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87th Texas Legislative Session Overview

The 87th Texas Legislative Session convened on January 12, 2021, in the middle of an extremely tumultuous year. The
global COVID-19 pandemic had changed the entire world, and the Texas Legislature was no exception. Things looked
quite different at the Capitol this session, including COVID-19 testing for entry, appointment requirements for meetings
with legislators and their staff, as well as other safety protocols. Just over a month after the start of session, Texas was
rocked by Winter Storm Uri, which brought snow, ice, extreme temperatures, and statewide water loss and power
outages. This event certainly affected the work that could be done at the Capitol and the focus of legislators. The rest of
the session moved along relatively smoothly, considering the circumstances.

After four and a half months, the 87th Texas Legislative Session concluded on May 31, 2021. By this time, the Legislature
had sent several significant behavioral health bills to the Governor, as well as some increases for behavioral health
strategies in the Texas budget.

Overall, more than 7,000 bills were filed this session, and NBHP tracked over 200 related to mental health and substance
use disorder services. NBHP also conducted more than 30 virtual and in-person legislative meetings; provided written
and oral testimony on 11 occasions; and mobilized more than 170 advocates to send over 1,500 messages to their
legislators on important mental health and substance used disorder-related bills.

NBHP’s six core legislative priorities included:


● Increase funding for a broad spectrum of prevention, early intervention, and treatment services for mental
illness and substance use disorders, including for suicide and opioid overdose prevention.
● Increase access to tele-behavioral health services across all populations in Texas.
● Increase jail diversion options for people with behavioral health issues.
● Expand supportive housing and recovery housing options for people with behavioral health issues.
● Expand Medicaid or other coverage options for people with behavioral health issues​​.​
● Improve access to mental health and substance use disorder services in primary, secondary and postsecondary
education.

NBHP Priority Bills that passed included: HB 4, which will expand telehealth service access, including for behavioral
health care; HB 133, which will extend Medicaid coverage for postpartum women from two months to six months; and
HB 707, which will require a study regarding the expansion of recovery housing in Texas. Additional details on these and
other bills will be shared in further detail in the overview of passed legislation.
Budget Overview
The biennial budget is the only required bill that the Texas Legislature must pass each session. The members of the
Senate Finance and House Appropriations Committees began holding hearings early in the session, and the conference
committee continued meeting through the waning days before adjournment. While the Legislature was faced with
several competing budget priorities, behavioral health services funding fared relatively well.

Several mental health and substance use disorder strategies across various state agencies received funding increases in
SB 1, the Texas Budget bill. These included community mental health services for adults, substance abuse services,
community mental health grants, and State Hospitals under the Texas Health & Human Services Commission; psychiatric
care provided through the Texas Department of Criminal Justice; and funding for students with disabilities through the
Texas Education Agency. Additionally, and importantly for the greater Houston area, the UTHealth Harris County
Psychiatric Center was allotted $40.3 million in operating funding for their new campus, the UTHealth Behavioral
Sciences Center (BSC). This funding will allow them to open a total of 264 beds in the new BSC, including 168
state-funded indigent beds.

Funding Differences by Strategy, FY 2020-2021 vs. FY 2022-2023

Under the Texas Health and Human Services Commission, Community Mental Health Services for Adults received $785.6
million for the biennium, an increase of $21.6 million over the last biennium, which will help expand access to services
for indigent populations. Community Mental Health Services for Children received a modest increase of $3.2 million, for
a total of $187.8 million for the next biennium, which indicates service provision will remain flat. Community Mental
Health Crisis Services received $231.4 million, a decrease of $111.8 million. However, this is due to moving Community
Mental Health Grant funding from this strategy into its own, and to increase it to $145 million over the biennium.
Substance Abuse Services received a total of $248.1 million in funding, an increase of $31.9 million that we hope will
lead to an expansion of services. Behavioral Health Waivers received $58.8 million over the biennium, a decrease of
$45.7, due to delays in program expansion, provider shortages, and other factors.1 Mental Health Community Hospitals
received $965.4 million and Community Mental Health Hospitals received $307 million over the biennium, increases of
$66.7 million and $36.4 respectively. These funds will help construct and/or renovate various state hospitals in Texas and
also will contribute to the operational cost of UTHealth Harris County Psychiatric Center’s new Behavioral Sciences
Center in Harris County.

