5 Things Texas: HCBS spending plan, Topical Agenda, Price transparency


Emily Boerger


It’s an odd time in COVID. Public opinion has turned gloomy, with Gallup reporting that more people are pessimistic about the future of COVID and getting the disease than are optimistic. That’s the first time since January that more folks are worried than hopeful.

Moreover, 1 in 3 vaccinated individuals are now “somewhat” or “very worried” about getting COVID. Thanks for hyping that 0.1% chance, media. Hope it was worth it.

Meanwhile 20% of unvaccinated individuals are “somewhat” or “very worried” about getting COVID. Maybe 80% of unvaccinated folks are a bit overconfident here. But, for those 20% that are worried, there is a vaccine. It will keep you from getting sick, and almost absolutely keep you out of the hospital. You’ll have less worry by getting it — trust me on this.





With help from Emily Boerger

1. HHSC submits HCBS spending plan

HHSC submitted its spending plan for home and community based services (HCBS) to CMS last month, taking advantage of ARPA’s 10% FMAP increase. Notable funding allocations include $181.41 million GF for provider retention, $30.8 million GF for adding capacity to various HCBS services to reach more Texans, and $5 million GF to transition all future 1915(c) waivers to managed care. (Sorry, I know that’s a lot of acronyms. Blame the game. Don’t blame the player.)

The commission also sought CMS’s clarification on several items including whether it’s allowed to claim enhanced FMAP funds for only a subset of eligible services, how the funding would be sustained, and whether the state can discontinue the enhanced support before the end of the pandemic. As of August 9th, CMS had clarified that states could accept the funding on a subset of services and addressed a budget neutrality question from HHSC, but has yet to clarify the commission’s other concerns and approve its proposal.


2. ICYMI: Topical Agenda now available

In case you missed it, we recently released the Topical Agenda for the 2021 North Texas State of Reform Health Policy Conference coming up on September 30th! It’s a set of topics pulled together from scores of hours of conversations with our Convening Panel, key stakeholders, and sponsors. We’ll be exploring politics and policy in health care, discussing the future of Medicaid in Texas, and diving deep into the changing nature of plan-provider relations, the impacts of COVID on our mental health, and the implications of health inequities.

Speakers and attendees will be able to choose either an in-person option, or a fully integrated virtual experience. And, you can change your mind at any time based on your comfort level.

You can view the Topical Agenda here for a sense of the conversations we have teed up, and if you have suggestions for speakers let us know. If you haven’t already registered, we’d be honored to have you join us!

3. Study: Texas hospitals noncompliant with price transparency rules

A recent nationwide study from PatientRightsAdvocate.org found 23 Texas hospitals – every surveyed hospital in the state – to be noncompliant with ACA price transparency rules. The study examined a random sample of 500 US hospitals to evaluate whether they met the federal rule’s two main requirements: to have a machine-readable standard charges list for all services and to have a charges list or price estimator tool for the 300 most common shoppable services.

In response to these findings, the Texas Hospital Association told State of Reform: “Texas hospitals have been subject to voluminous new requirements effective this year to disclose negotiated rates with payors both at the federal and state levels. Hospitals are working diligently to comply with these new laws as fast as possible, and some have made more progress than others.”


4. Vaccine mandates emerge as Delta variant fuels hospitalization surge

As the Delta variant spreads, Texas is experiencing its highest levels of COVID cases since February, with 11,491 new cases on August 9th alone. The state is averaging 8,877 daily hospitalizations, representing an over 100% increase over the last two weeks. The Dallas-Fort Worth area recently experienced an over 30% increase in hospital bed occupancy from COVID patients over a 30-day period, according to Steve Love, President and CEO of the DFW Hospital Council. Love also said these hospitals currently have some of their highest-ever levels of pediatric COVID patients.

In contrast to Gov. Abbott’s prohibition of government-mandated vaccine requirements, health systems like Houston Methodist, Baylor Scott & White Health, and other facilities in the state have implemented inoculation requirements for their employees. Texas nurses recently joined a national call for vaccine mandates for health workers.

5. Special session conflicts continue

As some House Democrats remain in DC to deny Republicans a quorum to pass their voting restrictions bill, Gov. Abbott announced a second special session on Saturday – following through on his promise to continue calling special sessions until his priority bills are passed. The Texas Supreme Court ruled on Tuesday that House Democrats could be arrested and taken back to the state if they refuse to return. Democrats are seeking a temporary injunction in a hearing on August 20th. The Texas Tribune reports that this delay could result in another uneventful special session.

In addition to legislation from his previous agenda that would restrict abortion-inducing drugs, Abbott’s expanded agenda for the new session includes the allocation of available ARPA funds. The governor is calling for lawmakers to direct the approximately $10.5 billion in unappropriated COVID relief funds into things like health care staffing needs, nursing home support, and vaccine administration.