REPRESENTATIVE JOE STRAUS: The House will come to order. Members, please register. Have all registered? Quorum is present. The House and gallery, please rise for the invocation. The Chair recognizes Representative Perry to provide an invocation.
REPRESENTATIVE CHARLES PERRY: Thank you, Mr. Speaker, members, and guests. Let us pray. Our most Gracious Heavenly Father, we set this time aside to acknowledge you, the giver of all that's good and righteous. We recognize that the answers to all the problems we face today as a state and nation are available from you. We just humble ourselves to pray. We praise you for the freedom and liberties that you've given to us, we praise you for the unconditional love and mercy you have given to the people of this nation and this state. We praise you for the opportunity to speak for all, specifically the innocent and the unborn. We recognize -- we praise you for the process we call democracy. As your word teaches, iron sharpens iron. We recognize that this is the opportunity to be a testimony to your balance of truth and grace. O Lord, I pray that as we enter into this chamber each and every day with an attitude of humility and (inaudible) that can only come from you. Give and (inaudible) trust us with the people's business. I pray that we tend to this responsibility with the same love and compassion that you extended to us through your son Jesus Christ, who gave us eternal life. All these things I ask in your name and in the name of your son, Jesus Christ. The only way, truth and life. And all the people said Amen. Chair recognizes Representative Schwertner to lead us in the pledge.
REPRESENTATIVE CHARLES SCHWERTNER: Thank you, Mr. Speaker. Members, guests, please rise and join me in reciting the pledge of allegiance to our American flag and to the Texas flag. [PLEDGE]
REPRESENTATIVE JOE STRAUS: Excuse Representative Truitt because of important business in the district, on the motion of Representative Alvarado. Excuse Representative Smithee because of important business, on the motion of Representative Flynn. Excuse Representative Gallego because of important business, on the motion of Representative Hochberg. Excuse Representative Woolley because of important business in the district, today and the remainder of the week, on the motion of Representative Weber. Excuse Representative Hilderbran because of important business, on the motion of Representative Madden. Excuse Representative Creighton because of business in the district, on the motion of Representative Madden. Is there objection? Chair hears none. So ordered. Chair announces the following proclamation from the governor:
THE CLERK: To the Senate and House of Representatives the of the 82nd Texas Legislature First Called Session. Whereas, the people of Texas through their state constitution have placed the power to call the legislature and this especial session in the hands of chief executive officer of the state. Those members of 82nd Texas Legislature First Called Session now convene to consider items presented to them by the governor. Now, therefore I, Rick Perry, Governor of the State of Texas, by the authority vested in me by Article 4, Section 8, and Article 3, Section 40 of the Texas Constitution, to hereby present the following subject matter to the 82nd Texas Legislature First Called Session for consideration: Legislation relating to the use of the federal security (inaudible) program by law enforcement agencies. The insurance of driver's license and personal identification certificates and the abolishment of sanctuary cities in Texas. In testimony whereof I sign my name officially, and cause the seal of the state to be affixed hereto at Austin, this seventh day of June, 2011. Rick Perry, Governor of Texas.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Hamilton.
REPRESENTATIVE MIKE HAMILTON: Members, if I could have your attention for just one second? We have a young adult right here. It is our member, Mr. Aaron Pena's birthday today. Be sure and tell him happy birthday.
REPRESENTATIVE JOE STRAUS: Following bills on first reading and referral.
THE CLERK: HCR 12 (By Dutton), Congratulating country-pop superstar Kenny Rogers on his achievements. To Rules and Resolutions. HR 11 (By Alonzo), Congratulating Julian Rodriguez on being named the 2011 valedictorian of Adamson High School in Dallas. To Rules and Resolutions. HR 12 (By Alonzo), Congratulating Adam Gonzalez on being named the 2011 salutatorian of Adamson High School in Dallas. To Rules and Resolutions. HR 13 (By Alonzo), Congratulating Kevin Prado on being named the 2011 valedictorian of Molina High School in Dallas. To Rules and Resolutions. HR 14 (By Alonzo), Congratulating Leticia Gallegos on being named the 2011 salutatorian of Molina High School in Dallas. To Rules and Resolutions. HR 15 (By Alonzo), Congratulating Gustavo Castillo on being named the 2011 valedictorian of Trini Garza Early College High School in Dallas. To Rules and Resolutions. HR 16 (By Alonzo), Congratulating Jocelyn Velasquez on being named the 2011 salutatorian of Trini Garza Early College High School in Dallas. To Rules and Resolutions. HR 17 (By Alonzo), Congratulating Xochitl Escobar on being named valedictorian of Sunset High School in Dallas. To Rules and Resolutions. HR 18 (By Alonzo), Congratulating Veronica Flores on being named salutatorian of Sunset High School in Dallas. To Rules and Resolutions. HR 19 (By Alonzo), Congratulating Kathy T. Do on being named the 2011 valedictorian of Grand Prairie High School. To Rules and Resolutions. HR 20 (By Alonzo), Congratulating Juan C. Cerda on being named the 2011 Salutatorian of Grand Prairie High School. To Rules and Resolutions. HR 21 (By Alonzo), Congratulating Rosa Walker on her induction into the Texas AFL-CIO Hall of Fame. To Rules and Resolutions. HR 22 (By Sheffield), Congratulating Ervin and Janice Schwindt of Belton on their 50th wedding anniversary. To Rules and Resolutions. HR 23 (By Sheffield), Congratulating Dr. Vernon D. Holleman and Shirley Holleman of Temple on their 50th wedding anniversary. To Rules and Resolutions. HR 24 (By Sheffield), Honoring Roy and Eloisa Donoso of Temple on their 50th wedding anniversary. To Rules and Resolutions. HR 25 (By Sheffield), Honoring Carl and Patsy Feller of Salado on their 60th wedding anniversary. To Rules and Resolutions. HR 26 (By Huberty), Congratulating Matthew Simpson of Huffman on being named valedictorian of the Class of 2011 at Hargrave High School. To Rules and Resolutions. HR 27 (By Huberty), Congratulating Paige Alan Sullivan on her graduation from Kingwood High School. To Rules and Resolutions. HR 28 (By Workman), Congratulating Lake Travis High School basketball coach Jan Jernberg on his retirement. To Rules and Resolutions. HR 29 (By Patrick), In memory of Ronald Gene Howell of Arlington. To Rules and Resolutions. HR 30 (By Y. Davis), Recognizing the Best Southwest Partnership on the occasion of the 25th anniversary of its incorporation. To Rules and Resolutions. HR 31 (By Paxton), Congratulating Burks Elementary School in McKinney on earning recognition as a Healthy Zone School. To Rules and Resolutions. HR 32 (By L. Gonzales), Congratulating Patti Jurena Wiggs of Round Rock on her retirement as a teacher at Park Crest Middle School in Pflugerville. To Rules and Resolutions. HR 33 (By Torres), Congratulating R. E. "Bob" Parker on his induction into the Corpus Christi Business Hall of Fame. To Rules and Resolutions. HR 34 (By Torres), Congratulating the marketing and community relations department of Driscoll Children's Hospital in Corpus Christi on winning three 2011 Aster Awards. To Rules and Resolutions. HR 35 (By Torres), Congratulating the Destination ImagiNation teams from Baker Middle School in Corpus Christi for advancing to the 2011 Destination ImagiNation Global Finals. To Rules and Resolutions. HR 36 (By Torres), Congratulating David Richter on his induction into the Corpus Christi Business Hall of Fame. To Rules and Resolutions. HR 37 (By Torres), Congratulating Dr. Robert R. Furgason on his induction into the Corpus Christi Business Hall of Fame. To Rules and Resolutions. HR 38 (By Torres), Congratulating Elizabeth Chu Richter on her induction into the Corpus Christi Business Hall of Fame. To Rules and Resolutions. HR 39 (By Dutton), Congratulating Gertrude Jack Lewis of Houston on the occasion of her 100th birthday. To Rules and Resolutions. HR 40 (By Cain), Congratulating Second Lieutenant Jermaine Dewayne Wright of Sulphur Springs on his graduation from the United States Military Academy at West Point. To Rules and Resolutions. HR 42 (By Guillen), In memory of Eladio Carrera of Rio Grande City. To Rules and Resolutions. HR 43 (By Guillen), Congratulating Homero Juan Salmon on his retirement as constable of Starr County Precinct 4. To Rules and Resolutions. HR 44 (By Dutton), Commemorating EXPO 2011, hosted by the Houston Minority Supplier Development Council. To Rules and Resolutions. HR 45 (By Guillen), Commending the Honorable John A. Pope III of McAllen for his distinguished work in the legal profession. To Rules and Resolutions. HR 46 (By Guillen), Honoring Lino Canales, Jr., for his contributions to the community as founder of the Starr County Town Crier. To Rules and Resolutions. HR 47 (By Guillen), In memory of Nidia Ann Leal. To Rules and Resolutions. HR 48 (By Guillen), Honoring Immaculate Conception Church in Rio Grande City for its service to the community. To Rules and Resolutions.
REPRESENTATIVE JOE STRAUS: Members, we only have one bill on the calendar today. If you have prefiled amendments, you need to get them into the system. Chair recognizes Representative Marquez for a recognition.
REPRESENTATIVE MARISA MARQUEZ: Thank you, Mr. Speaker, members. I'm just want to recognize some people that came all the way from the real west Texas. El Paso. The Hicks family. Welcome to your Capitol. And also I want to recognize another El Pasoan who just had a birthday, and that's Naomi Gonzales, who turned 55 on Saturday. Chair recognizes Representative Isaac.
REPRESENTATIVE JASON ISAAC: Thank you, Mr. Speaker, members, if I could have your attention real quick, and guests in the gallery; I'd like to welcome today in the north side of the gallery today, Sunshine Kid. The Sunshine Kid offers children with cancer an opportunity to attend Texas Hill Country Adventure. This year the group is hosting twenty-five teenagers from Dallas, Orlando, Baton Rouge, Las Vegas, Albuquerque and Durham, North Carolina. In addition to visiting the Capitol today this group will visit Sea-world and Schlitterbahn, that will be fun I know that's for sure. Show cars for kids provided transportation in classic cars today, and I know they appreciated the police escort as well. This is a special treat for the kids to be recognized today. We are usually not in session when they arrive, so I'm honored that they are here today. The kids will each receive a Texas flag flown over the Capitol as a reminder of their trip.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Alvarado.
REPRESENTATIVE CAROL ALVARADO: Thank you, Mr. Speaker. I'm happy to welcome the Sunshine Kids. I served on their board for the last couple of years. I'm very honored to welcome them. Members, these are some of the bravest kids that I know, because they face so many challenges and are literally fighting for their lives. And they do it with such dignity. And I want to say to all of you that are up there how much I admire you and are so pleased that you are here with us today. Also, Representative Sarah Davis is with us. The Sunshine Kids' facility in Houston is in her district. So we're so glad that you're here, and we have Brenna who's at the podium with us, and will be acting as speaker very briefly so thank you. Welcome.
REPRESENTATIVE JOE STRAUS: Members, if you have any amendments, please have them filed and scanned. We only have about five amendments up at the desk. Members, we're ready to go on the calendar. Chair lays out Senate Bill 7. The clerk will read the bill.
THE CLERK: SB 7 by Nelson. Relating to the administration, quality, efficiency and funding of health care and health and human services and health benefit programs in this state.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members. I lay out before you Senate Bill 7 today, that is a bill that actually does things that you all have heard about already. Either on this floor, in a conference scenario or otherwise. Basically what Senate Bill 7 does, it includes cost containment measures necessary to achieve the savings that are assumed in the budget and have been adopted already by the regular 82nd Legislative Session. It also includes measures designed to improve outcomes in the medicaid and CHIP children's health insurance program, and also across the the private health care system. The committee substitute that we looked at earlier, it had a few things that were changes in it, those have already been adopted. Ultimately, the purpose of this bill is to improve the health care quality and efficiency in the State of Texas. A little background is in order. This includes actually three large bills as well as a few smaller bills and things that were considered during the regular session. During the regular session we considered Senate Bill 7. This is the medicaid healthy outcome bill that was sponsored by Chair Kolkhorst and Senator Nelson across the way. It passed up in the Senate and House public health with no opposition, and it actually died in House calendars. However, it was amended with Senate Bill 23, which this body did here. And, ultimately, that went to conference largely unchanged by this body. Senate Bill 8 was the Texas healthy outcome bill, passed also by the House and the Senate. It did have an amendment to it, which was the health care compact at that time. This bill, in terms of Senate Bill 8, does not have the health care compact attached to it. And then there was Senate Bill 23, that passed both the Senate and the House. However, the bill did not make it back toward the House consider the conference committee due to the midnight expiration. It has broad based support. Texas Medical Association, the Hospital Association, Texas Pediatric Society, Family Physicians, (inaudible) Care for Children. Many others have had the opportunity to step up and have their voice heard in this bill. It's a large bill. Eleven articles in total. So, if you will, just let me lay these out to you and hit some of the high points for you: Article 1, which certainly compromises about half the bill, repeals the prohibition against managed care (inaudible) in Cameron, Hidalgo and Maverick counties. And it has the agreed upon language by Senator Hinojosa and Representative Veronica Gonzales with regard to certain protections. It also requires Health and Human Services to consider certain factors when awarding managed care contracting, including if a pharmacy benefit manager has been convicted of violating state or federal law, committed a breach of contract or assessed a fine or penalty of five hundred thousand dollars more in the previous three years. You may recall this was something brought by Representative Brown, that is included in this -- in this bill before you. It allows for the carve in of drugs into managed medicaid care while ensuring that the existing patient protections under fee for service are maintained. These, I will remind you, are the things that Representative Hobson and I worked very closely on and brought to you. Specifically, it allows for a single state formulary, it allows for any willing pharmacy, it prohibits mandated mail order and it also allows for prompt pay for pharmacy claims. It transfers children in the state kids insurance program to the children's health insurance program. It requires the commission to study and implement physician incentive programs to reduce emergency room use in nonemergency situations. It also establishes the medicaid CHIP quality based payments advisory committee, and it directs the commission in consultation with the committee to develop quality based outcome measures that focus on reducing potentially preventable events, which are defined in the bill. It requires the commission to use the quality based outcome measures to adjust medicaid, CHIP, reimbursements across all medicaid and CHIP payment systems, including fee for service and managed care. These provisions were largely what you saw in Senate Bill 7 during the -- during the previous regular session. It also establishes a state action doctrine to provide certified health collaboratives, safe harbor from state and federal antitrust laws. And moving into Article 3, which is largely what Senate Bill 8 was that you heard on the floor recently; it establishes the Texas Institute of Health Care Quality and Efficiency to improve health care quality, efficiency, accountability, education, cost containment in this state by encouraging health care provider collaboration. It requires the institute to complete an assessment of all health related data currently collected by the state and make recommendations for consolidating this data and improving health care transparency to the public. In addition, it creates a health care collaborative certification process, at the Texas Department of Insurance, and it requires the Attorney General's Office to review applications for certification and either concur or not concur with the Department of Insurance's decision to grant a certificate for collaboration. Moving on, in Article 5, it requires Department of State Health Services to coordinate with hospitals, develop a statewide patient wrist band protocol based on (inaudible) patient medical characteristics. Article 6 clarifies that the Department of State Health Services may designate the Federal National Health Care Safety Network for statewide health care associated infections reporting and preventable adverse events and makes reporting frequency consistent with the federal requirements. It requires the (inaudible) to publicly report hospital rate of potentially preventable readmissions and complications. In addition, it requires the State Health Services, in consultation with the Institute, to study how a recognition program that recognizes exemplary health facilities could be implemented. In Article 8, it allows the department of state health services to share health related data within the department, and with the Health and Human Services Commission. Article 8 requires hospitals and health care facilities to develop and implement a policy to protect its patients from vaccine preventable diseases. Article 9 establishes the Texas Emergency and Trauma Care Education Partnership Program. Article 10 creates a ban on the economic credentialing for physicians. And Article 11 is ultimately the effective date. And I know there's quite a number of amendments on this bill that have come forward. I believe I have at least one perfecting amendment to lay out, Mr. Speaker.
