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6 Document(s) [ Subject: Patient Protection and Affordable Care Act ]

Committee: Senate Business and Commerce
Title: Interim Report
Subjects: Electric utilities | Electric utility deregulation | Electric utility rates and charges | Emergency management | Flood insurance | Flood plains | Health insurance | Health insurance exchanges | Home equity lines of credit | Home equity loans | Hurricane Harvey | Mortgages | Natural disasters | Occupational licenses | Patient Protection and Affordable Care Act | Privacy | Social networking websites | Texas Constitution | Wills and estates |
Library Call Number: L1836.85 B963
Session: 85th R.S. (2017)
Online version: View report [133 pages]
Charges: This report should address the charges below.
1. Study infrastructure security and energy restoration post weather events. Identify ways state government entities can help utilities more effectively stage pre-hurricane mobilization crews for managing resources before an event.
2. Examine state mortgage requirements regarding the notification of homebuyers on their need for flood insurance in flood plains and flood pool areas and make recommendations on how to better inform consumers.
3. Examine local government regulations, including occupational licenses, as related to Hurricane Harvey and determine if any are a detriment to rebuilding efforts.
4. Examine and make recommendations on the need for changes to the Texas Constitution for home equity lenders to offer various forms of relief to Texas homeowners affected by natural disasters including, among others, the authority to enter into deferment agreements. This examination should include a study of home equity rules regarding negotiation, modification and refinancing and whether constitutionally established time periods can be waived in times of disasters.
5. Free Market Electricity: Examine the competitive nature of the Texas retail electric system and what government competitive intrusions in the free energy markets may have in distorting those markets. Review the impact of competitive versus noncompetitive retail electricity markets across the state in terms of price and reliability. Consider the projected impact of establishing competitive electric retail markets statewide.
6. Health Insurance Market Stability: Study the factors affecting health insurance markets in Texas, particularly the individual market, including federal and state law. Make recommendations that would result in increased stability in the markets and enhance value and affordability for individual consumers and businesses. Examine what steps the state needs to take to allow out-of-state health insurance sales. In developing its recommendations, the committee should consider the flexibility afforded to states by 1332 "state innovation" waivers, which allow states to modify or eliminate tax penalties associated with individual and employer coverage mandates; modify requirements for benefits and subsidies; and find alternative ways to provide benefit plan choices, determine eligibility for subsidies, and enroll consumers.
7. Licensing and Fees: Review licensing requirements and fees imposed on entities within the committee's jurisdiction. Make recommendations for state licenses and fees that should be reduced, repealed or transitioned to private-sector enforcement.
8. Social Media Access: Study access issues regarding digital assets of decedents. Study social media privacy laws and whether job applicants and students' privacy is jeopardized under current law.
9. Examine the 2018 electric reliability forecasts announced by ERCOT and review how expected diminished reserve markets will impact the rates of residential and business consumers. Monitor current mechanisms available to ERCOT to ensure grid reliability, identify trends in the wholesale electric market, and make recommendations to maintain grid reliability moving forward.
10. Monitoring Charge: Monitor the implementation of legislation addressed by the Senate Committee on Business and Commerce during the 85th Legislature, Regular Session, including: • The implementation of legislation to deregulate occupational licensing; • The settlement of out-of-network health benefit claims involving balance billing and patient's explanation of benefits statements; and • Make recommendations regarding any additional legislation needed to improve, enhance, and/ or complete implementation.
Committee: Senate Health and Human Services
Title: Interim Report
Subjects: Cancer Prevention and Research Institute of Texas | Child abuse | Child Protective Services | Computers and government | Contraceptives | Dental Examiners, Texas State Board of | Family planning | Foster care | Healthy Texas Women | Homelessness | Medicaid | Medicaid fraud | Medically uninsured | Mental health services | Mentally ill persons | Office of Inspector General, Health and Human Services Commission, Texas | Patient Protection and Affordable Care Act | Substance abuse | Temporary Assistance for Needy Families | Welfare eligibility | Welfare reform | Welfare-to-work | Women's health |
Library Call Number: L1836.83 H349
Session: 83rd R.S. (2013)
Online version: View report [58 pages]
Charges: This report should address the charges below.
1. Review the Department of Family and Protective Services’ efforts to reduce child fatalities. Review the process by which the Department of Family and Protective Services collects and uses data to evaluate agency performance and improve outcomes for children in the Child Protective Services system. Make recommendations to ensure the process effectively uses data to strategically improve caseworker performance, and identify and improve upon deficiencies within the system and improve overall outcomes for children and reduce child fatalities.
2. Monitor the implementation of programs that were created or expanded by the 83rd Legislature to improve mental health and substance abuse services and assess these efforts' contribution to improved outcomes such as reduced recidivism in state hospitals, diversion from emergency rooms and county jails, and access to permanent supportive housing. Identify and address gaps in the current mental health and substance abuse system and make recommendations to better coordinate services across agencies and programs.
3. Build on previous legislative achievements in women's healthcare by examining women’s access to preventative health care, pregnancy services, and post-partum care, and exploring ways to expand access and improve quality, particularly in rural and underserved areas of the state. Monitor the implementation of women's health programs in Texas. Assess these programs' impact on outcomes such as improving access to preventative services, reducing unplanned pregnancies, and achieving cost savings. Recommend ways to better coordinate the various programs in a manner that increases the number of women served, ensures adequate provider capacity statewide, and maximizes efficiencies to the state.
4. Identify cost-effective alternatives to Medicaid and the Affordable Care Act to better connect low income individuals to health care services through private market-based solutions, including Medicaid block grants and waivers. Recommendations should strive to encourage cost sharing, promote personal responsibility, reduce uncompensated care costs, contain increasing health care costs, improve access to care, address access to emergency department care issues in rural areas, promote the use of existing private coverage or employee sponsored coverage, reduce non-­?emergency use of emergency departments, and reduce the need for federal approval to the state Medicaid plan.
5. Evaluate the Temporary Assistance for Needy Families (TANF) program structure. Make recommendations to improve the program's operations and ensure the program achieves outcomes that allow TANF recipients to find employment and achieve self-sufficiency. Recommendations should seek to ensure Texas is using the most effective work-related requirements and drug testing protocols.
6. Evaluate the current state of prescription drug abuse and strategies for reducing prescription drug abuse in Texas. Make recommendations on how these policies can be improved or modified to enhance the State of Texas’ handling of services, treatments and education related to prescription drug abuse and to reduce the overall prevalence of prescription drug abuse.
7. Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 83rd Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
  • Monitor implementation of initiatives aimed at improving the quality and efficiency of Medicaid long-term care services and supports, including the redesign of services for individuals with intellectual and developmental disabilities.
  • Monitor implementation of initiatives aimed at reducing fraud, waste, and abuse in Texas Medicaid and other health and human services programs.
  • Dental Board Reforms: Monitor implementation of initiatives aimed at improving the State Board of Dental Examiners' ability to protect public safety, including strengthening the Board's authority and enforcement powers, improving the complaint review and resolution processes, and increasing staffing to improve the Board's ability to respond to complaints and potential fraudulent activity. Determine whether there are additional changes necessary to ensure that the Board is able to regulate the practice of dentistry and ensure public safety.
  • Cancer Prevention and Research Institute: Monitor implementation of initiatives aimed at restructuring the governance structure, eliminating conflicts of interest, and increasing transparency at the Cancer Prevention and Research Institute of Texas (CPRIT).
Committee: Senate State Affairs
Title: Interim Report
Subjects: Biometric identification | Cellular telephones | DNA databases | e-government | Electronic surveillance | Employees Retirement System of Texas | Health care costs | Health care navigators | Health insurance exchanges | Health insurance pools | Legislature, Texas | Medical billing | Patents | Patient Protection and Affordable Care Act | Personally identifiable information | Privacy | Rules of the Texas Senate | Search warrants | Searches and seizures | Small businesses | Teacher Retirement System of Texas | Texas Health Insurance Risk Pool | Texas Legislature Online | Texas Mutual Insurance | Websites | Workers' compensation |
Library Call Number: L1836.83 St29a
Session: 83rd R.S. (2013)
Online version: View report [128 pages]
Charges: This report should address the charges below.
1. Examine the negative economic impact on Texas business from legal issues involving threatened and actual patent litigation by "patent assertion entities" (PAEs). Consider the effects of PAE actions on innovation and economic development in Texas, paying particular attention to threats and lawsuits involving software and technology patent claims. Make recommendations on how the State of Texas can address problems related to frivolous legal actions and unsubstantiated patent claims asserted against legitimate business enterprises in light of the relevant federal jurisdiction, laws, regulations, and court rules in patent cases.
