House, Senate committees set course
with interim studies

By Kate McCann

Members of the Texas Legislature enjoyed just a short break between when the busy 81st Legislative Session wrapped up in June and when House Speaker Joe Straus, R-San Antonio, and Lt. Gov. David Dewhurst released the list of interim committee charges for the House in November and for the Senate in January. For the most part, the interim charges lay the groundwork for the 82nd session in 2011 and wrap up some unfinished business from the last session. Now the committees who received charges will get to work addressing the nearly 350 tasks set before them.

Whether stated or not, weighing heavily on every charge is the projected budget shortfall, which TAFP lobbyist Marshall Kenderdine says will be the largest we’ve ever seen. This takes some legislators back to the session in 2003 when the state towed a $10-billion deficit and had to make major cuts across all state agencies and programs.

However, Kenderdine says that there are a few differences this time around, including a considerable cushion in the so-called rainy day fund. “Going into this session, we’re going to have a big hole to fill, but legislative leaders have prepared for it better.” Dewhurst and Straus have the authority to scrutinize state spending, but Dewhurst has said in other interviews that, at least for now, “Medicaid, health and human services, and public education would probably be exempted.”

Other big issues to keep in mind over the election cycle and into the next session are a redistricting brawl that typically brings out the worst in our elected officials, and the sunset of some major state agencies including the Department of Insurance and Department of Transportation, among others.

Read on for a few of the topics lawmakers will tackle in the interim that could affect your patients and your practices.

House Committee on Appropriations
Appropriations will give the Texas Medicaid Program a thorough examination, studying cost drivers, caseload trends and regional variations in costs, plus the effectiveness of current cost-containment measures. The committee will propose ways to contain and control costs to the state and how to maximize federal funding, all without decreasing services.

In a joint charge with the House Committee on Public Health, Appropriations will study factors influencing health care cost trends in Texas. This includes the prevalence of medical imaging and how it affects the cost and quality of health care in Medicaid, the Employees Retirement System and the Teacher Retirement System.

House Committee on Public Health
Public Health will study ways to combat the rising obesity rates in Texas. This includes looking at the effect of legislation implemented in sessions past as well as ideas for better coordination of care and evidence-based strategies to reduce the impact of obesity on health care costs. The committee is encouraged to use available federal stimulus funds for obesity prevention. Separate charges instruct Public Health to examine the state’s ability to respond to the H1N1 flu virus and determine the effect of health information technology on streamlining health care delivery.

House Committee on County Affairs
County Affairs will look at county-level health care delivery models for indigent populations in urban and rural settings, examining coordination of care to improve continuity and quality.

House Committee on Higher Education
Higher Education will review the Texas Higher Education Coordinating Board, its data-collection systems, and its current aid programs including loan repayment.

House Committee on Ways and Means
Ways and Means will monitor the revised franchise tax, identify ways to simplify the tax, and improve compliance and fairness across Texas businesses.

Senate Committee on Finance
In addition to the hefty task of examining all state debt at all levels, Senate Finance will look at rural hospitals, their capacity, infrastructure, and the statewide impact of their services. There is potential for the committee to recommend creating a program to support rural hospitals.

All Senate committees are asked to monitor the implementation of legislation passed during the previous session. One item of many in Finance is to monitor the revenue receipts associated with the weight-based tobacco tax, which funds the updated Physician Education Loan Repayment Program.

Senate Committee on Health and Human Services
As expected, the bulk of interim tasks affecting Texas family physicians fall under the purview of Health and Human Services. One issue they’ll consider is the role of Advanced Practice Nurses and their potential effect on health care shortages, the cost of care, and patient safety. The committee will assess APNs’ independent prescriptive authority in states where prescriptive authority is delegated by a physician and how to “enhance the efficient use” of non-physician providers in Texas. More broadly, that task instructs the committee to examine the overall health care workforce, including physicians, nurses, dentists, and other professionals, and make recommendations to ensure access to care for needy populations.

As a joint charge with State Affairs, Health and Human Services will examine the effects of a federal health care overhaul: potential costs to the state; changes to insurance regulation, the high-risk pool, and Medicaid and CHIP; and the impact on all uninsured and uncompensated care programs. They will make recommendations for the efficient implementation of new programs.

The committee will examine the exchange of health care information between health care providers, possibly using the Medicaid exchange as framework for a statewide rollout or examining regional health information technology exchanges. They would study how HIT might improve quality of care, prevent medical errors, and reduce unnecessary services; what information the state should provide; and how to protect patients’ privacy.

Health and Human Services is charged with examining potential policies to improve the overall health of Texans, using individually-based and community-based prevention to address obesity, nutrition, and the management of chronic diseases. They are to examine obesity-related disparities between different ethnic groups, and the effect of second-hand smoke on business and service sector employees.

The committee will study health care quality improvement initiatives in the state on a host of topics: infection and adverse event reporting, payment reductions in Medicaid for preventable adverse events, identification of preventable readmissions, HIT implementation, and pay-for-performance programs, among others. They will identify ways to increase quality of care and contain health care costs using these initiatives.

Finally, Health and Human Services will study the Texas Medical Board relating to the disclosure of complaints.

Senate Committee on Higher Education
Similar to the task assigned to the House Committee on Higher Education, the Senate counterpart will review the Texas Higher Education Coordinating Board’s data-collection systems, reporting requirements, and ways to streamline reporting.

Senate Committee on Intergovernmental Relations
Intergovernmental Relations will study the practice of hospitals directly hiring physicians and how other states regulate this action. They will make recommendations based on their findings.

Senate Committee on State Affairs
In addition to the joint charge to examine potential changes stemming from federal health care reform, State Affairs will review the implementation of the Healthy Texas Program enacted by the 81st Legislature and Senate Bill 1731 enacted by the 80th Legislature. S.B. 1731 by Sen. Robert Duncan, R-Lubbock, was supported by TAFP for its potential to provide more information on the cost of health care services to employers, their employees and Texas patients. The bills also aimed to increase access to health insurance for small businesses and provide incentives for more small business owners to purchase insurance.

State Affairs will examine best practices for increasing access to health insurance and decreasing the cost of health insurance in the individual and small-group market, as well as the unscrupulous practices of health insurance companies.