Summary of the 1999 Legislative Session

The 1999 Legislature created the Children's Health Insurance Plan (CHIP) to provide affordable health insurance to half a million children of working poor parents. Children under the age 19 who live in families with income at or below 200 percent of the federal poverty level, or $33,400 for a family of four, will be eligible for services through a cost-sharing provision. CHIP benefits coverage will be benchmarked to the HMO plan offered to state employees.

The Legislature also increased funds for chest hospitals and for new medications for mental health clients, for funding higher education health-related institutions and for community mental health services for children.

The Legislature placed a moratorium on Medicaid managed care until the Health and Human Service Commission analyzes the impact of the managed care system. A voucher payment program for persons who receive Medicaid personal assistance and respite services also was authorized.

In the area of health care, the 1999 Legislature revamped the county indigent health care program and created a grants system for communities for essential public health services. In addition, a Border Health Institute in El Paso was established along with an education and prevention program for Hepatitis C.

The Legislature also moved to improve long-term care facility regulation and the quality of care in nursing homes. In addition, the Legislature required the Texas Department of Mental Health and Mental Retardation to analyze the disparity in costs and the quality of care between state-operated and privately operated residential services for individuals with mental retardation.

Interim committee charges

Senate Committee on Health

• Evaluate the changes in the Medicaid system since the beginning of Medicaid reform. The committee shall assess reform efforts in light of the original goals of Medicaid managed care, as well as the impact of Medicaid managed care on patient outcomes, cost implications to the state, and the impact on traditional providers of indigent care. The committee also shall evaluate the ability of Medicaid managed care organizations and the state to manage chronic illnesses and develop specific strategies for disease management for certain populations.

• Inventory and analyze the amount and type of research related to pharmaceuticals, biotechnology and genetics occurring in Texas. The committee shall examine the ethical implications associated with pharmaceuticals, genetic and biotechnology research.

• Review the type, amount, availability, and use of patient-specific medical information, including prescription data, and current statutory and regulatory provisions governing its availability.

• Study impact of the degree of choice granted physicians to administer immunizations to children under the Vaccinations For Children (VFC) Program. The committee shall focus on the health and fiscal implications to the public and private sectors of granting choices to physicians where more than one manufacturer produces the same vaccine at an equivalent price.

• Assess the preparedness of the Texas health care workforce to meet the health care needs of Texans beyond the year 2000, including methods to retain Texas-trained medical personnel. The committee shall evaluate the availability of health care providers in rural and urban areas.

• Monitor the implementation of SB 445, 76th Legislature, Regular Session relating to the Children's Health Insurance Program.

Senate Committee on Human Services

• Examine the continuum of care and support options available to Texans in need of long-term care. The committee shall evaluate the effectiveness of state regulatory efforts to ensure quality services. The committee, working in cooperation with the Senate Finance Committee, shall analyze the current state funding method for Medicaid long-term care and develop alternatives that both ensure quality service and control costs to the state. The committee shall develop recommendations to ensure individual and family choice in long-term care decisions and encourage more private sector and community involvement in the delivery of long-term care.

• Evaluate services provided to hardest-to-serve adult welfare recipients and services provided to children on welfare. The committee shall assess the state's ability to avoid long-term dependency on welfare for both groups and develop additional strategies to encourage self-sufficiency and movement from welfare to work.

• Monitor federal developments related to long-term care and welfare issues. In the event that significant developments occur, the committee shall evaluate their impact on Texas.

• Monitor the implementation of the following bills enacted during the 1999 Legislature: SB 30 relating to parental notification before an abortion may be performed on certain minors; SB 374 relating to the provision of certain long-term care services, to the continuation and functions of the Texas Department on Aging, and to the eventual consolidation of the Texas Department of Human Services and the Texas Department on Aging into a new agency on aging and disability services; and HB 2641 relating to the continuation and functions of the Health and Human Services Commission. The committee shall also monitor the effects of the additional resources provided to the Texas Department of Protective and Regulatory Services.

Senate Committee on Finance

• Review employee benefit issues facing the Employees Retirement System (ERS) and Teacher Retirement System (TRS). The review shall include, but is not limited to, funding contingencies, projected funding needs of TRS-Care, HMO competition and the cost of providing health plans, and the issues surrounding provision of Optional Retirement System or other alternatives for state employees. The committee shall coordinate study of this issue with the Committee on State Affairs. The final preparation of the report will be the responsibility of the Finance Committee.

• Review the expenditure by agencies and institutions that received appropriations from tobacco settlement proceeds to ensure the efficient and effective use of those funds, and identify priorities for future tobacco settlement proceeds.

• Evaluate the financial viability and educational effectiveness of graduate medical education in light of changes in Medicaid, managed care, and other cost factors, including the impact of uncompensated care. This evaluation shall include a review of the role of the state's teaching hospitals in the provision of indigent health care, and the role of graduate medical education in addressing health care needs of under-served regions of the state.

Special Committee on Border Affairs

• Assess the Border region's water and wastewater system infrastructure needs and the impact of the lack of adequate water and wastewater systems on health conditions along the Border. The committee shall develop both short-term and long-term recommendations to address these infrastructure needs.

• Assess the health conditions on the Border, including childhood diseases and chronic health problems endemic to the area such as diabetes and tuberculosis.

Joint Interim Committee on Health Benefit Mandates

• Study the extent that mandated health care benefits increase or have increased the premium costs of health coverage and the effect of any increased premium costs on the affordability and availability of health coverage to consumers.

• Study the effect of the mandated benefits on improving and maintaining the health of the state's residents.

• Study the number and percentage of residents covered by a health benefit plan that is subject to a mandate who have made or are anticipated to make a claim for each mandated benefit.

• Study whether alternatives to each mandated benefit are feasible and what impact those alternatives might have on other matters considered by the committee.

Blue Ribbon Task Force

• The task force is charged with focusing on programs that address the health care needs of the uninsured and indigent. The task force will develop a market-based improvement plan, including financing tools and models, to ensure that Texans have access to affordable health care coverage.