TEXAS RURAL HEALTH ASSOCIATION
Legislative Agenda for the 82nd Regular Session

1) Budget Cuts
• Medicaid payment cuts – Rural health providers experience higher levels of Medicaid than urban providers. As Medicaid tends to pay less than other coverage – such as Medicare and private insurance - any further reductions in Medicaid payments will strain rural providers. A certain repercussion is decreased rural services or less providers accepting Medicaid leaving many rural Texans without health care access.
• Continue TDRA - The Texas Department of Rural Affairs must remain a stand alone central point of contact agency for Texas rural issues. Moving it into another agency will not result in budget savings and will force its programs to be lost within a huge state agency.
• Restore loan repayment programs - Many health care worker loan repayment assistance programs are zeroed out in the proposed state budget. These programs are critical to recruitment and retention in rural areas. Without them, rural Texas will fall further behind in health care access.

2) Rural Health Care Workforce Development
• Fully fund state rural health care support programs – This includes full appropriation to the State Office of Rural Health at the Texas Department of Rural Affairs (TDRA) and state funding of the three (3) Texas Area Health Education Centers (AHEC).
• Allow physicians the option to be employed by rural hospitals - Current Texas state law prohibits hospitals from employing physicians, even when physicians request to be employed. Allowing rural hospitals to employ physicians is critical to recruitment and access to health care because it provides greater flexibility during the recruitment process.
• Expand capacity for nursing and allied health schools, faculty and programs – Despite efforts by the Legislature, a shortage is continuing in Texas and is projected to last for some time.
• Expand capacity to train mid-level practitioners and create more rural physician primary care residency slots and provide funding to support oral and mental health provider staffing for rural areas – Texas must increase the number of students in education and training programs that include rotations and residencies in rural settings.

3) Rural Health Care Programs
• Medicaid managed care to have negative impact in rural areas – The planned expansion of HMO type managed care Medicaid into rural areas will force rural providers, already dealing with higher levels of uninsured patients, to negotiate for their payments from HMOs rather than receive standard rates. This often results in providers choosing between taking a lesser payment or declining Medicaid patients all together. The savings from the managed care system is negligible in rural areas. Traditional Medicaid should be maintained in rural areas.
• Direct access to physical therapy services – In Texas, a person must first be referred from a physician or similar provider to access physical therapy services. However, they may directly access a chiropractor, podiatrist, massage therapist, or personal trainer. Physical therapy services are limited in rural Texas and removing referral requirements could enhance access.

4) Rural Health Care Infrastructure
• Develop a fund for Hospital Facility Replacement in tax poor counties - Many Texas rural hospitals were built more than 40 years ago with federal Hill-Burton Act funds and are now outdated, inefficient and often out of compliance with new fire and building codes. A number of these hospitals are located in counties with very low tax bases, meaning there are not adequate local tax revenues to replace the facility. A new fund should be established by the state to assist rural communities with replacing outdated hospitals (similar to the courthouse preservation fund) and/or to support the development and construction of facilities appropriate to those communities in need.
• Outsourced services weakening rural health infrastructure - Many Texas health insurance companies are increasingly outsourcing to off-site facilities for services such as laboratory tests and pathology work when the same services are also offered by the community hospitals and other providers where the patient receives care. Such outsourcing saves little in many cases but adds to the health care system complexity for patients, drains rural hospitals of revenue, and weakens the rural health care infrastructure. Third party health insurance payers should be required to contract with local health care providers for ancillary services unless it can be demonstrated that it adds substantial cost.

The Texas Legislature Online website provides you with valuable information about the legislative process. Find who represents you, the status of a specific bill, what bills are scheduled for debate in the house, and send an email to your representative. Visit http://www.capitol.state.tx.us