May 31: 2023 | Hospitals Stay Intact, Score Wins As Regular Session Wraps
They’re the two Latin words everyone involved with a turbulent and explosive session of the Texas Legislature longed to hear: sine die, signaling ultimate adjournment. And Monday, when the 2023 regular session finally reached sine die, hospitals were still alive – after months of hospital advocates beating back threats to their viability across Texas, while simultaneously working to promote a better health care environment …
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THA and its members accomplished all that during perhaps the most challenging session hospitals have faced in recent memory, scoring wins that represented both progress and avoidance of dangerous detours and regression for access to care. Hospitals tallied successes in their push to rebuild the state’s workforce, improve behavioral health care and fund programs and services through the state budget.
Here’s a high-level look back at how the entire session – and its final week – unfolded for hospitals.
Medicaid Coverage, Hospital-at-Home Join Growing “Win” List
One year of postpartum Medicaid coverage for new mothers – a high priority for THA, other groups and powerful lawmakers – finally got through the Legislature in this final week and headed to Gov. Greg Abbott’s desk. A conference committee resolved the introduction of a late amendment to House Bill 12 by Rep. Toni Rose (D-Dallas), which would represent a vast improvement on the current two-month coverage requirement. Gov. Abbott previously expressed support for one year of postpartum Medicaid coverage. If he signs the bill, the coverage extension would then need to earn approval from the federal government – which two years ago declined to sign off on Texas’ extending postpartum coverage from two months to six months. But for now, the advancement of HB 12 into state law would be a hugely impactful win for THA.
The final week also saw the House and Senate agree on a final version of Senate Bill 25 by Sen. Lois Kolkhorst (R-Brenham), a wide-ranging postsecondary nursing education bill that increases state support for nursing scholarships and offers new loan repayment assistance for nurses and nursing faculty. Like HB 12, that bill now sits with the governor.
Also in the final days, Gov. Abbott put his pen to the text of a high THA priority: House Bill 1890 by Rep. Jacey Jetton, which allows Texas hospitals to continue the highly successful federal hospital-at-home program that helped contain surge capacity during COVID-19. Gov. Abbott signed the bill last Saturday, adding HB 1890 to a list of legislative wins that began piling up in the final couple of weeks.
Other THA high-priority victories that were already signed into law included:
- Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels) and House sponsor Rep. Donna Howard (D-Austin), which requires all health care facilities to implement a workplace violence prevention policy maintain a workplace violence committee and provide workplace violence training at least annually. It also prohibits retaliation or discipline for reporting a violent incident in good faith.
- Senate Bill 840 by Sen. Royce West (D-Dallas), which enhances the penalty for assaulting a hospital worker to a third-degree felony.
- House Bill 49 by Rep. Stephanie Klick (R-Fort Worth), which contains THA-negotiated language to make final hospital investigation reports and outcomes public, as well as the number of times the state has investigated a given hospital.
Late work by THA’s advocacy team also resulted in one of THA’s top priorities getting added onto Senate Bill 1624 by Sen. Judith Zaffirini (D-Laredo): a requirement for the state to develop a process to electronically apply and receive approval for emergency detention orders, a key step to quicken and modernize access to behavioral health care. SB 1624 has been sent to the governor’s desk for his consideration.
THA on Defense
Perhaps the most intensively realized fruits of THA’s labor during this session were simply keeping hospitals open for business – by stopping legislation that would have been disastrous for facilities all over the state. THA repeatedly called on its members to sound off to lawmakers about measures that would have instituted dangerous government rate-setting. As filed, House Bill 1692 by Rep. James Frank (R-Wichita Falls) and Senate Bill 1275 by Sen. Kelly Hancock (R-North Richland Hills), both ultimately defeated by THA advocacy, would have banned hospital outpatient payments. And Rep. Frank’s House Bill 633, as filed, would have capped hospitals’ payments at the lowest contracted commercial rate they had with any health plan for services provided outside of insurance. A point of order on the House floor resulted in HB 633’s death. THA’s all-hands-on-deck approach to stop these harmful measures – which required participation from both engaged members and conscientious lawmakers – averted what could’ve been widespread disaster.
One major measure that did pass over THA’s opposition was Senate Bill 490 by Sen. Bryan Hughes (R-Mineola), which requires hospitals and other facilities to provide itemized bills to patients within 30 days of receiving payment from a third party and before collecting payment after care is provided. Gov. Abbott signed that bill into law on Monday.
The Funding Front: Significant Bumps
Along with major victories in standalone legislation, hospitals had plenty to cheer about in the state’s final budget for 2024-25 as well. Lawmakers, who started the session with a record surplus of more than $30 billion, meted out key funding for Medicaid, behavioral health, workforce and other THA priorities.
A few of the biggest positives included:
- Full funding for Medicaid – nearly $81 billion over the biennium – with full trauma and safety-net add-on payment funding within that amount;
- A tripling of the Medicaid rural labor and delivery add-on payment, from $500 to $1,500;
- The addition of nearly 200 new inpatient psychiatric behavioral health beds;
- A dramatic funding bump for the Loan Repayment Program for Mental Health Professionals, going from about $2 million in the current biennium to $28 million in the next one;
- A jump from $19 million in the current budget’s allotment for the Nursing Shortage Reduction Fund to nearly $47 million for 2024-25; and
- $25 million added to the base budget for nursing scholarships.
One source of disappointment for THA in the final budget was the absence of a rider directing the state to pursue a waiver from the institutions of mental disease (IMD) exclusion, a 15-day limit on most adult inpatient behavioral health stays in Medicaid. Despite adoption of the rider in the House version of the budget and broad support for its inclusion, the IMD exclusion rider failed to make it through to the budget conference committee’s final version.
