2007 Legislative Compendium: Public Health

Wellness Promotion and Prevention

State Employee Wellness/Promotion
House Bill 1297 by Rep. Dianne Delisi (R-Temple) and Sen. Jane Nelson (R-Lewisville) calls for the creation of a state employee wellness program to improve the health and wellness of state employees. TMA strongly supported the legislation, as did the Texas Public Health Coalition. The idea for a statewide employee wellness program emerged over three TMA Healthy Vision 2010 summit meetings held in 2006. The summits brought together leaders in medicine, business, health plans, and communities to identify ways to improve health care in Texas.

HB 1297 requires that a wellness coordinator create and develop a statewide wellness program to improve the health and wellness of state employees. The state's Legislative Budget Board (LBB) estimates this type of plan could save Texas $80 million in the first three to five years. The program may include:

  1. Educational opportunities that target the most costly health care claims, including stress management, nutrition, healthy eating habits, emotional well-being, fitness, disease prevention, and smoking cessation;
  2. Health risk assessment tools and programs;
  3. Health, nutrition, and fitness-related resources;
  4. Development of policy and environmental change strategies that integrate health behaviors and physical activity, including providing nutrition food choices in vending machines and state cafeterias; and
  5. Optional incentives that encourage participation in the wellness program, including allowing extra leave time for physical activity and participation in the wellness program and coordinating discounts with gyms and fitness centers.

The bill also establishes employee wellness demonstration projects that incorporate best practices for encouraging employee participation and the achievement of wellness benefits. A TMA member will be appointed to the Worksite Wellness Advisory Committee.

Health Plan Wellness Promotion
House Bill 2252 by Rep. Larry Taylor (R-Friendswood) and Sen. Tommy Williams (R-The Woodlands) allows health plans to provide consumers with information about wellness services (e.g., gym memberships and smoking cessation programs) when shopping for health insurance coverage. It also allows health plans to establish premium discounts, rebates, or a reduction in applicable copayments, coinsurance, or deductibles, or any combination of these incentives, for an insured person who participates in programs that promote disease prevention, wellness, and health.

Prevention and wellness promotion also were heavily featured in SB 10, the Medicaid reform bill by Senator Nelson and Representative Delisi.


Diabetes Mellitus Registry and Pilot
House Bill 2132 by Rep. Joe Strauss III (R-San Antonio) and Sen. Leticia Van de Putte (D-San Antonio) requires the Texas Department of State Health Services (DSHS) to create and maintain a diabetes mellitus registry as a pilot program. The pilot program would be implemented in a municipality with a population of between 1 and 2 million. The program would require tracking the prevalence of diabetes mellitus and the level of control of the disease among varying demographics. Trends of new diagnoses of diabetes and the health care costs associated with diabetes mellitus also would be monitored. The bill calls for DSHS and the participating public health district to promote educational programs about diabetes mellitus. The bill further outlines confidentiality measures to protect registrants.

Diabetes Prevention and Treatment
House Bill 3735 by Rep. Jim McReynolds (D-Lufkin) and Sen. Robert Nichols (R-Jacksonville) establishes a diabetes demonstration pilot program at the Memorial Health System of East Texas. The aim of the pilot is to provide a comprehensive approach for the prevention and treatment of acanthosis nigricans (AN) and diabetes. The program must: (1) focus on taking an epidemiological approach to disease surveillance; (2) identify the prevalence of AN and diabetes in persons in the service area; (3) provide wellness and health information and services to people positively screened for AN and diabetes; (4) improve access to care for people diagnosed with AN or diabetes; and (5) study the cost savings of early detection and treatment of AN and diabetes. The bill would provide for AN screening in a region not currently covered by the existing AN screening program, operated by The University of Texas-Pan American.

Type 2 Diabetes Education and Risk Assessment
Senate Bill 415 by Sen. Eduardo Lucio (D-Brownsville) and Representative McReynolds require that the Acanthosis Nigricans (AN) screening program be supplanted with the Type Two Diabetes Education and Risk Assessment Program, administered by UT Pan America Border Health Office. The type 2 diabetes screen is to be conducted among public and private school students in Texas Educational Agency (TEA) service centers. SB 415 also requires that body mass index (BMI) and blood pressure screens be conducted. In the event that the initial screen for type 2 diabetes yields a positive result, the bill requires that the parent and/or guardian receive a written report and be provided information on how to apply for Medicaid and CHIP. The bill establishes the Type Two Diabetes Risk Assessment Program Advisory Committee, which will include a member of TMA and the Texas Pediatric Society.

