FEATURED, FROM LEFT: Sen. Juan “Chuy” Hinojosa, D-McAllen, and Rep. Sergio Muñoz, Jr., D-Mission, recite the Pledge of Allegiance on Thursday, November 11, 2020 during the City of Pharr’s groundbreaking ceremony for its Wellness and Innovation Complex, located at 1121 E. Nolana Loop.
Photograph Courtesy CITY OF PHARR
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Women’s health, telehealth, and mental health among medical care issues that may see action by the Texas Legislature, announces House Research Organization
By DAVID A. DÍAZ
[email protected]
While COVID-19 and Medicaid expansion is sure to receive major attention during the ongoing 87th Texas Legislature, other key issues dealing with state health and human services may very well also be taken up by state lawmakers in the next few weeks and months, the House Research Organization has announced.
An enhanced postpartum care services package for low-income women, expanding broadband access in rural and underserved areas to help bridge the digital divide in health care and expanding mental health and substance use disorder services for certain populations, such as frontline workers, people of color, and rural communities, are among the legislative proposals that also may be considered by state lawmakers.
Those, and other medical and health care issues, are summarized in “Topics for the 87th Texas Legislature”, which was recently published by the House Research Organization, and provides an easy-to-understand, trustworthy guide.
The House Research Organization (HRO) is a nonpartisan independent department of the Texas House of Representatives. It provides impartial information on legislation and issues before the Texas Legislature. The HRO is governed by a broadly representative steering committee of 15 House members elected by the House membership to set policy for the organization, approve its budget, and ensure that its reports are objective.
DHR Health on Friday, February 26, 2021, released the highlights of “Topics for the 87th Texas Legislature” that focused on anticipated state health and human services legislation.
The Texas Legislature began its 140-day regular session on Tuesday, January 12, 2021, and ends on Monday, May 31, 2021
Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV Med”) own and operate a 519 licensed bed general acute care hospital with over 70 specialties and subspecialties located at 5501 South McColl in Edinburg. The facility is one of the largest physician-owned facilities in the United States that began as an ambulatory surgery center in 1997
DHR Health is the flagship teaching hospital for the University of Texas Rio Grande Valley School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.
DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing presence in McAllen, including its South Campus located immediately across Owassa Road in northeast McAllen.
“The 87th Legislature could consider proposals to address the uninsured rate in Texas. This could include proposals to expand Medicaid coverage for certain low-income adults, women, and children or to pursue federal waivers and create pilot programs to fund the delivery of health care,” the House Research Organization states in the publication. “Lawmakers also may consider proposals to increase access to telehealth in rural and underserved areas, strengthen consumer protections in health insurance, and implement immunization protocols for distributing COVID-19 vaccines.”
The summary of possible medical and health care measures, by subject matter, follows:
Telehealth.
During the COVID-19 pandemic, the Texas Department of Insurance on March 17, 2020, adopted an emergency rule temporarily requiring that health professionals’ reimbursement rates for telemedicine based services be at least the same as those for in-person services and that health plans offer telemedicine coverage on the same basis as in-person visits.
The 87th Legislature could discuss adopting payment parity for telemedicine services and other telehealth regulatory changes temporarily allowed during the pandemic. Proposals also could focus on expanding broadband access in rural and underserved areas to help bridge the digital divide in health care.
Vaccines.
Following declines in routine childhood vaccinations and inactive vaccination sites when local health department personnel were redeployed for the COVID-19 response, lawmakers in 2021 could discuss expanding provider eligibility to allow pharmacists to enroll and participate in the Texas Vaccines for Children Program, which provides low-cost vaccines to eligible children from birth through 18 years of age.
Legislators could discuss maintaining or increasing funding levels and recruiting additional providers for child and adult immunization programs. Other proposals may include revising the state’s immunization registry and identifying ways to use non-traditional vaccination providers and locations to expand access to vaccines for all ages. Lawmakers may consider proposals to authorize pharmacists to provide vaccines to children 7 to 13 years of age without a prescription.
Codifying certain emergency licensing provisions.
As part of the state’s response to the COVID-19 pandemic, Gov. Greg Abbott issued several waivers relating to emergency medical licensing for health care professionals. These orders temporarily allowed out-of-state practitioners to provide care in Texas, allowed certain qualified health care trainees to practice before passing their required licensing exams, and permitted oral prescriptive agreements between physicians and physician assistants.
The Legislature could seek to make some of these emergency licensure provisions permanent. Lawmakers also could consider proposals to allow advanced practice registered nurses (APRNs) to practice without physician delegation or supervision and to allow pharmacists to dispense certain non-diagnostic medications, which are medications used to treat common conditions that are easily identified by the patient, directly from a pharmacist working under a physician protocol.
