Legislative Priorities – 85th Session

Texas leads the nation in residents without health insurance at 19.1% of citizens and estimated >5 million uninsured Texans.

Lack of health insurance is associated with mortality. Studies reported in 1993 and 2009 showed a 25% and 40% relative increase in death for adults without insurance compared to those with private insurance. For children, it’s even worse with a 60% relative increase in dying and an estimated 17,000 American children deaths related to lack of insurance.

A high rate of uninsured Texans is bad for Texas. Uninsured Texans are more likely to delay care or forego preventive care. This leads to more expensive emergency room care or diagnosis of advanced stage disease requiring costly specialized therapies. They are less likely to receive follow-up care. Overall, this impacts Texas businesses with a depleted work force and missed days of work and productivity.

We want to improve access to care. It is critical that Texans receive access to health care so they can seek timely medical expertise and avoid delays in diagnosis. This appears associated with reducing preventable mortality.

We therefore recommend:

• Continued development of telemedicine to improve delivery of quality care at a fraction of the cost
• Increase the number of school-based clinics to deliver pediatric/ family health care in close proximity to education
• Limit the Medicaid funding cuts and consideration of plans to call down federal tax dollars
• Maintain funding for Graduate Medical Education primary care through the Texas Higher Education Coordinating Board

Pertinent legislation (telehealth and school-based clinics):

• 85(R) HB 1697 (Price): Relating to the establishment of a pediatric health electronic access in rural Texas grant program. (Passed out of the House on 4/6)
• 85(R) HB 2123 (Gonzales, Larry): Relating to the reimbursement of certain providers under the Medicaid program for the provision of telehealth services. This bill would allow school-based health clinics to be reimbursed through student’s Medicaid coverage for telehealth services. (Referred to Public Health Committee on 3/20)
• 85(R) SB 922 (Buckingham): Relating to the reimbursement of certain providers under the Medicaid program for the provision of telehealth services (Health and Human Services – left pending in committee on 4/5)
• 85(R) HB 2697 (Price): Relating to telemedicine and telehealth services. (Public Health Committee – left pending in committee on 3/28)
• 85(R) SB 1107 (Schwertner): Relating to telemedicine and telehealth services. (Passed out of the Senate on 3/29)
• 85(R) SB 2134 (Lucio): Relating to a plan to increase the use of telemedicine medical services and telehealth services in this state. (Referred to Health and Human Services on 3/28)

Pertinent legislation (Medicaid and CHIP):

Medicaid and CHIP currently provide essential access to healthcare for over 4 million Texans. Eighty percent of Medicaid enrollees are children, parents, and pregnant women. Fifty-three percent of births are paid by Medicaid. Without Medicaid and CHIP many hard working, low-income parents and their children will be uninsured with no access to primary or specialty care. We can make improvements to the Medicaid program to optimize health outcomes for Texas children!

Currently many children who are receiving medical assistance are forced to reapply every 6 months. This leads to many gaps in coverage and fragmented care. We recommend that children be allowed to stay enrolled in their medical assistance program until (1) the first anniversary of the date on which the child’s eligibility was determined; or (2) the child’s 19th birthday.

• 85(R) HB 1408 (Cortez): Relating to the period of continuous eligibility for the medical assistance program. (Human Services Committee and left pending in committee on 3/13)
• 85(R) SB 53 (Zaffirini): Relating to the period of continuous eligibility for the medical assistance program. (Referred to Health and Human Services on 1/24)

In 2016 two reports showed that the rate of maternal mortality in Texas had more than doubled over the past two years. African-American women were identified as being at the greatest risk of death (accounting for 11.4% of births but 28.8% of maternal deaths).

Early and ongoing prenatal care is vital to ensure pregnant women receive important preventive care, such as vaccines and nutritional counseling. Prenatal care also helps detect and manage behaviors and illnesses that may negatively impact the health of the mother and baby, including smoking, high blood pressure, substance abuse, and diabetes (all of which contribute to poor birth outcomes). Prenatal care also helps ensure that babies are born at term. Babies born prematurely cost ~18 times more than a full-term baby. Over the first year of life, HHSC estimates a premature baby will cost Texas Medicaid an average of $100,000, while a full term baby just costs $572.

