Every two years, Texas hospitals get less than five months to convince state lawmakers how to foster a better health care landscape in the Lone Star State.
That window opens today, and the Texas Hospital Association is ready to advance an ambitious legislative agenda to address the issues hospitals – and their patients – are facing as 2023 begins.
Some bills representing THA’s highest-priority agenda items have already been filed, and many more will quickly follow after the 88th Texas Legislature gavels in today. When hospital advocates make their case, they’ll be doing so to a legislature with familiar party composition. Following last November’s elections, the legislature is still wholly Republican-controlled, with an 86-64 GOP advantage in the House of Representatives, 19-12 in the Senate, and incumbent Republicans in both the governor’s and lieutenant governor’s chairs.
Traditionally, the first few weeks after session begins are relatively quiet. The chambers have yet to assign members to committees, and bills can’t be heard in committee until those panels are formed. But once committee assignments are announced and begin scheduling bills for consideration, the 140-day marathon gradually kicks into gear.
Here’s a look at the biggest items on THA’s agenda for this year’s session.
Workforce: More Hands on Deck
Re-fortifying a depleted workforce will be paramount for THA following the COVID-19 pandemic’s deleterious impact on hospital personnel numbers. For many physicians, nurses, allied health workers and others, the stress of an overtaxed hospital and exposure to the impacts a dangerous disease were too much to handle. Some retired early. Others left the profession – or at least, the pressure-packed hospital environment – well before their time. And today, hospitals everywhere find their personnel needs exceeding the available bodies.
But solutions exist, and so do untapped sources of eager talent that could fill the gap. In 2021, Texas nursing schools turned away more than 15,700 qualified applicants due to faculty shortages and clinical education capacity. The legislature can help schools find avenues to train those prospective nurses – and address other holes in the workforce – by committing funding to several key programs. THA is asking lawmakers for funding support for several programs, including:
- The Nursing Faculty Loan Repayment Assistance Program, which encourages qualified nurses to join the faculty at institutions of higher learning;
- The Physician Education Loan Repayment Program, which offers an incentive for physicians to practice in health professional shortage areas or to provide services for Medicaid and the Children’s Health Insurance Program; and
- The Loan Repayment Program for Mental Health Professionals, which helps many different types of behavioral health providers, including psychiatrists, psychologists, social workers and mental health advanced practice nurses.
THA-backed legislation to boost the nursing faculty loan repayment program is already filed. House Bill 901 by Rep. Stephanie Klick (R-Fort Worth) and Senate Bill 244 by Sen. Lois Kolkhorst (R-Brenham) would remove an annual cap of $7,000 in loan repayment assistance for nurses who work as faculty in a nursing degree program. The companion bills would also base the amount a nurse receives on the proportion of hours the nurse worked as a faculty member to the number of hours worked by a full-time nurse.
Also central to building and maintaining the health care workforce is making sure health care environments are a place where those workers feel safe. That’s why THA is backing already-filed legislation to prevent and address workplace violence. House Bill 112 by Rep. Donna Howard (D-Austin) and its companion, Senate Bill 240 by Sen. Donna Campbell, MD (R-New Braunfels) require hospitals, nursing facilities and other settings to establish a workplace violence prevention committee, or to authorize an existing committee at the facility, to develop a workplace violence prevention plan. The bill also prohibits discipline or discrimination against someone who reports a workplace violence incident in good faith.
Advancements in Behavioral Health
The alarming state of behavioral health in Texas coming out of COVID-19 demands attention as well. Funding for the aforementioned Loan Repayment Program for Mental Health Professionals is one way THA hopes to see the legislature tackle behavioral health care access, but it’s not the only step the state needs to take.
For years, adult inpatient behavioral health care in Medicaid has been hampered by an arbitrary federal limit known as the “institutes for mental diseases” (IMD) exclusion, which only allows coverage for a 15-day inpatient stay for adults between ages 21 and 64. Through a budget waiver, Texas can apply for a waiver from the federal IMD exclusion, a budgetary move that THA supported in 2021 and is doing so again this time around. Removing the exclusion would go a long way toward helping Texas adults with behavioral health needs requiring longer-term inpatient care.
THA will also support full Medicaid coverage for partial hospitalization services and intensive outpatient therapy to give mental health patients access to a full continuum of behavioral health care services. In partial hospitalization services, patients can receive psychiatric services during the day and return home at night, as opposed to traditional round-the-clock psychiatric care. Intensive outpatient therapy programs are similar to but shorter than partial hospitalization programs, but offer more behavioral health care than traditional outpatient therapy.
Stable Financial Footing
With a new report by Kaufman Hall showing nearly one in 10 Texas hospitals are at risk of closure, and nearly half operating in the red during 2022, THA is asking lawmakers to help facilities survive the continuing financial difficulties the pandemic has presented.
Among its asks on the financial front, THA is requesting that lawmakers support:
- Hospital reimbursements closer to the actual cost of services;
- Stability and maintenance of supplemental Medicaid payments to help cover unreimbursed costs; and
- Continued use of local or regional hospital provider participation funds to finance Medicaid hospital programs, pay for uncompensated care and support Medicaid 1115 Transformation Waiver projects that promote access to care.
THA is also prepared to play defense on protecting hospitals’ bottom line. It will work to convince lawmakers to oppose any decrease in hospital reimbursement payments, including through the use of site-neutral payments.
The Budget, Insurer Accountability and More
Many of THA’s hopes for a healthier state are predicated on how lawmakers decide to allocate the state’s two-year budget – this one for the 2024-25 biennium.
Texas Comptroller Glenn Hegar has projected a record surplus for legislators to work with, and THA hopes some of the extra funds can be directed toward maintaining funding for health and human services programs, including hospital payment rates for safety net, trauma and rural facilities, and targeted rural Medicaid payments to prevent rural hospitals from closing.
Other items near the top of THA’s priority list this session include:
- Comprehensive health coverage expansion to insure more Texans. That includes extending Medicaid coverage postpartum to 12 months for new mothers.
- Holding insurers accountable for their bureaucratic impediments to care that often culminate in “slow payment, low payment or no payment” for hospitals and providers. One particular point of emphasis for THA will be enforcement of the state’s “prudent layperson” standard for emergency care, which requires health plans to base emergency care coverage on the patient’s presenting symptoms, rather than the final diagnosis.
- Supporting policies and legislation that tackle health equity disparities that address nonmedical drivers of health, including a person’s socioeconomic status, access to healthy food and transportation, and neighborhood. The health disparities that result from those factors often disproportionately affect racial and ethnic minorities, and those disparities have been highlighted as a result of the pandemic.
Once the session begins, keep tabs on bill movement and THA’s advocacy on these issues using THA’s Advocacy App (available in the App Store); THA’s social media accounts on Twitter, LinkedIn, Facebook and Instagram; the Advocacy and Issues tabs on THA’s website; and THA’s weekly advocacy newsletter, the Health Care Advocate.