REPRESENTATIVE VAN TAYLOR: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: For what purpose?
REPRESENTATIVE VAN TAYLOR: Does the gentleman yield for a question?
REPRESENTATIVE JOE STRAUS: Dr. Zerwas, do you yield?
REPRESENTATIVE JOHN ZERWAS: I do.
REPRESENTATIVE VAN TAYLOR: Dr. Zerwas, what is the fiscal savings that the taxpayers of Texas will reap as a result of this legislation?
REPRESENTATIVE JOHN ZERWAS: The legislation is packaged approximately $468 million. The significant part of that is already baked into HB 1, which we have passed out. Most notably, the movement of managed care into the valley for the medicaid services. That accounts for approximately $300 million of those savings.
REPRESENTATIVE VAN TAYLOR: Okay. So this is going to save taxpayers a lot of money and reform our health care system in Texas?
REPRESENTATIVE JOHN ZERWAS: It will save the taxpayers money, it will give us a lot more mileage out of the dollars that we're currently using for the provision of health care. It should improve the overall quality of health care, also. There's a number of provisions in this bill that are intended not to just bring cost efficiencies, but also efficiencies that are related to the improvement in the quality of care. And so that's really what that entire bill is about. As we move through it, part of it actually moves out into the private sector, by creating these so-called health care collaboratives. These are -- given -- these are giving people a safe harbor, if you will, physicians that work together to jointly improve some cost deficiencies, to reduce duplicitous care, identify best practices out there. And then they are incentivized to enjoy what some of the cost savings would be, and they could be shared between the hospital and the physicians and so forth. So that will create a safe harbor that moves beyond our own health care that we're paying for through the medicaid system. But this same type of program is being packaged in there to create those same incentives in the medicaid program so that when the commission identifies managed care companies and others to work with, those organizations that are employing those types of methodologies that are going to promote quality care and efficiencies and so forth will be given a distinct consideration when it comes to the contracting time.
REPRESENTATIVE VAN TAYLOR: Well, you're to be commended for your hard work. This is a great piece of legislation. Thank you.
REPRESENTATIVE JOHN ZERWAS: Well, thank you. Well, what I will say is that this bill really represents the efforts of a lot of people in this chamber. And, most notably, Chairwoman Kolkhorst was deeply, deeply involved in a number of these issues, not only as the chair of the committee on public health, but also being the sponsor of two of the big bills that are already embedded in here; that being Senate Bill 7 and Senate Bill 8 from the previous regular session. Senate Bill 7, I'll remind the members, was in Senate Bill 23 which you heard and which was considered and then was conferenced back, but didn't meet the deadline in that conference committee report being heard. But the Senate Bill 7 portion of that, which is the medicaid quality improvement initiatives and efficiencies and so forth, was largely left unchanged from the point that it left this chamber. And so I will say that again, that was something for the most part this body has already heard. So thank you, appreciate that, Representative Taylor.
REPRESENTATIVE JOE STRAUS: Mr. Dutton, for what purpose?
REPRESENTATIVE HAROLD DUTTON: Would the gentleman yield for a question?
REPRESENTATIVE JOHN ZERWAS: I do.
REPRESENTATIVE HAROLD DUTTON: Thank you, Dr. Zerwas. Now, the $468 million of savings represented in this bill; is that right?
REPRESENTATIVE JOHN ZERWAS: Correct.
REPRESENTATIVE HAROLD DUTTON: You know, I read this bill and the thing that struck me most about this bill is -- and I believe I counted them. There are 35 ifs in this bill.
REPRESENTATIVE JOHN ZERWAS: Thirty-five?
REPRESENTATIVE HAROLD DUTTON: Ifs, I-F's.
REPRESENTATIVE JOHN ZERWAS: Yes, sir. Used in what context?
REPRESENTATIVE HAROLD DUTTON: Well -- well, let's take the first part. It says on line 16, it started out, if cost effective. I mean -- and then in line 18, if the commission developed an objective assessment. The next page, if the commission develops objective assessment. If the commission determines implementing age. The next page, if it is cost effective and feasible. I mean I'm just -- Are all of these savings dependent on these ifs being one way or the other, I guess?
REPRESENTATIVE JOHN ZERWAS: Well, I think that we want to make sure that we're not going down the road and doing things that aren't cost effective. If we get down there and, I'm sorry, I'm using the word also in this dialogue here. As we go down the road towards determining what various things we've identified in here if they are found not to be cost effective we certainly don't want the commission to continue on down that road. What I will say is a very solid number in here that is baked into the HB1 biennial budget is the movement of the managed care into the valley, where it hasn't been before.
REPRESENTATIVE HAROLD DUTTON: Isn't it true --
REPRESENTATIVE JOHN ZERWAS: Those cost savings are considered pretty hard numbers.
REPRESENTATIVE HAROLD DUTTON: Pretty -- pretty -- So there's a distinction in the bill between kind of the hard savings and the soft --
REPRESENTATIVE JOHN ZERWAS: Well, in my mind, there are -- there are some things in here that certainly it needs to be determined as we move forward, whether we'll see the full numbers. Whether legislative budget board and how they calculated some of those, I think that's left to some of their various things that they do to determine what the real cost savings are in there. So I basically lean on the legislative budget board and what their determination of the things we have in this bill are true savings or not, and we'll reap the benefits for the state.
REPRESENTATIVE HAROLD DUTTON: Well, I just never read that many ifs in one bill and --
REPRESENTATIVE JOHN ZERWAS: It's a big bill and it reaches out to do a lot of things. It is rather transformative in the kinds of things that it bring forward. So, correct.
REPRESENTATIVE HAROLD DUTTON: All right. Thank you.
REPRESENTATIVE VERONICA GONZALES: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: For what purpose, Ms. Gonzales?
REPRESENTATIVE VERONICA GONZALES: Yes, will the gentleman yield for a couple of questions?
REPRESENTATIVE JOE STRAUS: Dr. Zerwas, do you yield?
REPRESENTATIVE JOHN ZERWAS: I do.
REPRESENTATIVE VERONICA GONZALES: Dr. Zer was, I know you worked very hard on this bill --
REPRESENTATIVE JOHN ZERWAS: Well, as you did and many others in this chamber, and I greatly appreciate the effort that everybody has put into it.
REPRESENTATIVE VERONICA GONZALES: I understand that the the largest savings that is predicted from this bill will come from removing the moratorium on managed care on the Rio Grande Valley; is that correct?
REPRESENTATIVE JOHN ZERWAS: That's correct.
REPRESENTATIVE VERONICA GONZALES: And so those are assumptions that are being made based on somebody figuring out numbers that we -- nevertheless, we know that this is going to be the largest service area ever for managed care, are we're not?
REPRESENTATIVE JOHN ZERWAS: I believe geographically it's the largest service area.
REPRESENTATIVE VERONICA GONZALES: In fact, it will include Camera and Hidalgo, Webb, Maverick County and several counties throughout all of south Texas; is that right?
REPRESENTATIVE JOHN ZERWAS: That's correct. It's a unique environment that we're moving into and I think that that's one reason why we didn't go in there to begin with, is because we really needed to get our feet wet and learn how to understand managed care and how it would work or not work. So now I think we've had some experience with that I think that the comfort level, that we can move it out into the geographic area of south Texas there, and I think we can do it successfully.
REPRESENTATIVE VERONICA GONZALES: And is there anything in the bill that would put some kind of the checks and balances in the event that we are seeing managed care in an area this large is not getting us the type of savings that we predicted, or is not working well in terms of providing access to care? Is there anything in the bill that would allow for the managed care to end in areas such as the Rio Grande Valley?
REPRESENTATIVE JOHN ZERWAS: There's no -- there's no provision in there, but that certainly is an ongoing effort by the commission to make sure that we are, in fact, realizing the cost savings. And, most importantly, delivering the service to the patients in the area.
REPRESENTATIVE VERONICA GONZALES: And I appreciate you working with Senator Hinojosa and myself and the rest of the delegation and -- in terms of you understand that managed care is something that our area has fought for many years, it still doesn't necessarily support, but that you did help us to include some provisions that we hope will make things a little bit more palatable.
REPRESENTATIVE JOHN ZERWAS: In this bill those provisions do exactly that, that you and I spoke of, in conjunction Senator Hinojosa, we spent a considerable amount of time looking at things that could reasonably protect the valley but still create the opportunity for managed care to succeed. And so when those are all baked into this current bill, and I think that they're going to be things that are a good idea for this particular area.
REPRESENTATIVE VERONICA GONZALES: Well, I appreciate your help again. I know it's something we struggle with because our constituents are not necessarily supportive of it, but we do appreciate all the work that you've done with us to try to make it a little bit more reasonable for us.
REPRESENTATIVE JOHN ZERWAS: Well, thank you. I think you've made it a better bill by your input and where we've gotten to it.
REPRESENTATIVE VERONICA GONZALES: Thank you, Dr. Zerwas. Appreciate it.
REPRESENTATIVE JOHN ZERWAS: Appreciate it.
REPRESENTATIVE JOE STRAUS: Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Zerwas.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you Mr. Speaker and members. This is largely my perfecting amendment, if you will, that takes care of some various drafting omissions and so forth. It amends a provision that would require than an assessment for therapy services not be waived if that is not beneficial and feasible to the patient. It adds a provision that addresses the ability of the Department of Aging and Disability Services to ensure that elderly individuals may continue to access and utilize personal emergency response systems, whether they have a land-line or a cellular based phone line. And I thank Representative King for bringing this forward. It also adds a provision that requires the health care collaborative to include the participation of a hospital based position, if the collaborative actually includes hospital based physicians. It adds a provision that requires a compensation advisory committee that serves a health care collaborative to -- that a health care collaborative omit the consideration of a government payor's payment rate when setting the charges or fees for services provided through that collaborative. The government payor rates however, may be considered only with regard to health care services provided by a government payor. And it amends a provision to ensure that the health care collaborative does not accept risk. It also includes a provision in there with regard to having an (inaudible) website related to any information that may be sold to other entities out there. Again, I thank Representative King for bringing this forward, and she may have some additional amendments in that regard. And then there is also an amendment that recognizes the SNAP program, and some requirements that this particular program be primarily focused on the purchase of nutritional products that actually enhance the nutrition of those individuals that if they're on SNAP they are largely involved in our medicaid system. And, with that, Mr. Speaker, I would move adoption.
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker? Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Naishtat, for what purpose?
REPRESENTATIVE ELLIOT NAISHTAT: Will the gentleman yield for a question?
REPRESENTATIVE JOE STRAUS: Dr. Zerwas?
REPRESENTATIVE JOHN ZERWAS: I do.
REPRESENTATIVE ELLIOT NAISHTAT: Dr. Zerwas , did you say that the perfecting amendments include language from Representative King relating to the SNAP program, the food stamp program?
REPRESENTATIVE JOHN ZERWAS: Yes. This amendment does include an amendment that Representative King and I discussed in Appropriations this week, and I told her I would include that in this amendment. And I know Representative King is prepared to talk on that, and I'd be happy to surrender the mic to her if you'd like to have that conversation with her.
REPRESENTATIVE ELLIOT NAISHTAT: Thank you, I would.
REPRESENTATIVE JOHN ZERWAS: Yes.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative King.
REPRESENTATIVE SUSAN KING: Yes, Representative Naishtat, go ahead.
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker, will the gentle lady yield?
REPRESENTATIVE JOE STRAUS: Representative King, do you yield?
REPRESENTATIVE SUSAN KING: Of course.
REPRESENTATIVE ELLIOT NAISHTAT: Represent ative, could you please explain what your amendment, which is incorporated into the perfecting amendment purports to do, or would hopefully end up doing?
