Practice Tip of the Week: State Health Policy—What’s the Interim got to do with it?
Tuesday, August 27, 2019
Posted by: Kanaka Sathasivan
By: Ellen Martin, PhD, RN, CPHQ
Director of Practice, Texas Nurses Association
Every odd-numbered year, the Texas Legislature convenes for a 140-day regular legislative session. Because the session is a flurry of activity, it is easy to forget about all the work that is done between sessions, called the interim, during the even-numbered years. The Speaker of the House and Lieutenant Governor task the committees of their respective chambers with studying a variety of issues of priority and public interest.
These tasks, termed “interim charges,” give a clue to which issues will be important for that committee in the next session. Advocacy organizations take the opportunity to educate the legislators on issues and submit recommendations for interim charges. For example, the Texas Public Health Coalition recommends the House Public Health Committee monitor implementation of House Bill 1848 related to communicable diseases in long-term care facilities.
Once interim charges are issued, the committee then examines the issue in accordance with their charge and writes a report, all of which are archived. The charges can be quite lengthy, and sometimes involve a joint charge between two committees. For example, the 85th legislative charges included a joint charge to the House Committee on Human Services and House Committee on Public Health, directing them to:
Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian's substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Public Health)
Nurses who followed the 86th legislative session will recognize that children with mental illness was a one of many legislative priorities. The House Committee on Public Health Interim Report, published in December 2018, informed legislators on key issues in advance of the 86th legislative session.
Each interim report includes an executive summary which summarizes the findings on an issue. For example, the charge above was summarized in the report as:
Regarding Charge 6, related to the prevalence of children involved with Child Protective Services (CPS) due to the child having a mental illness and/or a substance use disorder or due to the child's guardian having a substance abuse disorder or an untreated mental illness, the Department of Family Protective Services (DFPS) reports that risk factors such as substance abuse, mental health concerns, and domestic violence are common factors in confirmed child abuse and neglect fatalities. Efforts by the state emphasize family preservation programs, including specialty courts and family-based services.
The full report includes detailed information on each charge with background on the issue, statistics, challenges and recommendations.
Sometimes nurses ask how they can get involved in an issue they care about. The first step is to know who else is working on that issue and what efforts are already underway. These interim reports provide a window into who is involved with an issue because the report includes a summary of the hearing and who was invited to testify (recognized state leaders on the issue) and the public is also invited to comment. All witnesses who testified are listed in the interim report, providing a starting place for the nurse to make connections.
For example, in summer 2018, an opportunity arose for nursing to give input on House Public Health Committee Charge 5 related to population health and care delivery in rural and underserved areas, telemedicine and rural hospital challenges. Certified Nurse Midwife Erin Biscone (D9) provided public testimony at the hearing on June 28, 2018, speaking on improving access to care through full practice authority for APRNs. Archived video of the interim committee hearings are available online. (Erin’s testimony starts at 4:25.)
The report and video archives can provide a valuable historical perspective on an issue.
We expect interim charges to be issued in the next few months and will share the charges of interest to nursing at that time. Meanwhile, which issues spark your passion for policy? Let us know in the comments below!