MEETING SUMMARY JANUARY 30 THROUGH FEBRUARY 10, 2017
 
Aging Texas Well Advisory Committee met on February 1, 2017.  The Health and Human Services Commission (HHSC) presented on Veteran Services in Texas. 
 
Medicaid Managed Care Advisory Committee met on February 8, 2017.  The committee heard from HHSC staff on transformation, network adequacy, Center for Medicare Medicaid Services rule changes and value based quality improvement.
 
The Palliative Care Interdisciplinary Advisory Committee met on February 9, 2017.   Senate Bill 512 and House Bill 995- relating to the form and revocations of medical powers of attorney and  the Sunset Commission Report on the Texas State Board of Pharmacy recommendation that physicians and physician assistants research the prescription drug monitoring program when opioids are prescribed.
 
 “OBESITY IS A STRONG PREDICTOR OF NON-HOSPICE USE AT THE END OF LIFE
 
The heavier individuals are, the less likely they are to experience hospice care and have the chance to die at home. Researchers at the University of Michigan (UM) are drawing this conclusion after an in-depth analysis of medical records from more than 5,600 seniors who took part in a long-term study. This research points to the fact that many obese seniors are experiencing worse health outcomes than do their peers, and this disparity comes with both a human and a financial cost.
 
UM researchers examined how an individual’s body mass index (BMI) correlated with the end-of-life care that they received. Not only did they find a lower usage of hospice among those with higher BMI, but they also found that those obese seniors who did receive hospice care spent on average fewer days in hospice care than those with a lower BMI.
 
About 60% of those studied died at home, but this proportion shrank as BMI rose. Instead, heavier seniors faced a higher likelihood of death in a hospital setting. They also tended to receive care in their last six months of life that was costlier than average.
 
This study did not look at the reason that obesity is correlated with lower use of hospice care. However, senior author Jennifer Griggs, MD, MPH, professor of public health at the UM Medical School, suggests some possible answers.
 
“For hospice teams, as for hospital and home-health teams, it can require more staff to take care of people who are obese, but Medicare hospice reimbursement is capped no matter what a person’s BMI,” she says. “Also, obesity may mask the signposts and changes that physicians might use to determine when it is time for a person to enter hospice.”
 
Griggs notes that the marked, unhealthy weight loss typically associated with active dying may be easier to notice on individuals with a lower BMI. Previous studies “have shown a general bias against people with obesity among healthcare professionals, especially physicians.” This bias may play a role in the differing health outcomes experienced by obese individuals.
 
Significantly, Griggs points out that obesity is not even mentioned as a barrier to high-quality care in “Dying in America,” a landmark Institute of Medicine report from 2014. These latest findings point to the need for a reevaluation of how individuals with more severe levels of obesity are cared for. “These patients voices, and those of their caregivers, need to be heard,” says John Harris, MD, who led the study during a fellowship at UM and is now an assistant professor at the University of Pittsburgh School of Medicine. “They may need extra help. They deserve the best healthcare and better health outcomes.”
 
Harris says the study’s findings point to an issue that is only going to become more urgent as the increasingly overweight and obese American public ages. “Many policies focus on preventing or reducing obesity in the US, but we will also need policies to encourage the provision of high-quality care for people with obesity,” he says. “More attention should be paid to payment structures that recognize the challenges involved with healthcare for men and women with obesity.” (Health Day, 2/6, consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/terminally-ill-obese-people-less-likely-to-get-hospice-care-719392.html; Medpage Today, 2/6, www.medpagetoday.com/PrimaryCare/Obesity/62932?xid=nl_mpt_DHE_2017-02-07; Science Daily, 2/7, www.sciencedaily.com/releases/2017/02/170207110908.htm)
 
 
HUMOR LOWERS STRESS AT END OF LIFE
 
For some families, the dying process can be an occasion for laughter as well as tears. “The process of dying comes with less stress when it’s something of a laughing matter,” writes Bruce Horovitz for Kaiser Health News. Dying individuals and their families can benefit from “a willingness to occasionally make light of the peculiarities – if not absurdities – that often go hand-in-hand with end-of-life situations.”
 