REPRESENTATIVE SUSAN KING: Yes. The question is what would the perfecting amendment component for SNAP do? SNAP, as many of you know, stands for Supplemental Nutritional Assistance Program, which is a new acronym that someone felt was important to replace food stamps. At this point in time, this is a complete federally regulated program and I suspect it will be for ever. However, the State of Texas does participate in it, as you know; and we are getting money to help administer the program for all kinds of issues with efficiency and everything else. But this only has to do with looking at the possibility of putting nutritional guidelines on SNAP. We cannot, underline, cannot do that to the State of Texas. What it would require, even though this is from the Food and Nutrition Act of 2008, it would require a waiver to consider the possibility of putting nutritional guidelines on the current SNAP program. As you know currently, all food items -- all food items with the exception of alcoholic beverages and live animals, I assume they mean lobster, are not allowed by SNAP. So it is my intent, and it has been under discussion in the public health arena for many years that we at least ask the federal government to get into the dialogue of consideration of nutritional guidelines on this huge food assistance program. Especially since every other food assistance program in the federal arena is, in fact, governed by nutritional guidelines. That's all it does. It does not put a hammer on anyone today, in two months, one year, two years. It allows for the conversation between the Department of Health and Human Services and the department at the federal level.
REPRESENTATIVE ELLIOT NAISHTAT: Represent ative King --
REPRESENTATIVE SUSAN KING: Yes, sir.
REPRESENTATIVE ELLIOT NAISHTAT: -- I understand what you're trying to accomplish, but I have a few questions.
REPRESENTATIVE SUSAN KING: Okay.
REPRESENTATIVE ELLIOT NAISHTAT: Wouldn't restricting SNAP, creating these guidelines which would result in low income people with hungry children having to choose between certain foods that may or may not be good for them? Wouldn't this create or present to small businesses in Texas an unfunded federal mandate in that they would have to bear the cost of retraining cashiers, it would create a need for signage, reprogramming computers, interpreting rules associated with this broad change? That would be the effect on small businesses in Texas, would it not?
REPRESENTATIVE SUSAN KING: I think that's a great question. I would categorically say no. This is the beginning of a discussion. This is in no way an unfunded mandate. This is no hammer in this. There is nothing that would say that there is a food desert or a place where food would not be available to certain socio-economic levels of individuals. There is nothing in this that does any of those things. Before anything would happen it would have to be a broadly discussed stakeholder discussion. This has never happened in this state. I don't know why Texas shouldn't be the first. They've shut this down in Minnesota because they cherry picked out Coke and candy and whatever and they targeted one industry. It has also been shut down in other states. Currently, the only exception in the United States is a pilot in Massachusetts which rewards people for healthy choices. And I would say even as recent as one week ago the first lady of United States of America has redesigned the food pyramid with My Place which consistently and openly suggests that it's important to have nutritional guidelines. So I believe that the government is slowly and painfully moving that way. So to your question and point, absolutely not. It does not do that and there's no intent for it to do that. It's only a conversation opener to make sure that --
REPRESENTATIVE ELLIOT NAISHTAT: Well what --
REPRESENTATIVE SUSAN KING: Yes?
REPRESENTATIVE ELLIOT NAISHTAT: I know it's a conversation opener --
REPRESENTATIVE SUSAN KING: Yes.
REPRESENTATIVE ELLIOT NAISHTAT: -- but let's say the federal government approves the waiver --
REPRESENTATIVE SUSAN KING: Okay.
REPRESENTATIVE ELLIOT NAISHTAT: -- then this moves beyond a conversation. Ultimately we would see these changes enacted in Texas. And I'm concerned about the impact on low income families and low income children who are the poorest of the poor, who will be restricted, restricted in terms of what they can purchase. And this ultimately would increase hunger by decreasing the amount of food that hungry families can afford. That would be the bottom line.
REPRESENTATIVE SUSAN KING: And I completely agree that that would not be a good thing to result from this, and that is not the intent. And so I believe that Texas would be looking at that. We are so huge, we're not Massachusetts, we're not a small state; so these types of factors would be -- have to be factored in. So because I say it is a beginning dialogue, all those parameters that would be disadvantageous to low income families would have to be considered. There's no reason why the State of Texas would intentionally create what many call a food desert, with the intent of keeping people from having something. We're not restricting foods, we're giving a broad overlay of nutrition. And, in fact, I doubt seriously that it would be a complete restriction if, in fact, it ever came in.
REPRESENTATIVE ELLIOT NAISHTAT: Would you say that you would not be restricting food?
REPRESENTATIVE SUSAN KING: I, you know, I'm not a nutritionist. I don't know how this broad base would be put out. But I don't think it's going to be a restriction in as much as saying these are the foods that would be allowable in the nutritional framework for SNAP.
REPRESENTATIVE ELLIOT NAISHTAT: Does your legislation, does your amendment resolve how the state would define quote, 'healthy food'?
REPRESENTATIVE SUSAN KING: It does not. There is no state nutritionist that I'm aware of. There could be. If they're here, please let me know. I don't know what your salary is. I don't believe that's the case. I believe that this is best left to experts that with all the doublespeak and all the intentional comments about obesity and food related disease and what will we do about strokes and heart attacks and diabetes. It's totally ridiculous, and not good policy to continue to not put this nutritional conversation with a major source of nutrition and intake for our citizens who we are trying to help for nutritional purposes.
REPRESENTATIVE JOE STRAUS: Representative Sheffield raises a point of order, the lady's time is expired. Following amendment to the amendment, the clerk will read the amendment.
THE CLERK: Amendment to the amendment by Geren.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Geren.
REPRESENTATIVE CHARLIE GEREN: Thank you, Mr. Speaker and members. This amendment to the amendment actually takes the SNAP language out so that the people that are on food stamps, most of whom, 80 percent or so of people that are on food stamps have to use their own money to buy some of the foods anyway, so you can buy this with your food stamps; if you take other things out you couldn't buy this. This $2.80 bar you could buy, this 60 cent Snickers Bar you couldn't buy. That could be a possibility of what happens with this. But, members, we need to not discriminate against the people that are on food stamps. Let them buy what they want to buy with this. They cannot buy beer, they cannot buy liquor, cigarettes, tobacco, nonfood items, vitamins and hot foods. I think that -- I'm just think that we're just getting too far into their business. And, besides that, the definition of food has to be changed by Congress in order to get the waiver. Currently, that's -- And this is from the USDA from their website. I put it on your desk. It says the current definition of food is a specific part of the act, any change to the definition would require action by Congress. So this is basically a waste of the Department of Health's time and our time.
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Naishtat, for what purpose?
REPRESENTATIVE ELLIOT NAISHTAT: Will the gentleman yield for a question?
REPRESENTATIVE CHARLIE GEREN: I'd be happy to.
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Geren , would you agree that restricting SNAP or food stamp purchases would ultimately be a bad idea for business, a bad idea for government and, worst of all, a bad idea for hungry Texans; including children?
REPRESENTATIVE CHARLIE GEREN: I do, Elliot. And I think that under -- I don't know who would even decide which foods would be the nutritional foods and which foods would not be. There's, you know, since in the -- between 1990 and 2000 over 12,000 new food products were entered, new products each year. And I don't know who's going to keep up with all of that. I think it would be a burden on business, it would be definitely a burden on families and embarrassing to get up there and say well, no, you can't have that Snickers Bar, but you can have that energy bar when they get up there to the checkout and go through all of that. And I mean that currently happens today.
REPRESENTATIVE ELLIOT NAISHTAT: Thank you for offering your amendment.
REPRESENTATIVE CHARLIE GEREN: Thank you, sir.
REPRESENTATIVE JOE STRAUS: Ms. King, for what purpose?
REPRESENTATIVE SUSAN KING: Mr. Speaker, would the gentleman yield?
REPRESENTATIVE JOE STRAUS: Mr. Geren, do you yield?
REPRESENTATIVE CHARLIE GEREN: Oh, I'd be happy to.
REPRESENTATIVE SUSAN KING: The items that you showed me earlier that you may or may not be able to purchase; what were they?
REPRESENTATIVE CHARLIE GEREN: One of them is the Snickers Candy Bar, the other is the Odwalla Chewy Nut Bar.
REPRESENTATIVE SUSAN KING: Well, I don't like Snickers but I'm sure --
REPRESENTATIVE CHARLIE GEREN: Well, this is a Snickers with almonds, you might like that because it doesn't have peanuts.
REPRESENTATIVE SUSAN KING: That's not the intent of this legislation, as I have said repeatedly. That would be left to nutritional experts, not legislators, not anyone who --
REPRESENTATIVE CHARLIE GEREN: I understand that, Ms. King. I understand that very well. But those experts would be the ones that might decide you could buy that bar, but you couldn't buy this one. And I don't -- never have I said that that is in this -- the language of this amendment. What I have said is it leaves it up to the experts that, honestly, I'm not sure that I want to trust with that decision.
REPRESENTATIVE SUSAN KING: Well, I certainly think a registered dietitian and someone whose major -- or their life work is nutritional science would have some idea. The other question, I think understood, what does that mean when you say we're getting into someone else's business? Did I miss hear? I think someone was talking back here.
REPRESENTATIVE CHARLIE GEREN: Yes, ma'am. I think when you're at the grocery store I don't think I need to be telling you what you're buying.
REPRESENTATIVE SUSAN KING: Absolutely. That could be a combination, or that could be an opinion if, in fact -- if, in fact, the money you were spending in the store was your money. This is a program that the government gives to people that --
REPRESENTATIVE CHARLIE GEREN: I'm sorry, Ms. King. I couldn't hear you. There's too much talking going on behind me.
REPRESENTATIVE SUSAN KING: SNAP was designed to help people that are hungry. This is a government program that if you are entitled to receive you do receive. So I would respectfully disagree that if this is a program that has spent year after year, billions and billions of dollars, it is in the best interest of individuals to give them a suggestion --
REPRESENTATIVE CHARLIE GEREN: And your question is what, ma'am?
REPRESENTATIVE SUSAN KING: You were asking about if we were getting into people's business and this is a government program.
REPRESENTATIVE CHARLIE GEREN: Once again, what is your question?
REPRESENTATIVE SUSAN KING: I wanted to know if you thought it was getting into people's business when you know that --
REPRESENTATIVE CHARLIE GEREN: And I answered yes.
REPRESENTATIVE SUSAN KING: -- the government is get giving these people an entitled program for the purpose of buying food.
REPRESENTATIVE CHARLIE GEREN: Ma'am, I'm well aware that they're giving them the money for, to buy the food.
REPRESENTATIVE SUSAN KING: So do you know of any other government grants that keep the money is just given to someone without any strings attached of any type of parameters?
REPRESENTATIVE CHARLIE GEREN: Ma'am, I'm not -- I'm not aware of any government programs that have the -- that have the restrictions or do not. I haven't ever gotten a government grant.
REPRESENTATIVE SUSAN KING: I believe this is probably one of the only, and I'm not supporting that we stop the program, I believe that --
REPRESENTATIVE CHARLIE GEREN: Oh, I don't think we should stop it.
REPRESENTATIVE SUSAN KING: -- common sense with regard to help people. And if they want to spend their funds in any way they can, they can. But this is a huge government program and the first lady herself has recognized --
REPRESENTATIVE CHARLIE GEREN: Yes, ma'am. I understand that. And, once again, what is your question?
REPRESENTATIVE SUSAN KING: About getting into someone's business. I think you answered it for me. Thank you.
REPRESENTATIVE CHARLIE GEREN: Thank you. REPRESENTATIVE LINDA HARPER-BROWN: Mr. Speaker, will the gentleman yield for a question?
REPRESENTATIVE JOE STRAUS: Mr. Geren, do you yield?
REPRESENTATIVE CHARLIE GEREN: I will. REPRESENTATIVE LINDA HARPER-BROWN: Thank you, Mr. Speaker. And Representative Geren, aren't you talking about, when you talking about getting into other people's business, you're talking about now that there could be a product every week or every month or some other product now that can be named or banned from this list, and the retailer then has the problem then of trying to keep up with this list and know what is allowed and what isn't allowed?
REPRESENTATIVE CHARLIE GEREN: Yes, ma'am. That's correct. And that's what could happen. REPRESENTATIVE LINDA HARPER-BROWN: That's right. And that's the biggest problem with this -- with the -- the amendment without your amendment to it.
REPRESENTATIVE CHARLIE GEREN: Well, and making -- and even making the people aware of what they can and cannot buy is going to be difficult. REPRESENTATIVE LINDA HARPER-BROWN: So we're really having private business do what -- become a social worker for the government program.
REPRESENTATIVE CHARLIE GEREN: That's correct, ma'am. REPRESENTATIVE LINDA HARPER-BROWN: Thank you.
REPRESENTATIVE CHARLIE GEREN: I move passage.
REPRESENTATIVE JOE STRAUS: Chair -- Chair recognizes Representative Oliveira.
REPRESENTATIVE RENE OLIVEIRA: Thank you, Mr. Speaker, members, I rise to speak in favor of Chairman Geren's amendment. Some of you all have been in -- will remember that under the Reagan years ketchup was considered a vegetable. When we have the government deciding what is or is not a vegetable or a fruit or a healthy product, it kind of shocks me that we're even debating this on this floor. I do respect Representative King's intent, but I think this is too hard a thing to do, particularly when you're looking at federal law that is going to preempt us when we're dealing with food stamps and other government programs. I think the issue becomes real clear, there is problem with childhood obesity, there is a problem with childhood diabetes; there are lots of problems. But you know what? It's not just a problem with poor children, it's all our children from all over our great state and our great nation. So it seems to me that we can trust even poor people to feed their children well, and we can trust rich people to feed their children well; and I don't see how it's good for us to put this burden on small mom and pop grocery stores, or large chains like HEB and Wal-Mart and others to try to decipher this. It is going to be an ever changing, ever moving list of what is healthy and what is not. Things that my father ate when he was young that people said that were healthy; I remember after his first heart attack he was told to eat a lot of red meat and cottage cheese, and a lot of other products like that. Well, we now know, I think with some certainty that that's not healthy. So it's going to be changing some times every month, every year. Things in the past that we thought was unhealthy are now listed as healthy. Things that in the past were listed as healthy are now unhealthy. I really believe that Chairman Geren has the right idea that we should not -- should not be putting this burden on our Texas business and our Texas grocers.
