88th Legislative Session Summary

The Texas Association for Home Care & Hospice set out with a bold and ambitious agenda for
the 88th Legislative Session, setting course and laying the groundwork to change the state of
home care and hospice in Texas. Our policy committees worked tirelessly to develop the
agendas and strategies that included budget and policy asks to address workforce shortages
through increased funding, minimize recruitment and retention barriers, expand opportunities for
providers with innovative programs, prevent obstacles on unfunded mandates, and ensure an
infrastructure to support the industry.

TAHC&H began the session hyperfocused on educating legislators and staff on the funding
structure of the payment rates for community care, private duty nursing, and pediatric therapy.
Well known to the industry, payment rates are complicated and require a deep level of
understanding in order to address the longstanding issues facing providers and their ability to
provide care and remain competitive in the labor market. TAHC&H developed a strategy to:

● Increase Medicaid reimbursement rates for attendant care
● Increase Private Duty Nursing rates to ensure access to quality care
● Increase Medicaid Pediatric Therapy rates to ensure access to medically necessary

TAHC&H members traveled from across the state each time to provide valuable testimony in
Senate Finance and House Appropriations hearings on days when hundreds of people signed
up to testify and shared multiple hours of testimony. TAHC&H members provided first hand
insight on their experiences attempting to recruit and retain community care attendants, nurses,
and therapists in the wake of the challenges of the public health emergency. Members testified
about their challenges hiring and retaining staff and their inability to meet the essential staffing
needs of the medically fragile children in our state. Members detailed how providers are dealing
with increased staff turnover, including losing professionals who leave the workforce due to
burnout, while the acuity of the children we serve in the home has gone up substantially.
Members shared the challenges in the continual battle of doing more with less and the limits in
serving only half of the hours clients need.

As the budget moved through the legislative process, we were grateful to Rep. Donna Howard
for carrying our riders to increase service supports, attendant rate enhancement and private
duty nursing, and to Rep. Steve Allison for carrying our rider for rate increases for pediatric
therapy. We were encouraged by the House’s recognition of the struggle of home care
providers and were pleased to see the adoption of an increase to the administrative portion and
rate enhancement adopted into Article II of the Budget. The rider for pediatric therapy was
adopted to Article XI for potential consideration later in the process. This recognition was a huge
win and will allow us to continue to build and develop champions for home health in the House.
On the Senate side, Sen. Perry was a tremendous champion for our cause and filed riders to
increase community care attendant wages and for private duty nursing, and Sen. Zaffirini filed
the rider for pediatric therapy. We were anxious that these riders were not adopted on the
Senate side, but as the Article II Committee reviewed and assessed the budget, they took a
different approach and adopted a base wage at $11/hour for community care before going into
negotiations in conference.

In our efforts to bring together the propositions of each Chamber, TAHC&H advocated to
continue with a holistic approach to adopt recommendations from the House and Senate to get
as close to an average rate of $15/hr., adopt rate increases for private duty nursing, and
pediatric therapy. On the second to last Monday before the end of session, the budget
committees held a hearing to lay out the investments made in home care for the 88th Legislative
Session. The conference committee landed on $10.60/hr. base rate, and even though an
increase in support services was not included, this is a huge increase to the base rate. This
advancement demonstrates that our hard work was acknowledged and lays the groundwork for
further education of the legislature on the need for additional investments in rate enhancement
and service support.

Private duty nursing received an $18 million investment, but unfortunately, no provisions were
made for add-ons for weekend or holiday shifts. Disappointingly, there were no increases
included for therapy services in the budget this session. We will continue to work on the data,
education, and strategic plan needed to ensure a robust and quality network of therapy
agencies are available to serve children with special needs.
But as we reflect on receiving less than what we hoped for, what we sought, and what providers
deserve - we are still proud of all the progress made this session! Looking back on the 87th
Legislative Session, home care providers were not included in the budget at all, and yet we
fight, we continue to pursue the rate increases necessary to ensure access to care for those
most in need of our services. In total, legislators made an investment of nearly $2 billion ($800
million GR) in community care, and these steps forward keep us advancing. We are forging a
path forward to ensure older adults, people with disabilities, and children with complex medical
needs have the option to remain in their homes and receive the care they deserve - no matter
how incremental the progress may feel at times.