Obesity/Physical Education

Physical Education for School-Age Children
Senate Bill 530 by Senator Nelson and Rep. Rob Eissler (R-The Woodlands) calls for increased physical education in grades K-8, requires an annual physical fitness assessment of students in grades K-12, and makes TEA responsible for implementation.

Specifically, the bill requires 30 minutes of daily physical activity for students in grades K-5, and four out of six semesters of physical activity for middle school students. The bill allows schools to use structured recess to accomplish the physical activity requirement. However, local school health advisory councils are directed to consider and make policy recommendations about the importance of daily recess for elementary school students. The bill also requires annual physical fitness assessment of students in grades 3-12, beginning in 2007-08. TEA is directed to analyze the results by school district, and correlate the results to student academic achievement levels, attendance levels, obesity, disciplinary problems, and school meal programs by Sept. 1 of the following year.

Interagency Obesity Council
Senate Bill 556 by Senator Lucio and Representative McReynolds establishes an interagency obesity council with representatives from DSHS, TEA, and the Texas Agriculture Commission for the purpose of discussing the status of each agency's programs that promote better health and nutrition and prevent obesity among children and adults. The council also will consider the feasibility of tax incentives for employers who promote activities designed to reduce obesity in the workforce. The council is required to give an annual report.

Obesity Awareness Week
House Bill 2313 by Rep. Patrick Rose (D-Dripping Springs) and Senator Nichols designates the second full week in September as Obesity Awareness Week. The goal is to raise awareness of the health risks associated with obesity and to encourage Texans to achieve and maintain a healthy lifestyle.

Preferential Contracting for Vendors Providing Healthier Foods
Senate Bill 35 by Senator Nelson and Representative McReynolds gives preferential contracting for food vendors bidding to operate in public cafeterias who provide food with higher nutritional value and who do not provide foods containing trans-fatty acids. In the final days of session, the bill died in House Calendars but was revived when it was added to an unrelated bill, House Bill 3560 by Rep. David Swinford.

Oversight of Nutritional Programs
House Bill 4062 by Rep. Sid Miller (R-Stephenville) and Senator Nelson moves the following nutrition programs from HHSC to the Texas Department of Agriculture: the commodity supplemental food program, food distribution program, emergency food assistance program, school lunch program, summer food service program, child and adult care food program, special milk program, and school breakfast program. The bill also calls for a study regarding trans-fatty acids and increasing participation in the school breakfast program.

Smoking Cessation/Tobacco Prevention and Control

Cigarette Safety
House Bill 2935 by Rep. Phil King (R-Weatherford) and Sen. Royce West (D-Dallas) prohibits the sale of cigarettes in Texas that do not meet certain fire safety standards. Cigarettes sold or offered for sale in Texas must be certified by the State fire marshal. Penalties are to be appropriated to the State fire marshal to support fire safety and prevention programs.

Point-of-Sale Health Warning
Senate Bill 91 by Senator Van de Putte and Rep. Bill Zedler (R-Arlington) amends the point-of-sale health warning signage for tobacco products to include the following language: "Pregnant women should not smoke. Smokers are more likely to have babies who are born premature or with low birth weight."

Smoking Prevention Near Miss

Statewide Smoking Ban
House Bill 9 by Rep. Myra Crownover (R-Denton) and Senate Bill 368 by Sen. Rodney Ellis (D-Houston), as filed, would have eliminated smoking in all workplaces and public places. Specifically, the bill prohibited smoking in all public places, places of employment, and seating areas of outdoor events. It also would have prohibited smoking within 15 feet outside of an entrance, operable window, or ventilation system of an enclosed area in which smoking was prohibited. The original bill exempted private residences unless used as child-care, adult day-care, or health care facilities; designated motel or hotel rooms; designated private or semiprivate rooms in nursing homes or long-term facilities; and private clubs that did not employ any employees. To win support, amendments were added to the bill that would exempt cigar bars and tobacco shops, and reduce certain penalties within the bill.

TMA, the Texas Association of Restaurants, the Public Health Coalition, the American Cancer Society-Texas Chapter, and many others were very supportive of the bill as filed. Given the broad support, this issue is likely to reemerge next session.


Human Papilloma Virus Mandate Prohibition
House Bill 1098 by Rep. Dennis Bonnen (R-Angleton) and Sen. Glenn Hagar Jr. (R-Katy) allows students to be admitted to elementary and/or secondary school without having had the human papilloma virus (HPV) vaccine. The bill calls for HHSC to provide educational material about HPV that is unbiased, medically and scientifically accurate, and peer reviewed. The bill also requires HHSC to make it available to parents or legal guardians at the appropriate time within the immunization schedule. The bill preempts the executive order previously issued by the governor, but expires Jan. 11, 2011, to allow for the legislature to revisit the HPV mandate.