REPRESENTATIVE JOE STRAUS: Mr. Veasey, for what purpose?
REPRESENTATIVE MARC VEASEY: Gentleman yield?
REPRESENTATIVE RENE OLIVEIRA: I yield.
REPRESENTATIVE JOE STRAUS: Gentleman yields.
REPRESENTATIVE MARC VEASEY: Thank you, Mr. Olivera. I Appreciate your comments and I'm going to support Representative Geren on his amendment. And I appreciate Representative King's intent on what she is trying to do, and she mentioned the healthy incentives pilot. And if I remember I had an amendment, I had an HCR on the floor that was voted down, that that was the healthy incentives pilot. And there is one county in Massachusetts that does this pilot and what it does is it works with this particular county and people that are on SNAP benefits, and it -- and they're doing a study to see whether or not by increasing their benefits or by adding, by using the healthy incentives pilots, and it's not (inaudible) it's not -- the SNAP benefits that they currently have are not included in the pool. This is a pool of money and they can use it to go to the farmer's market and to see if it basically increases people that are on SNAP using fruit and vegetables. And I think that that is probably a better way to go. I don't know if you agree with that, but I think it's probably a better --
REPRESENTATIVE RENE OLIVEIRA: I think it is. And, in fact, in our local communities -- I know in south Texas there are many different health care groups and nutrition groups that are out there in the poorest of places, around south Texas, educating people on what is good for their children and what is not good for their children, and the problems with too much sugar and the problems with too much fat, and the problems with too much meat and et cetera, et cetera --
REPRESENTATIVE MARC VEASEY: Of corn syrup and --
REPRESENTATIVE RENE OLIVEIRA: And I think if we try to micro-manage from this body we start making mistakes. Yes, we can turn it over to some panel of nutritionists, but I'm not sure I trust them either. Again, I think we're create a bureaucratic nightmare for our state, and I think we're invading the province of the federal government. The intention is good. The more we can educate people, the more foods that they should not be having. I worry about my children, and some day my grandchildren. But all I know now is it's going to be -- it's going to be changing all the time. And I think we need to leave this up to our local communities, our local schools and all these -- where I go to in my schools and all over the state they're teaching nutrition. Children are coming home and they're telling their parents what is healthy and not healthy. So I think it's starting to work out there without this particular measure.
REPRESENTATIVE MARC VEASEY: Representativ e Olivera, I believe that Representative King is trying to do the right thing, and I want to continue to help her on this mission. I just don't want to go down this particular avenue.
REPRESENTATIVE RENE OLIVEIRA: I agree, too. I admire her very much, and her intentions. And I just don't think we need to come up with this experiment and put this burden on local small businesses and grocers and food suppliers.
REPRESENTATIVE MARC VEASEY: You look at this small county in Massachusetts and you look at where there's an increase in diabetes and other health related diseases related to what we eat every day and lack of exercise, and I think that you will find out that the community of Massachusetts is probably not reflective of where you see all of these issues. And so I hope that we can work with Susan, Dr. Zerwas, Dr. Shelton and all these people that work with the medical community every day, and get our kids eating more fruits and vegetables. I'm just don't think that this is the right way. And I appreciate you supporting Representative Geren's amendment. And, once again, I commend Representative King, because I think she's trying to do the right thing.
REPRESENTATIVE RENE OLIVEIRA: I agree.
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Naishtat, for what purpose?
REPRESENTATIVE ELLIOT NAISHTAT: Will the gentleman yield for one question?
REPRESENTATIVE RENE OLIVEIRA: I yield.
REPRESENTATIVE ELLIOT NAISHTAT: Rene, would you agree with this statement that any proposals that limit purchasing options would unfairly treat SNAP food stamp customers differently from other consumers, would add additional complications to SNAP food stamp redemption, and would threaten to increase the stigma that SNAP food stamp beneficiaries and others associate with the program?
REPRESENTATIVE RENE OLIVEIRA: Yes, I think so. Again, what is deemed unhealthy today is healthy tomorrow. And I'm just don't know how we can do this discrimination and decide amongst ourselves here, or delegate it to a panel of nutritionists, particularly when we're still going to have the federal government decide this one way or the other. Whether we like it or not I think it's their rule that reigns supreme on this issue.
REPRESENTATIVE ELLIOT NAISHTAT: Thank you.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Raymond to speak in opposition.
REPRESENTATIVE RAYMOND: Thank you, Mr. Speaker. Members, I have a great deal of respect for Charlie Geren and for Rene Olivera, they're both very good friends of mine. But I strongly disagree with them on their position on this, and I think I disagree with Mr. Veasey on this as well. Members, this is real simple. We've looked at this in the human services committee, worked on this all session. A lot of us have worked on it longer than that. My city, the City of Laredo, strongly supports what Ms. King is trying to do here and what Dr. Zerwas is trying to do here. And what it comes down to is this: Many people in the State of Texas get the SNAP benefit. But I don't care which district you live in, most people in your district don't get SNAP, right? And what we found by now is that many of the people that receive SNAP, you're also seeing higher instances of diabetes. And so these two things that Charlie Geren held up, you see the difference between these two is that this one here will give you diabetes, this one here won't. And what we're trying to establish here is a moving us to a place where we do help people that need help buying food. That's what we do. It's government money that we're helping them. But at the same time not letting them go buy stuff that leads them physically to where it gets them to getting diabetes. Because then we have to pay more in medicaid. That's what happens. And it is an educational process. Once they know they can't buy cookies and candies and Coke and chips, they'll start learning why they can't; because it hurts them. It leads to diabetes. It costs us more in the long run. What we're trying to do, what Ms. King and Dr. Zerwas is trying to do here is the right way to go. We start to send a signal to Washington that we here in the State of Texas, we support the SNAP program but we want it to be done right. We don't want junk food purchased with these government dollars that we are helping people with. We don't want that. And, with all due respect, Mr. Olivera and Mr. Geren are wrong on this one. Dr. Zerwas and Ms. King are right. This is -- The language that's in the bill is good. It's a good step. It moves us toward educating people who are benefiting from a -- from a benefit they get from the government, that not buying junk food will not only help them; it will help them physically, but in the long run it will cost us less money because we don't have to spend so much on medicaid. You all know that we have very high instances of diabetes in this country. Very high in the State of Texas, going higher all the time. And along the border, where I represent, very high.
UNIDENTIFIED SPEAKER: Mr. Speaker?
REPRESENTATIVE RICHARD RAYMOND: We have to move people away from buying this and move them towards buying this. The grocery stores, everybody uses a bar-code. It's not going to be a big deal. You know, you can't buy cookies, candies, chips, sodas; stuff like that. But you'll still be able to buy -- still get the benefits that you are going to get, but you're going to get things that are less likely to cause diabetes, heart disease, et cetera. So I hope, and I know Dr. Zerwas is going to move to table the Geren amendment, I hope you will vote with Dr. Zerwas to table the Geren amendment.
REPRESENTATIVE LOIS KOLKHORST: Mr. Speaker, will the gentleman yield?
REPRESENTATIVE JOE STRAUS: Ms. Kolkhorst, for what purpose?
REPRESENTATIVE LOIS KOLKHORST: Mr. Chairman?
REPRESENTATIVE RICHARD RAYMOND: Yes.
REPRESENTATIVE LOIS KOLKHORST: I want to thank you for your work this session on these tough issues. I know that you and I share a lot of the same ideas on this particular issue, and we deal with obesity and diabetes and different things. So just a couple of quick questions. I was interested in an email that I received where I saw that there is quite a few people that are against this, and that is from the retailers and grocers and different things. And, of course, EPPP too. So I found it kind of interesting where these two meet. Do you think that this would help us be a healthier Texas?
REPRESENTATIVE RICHARD RAYMOND: It'll make us -- it'll help us to be a healthier Texas. But it's also, we have a responsibility in here, whether you're a democrat or a republican, when we're using public funds we need to do it in as responsible a fashion as possible. And we should not continue to use public funds to buy junk food. Yes, we use it to help people that need help, no question about that. But not to buy junk food.
REPRESENTATIVE LOIS KOLKHORST: And just finally I want to ask you a question, this is just -- this amendment is just a guideline. It's really just a start to say we need to move down a path to healthier foods, using taxpayer dollars for healthier foods, and that could, you know, apply to all of us, eating healthier foods because we're doing so much to promote farmers markets and things like that.
REPRESENTATIVE RICHARD RAYMOND: This is one of those things that I truly believe that democrats and republicans can send a meaningful message to Washington saying we want our people to be healthier, we want them to continue to get the SNAP benefit, but we want them to be healthier. We don't want to continue the rising instances of diabetes and heart disease. And that's what this -- that's what this language does.
REPRESENTATIVE LOIS KOLKHORST: I want to thank you for all your work this session on this particular issue.
REPRESENTATIVE RICHARD RAYMOND: Thank you.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members. I'm going to move to table the amendment by Chairman Geren. And the reason being, obviously, I support the the policy decision here. I think it that makes a lot of good sense to be concerned about the nutritional perspective of the people that we're subsidizing in terms of the tax dollars that are being used. So, members, if you think about this, don't think about whether they just got the freedom to go buy what they want to buy, think about the fact that we've got an epidemic of obesity among our children. There are some things that we can do about that, and part of that is in terms of defining what is the appropriate supplemental nutrition assistance program should look like. And think about what the words say. It is not food stamps anymore, although we have learned to coin it as such; it's supplemental nutrition. And we need to recognize the fact that the dollars currently aren't being used to the best benefit of those individuals that are the recipients of it. And if you aren't sure about that I can tell you, sit in public health for a little while and you'll get a very, very clear understanding that we see a lot of people that have preventable diseases -- this is the one you want -- that have preventable diseases, that -- that through appropriate nutrition it can make a big difference. And that's a lot of what we deal with when we look at various provisions that are on the medicaid program. And so, members, I'm going to move to table. I urge you to vote with me on this motion to table and support what I think is very sound policy.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Geren to close.
REPRESENTATIVE CHARLIE GEREN: Thank you members. I'd hope that you vote with me and vote no on the motion to table. This is -- We don't need to be discriminating against poor people who love their children just as much as rich people do. They're going spend their money, and the food stamps, the appropriate way. We shouldn't be taking that decision away from them. I hope that you'll vote no on the motion to table.
REPRESENTATIVE JOE STRAUS: Representative Geren sends up an amendment to the amendment. Representative Zerwas moves to table. This is on the motion to table. Vote aye, vote nay. The clerk will ring the bell. Have all voted? There being 28 ayes and 110 nays, motion to table fails.
REPRESENTATIVE CHARLIE GEREN: I think it's acceptable to the author, Mr. Speaker.
REPRESENTATIVE JOHN ZERWAS: The amendment to the amendment is acceptable to the author.
REPRESENTATIVE JOE STRAUS: The amendment -- Representative Geren sends up an amendment to the amendment, it's acceptable to the author. Is there objection? Chair hears none. The amendment to the amendment is adopted. Following amendment to the amendment, the clerk will read the amendment.
THE CLERK: Amendment to the amendment by Zerwas.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker. Members, this was an oversight when it talked about the notification system on a land-line versus a none land-line. And what we needed to put -- insert there is language which would recognize that these are poor people that are enrolled in a home or community based service waiver program; not all medicaid recipients, such that it would include a personal emergency response system as a service. And so, Mr. Speaker, this amendment to the amendment is acceptable to the author.
REPRESENTATIVE JOE STRAUS: Representative Zerwas sends up an amendment to the amendment. The amendment to the amendment is acceptable to the author. Is there objection? Chair hears none. The amendment to the amendment is adopted. Back on the Zerwas amendment as amended.
REPRESENTATIVE JOHN ZERWAS: I move adoption.
REPRESENTATIVE JOE STRAUS: Representative Zerwas sends up an amendment. Is there objection? Chair hears none. The amendment is adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Howard of Travis.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Howard.
REPRESENTATIVE DONNA HOWARD: Thank you, Mr. Speaker, members. Senate Bill 7 requires that the Health and Human Services Commissioner develop an objective assessment process to determine acute nursing care services. This is supposed to be a cost effectiveness measure. It does not indicate what the qualifications are for who will be making that assessment. My amendment simply states that that would be done by a physician, a registered nurse or a physician's assistant. And I believe it's acceptable to the author.
REPRESENTATIVE JOE STRAUS: Representative Howard sends up an amendment. It's acceptable to the author. Is there objection? Chair hears none. The amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Naishtat.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Naishtat.
REPRESENTATIVE ELLIOT NAISHTAT: Members, thank you for your patience. This amendment would -- would add a requirement that at least three consumers be appointed to the medicaid and CHIP quality payment advisory committee. It doesn't have consumers now. This would require that there be at least three consumers on this advisory committee. I believe it's acceptable to the author.
REPRESENTATIVE JOE STRAUS: Representative Naishtat sends up an amendment. It's acceptable to the author. Is there objection? Chair hears none. Amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Brown.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Brown.
REPRESENTATIVE FRED BROWN: Thank you, Mr. Speaker and members. Dr. Zerwas is right, they did put in -- in this bill that -- some antifraud language. But let me tell you what this antifraud language said, because it is weaker than circus Kool-Aid. It says that the (inaudible) considering approval of a subcontract between a managed care organization and a pharmacy benefit manager, blah, blah, blah, shall review and consider. Shall review and consider. Those, members, are all the teeth that were taken out of this amendment. We sat on the House floor on Senate Bill 23 that we did not want to tolerate fraud in our prescription drug program on medicaid. The amendment that I have today simply states -- it says that HSSC may not contract with the company, HMO, PBM or MCO or services within the past three years that have made a material misrepresentation or committed fraud, been convicted of violating a state or a federal law or assessed a penalty or fine in the amount of $500,000 or more in a state or federal administrative proceedings. And it makes it very, very clear; members, that this is a guideline for the head of HHSC and there's no deviation, and it's not subcontract. It's all the contracts. So, with that, Mr. Speaker, I move passage.
