2001 Legislative Compendium: Public Health and Science

Border Health | Health Coverage for the Uninsured | Child and Adolescent Health | Chronic Disease Prevention and Control | Public Health Protection and Promotion | Infectious Diseases | EMS and Trauma | Genetics | Tobacco Prevention and Control Funding

BORDER HEALTH

In the past five years, much legislative attention has been dedicated to improving the economic and health care infrastructure of the Texas-Mexico border. In 2001, the legislature continued to focus considerable time and resources on border health, implementing measures ranging from increased immunization funding to a study of a binational health benefit plan. 

For physicians, much of the debate about border health related to Medicaid funding, particularly for pediatricians and family physicians treating a high volume of Medicaid- and CHIP-eligible children.  To vocalize their concerns, border medical societies formed the Border Physician Coalition for Medicaid Access, joining forces with TMA to advocate a Medicaid rate update and eligibility simplification for children. Detailed analyses of medicine's 2001 Medicaid accomplishments are outlined in the "Medicaid" section. Outlined below is a recap of border Medicaid legislation as well as summaries of legislation specifically related to border health care.

Medicaid Legislation Impacting the Texas-Mexico Border
The Texas Legislature allocated $50 million in new state monies to update the Medicaid fee schedule for professional services. Combined with $75 million in federal matching monies, Texas will invest $125 million over the next two years to enhance payments for physicians and allied health professionals. 

Legislators' growing concerns about inadequate health care access along the border prompted state budget writers to target much of the new monies to "high-volume" practitioners living in border and other underserved communities. Additionally, the Texas Legislature enacted two bills creating workgroups to examine how to improve Medicaid funding along the Texas-Mexico border. These workgroups will meet over the interim and report back to the Health and Human Services Commission (HHSC) in time to develop legislative recommendations for the 2003 legislative session. (Details on the workgroups are provided above in the "Medicaid Rate Setting and Reporting" section.)

Additionally, SB 1 includes a rider directing HHSC to work with the federal government to develop an "enhanced" federal matching rate for Medicaid and other federal programs operated along the Texas-Mexico border. The federal government currently pays 60 percent of Texas' Medicaid costs.  In recent years, the federal matching portion has declined, reflecting the state's economic prosperity.  However, Texas' border with Mexico presents challenges with which few other states must contend, such as high rates of new and old world diseases; public health threats such as contaminated air, water, and soil; and health care for large numbers of immigrants seeking refuge within the state. Enhancing Texas' federal Medicaid match rate would recognize Texas' unique conditions and provide much-needed funding for increased provider reimbursements, health care infrastructure development, and public health initiatives.

TMA and the Border Physician Coalition for Medicaid Access already are working closely with HHSC to devise a strategy for securing additional federal Medicaid matching dollars to address Texas' unique border health care needs.

Border Telemedicine and Telehealth Pilots
To improve health care access and patient health status along the border , HB 2700, by Rep. Norma Chavez (D-El Paso) and Sen. Robert Duncan (R-Lubbock), requires HHSC to establish Medicaid telemedicine pilots within 150 miles of the Texas-Mexico border. Before establishing the pilots, HHSC must obtain support from the local medical community and government officials. The pilots are to be implemented before Jan. 1, 2003.

TMA worked with the bill authors to include agreed-to, uniform definitions of telemedicine and telehealth as included in the omnibus telemedicine legislation, SB 789. TMA monitored carefully the progress of HB 2700 to ensure that the omnibus legislation, which carried important provisions regarding quality of care and coordinated provider participation, was not superceded by bills that focused on specific areas of health care and did not address the larger issues of quality standards and infrastructure needs.

HB 2700 specifies that the goals of the telemedicine pilots are to:

  • Improve health outcomes by expanding patients' access to and use of health screenings, prenatal care, and medical or surgical follow-up visits;
  • Periodic consultations with specialists regarding chronic disorders;
  • Triage and pretransfer arrangements; and
  • Transmission of diagnostic information.

Additionally, the pilots must establish quantifiable measures for the services delivered. The pilots also will develop applications for the delivery of care for certain medical conditions, including but not limited to pregnancy, cancer, heart disease, and diabetes.

To protect existing patient-physician relationships, the bill includes language stating that the telemedicine services should not adversely affect the delivery of traditional, face-to-face medical care . Additionally, the bill specifies that HHSC may limit the number of participants within the pilot and that participation in the pilot does entitle participants to other government services.

The definition of "telemedicine medical service" and "telehealth" are identical to those contained in SB 789, the omnibus telemedicine legislation passed this session.

The bill also provides that health facilities participating in the fund may apply for grants monies from the Telecommunications Infrastructure Fund to help subsidize the cost of obtaining telemedical equipment and infrastructure and that HHSC must establish a telemedicine advisory committee. The committee is charged with the following:

  • Evaluating the state's telemedicine policies;
  • Establishing consistent telemedicine delivery and reimbursement standards;
  • Monitoring the types of services provided via telemedicine; and
  • Coordinating activities of state agencies whose programs include telemedicine services or consultations.

Advisory committee members include representatives from HHSC, Texas Department of Health, Center for Rural Health Initiatives, Telecommunications Infrastructure Fund, Texas State Board of Medical Examiners, Texas Board of Nurse Examiners, Texas Department of Insurance, Texas State Board of Pharmacy, health science centers, experts on telemedicine medical services and telehealth services, and consumers of telemedicine or telehealth services. HHSC must establish the committee by Dec. 1, 2001.

Cross-Border HMO
HB 2498 by Rep. Pat Haggerty (R-El Paso) and Sen. Eddie Lucio (D-Brownsville) establishes an interim committee to examine the feasibility of a binational health benefit plan. As originally proposed, the bill would have established a cross-border HMO targeting uninsured Mexican nationals living or working in Texas or Mexico. Mexican health care providers would have composed the plan's network, using Texas-based health care providers only for emergency services or out-of-network specialty referrals. Border physicians and TMA strongly objected to the bill because of concerns about how the plan would be regulated and its impact on Texas physicians' liability. Because of concerns raised about the bill, the bill authors agreed to study the issue further.

The interim committee appointed to study this issue will include seven members, including a medical practitioner, hospital, and HMO representative, all chosen by the governor; a Texas House and Senate member, both from the border; and representatives of the commissioners of insurance and health. The interim committee is charged with determining the need for a binational health plan, assessing the health care needs of the border and how those needs can be served by various providers, and assessing the affordability, cost-effectiveness, and potential health impact of a binational health plan. A report is due from the committee by Oct. 1, 2002.

Study of Binational Health Plan
SB 496 by Sen. Eliot Shapleigh (D-El Paso) also directs the Texas Department of Insurance and TDH to jointly study formation of a binational health plan for uninsured Mexican nationals living in Texas and to issue a report on their findings for consideration by the 78th legislature.

Texas Tech Diabetes Research Center
HB 2510 by Representative Chavez requires the Texas Tech University System Board of Regents to establish a Diabetes Research Center at the Texas Tech University Health Sciences Center campus in El Paso by Jan. 1, 2003. The center, for which Texas Tech was appropriated $600,000 for the biennium, will develop and conduct research on diabetes and disease-related conditions and must consult with the Texas-Mexico Border Health Coordination Office of The University of Texas-Pan American. HB 2510 took effect immediately.

