A raucous 2007 Texas Legislative Session ended on May 28 after legislators considered 6,198 bills, a 13% increase from the 2005 Session. The Federation of Texas Psychiatry identified 317 of these bills as potentially affecting the practice of psychiatry. A total of 1,478 bills passed the Legislature, 60 of which were on the Federation’s tracking list. The Governor has until June 17 to sign or veto the bills.

The Federation wishes to express appreciation to psychiatrists who met with legislators and candidates prior to the Session; who participated at the Federation’s Leadership Conference in August and Capitol Day in February; who reviewed bills and provided direction for the Federation’s lobbying efforts; who took time from busy schedules to come to Austin to testify on bills in committees; and, who responded to the Federation’s alerts to contact legislators prior to key votes. The Federation is grateful to the leadership of member organizations (TSPP, Academy, TSCAP, TOMA and TMA) for uniting psychiatry and giving psychiatry a more forceful voice in the legislative process. The Federation also wishes to thank our lobbyist, Steve Bresnen, and his associate, Annie Landmann, for their tireless and effective efforts in communicating psychiatry’s positions on bills to legislators and recommending amendments to make bills more acceptable to psychiatry and to patients.

During the Federation’s Leadership Conference in August, 2006, the Federation announced its key legislative priorities for the upcoming 2007 Texas Legislative Session: funding for public mental health services; full insurance parity for psychiatric illnesses; improved Medicaid reimbursement for physicians; protection from scope of practice initiatives that threaten patient safety; and funding for graduate medical education. Success and progress was made in each of these goals in the 2007 Session.

A top legislative priority was the request by the Department of State Health Services (DSHS) for $82 million for mental health crisis services. THIS REQUEST WAS FULLY FUNDED! ($ 27.3 Million for Fiscal Year 2008 and $ 54.7 Million for Fiscal Year 2009.) According to a budget rider (i.e. an attachment to the budget that designates how money must be spent), the crisis services money will be distributed around the state by a methodology that allocates a portion to achieve equity among local mental health authorities, a portion on a per capita basis, and a portion using a competitive process.

A historic 25% increase in Medicaid payments to physicians for children’s care, and a 10% hike for adult services was passed.

The Legislature responded to organized medicine’s call for funding for graduate medical education in an effort to keep more Texas trained physicians in Texas to care for patients. The Legislature appropriated nearly $86 million for graduate medical education.

Two bills were filed to ban medical research for children in the juvenile probation system (HB 1113 by Sylvester Turner and Carlos Uresti) and children committed to the Texas Youth Commission (HB 1111 by Sylvester Turner and Carlos Uresti). The Federation successfully had these two bills amended to remove the proposed ban and to require the reporting only of children participating in medical research programs who are in the juvenile probation system and committed to the Texas Youth Commission. Both bills passed with the Federation’s amendments.

Another bill was filed that banned the enrollment of foster children in medical research programs (SB 405 by Carlos Uresit and Sylvester Turner). The Federation was successful in removing the ban with an amendment that allows the enrollment of a foster child in a drug research program with a court order or with the consent of the foster child’s parent if the parent is authorized to provide medical consent by the court.

The Federation supported HB 518 by Elliot Naishtat and Kim Brimer which passed. It extends the time period allowed for detaining a person for a preliminary examination from 24 hours to 48 hours. The 48 hour period includes any time the patient spends waiting for medical care before the person receives the preliminary examination. If the 48 hour period ends on a Saturday, Sunday, legal holiday or before 4 pm on the first succeeding business day, the patient may be detained until 12 pm on the first succeeding business day. If the 48 hour period ends at a different time, the patient may be detained only until 4 pm on the day the 48 hour period ends.

The Federation successfully amended a bill (HB 2034 by Kirk England and Florence Shapiro) requiring licensure by the Council on Sex Offender Treatment of health care professionals who provide assessment and treatment of sex offenders. The amendment exempts from licensure a physician who prescribes medications to a person who may be deemed a sex offender.

For the second consecutive Session, a bill to grant psychologists prescribing privileges was not even filed. This outcome can be attributed in part to the effort of psychiatrists during the interim to meet and visit with legislators about issues affecting quality psychiatric care. For the first time in 15 years, psychologists attempted to file a bill to allow psychologists to admit patients to hospitals. This bill was never filed after legislators called the Federation’s office to inquire about the proposed bill.

SB 55 by Judith Zaffirini and Jerry Madden: CHEMICAL DEPENDENCY COUNSELORS: This bill address the regulation of chemical dependency councilors and establishes a peer assistance program for chemical dependency counselors to assist chemical dependency counselors whose ability to perform a professional service is impaired by abuse of or dependency on drugs and alcohol.

SB 993 by Jane Nelson and Jim McReynolds: NURSING: Establishes a process for reviewing complaints against nurses.