For an aging generation of Boomers who grew up with a steady background of laugh tracks on TV, humor might just be what the doctor ordered. “Laughter is the best medicine,” says Mary Kay Morrison, president for the Association of Applied and Therapeutic Humor, “unless you have diarrhea.” Humor can be particularly important for people nearing the end of life. “While death cannot be cured, your frame of mind is something you can change.”
 
Morrison’s group has a set of loose guidelines around the use of humor with dying people. Above all, it’s crucial that you make sure you know the dying person well enough before you use humor with them.
 
The National Cancer Institute encourages patients to build humor into their daily lives. This can happen in small ways, like buying a funny desk calendar or watching comics and TV shows. “The right humor at the right time, she says, can infuse the brain with pleasurable hits of the stimulant Dopamine, decrease muscle tension and anxiety in the body’s nervous system, and momentarily diminish feelings of anger or sadness.”
 
Hospice workers typically hear more morbid jokes than almost anyone. Allen Klein recalls volunteering at a hospice in the San Francisco Bay area, when an elderly woman told him one of her end-of-life wishes: She wanted to be cremated, and have her ashes mixed into paint and used to paint her husband’s bedroom. “Why would you want that?” Klein asked. “So I can look down at my husband and see if there’s any hanky-panky going on.” (Kaiser Health News, 2/6, khn.org/news/laughing-until-you-die/)
 
HOSPICE AND END-OF-LIFE NOTES
 

• The National Academy of Medicine published a guiding framework for patient and family engaged care. “This vision represents a shift in the traditional role patients and families have historically played in their own health care teams, as well as in ongoing quality improvement and care delivery efforts.” The full report is available online. (NAM, 1/31, nam.edu/wp-content/uploads/2017/01/Harnessing-Evidence-and-Experience-to-Change-Culture-A-Guiding-Framework-for-Patient-and-Family-Engaged-Care.pdf)

• A new $43 million residential hospice center in Dallas, the T. Boone Pickens Hospice and Palliative Care Center, aims to “feel like home.” “The facility includes a total of 36 spacious rooms that have en suite bathrooms, fold-out beds for guests and an office space for caregivers. A patio in each room faces out toward a 2.5-acre on-site lake, where winding pathways and lounge spaces ensure visitors won’t be confined to a room.” The link below leads to the article and a video about the center, which opens on 2/15. (Dallas News, 2/7, www.dallasnews.com/business/health-care/2017/02/07/dallas-boone-pickens-hospice-care-center-feel-like-home)

• Seriously ill undocumented immigrants face unique health care challenges in the United States – including a lack of access to hospice care. “‘Although hospice services have previously been shown to improve costs and quality of care at the end of life, undocumented immigrants may have difficulty accessing hospice, particularly in areas served predominately by smaller, for-profit hospices,’ said Dr. Nathan A. Gray from Duke University in Durham, North Carolina, who worked on the survey.” (JAMA Network, 2/6, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601077; Medscape, 2/8, www.medscape.com/viewarticle/875482)

• When physicians determine that CPR will not be helpful, but their surrogate insists that doctors perform CPR, what should happen? “Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations.” A Hastings Center Report examines this difficult issue. (Hastings Center Report, 1/11, onlinelibrary.wiley.com/doi/10.1002/hast.664/full)

• What comes after death? Could it be more beautiful than we can even imagine? Physician Edwin Leap describes Alfred, a 95-year-old man who is ready to take that journey. (KevinMD, 2/4, www.kevinmd.com/blog/2017/02/man-halfway-worlds.html)

• “Immortality is overrated,” says John Schumann, MD, reporting for NPR. “The message is simple: Think deeply about what you want beforehand. Then tell your family. Share it with your doctor. We truly want to honor your wishes.” (NPR, 2/4, www.npr.org/sections/health-shots/2017/02/04/513110234/why-immortality-is-overrated)

• Just as doctors begin to bill for advance care planning conversations, the specter of “death panels” reemerges on the political scene. “Rep. Steve King, R-Iowa, introduced a bill last month, the Protecting Life Until Natural Death Act, which would revoke Medicare reimbursement for the sessions, which he called ‘yet another life-devaluing policy.’” King’s proposed legislation “underscores deep feelings among conservatives who have long opposed such counseling and may seek to remove it from Medicare should Republicans attempt to make other changes to the entitlement program.” (USA Today, 2/9, www.usatoday.com/story/news/2017/02/09/kaiser-docs-bill-medicare-end--life-advice-death-panel-fears-reemerge/97715784/)

