COMING UP: 86th Legislative Session
It’s that time of year again. THOT shared recommendations with HHSC as it develops its legislative appropriations request (LAR) for the upcoming biennium. At the top of our list? GR funding to increase Medicaid base rates
85th Legislative Session Initiatives
(email THOT@THOTonline.org to request a free, full color printed legislative agenda pamphlet)
Shore up Texas’ GME investments and Medical Research – Texas needs more primary and specialty care providers for its rapidly growing and aging population. Education, patient care, and research together support Texas’ transformational healthcare system.
- Investing federal match to maintain existing residencies and infrastructure while we grow our GME capacity
- Targeted support for shortage specialty residencies.
- Increasing GR to fully fund Medicaid School GME costs through the GME Formula.
- Maintaining the Research Formula GR increase for medical research to keep Texas a world class research and health care destination.
Support Financing to Ensure Hospital System Stabilization and Sustainability – All Texas hospitals face increased risk with uncertain waiver funding and pending federal health care changes. While no group of Medicaid hospitals are paid their Medicaid costs; the largest public hospitals in Texas received the lowest Medicaid payments, and the smallest share of costs covered. Reductions in waiver funding for THOT members will trigger negative margins; service reductions and/or increased pressure on property taxes. Health care services and other essential GME, Trauma, and public health services are at risk.
THOT supports equitable, efficient targeting of scarce funds through:
- Appropriating GR for rate increases and/or providing flexibility for industry-funded rate increases.
- Targeting scarce funds to individual hospitals serving a disproportionate share of uninsured Texans and those on Medicaid.
Ensure Continued Funding of Regional Trauma Centers – THOT members operate 10 of the state’s 17 Level I regional trauma centers. Trauma systems are ready 24/7 for our first responders and for all Texans. Texas trauma funding helped create a successful trauma system: our trauma mortality rate is lower than most other state rates. THOT’s mission also supports vulnerable Texans, so we’ve proposed DRP funding alternatives to help find an alternative, dedicated, recurring, and sustainable source of funds for trauma services.
- Fully funding Texas Trauma needs at a minimum at last year’s level including the trauma add on; and appropriation of all funds in 5111 Trauma and EMS GR account.
- Identifying funding that is dedicated, recurring, and sustainable as a possible alternative to the current DRP program.
- Investing unallocated dedicated funding for critical trauma infrastructure development.
- Targeting scarce funds to ensure a proficient, system-ready, cost-effective, quality trauma system.
LOCAL AUTHORITY & RESPONSIBILITY
Ensure Continued Local Authority and Responsibility for Local Decisions – Texas should continue its tradition of local control.
- Local authority and decision-making for tax rates, use of taxes, ad valorem valuation, and bond authority.
Ensure the Texas’ Medicaid System is prepared for Value Based Care – THOT members share Texas’ goal of improving quality and cost in our healthcare system. Texas has an opportunity to improve the health of its beneficiaries and the value of the health care delivery system.
- Hospital and HMO rate setting methodologies that create incentives for providers to innovate and be rewarded for value based care.
- Selecting valid measures for provider performance so providers caring for complex, low-income, or at-risk Texans aren’t penalized.
- Using waiver DSRIP funding to support provider transformation to compete in value based care.
- Accounting for a broader range of services, higher costs and complexity at tertiary and quaternary health systems. Supporting residents, providing highly specialized healthcare services, keeping level one trauma systems at the ready, and being prepared for disaster or public health events create costs that can lead to disadvantages in cost-based competition that fails to account for these public goods. Hospitals that serve the community shouldn’t be penalized for their mission.
Texas has a compelling Waiver I success story and should negotiate to use Waiver II savings to create a block grant coverage program for uninsured Texans.
Texas can showcase what flexibility and locally-driven innovation can achieve in addressing our coverage challenges with a capped expenditure block grant for coverage for uninsured Texans. An 1115 Coverage Block Grant for uninsured Texans, funded with local contributions (IGT or LPPFs) and federal match from waiver savings can begin under a new administration as soon as Texas is granted the authority to use existing 1115 wavier funding and budget neutrality room for the program. Tex-CARE will provide care within local integrated care partnerships. Care will be more cost-effective, improve quality and showcase our Texas ingenuity, innovation, achievements while teeing up Texas health opportunities.
- Negotiating for an 1115 block grant for uninsured Texans using local health partnerships in a capped expenditure skin in the game Tex-CARE plan.
- Quickly and effectively implementing opportunities and outcomes for appropriately structured block grants in providing health care.
- Investing in local, community-driven integrated health care.
- Maximizing Waiver funding and health system support.
THOT supports a Texas approach to covering uninsured Texans. Creating a fairly-financed system of care for uninsured Texans will reduce costs and improve outcomes compared to how care is provided and funded today.
- A Texas-Style coverage system for uninsured Texans.