More Analysis to Come
For a more in-depth look back at how THA and its member hospitals fared in this session, stay tuned for THA’s End of Session Report, scheduled to be released in mid-June at www.tha.org. You can also listen to the recording of THA’s End of Session Member Call, held days before sine die on May 25, which is available here.
May 22, 2023 | Abbott Signs THA Workplace Violence Bill Into Law
One week from today, the slog will be over. The Texas Legislature’s 2023 session will gavel out, and THA will know exactly where hospitals stand after nearly five months of lobbying, maneuvering and interminable days and nights. But first, plenty of work still remains. Last week, for the first time this session, THA witnessed a piece of its efforts reach its ultimate destination, as one of its top-line initiatives finally earned the governor’s signature …
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On Thursday, Gov. Greg Abbott signed Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels) and House cosponsor Rep. Donna Howard (D-Austin) to tackle workplace violence at hospitals across Texas. SB 240 requires all health care facilities to implement a workplace violence prevention policy; maintain a workplace violence committee and provide workplace violence training at least annually. The bill also prohibits retaliation or discipline for reporting a violent incident in good faith. It will take effect on Sept. 1. THA will summarize SB 240 and other bills that become law in its post-session health law manual.
The governor received other THA-supported pieces of legislation to consider this week, with House Bills 1890 and 3162 both reaching his desk. HB 1890 by Rep. Jacey Jetton (R-Richmond), which would allow Texas hospitals to continue participation in the federal hospital-at-home program, passed the Senate on Monday. THA has been a staunch supporter of hospital-at-home following its success at helping facilities manage bed capacity during COVID-19.
The Senate on Thursday then approved HB 3162, which would reform the Texas Advance Directives Act’s dispute resolution process and its law on in-hospital do-not-resuscitate orders. THA, which worked on the bill with the Texas Medical Association, Texas Alliance for Life, Texas Right to Life and other stakeholders for more than 40 hours of face-to-face negotiations, submitted written testimony on the bill Tuesday in the Senate Health & Human Services Committee. THA’s testimony complimented the bill’s improved processes for patients, which include increasing the number of days of notice prior to a hospital ethics committee meeting, clarification on patient or surrogate representation at those meetings, and the providing of additional information to patients and their representatives.
More good news came with the advancement of Rep. Toni Rose’s (D-Dallas) bill to extend postpartum Medicaid coverage for mothers to one year. House Bill 12 had been stuck without movement in the Senate Health & Human Services Committee for about two weeks before finally receiving a hearing Tuesday, where THA submitted written testimony in support. Then on Thursday, the committee voted the bill out, 7-0.
Budget: No IMD Waiver, But Plenty of Funding Wins
The 10-member budget conference committee finished its work last week to reconcile the differences between the House and Senate versions of the 2024-25 budget, with substantial good news for hospitals mixed in with some disappointment.
If you’re a bad-news-first type, budget conferees did not adopt one of THA’s identified needs to solidify behavioral health care: a state waiver from the federal institutions of mental disease (IMD) exclusion, which caps Medicaid coverage for inpatient behavioral health stays at 15 days for patients ages 21 through 64. A budget rider for the IMD exclusion was previously included in the House’s version of the budget, but not the Senate’s, and did not make the final budget bill.
However, behavioral health funding elsewhere in the conferees’ final product provides a boost for hospitals. The committee added funding for nearly 200 additional state-purchased inpatient psychiatric beds, increased funding for community behavioral health grant programs, and also allocated funds for rural hospital telepsychiatry consultations. Conferees also tripled Medicaid rural and delivery add-on payments, taking them from $500 to $1,500, allocated $51 million for a new grant program to stabilize rural hospitals and fully funded EMS and trauma care payments. Women’s preventive health programs also received a funding increase, as did the Texas Department of State Health Services Maternal Health Unit. The conference committee’s agreed-upon budget must still be approved by both chambers and signed by the governor before session ends.
Itemized-Billing Bill Passes
A measure that requires hospitals to submit an itemized bill with every payment request made to a patient – opposed by THA – went to the governor’s desk last week. THA’s objections to Senate Bill 490 by Sen. Bryan Hughes (R-Mineola) were grounded in the administrative burden and expense the requirement would introduce for hospitals of all sizes and stripes, as well as patient confusion upon receiving paperwork they didn’t ask for.
However, before its finalization in the Senate last week, Sen. Hughes emphasized that SB 490 only applies to third-party debt collections. A motion by Sen. Charles Schwertner, MD (R-Georgetown) to have those remarks printed in the Senate Journal was accepted, which THA hopes will stave off any confusion or attempted overreach tied to the bill, if the governor signs it into law.
Look for the final Cap Recap of the 2023 regular session next week shortly after the Legislature’s May 29 adjournment.
May 15, 2023 | Bad Bills Stopped as Session Hits Home Stretch
We’re now on the other side of one of the Texas legislative session’s major milestones, and THA has emerged in strong shape, particularly after months of galvanizing membership to stop dangerous legislation on government rate-setting and hospital outpatient payments …
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Thursday night’s midnight deadline for House bills to reach at least second reading brought an official end to some troublesome legislation. But the biggest defensive victories for THA came earlier in the week. Last Monday, House Bill 633 by Rep. James Frank (R-Wichita Falls) reached the House floor. But lawmakers raised several procedural points of order on the bill, prompting the author to ask for a postponement until well after session ends. HB 633, as constituted entering Monday, would have capped hospital payments for services provided outside of insurance at the lowest contracted rate the hospital had with any commercial health plan – a detriment to both hospitals and the insurance system, as it would have incentivized patients to be uninsured.
Quickly following that news was another piece of addition by subtraction, as House Bill 5186 by Rep. Greg Bonnen, MD (R-Friendswood) wasn’t set for Thursday’s House calendar, meaning it wouldn’t reach the House floor ahead of the midnight deadline. HB 5186 would have established a legislative committee to set payment rates for four state employee health plans.
