April 12, 2017

Texas Legislative Digest - Issue 14

Issue 14 – April 10, 2017

House Debates Budget
Senate Bill 1, this session’s budget bill, was considered by the full House on April 6. At press time, the debate had not concluded. More than 400 amendments were submitted and up for consideration.

Rep. Sergio Muñoz (D-Palmview), House Insurance committee vice-chair, and Rep. Richard Peña Raymond (D-Laredo), House Human Services committee chair, submitted amendments to modify the state’s Medicaid managed care program. Muñoz’s amendments would have required the Health and Human Services Commission (HHSC) to do the following:

  1. Seek input from participating providers before reducing funding or implementing cost containment measures in the Medicaid program
  2. Provide a report to the legislature on network adequacy requirement violations by managed care organizations (MCOs) for the previous five years
  3. Prepare a study on the number of single-case agreements between out-of-network providers and Medicaid MCOs during the previous five years. A single-case agreement is between a Medicaid MCO and an out-of-network provider to provide a covered service to a specific member
  4. Direct HHSC to conduct audits to verify the accuracy and reliability of program and financial information reported by Medicaid MCOs. Audits are used to certify the accuracy of information that determines MCO compliance with contract requirements
  5. Track funding to Medicaid MCOs to ensure compliance with contract provisions addressing provider payments

Raymond’s amendment directs HHSC to study potential cost savings in administering prescription drug programs under its purview.

Muñoz would also appropriate an additional $500 million to TRS-Care, the state’s retired teacher health benefit program, from amounts intended for border security. TRS-Care currently faces a $1.1 billion budget shortfall.

Three legislators — Rep. Four Price (R-Amarillo), Rep. J.D. Sheffield, M.D. (R-Gatesville), and Rep. Chris Turner (D-Arlington) — submitted amendments that would provide direction to HHSC should the agency make requests for federal flexibility to create a more efficient Medicaid program under a block grant.

Amendment authors hope their House colleagues will support their changes to the chamber’s proposed $218.2 billion two-year budget. Not every amendment filed will be brought up on the floor, but the debate was expected to continue late into the night. During the 2015 session, the budget bill was voted out of the House after 17 hours of discussion. The budget is the only bill the legislature is constitutionally required to pass.

Bills Heard in House Insurance
The House Insurance committee met on April 4 and considered several bills of interest to health plans:

The four bills were left pending and will likely be considered for a vote at the committee’s next meeting on April 11.

Risk Pool Bills Considered
House Bill 3226 by Rep. Phillips and Senate Bill 2087 by Sen. Kelly Hancock (R-North Richland Hills) were both heard in public hearings on April 4. Phillips and Hancock are chairs of the House Insurance committee and the Senate Business and Commerce committee, respectively. As part of this year's health reform efforts, legislation is pending at the federal level that would provide federal funding for state risk pools to cover individuals with high-cost medical conditions or provide for a state reinsurance program for the individual market.

Because the final form of the federal funding is unknown at this time, but might be available prior to the next legislative session, changes in state law under HB 3226 and SB 2087 would authorize the Texas Department of Insurance to create a temporary high-risk pool or state reinsurance program, and access the federal funds on an interim basis. Phillips also filed an amendment to the proposed budget bill that would provide some state funding for implementation if HB 3226 is passed. Texas previously had a high-risk pool, the Texas Health Insurance Pool, that was established in 1997 as a result of passage of the Health Insurance Portability and Accountability Act. In 2013, legislation was passed to dissolve the Pool because of changes in federal law that generally prohibited health plans from rejecting applicants with health conditions.

Bills of Interest


The filibuster has a long history in the U.S. Senate. In 1841, when the Democratic minority hoped to block a bank bill promoted by Kentucky Senator Henry Clay, he threatened to change Senate rules to allow the majority to close debate. Missouri Senator Thomas Hart Benton rebuked Clay for trying to stifle the Senate's right to unlimited debate. Three quarters of a century later, in 1917, senators adopted a rule, at the urging of President Woodrow Wilson, that allowed the Senate to end a debate with a two-thirds majority vote – a device known as "cloture."

The new Senate rule was first put to the test in 1919, when the Senate invoked cloture to end a filibuster against the Treaty of Versailles. Even with the new cloture rule, filibusters remained an effective means to block legislation since a two-thirds vote is difficult to obtain. Over the next five decades, the Senate occasionally tried to invoke cloture, but usually failed to gain the necessary two-thirds vote. In 1975, the Senate reduced the number of votes required for cloture from two-thirds to three-fifths, or 60 of the current one hundred senators. Only 51 votes are needed to change the Senate rules.

April 10 is the 91st day of the 85th Legislature with 49 days remaining until final adjournment. Important dates related to the legislative session are: