87th
legislature
Improving access to mental health care remains a bipartisan brightspot during the 87th Legislature
The uncertainty surrounding the COVID-19 pandemic led to dire predictions that the 87th Legislative Session would usher in a biennium of budget cuts and austerity. However, a better-than-expected revenue projection meant less fiscal pain and, while the session featured a fair amount of political intrigue, the importance of mental health remained a fiercely bipartisan priority.
After the conclusion of the 87th Legislative Session, Governor Abbott called three special sessions. During the Third Called Special Session, the Texas Legislature again prioritized mental health, this time in key provisions of 87(3) SB 8, which allocated the nearly $16 billion overall American Rescue Plan Act (ARPA) federal funding awarded to Texas.
Ultimately, the Texas Legislature appropriated $8.85 billion to behavioral health across 25 state agencies, an increase of 34% over the previous biennium. Further, in a session that saw the total percentage of passed bills drop to only 15.5%, all of the bills identified as opportunities by the Meadows Institute were passed by the Legislature and went to Governor Greg Abbott’s desk to be signed into law.
Scaling Up The Texas Child Mental
Health Care Consortium
Created by the 86th Legislature, the Texas Child Mental Health Care Consortium (TCMHCC) spent its first year launching initiatives through 12 medical schools across the state, such as the Child Psychiatry Access Network (CPAN), which enables pediatricians and primary care providers to work with child psychiatry consultation hubs to reach effective treatment decisions, and the Texas Child Health Access Through Telemedicine (TCHATT), which gives schools critical access to health providers via telemedicine and telehealth to help meet the mental health needs of children and youth.
In total spending allocated in 2021, the Texas Legislature dedicated an increase of more than $132 million to TCMHCC, which further bolsters CPAN, TCHATT, and other key initiatives including research areas crucial to understanding mental illness and improving care.
Collaborative Care in Medicaid
The Collaborative Care Model (CoCM) integrates mental and physical health care under the supervision of a primary care provider (PCP) with an emphasis on early intervention and measuring outcomes. In CoCM, a patient is treated for mental illness at their PCP’s office, the same as any physical illness, with the PCP leading a team of professionals that includes a mental health specialist (either in person or working remotely) who carefully tracks each patient’s care. Utilizing measurement-based care ensures that patients are getting better and allows professionals to quickly identify any need to modify a treatment plan. CoCM means mental illnesses are identified and effectively treated far more rapidly than the current average wait of 8–10 years before a person gets help.
SB 672 (Buckingham) authorizes collaborative care reimbursement in Texas Medicaid, for both children and adults, to increase access to behavioral health services integrated into primary care. Since early intervention is more effective, this means substantial long-term cost savings as well.
SB 1
Senate bill (SB) 1 (Nelson)
increases TCMHCC’s funding by $19.5 million, which will maintain funding levels for CPAN, TCHATT, and other key initiatives, including research areas crucial to understanding mental illness and improving care.
SB 672
Senate bill (SB) 672 (Buckingham)
authorizes collaborative care reimbursement in Texas Medicaid, for both children and adults, to increase access to behavioral health services integrated into primary care. Since early intervention is more effective, it means substantial long-term cost savings as well.
HIGHLIGHTS FROM THE
STATE BUDGET, SB 1 (NELSON)
- Funds new beds created through Phase I of the State Hospital redesign, including 40 new beds at San Antonio State Hospital ($16.7 million), 70 new maximum-security unit beds at Kerrville State Hospital ($29.3 million), and the planned 2022 opening of a new inpatient facility in Houston, the John S. Dunn Behavioral Sciences Center ($40.3 million).
- Provides $30 million in funding over the biennium (fiscal years 2022–23) for increased community inpatient psychiatric bed capacity, evenly split between urban and rural areas.
- The supplemental budget, House Bill (HB) 2 (Bonnen), provides $321.3 million from the Economic Stabilization Fund for Phase III of the system redesign, including $276.5 million to finish the new Austin State Hospital and San Antonio State Hospital, and $44.75 million to begin planning efforts and acquire land for a new state hospital in Dallas.
- Fully funds—at $145 million for the biennium—four key mental health grant programs: Mental Health Grant Program for Justice-Involved Individuals, Community Mental Health Grant Program, Texas Veterans + Family Alliance, and Healthy Community Collaborative.
- Fully funds Phase I and Phase II requests for the ongoing statewide shift to Community-Based Care for children and youth in the foster care system ($41.8 million).
- Maintains the School Safety Allotment for fiscal years 2022–23 at $9.72 per student in average daily attendance ($100 million).
- Funds the Judicial Commission on Mental Health at $2.5 million for the biennium.
- Provides $2 million to establish new front-end Multisystemic Therapy (MST) teams in Harris County (Harris Center) and El Paso County (Emergence Health Network) to prevent youth from entering the juvenile justice and child welfare systems.
OTHER INITIATIVES
- SB 64 (Nelson) establishes the Texas First Responder Peer Network, helping to connect law enforcement officers with their peers to address mental health issues they can commonly develop during a career in law enforcement. SB 1 provides $1.05 million in funding for the network.
- HB 4 (Price) makes permanent flexibilities put in place during the COVID-19 crisis related to telemedicine and telehealth, including Medicaid reimbursement for some services delivered by telehealth or telephone (audio only). This means easier access to mental health care for Texans, particularly in rural and other underserved areas.
- HB 5 (Ashby) establishes a Broadband Development Office within the Comptroller’s Office charged with creating a state broadband plan and a development program to incentivize the expansion of high-speed internet. This is critical to leveraging telemedicine and telehealth access for remote and underserved areas.
- SB 49 (Zaffirini) enacts a series of recommendations from the Judicial Commission on Mental Health, including rules requiring inmate access to prescription medication that is determined necessary by a health professional for the care, treatment, or stabilization of mental illness.
- HB 133 (Rose) extends Medicaid coverage to new mothers from 2 months to 6 months post-delivery, expanding access to treatment for postpartum depression and other mental health concerns.
- HB 2595 (Price) requires the Texas Department of Insurance to develop and maintain a parity complaint portal that allows for Texans to report suspected parity violations.
Among the other funding distributed in special sessions was $237.8 million to the Health and Human Services Commission (HHSC) to construct a new state psychiatric hospital in Dallas, $15 million to HHSC to expand capacity at Sunrise Canyon Hospital in Lubbock, and $40 million to the Texas Facilities Commission to construct a 100-bed comprehensive behavioral health center to serve the Permian Basin.