• A perspective piece published in the New England Journal of Medicine asks whether Medicare’s payment system is equitable in the case of social risk factors. “A growing body of research indicates that social risk factors, including low socioeconomic position (as indicated, for example, by income or educational level), minority race or ethnic background, lower degree of acculturation, minority sexual orientation or gender identity, limited social relationships, and living alone or in a deprived neighborhood influence health outcomes. These findings are a concern for health care providers and policymakers because Medicare beneficiaries with such social risk factors are often concentrated among a subset of providers, particularly in inner-city or rural communities, and in some Medicare Advantage plans.” (NEJM, 2/9, www.nejm.org/doi/full/10.1056/NEJMp1700081)

• Medical students need training, including how to perform highly invasive but potentially life-saving procedures. Should future doctors be allowed to practice on patients who have little chance of recovery? Dr. Tom Fadial considers the ethics of procedures on the “nearly dead.” (KevinMD, 2/2, www.kevinmd.com/blog/2017/02/ethics-procedures-nearly-dead.html)

• “As a leading assisted living and nursing community in Gloucester County, United Methodist Communities at Pitman now offers another supportive option to people who cannot or prefer neither to receive hospice at home nor in the hospital. The newly-established Bridges at Pitman assists people to live out their last days with dignity and comfort.” (NJ.com, 2/9, www.nj.com/south-jersey-towns/index.ssf/2017/02/bridges_comes_to_pitman_umcs_t.html)

• Men face unique challenges in resolving grief, thanks to our society’s expectations around masculinity. “Our society expects men to avoid expressing feelings, to endure stress without giving up and to be able to bear pain. We do not expect to see men openly cry, to express loneliness, sadness or depression or to demonstrate other emotions. … Hospice of Michigan understands men’s unique needs and offers grief support to help them express and find healthy ways to deal with their feelings.” (Alpena News, 2/4, www.thealpenanews.com/opinion/editorials-and-columns/2017/02/men-face-unique-challenges-in-resolving-grief/)

• NPR shares a two-part story that investigates practices of funeral home pricing. “Funeral homes often aren’t forthcoming about how much things cost, or embed the information in elaborate package deals that can drive up the price of saying goodbye to loved ones,” says the report. NPR’s reporters say that they had a difficult time finding prices, and they say, “Federal regulators routinely find the homes violating a law that requires price disclosures.” When his father died, Ed Howard tried to learn funeral costs. “‘It took me as a longtime lawyer and a professional consumer advocate literally an eight-hour day just to get a solid list of what funeral services were offered by nearby funeral establishments and how much they cost. Eight hours.’"

• (NPR, 2/7, http://www.npr.org/2017/02/07/504020003/a-funeral-may-cost-you-thousands-less-just-by-crossing-the-street?utm_source=npr_newsletter&utm_medium=email&utm_content=20170212&utm_campaign=bestofnpr&utm_term=nprnews; NPR, 2/8, http://www.npr.org/2017/02/08/504031472/despite-decades-old-law-funeral-prices-are-still-unclear)

• An article in Healio offers an in-depth report on the work of hematologists and oncologists and their tasks in deciding whether to offer curative, aggressive care to their patients. The authors explore the difficulties of these decisions, the timing of end-of-life discussions, the provision of palliative care, and the challenges of honoring patient wishes. The choice of hospice, over hospital care, is especially challenging. “The fact that many hospice programs do not accept patients undergoing palliative chemotherapy, radiation or blood transfusions makes it difficult for patients with hematologic malignancies to spend their final days in the comfort of their homes,” says the article. (Healio, 2/10, http://www.healio.com/hematology-oncology/leukemia/news/print/hemonc-today/%7B3b604290-1e71-411b-bd64-b9bce9f96a2e%7D/hemoncs-toe-line-in-the-sand-between-quest-for-cure-overly-aggressive-end-of-life-care)

