BILL ANALYSIS

C.S.H.B. 4420

By: Rose

Public Health

Committee Report (Substituted)

BACKGROUND AND PURPOSE

The bill author has informed the committee that Texas' mental health care system is overstrained and over capacity and that the use of inpatient beds at mental health care facilities increased by 12 percent between 2023 and 2024, which includes patients who are adolescents, voluntarily committed, in a maximum security unit, or considered incompetent to stand trial. The bill author has further informed the committee that the competency restoration waitlist spans from months to over a year, frequently averaging over 200 days, and that the lack of acute psychiatric treatment means Texans cannot access the care they deserve, which endangers public health and slows our criminal justice system. C.S.H.B. 4420 seeks to assist Texas in making informed decisions regarding mental health services and better understanding the magnitude of this problem by directing the Health and Human Services Commission to conduct a study regarding the current supply of, and future need for, acute inpatient psychiatric treatment beds in inpatient mental health facilities.

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 this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 4420 amends the Health and Safety Code to require a hospital that provides mental health or chemical dependency services to submit to the Department of State Health Services (DSHS) financial and utilization data relating to the mental health and chemical dependency services provided by the hospital, including data relating to the total number of inpatient psychiatric beds, including the total number of beds disaggregated by age, online beds, and offline beds. For this purpose, the bill defines "online bed" as an inpatient psychiatric bed that is operational and occupied or unoccupied and available to serve patients and "offline bed" as an inpatient psychiatric bed that is unoccupied and unavailable to serve patients.

C.S.H.B. 4420 requires the Health and Human Services Commission (HHSC) to conduct a study regarding the availability of beds at inpatient mental health facilities in Texas that provide acute inpatient psychiatric treatment. The bill requires the study to evaluate the following:

· the current number of psychiatric beds available at inpatient mental health facilities in Texas that provide inpatient psychiatric treatment to individuals experiencing an acute mental health crisis, including a breakdown of beds available, as follows:

o at inpatient mental health facilities that are state hospitals operated by HHSC;

o at inpatient mental health facilities other than facilities operated by HHSC;

o at private inpatient mental health facilities; and

o for patients committed to a facility for competency restoration services under statutory provisions relating to incompetency to stand trial, committed to a facility under applicable Texas Mental Health Code provisions for emergency detention or court-ordered mental health services, committed to a facility after having been found not guilty by reason of insanity under applicable state law, voluntarily admitted to a facility, 18 years of age or older, 12 years of age or older but younger than 18 years of age, 11 years of age or younger, receiving not less than 365 days of mental health treatment in a facility, and who have been diagnosed with an intellectual or developmental disability;

· the total number of patients who received inpatient psychiatric treatment between September 1, 2025, and August 31, 2026, at inpatient mental health facilities in Texas, including private facilities, that provide that treatment to individuals experiencing an acute mental health crisis, including a breakdown of the following:

o the number of patients committed to a facility for competency restoration services under provisions relating to incompetency to stand trial, including the number of individuals committed under an initial order of commitment or an order extending the initial restoration period;

o the number of patients committed to a facility under applicable Texas Mental Health Code provisions for emergency detention or court-ordered mental health services;

o the number of patients committed to a facility after having been found not guilty by reason of insanity under applicable state law;

o the number of patients voluntarily admitted to a facility;

o the number of patients 18 years of age or older;

o the number of patients 12 years of age or older but younger than 18 years of age;

o the number of patients 11 years of age or younger;

o the percentage of patients admitted to a facility who require not less than 365 days of mental health treatment in a facility;

o the number of patients who have been diagnosed with an intellectual or developmental disability;

o the number of patients receiving services from a jail diversion program;

o the number of patients who have been admitted two or more times to a facility; and

o the number of patients who reach the 190-day limit of inpatient psychiatric treatment under the Medicare program; and

· the projected need over the next 10 years of inpatient mental health facilities that provide inpatient psychiatric treatment to individuals experiencing an acute mental health crisis for:

o additional inpatient psychiatric beds, including needed beds that are funded or under construction, and the projected percentage needed for patients who require not less than 365 days of treatment; and

o additional resources, including workforce needs, necessary to meet the demands described by the study.