Prevention of Type 2 Diabetes
In response to an alarming increase in type 2 diabetes among Texas youth, the 77th Texas Legislature passed HB 2989 by Rep. Roberto Gutierrez (D-McAllen) and Sen. Leticia Van de Putte (D-San Antonio). Last session, Representative Gutierrez passed a bill establishing an acanthosis nigricans (AN) screening pilot program along the border. Acanthosis nigricans is a light brown marking on the surface of the skin that may signal high insulin levels indicative of insulin resistance. The Texas-Mexico Border Health Coordination Office of UT-Pan American conducted the program.

HB 2989 extends the pilot to a full screening program in public and private schools along the border.  In addition:

  • The screening is to be conducted at the time of vision and hearing screenings;
  • The records are to be maintained at the school and are open to local health departments;
  • Each school is required to send to the coordination office a report on the screening status of children in the school;
  • If the child tests positive for AN, the person performing the screen must send a report to the parent or guardian that includes an explanation of AN and a statement on the need for further evaluation. 

HB 2989 takes effect Sept. 1, 2001. TMA, along with the Texas Pediatric Society, provided input into the public health debate surrounding mandated screening for a condition like AN. Physicians emphasized that the program must ensure appropriate medical follow-up and counseling for patients identified as part of the screening effort.

Border Health Institute Strategic Plan
When the 76th legislature created the Border Health Institute in 1999, no provision was made requiring its governing board to develop and implement a strategic plan. SB 837 by Senator Shapleigh requires the governing board of the Border Health Institute to develop a 10-year strategic plan and update the plan biennially. The strategic plan must include:

  • Goals, objectives, and performance standards for each of the institute's programs and a description of how those programs help the institute to achieve its purposes;
  • An assessment of the needs of the institute's programs and faculty; and
  • An assessment of the institute's need for new initiatives.

The bill also requires the governing board of the institute to submit not later than Dec. 15 of each even-numbered year to the legislature and the Texas Higher Education Coordinating Board (THECB) a report concerning the strategic plan, including any recommendations for legislative action.  SB 837 takes effect Sept. 1, 2001. 

Binational Treaty on Health Issues
While Texas has attempted to address many of the health issues facing the border population in Texas, binational cooperation at the federal level is essential to address these health concerns. In 1999, the Texas Legislature called for an in-depth study of the public health infrastructure and barriers to a cooperative effort between Texas and Mexico. Results of the study indicate that differences in technology and culture affect interaction between local and state health departments.

It is in the interest of the United States to control the spread of diseases, particularly in the border region where poverty and poor health conditions provide a large incubation ground for diseases. Senate Concurrent Resolution 21 by Senator Lucio asks the U.S. Congress to establish an agreement between the United States and Mexico to reflect a commitment to the issue of public health and acknowledgment that the spread of disease is an international problem without boundaries.

Border Faculty Loan Repayment Program: Budget Rider
THECB was allocated $100,000 for the biennium for the Border Faculty Loan Repayment Program. In addition to the appropriation, a rider in Article III of the Appropriations Act allows THECB to allocate additional funds from the TEXAS Grant Program to the loan repayment program, any unexpended funds appropriated to the program by the 76th legislature to be used for the 2002-03 biennium, and any unexpended funds at the end of FY 2002 to be appropriated for the same purposes in FY 2003. 

Border Health Near Misses

State Strategic Health Plan
Currently, the Texas Statewide Health Coordinating Council prepares and reviews a proposed state health plan every six years and updates the plan biennially. The health plan may not reflect the effects of growth in trade, transportation, the economy, and population in Texas resulting from the North American Free Trade Agreement (NAFTA). The impact of these changes may overwhelm the existing public health and medical infrastructure, not only in communities along the Texas-Mexico border but throughout the state. To keep up with emerging needs, a strategic health plan to address these issues must be in place.

SB 424 by Senator Shapleigh and Rep. Garnet Coleman (D-Houston) would have required TDH to develop a state strategic plan to address concerns relating to the potential effects of NAFTA on Texas. Specifically, the proposal directed TDH to examine the potential impact of increased contact and commerce between Texas and Mexico on the health of Texas residents, health care access and delivery, and the organizational infrastructure of the health care system. 

Gov. Rick Perry vetoed the bill and in his message to the legislature indicated that his disapproval stemmed from the bill's lack of a binational approach and the "cooperation and commitment of the United Mexican States." 

Border Health TMA Staff Contacts

  • Gayle Love, Director, Public Health Department,  (512) 370-1670
  • Helen Kent Davis, Director, Office of Governmental Affairs, (512) 370-1401

HEALTH COVERAGE FOR THE UNINSURED

Teacher Health Insurance
After more than six years of pursuing health insurance coverage for the state's teachers, the Texas Legislature passed HB 3343 by Rep. Paul Sadler (D-Henderson) and Sen. Teel Bivins (R-Amarillo) establishing a statewide health care benefits program for employees of school districts, charter schools, regional education service centers, and other educational districts whose employees are members of the Teacher Retirement System (TRS). The new program becomes effective Sept. 1, 2002, and will be administered by TRS.

When implemented next year, the program initially will cover small school districts, defined as districts with fewer than 500 employees. Eighty percent of school districts fit this category. Larger districts -those with 501 to 1,000 employees - also may join but must make the decision to do so no later than Sept. 1 of this year. Larger districts that opt not to participate during the initial offering may again seek to participate in 2005, unless TRS decides that an earlier opt-in is feasible.

The legislature appropriated $1.8 billion over the biennium to fund teacher health insurance.

Prescription Drug Coverage for Seniors
HB 1094 by Rep. Patricia Gray (D-Galveston) and Sen. Mike Moncrief (D-Fort Worth) establishes a prescription drug program for low-income Medicare patients. The program will be operated like the Texas Medicaid vendor drug program, except only state dollars will be used to fund the program unless federal dollars become available. Twenty-six other states have initiated programs designed to extend prescription drug coverage to low-income seniors. However, a recent federal appeals court ruling may undermine states' efforts. In the ruling, the judge ruled that states do not have the authority to extend Medicaid vendor drug requirements beyond the Medicaid population; only the federal government retains that authority. It is not clear whether the court's ruling will affect Texas.

HHSC will lead implementation of HB 1094. The bill states that HHSC may establish copayments for program participants, utilize a prescription drug formulary, use clinically appropriate prior authorizations before accessing designated drugs, and establish a drug utilization review program to ensure the appropriate use of drugs within the program. 

In establishing rules for the new program, HHSC is required to consult an advisory committee comprising an equal number of physicians, pharmacists, and pharmacologists appointed by the commissioner.  The bill also states that the commission may require that a generic drug be dispensed unless the prescribing practitioner clearly indicates, "dispense as written."

If funding is not sufficient to cover all eligible patients, HB 1094 allows HHSC to prioritize funding, with Medicare and disabled patients receiving first funding.

Rules implementing HB 1094 must be in place by Jan. 1, 2002.

Prescription Drugs for Indigent Patients
To clarify that physicians may dispense free pharmaceutical samples to indigent patients, Senator Moncrief sponsored SB 332.  The bill cleans up a provision of the Texas Medical Practice Act that prohibited physicians from providing indigent patients a full course of free medications given to the practice by a pharmaceutical manufacturer. 

