On Monday, October 23, Speaker of the House Joe Straus and Lt. Governor Dan Patrick released a full list of interim charges for Texas’ State House and State Senate committees to study before the 86th Legislative Session begins in January 2019. Many of the interim charges examine Hurricane Harvey and the state’s response, including the storm’s impact on public health, the juvenile justice system, agriculture and the state’s tax structure. In addition to these charges, Speaker Straus called for the creation of a Select Committee on Opioid and Substance Abuse which will study the prevalence and impact of substance abuse and substance use disorders in the state. This committee, chaired by Representative Four Price, is an extension of the work of the Select Committee on Mental Health, convened following the 84th Legislative Session.
Mental Health America of Greater Houston will be following many of the charges issued, with special attention to the following charges pertaining to mental and behavioral health:
House Committee on Appropriations:
- Examine the Early Childhood Intervention Program (ECI) in Texas, including a review of historical funding levels, programmatic changes, challenges providers face within the program and utilization trends. Evaluate ECI’s impact on reducing the long-term costs of public education and health care. Identify solutions to strengthen the program.
- Monitor Congressional action on federal healthcare reform and CHIP reauthorization. Identify potential impacts of any proposed federal changes. Identify short- and long-term benefits and challenges related to converting Texas Medicaid funding to a block grant or per capita cap methodology. Determine how Texas should best prepare for federal changes, including statutory and regulatory revisions, as well as any new administrative functions that may be needed. Explore opportunities to increase the state’s flexibility in administering its Medicaid program, including but not limited to the use of 1115 and 1332 waivers.
House Committee on Corrections:
- Examine the use of social workers and peer support specialists in the Texas criminal justice system to assist individuals on probation, on parole or who have been discharged, in order to reduce recidivism and improve outcomes. Identify best practices and make recommendations for legislative action.
House Committee on County Affairs:
- Study how counties identify defendants’ and inmates’ behavioral health needs and deferral opportunities to appropriate rehabilitative and transition services. Consider models for ensuring defendants and inmates with mental illness receive appropriate services upon release from the criminal justice system.
House Committee on Criminal Jurisprudence:
- Assess developments in medical science and legal standards related to the imposition of the death penalty on defendants with serious mental illness or intellectual and developmental disabilities. Review statutorily prescribed jury instructions used during capital sentencing.
House Committee on Defense & Veterans’ Affairs:
- Examine the needs of homeless veterans in Texas. Examine obstacles veterans may face finding housing across the state. Recommend measures to bolster the state’s efforts to address veteran homelessness in Texas.
- Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. In conducting this oversight, review the implementation of S.B. 27 (85R) and the related Veterans Mental Health Program, as well as S.B. 578 (85R) and the development of the Veterans Suicide Prevention Action Plan.
House Committee on Human Services:
- Review the history and any future roll-out of Medicaid Managed Care in Texas. Determine the impact managed care has had on the quality and cost of care. In the review, determine: initiatives that managed care organizations (MCOs) have implemented to improve quality of care; whether access to care and network adequacy contractual requirements are sufficient; and whether MCOs have improved the coordination of care. Also determine provider and Medicaid participants’ satisfaction within STAR, STAR Health, Star Kids, and STAR+Plus managed care programs. In addition, review the Health and Human Services Commission’s (HHSC) oversight of managed care organizations, and make recommendations for any needed improvement.
- Review the availability of prevention and early intervention programs and determine their effectiveness in reducing maltreatment of children. In addition, review services available to children emancipating out of foster care, as well as services available to families post-adoption. Determine if current services are adequately providing for children’s needs and meeting the objectives of the programs. While reviewing possible system improvements for children, follow the work of the Supreme Court of Texas Children’s Commissions’ Statewide Collaborative of Trauma-Informed Care to determine how trauma-informed care impacts outcomes for children.
- Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Public Health)
House Committee on Judiciary & Civil Jurisprudence:
- Study the increased use of specialty courts across the state. Examine the role these courts play in the judicial system and recommend improvements to ensure they continue to be appropriately and successfully utilized.
House Committee on Juvenile Justice & Family Issues:
- Evaluate the use of telemedicine to improve behavioral health services in the juvenile justice system.
House Committee on Public Health:
- Review state programs that provide women’s health services and recommend solutions to increase access to effective and timely care. During the review, identify services provided in each program, the number of providers and clients participating in the programs, and the enrollment and transition process between programs. Monitor the work of the Maternal Mortality and Morbidity Task Force and recommend solutions to reduce maternal deaths and morbidity. In addition, review the correlation between pre-term and low birth weight births and the use of alcohol and tobacco. Consider options to increase treatment options and deter usage of these substances.
- Study and make recommendations to improve services available for identifying and treating children with mental illness, including the application of trauma- and grief-informed practices. Identify strategies to assist in understanding the impact and recognizing the signs of trauma in children and providing school-based or community-based mental health services to children who need them. Analyze the role of the Texas Education Agency and of the regional Education Service Centers regarding mental health. In addition, review programs that treat early psychosis among youth and young adults.