HPV Vaccine Education
House Bill 1379 by Rep. Joe Deshotel (D-Beaumont) and Senator Nelson requires DSHS to produce and distribute informational materials about the HPV vaccine. The materials must include information relating to the effectiveness, availability, and contraindications of the vaccine. Course materials and instructions about sexually transmitted diseases should express that:

  1. Sexual intercourse is not required to become infected with HPV, and the avoidance of skin-to-skin contact involving the genital areas offers the best protection. Materials should state that both males and females may be infected with HPV. The virus' symptoms may not be present, and younger women are at greater risk of acquiring HPV than older women.
  2. HPV may be transmitted to an infant during childbirth.
  3. HPV plays a role in the development of genital warts, cervical cancer, and other diseases.
  4. Women need to continue to undergo pap smear testing, even if they have received a vaccination against HPV.

DSHS must collaborate with the Texas Cancer Council to develop educational programs for parents regarding HPV, and promote awareness of a minor's need for preventive services for cervical cancer. The bill also requires DSHS to develop and maintain a Web site that targets the public and health care professionals, and provides accurate, comprehensive information on all aspects of cervical cancer prevention, including vaccination against HPV. Materials must be provided in English and in Spanish. TMA strongly supported this bill.

Immunization Education/Awareness by School Districts
House Bill 1059 by Rep. Tan Parker (R-Flower Mound) and Senator Nelson is referred to as the "Emily Lastinger Act" in honor of children who have died from the flu. The bill requires school districts to post the following on their Web sites in English and in Spanish: (1) required vaccinations for school entry, including the influenza vaccine; (2) recommended vaccinations for public school students; (3) health districts that offer the influenza vaccine; and (4) a link to the DSHS Web site for exemption procedures. The bill instructs DSHS to prepare a list, suitable for posting on schools' Web sites, of required and recommended immunizations for school-age children.

Rotovirus Vaccine Coverage
House Bill 2636 by Rep. John Smithee (R-Amarillo) and Sen. Kim Brimer (R-Ft. Worth) is not health related, but in the last days of session, was amended to add rotovirus vaccine to the list of childhood immunizations required to be covered by health plans.

Flu Vaccine Education
House Bill 3184 by Rep. Garnet Coleman (D-Houston) and Sen. Bob Deuell, MD (R-Greenville), requires DSHS to provide information on its Web site about the benefits of annual vaccinations against influenza for children 6 to 59 months of age, and to distribute the information to parents of children in day-care facilities in August and September of each year.

House Bill 532 by Representative Dukes was amended to this bill. HB 532 allows each health care provider to select the specific influenza vaccine to be used under the Vaccines for Children (VFC) program from a list of approved vaccines. Currently, the VFC program offers the vaccines that it gets directly from the Centers for Disease Control and Prevention (CDC). Companion legislation was Senate Bill 811 by Senator Janek.

Immunizations for Low-Income Students of Higher Education Institutions
Senate Bill 140 by Senator Nelson and Rep. Lois Kolkhorst (R-Brenham) requires DSHS and the Texas Higher Education Coordinating Board to conduct a joint study of the feasibility of providing immunizations without charge or at a discount to economically disadvantaged students enrolled in health profession degree programs at institutions of higher education in this state. The study must examine potential methods of providing those immunizations.

Electronic Medical Records Interface With Immunization Registry
Senate Bill 204 by Senator Nelson and Representative Delisi requires that electronic medical records vendors in Texas must provide the ability to electronically interface with the Texas Immunization Registry, ImmTrac.

Pandemic Flu Preparation
Within the supplemental appropriations bill, HB 15, legislators allocated $11 million to purchase flu antiviral in the event of a pandemic flu outbreak.

Immunization Near Miss

Lifespan Immunization Registry
House Bill 1896 by Rep. Donna Howard (D-Austin) would have eliminated the age limit for maintaining records in the state immunization registry and required the retention of this information until the person's death. The bill also would have required health care professionals who administer an immunization to a person over 18 years of age to submit data of the immunization to DSHS. It also would have required DSHS to develop a program to educate first responders regarding the benefits of being included in the immunization registry, and it would have required DSHS to work with stakeholders to identify adult immunizations necessary in the event of a public health disaster.

The House Committee Substitute required recording of adverse reactions to vaccines and allowed for a regional health information exchange, in addition to central and local registries. It also would have provided specific immunity from liability for persons reporting, added a new section specifically relating to the administration of immunizations and medications during disasters and emergencies. It would have required that data elements be compatible with the standards of the Health Information Technology Standards Panel. TMA strongly supported this bill and will continue to advocate for it in the next legislative session.