The bill authorizes HHSC, in designing and conducting the study, to collaborate with public institutions of higher education in Texas that award medical degrees.

C.S.H.B. 4420 requires HHSC, not later than December 1, 2026, to prepare and submit to the legislature a written report containing the results of the study and any recommendations for legislative or other action. The bill's provisions relating to the study expire September 1, 2027.

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2025.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 4420 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.

Both the introduced and the substitute require a hospital that provides mental health or chemical dependency services to submit to DSHS financial and utilization data relating to the mental health and chemical dependency services provided by the hospital, including data related to inpatient psychiatric beds. However, the introduced required such a hospital to submit data relating to the availability of inpatient psychiatric beds by age, whereas the substitute requires such a hospital to submit data relating to the total number of inpatient psychiatric beds, including the total number of beds disaggregated by age, online beds, and offline beds. The substitute includes provisions absent from the introduced defining "online bed" and "offline bed" for that purpose.

Both the introduced and the substitute require HHSC to conduct a study regarding the availability of beds at inpatient mental health facilities in Texas that provide acute inpatient psychiatric treatment. However, those provisions differ as follows:

· the substitute specifies that the inpatient mental health facilities the study must evaluate are those that are state hospitals operated by HHSC or facilities other than those operated by HHSC, whereas the introduced specified that the inpatient mental health facilities the study must evaluate are those that are state hospitals operated by DSHS or facilities other than those operated by DSHS;

· the substitute includes a provision absent from the introduced requiring the study to evaluate a breakdown of beds available at private inpatient mental health facilities;

· whereas the introduced required the study to evaluate the beds available for patients civilly committed to a facility for sexual violence, the substitute requires the study to evaluate the beds available for patients committed to a facility for emergency detention or court-ordered mental health services;

· whereas the introduced required the study to evaluate the beds available for patients receiving long-term mental health treatment in a facility, the substitute requires the study to evaluate the beds available for patients receiving not less than 365 days of mental health treatment in a facility;

· whereas the introduced required the study to evaluate the current number of patients admitted to an inpatient mental health facility in Texas that provides inpatient psychiatric treatment to individuals experiencing an acute mental health crisis, including a breakdown of certain patient groups, the substitute requires the study to evaluate the total number of patients who received inpatient psychiatric treatment between September 1, 2025, and August 31, 2026, at inpatient mental health facilities in Texas, including private facilities, that provide that treatment to individuals experiencing an acute mental health crisis, including a breakdown of certain patient groups;

· with respect to those patient group breakdowns, the introduced and substitute differ in the following ways:

o the introduced included the number of patients civilly committed to a facility for sexual violence, whereas the substitute includes the number of patients committed to a facility for emergency detention or court-ordered mental health services;

o the introduced included the percentage of patients in Texas who will likely require long-term mental health treatment in a facility, whereas the substitute includes the percentage of patients admitted to a facility who require not less than 365 days of mental health treatment in a facility; and

o the substitute includes the number of patients who have been admitted two or more times to a facility and the number of patients who reach the 190-day limit of inpatient psychiatric treatment under the Medicare program, whereas the introduced did not;

· whereas the introduced required the study to evaluate the projected need over the next several years for additional psychiatric beds at inpatient mental health facilities that provide inpatient psychiatric treatment to individuals experiencing an acute mental health crisis, including the projected percentage of incoming patients who will likely require long-term mental health treatment in a facility, and current and anticipated resources, the substitute requires the study to evaluate the projected need over the next 10 years of inpatient mental health facilities that provide inpatient psychiatric treatment to individuals experiencing an acute mental health crisis for the following:

o additional resources;

· the introduced required HHSC to collect certain information at least twice, whereas the substitute does not; and

· the introduced required HHSC to prepare and submit to the legislature a written report containing the study's results and any recommendations for legislative or other action not later than September 1, 2026, whereas the substitute requires HHSC to do so not later than December 1, 2026.