Study on CHIP Buy-In Option for Uninsured Families
HB835 by Rep. Ann Kitchen (D-Austin) directs HHSC to study the feasibility of allowing uninsured families to buy into the CHIP program.  In determining the feasibility of such a program, HHSC is charged with examining a number of issues, including the fiscal impact to the state and to eligible families; the availability of private sector health care plans as well as their costs and what impact a buy-in arrangement could have on the private sector; the need for a buy-in CHIP plan, including the potential number of families who would enroll; potential plan design and benefits; and funding sources, including federal and local dollars.

In conducting the study, HHSC is required to consult with consumers, health benefit plans, and other interested groups.

HHSC must issue a report on its finding by Nov. 1, 2002.  HB 835 took effect immediately.

Health Care Coverage Near Miss
VETOED

Pilot Medicaid Program Extension for Low-Income Uninsured
HB 2807 by Representative Kitchen directed HHSC to establish a pilot project expanding Medicaid coverage to uninsured adults earning up to 200 percent of the federal poverty level. Funding for the pilot would have been provided by local health care dollars rather than directly by the state. By authorizing the use of local funds, Texas could draw additional federal Medicaid matching monies, stretching limited local indigent dollars even further. Other features of the bill required 12 months' continuous coverage for participants in the pilot as well as access to unlimited prescription drugs. The bill also required HHSC to establish a local advisory committee of physicians, hospitals, and patients to help develop the pilot's health care delivery system and to monitor health care utilization and costs.

Governor Perry vetoed the bill arguing that its implementation would distract HHSC from efforts to consolidate Medicaid into one state agency and to identify and implement cost-saving measures envisioned in the state's appropriations act.

TMA supported HB 2807.

Health Coverage for the Uninsured TMA Staff Contact

  • Helen Kent Davis, Director, Office of Governmental Affairs, (512) 370-1401

CHILD AND ADOLESCENT HEALTH

Coordinated School Health and Physical Activity
Dwindling physical activity and poor health and nutrition habits among Texas children have resulted in the highest percentage of students with obesity, type 2 diabetes, and heart disease in the history of the state.  Further, Texas leads the nation in waivers from physical education, resulting in only 20 percent of Texas high school students receiving physical education in any given year.  National guidelines recommend 150 minutes of physical activity per week for elementary schoolchildren and 225 minutes per week for middle and high school students.  However, Texas elementary and middle schools lack a time allotment for physical activity.  

In response to increasing concern among physicians over the rising rates of cardiovascular disease and type 2 diabetes among youth, TMA spearheaded the Texas Coalition for Coordinated School Health and Physical Activity in 2000, along with the Texas Pediatric Society, Texas Academy of Family Physicians, American Heart Association, American Cancer Society, Texas Parent-Teacher Association, Texas School Health Association, and other stakeholders as well as agency experts. Prior to the legislative session, the coalition developed a long-range plan to address this pervasive public health crisis, the center piece of which is SB 19, filed by Sen. Jane Nelson (R-Flower Mound) to institute within the public school system regular physical activity and coordinated school health for all students. 

The bill, passed by Senator Nelson and Rep. Jim Dunnam (D-Waco), authorizes the State Board of Education to write rules requiring students in grades six and below to participate in 30 minutes of physical activity per day. Allowing for local control, the requirement can be met through a school's physical education curriculum or through structured recess. Other features of the bill are as follows:

SB 19 also requires the Texas Education Agency (TEA) in association with TDH to assist schools with the implementation of a coordinated school health program. 

Each school's program must coordinate physical activity, nutrition services, parental involvement and health education to prevent obesity and conditions such as cardiovascular disease and type 2 diabetes.

As the result of a late-stage amendment by Representative Coleman, SB 19 incorporates important legislation to define a broader focus of concern for local school health advisory councils. Currently, the appointed bodies focus entirely on determining appropriate human sexuality education based on community values.

To allow for a phase-in period, districts are required to establish the coordinated health programs within each school by 2007. 

Now that the bill has passed, the Texas Coalition for Coordinated School Health and Physical Education, TMA's Project WATCH volunteers, and other stakeholders will be instrumental in ensuring fulfillment of the spirit of SB 19 in addressing chronic disease prevention and health promotion in Texas schoolchildren through regular physical activity and coordinated school health. 

School Health Advisory Councils
Provisions of legislation filed by Senator Van de Putte and Representative Coleman were attached to SB 19 to clarify statutes relating to local school health advisory councils. Currently, local school health advisory councils focus narrowly on human sexuality education. The new provision clarifies that the councils will address a comprehensive range of issues relevant to public health, including school nutrition services and health education in the prevention of obesity, cardiovascular disease, cancer, and other diseases. TMA's partnerships in the Texas Coalition for Coordinated School Health and Physical Education, TDH School Health Advisory Council, TMA Alliance, Project WATCH, and others will facilitate this change in existing local school health advisory councils while working toward the creation of councils in communities where they are currently lacking.

Child Passenger Safety
Building on legislation passed in 1999 that strengthened the law governing seat belt use by minors, SB 113 by Senator Moncrief and Rep. Tony Goolsby (R-Dallas) raises the requirement from age 15 to 17 for seat belt usage in a passenger vehicle. The TMA-supported measure also requires that:

  • Belts must be worn in the front and back seats of a vehicle.
  • The operator of a passenger vehicle commits an offense if the person allows a child between the ages of 4 and 17 to ride without wearing a safety belt.
  • Children up to age four or up to 36 inches tall must be secured in a child passenger safety seat system.  Previous laws only required up to age 2.
  • Lastly, SB 113 makes it a Class A misdemeanor to improperly install an airbag. 

SB 113 takes effect Sept. 1, 2001.

Additionally, SB 399 by Senator Duncan raises the prohibition on a child riding in an open truck bed, flatbed truck, or trailer from age 12 to 18 and removes the allowance for riding in a truck bed up to 35 miles an hour.

Following are permissible exemptions to SB 399:

  • Operating or towing the vehicle in a parade or emergency;
  • In the transport of farm workers from one field to another on a farm-to-market road, ranch-to-market road, or county road outside a municipality;
  • On a beach;
  • If it is the only vehicle owned by the family; or
  • Vehicles in hayrides.

SB 399 takes effect Sept. 1, 2001.

Teen Drivers
Supporters have tried since 1997 to enact a Graduated Driver License (GDL) program in Texas and finally succeeded in the 77th legislature. The Texas legislation was modeled on California policy, and since the introduction of the California GDL law, there has been a 25-percent drop in teen driving fatalities. SB 577 by Senator Bivins and Rep. Joe Driver (R-Garland) seeks to reduce injuries and death due to automobile accidents by requiring teenagers to gain more experience behind the wheel before driving alone and by limiting their passenger count and late-night driving.

Key provisions of SB 577 include the following:

  • A child under 18 must hold an instruction permit for at least 6 months before receiving a driver license.
  • While holding an instruction permit, the minor may not drive the car unless accompanied by someone over 21 (previously 18).
  • While holding an instruction permit, the minor may not have more than one passenger under 21, unless that person is a family member.
  • During the first six months a child under 18 holds a license, he or she may not drive after midnight or before 5 a.m. Exceptions are made for transportation related to employment, school activity, or a medical emergency.
  • During the first six months a child under 17 holds a motorcycle or moped license, the child may not operate the vehicle after midnight or before 5 a.m. unless he or she is within sight of his or her parent or guardian or for medical emergencies, employment, or school-related activities.