• Coherent Marketing, a market research and consulting firm, published a release on hospice futures. Citing growing numbers of aging Americans, hospices continue to grow. The report, titled “Hospice & Palliative Care Centers Market - Trends, Outlook, and Opportunity Analysis, 2016-2024,” is available for review at the link below. (Open PR, 2/13, http://www.openpr.com/news/434229/Hospice-Palliative-Care-Centers-Market-Trends-Outlook-and-Opportunity-Analysis-2016-2024.html)

 
 
PALLIATIVE CARE
 

• In a CNN debate on healthcare, nationally aired on 2/7, Pallimed says Sr. Ted Cruz “mischaracterized” palliative care. During the debate, Cruz said, “If we cut [costs] -- you know, you look at the elderly in much of Europe. The elderly here, when the elderly face life-threatening diseases, they’re often treated in the intensive care unit. In Europe, they’re often put in palliative care, essentially doped up with some drugs, and said, ‘Well, now is your time to go.’” This statement has gotten a lot of attention in the palliative medicine community, and there is concern of how to deal with such a misconception. (Pallimed Facebook, 2/8, https://www.facebook.com/Pallimed/photos/a.366421277312.158066.66207182312/10155209398862313/?type=3&theater)

• What is the role of palliative care when a family knows that their unborn child is not going to survive? “Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.” (JPM, 1/31, online.liebertpub.com/doi/abs/10.1089/jpm.2016.0430)

• The Mayo Clinic provides a comprehensive look at palliative care and hospice. “This article defines palliative care, describes how it differs from hospice, debunks some common myths associated with hospice and palliative care, and offers suggestions on how primary care providers can integrate palliative care into their practice.” (Mayo Clinic Proceedings, 2/2017, www.mayoclinicproceedings.org/article/S0025-6196(16)30763-7/fulltext)

• “How ready are you to pursue Community-Based Palliative Care Certification?” The Joint Commission is offering a free webinar at noon on February 16th. Registration is available online. (The Joint Commission, www.jointcommission.org/complimentary_webinar_ready_to_pursue_communitybased_palliative_care_certification/)

• What is the role of chaplains in providing palliative care? A study published in the Journal of Palliative Medicine “provides the first description of chaplains working in PC across the United States.” According to the study, chaplains see, on average, 5.2 patients per day. About half participate in PC rounds. Key responsibilities include relationship building, providing care at the time of death, and addressing spiritual issues. (JPM, 2/1, online.liebertpub.com/doi/abs/10.1089/jpm.2016.0308)

• Allison Silvers identifies three key components for ensuring access to palliative care for everyone who needs it. The components are: Educating all clinicians; increasing access directed to consumers; and proper funding for access. (AJMC, 2/5, www.ajmc.com/interviews/allison-silvers-identifies-3-key-components-to-ensuring-palliative-care-access)

• Could looking at a virtual hand reduce pain in your real hand? “Next time a nurse sticks a needle into your arm, don’t look away: it’ll be less painful. A new study shows that we feel less pain when we are looking at our body – and that this effect works with virtual reality too.” (New Scientist, 2/7, www.newscientist.com/article/2120537-looking-at-a-virtual-hand-reduces-the-pain-in-your-real-hand/)

 
 
OTHER NOTES
 

• Tom Price has been confirmed as Health Secretary under the Trump administration. “By a vote of 52 to 47, the Senate confirmed Mr. Price (R-GA) after a debate that focused as much on his ethics and investments as on his views on health policy. Democrats denounced his desire to rein in the growth of Medicare and Medicaid by making fundamental changes to the programs, which insure more than 100 million Americans.” (New York Times, 2/10, www.nytimes.com/2017/02/10/us/politics/tom-price-health-and-human-services.html)

• Atul Gawande explains why repealing Obamacare would be a huge setback for science. Gawande and researches are “voicing concerns that if we turn back to the pre-ACA days, people might be stingy with their health data out of fear of discrimination by insurance companies. And this comes at a time when scientists really need this information to advance our understanding of disease.” (Vox, 2/9, www.vox.com/science-and-health/2017/2/9/14553968/today-in-obamacare-atul-gawande-repeal-science)