Under the Department of Family & Protective Services, Substance Abuse Purchased Services received $27 million over
the next biennium, consistent with the funding awarded last budget cycle, which will maintain services offered to
vulnerable children and families.

Under the Texas Juvenile Justice Department, the Mental Health Service Grant strategy received $14.1 million over the
biennium, which also is consistent with the funding awarded last budget cycle. Additionally, Psychiatric Care received a
slight increase to around $1.9 million over the biennium, which also will maintain current service levels.

Under the Texas Department of Criminal Justice, Diversion Programs received $250.5 million for the biennium, Treatment
Alternatives to Incarceration received $21.4 million for the biennium, Psychiatric Care received $645 million for the
biennium, and Substance Abuse Treatment & Coordination received $65.5 million for the biennium. These dollars will
allow for maintenance of mental health and substance use disorder services offered to inmates, as well as diversion
efforts.

Under the Texas Education Agency, Students with Disabilities received $2.2 billion in funding, an increase of about $3
million, which also will maintain current service levels.

Please view Appendix A for budget comparisons between last biennium and the current biennium.

Legislative Overview of Passed Bills

NBHP tracked hundreds of behavioral health bills this session, with over 30 being passed into law. Summaries and
analyses of the bills can be viewed below. Bills annotated with an asterisk were NBHP priority bills:

Bill #: Bill Author: Bill Caption: Bill Summary:

HB 4* Price Requires the Health and Human Services Commission (HHSC) to provide Medicaid recipients
with the option to receive healthcare services, including behavioral healthcare services, via
telehealth; allows Medicaid Managed Care Organizations (MCOs) to provide reimbursement
for telehealth and telemedicine services, including audio only benefits for behavioral health
services; requires HHSC to implement policies/procedures for improving access to care
through telehealth/telemedicine; requires HHSC to allow MCOs to provide care coordination
via telecommunications; allows outpatient chemical dependency treatment programs
provided by treatment facilities to use telehealth to provide services to adult and adolescent
clients.

HB 133* Rose Extends Medicaid coverage for eligible pregnant women to six months following delivery or
an involuntary miscarriage; requires HHSC to transition all case management services
provided under the Medicaid children and pregnant women program to a Medicaid managed

1
https://www.lbb.state.tx.us/Documents/HAC_Summary_Recs/87R/Agency%20529.pdf
care model; requires HHSC to contract with MCOs to provide Healthy Texas Women services
to recipients and to identify and mitigate barriers to enrollment in the program.

HB 549 Thompson Shields from civil, criminal, and administrative liability a physician or mental health
professional who discloses a patient's confidential information to mental health personnel
due to a belief of probable immediate physical or emotional harm to the patient or physical
harm to others.

HB 707* Moody Requires HHSC to conduct a study to evaluate the status of and opportunities, challenges, and
needs to expand recovery housing in Texas; requires HHSC to submit the report to the
Legislature along with recommendations for legislative or other action.

HB 785 Allen Requires the child-specific special education committee to review a behavior improvement/
intervention plan for students annually to analyze changes in student circumstances, etc.;
requires school districts to notify parents of use of restraints on students and specific details.

HB 1080 Patterson Requires the University Interscholastic League to allow students to participate in activities
who currently receive outpatient mental health services from a mental health facility;
prohibits school districts from allowing the League to exclude these students if they are
currently receiving education from that school, even if the student has been absent from
school due to receiving services.

HB 1213 Darby Requires the county responsible for a hearing or proceeding for the involuntary detention of a
person with mental illness to pay the court reporter costs.

HB 1535 Klick Allows HHSC to develop a compassionate-use institutional review board to evaluate and
approve proposed research programs to study the medical use of low-THC cannabis in
treating medical conditions; requires the review board to be affiliated with a dispensing
organization and to file reports on its findings to HHSC; allows physicians to prescribe
low-cannabis THC if a patient is diagnosed with Post Traumatic Stress Disorder.

HB 1694 Raney Creates a defense to prosecution for a person who requests emergency medical assistance in
response to the possible overdose of another person or themselves during an ongoing
medical emergency, given that the actor stayed on the scene until medical assistance arrived
and cooperated with personnel, except in the following circumstances: 1) if the peace officer
was in the process of arresting or executing a search warrant on the person or if the person
was in the process of committing another offense, 2) if the person has been previously
convicted of or placed on deferred adjudication community supervision for a substance-use
related offense, 3) if the person has previously successfully used this defense to prosecution,
or 4) at any time during the preceding 18-month period the person has requested emergency
assistance in response to a possible overdose.

