behavioral health outcomes. Using a public health framework, HB 4183 develops a strategic plan that identifies best practices and promotes the development of early intervention and prevention strategies to mitigate the impact of ACEs. Methodist Health Ministries supports empowering struggling families, promoting safe relationships and environments and building resiliency in children and families. On Wednesday, May 15, HB 4183 was heard by the Senate Committee on Health and Human Services and was left pending, awaiting further action.

Bill Promotes Best Practices for Physical Activity in Schools

Texas has the seventh-highest obesity rate in the country for youths between the ages of 10 and 17, with more than 600,000 youths considered obese. Children who are overweight or obese are five times more likely to be overweight or obese as adults and have an increased likelihood of developing chronic diseases, including diabetes and heart disease. On May 9, the Senate Committee on Education heard House Bill 455 by Representative Alma Allen (D-Houston), which provides guidance to school districts on adequate recess time while maximizing the effectiveness of outdoor physical activity.

Daily recess is shown to have health, social and academic benefits for students. Currently, the state does not provide school districts with specific guidance as to the best-practices for constructive physical activity and outdoor play time. HB 455 directs the Texas School Health Advisory Committee to develop age-appropriate model recess policies that encourage constructive outdoor play time. Methodist Healthcare Ministries provided written testimony to the Senate Education Committee in support of preventing obesity early in a child’s life to improve their health and productivity into adulthood. The bill was left pending in committee and awaits further action.

Senate Passes Medical Transportation Pilot Program for New Mothers

For many mothers in rural and urban areas, transportation to medical appointments is a significant barrier resulting in forgone health care or missed appointments. Missed appointments delay care which is associated with disrupted patient care, increased medical costs and increased emergency room visits. On Thursday, May 16, the Texas Senate voted overwhelmingly in support of House Bill 25 by Representative Mary Gonzalez (D-Clint), which creates a pilot program allowing pregnant and postpartum women to ride with their children to their pregnancy-related medical appointments under the Medicaid medical transportation program.

Currently, state and federal funds are not allowed to be used to transport a person who is not a Medicaid beneficiary to a medical appointment. This results in mothers having to travel without their children if they are going to a prenatal or postpartum appointment. HB 25 would allow health plans to leverage existing partnerships with ridesharing services to arrange for transportation for mothers and their children. The pilot program seeks to determine if the program reduces pregnancy-related complications, improves access to medical care and decreases missed appointments. Methodist Healthcare Ministries supported HB 25 as it worked through the House and Senate committee process. The bill, as amended in the Senate, heads back to the House for concurrence.

Upcoming Hearings for the week of May 20

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Events

Monday, May 27 – Last day of the 86th Legislative Session (Sine Die)

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• State Trauma Program Funding Bill Moves Forward
• House Tackles Property Tax Reform
• Bexar County House Freshman Ray Lopez Files Bills Protecting Vulnerable Youths
• Adequate Physical Activity Key to Future of National Security

Upcoming Hearings for the week of May 6

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State Updates

State Trauma Program Funding Bill Moves Forward

Every four minutes someone in Texas is faced with an unexpected traumatic injury – annually resulting in over 130,000 trauma hospitalizations and costing designated trauma centers nearly $300 million in unreimbursed trauma care services. To help offset the unreimbursed costs and sustain the state’s trauma care system, the Texas Legislature created the Driver Responsibility Program (DRP) in 2003. Over the course of the 16-year program, however, the DRP has received growing opposition for its impact on low-income drivers and families. On May 1, Representative John Zerwas (R-Fulshear) laid out House Bill 2048 for consideration on the House floor, which repeals the DRP and proposes a new funding source for the state’s entire trauma care system.

The current DRP levies fines and surcharges over a three-year period for reckless driving and moving violations such as DWIs ($1,000 a year), driving without an insurance or valid ID ($250 a year) and driving with an expired license ($100 a year). When Texans are unable to pay the DRP fines, their driver’s licenses are revoked, resulting in more than 1.4 million drivers losing their licenses since the inception of the program. HB 2048 proposes reinstating revoked driver’s licenses due to unpaid fines, repealing the program, and replacing the funding using three different mechanisms: increasing state traffic fines from $30 to $50, imposing a $4 fee on auto insurance policies, and raising the fees for DWI to $3,000, $4,500, and $6,000 for subsequent convictions, respectively. The bill was amended on the House floor, including the addition of a provision that increases the amounts allocated to Emergency Medical Services and the Regional Advisory Councils by 2 percent and 1 percent, respectively.

