Border Health
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Health Coverage for the Uninsured
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Child and Adolescent Health
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Chronic Disease Prevention and Control
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Public Health Protection and Promotion
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Infectious Diseases
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EMS and Trauma
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Genetics
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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:
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Improve health outcomes by expanding patients' access to
and use of health screenings, prenatal care, and medical or
surgical follow-up visits;
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Periodic consultations with specialists regarding chronic
disorders;
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Triage and pretransfer arrangements; and
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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:
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Evaluating the state's telemedicine policies;
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Establishing consistent telemedicine delivery and
reimbursement standards;
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Monitoring the types of services provided via
telemedicine; and
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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:
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The screening is to be conducted at the time of vision and
hearing screenings;
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The records are to be maintained at the school and are
open to local health departments;
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Each school is required to send to the coordination office
a report on the screening status of children in the
school;
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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:
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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;
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An assessment of the needs of the institute's programs and
faculty; and
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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
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
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:
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Belts must be worn in the front and back seats of a
vehicle.
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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.
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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.
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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:
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Operating or towing the vehicle in a parade or
emergency;
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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;
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On a beach;
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If it is the only vehicle owned by the family; or
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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:
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A child under 18 must hold an instruction permit for at
least 6 months before receiving a driver license.
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While holding an instruction permit, the minor may not
drive the car unless accompanied by someone over 21 (previously
18).
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While holding an instruction permit, the minor may not
have more than one passenger under 21, unless that person is a
family member.
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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.
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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:
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The defendant is younger than 19 and the victim is at
least 13,
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The conviction is based solely on the ages of the
defendant and the victim,
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It is a first offense for the defendant,
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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
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Health Care Funding
|
Long-Term Care and End-of-Life
Issues
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Market Fairness/Managed Care
Reform
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Medicaid
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Medical Education
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Medical Licensure and
Discipline
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Medical Privacy
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Rural Health
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Scope of Practice
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Tort Reform/Medical Liability
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Workers' Compensation