Texas Hospital Association

Health Care Advocate: Jan. 26, 2023

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Advocacy News 
If you have questions or comments about the articles below, please contact [email protected].

Medicaid, Behavioral Health Budget Plans Include Good News for Hospitals

THA’s analysis of the Texas Legislature’s initial 2024-25 budget bills reveals lawmakers are planning to hold the line on safety-net, trauma and rural hospital add-on payments to care for the most vulnerable Texans, and increase their commitment to key pieces of the state’s behavioral health apparatus.

Those parts of the House and Senate bills add to the encouraging news for hospitals on top of the proposed workforce and behavioral health wins detailed in last week’s edition of the Health Care Advocate.

Maintaining funding for Medicaid safety-net, trauma and rural care was one of THA’s top priorities for the budget entering the Legislature’s new session, and both House Bill 1 by Rep. Greg Bonnen, MD (R-Friendswood) and Senate Bill 1 by Sen. Joan Huffman (R-Houston) do just that.

In both bills, overall Medicaid spending would increase by $4 billion per year from the 2022-23 budget: $38.4 billion for 2024 and $38.5 billion for 2025. And Texas Health and Human Services Commission Rider 8 would keep funding level for several key add-on payments, including:

  • $150 million per year (all funds) for safety-net add-ons;
  • $180 million per year for trauma add-ons; and
  • $30 million annually for rural outpatient add-ons.

A separate HHSC budget rider would keep funding level for Medicaid add-on payments for rural labor and delivery services: $8 million in each year of the budget.

Encouraging behavioral health allocations also emerged in the budget proposals beyond the sizable boost to the Loan Repayment Program for Mental Health Professionals reported last week in the Advocate ($28 million over the biennium, a $26 million increase from the current budget). Included riders would:

  • Allocate $126 million per year to maintain state psychiatric bed capacity and add 234 inpatient beds (85 in rural communities and 149 in urban areas);
  • Provide increased funds for grant programs for community mental health grants;
  • Supply increased funds for grants for reduction of recidivism, arrest and incarceration among people with mental illness;
  • Provide all-new funding for an innovation grant program for community-based mental health initiatives to provide access to care; and
  • Continue directing funds for community mental health services to be used toward obtaining additional federal funds via the Medicaid 1115 Transformation Waiver.

One of THA’s foremost behavioral-health priorities, however – a budget rider to fund a waiver from the federal “institutions for mental disease” (IMD) exclusion – is not included in these budget drafts. The IMD exclusion limits adult inpatient behavioral care by capping coverage for inpatient stays at 15 days for patients ages 21 to 64.

THA will continue to advocate for pursuit of a waiver from the IMD exclusion and other improvements as budget discussions evolve during the next few months. You can view THA’s full summary of the initial budget bills here.

Budget committees in both chambers will begin hearings on the bills in the coming weeks. Each budget version – House and Senate – must pass its parent chamber before the versions are reconciled in a conference committee this spring. (Jennifer Banda, J.D./Cameron Duncan, J.D./Sara González/Anna Stelter/Matt Turner)

Kolkhorst Reappointed Health and Human Services Chair

Lt. Gov. Dan Patrick put a familiar face in charge of the Texas Senate Committee on Health and Human Services when he announced committee assignments for the just-begun 2023 legislative session this week.

Sen. Lois Kolkhorst (R-Brenham) will again chair the Health and Human Services Committee, which will serve as the Senate’s authority on Texas’ health care policies, from public health to behavioral health priorities. Sen. Charles Perry (R-Lubbock) will serve as vice chair. Other members of the committee include:

  • Sen. César Blanco (D-El Paso);
  • Sen. Bob Hall (R-Edgewood);
  • Sen. Kelly Hancock (R-North Richland Hills);
  • Sen. Bryan Hughes (R-Mineola);
  • Sen. Morgan LaMantia (D-South Padre Island);
  • Sen. Borris Miles (D-Houston); and
  • Sen. Kevin Sparks (R-Midland).

No physicians were assigned to this year’s Committee on Health and Human Services. Sen. Donna Campbell, MD (R- New Braunfels) and Sen. Dawn Buckingham, MD (R-Lakeway) served on the committee during the 2021 session, but Sen. Campbell was not reassigned this year, while Buckingham is serving her first term as Texas Land Commissioner after being elected to that post last year.

Sen. Joan Huffman (R- Houston) will chair the Committee on Finance, which is in charge of the state’s revenue and taxation measures. The finance committee is especially important for its role in determining the budget in regard to Medicaid, behavioral health and workforce funding. Sen. Huffman is a new appointee to the chairship.

Sen. Brandon Creighton (R-Conroe) is the new chair for the Committee on Education and the Subcommittee on Higher Education. The higher education subcommittee will help determine the direction of Texas’ hospital workforce coming out of COVID-19. This includes training for physicians and nurses and education programs for future health care professionals.

Sen. Charles Schwertner, MD (R-Georgetown) will chair the Committee on Business and Commerce. This committee has historically regulated health care insurance, but it is unclear at this point if that will continue.