We therefore recommend:

• Reject reductions in Medicaid and CHIP eligibility for pregnant women, which is a potential cost-containment measure identified by the Health and Human Services Commission
• Maintain funding for the Healthy Texas Women and Family Planning programs, which provide women preventive health services, including well-woman exams, contraceptives, cancer screenings, and treatment for illnesses such as hypertension and diabetes

• 85(R) HB 2035 (Walle): Relating to the continuation of the Maternal Mortality and Morbidity Task Force. (Reported favorably from the Public Health Committee on 4/4)
• 85(R) HB 3966 (Walle): Relating to the duties and continuation of the Maternal Mortality and Morbidity Task Force. (Referred to the Public Health Committee on 4/3)
• 85(R) HB 2403 (Thierry): Relating to a study concerning maternal mortality and morbidity in the state’s African American population. (Referred to Public Health on 3/22)

Nationally, 46.4% of adults experience mental illness at least once in their lifetime; 26.2% of adults experience mental illness annually. >1.3 million Texas children (or 20%) have a mental health disorder. Texas has made great strides in improving funding for mental health services in the last two legislative sessions. Unfortunately, Texas continues to rank 49th in the US for per capita for spending on mental health.

We therefore recommend:

• Preserve funding for mental health care across the state of Texas.
• Utilize more integrated behavioral health models to provide both mental and physical health care.
• Utilization of telemedicine to make mental health care more accessible.
• Maintain Graduate Medical Education funding to continue the pipeline of trainees providing mental health to future Texans. Continue to grow the loan repayment program, an evidence-based program to bring more mental health providers to the underserved Texas population.
• Provide crisis intervention training for police officers to recognize mental health illness.
• Educate school staff to recognize mental health disorders and deliver first aid.

• 85(R) HB 10 (Price): Relating to access to and benefits for mental health conditions and substance use disorders. (Passed out of the House on 4/6)
• 85(R) SB 860 (Zaffirini): Relating to access to and benefits for mental health conditions and substance use disorders. (Business and Commerce, left pending in committee on 4/4).
  • HB 10 and SB 860 would give TDI the authority to enforce the mental health parity law for nearly all fully insured health plans for non-quantitative treatment limits. It also creates an ombudsman for behavioral health access to care designated by the HHSC executive commissioner and requires HHSC to establish and facilitate a mental health condition & substance use disorder parity workgroup.
• 85(R) HB 2094 (Price): Relating to coverage for serious mental illness, other disorders, and chemical dependency under certain health benefit plans. (Referred to the Public Health Committee on 3/16)
• 85(R) SB 861 (Zaffirini): Relating to coverage for serious mental illness, other disorders, and chemical dependency under certain health benefit plans. (Referred to Business & Commerce on 2/27)
  • HB 2094 and SB 861 would expand coverage of serious mental illness to include posttraumatic stress disorder. It would also extend coverage to include eating disorders and serious emotional disturbances of a child. It would also expand the types of plans which are required to provide coverage and requires a health benefit plan, generally, to provide coverage for chemical dependency care and treatment.
• 85(R) HB 2096 (Price): Relating to access to and benefits for mental health conditions and substance use disorders. (Filed 2/20) This bill includes HB 2094 and HB 10.
• 1 in 5 children have a mental health disease. Many of these children go undiagnosed and untreated. Untreated mental health disease can have a devastating effect on the health and education of Texas youth. We therefore support mandatory screening for mental health disease as part of the Texas Health Steps program.
  • 85(R) HB 1600 (Thompson, Senfronia): Relating to certain mental health screenings under the Texas Health Steps program. (Passed out of Public Health on 3/28 and sent to Calendars on 4/3)
  • 85(R) SB 817 (Watson): Relating to certain mental health screenings under the Texas Health Steps program. (Referred to Health and Human Services on 2/27)
• 85(R) HB 309 (Johnson, Jarvis): Relating to the establishment of a home and community-based services program under Medicaid for certain persons with severe and persistent mental illness. (Referred to Public Health on 2/15) This bill would require HHSC and DSHS to establish a home and community-based services program as part of Medicaid for persons with severe and persistent mental illness who are at greatest risk of being institutionalized.
• 85(R) HB 1486 (Price): Relating to peer specialists, peer services, and the provision of those services under the medical assistance program. (Out of Public Health and now sent to Calendars as of 4/7) This bill would require HHSC to include peer services in Medicaid, as permitted under federal law.
• 85(R) HB 1758 (Price): Relating to the provision of certain behavioral health services to children, adolescents, and their families under a contract with a managed care organization. (Referred to Public Health on 3/14)
• 85(R) SB 74 (Nelson): Relating to the provision of certain behavioral health services to children, adolescents, and their families under a contract with a managed care organization. (Passed the Senate and now received in the House on 4/4)
  • HB 1758 and SB 75 would allow a managed care provider that contracts with HHSC to provide targeted case management and psychiatric rehabilitative services to children, adolescents, and their families.
• 85(R) HB 1488 (Price): Relating to eligibility requirements for repayment assistance for certain mental health professional education loans. (Referred to Public Health Committee on 3/9) This bill would modify eligibility requirements for mental health professional loan repayment assistance by removing the one year requirement of completion for practice in a mental health professional shortage area. Eligible candidates must complete 2-5 years of service in a MHPSA.
• 85(R) SB 674 (Schwertner, Hinojosa): Relating to an expedited licensing process for certain physicians specializing in psychiatry; authorizing a fee. (Passed through the Senate and now in the House) This bill would create an expedited licensing process for physicians who have a license to practice medicine in another state and are board certified in psychiatry.
• 85(R) HB 2478 (Davis, Sarah): Relating to an innovation grant program to support residency training programs in psychiatric specialty fields. (Referred to Higher Education) This bill would award incentive payments to medical schools that administer innovative residency training programs designed to increase the number of physicians in psychiatric specialty fields.
• 85(R) SB 292 (Huffman, Nelson, Schwertner, Watson, Hinojosa, Menendez): Relating to the creation of a grant program to reduce recidivism, arrest, and incarceration of individuals with mental illness. (Health & Human Services – hearings on 3/29 and 4/5 – left pending in committee) This bill will require HHSC to use appropriated money for the purpose of creating a grant program to reduce recidivism, arrest, and incarceration of individuals with mental illness.

