Senate Committee on Health and Human Services

On September 13th, under Chair Charles Schwertner, the Senate Health and Human Services Committee held a lengthy hearing on its interim 1115 waiver charge[1], taking testimony from HHSC agency staff, Waiver Anchors and providers, health care advocates, and policy organizations. Discussion focused on the impact of Medicaid expansion and outcomes data associated with DSRIP projects that are funded under the 1115 Waiver.

HHSC laid out updates on waiver negotiations, and faced pointed questions about waiver costs and savings; outcome data and data showing system improvements. Chair Schwertner cited the just-released HMA UC study often in his comments and questions. THA and TORCH testified on the importance of the waiver to hospitals; and Danette Castle at the Texas Council of Community Centers and THOT’s own Daniel Deslatte (UT Health Northeast) gave provider perspectives on improvements in behavioral health systems, care outcomes and greater system coordination. The Center for Public Policy Priorities’ Anne Dunkelberg acknowledged HMA’s reputation and suggested several areas in which HMA assumptions used in the report raised questions. THOT’s Maureen Milligan provided specifics on the impact waiver funding has to Texas essential hospitals, particularly given their lower than average margins. As THOT has done in the recent hearings, including Dr. Cerise’s HAC testimony, she referenced emerging CMS policy and regulations in the waiver and in managed care rules and CMS’ work to move  states to increase Medicaid rates, provide broad health coverage, and develop equitable, sustainable, and transparent Medicaid financing. Milligan testified that there is an opportunity to leverage the waiver to invest in transformation and creation of integrated, value-based systems of care within Uncompensated Care, including hospitals and health systems in collaboration with physicians, behavioral health providers and community based organizations as part of a winning negotiation and transformation strategy for improving care and maximizing waiver funds.

Chair Schwertner was interested in the opportunity Milligan referenced as emerging from CMS activities, policies and the work on waiver renewal. The Chair sought more information and followed up with a request for a more detailed briefing.

[1] Chaired by Senator Charles Schwertner (R-Georgetown), the Senate Committee on Health and Human services has been charged with studying “the impact of the Section 1115 Texas Healthcare Transformation and Quality Improvement Program Waiver…” among other things on improving health outcomes, reducing costs, and providing access to health care for the uninsured, and monitor the renewal process of the waiver. Explore other mechanisms and make recommendations to control costs and increase quality and efficiency in the Medicaid program, including the pursuit of a block grant or a Section 1332 Medicaid State Innovation Waiver for the existing Medicaid program.”

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Daniel Deslatte, Vice President of Planning & Public Policy at UT Northeast also testifies on the 1115 Waiver at the Senate HHS Hearing.

Senate Committee on Finance

Chaired by Senator Jane Nelson (R-Flower Mound), the Senate Committee on Finance has been charged with monitoring “the implementation of legislation addressed by the Senate Finance Committee during the 84th Legislature, Regular Session and [making] recommendations for any legislation needed to improve, enhance, and/or complete implementation.” Included in this charge is monitoring the support for and the enhancement of graduate medical education (GME).

On September 15th, the Committee held a lengthy hearing on a number of items including the charge on GME. Texas Higher Education Coordinating Board’s Dr. Stacey Silverman provided an overview of GME funding, in particular Chair Nelson’s work to create and sustain grant funding for new residency positions. Of note to THOT’s upcoming advocacy agenda, Dr. Silverman highlighted the need to sustain residency positions that are funded with GME grants. Testimony supported funding for graduate medical education for new and existing residency programs. Committee members were receptive to the testimony and noted the need for the state to continue working towards the goal of funding 1.1 residency slots per medical student.

THOT’s testimony to the Committee highlighted the current funding and access inequities in the federal Medicare resident caps, and the importance of the state’s investment in GME. Milligan thanked the committee for the increase in funding during the 84th Legislative Session, and expressed THOT’s support for maintaining or increasing GME funding for new and existing programs.