• The Trump administration is supporting the “Right to Try” for terminally ill patients. A federal “Right to Try” law would give dying patients the chance to use drugs that hadn’t yet gotten approval from the FDA, but which might potentially have a positive impact on their disease. (Wall Street Journal, 2/8, www.wsj.com/articles/white-house-backs-right-to-try-law-for-terminally-ill-patients-1486508512)

• An article in LA Times shares the story of Mohamed Bzeek and his work as a foster parent for terminally ill children. He knew the children would die. “But in his more than two decades as a foster father, he took them in anyway — the sickest of the sick in Los Angeles County’s sprawling foster care system.” (LA Times, 2/11, http://www.latimes.com/local/lanow/la-me-ln-foster-father-sick-children-2017-story.html)

• Advocates for LGBT seniors are concerned about the potential repercussions of a possible “religious freedom” executive order being considered by the Trump administration. “Legal experts have described the draft order as “sweeping” and “staggering,” and have noted that order, if passed, would “go far beyond what the Supreme Court has identified as the limits of permissive religious accommodations,” the Nation reported.” (McKnight’s, 2/6, www.mcknights.com/news/advocates-for-lgbt-seniors-fear-repercussions-of-possible-religious-freedom-executive-order/article/636164/?DCMP=EMC-MCK_Daily&spMailingID=16483809&spUserID=NDI1OTM3MTEwNDES1&spJobID=960262927&spReportId=OTYwMjYyOTI3S0)

• Will doctors participate in California’s End of Life Option Act? “Physicians must now decide whether to assist patients asking for an end-of-life drug under the state’s new aid-in-dying law.” (Capital Public Radio, 2/8, www.capradio.org/articles/2017/02/08/will-they-or-wont-they-physician-participation-in-end-of-life-option-act/)

• A bill allowing doctor’s aid in dying is advancing through the New Mexico legislature. “A committee of the House of Representatives voted along party lines to advance a bill that would allow medical professionals to assist terminally ill patients in ending their own lives. The 4-3 vote came only months after the New Mexico Supreme Court’s unanimous decision in the case of a cancer patient who wanted the option to end her own life with the help of a doctor. The state’s highest court decided New Mexico law does not expressly provide patients the right to medical assistance in dying, and suggested the Legislature should clarify the issue.” (Los Alamos Monitor, 2/6, www.lamonitor.com/content/2017-state-legislature-house-committee-advances-bill-allowing-doctor%E2%80%99s-aid-dying)

• Arther L. Caplan, MD, interviewed Howard A. Grossman, MD, on the subject of physician-assisted dying. Grossman has been active in seeking to establish a right to physician-assisted suicide on the national level. “I do not believe that [physician-assisted dying] violates the oath to do no harm. I believe we do harm to people when we force them to go through the dying process because somehow we think it is a beautiful thing. I believe it is the individual’s choice.” (Medscape, 2/8, www.medscape.com/viewarticle/874168)

• How will we solve the growing caregiver crisis? “We are facing an extraordinary demographic shift that will create new challenges for our society and demand new policy solutions. Each day, 10,000 boomers turn 65 and over the next 30 years, the population of older adults will nearly double — growing from 48 million to 88 million, with the largest percentage increase among those 85 and older. This shift will profoundly impact families all across America.” (Next Avenue, 2/7, www.nextavenue.org/finding-solutions-growing-caregiver-crisis/)

 
 
ADDITIONAL INFORMATION ON BOARD CANDIDATES
 
In the last issue of the “UPDATE” the information was provided on each candidate for the Board of Directors.  Each candidate was given the opportunity to provide more information.
Tommie Farrell, MD FAAHPM HMDC
I have been involved with hospice since 2004 when I started working part-time at Hospice of Lubbock as an associate medical director.  I became board certified in Hospice and Palliative Medicine prior to the start of the ABIM board.  I then recertified the second year the ABIM board was offered.  I was the first full-time medical director in the city of Lubbock when I started work with VistaCare Hospice in 2007.  I later went to part-time hospice work to start a palliative care program at University Medical Center and also start the Fellowship Program for Hospice and Palliative Medicine at Texas Tech University Health Science Center.  I now live in Abilene Texas and am a medical director at Hendrick Hospice, the only non-profit hospice in Abilene. 
I have worked on volunteer projects nationally including working 7 years in the PC-FACS publication for AAHPM and now as the Exam Chair for the Hospice Medical Directory Certification Board. 
What I think I bring to any organization includes:

• Years of love and dedication to end-of-life care with stories of over 1600 patients and families for whom I have cared and been in their homes.
• Work in both for-profit and non-profit, education based and community based programs.  I feel comfortable discussing all these environments and have helped build bridges in a field that needs this more than the divisions that sometimes arise in end-of-life care.
• A passion for education and raising the level of evidence-based practice we follow in hospice care and care provided by physicians in hospice settings.

