Taking Stock: The 2023 Regular Session

THA staff looks back at wins and challenges in member call days before last Monday’s adjournment.


Over nearly five full months, THA advanced policy that furthered hospitals and health care across Texas, while absorbing relentless fire trained on hospitals at the same time.

In short, during the just-concluded regular session of the Texas Legislature, THA excelled at both defense and offense. And if the already-announced extra sessions require “special” teams to address hospital-related topics, THA and its members will be ready to take the field again.

Here’s a rundown of some of what THA accomplished – and beat back – between mid-January and the Legislature’s adjournment on Monday, with a video of a THA member call last week that offers more insight on what THA and its hospitals navigated during the winter and spring.

Wins: Major and varied

Lawmakers were receptive to many of THA’s top-line priorities, including its push to bolster sagging hospital workforce numbers. Two workforce retention bills aimed at protecting hospital personnel – Senate Bills 240 and 840 – have already been signed into law by Gov. Greg Abbott.

SB 240 requires 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. SB 840 enhances the penalty for assaulting a hospital worker on hospital property, elevating such an attack to a third-degree felony. Also on the topic of workforce, the Legislature passed Senate Bill 25, a wide-ranging boost for postsecondary nursing education, including scholarships and assistance for loan repayment. That bill is now at the governor’s desk.

Other major wins in standalone legislation included House Bill 1890, which allows Texas hospitals to continue to use the federal hospital-at-home program that helped with surge capacity management during COVID-19; House Bill 12, which would extend postpartum Medicaid coverage for new moms from two months to one year; and House Bill 49, a THA-negotiated measure to increase transparency of state findings in hospital investigations. Gov. Abbott has already signed the hospital-at-home and investigation bills into law, and has HB 12 on his desk for consideration.

THA’s advocacy to bolster health care funding in the state budget for 2024-25 also bore fruit. Crucial dollar allocations included full funding for the state Medicaid program in the next biennium; a tripling of the Medicaid rural labor and delivery add-on payment; new funding for inpatient psychiatric beds and large funding bumps for both the Nursing Shortage Reduction Fund and the Loan Repayment Program for Mental Health Professionals. The mental health loan repayment program, funded at $2 million in the current budget, will receive $28 million in 2024-25.

Challenges and disappointments

Insurer-supported legislation that threatened hospital business and operational interests required fervent, grassroots efforts to defeat – and THA and its hospitals answered the call.

From the beginning of session, THA was already working against a widespread and misinformed perception that hospitals were financially thriving as the COVID-19 pandemic wound down, despite research that clearly showed otherwise. Bills to ban hospital outpatient payments – known commonly as “facility fees” – and to institute government rate-setting would have spelled disaster for hospitals if they had made it into law. But with THA releasing multiple advocacy alerts to stop these dangerous measures, and members responding by sending thousands of messages to lawmakers, the worst ramifications this session could’ve had for hospitals won’t be realized.

Not every THA-opposed measure was stopped in its tracks, though. Senate Bill 490, 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, became law this week.

And on the flip side, THA didn’t see all of its top priorities reach passage. For example, the final budget didn’t include hospitals’ request for a state waiver from the federal institutions of mental disease exclusion, a 15-day limit on most adult inpatient behavioral health stays in Medicaid. A bill clarifying the state’s prudent-layperson standard for emergency care – a THA priority for multiple sessions now – also didn’t make it to the finish line.

Gov. Abbott has already called the first of what he said would be multiple special sessions. THA will monitor these sessions for any legislative measures that affect hospitals.

More to learn, more to come

On May 25, just a few days before this week’s adjournment, THA President/CEO John Hawkins and THA’s lobby, policy and legal teams gave an overview of what THA had accomplished – and, at the time, was still working to finalize – during THA’s End of Session Member Call. You can log in to your THA membership account to listen to the full call for information on the wins and challenges described above, and much more on THA’s activity during the regular session.

For a complete written postmortem recap and analysis, stay tuned for THA’s End of Session Report, scheduled to be released in mid-June.