THA’s main point of focus on Thursday night was making sure the central pieces of HB 633 and HB 5186 didn’t rear their heads as 11th-hour amendments in other bills. Fortunately, that didn’t come to pass. THA will continue keeping a close eye on legislation that remains alive – as well as possible budget riders – to identify and combat any resurrections of those or any other ill-advised tack-ons.
That will include watching for a resurrection of House Bill 1692 by Rep. Frank – which as filed would have banned hospital outpatient payments, and took on other troubling iterations from there. HB 1692 also didn’t make it past Thursday’s House deadline. The bill and its Senate companion were the subject of repeated THA Advocacy Alerts that urged members to stunt the momentum of those bills. That companion, Senate Bill 1275 by Sen. Kelly Hancock (R-North Richland Hills) is still alive, but has been stuck in committee since early April. THA will continue to watch it, as well as amendments or budget riders where a ban on outpatient payments might be resurrected.
Another fortunate victim of the House deadline was House Bill 840 by Rep. Gary Gates, which would have created a bundled pricing program in the Employees Retirement System of Texas. In a committee comment letter it submitted earlier this session, THA noted hospitals have seen bundled pricing setups lead to drastically reduced reimbursements.
Hospital Worker Assault Bill Heads to Governor
On the other hand, the advancement of the other “840” in this session was a big win last week for THA. Senate Bill 840 by Sen. Royce West (D-Dallas) to make an assault on a hospital worker a third-degree felony was approved by the House by a 139-1 vote and is now ready for Gov. Greg Abbott’s signature. In reaching passage by both chambers, SB 840 joins Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels) and House sponsor Rep. Donna Howard (D-Austin), a broader anti-workplace violence measure championed by THA that also is at Gov. Abbott’s desk.
One THA-supported bill tied to hospital worker safety died with Thursday night’s deadline, however. House Bill 4762 by Rep. Suleman Lalani, MD (D-Sugar Land) would have given hospital workers liability protection for justifiably defending themselves through a use of force. The bill reached Thursday night’s House calendar but did not get a reading that evening.
In other activity last week:
- THA’s bill to establish a state process for the federal hospital-at-home program took another step forward, with House Bill 1890 by Rep. Jacey Jetton (R-Richmond) getting voted out by the Senate Committee on Health & Human Services.
- A THA-opposed bill introducing onerous and costly burdens on hospitals in the name of price transparency passed the House on Wednesday and is close to heading to the governor’s desk. Senate Bill 490 by Sen. Bryan Hughes (R-Mineola) would require providers to accompany every request for payment from a patient with an itemized bill of services – which THA has warned would cause patient confusion and be an administrative and cost burden for hospitals. The Senate must sign off on a House amendment to the bill before it’s eligible to receive the governor’s signature. That amendment exempted physicians and federally qualified health centers from the bill.
- THA attorneys testified in committees to back priority pieces of legislation for hospitals, with Associate General Counsel Cesar Lopez, J.D., supporting House Bill 1236 by Rep. Tom Oliverson, MD (R-Cypress) to reinforce the prudent-layperson standard for emergency care, and Assistant General Counsel Heather De La Garza, J.D., testifying in support of Senate Bill 25 by Sen. Lois Kolkhorst (R-Brenham) to establish wide-ranging state support for nurse faculty training. HB 1236 was heard in the Senate Committee on Health & Human Services, while the House Committee on Higher Education took up SB 25.
May 8, 2023 | Workplace Violence Bill Reaches Precipice of Becoming Law
Only three days now remain until a pivotal point in the Texas Legislature’s 88th session. This Thursday, the House of Representatives will work until the clock strikes midnight adjudicating dozens and dozens of pieces of legislation. Any House bill that hasn’t advanced to second reading in the House by the end of the night will be dead. That will mean a long night not only for lawmakers, but for advocacy groups like THA as well, as they wait to see which bills make it out safely on the other side and which don’t …
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It also means that for many bills, last week was their last full week of life. But many crucial pieces of THA’s legislative agenda are already guaranteed to survive past this Thursday, and a largely encouraging series of events for hospitals last week included two major bills earning full passage.
Ready for the Governor
Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels) and House sponsor Rep. Donna Howard (D-Austin), THA’s signature workplace violence prevention initiative, earned final signoff Wednesday and a trip to Gov. Greg Abbott’s desk. SB 240 would require hospitals to maintain a workplace violence prevention committee and provide workplace violence training at least annually. It also prohibits disciplining or retaliating against a person who makes a good-faith report of a violent incident.
House Bill 49 by Rep. Stephanie Klick (R-Fort Worth) also is headed to the governor’s desk after passage in the Senate on Thursday by a 31-0 vote. That THA-supported bill increases transparency related to state investigations of hospitals, making reports and outcomes of those investigations available to the public. It also strengthens a hospital’s ability to release health records to a patient, or to a deceased patient’s parent, guardian or representative.
Home Sweet Home in the House
More good news came Tuesday when the House approved a THA-backed hospital-at-home measure, House Bill 1890 by Rep. Jacey Jetton (R-Richmond). During COVID-19, the Acute Hospital Care at Home waiver program administered by the Centers for Medicare & Medicaid Services (CMS) allowed facilities to treat eligible patients at home, helping to mitigate the surge that filled up inpatient beds in hospitals. House Bill 1890 sets up a state process to continue this program, involving approval from the state Health and Human Services Commission as well as CMS.
Meanwhile, on the Senate side, THA supported HB 1890’s companion with testimony from Anna Taranova of University Health in San Antonio, who spoke in favor of Senate Bill 1156 by Sen. José Menéndez (D-San Antonio) as the Senate Health & Human Services Committee took up that bill.
