87th Legislative Session/THOT Interim Study Responses

87th Session Priorities

86th Legislative Session Successes & Initiatives

THOT Achievements (PDF)

Graduate Medical Education (GME) & Research

Support and Shore up Texas’ GME investments and Medical Research – GME in Texas is underfunded while our State needs more primary and specialty care providers for its rapidly growing and aging population. Workforce education, patient care, and research together support Texas’ transformational healthcare system.

THOT Recommends:

  • Seeking federal match for existing Medicaid GME costs to support existing GME residencies and infrastructure as the foundation for growing our GME capacity.
  • Increasing GR to fully fund Medical School GME costs through the GME Formula.
  • Maintaining the Research Formula for medical research to keep Texas a world class research and health care destination.

Medicaid Financing

Develop a Sustainable Hospital Financing System with Funding Following the Patient – Low Medicaid rates make our health care system dependent on complex, unstable financing. While statewide hospital funding depends on public hospitals’ property taxes, those hospitals (and their tax payers) receive the smallest share of the state’s payments for their costs of care. Federal changes to waiver uncompensated care funding, CMS’ disapproval of Medicaid supplemental financing; and significant shifts in hospital funding make Medicaid financing more unstable than ever.

THOT Recommends:

  • Appropriating GR for rate increases and to more sustainably finance Medicaid payments.
  • Ensuring that Medicaid funding follows the patient by funding consistent percentage of Medicaid and uninsured patient costs among all hospital categories; or
  • Identifying clear policy reasons for additional financial support, such as supporting unfunded trauma care, unfunded workforce costs, and ensuring access to care.
  • Allowing local financing solutions, such as local provider participation funds to ensure Texas has the resources to fund Medicaid supplemental and waiver payments equitably.

Provide Fair Incentives for Value Based Care

Guarantee 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.

THOT Recommends:

  • Developing Hospital and HMO rate setting methodologies that create incentives for providers to innovate and be rewarded for value-based care.
  • Implementing sociodemographic adjustments for performance measures affected by non-clinical patient characteristics.
  • Using expiring waiver DSRIP funding to support provider transformation to compete in value-based care.
  • Creating value-based systems that account for differences in the range and complexity of services provided (e.g., at tertiary and quaternary health systems) and the underfunded community benefits some providers also make possible. Supporting GME residents, providing highly specialized healthcare services, keeping level one trauma systems at the ready, and being prepared for disasters or public health events contribute to value yet cause unanticipated financial disadvantages. Value based funding should support hospitals’ valued contributions to the health of Texas.

Trauma Funds

Safeguard Continued Funding and Proficiency of Regional Trauma Centers – THOT members operate nearly half of the state’s 18 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 alternative, dedicated, recurring, and sustainable sources of funding for trauma services.

THOT Recommends:

  • Fully funding Texas Trauma needs, at a minimum, at last biennium’s level including the trauma add-on.
  • Optional recurring, dedicated, sustainable and easily administered funding sources as possible alternatives to the current DRP program.
  • Targeting scarce trauma funds:
    • to maintain proficient, system-ready, cost-effective, Level 1 and academic medical center trauma systems; and
    • to help train trauma surgeons and nurses at academic medical centers.

Local Authority & Responsibility

Ensure Continued Local Authority and Responsibility for Local Decisions – Texas should continue its tradition of local control.

THOT Supports:

  • Local authority and decision-making for tax rates, use of taxes, ad valorem valuation, and bond authority.             

Support Texas-Style Coverage

Create a Transformative Coverage System for Uninsured Texans - Texas has a unique and timely opportunity to provide health care coverage for low income Texans through a capped expenditure waiver with expiring DSRIP funding. Using local contributions (IGTs or Local Provider Participation Funds) and federal matching funds available through existing waiver budget neutrality room, coverage through local systems of care will improve care and cost-effectiveness, foster system transformation to value based care, leverage DSRIP innovation, and innovate with flexibility not possible in today’s Medicaid program.

Behavioral Health

Support Continued and Additional Funding for Behavioral Health Services – While the 85th Legislature appropriated additional funding for Behavioral Health Services, access to these services continues to be a barrier for some individuals needing services and support in Texas.

THOT Recommends:

  • Continuing investments to increase the state’s mental health workforce.
  • Continuing initiatives to increase psychiatric beds.
  • Increasing funding to ensure access to inpatient and outpatient behavioral health services.