SB 577 takes effect Jan. 1, 2002. 

Vaccines For Children
SB 280 by Senator Nelson and Rep. Kyle Janek, MD (R-Houston) authorizes TDH to issue a request for information (RFI) from private entities to determine whether a private entity could provide a more effective and efficient system for storing and distributing the state's vaccine supply. The RFI must be distributed before Jan. 1, 2002. If the department is able to obtain cost savings from more efficient storage and distribution of vaccines under the Vaccines For Children (VFC) program, TDH may permit health care providers to choose the brand of vaccines to be used. TMA negotiated with industry representatives to ensure that physician choice would be implemented only if it does not create a two-tiered system that would force physicians to keep separate vaccine stocks and to differentiate administratively between patients based on their source of immunization funding. Physician choice may be implemented regionally as funds become available. SB 281 takes effect Sept. 1, 2001.

Lawmakers also passed SB 282 by Senator Nelson and Representative Janek requiring TDH to promote the VFC program to certain health care providers not currently enrolled in the program. The bill took effect immediately upon passage and calls for materials promoting the program to be distributed to physicians' offices no later than Oct. 1, 2001. TMA and TDH agreed during the session to work in collaboration during the interim to promote the VFC program to providers after examining additional opportunities for streamlining reporting and other aspects of physician participation in the program. 

Children's Nutrition
House Concurrent Resolution 223 by Representative Coleman and Senator Moncrief is intended to address the poor diets of Texas children, especially calcium deficient diets. HCR 223 directs the TDH to develop a list of foods and beverages that are naturally fortified with calcium and vitamin D and forward the list to TEA and to school superintendents and boards of primary and secondary schools in Texas.

Sexual Abuse
Currently in Texas, the attorney general's office may reimburse local governments for the cost of a sexual assault examination from the Crime Victim's Compensation Fund. However, through rules, the attorney general's office has been reimbursing for the examinations only if the examiner is a nurse who underwent the training course conducted by the attorney general's office. HB 131 by Rep. Joe Deshotel (D-Beaumont) and Sen. Ken Armbrister (D-Victoria) ensures that a physician can be reimbursed for an examination if the examination is conducted for the purpose of investigating or prosecuting a sexual assault.

In addition, Texas currently has a sex offender registry available to the public on the Internet.  However, the registry lists all child offenders regardless of their age or offense. Because of the way current sexual abuse laws are written in Texas, a child could commit a nonviolent offense and be listed in the registry based exclusively on the age of the defendant and victim. The registry includes a photo, name, address phone number, shoe size, etc. HB 2987 by Representative Deshotel and Senator Van de Putte would permit a defendant to petition the court for exemption from the registry under the following conditions:

  • The defendant is younger than 19 and the victim is at least 13,
  • The conviction is based solely on the ages of the defendant and the victim,
  • It is a first offense for the defendant,
  • The exemption does not threaten public safety as determined by a sex offender treatment provider.

Both HB 131 and HB 2987 take effect Sept. 1, 2001. TMA worked with the Texas Pediatric Society to support passage of these bills to protect children and adolescents affected by sexual assault or abuse.

Child Sexual Abuse
HB 360 by Rep. Miguel Wise (D-Weslaco) was amended in the Senate to broaden the definition of "abuse" to include conduct involving indecency with a child, sexual assault, and aggravated sexual assault. Indecency with a child includes "sexual contact."

Child Abuse Reporting: Budget Rider
The language of two budget riders in SB 1, the appropriations bill, are included below. The riders will be implemented through rulemaking. 

HHSC may distribute or provide appropriated funds only to recipients who show good faith efforts to comply with all child abuse reporting guidelines and requirements set forth in Chapter 261 of the Texas Family Code.

The Texas Department of Health may distribute or provide appropriated funds only to recipients who show good faith efforts to comply with all child abuse reporting guidelines and requirements set forth in Chapter 261 of the Family Code.

Possession of Asthma Medication
HB 1688 by Rep. Ruth Jones McClendon (D-San Antonio) entitles a public school student diagnosed with asthma to possess and self-administer prescription asthma medicine while on school property or at a school-related event or activity. Beginning with the 2001-02 school year, this law requires that the asthma medicine be prescribed for the applicable student and the prescription label on the medicine container indicates such, the medicine is administered in compliance with the prescription or written instructions from the physician, and the student's parent has provided a written permission and a written statement releasing the school district from liability for an injury arising from the self-administration. Also required is a written statement from the student's physician that states that the student is capable of self-administration, the name and purpose of the medicine and prescribed dose and circumstances under which the medicine may be administered, and the period for which the medicine is prescribed.

Supported by TMA, this bill was initiated by the efforts of the Texas Asthma Coalition.  HB 1688 became effective June 14, 2001.

Immunization Reporting: Budget Rider
Budget riders are implemented by agencies usually through the rulemaking process. TMA will be involved with other stakeholders to provide input into policy development surrounding these riders. 

Immunization Reporting: The Department of Health may distribute or provide appropriated funds only to providers and payers that show good faith efforts to comply with all immunization reporting guidelines and requirements set forth in Chapter 161, Health and Safety Code.

Increase Immunization: The Department of Health shall report to the Legislative Budget Board and the governor no later than Sept. 30 of each year of the biennium on plans to increase immunization rates in Texas, focusing on immunization of pre-school age children. It is the intent of the legislature that this report be used by the department in managing state and federal resources to increase immunization rates.

Child and Adolescent Health Near Misses

Immunizations: Personal Exemptions and ImmTrac Reporting
Legislation by Rep. Rick Green (R-Dripping Springs) to improve the state's ImmTrac system while addressing personal exemptions from state immunization requirements failed to pass. The bill represented a negotiated effort involving organized medicine, public health experts, legislative staff, the governor's office, and parent groups opposing mandatory vaccination and vaccine registration. TMA, the Texas Pediatric Society, and the Texas Academy of Family Physicians supported the bill and participated in all negotiations, representing policy decisions reflective of physician leadership throughout the state. A hearing on the bill in the House Public Health Committee drew extensive testimony, lasting more than six hours and involving a number of physicians speaking against the bill based on the interpretation that it provides a lax process for gaining exemptions from immunization. The negotiated bill ultimately died in the House Calendars Committee, while the Senate approved an alternate bill, SB 1237, authored by Senator Moncrief, chair of the Senate Health and Human Services Committee. SB 1237 contained only the negotiated provisions designed to improve the state health department's immunization tracking system, or ImmTrac. A working registry is believed to be the central tool needed to increase immunization rates among children and adolescents while reducing instances of over-immunization. The Senate measure failed to clear the House Public Health Committee late in the legislative session. 

Children's Mental Health Parity
For the past two years, TMA leadership on child and adolescent health issues has focused on improving children's mental and behavioral health in the state. The need for better coverage of mental health care has been blamed as one of the major barriers to better care for patients with mental illness, particularly children and adolescents. Legislation by Rep. David Farabee (D-Wichita Falls) and Senator Van de Putte to require health plans to cover the diagnosis and treatment of children with mental disorders cleared the Senate but failed to come up for a vote in the House prior to the final deadline. Health plans may continue to deny coverage for mental illnesses unless it is a "serious mental illness" as defined by state statute.

