House Speaker Straus Issues Interim Charges
Speaker Straus announced the 85th Legislative interim charges for the House of Representatives. By issuing interim charges, Speaker Straus highlighted issues that should receive study and discussion leading up to the next legislative session, which will begin in January 2019. Committees will report their findings to the House before that session begins. Speaker Straus also created the Select Committee on Opioids and Substance Abuse, which will study the prevalence and impact of substance abuse and substance use disorders in the state. Rep. Four Price of Amarillo will serve as the committee’s Chairman, while Rep. Joe Moody of El Paso will serve as Vice Chairman. The charges related to health and human services are listed below.
4. Monitor the ongoing implementation of S.B. 20 (84R), S.B. 533 (85R), and S.B. 255 (85R), as well as Article IX, Sections 7.04, 7.10, and 7.12 of the General Appropriations Act. Study the processes by which state agencies award, execute, manage, and monitor state contracts, and make recommendations on whether any changes are necessary to safeguard the best interest of the public and state. Evaluate measures utilized to determine vendor performance, and make recommendations on how to improve vendor selection and performance. When reviewing the Health and Human Services Commission’s (HHSC) managed care contracts, determine if HHSC has adequate data, staff, and processes to provide appropriately rigorous contract oversight, including but not limited to the use of outcome metrics. Consider whether HHSC properly enforces contractual sanctions when managed care organizations (MCOs) are out of compliance, as well as how HHSC uses Medicaid participants’ complaints regarding access to care to improve quality.
10. Examine the Early Childhood Intervention Program (ECI) in Texas, including a review of historical funding levels, programmatic changes, challenges providers face within the program, and utilization trends. Evaluate ECI’s impact on reducing the long-term costs of public education and health care. Identify solutions to strengthen the program.
11. Monitor Congressional action on federal healthcare reform and CHIP reauthorization. Identify potential impacts of any proposed federal changes. Identify short- and long-term benefits and challenges related to converting Texas Medicaid funding to a block grant or per capita cap methodology. Determine how Texas should best prepare for federal changes, including statutory and regulatory revisions, as well as any new administrative functions that may be needed. Explore opportunities to increase the state’s flexibility in administering its Medicaid program, including but not limited to the use of 1115 and 1332 waivers.
12. Review the state’s readiness to care for aging Texans by reviewing the reimbursement methodologies for nursing homes and assisted living facilities, including supplemental payments, Medicaid add-on payments, and availability of alternative methods of finance. Identify methodologies to adequately finance Medicaid rates for long-term care facilities under managed care capitation, support high-quality care for Texas seniors, accommodate new models of care, and encourage care coordination to treat higher incidence of complex conditions.
18. Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. In conducting this oversight, the Committee will also specifically monitor:
- All activities and expenditures related to Hurricane Harvey;
- Planned expenditures of funds appropriated for deferred maintenance across agencies;
- Any lapses in funding at the Department of Family and Protective Services (DFPS) or the Health and Human Services Commission (HHSC) for prevention and early intervention, and/or behavioral health services;
- Implementation of therapy rate increases and policy changes at HHSC;
- HHSC’s use of appropriated funds to expand Texas’s inpatient psychiatric infrastructure;
- Ongoing impact of critical-needs funding at DFPS;
- Medicaid cost-containment efforts;
- Impact of the Texas Education Agency’s reinterpretation of regulations related to the local option homestead exemption;
- Proposal by the University of Texas and Texas A&M systems to modernize the management of Permanent University Fund lands;
- Implementation of a capitated correctional managed healthcare rate; and
- The Department of Public Safety’s efforts to eliminate the sexual assault kit backlog with funds appropriated for that purpose.
- Study policies and protocols within the Texas Department of Criminal Justice to prevent the spread of infectious diseases. Examine when protocols are implemented and their efficacy in protecting the health and safety of inmates and state employees.
- Study how counties identify defendants’ and inmates’ behavioral health needs and deferral opportunities to appropriate rehabilitative and transition services. Consider models for ensuring defendants and inmates with mental illness receive appropriate services upon release from the criminal justice system.
Government Transparency and Organization.
- Study how state agencies can share knowledge and practices, reduce duplicative data gathering, and conduct business in a more efficient manner through interagency data sharing. Review best practices to provide the public with more transparency and access to government information.
- Study the impact of Hurricane Harvey and the response to the storm on individuals living in long-term care facilities, assisted living facilities, state supported living centers, licensed community group homes, and children in the foster care system. Identify and recommend necessary solutions to ensure appropriate disaster-related protocols are in place to keep vulnerable Texans protected. Also, identify any challenges state agencies experienced in responding to the storm or during recovery efforts.
- Review the history and any future roll-out of Medicaid Managed Care in Texas. Determine the impact managed care has had on the quality and cost of care. In the review, determine: initiatives that managed care organizations (MCOs) have implemented to improve quality of care; whether access to care and network adequacy contractual requirements are sufficient; and whether MCOs have improved the coordination of care. Also determine provider and Medicaid participants’ satisfaction within STAR, STAR Health, Star Kids, and STAR+Plus managed care programs. In addition, review the Health and Human Services Commission’s (HHSC) oversight of managed care organizations, and make recommendations for any needed improvement.
- Examine the survey process for nursing facilities to determine any duplication of government regulations. Consider recommendations to reduce duplication while ensuring patient safety is preserved.
- Review the availability of prevention and early intervention programs and determine their effectiveness in reducing maltreatment of children. In addition, review services available to children emancipating out of foster care, as well as services available to families post-adoption. Determine if current services are adequately providing for children’s needs and meeting the objectives of the programs. While reviewing possible system improvements for children, follow the work of the Supreme Court of Texas Children’s Commissions’ Statewide Collaborative of Trauma-Informed Care to determine how trauma-informed care impacts outcomes for children.
- Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Public Health)
- Monitor the HHSC’s implementation of Rider 219 in Article II of the General Appropriations Act related to prescription drug benefit administration in Medicaid. Analyze the role of pharmacy benefit managers in Texas Medicaid.
- Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. In conducting this oversight, the committee will also closely monitor the implementation of H.B. 4 (85R), H.B. 5 (85R), H.B. 7 (85R), and S.B. 11 (85R).
- Assess the status of the health insurance market in Texas and opportunities to improve this market through waivers of federal law or other mechanisms. Monitor any changes in federal law that may affect these options.
- Evaluate recent efforts by the Legislature and the Texas Department of Insurance to minimize instances of surprise medical billing and to ensure the adequacy of health insurance networks. Identify instances in which surprise billing most often occurs and ways to decrease its frequency through enhanced transparency or other methods.
- Examine the impacts of changes in prescription drug coverage and drug formularies on patients, particularly those with chronic conditions.
- Evaluate recent efforts in Texas and in other states to enhance transparency regarding the practices of pharmacy benefit managers.
Juvenile Justice and Family Issues.
- Evaluate the use of telemedicine to improve behavioral health services in the juvenile justice system.
- Examine programs in public schools that have proven results meeting the needs of and improving student achievement for students with disabilities, with an emphasis on programs specializing in autism, dysgraphia, and dyslexia. Recommend ways to support and scale innovative programs for these students, including providing supplemental services, or incentivizing public-private partnerships or inter district and charter school collaborations. Monitor the implementation and funding for the pilot programs authorized in H.B. 21 (85R) and review the Texas Education Agency’s compliance with S.B. 160 (85R), which prohibits special education student caps.
- Review state programs that provide women’s health services and recommend solutions to increase access to effective and timely care. During the review, identify services provided in each program, the number of providers and clients participating in the programs, and the enrollment and transition process between programs. Monitor the work of the Maternal Mortality and Morbidity Task Force and recommend solutions to reduce maternal deaths and morbidity. In addition, review the correlation between pre-term and low birth weight births and the use of alcohol and tobacco. Consider options to increase treatment options and deter usage of these substances.
- Study treatment of traumatic brain injury, Alzheimer’s, and dementia, and recommend opportunities for advancing treatment and cures.
- Study and make recommendations to improve services available for identifying and treating children with mental illness, including the application of trauma- and grief-informed practices. Identify strategies to assist in understanding the impact and recognizing the signs of trauma in children and providing school-based or community-based mental health services to children who need them. Analyze the role of the Texas Education Agency and of the regional Education Service Centers regarding mental health. In addition, review programs that treat early psychosis among youth and young adults.
- Study the overlays among housing instability, homelessness, and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Urban Affairs)
- Review opportunities to improve population health and health care delivery in rural and urban medically underserved areas. Identify potential opportunities to improve access to care, including the role of telemedicine. In the review, identify the challenges facing rural hospitals and the impact of rural hospital closures.
- Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Human Services)
- Evaluate the process of organ and bone marrow donations. Consider opportunities to improve organ and bone marrow donation awareness in order to increase the number of willing donors.
- Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. In conducting this oversight, the Committee will also specifically closely monitor the implementation of H.B. 10 (85R), H.B. 13 (85R), and S.B. 292 (85R).
- Study the overlays among housing instability, homelessness, and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Public Health)
Opioids and Substance Abuse.
- Study the prevalence and impact of substance use and substance use disorders in Texas, including co-occurring mental illness. Study the prevalence and impact of opioids and synthetic drugs in Texas. Review the history of overdoses and deaths due to overdoses. Also review other health-related impacts due to substance abuse. Identify substances that are contributing to overdoses, related deaths and health impacts, and compare the data to other states. During the review, identify effective and efficient prevention and treatment responses by health care systems, including hospital districts and coordination across state and local governments. Recommend solutions to prevent overdoses and related health impacts and deaths in Texas.
- Review the prevalence of substance abuse and substance use disorders in pregnant women, veterans, homeless individuals, and people with co-occurring mental illness. In the review, study the impact of opioids and identify available programs specifically targeted to these populations and the number of people served. Consider whether the programs have the capacity to meet the needs of Texans. In addition, research innovative programs from other states that have reduced substance abuse and substance use disorders, and determine if these programs would meet the needs of Texans. Recommend strategies to increase the capacity to provide effective services.
- Review policies and guidelines used by state agencies to monitor for and prevent abuse of prescription drugs in state-funded or state-administered programs. Include in this review policies implemented by the Texas Medicaid Program, the Division of Workers’ Compensation of the Texas Department of Insurance, the Teacher Retirement System, and the Employee Retirement System. Make recommendations regarding best practices.
- Monitor and evaluate the implementation of legislation passed by the 85th Legislature regarding the Prescription Monitoring Program. In addition, review the prescribing of addictive drugs by physicians and other health care providers within various geographic regions of this state. Determine the role of health care professionals in preventing overutilization and diversion of addictive prescriptions. Provide recommendations that will improve efforts to prevent overutilization and diversion of addictive prescriptions.
- Identify how opioids have impacted the normal scope of work for law enforcement, first responders, and hospital emergency department personnel.
- Examine the impact of substance abuse and substance use disorders on Texans who are involved in the adult or juvenile criminal justice system and/or the Child Protective Services system. Identify barriers to treatment and the availability of treatment in various areas of the state. Recommend solutions to improve state and local policy, including alternatives to justice system involvement, and ways to increase access to effective treatment and recovery options.
- Examine the impact of overdose reporting defense laws known as “Good Samaritan” laws.
- Identify the specialty courts in Texas that specialize in substance use disorders. Determine the effectiveness of these courts and consider solutions to increase the number of courts in Texas.