REPRESENTATIVE LEO BERMAN: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Berman, for what purpose?
REPRESENTATIVE JOHN KUEMPEL: Would the gentleman yield?
REPRESENTATIVE JOE STRAUS: Mr. Brown, do you yield?
REPRESENTATIVE FRED BROWN: Yes, sir. I do.
REPRESENTATIVE LEO BERMAN: All you are saying is that if a company defrauded the state we -- in the last three years, we don't want to do business with them?
REPRESENTATIVE FRED BROWN: Absolutely.
REPRESENTATIVE LEO BERMAN: That's a great amendment.
REPRESENTATIVE FRED BROWN: I'm glad you brought that up, Leo. Because in 2001 the Attorney General's Office has sued and won $283 million in the State of Texas for bad players, MCO's, HMO's and PDM's in the State of Texas.
REPRESENTATIVE LEO BERMAN: Well, you remember I was on Appropriations for four years when he did that. And I think what you got is a great amendment and I hope we accept it. Thank you.
REPRESENTATIVE SID MILLER: Mr. Speaker will the gentleman please yield?
REPRESENTATIVE JOE STRAUS: Mr. Brown, do you yield?
REPRESENTATIVE FRED BROWN: Yes, sir. I do.
REPRESENTATIVE SID MILLER: Fred, you said that our Attorney General had levied fines on what was that? I didn't quite hear it.
REPRESENTATIVE FRED BROWN: $283 million on pharmacy benefit managers, HMO's and MCO's in the State of Texas.
REPRESENTATIVE SID MILLER: And I assume after we levied those fines and found fraud that we no longer are continuing to do business with those companies?
REPRESENTATIVE FRED BROWN: Oh, no, sir. There's nothing in the law that says that we can't. So they just keep renewing contracts and, you know --
REPRESENTATIVE SID MILLER: You got to be kidding me.
REPRESENTATIVE FRED BROWN: No.
REPRESENTATIVE SID MILLER: The State of Texas is doing business with people that we have found that have defrauded us and we continue to do business with them?
REPRESENTATIVE FRED BROWN: Yes, sir. We do.
REPRESENTATIVE SID MILLER: Does your amendment prevent this?
REPRESENTATIVE FRED BROWN: Yes, sir. It does.
REPRESENTATIVE SID MILLER: I think you have a good amendment. I don't believe that we should be rewarding criminals or fraud to our -- that are taking advantage of our taxpayer dollars.
REPRESENTATIVE FRED BROWN: Thank you.
REPRESENTATIVE SID MILLER: Thank you.
REPRESENTATIVE FRED BROWN: Appreciate it.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members, I'm going to move to table Chairman Brown's amendment here. I know that's a real surprise, because he and I have been on the other side of this issue for most of it. And, in fact, we ended up with language which in the bill which clearly says that the commissioner must consider the things that are, in fact, in there. Specifically, if you look at number two, it says that if they had either a state or federal conviction; let me find the language real quick. Was convicted of violating a state or federal law. Well, just think for a minute how many state and federal laws are out there that have absolutely nothing to do with being a pharmacy benefit manager. And so there's a lot of a lot of vagueness in there that I think is really unacceptable. Should it be something that's looked at? Should it be something that in fact the commissioner should take into consideration of what the magnitude of what that state or federal law conviction was? Absolutely, they should. A material misrepresentation or committed fraud. I'm all about, you know, keeping somebody out of the game if they committed fraud. I think that's a big hurdle and, in fact, it should be -- it should be something that's recognized. But, again, it should be within the realm that the commissioner and the Attorney General, who is deeply involved in this now, has the option to look at this and it's not something that specifically is spelled out in statute. I don't disagree with the spirit of anything that Chairman Brown is putting before you here today, but I think is it is vested totally in what the commissioner has in terms of what they're supposed to look at in terms of granting contracts to various pharmacy benefit managers or otherwise. So, members, I'm going to move to table this. And I think that we have accurately put that into the bill. We have put the kind of strength and provisions that we need in the bill in order to provide for any of circumstances that Chairman Brown has listed out here.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Brown to close.
REPRESENTATIVE FRED BROWN: Thank you, Mr. Speaker and members. Members, we, as a body, amended Senate Bill 23. And we said the entire body, except for one person, voted that we are not going to -- we are not going to do business with players that rob the State of Texas. We said that HMO's, PBM's and MCO's that have defrauded the State of Texas were not going to be companies we're doing business with. We said that as a body. It went to the Senate and we even instructed our conferees to make sure that that language stayed in there. What they sent back was a watered down version which has no credence when it gets to HH --
REPRESENTATIVE SID MILLER: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Miller, for what purpose?
REPRESENTATIVE SID MILLER: I'd like to ask the gentleman a question.
REPRESENTATIVE JOE STRAUS: Mr. Brown, do you yield?
REPRESENTATIVE FRED BROWN: Yes, sir, I do.
REPRESENTATIVE SID MILLER: Representative Brown, I believe you said we passed this same amendment 148 to 1; is that correct?
REPRESENTATIVE FRED BROWN: That's correct.
REPRESENTATIVE SID MILLER: How would you -- If you supported the motion to table, basically your position would be that you would want to allow the state to contract with crooked PBM's and HMO's.
REPRESENTATIVE FRED BROWN: That's right, this --
REPRESENTATIVE SID MILLER: That's all this amendment says. And it -- in -- Dr. Zerwas, I have great respect for him. And he says it could be even a small penalty. Actually, I believe your amendment says a penalty or fine in amount of half a million dollars or more.
REPRESENTATIVE FRED BROWN: Yes, sir.
REPRESENTATIVE SID MILLER: So we're not talking about if they, you know, had some kind of small infraction or something. But they'd have to be fined five hundred million dollars or more. I think that's a significant crime against the State of Texas; would you not agree?
REPRESENTATIVE FRED BROWN: Absolutely.
REPRESENTATIVE SID MILLER: So, I still think you have a good bill. I don't believe Texas should contract with people convicted of fraud. And I would urge everyone to vote against the motion to table.
REPRESENTATIVE FRED BROWN: Thank you. Members, I ask you to stick with me on this amendment. This is important to the taxpayers of Texas. We do not need to do business with people who take advantage of us. So I'm asking with you today to stick with me again, and let the Senate know that we mean business. We want this passed and we want to send strict instructions to the head of Health and Human Services that we want our taxpayer dollars protected. Please vote no on the motion to table.
REPRESENTATIVE JOE STRAUS: Representative Brown sends up an amendment. Representative Zerwas moves to table. This is on the motion to table. Vote aye, vote nay. The clerk will ring the bell. Show Representative Zerwas voting aye. Representative Brown voting no. Have all voted? There being 7 ayes and 133 nays, the motion to table fails. Representative Brown sends up an amendment acceptable to the author. Is there objection? Chair hears none. Amendment is adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Hughes.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Hughes.
REPRESENTATIVE BRYAN HUGHES: Thank you, Mr. Speaker. Members, this is a very simple amendment that lines up language in this bill with language that's already been put in the budget. And it has to do with federally qualified health centers. There's hundreds of these all across Texas. And it makes sure that they are in the list of priorities to receive family planning funds. It doesn't limit funds, it just puts more facilities in place where the funds can be used. This language is already in the budget, passed by this House and the Senate, and it includes federally qualified health centers in the priority language. I believe it's acceptable to the author. It's acceptable, Doctor? I move adoption.
REPRESENTATIVE JOE STRAUS: Representative Hughes sends up an amendment. Is there objection? Chair hears none. The amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Zedler.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zedler.
REPRESENTATIVE BILL ZEDLER: Mr. Speaker, members, this amendment calls for the gathering of the consistent aggregated data relating to abortion procedures. It's fully supported by Texas Right to Life and I move adoption.
REPRESENTATIVE JOE STRAUS: Representative Zedler sends up an amendment. The amendment's acceptable to the author. Is there objection? Chair hears none. Amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Simpson.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Simpson.
REPRESENTATIVE DAVID SIMPSON: Thank you, Mr. Speaker. Members, this is an amendment that would basically stop the coercion of tax dollars for the use of abortion, either directly or indirectly.
REPRESENTATIVE DONNA HOWARD: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Ms. Howard, for what purpose?
REPRESENTATIVE DONNA HOWARD: I'd like to raise a point of order against the proposed amendment on the grounds that it violates House Rule 11, Section 2.
REPRESENTATIVE JOE STRAUS: Bring your point of order down front. Representative Howard raises a point of order. The point of order is sustained. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by King of Taylor.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative King. Chair recognizes Representative King.
REPRESENTATIVE SUSAN KING: Thank you, Mr. Speaker. Members, we have already passed -- not the SNAP part, heaven forbid, but we already have passed something in the perfecting amendment earlier having to do with listing information on the website of the Department of State Health Services about personal health care information that is sold as a revenue stream for Texas. Now, the other part of my amendment, and that's already passed, so I would like to tell you that my amendment is two other parameters of that amendment that just passed that people had heartburn with. And let me tell you what it does: Number one bullet point, the provider submits data as required by this chapter, and they must provide notice to the providers' patients. What that means is now, as a patient, either in a health care providers' office or an institution, they are sending your private health care information away to a vendor, fully identified, and they are selling it, if the person is not in a research institution. So they could be selling it to durable medical products entities, they could be selling to it law firms, they could be selling it to anyone who fills out the form to buy your personal data. But keep in mind I said it was originally identified, which means your address, your Social Security number and your date of birth. So when it is sent to a vendor they de-identify it. But, nevertheless, your personal data is being sold by the State of Texas. I am simply asking for you, the patient, to be informed. So that would mean that providers would say please know that your personal information is being sent to a location out of state, and this is to make you aware of that. It's no different than when you give informed accident for a procedure. Like, for example, if Charlie Geren was going to have his foot repaired you wouldn't just go up to him and say here, sign this, you would explain to him about what the procedure was. This is an effort to get full disclosure and transparency to patients, which is not done currently. Secondly, through this amendment, you must tell the people that although this information is collected, that it could be sent to other places and sold. I think it's transparency in government. I think it's fair minded, and I'd like to know any of you who would gave a speech in your district that says yes, we collect personal health care information, we send to a vendor and we sell it. I would be very interested to see if anybody would like to have that as one of their platforms. So this is far transparency in government, and this is the two parts of the amendment that were stripped out, asking people to do what's right; tell the patients we are taking this information, and secondarily that this information is taken and sold. The part that it would be placed, the people buying the information is already passed, it's going to be on the website. These are the other two parts of transparency in government and doing the right and fair thing for patients.
REPRESENTATIVE JOE STRAUS: Representative King sends up an amendment. The amendment is acceptable to the author. Is there objection? Chair hears none. Amendment's adopted. Representative Riddle? Representative Simpson? Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Riddle.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Riddle.
REPRESENTATIVE DEBBIE RIDDLE: Thank you, Mr. Speaker and members. This amendment is very simple. What it does is it simply changes the policy may to the policy must. This -- this talks about how -- for those physicians who do not want to be -- or who want to be exempted from vaccines, based on reasons of conscience or religious beliefs, that -- that that would be effective and they would not be required to have this vaccine.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker. Members, I'm going to speak in opposition to this particular provision. It seems like a small one. However, there's serious considerations as to what happens in the right to work issues related to the State of Texas. So this is a very, very important provision for the hospitals in terms of bringing this forward. They do believe strongly --
REPRESENTATIVE SENFRONIA THOMPSON: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mrs. Thompson, for what purpose?
REPRESENTATIVE JOHN ZERWAS: And it just --
REPRESENTATIVE SENFRONIA THOMPSON: May we have order?
REPRESENTATIVE JOHN ZERWAS: And so really -- Thank you, Chair Thompson. So really what this issue is related to is what happens in terms of the hiring practices of the hospital to be able to do that. There are the provisions in there that recognize conscientious objectors, there are those people who, for medical reasons, can't take a certain vaccine. But, at the end of the day, this is about the hospitals having the ability to ask their workers who have direct patient contact, or even near direct patient contact, that not be transmitting diseases that we know that are preventable. So, Mr. Speaker, I would move that -- to table this and that we leave the original wording in there, which says may have a policy related to this.
REPRESENTATIVE JOE STRAUS: Ms. Laubenberg , for what purpose?
REPRESENTATIVE JODIE LAUBENBERG: Mr. Speaker, would the gentleman yield, please?
REPRESENTATIVE JOE STRAUS: Mr. Zerwas, do you yield?
REPRESENTATIVE JOHN ZERWAS: I do.
REPRESENTATIVE JODIE LAUBENBERG: Represen tative Zerwas, you know we had this discussion during the regular session. And the provision that's in the bill now requires -- will allow the hospitals to require their health care workers to be vaccinated. But it does not require the hospitals to let those health care workers know that they can be exempt if they have a specific reason, religious or reason of conscience; correct? It does not require them to note -- let that health care worker know.
REPRESENTATIVE JOHN ZERWAS: It does have explicit language in there requiring them to consider conscientious objectors, and those that would have medical reasons for not being able to take a vaccine.
REPRESENTATIVE JODIE LAUBENBERG: To simply consider it, but they don't have to tell the health care worker anything. So they could give the impression to a grown adult, who is applying for a job, that unless you get these vaccines then you may not be hired. That would be the impression. What this amendment -- what Representative Riddle's amendment would do, would simply -- it does not eliminate the requirement for the vaccines; it simply requires the hospital to put in their policy that the health care worker would know that they have that choice. I mean we're talking about transparency and we're talking about adults, I just don't understand why the hospitals would be fighting a simple policy to allow the health care worker to know what their rights are. Why would -- Why is that a bad thing?