 
 
Hospice News Network is published 45-47 times a year.  Copyright, 2017.  All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers’ state organizations.  If readers need further information, they should consult the original source. HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders.  HNN disclaims all liability for validity of the information.  The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources.  Original sources must always be included in distribution to others. The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information.  HNN does not and cannot research the communications and materials shared and is not responsible for the content.  If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors.  Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here.

 
 
 
 

 
 
Federal Register:  https://www.federalregister.gov/
Texas Register:  http://www.sos.state.tx.us/texreg/index.shtml
New Mexico Register:   http://164.64.110.239/nmregister/
  
Federal News and Information
Palmetto GBA
The Home Health and Hospice Open Door Forum was held on February 8, 2017.  Topics covered were:  Hospice CAHPS, QRP and the Medicare Choices Model.  The CAHPS deadline was February 8, 2017.  The manual can be accessed at:  http://www.hospicecahpssurvey.org/ .  Exemptions forms are now available on the website.  Presentations from the QRP training will be available at the QRP website.  Web based training will be available this spring.  Eligibility changes have been made to the Medicare Care Choices Model due to a low number of admissions. 
 
National Hospice and Palliative Care Organization
 
Cap Reopening Questions
In response to provider questions about how the three year look back on cap liabilities is being implemented, Cap liabilities can only be recalculated for a period of three (3) years from the date of the Original Notice from the MAC.  The question is whether the recalculation is only based on the date on the original notice or is based on the date on the latest recalculation.  NHPCO has reached out to CMS to answer this question.  They are discussing internally and will provide the answer to the question soon.
 
Texas News and Information
 
Medicaid Hospice
The Medicaid Hospice Policy has moved under the Policy and Program, Policy and Program Development.  Michelle Erwin is responsible for this area.  The email for hospice questions will remain the same until the transformation is complete (hospice@dads.state.tx.us).  The Texas and New Mexico Hospice Organization has reached out to management staff for introductions and collaboration. 
 
 
 
 
 

 

 
Hospice providers will be receiving a legislative update so you can be aware of what is going on in your respective states during the session.  We hope that you will find this information helpful and inciteful.  If you have any questions or would like more information, please contact Maxcine “Max” Tomlinson at: mtomlinson@txnmhospice.org. 
 
New Mexico 2017 Legislative Session
 
Senate Bills
 
December 15, 2016
 
SB 8 (McSorley) – relating to health; amending and enacting sections of the Lynn and Erin Compassionate Use Act to provide for presumptive eligibility and three year certification and to establish new content and possession standards. 
 
SB 173 (Brandt) – this bill creates a Palliative Care Advisory Council and establishes the Viva La Viva Program.  Both of these activities will promote access to and the use of palliative care in appropriate circumstances.  The council will come under the Health Department.  They will advise the departments, on matters related to the establishment, maintenance, operation and outcomes related to palliative care initiatives in the state to increase awareness of, access to and use of palliative care services.  Viva La Viva will operate in conjunction with the Advisory Council.
 
January 20, 2017
HB 171 (Armstrong and McCamley) – relating to health care; enacting the end of life options act, rights, procedures and protections  relating to medical aid in dying and removing  criminal liability for attending healthcare providers who provide assistance in end of life options.   
 
January 25, 2017
 
SB 189 (Ortiz y Pino and Papen) – relating to health care information, liability for participation in a health information exchanges, requiring the development of a plan for the interoperability of electronic health records across healthcare providers and requiring participation in a statewide interoperable integrated health information exchange.  Healthcare includes palliative care.  Note:  that this bill defines “provider” as a health care institution, individual or group of individuals licensed, certified or authorized to deliver health care in the course of business and laboratories.  It does not specifically identify home health or hospice.
 