HB 1802 Dominguez Requires HHSC to collaborate with Baylor College of Medicine and a military veterans
hospital, or hospital that provides medical care to veterans, on a study to evaluate the
efficacy of alternative therapies, including the use of MDMA, psilocybin, and ketamine, to
treat mental illness and other medical conditions; requires the study to include a clinical trial
on the therapeutic efficacy of using psilocybin in the treatment of treatment-resistant
post-traumatic stress disorder in veterans; requires a quarterly report to be submitted to the
Legislature on the findings.

HB 2093 Cortez Adds physician assistants who have expertise in psychiatry or work in a mental health facility
to the definition of non-physician mental health professional in the Health & Safety Code.

HB 2287 Thompson Requires the Texas Education Agency (TEA) to collaborate with the Collaborative Task Force on
Public School Mental Health Services to collect and maintain an electronic database of mental
health services and trainings provided by school districts, with a focus on the development of
early mental health skills and emotional skills; requires TEA to collect data on the number of
students who were suspended/expelled and the number of reports of alleged child abuse
made to the Department of Family and Protective Services; requires HHSC to submit a report
to the Collaborative Task Force on Public School Mental Health Services.

HB 2595 Price Designates October as Mental Health Condition and Substance Use Disorder Parity Awareness
Month to increase awareness and compliance around state and federal rules and regulations
concerning availability of benefits for mental health conditions and SUD; requires the
commissioner of HHSC to develop a portal that allows health benefit plan enrollees to submit
complaints regarding violations of parity and to file an annual report regarding resolved and
unresolved complaints.

HB 2633 Johnson, Requires HHSC to create a dedicated funding account for human trafficking victims and a
Ann grant program to establish dedicated housing and treatment facilities for human trafficking
victims; requires facilities that are awarded the grant to provide immediate trauma support to
victims, wraparound services, safe and consistent shelter, etc.

HB 2822 Hull Prohibits the executive commissioner of HHSC from requiring prior authorization for a
non-preferred antipsychotic drug on the state formulary prescribed to an adult enrolled in a
state program administered by HHSC if the patient: 1) previously had been unsuccessfully
treated with a 14-day trial of a preferred drug under a single claim or 2) had previously
received prior authorization for the non-preferred drug and met certain other circumstances.

HB 3121 Turner Requires HHSC to develop and implement voluntary quality standards certification processes
to certify psychiatric residential youth treatment facilities; requires applicants to submit
applications to HHSC and to renew certification every two years; requires HHSC to develop
minimum standards for applicants which include obtaining accreditation by the Joint
Commission or another related entity, developing specific plans of care, etc.; exempts
facilities licensed as private mental hospitals/other mental facilities.

HB 3821 Hunter Requires HHSC to employ and train mental health professionals to assist in the administration
of the mental health program for veterans.

HB 4074 Hunter Requires the Statewide Behavioral Health Coordinating Council to include statewide suicide
prevention efforts in its five-year statewide behavioral health strategic plan and to create a
suicide prevention subcommittee to focus on these efforts.

SB 64 Nelson Requires the Texas Commission on Law Enforcement to develop a peer support network for
law enforcement officers that includes peer-to-peer counseling, training for peer service
coordinators that including suicide prevention, and recruitment and screening of mental
health professionals; prohibits revocation, suspension, or denial of a license solely based
upon a law enforcement officer’s participation in the peer-to-peer network.

SB 184 Johnson Requires the Department of State Health Services to work with HHSC to prepare a report on
the prevalence of eating disorders and eating disorder-related deaths in this state by
December 1st, 2023; requires a study on eating disorders among youth in the state by
December 1st, 2024.

SB 279 Hinojosa Requires Texas public schools and institutions of higher education to print the National
Suicide Prevention Lifeline and the Crisis Text Line (as well as the local suicide prevention
hotline, if they choose) on all student IDs for students in grades 6 or higher; allows
institutions of higher education to also include the contact information for campus police or
the security department, as well as the campus health clinic, on student ID cards.