House Bill 2048 received broad support from health care stakeholders, including the Texas Hospital Association, Texas Sheriff’s Association, HCA Healthcare, CHRISTUS Healthcare, University Health System, Doctors Hospital at Renaissance and the San Antonio Police Department. HB 2048 was voted out by the House on a vote of 143-0 and sent to the Senate where it awaits to be referred to committee. Methodist Healthcare Ministries supports the passage of HB 2048 and its efforts to develop a sustainable and equitable funding stream for the state’s trauma care system.

House Tackles Property Tax Reform

Property tax and education reform bills have been the top policy issues of the 2019 legislative session. Legislators have routinely heard from constituents who have voiced concerns with rising property taxes, and confusing tax systems. On April 30, the Texas House debated Senate Bill 2, sponsored in the House by Representative Dustin Burrow (R-Lubbock), who stressed to House members that the intent of SB 2 is to make the tax process more transparent, though the bill does not aim to lower property tax rates.

The House approved Senate Bill 2 by a vote of 107-40, with 20 members of the Democratic party voting in favor of the bill. As passed, the bill requires cities, counties and emergency service districts to hold an election to raise property tax revenue above 3.5 percent from the previous year, matching the version passed by the Senate last week. Both versions also allow taxing units to include indigent health care costs into their revenue growth calculations, although with slightly different mechanisms. Efforts to add amendments that would exclude flood risk mitigation, public safety expenses and economic development expenditures from the revenue growth calculations were voted down.

State leadership applauded the bill’s passage, despite strong opposition from cities and counties. Local government officials fear the unintended consequences of the reform will restrict both short term and long term growth needs without providing meaningful tax relief for its residents. Senate Bill 2 has moved to conference committee where conferees will negotiate final terms.

Bexar County House Freshman Ray Lopez Files Bills Protecting Vulnerable Youths

Newly sworn-in House member, Representative Ray Lopez (D-San Antonio), was given the opportunity to debate his bill, House Bill 4753, last week in the House Committee on International Relations and Economic Development. The bill calls for a study to examine the growing cost of child care affecting hard-working families throughout the state. Lopez, a former member of the San Antonio City Council, won a special election runoff to replace former state Representative Justin Rodriguez, who gave up his seat to accept an appointment as Bexar County Commissioner.

Lopez shared with committee members that some families are forced to spend up to 30 percent of their annual income on child care, much higher than the 7 percent level recommended by financial analysts. The disparity, disproportionately affecting single-family households with low incomes, recognizes that children of parents with limited incomes consequently lack access to child care resources. Representative Lopez stressed that investing in child care was the first step toward ensuring a child’s success and healthy development. HB 4753 was left pending in committee, where it will likely remain due to legislative session deadlines.

Representative Lopez also introduced House Bill 4757 which looks to improve access to healthcare coverage for youths in foster care. Under current law, youths aging out of foster care have access to state healthcare coverage until the age of 26, however many lose their coverage after they age out due to the difficult renewal processes and application forms that must be submitted annually. HB 4757 would streamline the redetermination process and create an auto-renewal process for youths after leaving state conservatorship to prevent any disruption in services, treatment or medication. Methodist Healthcare Ministries supports Representative Lopez’s initiative to protect the underserved and ensure access to healthcare coverage for all vulnerable populations.

Adequate Physical Activity Key to Future of National Security

Nearly 33 percent of youths in Texas are too overweight to serve in the military, and obesity is one of the leading reasons why 73 percent of young adults in Texas are ineligible to serve in the military. On May 1, Methodist Healthcare Ministries’ advocacy partners, Mission: Readiness and the Partnership for a Healthy Texas, held a press conference highlighting the importance of increasing physical activity in schools to curb the obesity epidemic. Senator Campbell (R-San Antonio) and Senator Kirk Watson (D-Austin) noted in their comments that this was a national security concern and both supported the implementation of obesity prevention strategies, such as the passage of Senate Bill 364 to ensure recess policies are adopted in all schools.

