Senator Robert "Bob" Deuell, M.D.
The Texas State Senate
District 2

For Immediate Release
March 28, 2003

***CAPITOL UPDATE***

Issues Facing the 78th Legislature

(Austin) - Recently, the Senate Research Center (SRC) issued a document highlighting some of the issues my Senate colleagues and I will address this session. This article contains the Senate Research Center report on long-term care and organ dontation. Subsequent articles will focus on other issue areas that will be addressed by the legislature. If you would like to view the full document, you can read it on-line at www.senate.state.tx.us, or contact my office for a copy.

Long-Term Care

Decreasing revenues and rising Medicaid costs are placing an increased burden on the ability of states to provide long-term care services. Nursing home costs are one of the largest expenditures in the Texas Medicaid long-term care program. Texas policymakers may consider a variety of costcontainment options, including: revising income eligibility requirements for nursing homes to tighten admissions; imposing provider taxes; transforming reimbursement systems from cost-based methods to prospective payment systems; enhancing estate recovery and asset transfer recoupment from Medicaid beneficiaries; capping the enrollment of some waiver programs; placing limits on personal care services; reducing or freezing rate reimbursement for nursing homes; and capping longterm care per diem costs.

Texas has been engaged in a major long-term care planning process since 1999 to expand home and community-based services for people with disabilities. Although the state has an array of community services, there are long waiting lists for those services. The legislature may also consider personal attendant care options and other community supports, including housing and transportation issues. Finding ways to increase the numbers of direct care workers in long-term care and provide incentives to nursing homes, home care agencies, and other long-term care providers to recruit and retain these workers also remain issues of concern.

Organ Donation and Allocation

Efforts have been made to develop a more equitable organ allocation system and identify methods to increase organ donation. A TDH task force identified several defects in the current Texas organ allocation system. Patients in Texas lack access to donor organs due to the current geographic boundaries, the lack of uniform and consistent listing criteria used by the transplant centers to prioritize patients on waiting lists, the failure of hospitals to adhere to the required referral law, and the difficulty in matching donor organs with patients who have a higher probability of rejecting a donor organ.

The legislature may consider legislation to require TDH to assist organ procurement organizations (OPOs), hospitals, and medical communities to develop best practices relating to organ donation and procurement. Other potential issues include making first-person consent legally binding and revising the procedures by which terms of an anatomical gift may be amended or revoked. A variance that would allow statewide distribution of organs for individuals who are highly sensitized to rejecting an organ may also be considered.

To contact Sen. Deuell about the legislative process, contact the Capitol Office at (512) 463-0102 or mail to Sen. Bob Deuell, Texas Senate, P.O. Box 12068, Austin, TX 78711. The website for the Texas Senate is www.Senate.state.tx.us. The e-mail address for Sen. Deuell is: bob.deuell@senate.state.tx.us.

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