SB 454 Kolkhorst Requires HHSC to require local mental health authorities (LMHAs) to meet at least quarterly
to collaborate on planning and implementing regional strategies to reduce, among other
things: local government costs of providing services for mental health crises, the incarceration
of persons with mental illness in county jails; and emergency room utilization by persons with
mental illness; requires HHSC to work with LMHAs to post the updated development plans on
its website annually.

SB 640 Menendez Requires HHSC to conduct a study to assess the interoperability needs and technology
readiness of behavioral health service providers in the state, including state hospitals, LMHAs,
freestanding psychiatric hospitals, etc.; requires the study to investigate use of electronic
health record (EHR) management systems and any barriers to use of EHRs; requires HHSC to
submit a report to the Legislature that includes a state plan for aligning interoperability and
technological capabilities in the provision of behavioral health service.

SB 642 West Prohibits HHSC from requiring the Department of Family & Protective Services (DFPS) to
conduct a child abuse investigation before allowing the child to participate in the
relinquishment avoidance program unless there is an allegation of abuse or neglect of the
child; allows local mental/behavioral health authorities to refer a child directly to the
relinquishment avoidance program without contacting DFPS first; requires HHSC and DFPS to
jointly adopt and post online protocols for the relinquishment avoidance program, including
eligibility for, application to, and the roles of each entity involved in the program.

SB 672 Buckingham Requires HHSC to reimburse healthcare providers for the provision of collaborative care
management services to children and adult Medicaid recipients who receive behavioral
health services.

SB 1359 Hughes Requires law enforcement agencies to develop and adopt a policy allowing the use of mental
health leave by peace officers who experience a traumatic event on the job.

SB 1575 Kolkhorst Within 60 days of a child’s placement in a residential treatment center by DFPS, requires a
court to assess the placement, determine if the child’s needs can be met by being placed in a
foster home, and, based upon the findings, approve or disapprove the placement; requires
DFPS, at each status review and permanency hearing, to provide the court with
documentation justifying the child’s continued placement in a residential treatment facility
over a foster home, as well as DFPS efforts to prepare the child to return home or to be
placed in foster care or with other potential guardians.

SB 1827 Huffman Establishes the Texas Opioid Abatement Account composed of money received by the state
from a statewide opioid settlement agreement and other approved sources; creates the Texas
Opioid Abatement Fund Council to ensure money recovered from a statewide settlement is
used to mitigate the opioid crisis in the state; specifies that state agencies may only use
appropriated money from the account for opioid use disorder prevention, intervention, and
treatment efforts; establishes the Opioid Abatement Trust Fund, consisting of a portion of the
money received from a statewide opioid settlement agreement, to be distributed to the Texas
Access to Justice Foundation, as well as to counties and municipalities to address
opioid-related issues in their communities.

SB 1921 Lucio Requires HHSC to provide fee-for-service reimbursement to health care providers who
provide behavioral health services to Medicaid recipients prior to their enrollment in
Medicaid managed care; requires HHSC to ensure that the health care providers are
reimbursed through a managed care model after confirmation of the Medicaid recipients’
enrollment with a managed care organization.

SB 2013 Hinojosa Requires HHSC to conduct a study on administrative penalties assessed against substance use
disorder service providers, including their economic impact and impact on service provision;
requires HHSC to post on its website current administrative penalty schedules for substance
use disorder service providers and to ensure they are accurate.

Missed Opportunities, The Interim, & Concluding Thoughts

NBHP is proud of the accomplishments achieved for behavioral health during this session, including increases in funding
in SB 1, expanded access to telehealth services across the state, extended Medicaid coverage for postpartum women,
initiation of a research study on the condition of recovery housing in the state, as well as dozens of other significant
changes that were covered above.

Of course, as with any session, there were substantial ‘missed opportunities’ for the advancement of mental health and
substance use disorder services. Some of these include:

● The Legislature’s failure to fully expand Medicaid coverage for millions of Texans in need. An expansion of
health care coverage of some sort is important for a variety of reasons. Lack of insurance strains underfunded
health systems and helps drive overutilization of emergency rooms and acute care. When individuals have
health coverage, they can more readily access timely care in more appropriate, non-acute settings. Medicaid
expansion could make 1.4 million Texans eligible for health insurance2, over 75% of whom are in a family with at
least one worker. As a result, Texas could draw down billions of dollars in federal funding each year. This influx of
funding could help save healthcare jobs, reduce local government reliance on property tax revenue for indigent
health care, and reduce hospitals’ uncompensated care. The Legislature’s failure to address full Medicaid
expansion despite numerous bills being filed on the topic was a major disappointment.