Community Care Advisory Committee and Strategic Plan
HB 1798 by Rep. Donna Howard and SB 663 by Sen. Charles Perry
In order to address the long standing problem of inadequate community care funding that
has a direct impact on workforce and client access to care, TAHC&H advocated for legislation to
require HHSC to create a viable and sustainable payment methodology. Rep. Donna Howard
filed HB 1798 and Sen. Charles Perry filed SB 663 to require HHSC to create a home and
community-based services payment advisory committee, and to develop and implement a
strategic plan to ensure network adequacy to fully capture cost-savings of community-based
programs. Previous examples such as the Hospital Payment Advisory Committee, as well as
the Nursing Home Payment Advisory Committee, have both proven their value in obtaining
industry engagement in solutions to complex issues surrounding payments.
HB 1798 was heard in the House Human Services Committee in early April with several
TAHC&H members traveling to the Capitol to register their support for the bill, and Jessica
Boston, Director of Government Affairs, provided testimony. The bill had momentum coming out
of the House after being voted out of the Human Services Committee and referred to the Local
and Consent Calendar reserved for those bills receiving unanimous consent. HB 1798 made it
to the Senate and was referred to the Senate Health and Human Services Committee, but ran
out of time to be heard before the last day of hearings. TAHC&H staff and the lobby team
worked diligently to draft amendments to attach the Advisory Committee section to another bill
that was likely to pass, but unfortunately, this bill ran out of time to pass. We will continue to
explore options to evaluate the rate structure and will seek opportunities over the interim for
further study.

Certified Health Aide Program
HB 3807 by Rep. Stephanie Klick and SB 1715 by Sen. Charles Perry
The COVID-19 pandemic accelerated a nationwide nursing shortage, impacting access to care
for medically fragile children and their families. As demand for nurses continues to outpace
supply, the ongoing needs of Texas children will no longer be able to be met at home, instead
forcing them into hospitals for routine care and leaving parents without a choice but to leave the
workforce. In order to Texas families have consistent care for their children without the
emotional and financial toll of an unnecessary hospital stay, Rep. Stephanie Klick and Sen.
Charles Perry filed HB 3807 and SB 1715 to create the Certified Health Aide (CHA) program to
ensure safe and continuous home care for vulnerable children, avoiding unnecessary hospital
stays and resulting in cost savings for the state. The CHA program would allow trusted and
willing adults to be trained as an alternative caregiver, in order to allow medically fragile children
to remain at home. Tasks delegated to CHAs may include G-Tube feeding, bathing and other
personal care, taking blood pressure and other vital signs, and medication administration -
which many families already do without any compensation or even foregoing employment in
order to provide this level of care.

TAHC&H is grateful to Chairman Frank for his support in hearing the legislation most important
to home care in the Human Services Committee. As association members came to the Capitol
to register their support, Pediatric Committee Chair Bill Sczepanski provided testimony
explaining that, “the nursing shortage has just gotten worse and worse. It used to be where it
was hard to find nurses for these children. Now, it’s impossible.” Members of the Human
Services Committee recognized the importance of additional options for families and voted HB
3807 out of committee with unanimous support. As the end of session deadlines quickly
approached, HB 3807 was placed on the General State Calendar for a vote, but was not heard
in time and died in the House.

EVV Technical Correction
HB 4627 by Rep. Stephanie Klick
Due to the continuous challenges of Electronic Visits Verification (EVV), TAHC&H made a vital
addition to the TAHC&H legislative agenda after the session began through legislation to seek a
technical correction to EVV. We were grateful to Chair Klick for filing this legislation to allow
providers to achieve a true open model system for EVV, increasing efficiency for the state and
flexibility for providers. HB 4627 would correct language that adds additional administrative
burdens and restricts HHSC’s ability to implement a true open model system. As providers have
experienced, language in the current EVV rule causes extraneous administrative processes for
HHSC to work with systems that are not directly contracted with the state. This revision would
allow HHSC to approve all EVV vendors who meet the set qualifications and maintain oversight,
increasing standardization and reliability. The update would give agencies a choice from several
vendors who are already approved and greatly reduce time for the approval and implementation
process for providers.

Despite the late addition of this legislation to the TAHC&H agenda, HB 4627 was heard in the
Human Services Committee in early April. With TAHC&H members continuing their march on
the Capitol educating legislators on the importance of this legislation, the bill was voted out of
the Human Services Committee and referred to the Local and Consent Calendar and was
passed out of the House with unanimous support. The bill was referred to the Senate Health
and Human Services Committee but did not receive a hearing in time before the deadline. The
TAHC&H lobby team and staff drafted several versions of the legislation as amendments and
sought to amend the changes to another bill, but ran out of time before the session ended.
TAHC&H will continue to meet with HHSC on this important topic throughout the interim as
rollout proceeds.

TAHC&H Advocacy in Action
Lobby Days (advocacy days, joint advocacy day, advocacy alerts)
Our progres would not be possible without the incredible dedication of TAHC&H members
volunteering their time and lending their voices to our advocacy efforts this session. With your
support, we were able to host multiple Advocacy Days, an inaugural Joint Advocacy Day with
fellow stakeholders, and sounded the alarm through Action Alerts all session long.
In February, we were proud to host over 150 TAHC&H members for our TAHC&H Lobby Day at
the Capitol and had 34 meetings with legislators and legislative staff during our visit. Kicking off
the legislative session with this level of engagement from our members set the course for a
successful and highly visible session for home care. The relationships we built were essential to
ensuring our success this session and for many sessions to come. We continued the
momentum with several TAHC&H Board of Director Members and TAHC&H Policy Committee
Chairs regularly visiting the Capitol to help with office visits and to help amplify the message and
necessity of home care in Texas.