THA staff had an active week of testimony as well, with attorneys weighing in on four different bills in Monday’s House Public Health hearing. Among those were a pair of bills with important implications for behavioral health care: House Bill 2507 by Rep. Jetton, which THA supports because it would allow physicians statewide to apply electronically for emergency detention warrants; and House Bill 2417 by Rep. Briscoe Cain (R-Deer Park), which would require peace officers who detain a person under emergency detention to deliver the Miranda warnings reserved for accused criminals.
THA testified with concerns on HB 2417, noting that much of the Miranda law doesn’t apply to those under emergency detention. General Counsel Steve Wohleb, J.D., noted in his testimony that detainees would be informed of rights that don’t exist under emergency detention law, such as the right to remain silent and the right to the presence of an attorney. That could make an already stressful situation for the person even more traumatic, Wohleb noted.
Itemized Billing Requirement Advances
Some THA-opposed measures continued their advance last week over hospitals’ objections. Notably, Senate Bill 490 by Sen. Bryan Hughes (R-Mineola), which would require providers to supply patients with an itemized bill accompanying every payment request, passed out of the House Public Health Committee. In committee testimony on both the bill and its House companion, THA has told lawmakers such a measure would create bureaucratic and financial burdens for hospitals as well as patient confusion.
May 1, 2023 | Senate Votes Produce Mixed Bag for Hospitals
We’ve reached the final month of the Texas legislative session, with just 28 days remaining. And last week’s activity at the Capitol likely represented a preview of the twists and turns the final month will have in store for THA, as both excellent legislation and troubling proposals advanced closer to becoming law – making it essential that hospital advocates stay attuned and involved …
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The Good: Senate Approves Two Workforce Bills; House Passes Prudent-Layperson
On the good side, the full Senate passed two measures tied to one of THA’s foremost priorities: Boosting and protecting the health care workforce. Senate Bill 840 by Sen. Royce West (D-Dallas) to make it a third-degree felony to assault a hospital worker advanced out of the Senate on Wednesday, adding more force behind THA’s push to shield workers from violence. THA testified in favor of that bill the previous week.
More good news came that same day, when Senate lawmakers voted out Senate Bill 2059 by Sen. Juan “Chuy” Hinojosa (D-McAllen), which would establish several types of grant programs tied to nursing education, including clinical-site nurse preceptor programs and innovative pilot programs. THA supported that measure in testimony the week before, and also testified in favor of its companion bill last Monday, with Assistant General Counsel Heather De La Garza expressing support for House Bill 3930 by Rep. John Bryant (D-Dallas).
Moving close to full passage was the THA-supported hospital investigation transparency bill, House Bill 49 by Rep. Stephanie Klick (R-Fort Worth). That bill – on which THA worked closely with the author to refine the language – was recommended for the Senate’s local and uncontested calendar, meaning it should pass soon as a formality. Once that happens, HB 49 will be ready to head to Gov. Greg Abbott’s desk for his signature.
THA’s behavioral health agenda advanced in a big way Friday with the House’s passage of House Bill 2337 by Rep. Tom Oliverson, MD (R-Cypress) to mandate Medicaid coverage for behavioral health partial hospitalization programs and intensive outpatient therapy. THA has strongly backed coverage for those programs to give behavioral health patients access to a full continuum of services.
And a reinforcement for the state’s prudent layperson standard for emergency care passed the House on Friday as well. House Bill 1236 by Rep. Olverson passed by a unanimous 147-0 vote. HB 1236 would clarify that insurers must provide coverage for emergency care based not on the final diagnosis, but on whether a prudent layperson would believe the medical event was an emergency.
The Bad: Government-Rate Setting Gets a Mulligan; Senate Passes Noncompete Restrictions
Unfortunately, advancement by several bad legislative omens for hospital business interests demonstrated the need for hospital advocates to remain vocal and vigilant all the way through to the Legislature’s adjournment.
A surprise reconsideration by the House Select Committee on Health Care Reform on House Bill 633 by Rep. James Frank resulted in the committee voting favorably on the bill – just days after the same committee failed to advance the same legislation. HB 633 would force hospitals to accept a government-set maximum rate for all services provided outside of insurance, which would be tethered to the hospital’s lowest contracted rate with any health insurer. That would incentivize patients to be uninsured, allowing them to obtain the lowest payment rate available. And THA is consistently opposed to any form of government-rate setting in the private insurance market.
In the midst of advancing some of THA’s biggest agenda items, the Senate also approved a troubling series of restrictions on physician noncompete agreements. Senate Bill 1534 by Sen. Charles Schwertner, MD (R-Georgetown) would limit noncompetes for physicians and other practitioners to a one-year time frame and either a five or 10-mile radius depending on the population size of counties in the area. THA previously testified against the bill and restrictions it deems arbitrary.
Senators also approved THA-opposed Senate Bill 490 by Sen. Bryan Hughes (R-Mineola), which would introduce an onerous and expensive administrative burden for hospitals by requiring them to produce an itemized bill for patients accompanying every single payment request. THA has noted that along with the cost in time and expense for hospitals, patients would be confused by extensive paperwork they didn’t ask for.
Coming Up: Do-Or-Die Day in the House
As we enter the final stretch of the 2023 session, one key date in the Legislature is just 10 days away. By the end of the House session on Thursday, May 11, any bill must have been considered by that chamber on second reading. Any bill that fails to achieve that milestone will be dead. Keep that date in mind, because the aftermath of May 11 will give THA and other hospital advocates a clearer picture on what the legislative battles will look like during the final two-plus-week sprint.
April 24, 2023 | Postpartum Medicaid Coverage Passes House
In today’s polarized political climate, few issues at the state level in Texas are more bipartisan than extending health insurance coverage for new mothers. It’s been a priority for THA for years, and also has the support of legislative power players, including Gov. Greg Abbott and House Speaker Dade Phelan (R-Beaumont) …
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That widely acknowledged need took a major step toward realization Friday when House Bill 12 by Rep. Toni Rose (D-Dallas) passed the full House of Representatives. HB 12 would grant new mothers enrolled in Medicaid 12 months of coverage postpartum, instead of the current two months. Data has consistently shown that many maternal complications and deaths occur after the current two-month coverage cutoff point. Friday’s 132-8 vote sends the bill to the Senate.