REPRESENTATIVE JOHN ZERWAS: Well, I think it comes right down to, you know, the ability for a hospital to effectively provide personnel, in the interest of the safety of the patient, without some of the other ripple effects that come along with that. So I think that the situation is if the hospitals have their hands tied on certain things, there may be circumstances where they aren't able to hire the kind of people that they want in order to provide that kind of direct care. And so I know personally that, you know -- you know, as a physician, I get all the vaccinations. I understand that. I don't have a conscientious objection to it, and I don't have the medical reasons for not getting those vaccines. But I do understand that people that day in and day out that are going to be making contact with patients and so forth, to have a vaccine preventable disease that the CDC recognizes, is a policy that the hospitals feel very strongly about. And that policy, and there was a lot of discussion amongst the stakeholders in this around this very language, to the extent that they said if that language is changed that, in essence, this vaccination policy really isn't going to help them. That they would, in fact, rather not have it because of what some of the complications that are centered around the delivery of care.
REPRESENTATIVE JODIE LAUBENBERG: Okay. The amendment that Representative Riddle is trying to present does not prohibit the hospitals from having the policy for the vaccine requirement, correct?
REPRESENTATIVE JOHN ZERWAS: Correct.
REPRESENTATIVE JODIE LAUBENBERG: Okay. Her amendment simply requires the hospitals to have a policy in writing to provide for that religious or conscientious exemption, correct?
REPRESENTATIVE JOHN ZERWAS: Let me find the language real quick and make sure we're reading it together.
REPRESENTATIVE JODIE LAUBENBERG: The amendment simply changes it from they may have a policy, something in writing, to they shall have something in writing, I believe; is that correct?
REPRESENTATIVE JOHN ZERWAS: The policy may include procedures for a covered individual to be exempt from the required vaccines based on reasons of conscience and including religious beliefs.
REPRESENTATIVE JODIE LAUBENBERG: Which means that they may not. Which means -- I'm asking a question. Which means that the hospital could avoid having anything that would indicate that the health care worker could take an exemption?
REPRESENTATIVE JOHN ZERWAS: Right. I think that the consideration here, and the reason that they have such concern about that specific language, is in terms of the balance of what is ultimately in the interests of the safety of the patient. And we know that lots of people continue to die of vaccinations, preventable diseases, as a result of direct contact. And the last place that we should expect any of that to happen is in a hospital facility, where we're trying to prevent any of these complications from --
REPRESENTATIVE JODIE LAUBENBERG: The hospitals will not tell us, they fight us every time on when we try to get them to report any of their infectious diseases that are picked up through hospital conditions. They fight us on that.
REPRESENTATIVE JOHN ZERWAS: In actuality, we have language in this bill that speaks to that very issue. And there wasn't any fight from the hospitals at all on that. There was a lot of good stakeholder input that came to that particular aspect of the bill.
REPRESENTATIVE JODIE LAUBENBERG: Well, I'm happy they're finally coming around. But again, here again, they're fighting transparency for their own employees. It -- If we don't change this language, it's one simple word, then basically employees will be fearful of losing their jobs. How will they be notified that they could be exempt? How will they know that? I mean, the world doesn't focus on us as much as we focus on ourselves.
REPRESENTATIVE JOHN ZERWAS: Right.
REPRESENTATIVE JODIE LAUBENBERG: So if the hospital chooses not to put that policy in place, then basically -- do I understand this correctly, the healthcare worker may never know that they have that option.
REPRESENTATIVE JOHN ZERWAS: Well, that perhaps is your perspective on it. I think the fact that --
REPRESENTATIVE JOE STRAUS: Representative Sheffield raises a point of order, that the gentleman's time is expired. Chair recognizes Representative Riddle to close.
REPRESENTATIVE DEBBIE RIDDLE: Members, this morning I received a call from the president of the National Foundation for Women Legislators. She's in Washington, D.C. She said women legislators from across the nation are looking at what we're doing here in Texas, and they're looking at this bill. And she said that this one small, yet very large part of this bill, it's simple but it's so very important; it's something that the women legislators from other states believe strongly that we need to have that wording there from may to shall. The reason for this, is that as Representative Laubenberg was saying, was for transparency. My office received a lot of calls, quite a few calls, I took many of them personally, from physicians from various parts of this state; saying that it was important for them to have this amendment favorably received.
REPRESENTATIVE DAVID SIMPSON: Mr. Speaker?
REPRESENTATIVE DEBBIE RIDDLE: So I would ask --
REPRESENTATIVE JOE STRAUS: Mr. Simpson, for what purpose?
REPRESENTATIVE DAVID SIMPSON: To ask a few questions, please.
REPRESENTATIVE JOE STRAUS: Ms. Riddle, do you yield for some questions, please?
REPRESENTATIVE DEBBIE RIDDLE: I would gladly yield.
REPRESENTATIVE DAVID SIMPSON: Thank you, Representative riddle.
REPRESENTATIVE DEBBIE RIDDLE: Mr. Speaker, I can't seem to hear him. May we have order, please?
REPRESENTATIVE JOE STRAUS: Could we have some order, please?
REPRESENTATIVE DAVID SIMPSON: So what you're proposing in this amendment is just to require that this notice of a religious exemption or conscientious exemption would be available; is that correct?
REPRESENTATIVE DEBBIE RIDDLE: That is correct.
REPRESENTATIVE DAVID SIMPSON: And would it go beyond -- If we don't have this, I mean the way it's worded now, would someone who -- whose doctor said that taking this vaccine would not be good for them, and if it wasn't a contraindication indicated by the Center for Disease Control, they would be prevented from working there even if their own doctor said that it would be bad to have this vaccine for them in particular?
REPRESENTATIVE DEBBIE RIDDLE: I'm having a little bit of difficulty hearing you, but if I think I heard you correctly I think that's the case.
REPRESENTATIVE DAVID SIMPSON: That's right? So it not only would provide religious exemption, but it would provide an exemption for a conscientious, good medical reason provided by your own doctor?
REPRESENTATIVE DEBBIE RIDDLE: If someone had a very good medical reason, and this was something that applied, yes; this would certainly apply to them.
REPRESENTATIVE DAVID SIMPSON: I think you have a very good amendment, which I'll support.
REPRESENTATIVE DEBBIE RIDDLE: I think in medicine, and I think even Dr. Zerwas would have to agree, one size does not fit all. And this amendment says that one size doesn't fit all. And it does give the transparency, and it does give the freedom. Legislators from across the nation are looking at this. From the call that I received from the National Foundation for Women Legislators, and the doctors across the state, they're very concerned about this and they want this amendment passed. Thank you very much.
REPRESENTATIVE DAVID SIMPSON: I support it. Thank you.
REPRESENTATIVE DEBBIE RIDDLE: Thank you, Mr. Speaker.
REPRESENTATIVE JOE STRAUS: Representative Riddle sends up an amendment. Representative Zerwas moves to table. The vote is on the motion to table. The clerk will ring the bell. Vote aye, vote nay. Show Representative Zerwas voting aye. Representative Riddle voting no. Show Representative Menendez voting aye. There being 84 ayes and 52 nays, the motion to table prevails. Chair recognizes Representative Strama for an introduction.
REPRESENTATIVE MARK STRAMA: Thank you, Mr. Speaker. Members, up in the gallery the today we are joined by the next generation of Texas Legislators, a group from the Junior Statesman of America. They're here from all over the state and I got to visit some with them yesterday. They're a very bright, thoughtful, articulate, energetic group thinking about the deep issues of the day. And I'd just like you to join me in welcoming them to the Texas House of Representatives.
REPRESENTATIVE JOE STRAUS: Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Menendez.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Menendez.
REPRESENTATIVE JOSE MENENDEZ: Thank you, Mr. Speaker. Members, this amendment adds the committee substitute of House Bill 985, which died on the calendar during the session. There is no fiscal note on this amendment. It is acceptable to the author, and what this amendment does, members, it -- all it does is three simple things: Consolidates two chapters of the health safety code, Chapter 248 for nursing homes, and 247 for assisted living facilities into a single chapter for the purposes of reporting abuse and neglect. Using Chapter 242 as a basis, all it does a make a standard set of rules for two types of facilities that essentially do the same functions, easily operated by the same rules. It is an efficiency common sense measure. The second thing that the amendment does is it directs the department to reassess current procedures and make internal changes as appropriate, using existing resources to make a reporting and investigation process as responsive as possible. And finally, members, the department will report back to the legislature the reports of these experts and provide appropriate recommendations that may need legislative attention next session. It is acceptable to the author and I move adoption.
REPRESENTATIVE JOE STRAUS: Representative Menendez sends up an amendment. The amendment is acceptable to the author. Is there objection? Chair hears none. The amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Alonzo.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Alonzo. The amendment's withdrawn. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Kolkhorst.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Kolkhorst.
REPRESENTATIVE LOIS KOLKHORST: Thank you, Mr. Speaker and members. This amendment is the health care compact that we have seen on the House floor now three times.
REPRESENTATIVE LARRY PHILLIPS: Mr. Speaker, will the gentle lady yield?
REPRESENTATIVE JOE STRAUS: Ms. Kolkhorst, do you yield?
REPRESENTATIVE LOIS KOLKHORST: I will.
REPRESENTATIVE LARRY PHILLIPS: Now, is that the health care compact that we have voted on like a dozen times?
REPRESENTATIVE LOIS KOLKHORST: Yes, sir.
REPRESENTATIVE LARRY PHILLIPS: How many times have we actually voted on it?
REPRESENTATIVE LOIS KOLKHORST: We have voted on it on the House floor three times.
REPRESENTATIVE LARRY PHILLIPS: And you also have it as a bill?
REPRESENTATIVE LOIS KOLKHORST: Yes.
REPRESENTATIVE LARRY PHILLIPS: So are we going to get to vote on it again?
REPRESENTATIVE LOIS KOLKHORST: It is in calendars right now, so I'm not advised.
REPRESENTATIVE LARRY PHILLIPS: So have you changed anything since we voted on it the other three times?
REPRESENTATIVE LOIS KOLKHORST: No, sir.
REPRESENTATIVE LARRY PHILLIPS: So is this acceptable to the author?
REPRESENTATIVE LOIS KOLKHORST: It is.
REPRESENTATIVE LARRY PHILLIPS: All right. So probably going to be quick today.
REPRESENTATIVE LOIS KOLKHORST: Thank you, Mr. Chairman.
REPRESENTATIVE LARRY PHILLIPS: Thank you.
REPRESENTATIVE LOIS KOLKHORST: Move passage.
REPRESENTATIVE JOE STRAUS: Representative Kolkhorst sends up an amendment --
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker?
REPRESENTATIVE JOE STRAUS: Mr. Naishtat, for what purpose?
REPRESENTATIVE ELLIOT NAISHTAT: Will the chairperson yield for a couple of questions?
REPRESENTATIVE JOE STRAUS: Ms. Kolkhorst, do you yield for a couple of questions?
REPRESENTATIVE LOIS KOLKHORST: I do.
REPRESENTATIVE ELLIOT NAISHTAT: Thank you. This is the bill which complicated passage of your Senate Bill, was it 7 or 8; on the last night of the session?
REPRESENTATIVE LOIS KOLKHORST: Senate Bill 8.
REPRESENTATIVE ELLIOT NAISHTAT: Yeah, okay. First question:
REPRESENTATIVE LOIS KOLKHORST: Yes, sir.
REPRESENTATIVE ELLIOT NAISHTAT: Would we be giving up the right -- would Texas be giving up the right to increase federal funding for medicare or medicaid in cases of increased enrollment or need from an unexpected economic downturn or pandemic, because we would have a block grant; so if we were to have some unforeseen circumstance or emergency, would we be prohibited or precluded from getting additional federal funds?
REPRESENTATIVE LOIS KOLKHORST: Yeah, I've read something about that, Elliot, and I would say that what the compact does is it takes -- and I know we've discussed this a lot, it takes the 2010 snapshot, and then it does increase, based upon our population growth -- our growth and inflation. But the things that I've read about the pandemic, or other emergencies, I think that that would be something that we could negotiate potentially with Congress. And it depends, as you have a compact you have a give and take, we'll have a compact committee, not just in Texas, but with the other states that will be messaging back and forth with Congress. So I don't think that that is set in stone in any way.
REPRESENTATIVE ELLIOT NAISHTAT: Not --
REPRESENTATIVE LOIS KOLKHORST: These are new issues.
REPRESENTATIVE ELLIOT NAISHTAT: Uh-huh.
REPRESENTATIVE LOIS KOLKHORST: This is a new concept. I think the testimony in committee this week was, you know, certainly we are a part of, I think it is 24 compacts here in the State of Texas. We have the low level waste compact that we had come through this session. This is a new compact when it is applied to health care.
REPRESENTATIVE ELLIOT NAISHTAT: It's an unprecedented concept, is it not?
REPRESENTATIVE LOIS KOLKHORST: I would say unprecedented, defined as it is new. It's never been done. Yes, there's no precedent that --
REPRESENTATIVE ELLIOT NAISHTAT: But getting back to what I was asking you about, under any compact with the 2010 level funding, federal dollars would no longer be automatically available to help cover increased exceptionable cost?
REPRESENTATIVE LOIS KOLKHORST: And I think part of the struggle that we have here in Texas, is that we continue to see our F mat, you know, decrease, and certainly in the enhanced F mat year of the stimulus fund, they are funding, which 2010 is included in some of those numbers. I think our top watermark that was we received about $18.5 billion in all funds, not in all funds, but in the federal funds. And then we saw it fall to 14.3 billion in the current -- the biennium that we're working on right now in HB 1. So certainly we know, and the Health and Human Service Commissioner has testified that we believe how the F mat is structured today we will continue to move all the way back to 50 percent, because of how the F map is calculated.
REPRESENTATIVE ELLIOT NAISHTAT: Okay. But tell me if I'm right or wrong, that the bill includes no -- no requirements that the state continue to serve the same populations, or provide the same health care benefits currently provided under medicare medicaid and CHIP?
REPRESENTATIVE LOIS KOLKHORST: Right. So what the bill does require, Elliot, is that you have to use these funds for healthcare. It's not like we can take the federal dollars, and the difference in a compact is we don't have a put our money up to match or draw them. They automatically flow so the first dollar in is the fed dollar. But we cannot use that money for anything else but healthcare. And then, if we don't use up all the healthcare dollars, that money actually goes back to the federal government.
