Texas Department of State Health Services
SB 969 - Public Health Funding and Policy Committee (PHFPC)
April 12, 2013
TALHO Offices
2600 McHale Court, Suite 100
Austin, TX 78758
Committee Members Other Attendees
Stephen Williams Larry Johnson, Abilene-Taylor Co PHD Beverly Bowen, WTxHITREC
Dr. Chip Riggins Patty Melchior, DSHS DCPS CMU Bruce Burns, DSHS, CHS
Dr. Mark Guidry (phone) Michele Austin, Houston HHS Kevin Veal, DSHS, DRS
Dr. Paul McGaha (phone) Bing Burton, Denton Co H.D
Dr. Deborah McCullough Anna Osborne, DSHS
Dr. Brian Smith Jennifer Smith, TALHO
Dr. Richard Kurz (phone) Michael Hill, TALHO
Susana Garcia, DSHS DCPS CMU
Debbie Bennett, DSHS DCPS CMU
Dan Smith, DSHS, RLHS By phone/video
Rachael Hendrickson, DSHS, OGA Bain Cate, Victoria County HD
David Gruber, DSHS, RLHS Mike Messinger, DSHS, RLHS
Nagla Elerian, DSHS, CHS
Justin Henderson, Texas Ophthalmology Assn.
Monty Waters, DSHS, OGA
Mr. Stephen Williams called the meeting to order and asked the Committee to introduce themselves to the audience and participants who joined via conference call.
Mr. Williams asked the Committee to vote on approval of the March 20th PHFPC meeting minutes.Dr. Rick Kurz motioned, Dr. Deb McCullough seconded.
TB Funding Formula – Mr. Janna Zumbrun reported that a external workgroup worked to propose a new TB funding formula and eligible criteria. Recommendations came to the PHFPC Policy Subcommittee and then to the full committee. Next, the recommendations went to Dr. Lakey. He is still considering and has asked additional information. Once he does make a decision the program will need to communicate with all LHDs about the elements and also to request locals to provide latent TB infection data from 2010. The program is hoping to have an approved formula within a few days. Dr. Smith asked when it would be effective. Ms. Zumbrun said the goal is for state funds by September 1 and federal funds, January 1. Dr. Riggins said based on a discussion yesterday, this formula might be limited by unavailability of funds and one could argue that the formula should be implementable. He has concerns. Ms Zumbrun said there are still eligibility criteria, so some local health departments (LHDs) will choose not to go for the funding because of the eligibility requirements. For example, as proposed, there will be a 20% local match required. The new eligibility requirements will likely mean that some LHDs will not be interested or have the capacity. Dr. Riggins said many LHDs struggle to have the critical mass to do good epi work, and if the gateway is set so high that the majority of LHDs cannot participate then we have failed. Ms. Zumbrun advised that based on preliminary estimates, the majority should be able to participate. It is easier to delegate some of the activities and CDC requirements. Dr. Guidry suggested that if we feel there is a chance that a LHD with a current program might close up, it would it be wise for the program to do a survey to find out how they would be impacted. Ms. Zumbrun said that is a good point. As soon as Dr. Lakey makes a decision, there will be a communication sent to determine which LHDs are interested. The program does not anticipate that current LHDs with a program will opt out. Yesterday a suggestion was made about having a meeting with LHDs after. Ms. Zumbrun shares Dr. Riggins’ sentiments that we need to be as inclusive as possible. Ms. Zumbrun said DSHS does not have visibility on what LHDs are spending on TB. Dr. Guidry said the LHD Survey did capture some of that.
CMPS – Ms. Patty Melchior advised that some items have been added to the schedule. Establishing a Contract System Administrator (CSA) for your agency is critical. The CSA will collaborate with others in your agency. Once your agency registers we will enter your contracts into the system. With the contract bundling, we have a document that you print out and take to your commissioner’s court and then get signatures. In July and August there will be extensive training. There will be an eLearning process but also instructor lead training that will help you get your money. As soon as we get that scheduled we will get that out. Ms. Melchior recommends you go in on the 15th and look at the eLearning and if you need more training you can do the classroom setting. You will learn the system overview which includes navigation, log in and password. The CSA can view the available training, but that individual really needs to attend the training in person. April 29th is the go-live date. Next steps after you identify your CSA, are to determine who should have access to CMPS, determine what roles they have, mark your calendar for April 29th, register your organization between April 29 and May 17, then add users and assign roles. Dr. Riggins said that at the last meeting we discussed trying to incorporate essential services terminology into our contracting process. There is a domain for state and local development; Domain 11. The model standards for state and local accreditation speak to this. Dr. Riggins suggested Ms. Melchior and her team take a look at that and try and incorporate that into the training.