Child Health and Safety

Seat Belts on School Buses
House Bill 323 by Rep. Mike Hamilton (R-Mauriceville) and Senator Lucio requires three-point seat belts on buses that transport schoolchildren. The provisions of this bill apply to all school buses purchased after 2010, and require implementation for all buses purchased or contracted as of 2014. Chartered buses and mass transit buses that transport schoolchildren are exempt from the seat belt requirement. This bill is contingent upon appropriations for reimbursement to school districts for the expenses incurred related to this statute. It allows for donations to fund the purchase of the seat belts and for acknowledging donors by signs on the school buses.

Child Protective Services
Senate Bill 758 by Senator Nelson and Representative Rose revises Child Protective Services (CPS) reforms adopted in 2005 and implements new ones. Significant components of the bill:

  • Remove the requirement that the state privatize substitute care and case management;
  • Support in-home support services for families in which poverty is the primary underlying cause of neglect and for which such support could result in the child staying in the home or being reunited with the family more quickly;
  • Establish adoption subsidies and create initiatives for increasing the number of foster care families; and
  • Establish a Committee on Pediatric Centers of Excellence for the assessment, diagnosis, and treatment of child abuse. The committee must include three pediatricians specializing in treating victims of child abuse.

Child Safety Month
House Bill 1045 by Rep. Vicki Truitt (R-Keller) and Sen. Judith Zaffirini (D-Laredo), accompanied by House Calendar Resolution 73 by Representative Truitt and Senator Nelson, establishes April as Child Safety Month.

Child Health/Safety Near Miss

Booster Seat Bill
Senator Bill 60 by Senator Zaffirini and Rep. Fred Brown (R-College Station) would have raised the age that a child must be secured in a child passenger seat in a vehicle to age 8, or taller than four feet, nine inches. The bill passed the Senate 26-4 but died in the House Transportation Committee even though similar legislation passed in the House previously. TMA and TPS strongly supported the bill. Texas will lose $19 million in federal transportation funding for failure to adopt the legislation.

Cancer Prevention and Screening

Cancer Prevention and Research Institute
House Bill 14 by Rep. Jim Keffer (R-Eastland) and Senator Nelson calls for the creation of the Cancer Prevention and Research Institute of Texas to: (1) create and expedite innovation in the area of cancer research and to enhance the potential for a medical or scientific breakthrough in the prevention of cancer and cures for cancer; (2) attract, create, or expand research capabilities of public or private institutions of higher education and other public or private entities to promote a substantial increase in cancer research and the creation of high-quality new jobs; and (3) implement the Texas Cancer Plan.

The bill creates an oversight committee for the institute, a scientific research committee, and a cancer research fund. Physician members will be included on the oversight committee.

The Scientific Research Committee will review grant and loan applications and make recommendations to the oversight committee regarding the award of research, therapy development, and clinical trial grants and loans from the Cancer Research Fund.

Accompanying HB 14 was House Joint Resolution (HJR) 90, by the same authors, authorizing $3 billion in bond sales over 10 years to fund the institute. The bond measure must be approved by voters this fall. If approved, the new funding would be placed in the Cancer Research Fund, a dedicated account in the general revenue fund that consists of: (1) money received from the sale of bonds; (2) patent, royalty, and license fees and other income; (3) legislative appropriations; (4) gifts, grants, including federal grants, and other donations; and (5) interest earned on investments of money in the fund. Every dollar in state funding would have to be matched by 50 cents from federal or private sources.

The fund will be used to pay for: (1) grants and loans for cancer prevention and research and facilities to realize therapies, protocols, and medical procedures that will result in, as speedily as possible, the cure for, or substantial mitigation of, all forms of cancer in humans; (2) the purchase of needed laboratory facilities by or on behalf of a state agency or grant recipient; and (3) operation of the institute. Authorizes the Texas Public Finance Authority to issue and sell general obligation bonds of the state for the cancer research fund.

The bill additionally calls for reorganization of agencies involved in cancer research and prevention. 

Medicaid Coverage for Breast and Cervical Cancer Treatment
Senate Bill 10, the Medicaid Omnibus bill includes a provision that will expand the number of women who may receive treatment under the Breast and Cervical Treatment Act (BCCTA).