January 19, 2017
 
SB 116 (Ortiz y Peno) – this bill authorizes early release parole for eligible inmates on medical or geriatric parole.  The bill outlines the eligibility requirements, such as terminally ill, not a danger to self or society, and what the parole board must consider in these situations. 
 
House Bills
 
January 17, 2017
 
HB 2 (Lundstrom) – making general appropriations and authorizing expenditures by state agencies. Health, hospitals and human services are found in Section F.
 
January 24, 2017
 
HB 228 (Dow and Fajardi) – Enacting the Right to Try Act.  This bill allows for persons who have an advanced illness to try investigational drugs that have successfully completed phase one of a clinical trial.  This bill addresses eligibility, consent, liability for costs and exemption from discipline, law suites, etc.  Any individual on hospice that wants to try an investigational drug must discharge from hospice care.  Note:  while this bill covers similar areas to HB 263, they are not considered companion bills. 
 
January 26, 2017
 
HB 263( Powdrell-Culbert) – access to treatments for terminally ill patients and enacting the Right to Try Act.  This bill allows for persons who have an advanced illness to try investigational drugs that have successfully completed phase one of a clinical trial.  This bill addresses eligibility, consent, liability for costs and exemption from discipline, law suites, etc.  Any individual on hospice that wants to try an investigational drug must discharge from hospice care.  Note:  while this bill covers similar areas to HB 228, they are not considered companion bills. 
 
January 27, 2017
 
HB 170 (Armstrong) – This bill adds to the exemptions under Section 26-1-16.1 NMSA 1978 which established a requirement that medical practitioners check the prescription monitoring program before prescribing opioid pain medications to patients having pain from cancer or for the treatment of cancer.  Exemptions are:  one who is experiencing pain caused by cancer or the treatment of cancer, a person in a nursing facility or a person in hospice care. 
 
Texas 85th Legislative Session
 
Senate Bills:
 
November 14, 2016
 
SB 269 (Menendez)- relating to the possession, use, cultivation, distribution, transportation and delivery of medical cannabis for medical use by qualifying patients with certain debilitating medical conditions and the licensing of dispensing organizations and testing facilities; authorizing fees.  History:  SB 339 passed during the 84th Legislative Session.  This bill was known as the Texas Compassionate Use Act.  The intent was to make this available to people suffering from severe medical conditions. 
 
January 6, 2017
 
SB 433 (Rodriquez) – relating to the prescribing and ordering of Schedule II controlled substances certain advanced practice registered nurses and physician assistants.
 
January 17, 2017
 
SB 1 (Nelson) – this document addresses the Legislative Budget Board recommendations for the 2018-2019 Biennium.  Hospice information can be located under Article II Health and Human Services. Specific hospice data are as follows:
Performance Measures

 
SB 512 (Rodriguez)/Companion HB 995 (Wray) – relating to the form and revocation of medical powers of attorney (POA).  This bill addresses automatic revocations when individuals have divorced.  It addresses what an agent may or may not do, signature requirements, the POA is effective when the physician certifies that a person is no longer able to make healthcare decisions, and if, the person appoints a health or residential care provider or employee the potential appointee has to choose between acting as the agent or as the health or residential care provider as the law does not allow for both. 
Note:  The Palliative Care Interdisciplinary Advisory Committee, which is made up of primarily physicians, has expressed concern over this bill.  They believe that it gives too much medical decision making power to the alternate agent who has no experience in medicine and forcing the physician to comply with the agent’s decision even if it is not in the best interest of the patient.   They believe that this bill reflects the “treat to transfer” concept.  
 
January 31, 2017
 
SB 681 (Hancock) Companion HB 1415 – relating to the licensing and authority of advanced practice registered nurses (APRN).  This bill will allow for APRN’s to order, perform and interpret diagnostic tests, formulate medical diagnosis, treat health problems, prescribe therapeutic and corrective measures, support services for various professions, such as hospice  care, prescribe/order/procure/administer/and dispense drugs and devices which includes controlled substances, make referrals, be the primary care provider.  The bill allows for the board (BON) to authorize an APRN prescriptive authority in the following settings: hospital facility based practice, emergency room and physician certified and individual elected hospice care for a terminal illness. 
 