Legislative Session Update - Rachael Hendrickson with DSHS Office of Government Affairs gave an update that this Tuesday, two years ago, the House had passed 60+ statewide impact this time only 19. We are not seeing a lot of hustle and bustle. There is a more laid back feel probably because of the budget. May 6th is the last day the House can report out House bills. There are 45 days left. They have already passed a budget a month earlier than usual. SB 1 passed last week. Both Senate and House versions include $100 million each year for primary health care expansion. Both versions also include $3 million each year for foodborne illness investigation response. The adult safety net program there is a $4 million difference between the House and Senate versions. The funding for meningitis vaccinations is not included. They are assuming there will be a change to the college requirement of which kids have to get the vaccine. The age limit is expected to lower. The department had asked for funds for TB investigations and outbreak response. This was partially funded in SB 1 and seems to be pretty stable. The Senate is going to disagree on the House amendment so the bill can go to conference. Then comes the vote on the final version. The main focus has really been on mental health. There is additional mental health funding. Ms. Hendrickson pulled some bills that have potential local impact. HB 46 - Raw milk bill has been left pending. HB 910 - Direct Food Sales - Very broad but has to do with food sold at farmers’ markets. This passed out of committee and it was considered in calendars, but not choice was made to put it on the House floor. HB 970 - Cottage Food - heard in committee and left pending. SB 62 - College meningitis - looks like it will pass. It exempts community colleges. SB 127 - passed out of the senate and has been referred to Public Health. It will likely be picked up by Rep Kolkhorst. SB 186 - Mosquito abatement. This has gone through the Senate and is over on the house to see if it gets referred to committee. SB 872 – County Indigent. It allows counties to use Intergovernmental Governmental Transfer to apply to the state match for county indigent programs. It was heard in committee this week. Dr. Smith said there is a sleeper bill in there that determines how we send electronic information. Ms. Hendrickson said it has been set for hearing on Monday. It will look different in the committee because they are working on substitute language. It will have a great impact. Dr. McCullough said she has concerns that there will be a very quick turnaround for the application. Ms. Hendrickson advised that Dr. Lakey is asking each division to make a plan of how they can spend the money so they can hit the ground running and be ready to roll out. Dr. Kurz asked if we know what the likely fate on the guns on campus bill is. Ms. Hendrickson has not heard too much at this point. You might see those bills coming up in committee hearing. With the focus on mental health, she does not see leadership bringing that up on the floor. Dr. Riggins said there is a SME who is consulting on the meaningful use and public health. The HHSC has the office of e-health. They are the point on it. DSHS IT is involved in terms of the practical implementation as well as legal counsel. Dr. Riggins said that is something we could and should get behind. It has additional meaning to us. If you have a summary you could send out through TALHO. Once we see what Dr. Zerwas will be presenting at the committee, we can get to Glenna to share. Dr. Riggins is concerned because it is moving and local public health is not very involved. Ms. Hendrickson shared that it is her impression that Dr. Zerwas is very aware of meaningful use and once he understood the implications he decided this should be a bill. If he wants to pass this, he can get it done. Jennifer Smith said you can contact Lou Kreidler is the chair of TALHO’s legislative committee, and if you have questions, please contact her.
Presentation from Health Information Technology Regional Extension Center (HITREC) – Ms. Beverly Bowen shared that the HITREC is doing pioneer work out in the 108 most western counties of Texas. They have worked with Dr. McCullough at Andrews County Health Department, and she has implemented and met meaningful use. She has overcome many obstacles. The Electronic Health Record (EHR) transformation in American Health Care originated with the creation of the Office of the National Coordinator for HIT that was implemented in 1996 under the Bush Administration and has been continued with significant funding to provide regional service centers to assist eligible providers and hospitals and a few other entities to select, adopt and meaningfully use EHRs. While these tools are important to the success of the Patient Protection and Affordable Care Act, otherwise known as “Obamacare”, the wide scale implementation of this EHR transformation did not arise from it. There has been a long standing movement to modernize record keeping, to implementation of health information exchange, and to foster improvements in patient safety, health outcomes – including population health, and in lowering costs dating to the IOM reports on the Quality Chasm in American Health Care published in the late 1990s.
There are the tenets of the program which is up to the choice of the client, Medicaid and Medicare. It is important to note that 2% penalties on gross billables start for those who fail to elect one of these programs by 2016. To avert the penalties the ONC devised the HITREC Programs.
Dr. McCullough said that you are eligible for Medicaid id you see 30% of your pop eligible for Medicaid . On the Medicare side, your physician had to give his Medicare number to your entity. If you are pure Medicaid you are ok, but if you are a mix then the penalty kicks in 2015. In April 2010, Texas RECs were awarded grants by the HHS Office of the National Coordinator for Health Information Technology. RECs are currently in year three of a four year grant with no continuation funding on the horizon except for fee-for-service lines
RECs were contracted to support 5,631 priority primary care providers in Texas in adopting EHR. RECs were contracted to enroll and support 111 critical access and rural hospitals of 50 beds or less. RECs are also contracted to serve critical access in rural hospitals. We are about 50% of our target. The RECs do work with eligible providers that are affiliated with public health entities. Public health departments have not been the focus, we feel there are areas of collaboration that do exist and could be explored. The vision of the RECs is to be recognized as a center of excellence by aligning our services with the National Quality Strategy, providing support for Patient Centered Medical Homes and the goals of the Partnership for Patients through collaboration with primary care providers and health care specialists in Texas and to engage public health entities in driving toward better population health outcomes. It is also important to remain a trusted partner and reference source to achieve current and future quality reporting measures.
Some of best practices: We have worked with HHSC, Medicaid and CHIP, Texas Office of E-Health. We have collaborated with Health Information Exchange organizations and other key stakeholders as part of a statewide integration strategy. We have developed white papers for our clients and regularly develop and post on the ONC's health resource center. On July 13th of 2011 federal officials announced the release of the final stage 1 rule defining how hospitals and health care providers can demonstrate "meaningful use" of electronic health records to qualify for federal incentive payments. Core to these definitions are the requirements that physicians meet a set of 15 core objectives during the first stage of the incentive program. Hospitals are required to meet 14 core objectives for Stage 1. In addition, all health care providers will need to comply with five objectives out of a "menu" of 10 options. These criteria drive to taking health information to a new level to support patient care with more complete and accurate information, better access and coordinated care based on most recent information, and to patient empowerment. With this information better decision can be made to manage vulnerable populations, to help eliminate health disparities and to ensure that “best practices” lead to efficient care.