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Committee on Health and Human Services - 80th R.S. (2007)
Monitor the Department of Aging and Disability Services' improvement plan for the system of care for individuals with developmental disabilities, focusing on efforts to improve state schools and provide more community care options. Evaluate the process for preventing, reporting, and investigating abuse and neglect in state schools, ICF/MRs and the Home and Community-Based Services (HCS) program. Determine the short-term and long-term financial impact of increasing the number of individuals served in home or community locations and the financial impact this shift has on state schools. Monitor the department's efforts to convert institutions to community care providers through the money-follows-the-person program designed to improve access to community care services. Specifically make recommendations on:
- how to further improve the system of care for individuals with developmental disabilities;
- preventing, reporting, and investigating abuse and neglect;
- developing a transition plan for reducing waiting list for community care service;
- incentives for converting institutions into community care providers; and
- a long term plan to address issues that result from the current federal Department of Justice investigation.
Study and make recommendations related to creating an outcome-based reimbursement model in Texas' Medicaid program as a way to improve quality of care, reduce medical errors, and create cost savings. Develop a pilot health care program that pays for best practices, rather than only paying for actual procedures performed. Examine the Centers for Medicare and Medicaid's (CMS) efforts to create an outcome-based system in the Medicare payment system that sanctions serious, preventable medical errors. Examine Pennsylvania's efforts to implement a similar outcome-based reimbursement model to make providers more vigilant about patient care, encourage best practices, and reduce costs in their Medicaid program. If necessary, examine other health care coverage models that have successfully incorporated an outcome-based reimbursement system. Consider pay-for-performance, options that reward good outcomes and the use of best practices, and changes to the reimbursement system that will reduce serious preventable medical errors and hospital acquired infections.
Study the effectiveness of the Resiliency and Disease Management (RDM) program in the mental health service delivery system, implementation of changes to the crisis care program, and recommendations for appropriate use of the mental health transformation grant. Identify strategies to increase access to services and meet future demand for services. Examine resource allocation and opportunities to maximize funding. Policy recommendations should maximize the number of inpatient psychiatric acute care beds, enhance access to outpatient services, promote the use of recovery-based services, and enhance access to community-based services.
Monitor the implementation of the Department of Family and Protective Services’ improvement plan to reduce caseloads for Child Protective Service caseworkers, and to provide family-based safety services and ongoing substitute care services. Evaluate the efficiency of Child Protective Services "functional units," and determine if other organizational models would allow for a reduction in caseworkers' caseloads, without increasing other administrative costs. Develop recommendations aimed at lowering individual caseloads, making casework more efficient, and improving the retention of caseworkers. Assess the viability of caseworker reimbursement as a manner to lower caseworker turnover.
Monitor the implementation of the Department of Family and Protective Services' plan to stabilize the foster care system and increase permanency options for children. Study placement capacity to determine how Child Protective Services can better develop the necessary adoptions or foster homes to meet the needs of children and families by increasing foster care capacity, recruiting and retaining more foster and adoptive parents, increasing the use of relative care, and developing best practices for reducing foster care placement breakdowns. This includes studying innovative ways to promote adoption and kinship care in Texas and best practices for foster/adoptive parents to improve their ability to care for abused and neglected children. Explore potential improvements and enhancements in the Preparation for Adult Living (PAL) program to increase successful transitioning from foster care to adult living. Study current death review processes for children who die while in state care.
Examine Texas' current strategies for preventing child abuse. Specifically study the effectiveness of current programs and how these programs compare to other state efforts. Identify national research-based solutions, including best practices and programs addressing sexual abuse. Explore promising existing and emerging approaches to child abuse and neglect prevention, especially those with a strong evidence base. Identify additional funding sources for increased child abuse prevention activities by the state.
Study the changes in statute contained in SB 10 80th R.S., as well as the state's current prevention and wellness efforts and chronic care management efforts, and identify opportunities for improvement in state policies and programs. Examine options for expanding and optimizing the state's current investment in wellness programs and management tools for individuals with chronic care conditions, including options that address childhood asthma. Review partnerships with the private sector that specifically address the following:
- tobacco cessation, including the evaluation of a statewide smoking ban in public places;
- reducing obesity;
- availability and effectiveness of childhood and adult vaccines, including public education programs to promote the use of vaccines; and
- more effective management of chronic care conditions.
Study the effectiveness and efficiency of nursing homes and home-based solutions/home care in Texas, and make recommendations to improve nursing homes and their funding. Identify and study successful nursing home funding models established by other states. Consider ways to fund infrastructure for nursing and therapists and home care. Examine the possibility of an incentive-based “pay for performance” rate plan for nursing facilities and consider factors that it could be based on, taking into account similar plans implemented in other states. Make recommendations on how best to use Medicaid to fund skilled nursing and home health care in Texas. Explore options for improving graduation rates for nurses in Texas.
Study and address ethical issues surrounding the impact of a pandemic influenza in this state, particularly focusing on the following:
- the availability of human and material resources;
- the benefits and burdens of mass vaccination plans;
- the involvement of private sector professional organizations and businesses in the state's pandemic influenza preparedness and response plans; and
- development and implementation of communication plans that will inform and prepare the public on risk reduction behaviors and local/state preparedness and response.
Study the potential for development of Health Enterprise Zones, which could offer tax incentives to medical providers who locate within the boundaries of designated medically underserved areas. Analyze similar legislation enacted in other states, specifically New Jersey, and estimate costs and benefits. Consider expanding incentives to medically related industries such as medical research facilities, laboratories and equipment manufacturers in order to spur economic development.
Monitor the collection and availability of cord blood stem cells for treatments and research in Texas. Review the current state of basic and clinical research using these and other types of adult stem cells. Assess the potential for clinical and economic benefits from current and increased adult stem cell research.
Review Medicaid provider reimbursement rate methodologies, including the impact of factors such as infrastructure concerns, federal minimum wage changes, and cost reports. Study the impact on access to care, quality of care, and value, and make recommendations for legislative changes, taking into account rate increases contained in the current budget. (Joint charge with Senate Finance Committee)
Study the state's current and long-range need for physicians, dentists, nurses, and
other allied health and long-term care professionals. Make recommendations on how the state can help recruit high-need professions, especially for primary care providers and long-term care professionals in the underserved regions of Texas. (Joint charge with the Senate Committee on International Relations and Trade)
Monitor the implementation of legislation addressed by the Health and Human Services Committee, 80th R.S., and make recommendations for any legislation needed to improve, enhance, and/or complete implementation. Specifically, report on the implementation of SB 10 80th R.S., to ensure meaningful improvement in access to quality care in the Texas Medicaid program, focusing on how to cover more uninsured in Texas with market-based plans or premium assistance for employer health plans, and monitor the creation of the Texas Cancer Research and Prevention Institute.
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