Child and Adolescent Health TMA Staff Contact

  • Gayle Love, Director, Public Health Department, (512) 370-1670

CHRONIC DISEASE PREVENTION AND CONTROL

Health Plan Colorectal Cancer Screening
SB 1467 by Senator Moncrief directs insurance companies to cover certain screening procedures for colon cancer. The Texas Society for Gastroenterology and Endoscopy actively promoted the bill, which is based on legislation in Virginia requiring health plans to adhere to national cancer screening guidelines published by the American College of Gastroenterology and Endoscopy and the American Cancer Society. While SB 1467 does not specifically reference the national guidelines, the bill does say that insurance companies must offer (1) fecal occult of the stool annually and flexible sigmoidoscopy every five years, or (2) colonoscopy every 10 years to patients over age 50 who are at normal risk for colon cancer. Health plans are required to notify patients of this benefit.

TDI is required to implement rules for SB 1467. The act takes effect Sept. 1, 2001, but only applies to health plan contracts issued on or after Jan. 1, 2002.

Texas Cancer Registry
SB 285 by Senator Nelson and Rep. Diane Delisi (R-Temple) passed with considerable input from TMA and interested specialty societies. The purpose of the registry is to serve as a tool in the early recognition, prevention, cure, and control of cancer. The bill modernizes the state cancer reporting statute to reflect acceptable federal guidelines rather than leaving reporting timelines and other requirements open to unwanted administrative changes that could place additional unnecessary burdens on physicians caring for cancer patients in Texas. 

TMA and a coalition of physician specialty societies, the American Cancer Society, and others advocated throughout the session an exceptional item request that would have increased state funding for cancer reporting and surveillance in Texas, thus improving the quality of Texas cancer data. The Texas Cancer Registry currently does not meet Centers for Disease Control and Prevention standards for timeliness and completeness. Had the exceptional item request been funded, one benefit to physicians would have been the availability of tumor registrars supported by the state to collect and report cancer incidence from physician offices. 

The Texas Cancer Registry will continue to devote federal dollars toward improvement of the reporting process and data quality and will pilot the new reporting procedures in physician offices prior to rulemaking, at which time TMA and other stakeholders will have a voice in development of cancer reporting regulations. The bill takes effect Sept. 1, 2001.

Specific results of the cancer registry legislation include the following:

  • Clarification of definitions to exclude reporting of precancerous conditions and certain tumorous conditions;
  • Expansion of the list of required reporters of cancer from hospitals and cancer treatment centers to include health care facilities, clinical laboratories, and health care practitioners, to meet federal requirements;
  • Establishment of timelines and formats for reporting based on U.S. Department of Health and Human Services regulations;
  • Provision of a cost recovery mechanism for TDH to utilize if an entity fails to report required data, in which case the entity must reimburse the department for the costs of accessing and reporting the data;
  • Allowance for reporters to request a hearing if reimbursement demands from the department are felt to be unreasonable; and
  • Provision of further clarification of reporting responsibilities.

In addition, the legislation indicates conditions under which registry data may be released:

  • For statistical purposes without individually identifiable information,
  • With the consent of the person, or
  • To promote cancer research.

TMA and various specialty societies will monitor closely the rulemaking process for this legislation to ensure that physician concerns are addressed, while continuing collaboration with medical schools and research facilities to improve the quality of cancer data available through the cancer registry.

Texas Pediatric Diabetes Research Advisory Committee
SB 1456 by Senator Lucio and Rep. Jaime Capelo (D-Corpus Christi) directs the commissioner of health and the Texas Diabetes Council to establish a pediatric diabetes research advisory committee. SB 1456 takes effect Sept. 1, 2001. The advisory committee is to be made up of the chair of the Texas Diabetes Council and 14 members appointed by the commissioner representing the following:

  • TDH,
  • Juvenile Diabetes Research Foundation,
  • American Diabetes Association,
  • Research professionals from academic or biomedical research, and
  • The health care industry.

The advisory committee is to submit a report to the commissioner of health by Dec. 1, 2002, composed of the following:

  • A plan to research pediatric diabetes,
  • Assessment of the resources available in the state as sites for research opportunities,
  • Analysis of the impact of diabetes on the economy, and
  • Recommendations to the legislature and governor on research programs in pediatric diabetes and funding alternatives.

Texas Asthma and Allergy Research Advisory Committee
SB 616, sponsored by Senator Van de Putte, has a provision establishing an Asthma and Allergy Research Advisory Committee. Representatives Delisi and Capelo sponsored the provision. The advisory committee will include nine members selected by the governor. The committee's charge is to develop a plan to research asthma and allergy and associated medical conditions in Texas, assess resources in Texas as possible sites for research opportunities, analyze the impact of asthma and allergy on the economy of the state and on the health of residents, and make recommendations to the legislature and governor concerning research programs and funding alternatives. The bill requires the committee to be abolished by January 2003.

The Texas Asthma Coalition, recently created through the efforts of TDH, the American Lung Association, and other professional organizations, was involved with the successful passage of this bill.

Periodic Health Assessments for Adults
SB 544 by Sen. J.E. "Buster" Brown (R-Lake Jackson) mandates that HMOs include periodic health evaluations for each adult enrollee under certain coverage. The risk assessment must be performed for an adult enrollee once every three years, except for women, who also are covered for an annual well-woman exam. TDI will implement the bill.

Chronic Disease Prevention and Control Near Misses

Chronic Disease Prevention and Control TMA Staff Contacts

  • Jenny Young, Manager and Policy Analyst, Public Health Department, (512) 370-1462
  • Barbara James, RN, Director, Science and Quality Department,  (512) 370-1400

PUBLIC HEALTH PROTECTION AND PROMOTION

Health Disparities Reduction
HB 757 by Representative Coleman creates a nine-member task force under TDH intended to assist the department in accomplishing its goals related to eliminating disparities among certain populations of Texans' in terms of health status and level of access to health care.

The task force will perform the following as necessary:

  • Investigate and report on issues related to health and health access disparities among multicultural, disadvantaged, and regional populations;
  • Develop short-term and long-term strategies to eliminate health and health access disparities among multicultural, disadvantaged, and regional populations, with a focus on reorganizing department programs to eliminate those disparities;
  • Monitor the progress of the department in eliminating health disparities; and
  • Advise the department on the implementation of any targeted programs or funding authorized by the legislature to address health and health access disparities.

In performing these duties, the task force shall consult with the department, the Office of Minority Health and Cultural Competency, women's health offices of the department, and any other relevant division of the department.  In addition, the task force shall submit an annual report on the progress of the department in its goals and will deliver the report to the governor, lieutenant governor, and speaker of the House of Representatives.  TMA supported the bill throughout the session and worked to perfect it by ensuring that, at a minimum, health care organizations would be represented on the task force.  The bill takes effect Sept. 1, 2001. 

Indoor Tanning Facilities
The American Cancer Society projects that Texas will have 3,400 new melanoma cases in 2000; this number reflects a substantial increase from the 2,900 cases that were estimated for 1999.  Between 1995 and 1997, 1,362 Texans succumbed to the disease. HB 663 was filed by Rep. Ron Lewis (D-Mauriceville) due to the increased rates of melanoma in Texas and general concern among dermatologists about the increased risk of the disease following UV exposure during childhood.  Together with Senator Nelson, Representative Lewis worked with TMA and the Texas Dermatological Society to pass a bill designed to reduce children's access to tanning facilities as well as provide more appropriate warning of the dangers of indoor tanning. 