Also on hospitals’ collective radar, Sen. Bryan Hughes (R-Mineola) was named the chair of the Committee on State Affairs. This committee handles many of the hot-button political topics, from electricity regulation to elections to end-of-life care. (Jennifer Banda, J.D.)

Texas Congressmen Appointed to U.S. House COVID Subcommittee

Two members of the Texas congressional delegation, including one of the state’s physician-legislators in Congress, were appointed to a new, COVID-19-focused House of Representatives subcommittee Wednesday by House Speaker Kevin McCarthy (R-Calif.).

Rep. Michael Cloud (R-Victoria) and Rep. Ronny Jackson, MD (R-Amarillo) were appointed to the Select Subcommittee on the Coronavirus Pandemic. Rep. Jackson, first elected in 2020 as the representative of Texas’ 13th congressional district, became the chamber’s second Texas physician alongside longtime Rep. Michael Burgess, MD (R-Lewisville). (Jennifer Banda, J.D./Carrie Kroll)

Last Chance to Register for THA’s Annual Conference Before Prices Increase

To ensure Texas hospital executives can register for THA’s 2023 Annual Conference & Expo and reserve their hotel room, THA has reverted registration prices to regular pricing now through this Friday, Jan. 27. After Friday, late registration prices will be in effect. No code is necessary at checkout. Additionally, the hotel block and reduced room rate at the Hilton Austin will expire after Friday. The conference is scheduled for Feb. 14-15. Learn more and register here. (Lindsay Thompson)

DSHS Debuts New COVID Vaccine Ordering Process

The Texas Department of State Health Services (DSHS) has adopted a new COVID-19 request process in its Vaccine Allocation and Ordering System (VAOS). The “COVID Open Ordering” system will allow enrolled providers to order multiple COVID-19 vaccines and streamline the data entry process, DSHS says. A new tile will appear on VAOS, with the COVID Open Ordering name, after logging in to order.

The DSHS Immunization Program will demonstrate the system on Tuesday, Jan. 31, at 1 p.m. during “VAOS Office Hours.” Additional information on COVID-19 vaccine management and VAOS can be found here. Questions about the new process can be addressed to [email protected]. And a guide presentation is available to download here. (Carrie Kroll/Erika Ramirez)

CDC Data: Bivalent COVID Boosters Add Protection

New research from the Centers for Disease Control and Prevention (CDC) released Wednesday shows that the latest, bivalent COVID-19 booster is providing additional protection against the newest variants “for at least first 3 months” after vaccination if a person has received between two and four previous shots, with that protection increasing by around 50% for younger adults.

The CDC report measured vaccine effectiveness against the subvariants Omicron BA.5 – which became one of the dominant subvariants in the U.S. during 2022 – and the more recent Omicron XBB/XBB.1.5 subvariant now “gaining predominance nationwide.” CDC’s Increased Community Access to Testing national pharmacy program collected the testing data from adults with a normal immune response from Dec. 1, 2022, to Jan. 13, 2023. CDC says the report contains the first estimates of a bivalent booster shot’s effectiveness against XBB-related subvariants.

The data showed “generally similar” vaccine effectiveness across age groups, according to the report, including:

  • Ages 18-49 – 52% effectiveness against symptomatic BA.5, 49% against symptomatic XBB/XBB.1.5;
  • Ages 50-64 – 43% against BA.5, 40% against XBB/XBB.1.5; and
  • Ages 65 and older – 37% against BA.5, 43% against XBB/XBB.1.5.

CDC said evidence of waning effectiveness after two to three months “was minimal, although estimates were imprecise.”

“All persons should stay up to date with recommended COVID-19 vaccines, including receiving a bivalent booster dose when eligible,” the report said. (Carrie Kroll/Erika Ramirez)

FDA Advisory Committee Recommends COVID Vaccine Series Update

A U.S. Food and Drug Administration (FDA) advisory committee voted to submit a recommendation to FDA to update the primary COVID-19 vaccine series with bivalent shots.

In a unanimous vote, the Vaccine and Related Biological Products Advisory Committee recommended updating the makeup for all future primary and booster vaccines to bivalent vaccines to protect against the Omicron variant. Omicron has recently produced the most prevalent subvariants of the disease.

FDA’s briefing document for the meeting included a prediction that COVID-19 will evolve much like the flu, which would require annual updates for the most prevalent strains.

“FDA anticipates conducting an assessment of [COVID-19] strains at least annually and to engage [the advisory committee] in about early June of each year regarding strain selection for the fall season,” the briefing document said. “Subsequently, a decision on the recommended vaccine composition would be made in time for any updated vaccine to be in production in time to be deployed for use no later than September of each calendar year.”

The committee engaged in discussion on that topic today but did not issue a recommendation on whether to update the vaccine annually. A live-blog recap of today’s meeting from STAT is available here. (Carrie Kroll/Erika Ramirez)

Directed Payment Program Enrollment Opens Next Week

The Texas Health and Human Services Commission’s (HHSC’s) Directed Payment Programs (DPPs) will be opening enrollment for program year three (state fiscal year 2024) on Feb. 1. HHSC will distribute notifications on that date with links to the applications for each DPP.