Dr. Deanna Hoelscher, Regional Dean of the UTHealth School of Public Health at Austin, explained that childhood obesity is estimated to cost an additional $12,900 in medical care per overweight child, placing a significant burden on the healthcare system. Retired U.S. Army Major General Rick Noriega added that engaging in meaningful recess and physical activity in schools would ensure Texas develops a healthy workforce and strong military. With the obesity rate of fourth-grade students in Texas currently 44 percent higher than the national average, the time to act is now.

Methodist Healthcare Ministries remains a staunch advocate in preventing childhood obesity. It supports an upstream approach which includes supporting the Partnership for a Healthy Texas’ Senate Bill 1834, which creates a pilot program to incentivize the purchasing of healthy foods for individuals using SNAP benefits and Senate Bill 952, which creates standards for nutrition, physical activity and screen time in licensed child care facilities. Both bills have passed the Senate and are waiting to be heard in the House Committee on Human Services.

Upcoming Hearings for the week of May 6

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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In this issue:

• Knowing the Immunization Status of Students in a School Campus Matters

• Increasing the Physician Loan Repayment CapHelps Rural and Underserved Areas

• APRNs and PAs Prescribing Authority Improves Access to Care

• State Property Tax Cap Bill Weakens Local Health Care Safety Net Systems

Upcoming Hearings for the week of April 29

Upcoming Meetings & Events

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State Updates

Knowing the Immunization Status of Students in a School Campus Matters

Texas has seen a twentyfold increase since 2003 in the number of nonmedical exemptions for school vaccination requirements. Vaccination exemptions tend to cluster geographically, create pockets of under-vaccinated children, and leave communities vulnerable to disease outbreaks, such as measles and whooping cough. On April 23, Senator Kel Seliger (R-Midland) laid out Senate Bill 329, also known as the “Parent’s Right to Know Bill,” in the Senate Health and Human Services Committee. The bill aims to improve community awareness on the importance of vaccinations and improve the state’s ability to identify pockets of disease and implement timely public health interventions.

Immunization exemption data currently collected by the state of Texas is aggregated at the school district level. Parents in support of SB 329 contend that sharing the data at the local campus level will improve community awareness and allow families to make informed decisions when enrolling their children in school. Testimony shared with committee members pointed out that parents of children with compromised immune systems need access to the data collected by the government on their child’s immediate surroundings so that they can make decisions related to their child’s health and well-being. Rekha Lakshmanan, with The Immunization Partnership, testified in support of SB 329, noting the bill ultimately seeks to provide greater transparency regarding the number of immunization exemptions which puts Texans unnecessarily at risk of vaccine-preventable diseases. Witnesses opposed to the bill claimed improving transparency would result in a backlash against unvaccinated individuals.

Organizations signing up in support of SB 329 included the Texas PTA, Williamson County Health District, Texas Public Health Coalition and Texas Medical Association, which explained how the school campus data would be invaluable in responding quickly to disease outbreaks. Methodist Healthcare Ministries supports SB 329 and is a longtime advocate of immunization policies that protect children and their families. The bill was left pending in committee.

Increasing the Physician Education Loan Repayment Cap

Texas ranks 47th in the nation in its ratio of primary care physicians to total population. The low ratio of primary care providers impacts access to care, especially for the 6 million Texans living in 123 counties with a full primary care professional shortage area designation. To encourage new physicians to work in underserved communities, Texas currently pays up to $160,000 of a physician’s student loan in return for a four-year commitment to practice in an underserved area and care for patients enrolled in the CHIP and Medicaid programs. Over the last five years, the program, known as the Physician Education Loan Repayment Program (PELRP), has enrolled 750 physicians caring for patients in rural communities, urban community health centers and correctional facilities. On April 23, the Senate Higher Education Committee took testimony on Senate Bill 998 by Senator Chuy Hinojosa (D-McAllen), which revamps the PELRP by increasing the maximum available loan repayment amount to each participating physician by $20,000 over a four-year term for a maximum of $180,000. This increased amount more closely reflects the educational debt load of recent medical graduates.