As a result of the bill:

  • Any child under the age of 13 may not use a tanning facility unless the facility receives written permission from the child's physician and the child's parent remains at the facility while the child uses the tanning bed,
  • A parent must accompany children under the age of 16 to the facility during use of the tanning bed,
  • A child under the age of 18 must provide written consent from their parent or guardian to use a tanning bed. 

HB 663 takes effect Sept. 1, 2001.

Infant Mortality and Newborn Week
TMA supported the passage of SB 55 by Sen. Judith Zaffirini (D-Laredo) and Rep. Richard Raymond (D-Laredo) directing the Department of Human Services to develop and implement a statewide education program designed to prevent and reduce infant mortality in the state. The department is required to request the assistance of individuals, private organizations, governmental entities, and experts in development of the program.  SB 55 directs the agency to obtain input from outside organizations with knowledge of infant mortality prevention.  SB 55 takes effect Jan. 1, 2002. 

Additionally, TMA's Committee on Maternal and Perinatal Health was instrumental in Senate Resolution 750 by Sen. Jeff Wentworth (R-San Antonio) and Senator Zaffirini, which creates Texas Newborn Babies Week.  The resolution was filed to help focus the public's attention on the importance of prenatal and infant health care and the need for improved access to health services for expectant and new mothers. This formal observance will serve to educate the public on infant health risks and increase awareness of the importance of childhood immunizations.

Feb. 4-10, 2002, is designated as Texas Newborn Babies Week.

Donor Milk Bank
According to the American Academy of Pediatrics (AAP), epidemiologic research indicates that human milk and breastfeeding of infants, including those who are premature or sick, improves the infant's general health, growth, and development, while significantly reducing risk for a large number of acute and chronic diseases.  In some instances, a mother may not be able to breastfeed her child, such as when the mother has used illegal drugs or is taking certain prescription medications, or if the mother has been infected with the human immunodeficiency virus (HIV) or another disease. Donor milk banks provide human milk when direct breastfeeding is not possible. To ensure careful handling at each stage of processing and distribution, a rigid protocol is needed. HB 391 by Rep. Glen Maxey (D-Austin) requires TDH to establish minimum standards for the procurement, processing, distribution, or use of human milk by donor milk banks. TMA supported the bill in its passage, to protect the health of mothers and infants served by human milk donor banks.

Public Health Promotion and Protection Near Misses

Regulation of Ephedrine
In 1999, TDH promulgated new regulations setting standards for the formulation, sale, and distribution of dietary supplements containing ephedrine group alkaloids. In addition, on July 7, 2000, the department adopted a regulation that will require, as of Sept. 1, 2001, that a dietary supplement product containing ephedra have on its label the toll-free number of the U.S. Food and Drug Administration MedWatch reporting system. As proposed, HB 3619 by Rep. Arlene Wohlgemuth (R-Burleson) and SB 1531 by Sen. Ken Armbrister (D-Victoria) would require a specified cautionary statement on the product label about the possible side effects from taking too large of a dose of ephedrine, other information relating to the amount of ephedrine per serving, and the recommended daily intake of the ephedrine group alkaloids.

TMA opposed the bills based on the threat they posed to current rules, which better protect the public health by ensuring that reports of ephedrine adverse events and public information are handled by the FDA as opposed to private companies. After the rationale for organized medicine's opposition was communicated, the bills were withdrawn from further consideration. A budget rider that would have created a similar situation also was withdrawn.

Public Health Enforcement
HB 617 by Rep. Robert Puente (D-San Antonio), which embodies a policy opposed by the TMA Council on Public Health, did not pass the 77th legislature. The bill would have allowed municipalities to use volunteers from neighborhood associations to help enforce certain municipal health and safety ordinances.

Abortion Coverage
A number of abortion bills were filed relating to abortion services, including bills limiting the number of abortions that can be performed in a physician's office before it becomes regulated as an abortion facility, regulating when life begins, relief of the fetus from fetal pain when performing abortions, evidentiary standard in parental notification court bypass procedure, and several bills on injury to an unborn child.  All of these bills failed to pass. An amendment was placed on a bill that likely expands the requirement of a physician to report child abuse and neglect under the Family Code. Under the definition of "abuse and neglect," specific offenses under the Penal Code of sexual assault, aggravated sexual assault, and sexual contact with a child were added, and these offenses would be required to be reported.

Public Health Promotion and Protection TMA Staff Contacts

  • Jenny Young, Manager and Policy Analyst, Public Health Department,  (512) 370-1462
  • Gayle Love, Director, Public Health Department, (512) 370-1670

INFECTIOUS DISEASES

Bacterial Meningitis Education
An outbreak of bacterial meningitis in the winter of 2001 in Southeast Texas sparked concern among Texans and the 77th legislature, resulting in SB 31 by Senator Zaffirini and Representative Raymond.  Dormitory residents and some children and adolescents are at increased risk of contracting bacterial meningitis because of crowded living environments. SB 31 requires that all college and university students be provided with information regarding the risks, symptoms, and vaccine for bacterial meningitis and the availability of a vaccine to students through the student health center. 

The bill requires the Texas Higher Education Coordinating Board (THECB) to prescribe procedures by which each institution of higher education will provide information relating to bacterial meningitis to new students of the institution. The coordinating board is instructed to consult with TDH in prescribing the content of the information to be provided to students about bacterial meningitis and to establish an advisory committee to assist the coordinating board in the initial implementation of SB 31.

To reach public school students and their parents, the bill also directs TEA and school districts to provide information relating to bacterial meningitis to students and their parents each school year. TEA is directed to consult with TDH in developing the content to be provided to students and to establish an advisory committee to assist the agency in the initial implementation of SB 31. TMA supported the passage of SB 31 and agreed to assist in the education of physicians and the public in keeping with the bill, to protect the public from bacterial meningitis. 

SB 31 took effect May 22, 2001, upon passage by the legislature.

Statewide Hepatitis C Plan
Currently, it is estimated that four million Americans, or 1.8 percent of the population, are infected with hepatitis C, and 350,000 Texans are infected with the virus. HB 1652 was passed last session and directed TDH to conduct studies, develop education and training materials, and establish testing sites for hepatitis C. However, a more comprehensive approach allows Texas to address this public health issue in the long term. SB 338 by Sen. Frank Madla (D-San Antonio) directs TDH to develop a state plan for hepatitis C in order to respond comprehensively to hepatitis C in this state. TMA continued its advocacy of hepatitis C prevention and treatment in Texas by supporting SB 338 and other relevant legislation during the session. 

Specifically, the plan requires TDH to accomplish the following:

  • Develop strategies for prevention and treatment of specific groups of people;
  • Seek input from certain people and groups in formulating the plan;
  • Update the plan biennially and file the plan, not later than Oct. 1 of each even-numbered year, with the governor, lieutenant governor, and the speaker of the House of Representatives.

Interagency Council on HIV, AIDS, and Hepatitis
The HIV/AIDS Interagency Council was created by the 73rd legislature to facilitate communication and cooperation between agencies and associations that provide HIV/AIDS-related services. TDH recently has reported that hepatitis infection has become a serious public health concern.  HB 768 by Representative Maxey and Senator Nelson expands the scope of the council to include hepatitis and adds representatives of the Texas Department on Aging and the Texas Workforce Commission.  The bill takes effect Sept. 1, 2001. 