- Study the overlays among housing instability, homelessness, and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Urban Affairs)
- Review opportunities to improve population health and health care delivery in rural and urban medically underserved areas. Identify potential opportunities to improve access to care, including the role of telemedicine. In the review, identify the challenges facing rural hospitals and the impact of rural hospital closures.
- Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Human Services)
House Committee on Urban Affairs:
- Study the overlays among housing instability, homelessness and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Public Health)
House Select Committee on Opioids and Substance Abuse:
- Study the prevalence and impact of substance use and substance use disorders in Texas, including co-occurring mental illness. Study the prevalence and impact of opioids and synthetic drugs in Texas. Review the history of overdoses and deaths due to overdoses. Also review other health-related impacts due to substance abuse. Identify substances that are contributing to overdoses, related deaths and health impacts, and compare the data to other states. During the review, identify effective and efficient prevention and treatment responses by health care systems, including hospital districts and coordination across state and local governments. Recommend solutions to prevent overdoses and related health impacts and deaths in Texas.
- Review the prevalence of substance abuse and substance use disorders in pregnant women, veterans, homeless individuals and people with co-occurring mental illness. In the review, study the impact of opioids and identify available programs specifically targeted to these populations and the number of people served. Consider whether the programs have the capacity to meet the needs of Texans. In addition, research innovative programs from other states that have reduced substance abuse and substance use disorders, and determine if these programs would meet the needs of Texans. Recommend strategies to increase the capacity to provide effective services.
- Examine the impact of substance abuse and substance use disorders on Texans who are involved in the adult or juvenile criminal justice system and/or the Child Protective Services system. Identify barriers to treatment and the availability of treatment in various areas of the state. Recommend solutions to improve state and local policy, including alternatives to justice system involvement, and ways to increase access to effective treatment and recovery options.
- Identify the specialty courts in Texas that specialize in substance use disorders. Determine the effectiveness of these courts and consider solutions to increase the number of courts in Texas.
For a full list of the Texas State House of Representatives’ Interim Charges, click here.
Senate Finance Committee:
- Adult and Juvenile Corrections Funding: Examine the funding patterns used to fund the juvenile justice system and adult probation departments. Develop recommendations to ensure the Texas Juvenile Justice Department budget does not dis-incentivize the use of cost-effective best practices such as diverting youth from the juvenile justice system, providing services to youth in their community and keeping youth closer to home. In addition, review funding to adult probation departments and ensure it provides for an equitable distribution to all Texas Probation Departments.
- Monitor the state’s progress in coordinating behavioral health services and expenditures across state government, pursuant to Article IX section 10.04, including the impact of new local grant funding provided by the 85th Legislature.
Senate Health and Human Services Committee:
- Substance Abuse/Opioids: Review substance use prevention, intervention and recovery programs operated or funded by the state and make recommendations to enhance services, outreach and agency coordination. Examine the adequacy of substance use, services for pregnant and postpartum women enrolled in Medicaid or the Healthy Texas Women Program and recommend ways to improve substance use related health outcomes for these women and their newborns. Examine the impact of recent legislative efforts to curb overprescribing and doctor shopping via the prescription monitoring program and recommend ways to expand on current efforts.
- Medicaid Managed Care Quality and Compliance: Review the Health and Human Services Commission’s efforts to improve quality and efficiency in the Medicaid program, including pay-for-quality initiatives in Medicaid managed care. Compare alternative payment models and value-based payment arrangements with providers in Medicaid managed care, the Employees Retirement System and the Teachers Retirement System, and identify areas for cross-collaboration and coordination among these entities.
- Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 85th Legislature and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
- Initiatives to increase capacity and reduce waitlists in the mental health system, including the construction of state hospitals and new community grant programs;
- Initiatives to better understand the causes of maternal mortality and morbidity, including the impact of legislation passed during the first special session of the 85th Legislature. Recommend ways to improve health outcomes for pregnant women and methods to better collect data related to maternal mortality and morbidity;
- Initiatives intended to improve child safety, Child Protective Services workforce retention, and development of additional capacity in the foster care system. Make additional recommendations to ensure children with elevated levels of medical or mental health needs receive timely access to services in the least restrictive setting.
Senate Veterans’ Affairs and Border Security Committee:
- Veterans’ Health: Study the effectiveness of veterans’ health and mental health initiatives in Texas and recommend ways to improve access and delivery. Explore the state of the federal VA Choice Program, including potential expiration, continuation or expansion of the program. Consider the impact of the VA Choice Program on improving the delivery of health care, and determine ways to raise awareness and increase participation among Texas veterans. Consider the potential connection between chronic pain and mental health and identify strategies to improve the prevention of veteran suicide.
- Monitor the implementation and impact of legislation passed by the Texas Legislature, including SB 27 by Campbell 85(R), relating to the mental health program for veterans.
For a full list of the Texas State Senate’s Interim Charges, click here.