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3 Document(s) [ Subject: ]

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: Senate Health and Human Services
Title: Interim Report
Library Catalog Title: Interim report to the 81st Legislature
Subjects: Adoption | Aging and Disability Services, Texas Department of | Anti-smoking campaigns | Asthma | Caseworkers | Child abuse prevention | Child Protective Services | Community support services | Disease management | Disease preparedness | Disease prevention | Family and Protective Services, Texas Department of | Family Based Safety Services | Family preservation | Foster care | Health care providers | Health Enterprise Zones | Health insurance premium subsidies | Home health care services | Immunizations | Influenza | Medicaid | Medical errors | Medical reimbursements | Medically uninsured | Mental health services | Mentally disabled persons | Nursing homes | Obesity | Persons with disabilities | Preparation for Adult Living | Rural health care | State supported living centers | Stem cell research | Umbilical cord blood |
Library Call Number: L1836.80 H349
Session: 80th R.S. (2007)
Online version: View report [379 pages  File size: 16,580 kb]
Charges: This report should address the charges below.
1. Monitor the Department of Aging and Disability Services' improvement plan for the system of care for individuals with developmental disabilities, focusing on efforts to improve state schools and provide more community care options. Evaluate the process for preventing, reporting, and investigating abuse and neglect in state schools, ICF/MRs and the Home and Community-Based Services (HCS) program. Determine the short-term and long-term financial impact of increasing the number of individuals served in home or community locations and the financial impact this shift has on state schools. Monitor the department's efforts to convert institutions to community care providers through the money-follows-the-person program designed to improve access to community care services. Specifically make recommendations on:
  • how to further improve the system of care for individuals with developmental disabilities;
  • preventing, reporting, and investigating abuse and neglect;
  • developing a transition plan for reducing waiting list for community care service;
  • incentives for converting institutions into community care providers; and
  • a long term plan to address issues that result from the current federal Department of Justice investigation.
2. Study and make recommendations related to creating an outcome-based reimbursement model in Texas' Medicaid program as a way to improve quality of care, reduce medical errors, and create cost savings. Develop a pilot health care program that pays for best practices, rather than only paying for actual procedures performed. Examine the Centers for Medicare and Medicaid's (CMS) efforts to create an outcome-based system in the Medicare payment system that sanctions serious, preventable medical errors. Examine Pennsylvania's efforts to implement a similar outcome-based reimbursement model to make providers more vigilant about patient care, encourage best practices, and reduce costs in their Medicaid program. If necessary, examine other health care coverage models that have successfully incorporated an outcome-based reimbursement system. Consider pay-for-performance, options that reward good outcomes and the use of best practices, and changes to the reimbursement system that will reduce serious preventable medical errors and hospital acquired infections.
3. Study the effectiveness of the Resiliency and Disease Management (RDM) program in the mental health service delivery system, implementation of changes to the crisis care program, and recommendations for appropriate use of the mental health transformation grant. Identify strategies to increase access to services and meet future demand for services. Examine resource allocation and opportunities to maximize funding. Policy recommendations should maximize the number of inpatient psychiatric acute care beds, enhance access to outpatient services, promote the use of recovery-based services, and enhance access to community-based services.
4. Monitor the implementation of the Department of Family and Protective Services’ improvement plan to reduce caseloads for Child Protective Service caseworkers, and to provide family-based safety services and ongoing substitute care services. Evaluate the efficiency of Child Protective Services "functional units," and determine if other organizational models would allow for a reduction in caseworkers' caseloads, without increasing other administrative costs. Develop recommendations aimed at lowering individual caseloads, making casework more efficient, and improving the retention of caseworkers. Assess the viability of caseworker reimbursement as a manner to lower caseworker turnover.
5. Monitor the implementation of the Department of Family and Protective Services' plan to stabilize the foster care system and increase permanency options for children. Study placement capacity to determine how Child Protective Services can better develop the necessary adoptions or foster homes to meet the needs of children and families by increasing foster care capacity, recruiting and retaining more foster and adoptive parents, increasing the use of relative care, and developing best practices for reducing foster care placement breakdowns. This includes studying innovative ways to promote adoption and kinship care in Texas and best practices for foster/adoptive parents to improve their ability to care for abused and neglected children. Explore potential improvements and enhancements in the Preparation for Adult Living (PAL) program to increase successful transitioning from foster care to adult living. Study current death review processes for children who die while in state care.
6. Examine Texas' current strategies for preventing child abuse. Specifically study the effectiveness of current programs and how these programs compare to other state efforts. Identify national research-based solutions, including best practices and programs addressing sexual abuse. Explore promising existing and emerging approaches to child abuse and neglect prevention, especially those with a strong evidence base. Identify additional funding sources for increased child abuse prevention activities by the state.
7. Study the changes in statute contained in SB 10, 80th Legislature, Regular Session, as well as the state's current prevention and wellness efforts and chronic care management efforts, and identify opportunities for improvement in state policies and programs. Examine options for expanding and optimizing the state's current investment in wellness programs and management tools for individuals with chronic care conditions, including options that address childhood asthma. Review partnerships with the private sector that specifically address the following:
  • tobacco cessation, including the evaluation of a statewide smoking ban in public places;
  • reducing obesity;
  • availability and effectiveness of childhood and adult vaccines, including public education programs to promote the use of vaccines; and
  • more effective management of chronic care conditions.