HOUSE BILLS
 
November 14, 2016
 
HB 91(White) – relating to a review of occupational licensing requirements related to an applicant’s criminal history.  This bill requires that a licensing authority (department, commission, state agency) that has an eligibility
requirement related to an applicant ’ s criminal history, review the requirement and make a recommendation regarding whether the requirement should be retained, modified, or repealed.
 
HB 118 (Moody) – relating to the personal needs allowance for certain Medicaid recipients who are residents of long term care facilities.
 
HB 280 (Howard) – relating to a grant that will fund innovative approaches for reducing workplace violence (verbal and physical) against  nurses in hospitals, nursing facilities, emergency medical care facilities and home health agencies.
 
HB 292 (Munoz) – relating to the expansion of eligibility of Medicaid in certain counties under Accountable Care Act (ACA).
 
November 22, 1016
 
HB 439 (Collier) – relating to an advance directive and do not resuscitate order of a pregnant patient. 
 
December 6, 2016
 
HB 507 (Israel) - relating to the expansion of eligibility for medical assistance to certain persons under the federal Patient Protection and ACA.
 
December 20, 2016
 
HB 656 (Minjarez) - relating to employment leave for certain family or medical obligations; imposing an assessment.  Hospice is identified as one of the employers.
 
HB 661 (Parker) –relating to access to certain investigational drugs, biological products, and devices that are in clinical trials by patients with severe chronic diseases.
 
January 3, 2017
 
HB 810 (Parker) – relating to the provision of certain investigational stem cell treatments to patients with certain severe chronic diseases or terminal illnesses. 
 
January 12, 2017
 
HB 995 (Wray)/ Companion SB 512 – relating to the form and revocation of medical powers of attorney.  This bill addresses automatic revocations when individuals have divorced.  It addresses what an agent may or may not do, signature requirements, the POA is effective when the physician certifies that a person is no longer able to make healthcare decisions, and if, the person appoints a health or residential care provider or employee the potential appointee has to choose between acting as the agent or as the health or residential care provider as the law does not allow for both.
Note:  The Palliative Care Interdisciplinary Advisory Committee, which is made up of primarily physicians, has expressed concern over this bill.  They believe that it gives too much medical decision making power to the alternate agent who has no experience in medicine and forcing the physician to comply with the agent’s decision even if it is not in the best interest of the patient.   They believe that this bill reflects the “treat to transfer” concept.  
 
February 1, 2017
 
HB 1415 (Klick)/Companion SB 681 – relating to the licensing and authority of advanced practice registered nurses (APRN).  This bill will allow for APRN’s to order, perform and interpret diagnostic tests, formulate medical diagnosis, treat health problems, prescribe therapeutic and corrective measures, support services for various professions, such as hospice  care, prescribe/order/procure/administer/and dispense drugs and devices which includes controlled substances, make referrals, be the primary care provider.  The bill allows for the board (BON) to authorize an APRN prescriptive authority in the following settings: hospital facility based practice, emergency room and physician certified and individual elected hospice care for a terminal illness. 
 
February 9, 2017
 
HB 1726 ( Cortez)-  relating to the abuse, neglect and exploitation (ANE) of recipients of home health services; providing penalties; creating offense.  Some areas this bill addresses are: defines ANE rather than refer the provider to the Penal Code, employees will sign a statement about “duty to report”, it spells out time lines for reporting by providers/investigations by the Commission/law enforcement,  states that anonyous reports need to be discouraged, but taken and do not have  to be investigated, it outlines the duties of law enforcement for joint investigations, and outlines the forms of  injunctive relief a person who has been retalitated against may receive.  Note:  this bill does apply to hospice providers. 
 
Texas Capitol Hill Day
Texas New Mexico Hospice Organization will be hosting Capitol Hill Day in April 2015.  We hope that you will consider participating this year!  More information will be provided as the session moves along. 


 

Copyright © 2017 TNMHO, All rights reserved.
This is a members only newsletter and regulatory update list. You must be a member of TX & NM Hospice Organization to get these emails.

Our mailing address is:

TNMHO

1108 LAVACA ST

AUSTIN, TEXAS 78701

Add us to your address book

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list