BCCTA is a special Medicaid program that provides cancer screening, diagnosis, and treatment for low-income, uninsured women. Currently, a woman must be screened by a designated provider in order to be eligible for treatment. The provision specifies that as long as a woman is otherwise eligible for coverage, she may receive treatment regardless of whether the screening was performed by a designated BCCTA provider and regardless of whether federal matching funds are available. While the woman is being treated, she is eligible for full Medicaid benefits. HB 1 allocates state general revenue to provide additional coverage. As a result of the legislation, 1,200 additional low-income women are expected to get cancer treatment.

Dating Violence
House Bill 121 by Representative Dukes and Sen. Juan "Chuy" Hinojosa (D-McAllen) requires that each school district adopt and implement a dating violence policy that includes a definition of "dating violence," and that addresses safety planning, enforcement of protective orders, school-based alternatives to protective orders, training for teachers and administrators, counseling for affected students, and awareness education for students and parents. The bill became effective immediately.

Infectious Diseases

Health Care-Related Infections
Senate Bill 288 by Senator Nelson and sponsored by Representative Delisi establishes an Advisory Panel on Health Care-Related Infections and a reporting system under the auspices of DSHS. This statute requires the reporting of risk-adjusted infection rates for central line, specified surgical sites, and pediatric respiratory syncytial virus on at least an annual basis.

HB 1370 by Representative Coleman and sponsored by Senator Zaffirini, updates the statute governing the Interagency Coordinating Council for HIV and hepatitis with the new names of the health and human services agencies. The bill adds the Texas Higher Education Coordinating Board to the list of agencies that compose the council. The council is placed under the Texas Health and Human Services Commission rather than DSHS. The bill also calls for the identification of all statewide plans related to these diseases; a complete inventory of all monies spent; state agency interactions and policy issues; assessment of gaps in service; identification of barriers to services, particularly for marginalized populations; identification of unique service needs; evaluation of levels of service and quality of care provided for persons infected with HIV, AIDS, and hepatitis as compare with national standards; and identification of emerging issues.

Methicillin-Resistant Staphylococcus Aureus
House Bill 1082 by Representative Straus and sponsored by Senator Van de Putte, establishes a pilot program to research and implement procedures for reporting cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) and requires the reports to be made public with a summary by location.

Needle Exchange
Senate Bill 10, the Medicaid Omnibus Reform bill by Senator Nelson and Representative Delisi, includes a provision allowing Bexar County to establish a needle exchange program to help reduce incidence of communicable diseases such as hepatitis B and HIV.

Disaster Preparedness and Planning

Statewide Mutual Aid System
Senate Bill 11 by Senator Nelson and Rep. Frank Corte Jr. (R-San Antonio) creates a Texas Statewide Mutual Aid System that will provide integrated statewide disaster preparedness aid response capability among local government entities without a written mutual aid agreement. The bill also calls for the division of the state into disaster districts to engage homeland security preparedness and response activities along the boundaries of the state transportation regions. More than 15 other bills were absorbed into SB 11, including provisions related to school safety, establishment of a Border Security Council, trafficking of persons, street gangs, and enhanced driver licenses.

In the closing days of session, several other bills important to organized medicine also were added to SB 11:

  • Senate Bill 1186 by Senator Nelson, allowing for the inclusion in the immunization registry information about immunizations for first responders.
  • Senate Bill 810 by Senator Janek, allowing for quarantine for persons exposed to or infected with a communicable disease.
  • Senate Bill 1499 by Senator Zaffirini, requiring that the notice of an emergency meeting to address the relocation of a large number of residents in the event of a disaster be provided to the news media no later than one hour before the meeting.

Filling of Prescriptions in the Event of an Emergency
Senate Bill 1658 by Senator Nichols and Rep. Charles Hopson (D-Jacksonville) allows pharmacists to use their professional judgment in dispensing non-Schedule II prescription drugs in an emergency. In the aftermath of Hurricanes Katrina and Rita, it was realized that the traditional access to health care is often compromised when prescription drugs may be needed the most. SB 1658 is intended to allow continued access of a patient to his or her prescription drugs during these situations. Pharmacists are allowed to dispense prescriptions without physician contact in the event that not filling the prescription may disrupt the patient's therapy, the pharmacist is unable to contact the physician after considerable effort, the quantity does not exceed a 72-hour supply, or there is a natural or manmade disaster preventing contact with the physician.

Disaster Planning for Pets
House Bill 88 by Representative Branch added a provision to the government code regarding disaster planning for the humane evacuation, transport, and sheltering of pets in a disaster. The bill requires that service animals be evacuated with the person with a disability and household pets with owners, if it is feasible and does not cause any danger.

TMA Public Health Staff Team:

Legislative: Greg Herzog
Policy: Gayle Love, Audra Bryant, and Susan Griffin
Legal:  Lee Spangler and Kelly Walla

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