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Legislative Update from the
Children’s Hospital Association of Texas (CHAT)

The 85th Texas Legislative Session began on January 10, and legislators are likely to address many issues that directly affect health care for Texas children. CHAT encourages your active engagement in and support of these issues.  Additionally, both the federal and state governments are discussing extensive reform of the Medicaid program. 

Over three million Texas children are enrolled in Medicaid, which provides coverage for basic preventive services as well as for highly specialized care for children with complex medical conditions. Children with access to Medicaid are more likely to attend school, graduate from high school, and go to college, becoming healthier adults who will earn higher wages and pay more in taxes than children who do not have appropriate health care. 
 
Topics of particular interest include improvements to medical care for children in state conservatorship, appropriate funding for health care services for children, and ensuring that Medicaid continues to provide developmentally and age-appropriate care for children to ensure that they become healthy and productive adults.

Children in Foster Care
Need Improved Medical Care

As legislators look at plans to overhaul the Texas foster care system, CHAT is advocating for two main changes:

  • A required initial health screening exam within 72 hours of a child entering foster care.
Currently the earliest that most children entering foster care in Texas must be seen by a physician is within 30 days. During this month, any number of physical, developmental, and mental health conditions may go undiagnosed or unaddressed, resulting in poorer outcomes for children as well as inappropriate, delayed or disrupted foster care placement.

It has also been reported that foster care children receive this initial exam within the first 30 days only about half of the time. Receiving this initial screening exam will make placements more successful because foster parents will receive information about the child and will have a medical home for that child.  Screening will also identify issues that are not readily apparent that specialists who treat abused and neglected children can identify and treat.
  • A state-funded Child Protective Services (CPS) worker to be placed in children’s hospitals and/or specialty foster care clinics to avoid placement disruptions and lengthy hospital stays beyond days that are medically necessary. 

Placing CPS workers in children’s hospitals and clinics that provide a comprehensive array of services designed for children in foster care will avoid unnecessary days in the hospital and help ensure proper placement of children. A CPS worker in the hospital could reduce hospital stays (which helps reduce overall costs), reduce disrupted placements and ensure more in-home support is provided.

Pay Hospitals Appropriately for
Providing Outpatient Services


CHAT supports an increase in outpatient hospital reimbursement rates. Outpatient services are medical procedures or tests that can be done in a medical center without an overnight stay. Not all medical services could or should be provided in an outpatient setting; however, many medical services are properly delivered in an outpatient setting. 
 
More than 2 million outpatient visits occurred at CHAT member hospitals in 2014. Medicaid reimburses hospitals only part of what it costs them to provide these services – between 70% and 76% of allowable costs. Children’s hospitals incur substantial Medicaid shortfalls because of low Medicaid payment rates for outpatient services.

A recent survey of CHAT member hospitals indicated a total annual loss of $58 million in Medicaid-allowable costs that were not reimbursed. Hospitals could provide more outpatient capacity if appropriately reimbursed for these services.
 
Why Outpatient Services Are Important
  • Outpatient services are:
    • Often closer to people’s homes, meaning less time away from work or school to receive services; and
    • Provided at a lower cost than inpatient services.
  • Using outpatient services:
    • Ensures capacity in the inpatient setting for those who need that level of care; and
    • Meets the triple aim of the Institute for Healthcare Improvement to (1) improve patient experience of care (including quality and satisfaction); (2) improve the health of populations, and (3) reduce the per capita cost of health care. 
While some services will always be delivered appropriately in an inpatient setting and some patients may need that level of care, the current reimbursement system is a disincentive for providing outpatient services when appropriate.
 
The state should increase the amount of outpatient reimbursement in Medicaid to incentivize additional appropriate use of outpatient services.

You Can Help!


There is strength in numbers! We will keep you informed about these important issues during the legislative session. You may be asked to contact your legislators before key votes.
 
You can also help spread the word to your co-workers, colleagues, and other business and personal contacts. Educate them about children’s health care issues and encourage them to get involved.
 
You CAN make a difference!
 
If this newsletter has been forwarded to you and you would like to receive additional newsletters, please visit our website and sign up at the bottom of the home page. 

Children’s Health Care Issues in the News


Click on the following links to learn more about some of the issues impacting children’s health care in Texas.
 
“What Led to the ‘Broken’ Foster Care System in Texas”
 
“Texas Lawmakers Fired Up About State CPS and Foster Care Woes”
 
“Judge in Foster Care Case Pushes Texas for Swift Improvements, Demands More Information
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