2. Examine possible measures to protect the personal privacy of Texas residents from governmental and commercial surveillance, including: (1) any necessary limits on warrantless search and seizure of data from electronic devices and wireless providers, including digital content and geolocational data; (2) any necessary protections against non-consented video and audio recordings collected by private handheld and wearable mobile devices and other private surveillance; and (3) any necessary limits on warrantless monitoring of the physical location of individuals through the use of biometrics, RFID chips, facial recognition, or other technologies. Examine related measures proposed or passed in other states.
3. Review the types and scope of personal data collected by governmental and commercial entities and consider methods to minimize the government’s collection of data on its citizens. The study should include: (1) whether sufficient protections exist for DNA samples and information, including whether there should be a prohibition on the creation of DNA databases, except for felons and sex offenders; (2) methods to protect the privacy of gun owners from aggregated purchasing pattern tracking; (3) mechanisms to ensure that private health care information is properly protected; and (4) ways to ensure that previously anonymous data is not improperly re-identified and marketed. Examine related measures proposed or passed in other states.
4. Examine possible reforms designed to increase citizens' ability to know what data is being collected about them by governmental andcommercial entities and with whom that data is being shared, including an analysis of consumer informed consent. Examine related measures proposed or passed in other states.
5. Study the online legislative resources available to the public from Texas Senate Committee websites and compare esources to those provided by other state legislative committees in Texas and other states. Determine how Texas Senate websites can be improved to provide a more interactive and transparent government.
6. Study the emerging negative impacts of the Federal Affordable Care Act, including the use of navigators, and make recommendations to mitigate any unintended consequences including rising health insurance premiums, lack of access to healthcare, mishandling of Texans' private information by insufficiently-trained navigators, and the Act’s overall effect on Texas employers and insurance consumers. Evaluate free-market alternatives to the Act, including state-led proposals to repeal, reduce or replace the Act. Closely monitor and make recommendations on the continuation of the Texas Health Insurance Pool.
7. Study and make recommendations on increasing medical price transparency in Texas, including studying the impact of SB 1731, 80th Legislative Session. Analyze relevant reforms considered or implemented in other states, and make recommendations regarding potential changes designed to create a more open marketplace for enhanced consumer decision making in Texas.
8. Monitor the actuarial and financial conditions of the pension and health care programs administered by the Teacher Retirement System (TRS) and the Employees Retirement System (ERS).
9. Monitor the implementation of legislation addressed by the Senate Committee on State Affairs, 83rd Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation.
10. Study and make recommendations relative to the structure of Texas Mutual Insurance Company and the residual market for workers’ compensation insurance in Texas.
Committee: Senate Health and Human Services
Title: Interim Report
Subjects: Cancer Prevention and Research Institute of Texas | Caseworkers | Child Protective Services | Children's Health Insurance Program | Dental care | Foster care | Health care | Health care costs | Health insurance | Immunizations | Long-term care | Managed care | Medicaid | Medicaid eligibility | Medical research | Mental health services | Nursing homes | Patient Protection and Affordable Care Act | Public health | State Health Services, Texas Department of | State supported living centers |
Library Call Number: L1836.82 H349
Session: 82nd R.S. (2011)
Online version: View report [186 pages]
Charges: This report should address the charges below.
1. Monitor the potential impact of the Patient Protection and Affordable Care Act (PPACA) on insurance regulations, Medicaid and CHIP, health care outcomes and overall health of all Texans, and the state budget in Texas. Additionally, monitor the current constitutional challenges to PPACA and other court cases associated with PPACA, and ensure that the state does not expend any resources until judicial direction is clear. (Joint charge with Senate State Affairs Committee)
2. Monitor the potential impact of the Patient Protection and Affordable Care Act (PPACA) on insurance regulations, Medicaid and Children's Health Insurance Program (CHIP), health care outcomes, health care workforce, overall health of all Texans, and the state budget in Texas. Additionally, monitor the current constitutional challenges to PPACA, and other court cases associated with PPACA, and ensure that the state does not expend any resources until judicial direction is clear. (Joint charge with Senate State Affairs Committee)
3. Evaluate the implementation of cost-containment strategies across the Health and Human Services Enterprise to determine if and how each strategy can be expanded upon to achieve additional savings next biennium. The evaluation should include but is not limited to: the expansion of managed care, co-­pays in Medicaid, electronic visit verification, and independent assessments for long-­? term care services. The evaluation should also consider new cost-containment strategies that will increase efficiencies and reduce costs. This evaluation should include but not be limited to: Medicaid, Early Childhood Intervention Services, and immunizations.
