By Richard Lee
For the fort bend star
The Senate gave unanimous assent to a three-bill package of legislation Wednesday aimed at helping communities still dealing with the aftermath of 2017’s Hurricane Harvey and preparing the state for the next natural disaster.
Under Lubbock Sen. Charles Perry’s SB 8, state agencies would work with regional partners to generate a statewide flood mitigation plan. Headed up by the Texas Water Development Board, the process described by the bill would focus on flood planning by watershed for the first time, said Perry, and it’s something the state should’ve done long ago.
“As I was going through the process of developing this bill, it was clear to me that we’ve had many, many projects over the past several decades that were great ideas,” he said. “Had they only been implemented or funded or made a priority, Harvey’s effects would’ve been minimized.”
The bill would also require that the TWDB ensure regional flood plans don’t conflict with or negatively impact neighboring areas.
SB 6, by Brenham Sen. Lois Kolkhorst, also looks to the next storm by creating a “how-to” manual for local officials dealing with the aftermath of a natural disaster. The bill would leverage experience at state disaster response agencies by directing them to develop a model guide to help officials apply for federal aid, work with volunteer aid organizations, provide for short- and long-term housing needs and remove debris. It would also direct these agencies to devise a program to train and certify emergency management directors.
Paying for all of this is Conroe Sen. Brandon Creighton’s SB 7, which would create the Texas Infrastructure Resiliency Fund. Appropriated $1.65 billion in rainy day funds under the Senate’s supplemental budget proposal last week, this fund would offer grants and low- or no-interest loans to design and build flood mitigation projects from the flood planning process created in SB 8. It would also draw down federal aid money by offering up three-quarters of the fund matching requirement to communities applying for federal disaster aid or flood mitigation programs.
Lt. Gov. Dan Patrick praised members for their unanimous and swift action on this issue.
“Members, the fact that Senate Bills 6, 7 and 8 will pass 31 to nothing on each bill, I think is one of the greatest achievements that I’ve seen since I’ve been in the Senate of moving significant legislation forward,” he said from the Senate rostrum. “I thank every one of you for realizing these are statewide issues and coming together to help your fellow senators who were in specific need.”
In committee this week, a number of key bills had hearings before Senate panels. They include:
• SB 21, by Houston Sen. Joan Huffman, which would raise the minimum age to buy tobacco or nicotine products from 18 to 21.
• SB 22, by New Braunfels Sen. Donna Campbell, would put in statute what has been a fiscal policy of disallowing state money going to abortion providers, and extend this prohibition to local tax dollars.
• SJR 24, by Kolkhorst, would ask voters to approve the dedication of all revenues from the state sporting goods sales tax to Texas Parks and Wildlife Department and Texas Historical Commission.
• SB 653, by Edgewood Sen. Bob Hall, would bar cities from enforcing red light violations using intersection cameras.
• SB 1264 by North Richland Hills Sen. Kelly Hancock, would prohibit “surprise billing” from out-of-network emergency health care or non-network providers at in-network hospitals.
Rural Health Care
Texas is facing an epidemic of rural hospital closures, but Lubbock Sen. Charles Perry said he hopes that putting a long-standing budget policy into state law will help keep these critical providers open for the rural Texans that rely on them. Since 2013, 21 hospitals in rural areas have closed in Texas.
A major reason for that, said Perry, is underpayment for Medicaid reimbursements, which cost these facilities hundreds of millions of dollars in uncompensated care every biennium. There are 38 such hospitals in his district alone, more than any other legislator.
“It’s safe to say that 10 of those will no longer be open by the time we come back next session, possibly more, if we don’t do what the state has said it’s supposed to do for years now and that’s reimburse Medicaid at cost,” said Perry. “It’s just time that we step up and honor that.”
His bill, SB 170, was considered before the Senate Health and Human Services Committee last Tuesday and would enshrine what has been a regular budget provision into state law, directing the state health commission to develop a method to ensure that rural hospitals get full Medicaid reimbursement.
While most Texans today live in urban or suburban regions, 3 million people live in one of the state’s 170 rural counties. They tend to be older, poorer and less healthy than urban populations, according to a 2018 paper released by the Texas A&M Rural and Community Health Institute.
Often, rural hospitals are the only regional healthcare providers that accept Medicaid, and may be the only medical providers at all for miles. Eighty rural counties have fewer than five physicians; 35 have none at all. Despite the need, Texas has had more rural hospital closures than any other state.
Funding for rural hospitals has been aided by a provision placed in the state budget every session since 1993, requiring reimbursement for the full allowable cost of service for Medicaid patients. This worked well until the state handed over administration of Medicaid to managed care organizations in 2012. Because the contracts between the state and the MCOs omitted the budget provision, says the Texas Organization of Rural and Community Hospitals (TORCH), rural hospitals have seen their Medicaid reimbursements decline. Perry believes it’s more than just that. In his opinion, the legislature bears some responsibility.
“We have not put the money for it to pass through,” he said.
Complicating this process has been difficulty getting various agencies to agree on what the rural hospitals are owed. HHSC has been skeptical of the use of annual Medicare cost reports required by federal agencies, saying they fail to account for a number of variables across various populations, according to agency testimony at Tuesday’s hearing. Perry pushed back.
“MCOs have a methodology and we have a methodology. There should be one methodology,” he said. “What I hear is the state has a desire to make sure that Medicaid cost reimbursement in rural healthcare is at cost regardless of who’s the payer source.”
Perry asked that the agency continue to work with him on determining the best way to accurately assess the true cost of the Medicaid shortfall to rural hospitals.
The shortfall causes not only hospital closures, said TORCH’s Don McBeath, but also a reduction in critical services, notably obstetrics. Across Texas, he said, about 50 percent of infants are delivered to patients covered by Medicaid; in rural regions, the rate is 70 percent.
“Obviously when you have an underpayment, that’s disproportionally amplified in the rural areas,” he said.
The gap in delivery services was particularly concerning to New Braunfels Sen. Donna Campbell, who has worked as an emergency room physician in rural Colorado County for the last 25 years.
“I can’t tell you members how important it is for us to find the resources to keep our rural hospitals open…I want [infants] delivered in labor and delivery rooms, not the emergency room where I work,” she said.