Workplace Violence Bill Nears Full Passage
On the heels of that big win, THA may soon see one of its highest-priority bills become the first one to earn approval by both chambers of the Texas Legislature during the 2023 session.
Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels), a bill aimed at preventing workplace violence, passed the House last Tuesday with amendments. That means the bill must head back to the Senate for concurrence on those amendments. Once that happens, it will head to Gov. Abbott’s desk.
SB 240 – as well as its companion, House Bill 112 by Rep. Donna Howard (D-Austin), would require hospitals to maintain a workplace violence prevention committee and provide training on workplace violence at least annually. It would also prohibit retaliation or discipline for reporting an incident in good faith.
Streamlining Emergency Detention Orders
THA also saw encouraging advancement on a key behavioral health measure to protect patients experiencing a psychiatric crisis. Senate Bill 1433 by Sen. Juan “Chuy” Hinojosa, which would ensure physicians can apply electronically for emergency detention orders across the state, was voted out of the Senate Committee on Criminal Justice, then recommended for the Senate’s local and uncontested calendar. That effectively sets up SB 1433 for a rubber-stamp vote by the full Senate.
Keeping Payment-Killers at Bay
Two highlights of THA’s week included lack of advancement on legislation that would collectively depress hospital payments, incentivize patients to be uninsured and force clinics all over Texas to close, severely decreasing access to care.
House Bill 633 by Rep. James Frank (R-Wichita Falls) failed to earn enough favorable votes to advance out of the House Select Committee on Health Care Reform on Thursday morning. That bill would force hospitals to adhere to a government-set maximum payment rate for all services not provided under insurance, tied to that hospital’s lowest contracted rate with any health insurer. THA is opposed to any sort of government rate-setting in the private market, and under HB 633, patients would be able to obtain the lowest payment rate simply by not being insured.
That bill’s stalling was a major win of the moment for THA, and so was inactivity Wednesday on the latest version of Senate Bill 1275 by Sen. Kelly Hancock (R-North Richland Hills), which remained pending in the Senate Health & Human Services Committee. SB 1275 was previously one of two bills which targeted a ban on hospital outpatient payments, drawing fervent advocacy from THA in opposition. The latest version of SB 1275 attempts to ban all hospital facility fees for telemedicine or telehealth services – whether inpatient or outpatient. Telehealth is an increasingly crucial component of access to care across Texas. Prohibiting reimbursement would take Texas health care backward.
Itemized Billing Proposal Advances Over THA Opposition
Not all THA-opposed legislation stalled, however. The Senate Health & Human Services Committee gave a favorable vote Thursday to Senate Bill 490 by Sen. Bryan Hughes (R-Mineola), despite opposing written testimony from THA. SB 490 would require hospitals to present an itemized bill to patients with any request for payment. THA’s written testimony from Assistant General Counsel Heather De La Garza, J.D., said meeting the requirement would be costly for hospitals and confusing for patients.
Among other major bills THA opposed last week was House Bill 2017 by Rep. Tom Oliverson, MD (R-Cypress), which would generally allow health insurers to seek a waiver from any insurance law, regulation or requirement if the insurer believes it would stifle innovation. The state insurance commissioner would unilaterally decide whether the waiver would be granted. THA submitted written testimony noting the bill would give the commissioner unprecedented discretion, and would erode the state’s gains in offering robust health insurance coverage and consumer protections.
April 17, 2023 | Continuing the Outpatient Payment Fight
There’s no good way to eliminate a business’s ability to recoup the lion’s share of its costs for the services it performs. Yet still – despite THA’s repeated warnings – that’s what legislation examined in committee hearings in each of the last two weeks would do to outpatient hospital clinics, banning what are colloquially known as “facility fees.” …
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THA continued its strenuous pushback against a proposed ban on hospital outpatient payments last Thursday when it testified against the latest version of House Bill 1692 by Rep. James Frank (R-Wichita Falls). The measure would take away the only revenue source paying for patients’ care at outpatient clinics, aside from physician service fees.
Despite weeks of THA opposition, it remains a bill that represents devastation for access to care across Texas. If such a ban passes, outpatient clinics all over the state would close. And the committee substitute for HB 1692 – which THA General Counsel Steve Wohleb, J.D., opposed in Thursday’s hearing of the House Select Committee on Health Care Reform – adds a troubling wrinkle to the picture.
The substitute bill would ban facility fees for preventive services in both inpatient and outpatient settings. By the federal definition of preventive services, that would include numerous procedures, including colonoscopies, ultrasounds, mammograms and many common immunizations. Wohleb’s testimony emphasized that hospitals wouldn’t be able to charge for the costs of nurse staffing, equipment and supplies for these services, among other expenses. Also testifying against the bill was Frank Beaman, CEO of Faith Community Health System, noting the challenges it would present in rural communities and the danger it poses to access to care.
THA is continuing to closely monitor the progress of these bills and working diligently to stop them.
Key Behavioral Health Bill Advances
In a significant step forward for THA’s behavioral health agenda this session, a bill that would require Medicaid coverage for partial hospitalization and intensive outpatient therapy services was voted out of committee. House Bill 2337 by Rep. Tom Oliverson, MD (R-Cypress) earned a favorable report from the House Committee on Human Services last Tuesday. Partial hospitalization and intensive outpatient therapy allow patients to split their time between receiving psychiatric care in a facility and spending time at home. The bill passed out of committee a week after Chris Bryan, vice president of IT and public policy for Clarity Child Guidance Center in San Antonio, testified for THA in support of it.
Making Grant Gestures
After helping that measure get to the next level, Bryan returned to the Capitol this week to register THA’s support for a bill establishing a grant program for behavioral health hospitals to boost their health information technology capabilities. Senate Bill 1903 by Sen. Jose Menendez (D-San Antonio) would help behavioral health facilities catch up to physical hospitals in the areas of electronic health record-keeping and management. During her testimony to the Senate Committee on Health & Human Services, Bryan emphasized that behavioral health hospitals are far behind the curve in that area.
THA also supported a grant program to address nursing faculty shortages with Assistant General Counsel Heather De La Garza, J.D.’s testimony Thursday on Senate Bill 2059 in the Senate Subcommittee on Higher Education. The bill by Sen. Juan “Chuy” Hinojosa (D-McAllen) would establish grant programs to install nurse preceptors at clinical sites, as well as fund pilot programs and part-time faculty nurses.
Rejecting Rate-Setting, Physician-on-Premises Burden
Other THA testimonies this week sought to protect hospitals from two of their most common sources of aggravation: onerous, unworkable burdens and government rate-setting. Senate Bill 1193 by Sen. Charles Schwertner, MD (R-Georgetown) would mandate that all hospitals have at least one physician present at all times – and give patients in all hospitals the right to request that a physician perform all of the patient’s health care services. Wohleb opposed the bill for THA in the Senate Health & Human Services Committee, noting that it would undermine existing law that provides flexibility for rural hospitals in areas with a physician shortage.
De La Garza represented hospitals against House Bill 5186 by Rep. Greg Bonnen, MD (R-Friendswood), which as filed would pave the way for the state budget to cap payment rates for treating those insured in the state’s employee and teacher retirement systems, as well as the University of Texas and Texas A&M systems. De La Garza said the bill would represent a significant step backward, and that if providers are paid less, it doesn’t lower the cost to provide health care.
April 10, 2023 | Tell Them No: Ill-Advised Legislation Repeatedly Puts THA, Hospitals in “Oppose” Column
Sen. Lois Kolkhorst (R-Brenham) teased THA General Counsel Steve Wohleb as he prepared to testify on his third bill of Wednesday’s Senate Committee on Health & Human Services hearing, saying, “I notice you’re not for any of these bills we heard today.” …
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Some weeks end up like that. For THA, it was a week to repeatedly stand against problematic legislation, and THA membership, THA staff and THA’s written words combined to offer committees detailed descriptions on why myriad bills were so harmful to hospitals.
The alarming notion of banning hospital outpatient payments – legislated in a House bill pulled down last week for reworking – came abruptly roaring back in the Senate with the sudden scheduling of Senate Bill 1275 for hearing Wednesday in Sen. Kolkhorst’s committee. THA issued an Advocacy Alert to its members for the second time in as many weeks, and Wohleb appeared at the Health & Human hearing to detail the crushing impact SB 1275, authored by Sen. Kelly Hancock (R-North Richland Hills), would have. Prohibiting hospital outpatient payments – which cover the entirety of a patient’s care aside from a physician’s fee – would force clinics across the state to close, decimating access to care.
Earlier in the week, Memorial Hermann Health System stepped up to represent THA against House Bill 1973 by Rep. Caroline Harris (R-Round Rock), which would require hospitals to give all patients “a written, itemized bill of charges for all health care services and supplies provided” in order to receive payment. Not doing so would prevent hospitals (and providers) from pursuing debt collection. Michelle Lindsley, Memorial Hermann’s vice president of managed care, said while the hospital and THA support price transparency, HB 1973 would introduce operational and financial challenges for hospitals and confuse patients to boot.
Other legislation THA opposed this week included:
- Senate Bill 1534 by Sen. Charles Schwertner, MD (R-Georgetown), which would severely restrict physician noncompete agreements – including limits on time (one year) and distance (a five-mile radius). Wohleb said the current law “has provided certainty to physicians and their employers” and warned the legislation would “hardwire arbitrary restrictions on physician noncompetes into statute.” THA is working with Sen. Schwertner to improve the bill.
- House Bill 2960 by Rep. Briscoe Cain (R-Deer Park) to repeal the law allowing a person or entity to provide notice of firearms being prohibited on a property. Wohleb told the House Select Committee on Safety about the bill’s troubling implications for hospitals and mental health facilities, which by law would have a considerably more difficult time keeping a person with a firearm off their premises.
A Partially Good Week
There was plenty of legislative action during the week that THA could support, as well – in particular, when the House Human Services Committee examined THA’s proposal of mandatory Medicaid coverage for partial hospitalization programs and intensive outpatient therapy (PHP/IOT).
The THA-spearheaded vehicle for that proposal is House Bill 2337 by Rep. Tom Oliverson, and Chris Bryan, vice president of IT and public policy for Clarity Child Guidance Center in San Antonio, testified for THA in support. Speaking to the impact of PHP on Clarity’s patients, Bryan told the committee PHP costs about half of a traditional inpatient stay, and the time children spend at home with their families – instead of a round-the-clock inpatient stay – proves to be valuable.
House Postpones Look at Workplace Violence Bill
In House floor activity, THA-supported legislation on workplace violence prevention moved closer to final passage last week. After House Bill 112 by Rep. Donna Howard (D-Austin) was placed on the House floor calendar for Wednesday, consideration of the bill was postponed to wait for its Senate companion to catch up, a legislative strategy to ensure quick final passage.
That companion, Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels), has already passed the Senate and can therefore be taken up quickly in the House thanks to the postponement request by Rep. Howard. Both bills would require facilities to maintain a workplace violence prevention committee and train employees on prevention at least annually.
SB 240 is one of a few THA-priority bills that have passed one chamber thus far. Senate Bill 25 by Sen. Kolkhorst, which would help with hospital workforce shortages by offering scholarships and loan repayment opportunities tied to nursing education, has also passed the Senate. On the House side, House Bill 49 by Rep. Stephanie Klick (R-Fort Worth), a bill to increase hospital investigation transparency, has passed that chamber.