For more information on individual programs and to review proposed fiscal-year 2024 changes, visit the HHSC webpage on each of the following DPPs:

Enrollment will close Feb. 21. (Anna Stelter/Matt Turner)

Texas Register Highlights

The Texas Health and Human Services Commission (HHSC) adopted amendments to Title 1, Texas Administrative Code, Part 15, Chapter 354 (Medicaid Health Services), including revisions in Subchapter A to §354.1430, concerning Definitions; §354.1432, concerning Telemedicine and Telehealth Benefits and Limitations; §354.1434, concerning Home Telemonitoring Benefits and Limitations; and new §354.1435, concerning Provision of Behavioral Health Services through an Audio-Only Platform; and §354.1436, concerning Provision of Non-behavioral Health Services Using an Audio-only Platform; and in Subchapter M, Division 1, amendments to §354.2603, concerning Definitions; §354.2607, concerning Assessment and Service Authorization; and §354.2609, concerning Recovery/Treatment Planning, Recovery/Treatment Plan Review, and Discharge Summary; in Division 2, amendments to §354.2655, concerning Mental Health Targeted Case Management Services; and §354.2657, concerning Documentation Requirements; and in Division 3, amendments to §354.2707, concerning Crisis Intervention Services; §354.2709, concerning Medication Training and Support Services; §354.2711, concerning Psychosocial Rehabilitative Services; and §354.2713, concerning Skills Training and Development Services. Sections 354.1430, 354.1432, 354.1434, 354.1435, 354.1436, 354.2603, 354.2607, 354.2609, 354.2655, 354.2657, 354.2707, 354.2709, 354.2711, and 354.2713 were adopted without changes to the proposed text as published in the Oct. 21, 2022, issue of the Texas Register (47 TexReg 6921) and were not republished.

The adopted rules are necessary to implement Texas Government Code §531.02161 that was added by House Bill 4, 87th Legislature (2021). Texas Government Code §531.02161 requires HHSC to develop and implement policies and procedures for the provision of health care services delivered via telemedicine and telehealth, including certain behavioral health services, by implementing changes in state law. The adopted rules also implement Texas Government Code, §531.001, amended by S.B. 1107, 85th Legislature (2017) to standardize definitions for telemedicine medical services and telehealth services; Texas Government Code, §531.001 and §531.0217(d), amended by S.B. 670, 86th Legislature (2019) to require reimbursement parity, to prevent denial of services solely because an in-person medical service did not occur and to not limit a physician’s choice of platform; and Texas Government Code, §531.02164 (c-1), added by H.B. 1063, 86th Legislature (2019) to allow home telemonitoring services for people with diabetes, heart disease and other specific conditions. The effective date of the changes was Jan. 23. (Jan. 20)

The Texas Health and Human Services Commission (HHSC) adopted an amendment to Title 26, Texas Administrative Code, Chapter 554 (Nursing Facility Requirements for Licensure and Medicaid Certification), §554.1914, concerning Emergency Preparedness and Response. The amendment was adopted without changes as published in the Sept. 16, 2022, issue of the Texas Register (47 TexReg 5729) and was not republished. Background information provided indicated the amendment is necessary to implement a new procedure that requires the program provider to assign a designee to enroll and respond to requests through the Emergency Communication System in the format established by HHSC. The effective date of the amendment was Jan. 24. (Jan. 20)

The Texas Health and Human Services Commission (HHSC) announced its intent to submit an amendment to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The proposed amendment has been effective since March 1, 2021. The proposed amendment documents coverage of COVID-19 prevention and treatment as benefits in Texas Medicaid, including coverage for conditions that may seriously complicate COVID-19 treatment. The proposed amendment was estimated to result in an additional annual aggregate expenditure of $406,815,439 for federal fiscal year (FFY) 2021, consisting of $276,675,180 in federal funds and $130,140,259 in state general revenue. For FFY 2022, the estimated additional annual expenditure was $442,010,076 consisting of $296,146,751 in federal funds and $145,863,325 in state general revenue. For FFY 2023, the estimated additional annual expenditure is $149,511,157 consisting of $57,681,404 in federal funds and $91,829,753 in state general revenue. (Jan. 20) (Steve Wohleb, J.D.)

Federal Register Highlights

The National Vaccine Advisory Committee (NVAC) announced that it will hold a virtual meeting open to the public and accept public comments. The meeting will be held Feb. 2-3. The confirmed meeting times and agenda will be posted on the NVAC website here as soon as they become available. NVAC will hear presentations on COVID-19, respiratory syncytial virus, meningitis, and measles. Members of the public will have the opportunity to provide comment at the NVAC meeting during the public comment period designated on the agenda. Participants are also welcome to submit written comments in advance. (Jan. 24) (Steve Wohleb, J.D.)

The Health Care Advocate is a publication of the Texas Hospital Association, 1108 Lavaca, Austin Tx 78701. Telephone 512/465-1570 for information. For additional information regarding specific articles, please contact the THA staff member(s) listed at the bottom of each full article. According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by Jennifer Banda, J.D., Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas 78701-2180.