According to the Association of American Medical Colleges, 76 percent of medical students graduate with student debt and their total debt load has increased significantly over the past decade. The average educational debt of a new physician has grown from $173,000 in 2011 to $190,000 in 2016. Testifying in support of SB 998, Alan Schalscha, Chief Medical Officer of CommUnityCare, emphasized that the increased loan repayment amount is necessary to remain competitive with actual physician debt and will assist in attracting physicians to practice in medically underserved areas. The bill received support from many stakeholders, including the Texas Association of Community Health Centers, the Teaching Hospitals of Texas and the Texas Medical Association. Methodist Healthcare Ministries works to secure physicians for rural clinics who are often unable to successfully recruit providers for their communities. Passage of SB 998 will strengthen the PELRP and allow medically underserved areas to competitively recruit physicians for necessary medical care. The bill was left pending in committee.

APRNs and PAs Prescribing Authority Improves Access to Care

In Texas today, there are 206 counties designated as a mental health professional shortage area, with 73 percent of these counties lacking a single psychiatrist. As a result, patients must often wait several weeks or drive several hours for an appointment to see a psychiatrist. Currently, only psychiatrists can prescribe schedule II controlled substances, such as ADHD medication, pain medication or even opioid treatment medications. However, 42 other states already allow advanced practice registered nurses (APRNs) and physician assistants (PAs) to prescribe these drugs under a physician’s supervision. On April 24, the House Public Health Committee heard testimony on House Bill 2250 by Representative Eddie Lucio, III (D-San Benito), which looks to improve continuity of care, increase access to care and reduce administrative burdens for hospitals.

The future of health care depends on a team-based approach to patient care. Under the current law, a supervising physician must be present for an APRN or PA to prescribe or adjust a Schedule II drug. Testifying in support of House Bill 2250, Sharon Hilgartener, with Texas Nurse Practitioners, stated that changing the dosage of pain medication while the patient is in the hospital is currently within her scope of practice. However, upon discharge, if the dosage on a patient’s prescription needs to change, a physician must sign off. The inability to reach a physician often results in delayed patient discharge, decreased throughput, decreased patient satisfaction scores and ultimately lower reimbursement rates. The Texas Medical Association also went on record in support of HB 2250. Methodist Healthcare Ministries values a patient-centered system of care that reflects the patients’ needs and improves access to health care services. The bill was left pending in committee.

State Property Tax Cap Bill Weakens Local Health Care Safety Net Systems

Texas’ rapid population increase places an unparalleled demand on its police, firefighters, paramedics and other local community services. As the cost of providing these services continues to rise, local governments rely on their ability to raise funds through property tax revenues to meet the needs of their residents. Under current law, local governments may raise property tax revenue by up to 8 percent without holding a local election. On April 15, the Texas Senate passed Senate Bill 2 by Senator Paul Bettencourt (R-Houston), which seeks to limit the capacity of local governments and special purpose districts to raise taxes by more than 3.5 percent above the previous year’s revenue and retains a 2.5 percent revenue cap for school districts. Reducing the property tax cap restricts local governments from providing necessary services, such as building and maintaining essential infrastructure, investing in schools and protecting against public health threats.

Local government officials and health care advocates from across the state are opposed to the current language in the Senate’s property tax cap legislation. The legislation threatens to weaken an already vulnerable health care safety net system, especially for providers in rural communities, who cannot rely on state and federal reimbursement to remain viable. Property tax revenues are also used to maintain the underfunded Texas trauma system as well as to offset the state’s share of Medicaid payments to hospitals.

Senate Bill 2 differs from the House’s property tax bill, House Bill 2 by Representative Dustin Burrows (R-Lubbock), which will be debated April 30 on the House floor. The current proposal places a 2.5 percent revenue cap on counties, cities and special purpose districts; however, the bill exempts local hospital districts and school districts from the revenue cap.

Methodist Healthcare Ministries remains engaged in tracking state legislation that restricts local governments from meeting their basic obligations to citizens. Texas needs a fully funded and sustainable health care safety net system to serve the uninsured and underserved of this state.

Upcoming Hearings for the week of April 29

• Posted Agendas for House Committees

• Posted Agendas for Senate Committees

Upcoming Meetings & Events

Saturday, May 4 at 10:30 – Minds Matter Conference; Breaking the Silence on Suicide (San Antonio College)​

For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.

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