April 3, 2023 | Shelving of Access-Crushing Bill Highlights Solid Week for Hospitals
Advancement of several THA-priority bills provided highlights of last week’s activity at the Capitol – but it was the temporary shelving of immeasurably dangerous legislation that brought a sigh of relief across the Texas hospital community …
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THA mobilized its membership early in the week to vehemently oppose House Bill 1692 – which, as drafted, would have outlawed hospital outpatient payments at every hospital in Texas. Those payments – also known by the broader term “facility fees” – are essential to keeping off-campus, outpatient clinics open across Texas and preserving access to care. Hospital outpatient payments fund all aspects of a patient’s care aside from physician payments. Without them, hospital outpatient services wouldn’t be possible in Texas.
The bill was scheduled to be heard at last Thursday’s hearing of the House Select Committee on Health Care Reform, where THA and others were to testify in opposition. Ahead of that hearing, THA issued an action alert urging its members to contact lawmakers on the committee and stress the importance of opposing HB 1692. A news release and outreach to media also were part of THA’s aggressive push to stop the bill.
After that effort kicked into gear, the bill’s author, Rep. James Frank (R-Wichita Falls), decided to pull HB 1692 from Thursday’s committee calendar to rework the legislation – giving hospitals and their advocates breathing room, and more time to advocate for preserving the continued sustainability of outpatient services.
THA will continue to work with its members and lawmakers on this crucial issue and keep tabs on the progress of HB 1692. Learn more about the issue, and the bill, in THA’s white paper on hospital outpatient payments.
Hospital-at-Home, Prudent Layperson Bills Advance
Aside from that case of addition by subtraction, hospitals also saw encouraging advancement on several beneficial pieces of legislation. Two crucial bills were voted out of committee last week: House Bill 1890 by Rep. Jacey Jetton (R-Richmond) to continue hospital-at-home programs in Texas, and House Bill 1236 by Rep. Tom Oliverson, MD (R-Cypress), the emergency-care measure known as the “prudent layperson” bill.
HB 1890 earned approval from the House Public Health Committee last Monday. It allows Texas facilities to operate a hospital-at-home program after receiving approval from both Medicare at the federal level and the Texas Health and Human Services Commission. Those programs proved to be an efficient and effective alternative to regular hospitalization for patients during COVID-19, allowing hospitals to expand surge capacity by treating eligible patients at home.
On Thursday, the House Committee on Insurance voted out HB 1236, which would help ensure that health insurers can’t retroactively deny coverage for emergency care based on a patient’s ultimate diagnosis, but instead must base it on a prudent layperson’s understanding of medicine at the time of the medical event.
THA Under Oath
THA also continued testifying in earnest on measures in which hospitals’ voices need to be heard. Among those measures was House Bill 1647 by Rep. Cody Harris (R-Palestine) to outlaw white-bagging for cancer and other life-threatening conditions. White-bagging is the health insurer practice of requiring drugs to be purchased through specialty pharmacies before being shipped to the patient’s treatment location. THA supports a ban on white-bagging and was a supporter of the original version of the bill, but a committee substitute for HB 1647 now exempts hospitals from the white-bagging ban after aggressive health insurer lobbying. Binita Patel of Memorial Hermann Health System testified on the bill for THA to explain that hospital practitioners can’t provide the highest-quality level of care without a white-bagging ban.
THA also testified in support of identical House bills that would make it a third-degree felony to assault a hospital worker. THA Assistant General Counsel Heather De La Garza, J.D., appeared before the House Committee on Criminal Jurisprudence to support those measures, House Bill 3548 by Rep. Rafael Anchía (D-Dallas) and House Bill 2189 by Rep. Julie Johnson (D-Farmers Branch). These bills continue THA’s efforts to support legislation to help keep the health care workforce safe.
This week: Workplace Violence Bill Could Pass House
This coming week, House Bill 112 by Rep. Donna Howard (D-Austin) to address and prevent workplace violence could join its companion bill in passing out of its parent chamber. The bill – which would require facilities to maintain a workplace violence prevention committee and provide at least annual training or education – is on the House calendar for this Wednesday. Senate Bill 240 by Sen. Donna Campbell (R-New Braunfels), the bill’s companion, already passed out of the full Senate.
Monday of this week, price transparency was scheduled to be on the House Public Health agenda as that committee took up House Bill 1973 by Caroline Harris (R-Round Rock), which would require providers to supply patients with an itemized bill of charges for all services. THA planned to testify against the measure.
March 27, 2023 | THA Gets Frank About Troublesome Rate-Setting
In the midst of about a dozen THA testimonies and a couple of key bill advancements, one fight loomed large above the rest last week at the Capitol, as THA hit back hard against a bill that would institute government rate-setting and depress insurance coverage …
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House Bill 633 by Rep. James Frank (R-Wichita Falls) was the subject of a THA member alert last week and also came under scrutiny in the House Select Committee on Health Care Reform, where THA attorney Heather De La Garza, J.D., testified against it. A committee substitute for the bill would require hospitals to accept the lowest contracted rate the hospital has with any health plan as full payment from self-pay patients and patients paying outside insurance.
De La Garza said passing the bill would “set Texas on a dangerous [course] of government rate-setting in the private health care market” and said hospitals need to be able to react to market forces. She said the bill may also disincentivize Texans from buying comprehensive insurance. HB 633, she said, would mandate Texas hospitals to potentially provide health care at a financial loss.
“Paying a provider less does not lower the cost to provide health care,” De La Garza added. “The cost to staff and equip a hospital remains the same, or at times even increases depending on external market forces.”
Rep. Frank, who sits on the committee, raised the issue of hospitals receiving large amounts of government funding for uncompensated care. De La Garza reminded the committee that in 2020, even after receiving governmental payments, Texas hospitals still had an uncompensated-care shortfall of $4.6 billion.