HB 654 by Harvey Hilderbran and Troy Fraser: HILL COUNTRY MH AUTHORITY CRISIS STABILIZATION UNIT: Directs the DSHS to implement a crisis stabilization unit pilot project by establishing and operating a 16-bed crisis stabilization unit on the grounds of Kerrville State Hospital, in a building separate from Kerrville State Hospital.

HB 2439 by Vicki Truett and Kyle Janek: FUNCTIONS OF LOCAL MENTAL HEALTH AUTHORITIES: The Executive Commissioner of HHSC may delegate to local authorities the authority and responsibilities of the executive commissioner, the commission, or a department of the commission related to planning, policy development, coordination, resource allocation, and resource development for and oversight of mental health and mental retardation in the most appropriate and available setting to meet individual needs in the service area. Before DSHS institutes change in payment methodology for mental health services, the department shall evaluate various forms of payment for services, including fee-for-service, case rate, capitation, and other appropriate payment methods to determine the most cost-effective and efficient form of payment for services and report its findings by January 1, 2009. The local authority network advisory committee is expanded to include equal numbers of representatives of local mental health authorities, community mental health service providers, private mental health service providers, local government officials, advocates for individuals with mental health needs, consumers of mental health services, family members of individuals with mental health needs, and other individuals with expertise in the field of mental health. A local mental health authority shall develop a local network development plan for review and approval by DSHS regarding the configuration and development of the local mental health authority’s provider network. The plan must reflect local needs and priorities and maximize consumer choice and access to qualified service providers. The executive commissioner shall adopt rules for the roles and responsibilities of local mental health authorities for Medicaid programs which shall include: access; intake; eligibility functions; enrollment, initial person-centered assessment, and service authorization; utilization management; safety net functions, including crisis management services and assistance in accessing facility-based care; service coordination functions; provision and oversight of state general revenue services; local planning functions; and processes to assure accountability in performance, compliance, and monitoring. DSHS shall establish an online clearinghouse of information relating to best practices of local mental health authorities regarding the provision of mental health services, development of a local provider network, and achievement of the best return on public investment in mental health services. A local mental health authority may serve as a provider of services if, through the local network development plan process, the local authority determines that at least one of the following applies: 1) interested qualified service providers are not available to provide services or no service provider meets the local authority’s procurement requirements; 2) the local authority’s network of providers does not provide a minimum level of consumer choice by presenting consumers with two or more qualified service providers in the local authority’s network for service packages and presenting consumers with two or more qualified service providers in the local authority’s network for specific services within a service package; and 3) the local authority’s provider network does not provide consumers in the local service area with access to service at least equal to the level of access provided as of the a date the executive commissioner specifies: a) the combined volume of services delivered by qualified service providers in the local network does not meet all of the local authority’s service capacity for each service package identified in the local network development plan; b) the performance of the services by the local authority is necessary to preserve critical infrastructure and ensure continuous provision of services; or, c) existing contracts or other agreements restrict the local authority from contracting with qualified service providers for services to the local network development plan. If a local mental health authority continues to provide services, the local authority shall identify in its local network development plan; a) the proportion of its local network services that the local authority will provide; and b) the local authority’s basis for its determination that the local authority must continue to provide services.

HB 2524 by Ruth Jones McClendon and Leticia Van de Putte: PILOT PROJECT: The DSHS shall develop a pilot project in Bexar County to address jail overcrowding by diverting persons with mental illness or substance abuse problems to inpatient and outpatient services using a public safety triage and detoxification unit.

HB 109 by Sylvester Turner and Kip Averitt: CHILD HEALTH PROGRAM: The HHSC is to conduct a community outreach and education campaign to provide information relating to the availability of health benefits for children under Medicaid. The eligibility period for coverage under the child health plan shall not exceed 12 months. During the sixth month of enrollment, the commission shall review the net family income to determine whether or not it exceeds income eligibility limits.

HB 724 by Burt Solomons and Mike Jackson: WORKER’S COMPENSATION: A party to a medical dispute regarding health care provider fees or an appeal of an independent review organization decision regarding determination of medical necessity is entitled to a contested case hearing. If the party is aggrieved by the decision, the party may seek judicial review of the decision.

HB 1003 by Helen Giddings and Kirk Watson: WORKER’S COMPENSATION: Utilization review agents performing reviews of health care services under Worker’s Compensation for an independent review organization must be doctors licensed to practice in Texas.

HB 1005 by Helen Giddings and Leticia Van de Putte: WORKER’S COMPENSATION: A health care provider who erroneously submits a claim for payment forfeits the right to reimbursement for the claim if the provider fails to submit the claim to the correct worker’s compensation carrier within 95 days after the date the provider is notified of the erroneous submission of the claim.