REPRESENTATIVE ELLIOT NAISHTAT: Does the bill make any provision for actions that would build additional capacity to cover Texas' 6.4 million uninsured people?
REPRESENTATIVE LOIS KOLKHORST: Say that again, Elliot.
REPRESENTATIVE ELLIOT NAISHTAT: Does the bill make any provision for actions that would build additional capacity to cover our $6.4 million -- million uninsured people?
REPRESENTATIVE LOIS KOLKHORST: No. I would I would say that it's silent to that, but what we have is, you know, our incentive to do that is we'll have these dollars, we can use look at best practices in other states as part of the what the compacts come together and do. And what we are going to be able to do is hopefully cover more people. And I know that we've heard testimony on some of the innovative ways that we can do that, and I think that the decision makers are going to be here in Austin. So as you look at people that come and testify and do things, we'll be deciding on though how we spend those dollars, rather than asking Washington, D.C. no matter who the administration is. And we have tried for block granting for a long time, and we've seen, you know, Rhode Island got in under the wire when Bush was giving some. Certainly, President Obama and his administration is looking at innovative waivers that they've moved up from 2017 to 2014. So what we've -- what we're incentivized to do is that these federal dollars cannot supplant into education, they cannot supplant into say highways and different things. They have to be used for healthcare reasons. You and I both know on the public health committee we have struggled so much with the variations that we see in this very large state. You know, down in south Texas I think Chairman Raymond testified today about diabetes, and some of the struggles that we have down in south Texas, where we are seeing obesity, diabetes and heart disease. We have other kinds of areas in the State of Texas, whether heart disease is very prevalent in east Texas, where we can start to look at health care packages that are used to try to direct to certain areas of our state some of the -- the real almost pandemics that we're seeing in that regard.
REPRESENTATIVE ELLIOT NAISHTAT: I have one last question.
REPRESENTATIVE LOIS KOLKHORST: Yes, sir.
REPRESENTATIVE ELLIOT NAISHTAT: Would you agree that simply capping funding for health care doesn't control health care costs, but shifts them to local governments, charities, families and local property taxpayers?
REPRESENTATIVE LOIS KOLKHORST: No, I would disagree with that and I don't think that this is a cap, because there is the ability to grow. Texas is a growing state. So if we were not a growing state I would certainly have a problem with the formula that's embedded in the compact. I don't believe that this is going to cap our funding for the rest of the -- while we serve here, or into the infinity. What it I do know, Elliot, and what I'm struggling with, is the economy and where we are and the messages that we're getting from Washington D.C., and you know, on the Affordable Care Act they cut a half a trillion dollars from medicare by the year 2019 to try to save money. There's a lot of things shifting in Washington, D.C. and I certainly think that we are incentivized here in the State of Texas to come up with a model where we can serve the needs of our Texans and not throw people off the rolls. You know that I say that all the time as a republican. I am not here to throw people off the rolls and throw them away from our health care system. We're trying to build a health care system. When we talk about bending the curve, and a lot of people talk about medical inflation, and that it's so much higher than other inflationary markers that we use; we as a nation have to bend that curve. One of our goals is to bend the curve of medical inflation or, simply stated, that's one of my goals so that we can afford health care in the future. Thank you. Move passage.
REPRESENTATIVE JOE STRAUS: Excuse Representative Castro because of important business, on the motion of Representative Marquez. Is there objection? Chair hears none. So ordered. Representative Kolkhorst sends up an amendment. It's acceptable to the author. Is there objection? Chair hears none. So ordered. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Kolkhorst.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Kolkhorst.
REPRESENTATIVE LOIS KOLKHORST: Thank you, Mr. Speaker and members, this is the health care waiver that we saw on HB 13 that is set to be heard tomorrow also on the floor. I do believe that this is acceptable to the author. We have passed this a in a bipartisan manner. I move passage.
REPRESENTATIVE JOE STRAUS: Representative Kolkhorst send up an amendment. It's acceptable to the author. Is there objection? Chair hears none. The amendment is adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Riddle.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Riddle.
REPRESENTATIVE DEBBIE RIDDLE: Members, this amendment simply says that for anyone who applies or receives any of these supplemental nutritional programs, they have to be here legally. And I believe this is acceptable to the author.
REPRESENTATIVE JOE STRAUS: Representative Riddle sends up an amendment, it's acceptable to the author. Is there objection? Chair hears none. The amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Christian.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Christian.
REPRESENTATIVE WAYNE CHRISTIAN: Thank you, Mr. Speaker. Mr. Speaker, this amendment -- We are sending each year literally hundred dollars of advanced nurse practitioner graduates to other states that could be doing general practice basic care all across the State of Texas. We've addressed this for several sessions. This amendment simply asks our state to do a study during the interim to see what the benefits or the negatives are regarding allowing advanced practice nurses to practice medicine without severe regulations, in just the areas that they are allowed and licensed and certified to perform their duties. This does not allow them to do it, it simply asks that a study to be done so we'll simply have the facts, pluses and minuses, next session. I move passage.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Zerwas.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members. I'm going to move to table this amendment. This is something that we did here in public health committee. And, in point of fact, that the speaker and the Lieutenant Governor can appoint whatever they want to appoint, that they see is some of the most important needs out there. It's not something that we need to put in statute. I have a great deal of respect for advanced practice nurses and the professionals that work with us. However, I think that (inaudible) whether this merits a rise to an interim study, I think that
(inaudible) the Lieutenant Governor and the Speaker. And with that, yes, Mr. Speaker I'll yield.
REPRESENTATIVE JOE STRAUS: Gentleman yields.
REPRESENTATIVE DONNA HOWARD: Thank you, Dr. Zerwas. Just questioning why you would have a problem with having a study that is looking at something that really has the the opportunity to provide cost savings, access to health care that a lot of people in this state would really like to see, to be able to expand the opportunity to have qualified health care providers, especially providing the primary and preventive care that's so important throughout the state.
REPRESENTATIVE JOHN ZERWAS: Certainly, I'm not at all opposed to that, and you know that, and you and I have had a lot of conversations about that. But I do think that if we're going look at that overall access, and let's look at it in a much more comprehensive way. Let's look at what the role of telehealth might be and the use of telehealth. Under the current provisions that we have with regard to the current amount of prescriptive authority that various people have, under the current amount of supervision that we have; there are a lot of other things that we could look at in terms of things that create access to care out there. And so I think that looking at this in a limited fashion, and looking at it through statute, as opposed to the discretion of the Speaker and the Lieutenant Governor, it's just not warranted. And sitting through public health, and I know you've been through a lot of those committee meetings, but I can tell you sitting through that for the last two years we thoroughly discussed this issue related to prescriptive authority. And if there has ever been a study done it's been done through the committee process in this particular area. And over time there are provisions that are made that are intended to address the needs out there. But my primary issue here is that if we're going look at trying to improve access to care then let's not just look at it through somebody's scope of prescriptive authority or scope of practice, let's look at it also in the realm of some greater technology that might be out there.
REPRESENTATIVE DONNA HOWARD: Well, and I appreciate what you're suggesting about having a larger context for study, and I think that's an excellent idea. But in terms of the health care professionals, would you not say that that is a unique area of expansion -- expansion of the health care delivery system that has the potential to reap huge benefits for the state, in and of itself; regardless of all the other things that we might also be looking at?
REPRESENTATIVE JOHN ZERWAS: Well, I'm not sure if it does or not. Because if you look at other states where you do see more advanced prescriptive authority for non physicians, actually what you see is these people migrate to the more urban areas. There's nothing that really asks if they go out to the medically under-served areas or the rural areas. However, there is -- there are some things that are considered to try to move physicians out into the rural areas, and Representative Gonzales has one of those and it's going to be an amendment to this bill which does give some people some provisions of relief on their medical licensure that allows them to go into the more medically underserved areas and rural communities and so forth. So, yeah, I think there's a lot of things that we can look at. But even when you look at those issues related to advanced prescriptive authority for other individuals that may or may not have training to do that, I think that you'll find that you still struggle with those issues related to access to care in those under-served areas.
REPRESENTATIVE DONNA HOWARD: You are aware of the fact, are you not, Dr. Zerwas, that we have access to care issues even in the urban portions of our state in terms of not having sufficient primary care providers?
REPRESENTATIVE JOHN ZERWAS: Right. Absolutely aware. But I'm also aware of issues that in the urban areas where healthier incomes can be realized, that's where we often times find people.
REPRESENTATIVE DONNA HOWARD: I appreciate what you are saying. I hope that we will have some kind of a study. I would look forward to that. I also think that Representative Christian has a good amendment here, so thank you very much.
REPRESENTATIVE JOHN ZERWAS: Thank you. I move to table.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Christian to close.
REPRESENTATIVE WAYNE CHRISTIAN: Thank you, Mr. Speaker. Members, I think you want to pay real good attention to this, because all it's doing is asking for a study. Legislative budget board came to me during the interim and said this would save taxpayers millions of dollars. It's a money saving item if we decide to do it. We fought to allow this to bring more medical care, the provision of health care at a lower cost all across this state. Medicaid, in the interim, by itself, threatens to bring from $15 to $18 billion additional cost. We must start addressing providing primary care and providing greater access of care in the State of Texas. All this does is say let's study it before the next -- next session, during the interim, and get the facts to work on to save money, to provide better and more medical care, and provision across the state and to make sure that those people that do not have the access -- Let me remind you that there are senior citizens living in rural parts of the state literally a hundred miles from the nearest physician, that must make the decision of whether to eat, buy their medicine or make a trip to the doctor. They can't do them all. There are literally hundreds of advanced nurse practitioners that could provide primary care through our entire state to these people that currently do not have it. So, I ask you not to pass the law, but to please allow the study to be done during this interim so that you and I can make a wise decision to help our citizens get the medical care they need. And I hope that you'll vote against the motion to table.
REPRESENTATIVE JOE STRAUS: Representative Christian sends up an amendment. The amendment is acceptable to the author. Is there objection? Chair hears none. The amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Gonzales of Hidalgo.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Gonzales.
REPRESENTATIVE VERONICA GONZALES: Thank you, Mr. Speaker. Members, this amendment will allow counties without hospital districts that enter into what are known as upper payment limit agreements with private hospitals, to treatment indigent patients to be reimbursed in the same manner as county hospital districts. I'm glad that I'm joined in this amendment by Dr. Schwertner, Larry Gonzales, Representative Deshotel and there's a few other members in the valley delegation as well. This will benefit only a few counties and I believe it's acceptable to the author.
REPRESENTATIVE JOE STRAUS: Representative Gonzales sends up an amendment. The amendment is acceptable to the author. Is there objection? Chair hears none. The the amendment's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Guillen.
REPRESENTATIVE JOE STRAUS: Chair recognizes Representative Guillen.
REPRESENTATIVE RYAN GUILLEN: Thank you, Mr. Speaker. Members, this amendment will explore the benefits of medicaid recipients eligible for home health services, so that they can stay at home and within the community at a lower cost to the state. It passed in this House, unanimously, during the regular session. And it's acceptable to the author and I move passage.
REPRESENTATIVE JOE STRAUS: Representative Guillen sends up an amendment. It's acceptable to the author. Is there objection? Chair hears none. Amendment's adopted.
THE CHAIR: Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Eiland.
THE CHAIR: Chair recognizes Representative Eiland.
REPRESENTATIVE CRAIG EILAND: Thank you members, this is the amendment that we passed on several occasions dealing -- It's acceptable to the author. It's also co sponsored by Dr. Zerwas and the other doctors in the House. And it deals with health care, financing, transparency, making sure that if somebody takes advantage of a physician or hospital discounts that they have a contract and/or the physician knows that they're going to take advantage of that discount. Move adoption.
THE CHAIR: Representative Eiland sends up an amendment. It's acceptable to the author. Is there any objection? Hearing none. Move passage. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Chisum.
THE CHAIR: Chair recognizes Representative Chisum.
REPRESENTATIVE WARREN CHISUM: Mr. Speaker and members, this amendment allows chiropractors to do their work and get paid by the insurance companies. But I believe there's an amendment to the amendment.
THE CHAIR: Following amendment to the amendment.
THE CLERK: Amendment to the amendment by Schwertner.
THE CHAIR: Chair recognizes Representative Schwertner.
REPRESENTATIVE SCHWERTNER: Thank you, members. This is an agreed to amendment by the author. This amendment ties the original amendment in reference to its language in Section -- on line 19, 20 saying laws and rules, it says state law -- in the second change it adds limits this amendment to the occupations under Subchapter C. And third aspect of this amendment to the amendment changes the word practice to license. And, again, it's agreeable to Representative Chisum and I move adoption.
THE CHAIR: The amendment to the amendment is acceptable to the author. Is there any objection? Hearing none. It's adopted. Members, we are now on the Chisum amendment as amended; and it is acceptable to the author. Any objection? Hearing none. It's adopted. Is Mr. Hardcastle on the floor of the House? Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Hardcastle.
THE CHAIR: Chair recognizes Representative Hardcastle.
REPRESENTATIVE RICK HARDCASTLE: Thank you, Mrs. Speaker. Members, this amendment is -- this amendment is relating to (inaudible) largest stem cell banks in the State of Texas. This is blood and tissue taken from a live human to be given back to that same human --
THE CHAIR: Representative Thompson, for what purpose? Representative Thompson?
REPRESENTATIVE SENFRONIA THOMPSON: I'd like to raise a point of order against this amendment. Germaneness.
THE CHAIR: Okay. Representative Thompson, please bring your point of order down. Representative Thompson raises a point of order and the point of order is withdrawn. Chair recognizes Representative Hardcastle.
REPRESENTATIVE RICK HARDCASTLE: Madam Speaker, members, this is very specific and it is for all the new technology that's moving so fast in this state. And it gives the commissioner or the commission the opportunity to decide whether it's adding to healthcare or not, and they can determine and make rules --
THE CHAIR: Representative Thompson, for what purpose?
REPRESENTATIVE RICK HARDCASTLE: -- would be legal or not.
REPRESENTATIVE SENFRONIA THOMPSON: Madam Speaker, will the gentleman yield or you would like me to let him continue?
