Written by Aisha Ainsworth

For 140 days during odd-numbered years, the Texas Capitol is bustling with people and work—like a lawmaking Santa’s workshop churning out toys in time for Christmas. Community and industry advocates fill the Capitol’s halls to ask for assistance or to voice their opinions on specific public policy priorities. Lawmakers and their staffers work from dawn until dusk to whip votes and meet the many deadlines that are determining factors in whether their bill can become a law.

But the 140-day legislative session is just one piece of the policymaking process.

The interim—the period between the end of one legislative session and the beginning of the next—is just as busy and just as important.

And Texas hospitals have a vital role.

Texas Hospitals and the Legislature

The legislative session is the beginning of the policymaking process. The Texas Constitution reserves the first 30 days of each session for introducing legislation. During the next 30 days, lawmakers can begin considering those bills in committee hearings. It’s with only 80 days remaining that lawmakers can try to get their bills heard and approved twice by the full chamber from which they originated before the process must begin again in the opposite chamber.

This timetable leaves little time to tease out complex issues. So policymakers use the interim and the time it permits to study up on important issues or “interim charges” so they’re ready with a plan of attack by the upcoming session. Several months after the legislative session ends, the Speaker of the Texas House of Representatives and the Lieutenant Governor issue charges for the committees in their respective chambers to study. Typically, the committees issue reports summarizing their work and recommendations in December, a month before the next legislative session.

For Texas hospitals, this is an opportunity to educate lawmakers about our work through educational resources, workgroup meetings and presentations in committee hearings. The Texas Hospital Association’s advocacy and legal teams work with lawmakers and their staff to identify meaningful solutions to some of our most pressing challenges.

For example, during the 2017 legislative session, lawmakers unsuccessfully sought to repeal the source of funding for uncompensated trauma care costs. The legislature also sought to cap local jurisdictions’ property tax revenue, which feeds two-thirds of all Medicaid hospital payments.

While neither effort came to fruition, both issues are among a long list that lawmakers will study prior to the 2019 session.

In addition to county revenue tax caps and funding for trauma hospitals, lawmakers will consider a number of interim charges impacting Texas hospitals, including the impact and prevalence of opioid misuse and substance use, the state’s use of the “Rainy Day” Fund, federal health care reform, reauthorization of and funding for the Children’s Health Insurance Program, health care cost transparency and workforce issues, to name just a few.

Also consuming much of the interim focus is Hurricane Harvey.

Nearly every committee in the Texas Senate and House of Representatives will study different aspects of the hurricane—from the public health response to how the state will better prepare for future disasters.

During this interim, THA already has testified on hospitals’ public health response to Hurricane Harvey and will testify again on Medicaid quality, value-based payments and health care cost transparency.

Rules of Engagement

The interim is a time for looking ahead to the next legislative session, but it’s also a time of rulemaking to implement the laws of the previous session.

The legislature often grants state agencies rulemaking authority to implement the laws it passes and enforce compliance with those laws. Health-related laws fall predominantly within the purview of the state’s main health agency—the Texas Health and Human Services Commission.

When THHSC or another state agency wants to create a new policy or change an existing one, it proposes a new rule or amends an existing rule. This usually happens in the interim when the laws the legislature just passed take effect.

THA is heavily involved in the rulemaking process on behalf of member hospitals. If a proposed rule would have significant consequences for Texas hospitals or patients, THA employs a number of tactics with member hospitals’ engagement to try to change the course of the rule—from submitting written comments requesting clarification or specific rule changes, to attending administrative hearings on the rule to meeting with agency officials.

This interim will be marked by Texas hospitals’ work to comply with the new $25 billion, five-year Medicaid 1115 Waiver that the Centers for Medicare & Medicaid Services approved late last year. In order to obtain this funding, the state must set new policies and amend existing ones to govern the distribution of vital hospital supplemental payments. First up on the rulemaking agenda will be to implement the new funding policy to regulate uncompensated care payments that cover some of hospitals’ costs for care provided to the uninsured.

The months leading up to the 2019 legislative session will be demanding for Texas hospitals, but THA will use this time as an opportunity to advance the industry’s policy positions so that all Texas hospitals can continue providing the best possible care to their patients.

More information on the interim charges is available on www.tha.org/interim2018.