HB 1006 by Helen Giddings and Kirk Watson: WORKER’S COMPENSATION: Utilization review agents or an insurance carrier that uses doctors to perform reviews of health care services provided under Worker’s Compensation, including utilization review and retrospective review, or peer reviews, may only use doctors licensed to practice in Texas.

HB 1579 by Ryan Guillen and Robert Deuell: REIMBURSEMENT FOR SERVICES OUTSIDE OF REGULAR BUSINESS HOURS: A federally qualified health center, rural health clinic or municipal health department’s public clinic is to be reimbursed for health care services provided to a recipient receiving medical assistance through any Medicaid managed care model or arrangement outside of regular business hours, including on a weekend or holiday, at a rate that is equal to the allowable rate for those services.

HB 1594 by John Zerwas and John Carona: EXPEDITED CREDENTIALING: Establishes procedures for expedited credentialing of a physician who is joining a medical group with a contract with a managed care plan. To qualify for expedited credentialing, an applicant physician must be licensed by and be in good standing with the Texas Medical Board; submit all documentation required by the issuer of the managed care plan, and agree to comply with the terms of the managed care plan’s participating provider contract.

SB 10 by Jane Nelson and Dianne Delisi: MEDICAID REFORM: A major bill designed to increase access to health insurance and to ensure that services are delivered as efficiently as possible under the Medicaid program. Allows the HHSC to contract for the implementation of an acute care Medicaid billing coordination system for the fee-for-service and primary care case management delivery models that will identify within 24 hours whether another entity has primary responsibility for paying the claim and submit the claim to the entity the system determines is the primary payor. The HHSc is to provide medical transportation services for clients of eligible health and human services programs. HHSC is to develop and implement a pilot program under which Medicaid recipients are provided positive incentives to lead healthy lifestyles. If feasible, HHSC is to develop and impalement a Medicaid health savings account pilot program that is consistent with federal law. The HHSC may seek a waiver to develop and implement tailored benefit packages. The HHSC is to identify state or federal non-Medicaid programs that provide health care services to persons whose health care needs could be met by providing customized benefits. The HHSC is to study the feasibility of increasing the use of technology to strengthen the detection and deference of fraud in the Medicaid program. The HHSC may seek a waiver to the state Medicaid plan to allow the commission to more efficiently and effectively use federal money paid to the state under various programs to defray costs associated with providing uncompensated care. Subject to the granting of a waiver, a Texas health opportunity pool trust fund will be created as a trust fund outside the state treasury to be held by the comptroller and administered by the HHSC on behalf of residents who do not have private health benefits coverage and health care providers providing uncompensated care for these residents. The HHSC may develop and implement a demonstration project to determine whether paying an enhanced Medicaid reimbursement rate to a nursing facility that provides continuous, on-site oversight of residents by physicians specializing in geriatric medicine results in improved overall health of residents and cost savings resulting from a reduction of acute care hospitalization and pharmaceutical costs. The HHSC is to establish outcome-based performance measures and incentives to include in each contract between a HMO and the HHSC for the provision of health care services to recipients that is procured and managed under a value-based purchasing model. A regional or local health care program may contract with health care providers within the boundaries of the participating county or counties to provide health care services to the employees of participating small employers and the dependents of those employees. If feasible, the HHSC may require each recipient of medical assistance to designate a primary provider with whom the recipient will have a continuous, ongoing professional relationship and who will provide and coordinate the recipient’s initial and primary care, maintain the continuity of care provided to the recipient, and initiate any referrals to other health care professionals. If feasible and permitted under federal law, the HHSC may adopt cost-sharing provisions that require a recipient who chooses a high-cost medical service provided through a hospital emergency room to pay a copayment, premium payment, or other cost-sharing payment for the high-cost medical service. The HHSC shall develop and implement a pilot program for providing health information technology, including electronic health records, for use by primary care providers who provide medical assistance to recipients.

SB 24 by Jane Nelson and Susan King: TELEMEDICINE: Permits HHSC to reimburse under Medicaid telemedicine medical service provided by a physician who is assessing and evaluating the patient from a distant site if a health professional acting under the delegation and supervision of that physician is present with the patient at the time the service is provided and the medical condition, illness or injury for which the patient is receiving the service is not likely, within a reasonable degree of medical certainty, to undergo material deterioration within the 30-day period following the date of the service.

SB 760 by Jane Nelson and Dianne Delisi: TELEMEDICINE: Encourages health care providers and health care facilities to participate as telemedicine medical service providers in the health care delivery system.

SB 1694 by Jane Nelson and Jim Jackson: MEDICAID FRAUD INVESTIGATIONS: Allows a participating agency to submit a written request for information regarding a health care professional or managed care organization that is the subject of an investigation by the participating agency to any other participating agency. "Participating agency" means the Medicaid fraud enforcement division of the office of the attorney general and each board or agency with authority to license, register, regulate, or certify a health care professional or managed care organization that may participate in the state Medicaid program. A participating agency that discovers information that may indicate fraud or abuse by a health care professional or managed care organization may provide that information to any other participating agency unless the release of the information is prohibited by law.