8. Study the effectiveness and efficiency of nursing homes and home-based solutions/home care in Texas, and make recommendations to improve nursing homes and their funding. Identify and study successful nursing home funding models established by other states. Consider ways to fund infrastructure for nursing and therapists and home care. Examine the possibility of an incentive-based “pay for performance” rate plan for nursing facilities and consider factors that it could be based on, taking into account similar plans implemented in other states. Make recommendations on how best to use Medicaid to fund skilled nursing and home health care in Texas. Explore options for improving graduation rates for nurses in Texas.
9. Study and address ethical issues surrounding the impact of a pandemic influenza in this state, particularly focusing on the following:
  • the availability of human and material resources;
  • the benefits and burdens of mass vaccination plans;
  • the involvement of private sector professional organizations and businesses in the state's pandemic influenza preparedness and response plans; and
  • development and implementation of communication plans that will inform and prepare the public on risk reduction behaviors and local/state preparedness and response.
10. Study the potential for development of Health Enterprise Zones, which could offer tax incentives to medical providers who locate within the boundaries of designated medically underserved areas. Analyze similar legislation enacted in other states, specifically New Jersey, and estimate costs and benefits. Consider expanding incentives to medically related industries such as medical research facilities, laboratories and equipment manufacturers in order to spur economic development.
11. Monitor the collection and availability of cord blood stem cells for treatments and research in Texas. Review the current state of basic and clinical research using these and other types of adult stem cells. Assess the potential for clinical and economic benefits from current and increased adult stem cell research.
12. Review Medicaid provider reimbursement rate methodologies, including the impact of factors such as infrastructure concerns, federal minimum wage changes, and cost reports. Study the impact on access to care, quality of care, and value, and make recommendations for legislative changes, taking into account rate increases contained in the current budget. (Joint charge with Senate Finance Committee)
13. Study the state's current and long-range need for physicians, dentists, nurses, and other allied health and long-term care professionals. Make recommendations on how the state can help recruit high-need professions, especially for primary care providers and long-term care professionals in the underserved regions of Texas. (Joint charge with the Senate Committee on International Relations and Trade)
14. Monitor the implementation of legislation addressed by the Health and Human Services Committee, 80th Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation. Specifically, report on the implementation of SB 10, 80th Legislature, Regular Session, to ensure meaningful improvement in access to quality care in the Texas Medicaid program, focusing on how to cover more uninsured in Texas with market-based plans or premium assistance for employer health plans, and monitor the creation of the Texas Cancer Research and Prevention Institute.
Committee: Senate Health and Human Services
Title: Interim Report
Library Catalog Title: Interim report to the 80th Legislature
Subjects: 211 telephone system | Adult Protective Services | Caseworkers | Child nutrition programs | Child Protective Services | Children's Health Insurance Program enrollment and eligibility | Children's mental health | Community support services | Diet and nutrition | Family and Protective Services, Texas Department of | Federally qualified health centers | Guardianship | Health care | Immunizations | Influenza | Medicaid | Medical assistants | Mental health services | Mentally ill inmates | Mentally ill persons | Nurses | Nursing shortages | Obesity | Pharmacists | Physical fitness | Physicians | Social service agencies | Stem cell research | Telemedicine | Texas Emerging Technology Fund |
Library Call Number: L1836.79 H349
Session: 79th R.S. (2005)
Online version: View report [201 pages  File size: 3,167 kb]
Charges: This report should address the charges below.
1. Study and make recommendations for improving delivery of Texas' mental health services; consider local and regional delivery systems including access to care, cost effectiveness, choice and competition, and quality of care.
2. Monitor state and federal Medicaid reform proposals, including their impact on the Medicaid program in Texas, as well as cost-containment measures in other states, and make recommendations for legislative action, as appropriate.
3. Study and make recommendations relating to filling shortages in the health care workforce and improving medical educational services. Evaluate the state's use of the National Health Service Corps and Federally Qualified Health Centers (FQHCs) to address the needs of the Medicaid/Medicare and underinsured populations
4. Examine the strategies used by other states that have had success with FQHCs and make recommendations for increasing the number of FQHCs in Texas.
5. Study and make recommendations relating to policy issues surrounding the use of emerging skin cell research, and other technologies.
6. Study and make recommendations for improving vaccination rates and ensuring an adequate vaccination supply in the state. Include an analysis of vaccine manufacturing and purchasing policies.
7. Evaluate and make recommendations relating to the creation of a comprehensive and statewide nutrition and physical activity plan to address obesity and chronic diseases. Examine options for funding components of such a plan.
8. Monitor the implementation of SB 6, 79th Legislature, Regular Session, relating to Child and Adult Protective Services. Study and make recommendations for development and enhancements to protocols for joint investigations by child protective service workers and law enforcement and for interviews with children for disclosure of abuse.
9. Study the current use of the 2-1-1 network to provide access to information on federal, state, and local resources. Examine and make recommendations on strategies that improve the coordination of service information and expand the availability of information on services currently provided by community and faith-based organizations.
10. Monitor the implementation of HB 2292, 78th Legislature, Regular Session, relating to health and human services. Focus on implementation of service coordination and consolidation efforts to assess the impact on service quality, while reducing costs.

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