We also hosted a Joint Advocacy Briefing to bring together our fellow stakeholders and
demonstrate a united front on rate increases for community care attendants. With several
legislative offices in attendance, we were grateful for their interest and support of the fight

For those who were unable to travel to Austin, we were so grateful for your participation in all
the calls to action. Whether it was submitting written testimony during hearings, calling your
Representatives and Senators, or participating in our Action Alerts - your engagement is what
makes TAHC&H strong and successful during the session. Thank you for taking the time, we
know you are overextended running your business, but participating as constituents and
advocates moved the needle more than ever before this session.

Passed Legislation Impacting Home Care and Hospice
We were grateful to our legislative champions who raised the profile of home care and hospice
by filing legislation that created good policy and brought the spotlight to the work you do. We
appreciate every time home care and hospice are recognized and elevate your role in the health
care continuum. Additionally, several bills passed that we want to share as they will have an
impact on how you do business. As we look forward to the interim, TAHC&H will continue to
track these policy updates and weigh in on the rulemaking process to follow to implement these

HB 44 - Prohibits discrimination based on immunization status
This bill would require providers who participate in Medicaid or CHIP or are part of an MCO to
provide health care services regardless of an enrollee's vaccination status. In the event a
provider refuses treatment, HHSC would be required to withhold provider reimbursement for
services and disenroll the provider.

HB 1009 - Criminal History Checks
Requires HHSC to review state and federal criminal history record information and to obtain
electronic updates from DPS of arrests and convictions for each residential caregiver who holds
a license. Caregivers convicted of an offense may not provide direct care to an individual with
IDD. HHSC is required to disenroll a caregiver from Medicaid convicted of an offense.
Reportable conduct to include CDS and also includes more stringent requirements for
residential care which would include DBMD providers.

HB 2727 - Home Telemonitoring Services under Medicaid.
Amends the definition of “home telemonitoring service” to include remote health data monitoring
provided by rural health clinics and federally qualified health centers. Home telemonitoring
services would be eligible for Medicaid reimbursement if the service was determined to be
clinically effective, rather than cost-effective and feasible.

HB 4696 - New Reporting Requirements for ANE
Requires HCSSAs to report abuse, exploitation, or neglect by an employee to HHSC, including
pediatric extended care centers, requiring an unannounced investigation and photographic

SB 25 – Nursing Education Investments
SB 25 sought to rapidly increase the number of nursing graduates by targeting bottlenecks in
the education pipeline and directing funds to alleviate those bottlenecks.This bill was a top
priority due to the significant nursing shortage in Texas. It creates a new scholarship program
for nursing students (funded at $25M), expands the Nursing Faculty Loan Repayment
Assistance Program (NFLRP) to include part-time faculty, grants the Texas Higher Education
Coordinating Board the authority to increase the award amount via rulemaking, and extends the
Nursing Innovation Grant Program (NIGP) to 2027. This bill is also supported by funding for the
Professional Nursing Shortage Reduction Program (NSRP).

SB 29 - Prohibits Vaccine Mandates
Prohibits the possibility of certain local governments from implementing COVID-19 policies like
mask mandates, vaccine mandates, and mandates to close businesses or schools.

SB 240 - Workplace Violence Prevention
This bill would require facilities to create a workplace violence prevention committee to develop
a workplace violence prevention plan, policies, and reporting and response services. SB 240
establishes a comprehensive, statewide approach to preventing workplace violence against
healthcare workers. It is the product of years of advocacy and received bipartisan support
throughout the legislative process. It was one of the first bills sent to the Governor’s desk this
session. When responding to incidents of workplace violence, a facility must offer immediate
post-incident services, including any necessary acute medical treatment for each health care
provider or employee of the facility who was directly involved in the incident. This law is further
complemented by the Workplace Violence Prevention Grant Program, which helps fund
innovative approaches to preventing workplace violence, and law enforcement agencies
throughout the state who can enforce laws against assaulting health care workers.

SB 485 and SB 739

These bills designate the second Saturday in October as Hospice and Palliative Care Day, and designate October 10 as Supportive Palliative Care Awareness Day. We are grateful to Sen. Nathan Johnson for the recognition and celebration of the industry, and appreciate his advocacy as a champion for hospice. Unfortunately, SB 485 was vetoed by Gov. Abbott on June 16, 2023, however, we will continue to work with Sen. Johnson to raise awareness for hospice services and providers.