Continuing Education on Hepatitis C
Hepatitis C is a chronic liver disease caused by the hepatitis C virus (HCV). According to the Centers for Disease Control, an estimated 8,000 to 10,000 Americans die each year from hepatitis C and approximately four million others have been infected with HCV. Most HCV infected persons are between 30 and 49 years of age and are expected to develop chronic liver disease as they age. Consequently, the number of deaths attributable to HCV could increase substantially during the next two decades. It is imperative that health care professionals are knowledgeable about the diagnosis, treatment, and prevention of hepatitis C.

Currently, the Board of Nurse Examiners may require licensed nurses to complete as much as 20 hours of continuing education every two years to maintain their license. HB 2650 by Representative Capelo and Senator Madla requires the board to develop hepatitis C continuing education training and requires licensed nurses to complete at least two hours of continuing education instruction related to hepatitis C as part of the 20 hours.

HB767 by Representative Maxey and Senator Nelson adds training related to the prevention and treatment of HIV/ADS, hepatitis C, and other sexually transmitted diseases to the continuing education requirements for a licensed chemical dependency counselor (LCDC).  The Texas Commission on Alcohol and Drug Abuse is charged with preparing and administering a training component that will provide LCDC's with six hours of training on the subject per each two-year licensing period. In developing the training component, the commission shall consult with TDH.

The training component for LCDC's must provide participants with the following:

  • Background on HIV, hepatitis C, and sexually transmitted diseases in the context of chemical dependency counseling; and
  • Information relating to the special needs of persons with positive test results, including the importance of prevention, early intervention, and treatment and recognition of psychosocial needs.

HB767 took effect on May 21, 2001.

Testing for Accidental Exposure to Hepatitis
Current law requires licensed hospitals to take reasonable steps to test patients for hepatitis B or C following an accidental exposure of a health care worker to a patient's blood or other body fluids. However, emergency medical service personnel and other persons who render assistance and are exposed to the patient's body fluids are not included under testing requirements. SB 1006 by Senator Van de Putte requires a licensed hospital receiving a patient to take reasonable steps to test the patient for hepatitis B or C after the notification of exposure of personnel to a patient's blood or other body fluid.

Specific provisions are as follows:

  • The person exposed, or the organization that employs the person or for which the person works as a volunteer in connection with rendering the assistance, is responsible for paying the costs of the test.
  • The bill requires the hospital to provide the test results to TDH or the local health authority, which is responsible for following the established procedures to inform the person exposed and, if applicable, the patient regarding the test results.
  • The bill requires the hospital to follow applicable reporting requirements.
  • The bill applies only in a case of accidental exposure of certified emergency medical services personnel, a firefighter, a peace officer, or a first responder who renders assistance at the scene of an emergency or during transport to the hospital to blood or other body fluids of a patient who is transported to a licensed hospital.  SB 1006 took effect immediately.

Infectious Disease Near Miss

Harm Reduction Through Needle Exchange
HB288, by Representative Maxey, which reflects TMA policy on needle exchange programs, would have allowed community-based organizations with a memorandum of understanding with TDH to provide harm reduction services to intravenous drug users, including health and substance abuse referrals and prevention information about HIV and hepatitis. The bill also would have authorized certain persons involved with the program to dispense needles and syringes and provide for their storage and disposal. The purpose of the bill was to combat the spread of infectious and communicable diseases including HIV, AIDS, and hepatitis B and C through needle exchange and education programs. The proposal did gain greater support than in previous sessions, passing the House Public Health Committee by a vote of 6-1. 

Infectious Diseases TMA Staff Contacts

  • Gayle Love, Director, Public Health Department,  (512) 370-1670
  • Jenny Young, Manager and Policy Analyst, Public Health Department, (512) 370-1462

EMS and TRAUMA

CPR Instruction in Schools
In an attempt to ensure more Texans are trained in the lifesaving technique of cardiopulmonary resuscitation (CPR), HB 821 by Rep. Helen Giddings (D-Dallas) and Senator Bivins allows TEA to accept donations, including equipment, to provide CPR instruction to students.  TEA may adopt rules as necessary to implement the bill.  The bill was revised in the Senate Education Committee from its original form, which required schools to provide students and certain school officials with training on CPR.  TMA was supportive of the bill. 

Abandonment of Newborns and Children
In an attempt to address the abandonment of newborns and children, legislation was passed last session that would permit a parent to leave a child, within 30 days of birth, with an emergency medical services provider without facing penalties. This session, the statute was amended by HB 706, sponsored by Rep. Geanie Morrison (R-Victoria) and Sen. Carlos Truan (D-Corpus Christi). The bill permits other entities to accept abandoned children, which include a hospital and a child-placing entity. The bill also states that an entity which takes possession of a child is not required to obtain the identity of the parent and is not liable for any damages that may come to the child unless those damages are related to negligence. The Department of Protective and Regulatory Services will reimburse the provider for any cost related to the care and possession of the child. Lastly, in the termination of the parent-child relationship, it is assumed by the court that the parent did terminate these rights by leaving the child in the possession of a provider. HB 706 takes effect Sept. 1, 2001.

EMS Districts Act
Currently, counties and cities can create crime control and prevention districts funded by an increase in the local sales tax, contingent on the approval of the voters. The state authorizes volunteer and rural fire districts; municipalities, however, do not have the authority to create districts for purposes of fire control, prevention, and emergency medical services. HB 1096 by Rep. Vilma Luna (D-Corpus Christi) and Sen. Mario Gallegos (D-Houston) establishes the Fire Control, Prevention, and Emergency Medical Services District Act to allow a municipality to establish, on voter approval, a fire control, prevention, and emergency medical services district in all or a portion of the municipality. HB 1096 took effect June 1, 2001. 

Administration of Epinephrine by EMTs
Individuals with allergies and asthma can experience a severe allergic reaction that results in anaphylactic shock, which is life threatening. According to the American College of Allergy, Asthma, and Immunology, an estimated 50 people die each year nationally as a result of insect sting reactions, and the Journal of Allergy and Clinical Immunology documented 32 cases of fatal food allergy-induced anaphylaxis between 1994 and 1999. The preferred treatment for severe allergic reactions is the subcutaneous administration of epinephrine, also known as adrenalin.

Texas has four levels of emergency medical technicians (EMTs). However, only EMTs who are paramedics are permitted to carry and administer epinephrine, while basic and intermediate EMTs may only assist an individual in administering the individual's own auto-injector of epinephrine. Fatal outcomes are most often associated with either not using epinephrine or a delay in its use. Equipping all levels of EMTs with the knowledge and authority to carry and administer epinephrine could save lives. HB 2648 by Representative Capelo and Senator Madla provides for the training and use of epinephrine auto-injector devices by all EMTs and first response providers in Texas.

Organized medicine provided input into the bill, which was amended a number of times during the legislative session.  Key amendments made improvements such as:

  • Requiring the administration of epinephrine in keeping with the national standard training curriculum for emergency medical technicians,
  • Requiring a delegated practice agreement that provides for medical supervision by a licensed physician who either acts as a medical director for an emergency or who has knowledge and experience in the delivery of emergency care, and
  • Requiring an EMT to report the use of epinephrine to the physician supervising the activities of the emergency medical services personnel.