Postpartum Medicaid Coverage Bill Clears Committee
Two key bills with strong THA support passed out of committee this week, making them eligible for consideration on the floor of their parent chamber. House Bill 12 by Rep. Toni Rose (D-Dallas) to extend Medicaid coverage for new mothers to 12 months postpartum, earned approval from the Select Committee on Health Care Reform. Right now, new moms in Texas only have Medicaid coverage for two months postpartum, and data show maternal complications and deaths often occur beyond that two-month window.
Senate Bill 25 by Sen. Lois Kolkhorst (R-Brenham), which would boost state support for nursing-related postsecondary education, also cleared committee. Among its key steps, the bill would remove an annual $7,000 cap for loan repayment assistance for nurses who work as faculty in a nursing degree program and would revive a dormant nursing scholarship fund, a priority for Texas Lt. Gov. Dan Patrick. The Senate Health and Human Services Committee gave the bill its signoff.
Vaccines, Emergency Care and More
THA testifiers represented hospitals on a host of issues during the week, but in terms of quantity, one general topic required more attention than the rest: Vaccines, especially in relation to COVID-19. THA attorney Cesar Lopez, J.D., represented hospitals on several bills on that topic, including registering THA’s opposition to House Bill 44 by Rep. Valoree Swanson (R-Spring). Under HB 44, providers could not require patients to be vaccinated for any infectious disease. Lopez also registered THA’s concerns on several other measures – including:
- House Bill 81 by Rep. Brian Harrison (R-Midlothian), which would require providers to obtain informed consent before providing a COVID-19 vaccine and prohibit them from compelling an employee to receive the vaccine; and
- Senate Bill 1024 by Sen. Kolkhorst, which would prohibit not only vaccine mandates, but also mask mandates by any entity that receives state funding.
Measures that THA testified in support of included a bill that would establish a state process for the successful hospital-at-home program that became a useful byproduct of the pandemic, and one that would strengthen the “prudent layperson” standard for emergency care.
Anna Taranova of University Health San Antonio spoke for THA on the hospital-at-home measure – House Bill 1890 by Rep. Jacey Jetton (R-Richmond) – while Lopez represented THA on the prudent layperson bill, House Bill 1236 by Rep. Tom Oliverson, MD (R-Cypress). That bill would clarify that an insurer can’t base coverage for emergency care on the patient’s final diagnosis, but on whether a prudent layperson would believe the emergent event was, in fact, an emergency.
March 20, 2023 | Workplace Violence Bill Clears First Hurdle
The most jam-packed week of committee testimony for THA thus far this session included not just talk, but action as well – as THA’s vehicle for addressing workplace violence passed out of committee, becoming the first THA bill of this session to clear that milestone …
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The House Committee on Public Health voted out House Bill 112 by Rep. Donna Howard (D-Austin) on Tuesday, making the bill eligible for consideration by the full House. Like its companion, Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels), the bill requires all hospitals and health care facilities to maintain a workplace violence committee and implement annual individualized violence prevention training. It also prohibits retaliation against someone who reports a workplace violence incident.
Violence in hospitals has been a heightened concern since the beginning of the COVID-19 pandemic, with a recent THA workforce survey revealing more than 60% of hospitals have seen an increase in violence severity since the pandemic began.
SB 240 itself was under examination on the other side of the Capitol, with THA Assistant General Counsel Heather De La Garza, J.D., testifying in support of the bill last Wednesday in front of the Senate Committee on Health and Human Services.
THA testified two other times during the week to oppose a pair of measures that pose problems as drafted:
- Senate Bill 1197 by Sen. Bob Hall (R-Edgewood), which would introduce new, monthly reporting burdens on hospitals related to their existing requirement to report suspected cases of child abuse to the state. Hospitals would be required to submit a monthly report containing the number of times it reported alleged or suspected child abuse, exploitation or neglect, as well as any code the hospital used for diagnosing or treating the alleged or suspected victim. A committee substitute for the bill adds another requirement: for each monthly report to contain attachments of signed affidavits from hospital agents/employees who made an alleged/suspected abuse report during that month. THA General Counsel Steve Wohleb, J.D. testified Wednesday in the Senate Health and Human Services Committee against the bill, noting hospitals’ lack of infrastructure in place to meet its proposed requirements.
- House Bill 1001 by Rep. Giovanni Capriglione (R-Southlake), which would adjust the language of existing Consumer Choice health plan law and open the door for insurers to offer a larger number of cheap plans with potentially scant coverage. De La Garza told the House Select Committee on Health Care Reform on Thursday that as written, HB 1001 potentially erodes the gains Texas has made in ensuring quality comprehensive coverage is available to Texas citizens.” THA is working with Rep. Capriglione and hopes to arrive at language that would instead help further those gains.
Postpartum Coverage Extension Gets a Hearing
Also Thursday, THA registered its support on a measure that would extend postpartum Medicaid coverage for new mothers to one year instead of the current two months. House Bill 12 by Rep. Toni Rose (D-Dallas), a priority measure for House Speaker Dade Phelan (R-Beaumont), came up for hearing in the House Select Committee on Health Care Reform. THA is in staunch support of the coverage expansion, as Medicaid covers more than half of Texas births and more than a quarter of the state’s maternal deaths occur between 43 days and one year after delivery.
Trusting Hospitals on Vaccines
COVID-19 vaccine mandates – in hospitals and elsewhere – continue to be a hot topic at the Capitol, and THA continues to fight for hospitals’ right to take common-sense safety measures as the facility sees fit. THA’s newest white paper, COVID-19 Vaccinations: Trust Hospitals to Protect Their Unique Communities, debunks myths about the COVID-19 vaccine and explains why hospitals need to have the latitude to require it among their employees. You can download this white paper, and all of THA’s other recent explainers, on THA’s White Papers & Reports page.