4. Review the state's current investment in health care innovation, including translational research and the Cancer Prevention Research Institute, which focuses on rapid transfer of new technology experimentation directly into the clinical environment. Make recommendations to improve the health of Texans and encourage continued medical research in the most cost-effective manner possible.
5. Review existing policies for prior authorization and medical necessity review across the Medicaid Program, including nursing homes and orthodontic services. Make recommendations on how these policies could be improved to save money by reducing unnecessary utilization and fraud.
6. Review the Medicaid Home and Community Based Services Waivers to identify strategies to lower costs, improve quality, and increase access to services. Areas of the review should include, but are not limited to:
  • Functional eligibility determinations to ensure services are only being delivered to individuals that qualify;
  • Financial eligibility determinations to ensure parental income and resources are considered when the client is a minor;
  • Coordination of acute and long-term care services;
  • Development and use of lower-cost community care waiver options;
  • Coordination with the Department of Family and Protective Services (DFPS) for waiver services for children in conservatorships;
  • Reinvesting savings into accessibility of community care for individuals waiting for services.
7. Evaluate the management structure and supervision of CPS caseworkers with an emphasis on rural areas. Identify any legislative changes that could assist DFPS in maximizing efficiency, improving quality casework and supervision, and increasing caseworker retention. Identify any legislative changes that could improve the quality of care children receive while in Child Protective Services custody, including improving permanency outcomes.
8. Examine the delivery and financing of public health services in our state, including how federal funds are distributed by the state to local health departments and whether the work done by Regional Health Departments operated by the Department of State Health Services overlap unnecessarily with local health departments.
9. Review the state's public mental health system and make recommendations to improve access, service utilization, patient outcomes and system efficiencies. Study current service delivery models for outpatient and inpatient care, funding levels, financing methodologies, services provided, and available community-based alternatives to hospitalization. The review should look to other states for best practices or models that may be successful in Texas. The study shall also review and recommend "best value" practices that the state's public mental health system may implement to maximize the use of federal, state, and local funds.
10. Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
  • Health Care Quality and Efficiency - Monitor implementation of initiatives aimed at improving health care quality and efficiency in Texas, including: the transition of Medicaid and the CHIP to quality-based payments, establishment of the Texas Institute of Health Care Quality and Efficiency, implementation of the Health Care Collaborative certificate, patient-centered medical home for high-cost populations, development and use of potentially preventable event outcome measures, and reduction of health care-associated infections. Include recommendations on how to improve and build upon these initiatives, including improving birth outcomes and reducing infant and maternal mortality;
  • Federal Flexibility - Monitor implementation of initiatives to increase state flexibility, including the Health Care Compact and the Medicaid Demonstration Waiver;
  • Foster Care Redesign - Monitor implementation of the initiative to redesign the foster care system;
  • Implementation of DOJ Settlement agreement to address State Supported Living Center concerns.
Committee: House Public Health
Title: Interim Report
Subjects: Dental care | Dental Examiners, Texas State Board of | Farmers | Food safety | Health care costs | Hunger | Medicaid | Medical education | Medical records | Nurse practitioners | Patient Protection and Affordable Care Act | Physician assistants | Physician shortages | Property tax exemptions | Public health | School nutrition | Small farms | State hospitals | Supplemental Nutrition Assistance Program |
Library Call Number: L1836.82 H349h
Session: 82nd R.S. (2011)
Online version: View report [66 pages]
Charges: This report should address the charges below.
1. Examine the adequacy of the primary care workforce in Texas and assess the impact of an aging population, the passage of the Patient Protection and Affordable Care Act, and state and federal funding reductions to graduate medical education and physician loan repayment programs. Study the potential impact of medical school innovations, new practice models, alternative reimbursement strategies, expanded roles for physician extenders, and greater utilization of telemedicine. Make recommendations to increase patient access to primary care and address geographic disparities.
2. Study the various health registries maintained by the state, including the similarities and differences in reporting, consent, security, and portability of data. Assess registry compliance with standards for the protection and transmission of registry data and identify any additional steps necessary to ensure security, efficiency, and utilization.
