1 My Tilting Nursing Policy Cap: 84th Legislative Session and Regulatory UpdateElizabeth N. Sjoberg RN, J.D. Associate General Counsel Texas Hospital Association
2 Resources New Health Care Laws: A Report on the 84th Texas Legislature Healthcare Providers Products and Services Featured Product (online access for THA members in upper right-hand corner) Texas Legislature Online
3 Significant Changes in State LeadershipNew Governor, Lt. Governor, Attorney General, Comptroller, Land Commission and Agriculture Commissioner Major changes in the Legislature New presiding officer in the Senate (Lt. Governor) 8 new Senators (out of 31 total) New chairs of Finance, HHS, State Affairs (Big 3 of Health) Sen. Nelson moves to Finance and Sen. Schwertner is new chair of HHS Committee Speaker Straus re- elected BUT Committee Chairmen shuffle About 2/3rds of the House had 2 or less sessions of experience Legislature, particularly Senate, more conservative
4 Bill Statistics Filed---6,276 (*83rd Legislature – 5868)Vetoed by the Governor (* 83rd Legislature – 28) Passed (*83rd Legislature – 1437)
5 Sunset Advisory Commission 2014-15State Office of Administrative Hearings Tax Division State Office of Administrative Hearings Department of Aging and Disability Services Department of Assistive and Rehabilitative Services Interagency Task Force for Children With Special Needs Texas Council for Developmental Disabilities Texas Education Agency (Limited Scope Review) Texas Facilities Commission (Re-review) Department of Family and Protective Services Health and Human Services Commission Texas Health Care Information Division (Special Purpose Review)
6 Sunset Advisory Commission 2014-15Texas Health Services Authority Department of State Health Services Governor’s Committee on People with Disabilities Texas Council on Purchasing from People with Disabilities Entry Criteria for Self-Directed Semi-Independent Agencies (Special Review) State Soil and Water Conservation Board (Limited Scope Review) University Interscholastic League Texas Workforce Commission, Texas Texas Workforce Investment Council
7 State Budget $712.6 million AF (all but $5 million GR comes from trauma fund) - Supplemental Hospital Financing through Add-ons for Trauma, Safety-Net, and Rural hospitals (* critical to the renegotiation of the 1115 Medicaid Transformation Waiver) $137.8 million GR – Transfer of Expanded Primary Health Care Program and Family Planning Program Almost $34 million for Professional Nursing Shortage Reduction Program and continuation of $10 million in tobacco earnings for nursing school innovation grants $20 million GR increase to implement grant program for mental health services to veterans
8 State Budget $53 million GR – Increase in GME (ensures a residency spot for every medical school graduate) and $33 million for physician education loan repayment program $50 million GR for inpatient community beds (100 new beds in and 150 beds in 2017); $46.5 million GR to expand outpatient capacity; $31 million GR in Crisis Service alternative programs Quality-based reforms – Quality-based payment systems for providers and/or facilities; Bundled payment Medicaid initiative, including a shared savings component for providers that meet quality-based outcomes
9 Behavioral Health SB 359—VETOED: “lays the groundwork for future erosion of constitutional liberties”. Would have allowed physicians to initiate a temporary hold on a mentally ill patient suspected of being a danger to themselves or others, if the governing body of a facility adopted a policy permitting a hold. The hold could last four hours unless the facility called a peace officer for an emergency detention.
10 Children’s Health CareHB 3433 – Extends implementation delay of designation process by one year for neonatal standards (2018) and maternal standards (2020) to address scope and timeline of process; current law requires designation to receive Medicaid payments. Rulemaking. HB 2131 – Establishes designation of Centers of Excellence in Fetal Diagnosis and Therapy. Rulemaking. HB 3374 – Requires a health care provider who administers a test for Down Syndrome OR who initially diagnoses a child with Down Syndrome to distribute information developed by DSHS.
11 Children’s Health CareHB 791 – Requires education for congenital cytomegalovirus (CMV); Texas Department of State Health Services and Texas Medical Board must develop materials re: incidence and transmission of disease. HB 2574 – Requires hospitals and other health care providers to distribute information on dangers of heatstroke of a child left unattended in a motor vehicle; must be included in resource pamphlet distributed to new parents at time of discharge.
12 Emergency/Trauma CareSB 1899/HB 2020 – Based on facility policy, allows EMT/paramedics to provide advanced life support in a facility’s emergency or urgent care setting (including a hospital ER and freestanding ER). Includes specific definitions for “advanced life support” and “direct supervision”. Also includes additional licensure procedures for EMS providers. HB 1446 – Provides increased reimbursement for victims of sexual assault and creates the Governor’s Program for Victims of Child Sex Trafficking.
13 Emergency/Trauma CareDID NOT PASS SB 93 – Repeal of the Driver Responsibility Program (DRP) HB 80 – Prohibition on Texting While Driving SB 715 – Repeal of Red Light Cameras
14 End-of-Life Care HB 3074 – Addresses “artificially administered nutrition and hydration” (AANH) as ordinary care, unless becomes extraordinary care as described by elements in law: hastens patient’s death; medically contraindicated such that provision seriously exacerbates condition not outweighed by benefit of treatment; medically ineffective in prolonging life; or contrary to patient’s or surrogate’s clearly documented desire not to receive AANH. Revises conflict resolution process § , Texas Advance Directives Act (requires copy of medical records).
