BILL ANALYSIS

 

 

 

C.S.H.B. 4687

By: Campos

Public Health

Committee Report (Substituted)

 

 

 

BACKGROUND AND PURPOSE

 

The COVID-19 pandemic has highlighted many opportunities to improve critical public health support systems in Texas, specifically mental health, substance use, and public health, which would benefit from greater intentional coordination in providing services. These overlapping sectors are currently strained to meet their responsibilities due to shared limitations. The sectors are typically managed separately, limiting the impact they can have on improving population health, despite the understanding that human experience cuts across these systems. C.S.H.B. 4687 seeks to create a framework to drive greater collaboration between substance, mental health, and public health sectors in critical areas of funding, data interoperability, and workforce training by establishing the mental health, substance use, and public health initiative council to ensure that money allocated to the initiative trust fund created under the bill is allocated fairly and spent to improve the coordination among those sectors. The council will annually establish procedures for grant applications and evaluation and will coordinate biennially with the statewide behavioral health coordinating council for grant evaluations.

 

CRIMINAL JUSTICE IMPACT

 

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

 

RULEMAKING AUTHORITY

 

It is the committee's opinion that rulemaking authority is expressly granted to the mental health, substance use, and public health initiative council in SECTION 1 of this bill.

 

ANALYSIS

 

C.S.H.B. 4687 amends the Government Code to establish the mental health, substance use, and public health initiative council to ensure that money allocated to the mental health, substance use, and public health initiative trust fund is allocated fairly and spent to improve the coordination among mental health, substance use, and public health. The bill establishes the composition of the 14-member council, as follows:

·         one member appointed by the governor who is a current or retired health care operations professional with 10 or more years of experience in matters of substance use, mental health, and public health;

·         one member appointed by the lieutenant governor who is a current or retired health care operations professional with such experience;

·         one member appointed by the speaker of the house of representatives who is a current or retired health care operations professional with such experience;

·         three members appointed by the executive commissioner of the Health and Human Services Commission (HHSC) who are from academia or the medical profession and have significant experience in matters of substance use, mental health, and public health;

·         seven members appointed by the executive commissioner of HHSC as follows:

o   one member who is a current or former employee of a rural hospital district;

o   one member who is a current or former employee of a local health authority;

o   one member who is a current or former employee of a local mental health authority as defined by the Health and Safety Code;

o   one member who is a current or former employee of a federally qualified health center in Texas;

o   one member who has lived experience with a mental health condition or substance abuse condition; and

o   two members with at least 10 years of experience working with a health philanthropy nonprofit organization or foundation; and

·         the comptroller of public accounts or the comptroller's designee.

The bill requires the appointing authorities, as soon as practicable after the bill's effective date, to appoint the members of the council.

 

C.S.H.B. 4687 establishes that the comptroller or the comptroller's designee serves as the presiding officer of the council and is a nonvoting member. The bill requires the executive commissioner of HHSC, in making the appointments for the three members who are from academia or the medical profession, to appoint members from lists provided by the governing bodies of six rural counties and six rural municipalities selected by the executive commissioner with each list naming two qualified candidates with experience in substance use treatment, education, and research. The bill requires the governor, lieutenant governor, and speaker, in making their applicable appointments, to coordinate to ensure that the membership of the council reflects, to the extent possible, the ethnic and geographic diversity of Texas. The council is administratively attached to the Department of State Health Services (DSHS). The bill requires DSHS to provide the staff and facilities necessary to assist the council in performing its duties. The council is subject to state open meeting laws.

 

C.S.H.B. 4687 establishes the mental health, substance use, and public health initiative trust fund outside the state treasury for the purposes of the bill's provisions. The trust fund is not a part of the state's general funds. The bill establishes that the fund is administered by the Texas Treasury Safekeeping Trust Company, which may authorize money from the fund to be invested with money from the state treasury and establish in the fund accounts to facilitate the administration of money in the fund. The fund consists of the following components:

·         an initial appropriation of money by the legislature to the fund as permanent principal for the fund;

·         any additional legislative appropriations of money for the purposes of the fund;

·         interest or other earnings on money credited to or allocable to the fund; and

·         money from gifts, grants, or donations to the fund.

 

C.S.H.B. 4687 does the following with respect to the trust fund:

·         prohibits the money initially appropriated by the legislature as permanent principal for the fund from being used for any purpose other than to gain interest or other investment earnings;

·         restricts the use of money in the fund gained as interest or other earnings on the investment of the permanent principal of the fund to providing grants in accordance with the council's grant program and to paying the necessary and reasonable expenses of administering the fund;

·         requires the trust company, in making investments of money in the fund, to exercise the judgment and care under the circumstances then prevailing that a person of ordinary prudence, discretion, and intelligence exercises in the management of the person's own affairs;

·         authorizes the trust company to appoint one or more commercial banks, depository trust companies, or other similar entities to serve as the custodian of the fund; and

·         requires the trust company, not later than October 1 of each year, to submit a written report to the legislature detailing all expenditures made by the council during the preceding state fiscal year and detailing any amount of money greater than the initial appropriation of permanent principal by the legislature that is held in the fund.

 

C.S.H.B. 4687 requires the council to establish a grant program to award grants for programs that improve the coordination between substance use, mental health, and public health care services in Texas providing services to individuals with co-occurring mental health and substance use disorders. A program funded through a grant awarded under the grant program must improve the coordination between substance use, mental health, and public health care services in Texas through the following:

·         evidence-based preventative or therapeutic measures, research, the implementation of new technology, data collection, education programs, or capital improvements; and

·         providing an efficient and cost-effective method that is directed to support the coordination of personnel, capital improvements, data interoperability, or long-term financial sustainability of the mental health care, substance use, and public health care providers.

 

C.S.H.B. 4687 requires the council to annually establish procedures for submitting, accepting, and evaluating grant applications under the bill's provisions. A decision by the council to award a grant requires the unanimous approval of all members of the council. The bill requires the council, in coordination with the statewide behavioral health coordinating council, to evaluate grant applications at least biennially. The bill requires the mental health, substance use, and public health initiative council to adopt rules to implement the bill's provisions.

 

EFFECTIVE DATE

 

On passage, or, if the bill does not receive the necessary vote, September 1, 2023.

 

COMPARISON OF INTRODUCED AND SUBSTITUTE

 

While C.S.H.B. 4687 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

 

The substitute changes the composition of the council by increasing the number of members appointed by the executive commissioner of HHSC from five, as in the introduced, to seven and requiring one of the two additional members to be a current or former employee of a local mental health authority and one to have lived experience with a mental health condition or substance abuse condition.