SB 1731 by Robert Duncan and Carl Isett: CONSUMER ACCESS TO FINANCIAL INFORMATION: A comprehensive bill which includes a provision that allows consumers to access via the internet facility pricing practices.

HB 431 by Jerry Madden and John Whitmire: CRIMINAL PROCEDURE: A judge sentencing a person convicted of a state jail felony may release the person to a medical care facility or medical treatment program if the Texas Correctional Office on Offenders with Medical or Mental Impairments identifies the person as being elderly, physically disabled, mentally ill, terminally ill, mentally retarded or having a condition requiring long-term care and in cooperation with the community supervision and corrections department serving the sentencing court, prepares for the defendant a medically recommended intensive supervision plan.

HB 1545 by Aaron Pena and Robert Duncan: CRIMINAL PROCEDURE: If the court of criminal appeals enters a judgement that a defendant is not incompetent to be executed, the court may withdraw any stay of execution and the trial court may set an execution date.

SB 778 by Chris Harris and Vicki Truett: APPLICATIONS FOR EMERGENCY DETENTION: Provides a procedure to permit a physician to present an application for emergency detention by secure electronic means, including satellite transmission, closed-circuit television transmission, or any other method of secured two-way electronic communication.

HB 2580 by Ellliott Naishtat and Jane Nelson: FOSTER CHILDREN: The Department of Family and Protective Services may designate the child’s foster parent or the child’s parent, if the parent’s rights have not been terminated, to exercise the duty and responsibility of providing informed consent on behalf of the department.

SB 758 by Jane Nelson and Patrick Rose: CHILD PROTECTIVE SERVICES: If a child is transferred from a reporting medical facility to another medical facility to treat the injury or condition that formed the basis for the original report, the transferee medical facility shall, at the department’s request, release to the department records relating to the injury or condition without requiring parental consent or a court order. The department shall have a goal of privatizing case management services to 5% of the cases in which the department has been appointed temporary or permanent managing conservator of a child. Establishes a committee on pediatric centers of excellence which will develop guidelines for designating regional pediatric centers of excellence, develop procedures and protocols for physicians, nurses, hospitals, and other health care providers to follow in evaluating suspected cases of child abuse and neglect and methods to finance the centers of excellence and service.

HB 1066 by Diane Delisi and Jane Nelson: ELECTRONIC HEALTH RECORDS: Establishes the Texas Health Services Authority as a public-private collaborative to implement state-level health information technology.

HB 2042 by Dawnna Dukes and Jane Nelson: DATABASE OF MEDICAID PROVIDERS: Requires the HHSC to establish and administer an electronic, searchable, Internet-based database of all participating providers of the Medicaid program.

SB 36 by Jane Nelson and Craig Eiland: TEXAS MEDICAL BOARD: An applicant who, on September 1, 2005, held a physician-in-training permit or had an application for the permit pending before the Texas Medical Board must pass each part of the examination within three attempts, except that, if the applicant has passed all but one part of the examination within three attempts, the applicant may take the remaining part of the examination one additional time. However, an applicant is considered to have satisfied the requirements if the applicant: passed all but one part of the examination within three attempts and passed the remaining part of the examination within six attempts; is specialty board certified; and has completed in this state an additional two years of postgraduate medical training approved by the board.

SB 44 By Jane Nelson and Yvonne Gonzalez Toureilles: FAMILY VIOLENCE: Includes a provision requiring the accreditation of providers offering services for battering intervention and prevention services as well as the development of guidelines for battering intervention and prevention services. The accreditation and guidelines will be issued through the Community Justice Assistance Division of the Texas Department of Criminal Justice.

SB 839 by Robert Duncan and Jerry Madden: AGENCY EXCHANGE OF INFORMATION: Requires the following agencies to adopt a memorandum of understanding that establishes their respective responsibilities to institute a continuity of care and service program for offenders with mental impairments in the criminal justice system: Dept. of Criminal Justice, the Dept. Of State Health Services, the bureau of identification and records of the Dept. Of Public Safety, representatives of local mental health or mental retardation authorities appointed by the commissioner of DSHS, and the directors of community supervision and corrections departments.

SB 1107 by Kirk Watson and Elliott Naishtat: EMPLOYMENT OF PHYSICIANS: Allows a hospital district to employ physicians and employ a physician as a medical director if the physician provides only policy, administrative and managerial services, and does not provide direct patient care or otherwise practice medicine at or for the district. This is applicable only to a hospital district created in a county with a population of more than 800,000 that was not included in the boundaries of a hospital district before September 1, 2003.