2
https://covertexasnow.org/posts/2020/8/10/texas-should-be-the-next-red-state-to-expand-medicaid
● Not only did the Legislature fail to take advantage of billions of dollars in federal funding to expand Medicaid
coverage, but it also failed to pass any legislation that would have required private insurance companies to
expand coverage for different populations with mental illness. These include HB 240 by Thompson/SB 51 by
Zaffirini, which would have required private health plans to provide coverage for serious emotional disturbance
of a child; SB 91 by Menendez, which would have required private health plans to provide coverage for
Post-Traumatic Stress Disorder; and SB 1141 by Zaffirini, which would have required health benefit group plans
to provide coverage for early treatment of the first episode of psychosis in individuals. Unfortunately, no efforts
to expand private health care coverage options for people with mental illness gained any traction this session.
● Failure to provide payment parity between telehealth and in-person services. Telehealth has been utilized
during the pandemic at an unprecedented rate, and several studies have found that tele-behavioral health is as
effective as in-person therapy.3 Studies also suggest that telehealth services can save patients both time and
money related to travel, as well as reduce provider no-show rates.4,5 Several bills were filed that would have
ensured fair compensation for providers of telehealth services - some in private health insurance and some in
Medicaid - however, none of these bills passed.
● SB 36 by Zaffirini, which was passed by the Legislature and then vetoed by the Governor, would have
established the Collaborative Task Force on Higher Education Mental Health Services to work with the Texas
Higher Education Coordinating Board to study and evaluate mental health services provided to students at
institutions of higher education and to research the capacity of these institutions to identify and address the
mental health needs of students. Mental health needs in higher education have been overlooked for far too
long, and it is unfortunate that Governor Abbott vetoed this bill.
● The creation of a jail diversion program in Fort Bend County. HB 79 by Reynolds would have required a jail
diversion pilot program to begin in Fort Bend County, which could have helped reduce the incarceration rate of
individuals with mental illness and/or substance use disorder. Jail diversion programs work, as evidenced by the
Judge Ed Emmett Mental Health Diversion Center in Harris County, and should be expanded across greater
Houston and the state.
● Failure to create a voluntary certification for recovery housing. A voluntary certification process could have
helped recovery housing facilities adhere to highly respected and evidence-based standards, such as those set
forth by the National Alliance for Recovery Residences. The standards could have improved the quality and
operation of these facilities and provided additional safeguards for residents.
● HB 662 by Collier would have allowed the Texas Department of Housing and Community Affairs to administer a
homeless housing and services program in counties to procure, develop, and construct housing options for
homeless persons and to provide programs designed to eliminate homelessness. For many people experiencing
a behavioral health issue, housing is often the cornerstone of treatment. Without a safe, stable place to live,
medication adherence and abstinence from substances can prove difficult. In addition, many who leave acute
care treatment need a transitional period of housing and wraparound support to successfully reintegrate back
into the community. It is critical that measures are taken to build and expand affordable housing in greater
Houston and across Texas.
● Failure to address the behavioral health workforce shortage across the state. The behavioral health workforce
shortage is dire, with all but one Texas county being designated a total or partial Mental Health Professional
Shortage Area in January 2021. SB 1564 by Lucio would have required the statewide behavioral health
coordinating council to develop a comprehensive plan to increase and improve the workforce in this state to

3
https://nasadad.org/wp-content/uploads/2015/03/Telehealth-in-State-Substance-Use-Disorder-SUD-Services-2009.pdf
4
https://www.bmc.org/healthcity/policy-and-industry/telepsychiatry-ACO-costs-engagement
5

https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/new-data-shows-patients-save-fuel-time-and-missed-appointments-
with-telehealth
serve persons with mental health and substance use issues. Unfortunately, that bill did not gain any traction this
session, despite our desperate need to expand the behavioral health workforce.

NBHP will continue to work on many of these areas during the Interim. We also will be supporting local initiatives in
Houston and Harris County, formulating Interim Charge recommendations for the Legislature, and participating in any
relevant topic areas during the Special Sessions.

We look forward to working together to further advance the field of behavioral health in Texas during the Interim and
into the 88th Legislative Session in 2023!

Appendix

Please see Appendix Item 1, Table 1 below:

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