Ben’s Blog 2017 (#8); May 11
Status report on “live or die” day for proposed bills
Today (Thursday, May 11) is a magic day for this legislative session: when the clock strikes midnight tonight, the hundreds and hundreds of House bill that have made it through the laborious legislative process either live or die. If a bill has not cleared the hurdles of approval in the House by that time, it is dead. The only hope for resuscitation is to find a suitable bill that has cleared the House, and attach all or parts of the failed bill to the active bill as a floor amendment. That is certainly a long shot.
It is the 122nd day of the legislative session and the LAST DAY for the House to consider on second reading House bills on their daily or supplemental calendar. Tomorrow (Friday, May 12) will be the LAST DAY for the House to consider second and third readings and ALL third readings of House bills on the supplemental calendar.
Meanwhile, the House and Senate Conference Committee continues to work into the wee hours every morning, attempting to reconcile (1) the methodology for funding of the proposed budget and (2) the allocation of resources (money) into each of the line items in specific articles of the state budget.
For UTMB’s budget allocations, those discussions remain ongoing:
Still in discussion from Article II is our request to restore $8.9 million that was removed from our indigent health care funding. This 91% reduction in funding would severely limit UTMB’s ability to deliver indigent health care services. Remember that we spent almost $50 million to provide care for 22,000 indigent patients from 124 Texas counties last fiscal year.
We also continue discussions with both House and Senate conferees and leadership regarding the Special Item reductions that target Article III funding related to our hospital and educational programming. The Senate has proposed restoration of the funding amount, but not necessarily the item itself, by adding the funds to the General Revenue Formula. On the other hand, the $13.8 million in reductions proposed by the House remain in play. This includes a 5% reduction in funding for the completion of the Bio-Containment Critical Care Unit and a 60% reduction of Article III indigent care funds—or the loss of another $3.4 million in addition to the $8.9 million in Article II funding discussed above. This equates to a total potential loss of $13.3 million in available funds for delivery of indigent health care services.
In addition, a proposed 60% reduction in primary care physician services funding would remove $6.1 million that is used to support our primary care training programs, student clinics and community programming. One of the most unfortunate reductions would be the proposed 60% reduction in Area Health Education Center (AHEC) funding, which could result in the closure of multiple regional centers and the loss of the infrastructure for student community resource scheduling and housing management. Such a loss would herald an end to 40 years of relationship-building with Texas physicians, hospitals and communities. Losses to chronic home dialysis would essentially end the program.
Another item we are watching this session is a demand from the Senate Finance Cost Containment Subcommittee that UTMB and the other UT System Health Related Institutions restructure our contract for delivering health care services to the Employee Retirement System population to a rate that falls below the cost of that care. This would result in a $10.6 million loss to UTMB. Although UTMB and the other UT System HRIs are willing to work with the ERS Third Party Administration to identify ways to achieve cost savings, lowering of reimbursement rates in a way that results in losses to the provider institutions is not first on our list of options. However, the rider for this request comes with the specification that the HRIs must accept the lower reimbursement rate or forgo their Article III appropriation funding.
Our no-cost request for UTMB’s mission-specific hospital funding formula remains on the table, with the hopes that Rep. Bonnen and Rep. Faircloth can get it attached to a bill as a rider or amendment in the final days of the session.
In Article V related to Criminal Justice funding, we have engaged in a lengthy series of meetings and educational discussions related to the funding methodology and amounts for the Correctional Managed Health Care program. The long and short of it is that the Senate’s proposal to reduce funding by $140.8 million yields such a large loss to UTMB that we would not be able to remain the delivery agent for those services. In essence, UTMB would have to exit the contract or cut our academic and hospital programming to support the care of prisoners, which is unacceptable. Fortunately, the House and Senate differ on their view of this issue so there will be more discussion in Conference Committee.
The Senate did recognize the need for additional CMC infirmary beds to decompress the lengths of stay in TDCJ Hospital Galveston and placed $2 million in their proposed budget for that purpose. They also added $20.9 million to hire staff for the additional beds and provided another $37.9 million for market-level salary adjustments for CMC unit health care staff. The House deferred most of its items to Article XI for pending discussion, but it did place $1.5 million in the CMC budget to provide “take home” prescription medication for offenders upon parole or discharge. The House also placed $22 million in its proposed conference budget for repair and renovation to Hospital Galveston; the Senate did not mirror that action. In fact, the Senate declared that UTMB owns HG and therefore should be responsible for all repairs and renovations from the overall UTMB budget, prohibiting the use of any other state or TDCJ funds for that purpose.
As you can see, there is a lot for the conferees to discuss, resolve and meld into a budget. And, UTMB has a lot at risk over the next couple of weeks before sine die (end of session) on May 29.
The question now facing all at the capitol building is “will there be a special session?” Many legislators feel that they will be able to work out an acceptable budget that meets the expenditure amounts approved by the Comptroller by May 29 and that the Governor will sign the budget. Others are not so sure about the time frame. Stay tuned!