3. Monitor implementation of the federal Patient Protection and Affordable Care Act, including any changes that may result from ongoing litigation or legislative modification or repeal. (Joint with the House Committee on Insurance)
4. Identify policies to alleviate food insecurity, increase access to healthy foods, and incent good nutrition within existing food assistance programs. Consider initiatives in Texas and other states to eliminate food deserts and grocery gaps, encourage urban agriculture and farmers' markets, and increase participation in the Summer Food Program. Evaluate the desirability and feasibility of incorporating nutritional standards in the Supplemental Nutrition Assistance Program (SNAP). Monitor congressional activity on the 2012 Farm Bill and consider its impact on Texas. (Joint with the House Committee on Human Services)
5. Monitor the agencies and programs under the committee's jurisdiction and the implementation of relevant legislation passed by the 82nd Legislature.
Committee: Senate State Affairs
Title: Interim Report
Subjects: Consumer credit | Eminent domain | Employee Retirement Income Security Act of 1974 | Employees Retirement System of Texas | Federal government | Firefighters | Forest Service, Texas A&M | Health insurance | Health insurance exchanges | Liability | Medicaid | Military personnel | Municipalities | Patient Protection and Affordable Care Act | Peace officers | Primary elections | Property rights | Public retirement systems | Public Safety, Texas Department of | State employee benefits | State employee turnover | States' rights | Statutes of limitation | Teacher Retirement System of Texas | Voting by mail | Voting systems | Wildfires | Workers' compensation | Zoning |
Library Call Number: L1836.82 St29a
Session: 82nd R.S. (2011)
Online version: View report [177 pages]
Charges: This report should address the charges below.
1. Study the policies and actions the State can pursue to preserve state authority and protect Texas citizens from federal overreach in the form of conditional federal grants, conditional federal preemption, and excessive legislation and regulation interfering with states' enumerated powers by Congress.
2. Examine the Texas Workers' Compensation system and make recommendations for changes to meet the needs of Texas employers and employees. Specifically, review the following:
  • the dispute resolution process and benefits available from employers that do not subscribe to workers compensation;
  • the adequacy of income benefits in the workers’ compensation system, specifically on high?wage earners receiving the maximum compensation rate;
  • identify and report on fatalities in the Workers’ Compensation System, including the amount of death and burial benefits paid to beneficiaries and the Subsequent Injury Fund since 2000;
  • the return-­to-­work numbers and results for injured employees in the Workers’ Compensation System that are referred to the Department of Assistive and Rehabilitative Services.
3. Study the feasibility and fiscal impact to consumers of altering the insurance code to allow for the purchase of health insurance across state lines.
4. Monitor the potential impact of the Patient Protection and Affordable Care Act (PPACA) on insurance regulations, Medicaid and CHIP, health care outcomes and overall health of all Texans, and the state budget in Texas. Additionally, monitor the current constitutional challenges to PPACA and other court cases associated with PPACA, and ensure that the state does not expend any resources until judicial direction is clear. (Joint charge with Senate Health & Human Services Committee)
5. Study and make recommendations on statutory provisions and judicial decisions relating to the statute of limitations on a cause of action relating to consumer debt.
6. Examine establishing a workforce retention program or deferred retirement option plan (DROP) for Texas Department of Public Safety commissioned peace officers and whether any plan can be built with actuarially sustainable factors while meeting the needs of officers.
7. Examine the feasibility of implementing Health Reimbursement Accounts and Medicare exchanges for Medicare eligible participants currently covered by and receiving health coverage through the Employees Retirement System, the Teachers Retirement System, the University of Texas, and Texas A&M University. Identify any cost savings to the state and to retirees that would occur under such a plan.
8. Consider the costs and benefits of the creation of liability protection for private companies and individuals when commissioned by the Texas Forest Service to assist in fighting a fire that is not on the company's or individual's own land. Examine whether state policy should prohibit an employer from terminating an employee who is a volunteer firefighter on the grounds that the employee missed work because the employee was responding to an emergency. Identify any appropriate limitations that should apply to such a policy.
9. Examine the effectiveness of the Private Real Property Rights Preservation Act (Chapter 2007, Government Code), and whether it should apply to municipalities.
10. Monitor the implementation of legislation addressed by the Senate Committee on State Affairs, 82nd Legislature, Regular and Called Sessions, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation. Specifically, monitor the following:
  • implementation of SB 100, relating to the implementation of the MOVE Act, and the impact on local and statewide elections and military voters;
  • implementation of the Interstate Health Care Compact.

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