TDH will adopt rules to implement the bill, which is to take effect Jan. 1, 2002. 

EMS Providers in Rural Areas
In its interim report to the 77th Texas Legislature, the House Committee on Public Health examined the requirements imposed on emergency medical service (EMS) providers in rural areas to determine whether individual requirements encourage or hinder the provision of services. HB 2446 by Rep. Bob Glaze (D-Gilmer) and Senator Madla addresses the recommendations outlined in the interim report including:

  • Allowing an advisory council to advise the Texas Board of Health on emergency medical services,
  • Allowing counties to reimburse EMS providers under the Indigent Health Care and Treatment Act at Medicaid rates, and
  • Considering the standardization and simplification of EMS terminology and classification of providers.

The bill also addresses recommendations offered by TDH:

  • Establishing a peer assistance program, and
  • Providing confidentiality for the regional advisory council's quality improvement and data process.

EMS and Trauma Near Misses

Funding Through Motor Vehicle Registration
In 1999, the legislature created the tertiary care account to help reimburse hospitals for some of the $65 million spent on free trauma care for indigent residents in 1997. The tertiary care account may only reimburse hospitals for services delivered to out-of-county residents living below the poverty level that participate in the specified trauma network. Originally, the tertiary care account was funded by unclaimed prize money from the Texas Lottery, which averages about $16 million per year. However, the need for funds is not fully met. HB 893 by Rep. Juan Hinojosa (D-McAllen) and Sen. Chris Harris (R-Arlington) would have created an additional fee for motor vehicle registration dedicated to the tertiary care account.  The bill quickly gained support, including that of TMA's Committee on EMS and Trauma, due to the tenuous situation of the state's underfunded EMS system. Opposition soon arose as the proposal would impose the fee on consumers, and ultimately, the bill was kept from being considered in the Senate. 

UIL Medical Advisory Board Bill
HB 2452 by Rep. Scott Hochberg (D-Houston) would have created a physician-dominated medical advisory board to develop procedures and standards for determining when a student injured during University Interscholastic League competition is fit to return to play.  Parents and coaches would be provided with information and resources to support informed decision making to prevent further injury and, in some cases, death following an initial sports injury. The bill passed House and Senate committees but ran into opposition from coaching groups that had not expected the measure to survive that far into the process.  The bill was removed from consideration by the full Senate late in the session. 

EMS/Trauma TMA Staff Contacts

  • Gayle Love, Director, Public Health Department,  (512) 370-1670
  • Jenny Young, Manager and Policy Analyst, Public Health Department, (512) 370-1462

GENETICS

Umbilical Cord Blood Bank
Authored by Rep. Kenn George (R-Dallas), signed by the governor, and effective Sept. 1, 2001, HB 3572 establishes in Texas an umbilical cord blood bank for recipients of blood and blood components who are unrelated to the donors of the blood. HHSC is required by Jan. 1, 2002, to establish a program to award a grant of start-up money for the establishment of the blood bank. The recipient of the grant must agree to operate and maintain the blood bank in this state for at least eight years, and gather, collect, and preserve umbilical cord blood only from live births. Sen. Jon Lindsay (R-Houston) introduced an amendment that authorized a one-time grant only; the grant is authorized in the fiscal biennium beginning Sept. 1, 2001, and may be awarded in subsequent bienniums only if money is specifically appropriated for that purpose.

Bill history includes the appointment of a conference committee to resolve the differences between the two houses when the House did not concur in the initial Senate amendments. The fiscal note for this bill includes an estimated two-year net impact to the General Revenue Related Funds of a negative $6,800,000. It is anticipated that payment for the services will recoup/cover costs in the future.

Prohibition on Genetic Discrimination
SB 12 by Senator Nelson prohibits discrimination based on the use of genetic testing information in the determination of eligibility for employment, an occupational license, or insurance coverage. It includes changes to the Texas Revised Statutes, Labor Code, and Insurance Code. The bill further defines terms such as "family health history," "genetic characteristic," "genetic information," and "genetic test." It also includes the direction that licensing authorities may not deny an application or renewal of license based on the applicant's refusal to submit to a genetic test or to reveal the results to any genetic testing. Supported by TMA, the bill includes language and concepts suggested by geneticists active within the TMA council and committee structure.

The bill mandates the confidentiality of genetic information regardless of the source of the information. Disclosure of information must be specifically authorized by the individual in writing and must include a description of the information to be disclosed, the name of the person or entity to whom the disclosure is made, and the purpose for the disclosure. Exceptions to this disclosure are those requests authorized under a state or federal criminal law, by specific order of a state or federal court, or other state or federal law.

Genetics Near Miss

Retention of Newborn Screening Blood Samples
HB 1239 by Rep. Ron Wilson (D-Houston) was left pending in the House. This bill would have required TDH to retain all blood specimens used for newborn screening testing. It carried a fiscal note of approximately $900,000. TMA did not support this legislation.

Genetics Staff TMA Staff Contact

  • Barbara James, RN, Director, Science and Quality Department,  (512) 370-1400

TOBACCO PREVENTION AND CONTROL FUNDING

The 76th Texas Legislature was charged with allocating the initial $1.8 billion of Texas' landmark $17.3 billion tobacco settlement. As a matter of unwavering principle, TMA worked diligently to convince the legislature that all tobacco settlement dollars be dedicated to the improvement of the health of Texans through funding of direct medical care, prevention, and research.

Laying the groundwork for TMA's efforts was the 1998 Memorandum of Understanding (MOU) signed by Sen. Bill Ratliff (R-Mt. Pleasant), then chair of the Senate Committee on Finance; Rep. Rob Junell (D-San Angelo), chair of the House Committee on Appropriations; and then Attorney General Dan Morales. The MOU outlined the health care priorities to be funded with the state's first tobacco settlement installment, which TMA supported through the Coalition for Healthy Texans, an organization comprising more than 40 provider and consumer organizations. The coalition advocated vigorously throughout the session to dedicate the tobacco funds to health care. Thanks to strong legislative leadership and the commitment of the coalition, attempts to divert tobacco dollars to fund non-health care-related projects were soundly rejected.

Unfortunately, no similar agreement existed for the 77th legislature, or for future sessions. However, throughout the session, TMA supported allocation of tobacco settlement dollars to fund CHIP, Medicaid, public health services, and other health priorities.  In the end, all of the tobacco settlement proceeds were directed to health care categories.  Of particular interest is the increase in funding for tobacco prevention and cessation.  Through proceeds from the Permanent Fund for Tobacco Prevention, and other general revenue, $14 million was allocated per year to expand Texas' tobacco prevention and cessation program.  The increase will allow the program, which demonstrated swift success in reducing tobacco consumption during the pilot phase, to be expanded to reach about one-fourth of the state. 

Tobacco Prevention and Control Funding TMA Staff Contact

  • Gayle Love, Director, Public Health Department,  (512) 370-1670

Overview | Health Care Funding | Long-Term Care and End-of-Life Issues | Market Fairness/Managed Care Reform | Medicaid  | Medical Education | Medical Licensure and Discipline  | Medical Privacy | Rural Health | Scope of Practice | Tort Reform/Medical Liability | Workers' Compensation


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