REPRESENTATIVE RICK HARDCASTLE: Certainly yield.
REPRESENTATIVE SENFRONIA THOMPSON: Okay. Would you tell us what an analogue is?
REPRESENTATIVE RICK HARDCASTLE: That is a stem cell derived from your own body, put back in your own body.
REPRESENTATIVE SENFRONIA THOMPSON: Okay. And as defined -- It's not the defined in our code? What code --
REPRESENTATIVE RICK HARDCASTLE: It's not defined in Texas, but it is defined in national medical code.
REPRESENTATIVE SENFRONIA THOMPSON: Federa l code? Federal code?
REPRESENTATIVE RICK HARDCASTLE: If you want to call it federal code, yes, ma'am.
REPRESENTATIVE SENFRONIA THOMPSON: Federal ? The federal? Do we know how this particular amendment is going to impact ongoing research?
REPRESENTATIVE RICK HARDCASTLE: Now, it exclusively leaves out all of the facilities that we got doing research. It is --
REPRESENTATIVE SENFRONIA THOMPSON: Would you be kind enough to accept an amendment to make sure that we do that?
REPRESENTATIVE RICK HARDCASTLE: I have to look at your amendment, because we think we've left everybody out that we --
REPRESENTATIVE SENFRONIA THOMPSON: I just want to make sure that we're not affecting or impacting ongoing research that's already in place and ongoing at this particular time.
REPRESENTATIVE RICK HARDCASTLE: And we spent all day yesterday and half of this morning going over with all the lawyers to make sure that we're not affecting that.
REPRESENTATIVE SENFRONIA THOMPSON: Well, do we know whether or not we're impacting cord blood banks?
REPRESENTATIVE RICK HARDCASTLE: We specifically -- If you'll look at my amendment, specifically last two lines in my amendment specifically leaves out Chapter 162, which is the cord blood -- which is the cord blood bank.
REPRESENTATIVE SENFRONIA THOMPSON: Is that bone marrow?
REPRESENTATIVE RICK HARDCASTLE: It doesn't affect bone marrow, it doesn't affect anything -- The lawyers at MD Anderson have looked at it. It doesn't affect anything we're currently doing. This is aimed at the people that are starting to use the technology that was formally over-seized in this state, and making sure that the health commission, along with Texas Medical Board, have all the authority they need to regulate them as --
REPRESENTATIVE SENFRONIA THOMPSON: What about the vast array of other existing and new medical treatments? With the new bureaucracy, is this going to impact any of them?
REPRESENTATIVE RICK HARDCASTLE: It will not impact any of them.
REPRESENTATIVE SENFRONIA THOMPSON: So what I'd like to do is ask you to look at, as soon as available, the amendment to the amendment to be sure that we're not impacting any of the ongoing researches that --
REPRESENTATIVE RICK HARDCASTLE: I will gladly look at your amendment to the amendment --
REPRESENTATIVE SENFRONIA THOMPSON: I know you're going to like it and accept it.
REPRESENTATIVE DEBBIE RIDDLE: Mr. Chairman, would the gentleman yield?
THE CHAIR: Representative Riddle, for what purpose?
REPRESENTATIVE DEBBIE RIDDLE: Would the gentleman yield?
THE CHAIR: Mr. Hardcastle, will you yield?
REPRESENTATIVE RICK HARDCASTLE: Certainly.
THE CHAIR: He yields.
REPRESENTATIVE DEBBIE RIDDLE: Thank you very much, Representative Hardcastle. You said that this would not affect the research that is currently going on.
REPRESENTATIVE RICK HARDCASTLE: No.
REPRESENTATIVE DEBBIE RIDDLE: But tell me about research that we might have in the future. Tell me about research that might be coming up, research that we may not even be aware of.
REPRESENTATIVE RICK HARDCASTLE: The only thing this amendment affects is if you are banking -- if somebody creates a lab to extract your stem cells and bank them for you, for your future use, in the future. And that is the newest treatment for a lot of blood diseases, a lot of autoimmune diseases. But it's all being done in foreign countries. And there are some entities that are looking at doing this here. I sat through a presentation Friday at the Texas Medical Board, and I'm quite sure that the Medical Board has the authority to regulate doctors. And all this amendment does is make sure that the health commissioner has the authority to write rules on these labs that store the stem cells, your own stem cells.
REPRESENTATIVE DEBBIE RIDDLE: Okay. Well I'm just concerned that I don't want it to affect any future research.
REPRESENTATIVE RICK HARDCASTLE: And, Ms. Riddle, I would be very cautious how I say it; but that is one of my biggest concerns, and has been for the last ten to twelve years of my service in the legislature, is to make sure that we continue to do all the research that's available on all the new science, including stem cells.
REPRESENTATIVE DEBBIE RIDDLE: Well, I respect you highly, and I felt like that was probably the case. But I felt like it was important to just nail that down, thank you.
REPRESENTATIVE RICK HARDCASTLE: Thank you.
THE CHAIR: Representative Brown, for what purpose?
REPRESENTATIVE FRED BROWN: Madam Speaker, could I request that we have subtitles on our computers when Chairman Hardcastle gets up to speak?
THE CHAIR: Would that mean a translation? The following amendment to the amendment.
THE CLERK: Amendment to the amendment by Thompson.
THE CHAIR: Chair recognizes Chairwoman Thompson.
REPRESENTATIVE SENFRONIA THOMPSON: Madam Speaker and members, we have a become a leader in the United States on adult stem cell research. And what I don't want to happen is that we pass -- pass -- put an amendment on this bill that will slow down the progress or negatively impact the adult stem cell research
(inaudible) at this particular time. And I appreciate my colleague accepting my amendment to the amendment.
THE CHAIR: The amendment is -- the amendment to the amendment is accepted by the author. Is there any objection? It's adopted. Representative Thompson sends up an amendment, the amendment to the amendment is acceptable to the author. Is there objection? Now we are on Representative Hardcastle's amendment as amended.
REPRESENTATIVE RICK HARDCASTLE: And I move passage.
THE CHAIR: It's acceptable to the author. Any objection? Hearing none. The following amendment, clerk will read the amendment.
THE CLERK: Amendment by Jackson.
THE CHAIR: Chair recognizes Representative Jackson.
REPRESENTATIVE JIM JACKSON: Madam Speaker, members, this amendment is language found -- that was found in Senate Bill 101 in the regular session. It's half the language. The other is half is just adopted by agreement. It's a Chisum amendment. It simply brings possible efficiencies to collaboration --
UNIDENTIFIED SPEAKER: Madam Speaker --
REPRESENTATIVE JIM JACKSON: -- between physicians and chiropractors --
THE CHAIR: Representative Schwertner, for what purpose?
REPRESENTATIVE CHARLES SCHWERTNER: I'd like to call a point of order in regards to further consideration of this amendment, based on Rule 11, Section 2.
THE CHAIR: Okay. Please bring your point of order down. Representative Schwertner raises a point of order, and the point of order is respectfully overruled. Chair recognizes Representative Jackson.
REPRESENTATIVE JIM JACKSON: Members, again, this is language that was originally found in Senate Bill 101 that passed the Senate, passed out of the House committee and died on the calendar the night that we -- that the calendar died. It simply brings possible efficiencies to collaboration between physicians and chiropractors by allowing them to form business entities as a partnership, just as some other people can do now, a podiatrist can do it, and ophthalmologist can do it. And this simply allows chiropractors to do it along with physicians. Just in government there could be efficiency. I believe it's acceptable to the author.
THE CHAIR: Representative Jackson sets up an amendment. It is acceptable to the author. Is there any objection? Hearing none. It's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Alonzo.
REPRESENTATIVE ROBERTO ALONZO: Yes, members, this is an --
THE CHAIR: Chair recognizes Representative Alonzo.
REPRESENTATIVE ROBERTO ALONZO: Sorry. This amendment that we passed during the regular session and passed 89 to 50, it basically says for hospital reimbursed for health care. I believe it's acceptable to the author.
THE CHAIR: Representative Alonzo sets up an amendment. The amendment is acceptable to the author. Is there any objection? Hearing none. It's adopted. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Christian.
THE CHAIR: Chair recognizes Representative Christian.
REPRESENTATIVE WAYNE CHRISTIAN: Thank you, Mr. Speaker -- Madam Speaker, this amendment says that if a hospital district for any local entity takes --
REPRESENTATIVE DONNA HOWARD: Madam Speaker?
THE CHAIR: Representative Howard, for what purpose?
REPRESENTATIVE DONNA HOWARD: I'd like to raise a point of order against the proposed amendment on the grounds it violates House Rule 11, Section 2.
THE CHAIR: Bring your point of order down front. Point of order is respectfully overruled. Chair recognizes Representative Christian.
REPRESENTATIVE WAYNE CHRISTIAN: Thank you, Mr. Speaker. This is a bill that did pass into calendars --
THE CHAIR: Mr. Naishtat, for what purpose?
REPRESENTATIVE ELLIOT NAISHTAT: Mr. Speaker, I raise a point of order against the proposed amendment on the grounds that it violates Rule 8, Section 3.
THE CHAIR: Bring your point of order down front. Point of order is respectfully overruled. Chair recognizes Representative Christian.
REPRESENTATIVE WAYNE CHRISTIAN: Move passage.
THE CHAIR: Representative Christian sends up an amendment. It is acceptable to the author. Is there any objection? Chair hears -- Record vote's been requested. Record vote's granted. The clerk will ring the bell. Representative Christian voting aye. Representative Zerwas voting aye. Representative Simpson voting aye. Members, you've got plenty of time to vote. Have all voted? Representative Lucio voting nay. Have all voted? Being 100 ayes, 31 nays, 2 present not voting; amendment is adopted. Following amendment, the clerk will read the amendment. Following amendment, the clerk will read the amendment. Following amendment, the clerk will read the amendment.
THE CLERK: Amendment by Lucio.
THE CHAIR: Chair recognizes Representative Lucio to explain the amendment.
REPRESENTATIVE EDDIE LUCIO: Thank you, Mr. Speaker. Members, this is a very kind of convoluted, complex amendment; but to try to break it down to its basic elements, as we are deviating substantially from the current structure of what's called the standard dollar amount that individually based per hospital to a now a statewide standard dollar amount. And what this creates is a floor that they will not lose more than 8 percent of the adjusted rate that this bill is proposing. And I know it's acceptable to the author and he has an amendment to clarify that and I will let him lay out his amendment to the amendment.
THE CHAIR: Following amendment to the amendment. The clerk will read the amendment.
THE CLERK: Amendment to the amendment by Zerwas.
THE CHAIR: Chair recognizes Representative Zerwas to explain the amendment to the amendment.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members. As Representative Lucio said, this is a real deep in the weeds issue that is relating to transitioning to a statewide standard dollar amount for reimbursement in the medicaid program. This limits hospitals from enduring too much of a loss in income by limiting it to 8 percent of a loss when they transition to the SDA. We've worked closely with Representative Lucio on this, as well as the commission, to make sure we get in the right place on this. And I think it's acceptable to the author.
THE CHAIR: Representative Zerwas sends up an amendment to the amendment, it's acceptable to the author. Is there any objection? Chair hears none. The amendment's adopted. We're now back on the Lucio amendment as amended. Chair recognizes Representative Lucio to close.
REPRESENTATIVE EDDIE LUCIO: Move adoption.
THE CHAIR: Members, you've heard the motion. The amendment's acceptable to the author. Is there any objection? Chair hears none. The amendment to the amendment -- the amendment is adopted. Mr. Simpson? Mr. Simpson? Chair recognizes Representative Zerwas to close.
REPRESENTATIVE JOHN ZERWAS: Thank you members. Thank you for your patience and endurance today and I close.
THE CHAIR: Question occurs on passage to engrossment -- Anyone wishing to speak for or against SB 7? Chair recognizes Representative Simpson to speak against SB 7.
REPRESENTATIVE DAVID SIMPSON: Thank you, Mr. Speaker. Members, I support efficiency, transparency with respect to our present medicaid provisions; but there is much in this bill beyond those concerns. If you look on page -- on Article 2, page 69, it deals with legislative findings and intent in compliance with antitrust laws. And then on page 70, it says the legislature intends to exempt from antitrust laws and provide immunity from federal antitrust laws through the state action, doctrine, health care collaborative that holds a certificate of authority under such and such chapters. We are granting immunities for things that we should not be doing. I'm for efficiency on something that we've already committed to subsidize to help with medicare, but the next article deals -- Article 3 deals with the Texas Institute of Health Care Quality and Efficiency. When has government made something proficient? Think about the Post Office, think about the Department of Justice toilet, the Department of Defense, I should say. There's much in this bill that I dare say much of us have not even read. I would like to just implement the first portion. We are implementing with this bill a vaccination policy that will require every nurse, every health care worker, to receive a vaccination even if they have a conscientious objection that the Center for Disease Control doesn't recognize. It doesn't -- they're going to strip out more than likely the religious exemption. If we put it in there, and I don't believe it's in there. We are going to be disclosing, on page 132, confidential information. And how confidential is our private, personal health care information that we are forced to give the government? It's not very confidential if the government knows about it. And, furthermore, it says it can share this confidential information with other agencies. Just so long they keep it confidential. That's kind of like telling you that what I'm about to tell you is a secret, but you keep it a secret, too. I would urge you to oppose this bill that grows our government. I urge you to vote no on SB 7. Thank you.
THE CHAIR: Representative Zerwas to close.
REPRESENTATIVE JOHN ZERWAS: Thank you, Mr. Speaker and members. And for the second time, I close.
REPRESENTATIVE JOE STRAUS: Question occurs on passage to engrossment of Senate Bill 7. The clerk will ring the bell. Members, strict enforcement's been requested. Strict enforcement has been granted. Please vote from your desk. Have all voted? There being 91 ayes and 47 nays, Senate Bill 7 is passed to engrossment. Members, are there any other announcements? No further announcements. Representative Otto makes the motion that the House stand adjourned until 10:00 a.m. tomorrow. House stands adjourned.
(The House stands adjourned.)