15 End-of-Life Care HB 1874 – Establishes the Palliative Care Interdisciplinary Advisory Council to develop a report to educate Texans about role and availability of palliative care, as well as policies and rights related to such care, life-sustaining treatments and advance directives. HB 21 – The “Right to Try” bill allows terminally ill patients, with their physicians' approval and after meeting certain criteria, access to not yet approved drugs that are in a clinical trial phase.
16 End-of-Life Care DID NOT PASSHB 2351 – Would have required that policies of hospital ethics committees engaged in the conflict resolution process under the Texas Advance Directives Act include provisions that members would not discriminate against patients and have no conflicts of interest. HB 3095 – Would have amended Medical Power of Attorney to allow co-agents with equal authority, more than one approved form and confusing retroactive date.
17 Health Care ProfessionalsSB 1753 – The “Badge Bill” requires addition of “plain language” descriptors on 29 health care professionals’ hospital badges in expectation to create better transparency in care of patients. Example: “RN” and “registered nurse”; “M.D.” and “physician”. Four-year implementation due to recent re-badging of professionals based on bill that passed in 2013.
18 Health Care ProfessionalsDID NOT PASS HB 1069 –Certification of Interpreters for Persons Deaf or Hard of Hearing HB 848 – Licensing of Radiologist Assistants HB 2267 – Licensing of Anesthesiologist Assistants
19 Hospital Operations HB 910 – Allows open carry of handguns, but did not eliminate the current prohibition against carrying handguns in hospitals, nursing homes and churches. SB 11 – Allows CHL holders to carry concealed handguns on grounds of a publically operated technical institute, college or university. However, prohibits possession of handguns on premises of a hospital operated by these public institutions of higher education.
20 Hospital Operations – Freestanding ERsSB 425 – Requires notice/notification by free standing ERs – both independent and operating under a hospital license. Facilities must: post a notice that there is a facility fee and that fee is comparable to fees in a hospital emergency room; provide notice on the facility website, at the entrance of the facility, in each patient exam room and at the location where a patient pays for services; and notify persons that the physicians at the facility charge separately for services and may not be in-network.
21 Hospital Operations SB 1881 – Establishes a supported decision-making agreement as an alternative to limit or avoid guardianship. Allows an adult with a physical or mental impairment that limits one or more major life activities to voluntarily enter into an agreement with a supporter to do a number of activities, including: Assistance in understanding responsibilities of adult’s life decisions; Assistance in collecting/obtaining information relevant to a given life decision re: medical, psychological, financial, educational or treatment records from any person. Supporter must ensure PHI under HIPAA is kept privileged and confidential. Agreement may be in any form as long as not inconsistent with the form in the law.
22 Hospital Operations DID NOT PASSHB 308 – Repeal of Prohibition of Handguns in Hospitals and Nursing Homes HB 3903 – Caregivers Act
23 Nursing Practice HB 2696 – Requires study to determine next legislative and regulatory steps re: violence against nurses in the workplace (hospitals, nursing facilities, home health agencies and freestanding emergency medical care facilities). The Texas Center for Nursing Workforce Studies, funded by a designated amount included in nursing licensure fees, will conduct one nursing and one facility survey to assess the prevalence and types of workforce violence occurring and strategies successfully preventing workplace violence.
24 Nursing Practice DID NOT PASS SB 1160 – Workplace ViolenceHB 3820 – Safe Patient Handling HB 2602 – APRNs’ Scope of Practice relating to Schedule II Controlled Substances to address: Palliative Care Psych/Behavioral Health Hospital Discharge Prescriptions
25 Patient Safety SB 373 – Requires hospitals that have committed a potentially preventable adverse event (PPE) to develop and implement a plan for approval by the Texas Department of State Health Services to address deficiencies that contributed to the event.
26 Pharmacies and PharmacistsSB 460 – Authorizes a pharmacist during a natural or man-made disaster to dispense not more than a 30-day supply of a dangerous drug without practitioner authorization if failure to “refill” may result in interruption of a therapeutic regimen. Allows the Pharmacy Board to inspect financial records of the pharmacy. Requires a pharmacist to provide to Pharmacy Board “records of the pharmacist’s practice that occurs outside of a pharmacy.” Disqualifies an applicant for pharmacy license (not pharmacist license) if an owner of the pharmacy has had a pharmacist license in any state restricted, suspended or revoked. Also, if an owner has “surrendered license for any reason” the application is disqualified.
27 Public Health HB 2171 – Requires the immunization registry to maintain immunization information until a person reaches age 26. After age 18, two attempts to provide notice to individual that their information is in the registry and will remain in registry until age 26, unless the individual withdraws consent or provides consent to remain in registry beyond age 26. After age 25, two attempts must be made to contact an individual and provide notice. DSHS notice attempts may be made by telephone, , regular mail, or general outreach efforts through individual’s health care provider, school district, or institution of higher education.
28 Women’s Health Care SB 1128 – Requires a physician, during a patient’s gestation or at delivery – but not earlier than 28th week – to submit to a laboratory a sample of a woman’s blood for diagnostic testing for the presence of syphilis. DSHS must report to the legislature the number of early congenital syphilis and late congenital syphilis diagnosed in Texas.
29 Women’s Health Care HB 635 – Requires hospitals to release fetal remains upon a parent’s request; fetal remains are not classified as pathologic waste. HB 1670 – Requires hospitals and birthing centers to permit a woman (or her spouse in some instances) to take her placenta from the hospital if certain conditions are met.
30 My Tilting Nursing Policy Cap: 84th Legislative Session and Regulatory Update QUESTIONS?