Health care costs and price transparency.
Legislators could consider proposals addressing affordability and access in the health care system and implementing certain financing models.
Price transparency.
As lawmakers address concerns about rising health care costs, the Legislature could consider proposals to increase price transparency of medical services and pharmaceutical drugs.
Legislators could discuss granting consumers the “right to shop” by comparing prices and information on the quality of health care services and procedures among different providers. The proposal could include establishing a centralized database containing billed charges from all health providers, reimbursement rates for in-network and out-of-network claims, and cost-sharing features such as deductibles, co-pays, coinsurance, and out-of-pocket amounts.
Health care costs.
Lawmakers could consider proposals to pursue a federal Section 1332 waiver (State Innovation Waiver) under the Affordable Care Act to increase Texans’ access to health care. Proposals for using a 1332 waiver could include creating a state reinsurance program, which provides payments to health insurers to help offset the costs of enrollees with large medical claims.
The Legislature could consider proposals to expand the attorney general’s authority to review physician and hospital mergers and consolidations and to address price-gouging protections for consumers and enforcement of current antifraud laws.
Legislators also may discuss proposals to prohibit facility and observation fees for non-emergency and non-hospital services.
Balance billing.
The 86th Legislature in 2019 enacted Senate Bill 1264 by Sen. Kelly Hancock, R-Richland Hills, which prohibited certain health insurers from balance billing patients and created a mediation and arbitration system to settle balance bills (also known as surprise medical bills) between health plans and out-of-network providers and facilities.
Lawmakers in 2021 could consider proposals to apply consumer protections for balance billing to emergency medical transportation services, COVID-19 testing and treatment, and alternative
health plans (e.g. direct primary care arrangements, health care sharing ministries, and other short-term plans).
Proposals could include requiring all health professional licensing agencies to enforce the balance billing prohibition and removing the use of billed charges as the standard for resolving payment disputes.
Abortion.
The 86th Legislature in 2019 enacted Senate Bill 22 by Sen. Donna Campbell, R-New Braunfels, which prohibits government entities from entering taxpayer resource transactions with certain abortion providers or their affiliates.
Proposals in 2021 could seek to clarify the law’s definition of “taxpayer resource transaction” to address funding loopholes.
Legislators also could consider proposals to change the funding levels for the Alternatives to Abortion program and discuss other proposals, such as prohibiting a person from performing an abortion when a heartbeat is detected or prohibiting abortions based on gender, race, or genetic abnormalities.
Women’s health.
The 86th Legislature in 2019 enacted Senate Bill 75o by by Lois Kolkhorst, R-Brenham, which required the Health and Human Services Commission (HHSC) to evaluate and develop an enhanced postpartum care services package for low-income women enrolled in the Healthy Texas Women (HTW) program.
On September 1, 2020, HHSC released the new services package (also known as HTW Plus), which focuses on treating major health conditions recognized as contributing to maternal morbidity and mortality in Texas, such as postpartum depression and other mental health conditions, cardiovascular and coronary conditions, and substance use disorders. The 87th Legislature could examine proposals to ensure enough providers are available to provide comprehensive mental health and substance use services for postpartum women.
Other proposals could focus on expanding access to long-acting reversible contraceptives for women enrolled in Medicaid or HTW and incorporating HTW into a managed care model.
Lawmakers could discuss funding levels for the HTW program and Family Planning Program.
Mental health.
The Texas Health and Human Services Commission on March 20, 2020, authorized Medicaid providers to submit insurance claims to receive reimbursement for certain behavioral health services delivered by telephone, including substance use disorder services, mental health rehabilitation, peer specialist services, and psychotherapy.
The 87th Texas Legislature could discuss amending state law to allow Medicaid reimbursement for behavioral health services delivered by telephone. Legislators also could discuss expanding mental health and substance use disorder services for certain populations, such as frontline workers, people of color, and rural communities.
Legislators could consider creating a perinatal psychiatric access program (similar to the Children’s Psychiatric Access Network created by Senate Bill 11 by Taylor in the 86th Legislature) that would offer training and teleconsultation with psychiatrists to increase the number of health professionals with the skills to serve mothers facing mental health challenges.
Medicaid.
Medicaid expansion in Texas, which is supported by the Valley’s three state senators and eight state representatives, will be a major legislative issue during the ongoing 87th Texas Legislature.
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age.
Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. Others, such as Texas, haven’t.
https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
Medicaid is the state and federal cooperative venture that provides medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without medical care for themselves and their children.
https://www.benefits.gov/benefit/1640
Also according to “Topics for the 87th Legislature”:
• Texas’ Section 1115 Medicaid waiver, which is a federal waiver under the Social Security Act that provides states more flexibility in designing Medicaid programs, expires September 30, 2022. The 87th Legislature could discuss renewing the 1115 waiver, which includes two funding pools (uncompensated care and the Delivery System Reform Incentive Payment, or DSRIP, program) providing billions of dollars in supplemental funding to hospitals and health care providers. Because the federal share of the DSRIP will expire in 2021 and uncompensated care pools will phase out by 2022, lawmakers could discuss alternative payment models for hospitals and providers.
• On November 10, 2020, the U.S. Supreme Court heard oral arguments in California v. Texas to determine the constitutionality of the Affordable Care Act’s (ACA) minimum-coverage provision and whether it is severable from the rest of the ACA. Depending on the outcome, the Legislature could seek to modify minimum standards for health insurance coverage and consumer protections under the ACA.
• Legislators could consider proposals to change Texas’ Medicaid program by expanding Medicaid under the ACA, pursuing a block grant, or creating pilot programs to increase access to direct primary care. Other proposals may include maintaining or increasing provider reimbursement rates, extending Medicaid postpartum coverage from 60 days to 12 months, and developing value-based payment models in Medicaid managed care. Proposals could emerge to increase oversight of pharmacy benefit managers’ administration of prescription drug benefits in Medicaid managed care.
The full text of “Topics for the 87th Legislature” is available online, free-of-charge, at:
https://hro.house.texas.gov/pdf/focus/topics87-1.pdf
DHR HEALTH RECRUITING PARTICIPANTS FOR NATIONAL STUDY ON WHETHER LIPITOR® CAN HELP PREVENT DEMENTIA, DISABILITY, OR HEART DISEASE IN PEOPLE 75 YEARS OF AGE AND OLDER
DHR Health Institute for Research and Development, which is affiliated with DHR Health, on Monday, February 22, 2021, announced that it is recruiting participants for a clinical trial known as PREVENTABLE.
The study, coordinated by Duke University and funded by the National Institutes of Health, will investigate whether taking atorvastatin can prevent dementia, disability, and heart disease in adults 75 and over.
Atorvastatin, more commonly known as Lipitor®, is normally used to lower cholesterol.
The PREVENTABLE study is being conducted simultaneously at 100 sites across the U.S. This is a unique opportunity for individuals to feel a part of something bigger to advance medical knowledge for adults 75 and older.
Participants will be joining up to 20,000 others interested in learning if atorvastatin will allow people to live well for longer. Participants, who must not currently have heart disease or dementia, will be randomized, some receiving atorvastatin and others receiving a placebo. This placebo is a pill that looks like atorvastatin but does not have medicine in it.
Researchers will follow participants for up to five years and test their memory, thinking, and physical abilities and will watch them during this time for conditions such as heart attacks and strokes.
PREVENTABLE has been designed to be easy for participants. Researchers will follow participants using electronic health records and Medicare data. Study visits will be done by phone, and the atorvastatin or placebo will be shipped to participants’ homes every three months.
“Few studies have focused exclusively on individuals aged 75 or older,” said Dr. Sohail Rao, Executive Vice President. DHR Health and President and CEO, DHR Health Institute for Research & Development. “While statins have been shown to reduce the risk of cardiovascular events for some patients, PREVENTABLE will help us learn if they are helpful for older adults who do not have heart disease.”
According to the Centers for Disease Control, “Among people ages 65 and older, African Americans have the highest prevalence of Alzheimer’s disease and related dementias (13.8 percent), followed by Hispanics (12.2 percent) and non-Hispanic whites (10.3 percent), American Indian and Alaska Natives (9.1 percent), and Asian and Pacific Islanders (8.4 percent).”
The population in the Rio Grande Valley makes the region an important site for PREVENTABLE.
“Patients often ask me what they can do to stay healthy and prevent dementia,” said Dr. Karen Alexander, a geriatric cardiologist at Duke University Medical Center and principal investigator for PREVENTABLE. “Results from this study will help us provide valuable answers to improve how we age.”
PREVENTABLE is funded by the National Institute of Aging and the National Heart, Lung, & Blood Institute of the National Institutes of Health under award number U19AG065188.
To learn more about PREVENTABLE, visit http://www.preventabletrial.org. To find out who can take part in the study, or for more information, please call 956-362-2391 or email [email protected].
DHR Health Institute for Research & Development, affiliated with DHR Health, is a nonprofit organized under the Federal Internal Revenue Service Code 501(c)(3).
DHR Health Institute for Research and Development leads the way for innovative, state-of-the-art clinical research in the Rio Grande Valley. For more information, please call 956-362-2387 or visit its website at dhrresearch.org. Join our social-media community @DHRResearch.
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R-Myna Evans contributed to this report. For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).
