Legislative Interim: Texas hospitals’ year-round policy work

Special to Medical Journal – Houston BY TED SHAW, President/CEO, Texas Hospital Association

Packed with lively debates, committee hearings that continue into the early morning hours and nonstop news coverage, it’s no surprise that Texas’ biannual legislative sessions get all the attention for addressing the state’s public policy needs.

Because Texas’ legislative sessions last for about four months every two years, there’s a misconception that work on these policy issues occurs part-time. In reality, however, work on the state’s policy priorities occurs year-round.

The interim—the period between the end of one legislative session and the beginning of the next—is just as busy and just as important, and Texas hospitals have a vital role.

In the 140 short days of the legislative session, Texas lawmakers introduce bills and shepherd them through a labyrinth of procedural hoops and deadlines, with the hope that they will become law. This timetable leaves little time to tease out complex issues, so policymakers use the interim to study important issues or “interim charges” prior to the upcoming session. The Speaker of the Texas House of Representatives and the Lieutenant Governor kick off the interim work by distributing “charges” or specific topics for the committees in their respective chambers to study, consider in legislative hearings and issue recommendations.

Texas hospitals, in turn, use the interim to educate lawmakers on issues and policy priorities that will inform their upcoming legislative agenda and identify meaningful solutions to some of the industry’s most pressing challenges.

In addition to county revenue tax caps and funding for trauma hospitals, lawmakers are considering a number of interim charges that impact Texas hospitals leading up the 2019 legislative session next January, including the impact of opioid misuse and substance use, the state’s use of the “Rainy Day” Fund, federal health care reform, health care cost transparency and workforce issues. Also consuming much of the interim focus is Hurricane Harvey.

Nearly every committee in the Texas Senate and House of Representatives will study different aspects of the hurricane—from the public health response to how the state will better prepare for future disasters.

The interim is a time for looking ahead to the next legislative session, but it’s also a time of rulemaking to implement the laws of the previous session.

The legislature grants state agencies rulemaking authority to implement the laws it passes and enforce day-to-day compliance with those laws. The Texas Health and Human Services Commission, for example, sets new or amends existing health policy through its rules.

Engaging THHSC on its rules is another opportunity for Texas hospitals to affect policy decisions in the interim. If a proposed rule would have significant consequences for Texas hospitals or patients, Texas hospitals submit written comments requesting clarification or specific rule changes and attend administrative hearings on the rule.

This interim will be marked by Texas hospitals’ work to comply with the new $25 billion Medicaid 1115 Waiver. In order to obtain this funding, THHSC must set new policies and amend existing ones to govern the distribution of vital hospital supplemental payments. Implementing the new funding policy to regulate uncompensated care payments that cover some of hospitals’ costs for care provided to the uninsured is first up on the rulemaking agenda.

The months leading up to the 2019 legislative session are an opportunity for the Texas hospital community to advance good health care policy so that all Texas hospitals can continue providing the best possible care to patients in every community across the state.