Perinatal depression (PPD) is a serious depressive mood disorder that affects mothers during pregnancy and the year following childbirth. While there is no formal collection of PPD diagnoses across the U.S., it is estimated that 10-25% of women suffer from PPD. Beyond significant maternal distress, untreated PPD is associated with poor child health outcomes.

In 2015 – 2016, Texas recognized the importance of increasing the awareness, education, and continuity of care for women with PPD. Initiatives included the designation of May as PPD Awareness Month in tandem with a PPD outreach campaign in May 2016, as well as the HTW auto-enrollment process to close the coverage gap for vulnerable Texas women using MPW. However, there are still many barriers to identifying and treating Texas mothers with PPD.

We therefore recommend:

Change Texas Medicaid policy to allow pediatricians and family physicians to screen mothers for PPD during well-child visits and reimburse both screening and treatment costs through Children’s Medicaid (CHIP): In May of 2016, the Centers for Medicaid Services (CMS) issued guidelines on maternal depression screening and treatment, stating “State Medicaid agencies may cover maternal depression as part of a well-child visit.” The document also mentioned that reimbursement mechanisms are left up to the discretion of the state. To make PPD screening and treatment more accessible to Texas mothers on Medicaid, we suggest allowing pediatricians and family physicians to screen for PPD at well-child visits. The American Academy of Pediatrics recommends screening for PPD at well-child visits, and the majority of pediatricians feel that PPD screening is within the scope of their practice. Given that pediatricians will see the family 5-6 times within the first year for newborn care, they are in the best position to monitor a mother’s mental health. Illinois, Colorado, Minnesota, North Dakota, and Virginia already allow PPD screening to be covered through the infant’s Medicaid. If screened positive, they should be able to refer to the appropriate provider, ideally covered by CHIP if the mother is otherwise not covered for treatment. Maternal health is child health. Healthy women are better equipped to take care of their children. Reimbursing PPD screening and treatment through CHIP provides a safety net for families regardless of maternal insurance status.

Extend Medicaid for Pregnant Women coverage to one year post-childbirth while HTW becomes more established among Texas providers: Given demonstrated underreporting of PPD in Texas mothers using Medicaid in 2014 (1.7% from Medicaid versus 16.9% from PRAMS), it is critical that Texas supports PPD screening and treatment surrounding childbirth as much as possible. This can be accomplished through two routes: extending coverage under MPW and increasing the effectiveness of HTW. By definition, PPD can occur during pregnancy and throughout the year after childbirth. However, the recent DSHS report on PPD suggested that the previous loss of insurance coverage 60 days after childbirth could have contributed to under-diagnosis of PPD in Medicaid patients. While the administrative dust settles on HTW, continuity of care would be best facilitated by an extension of MPW coverage for the year following childbirth. This gives HTW time to establish strong relationships with Texas providers through greater provider education about HTW, HTW incentives for providers to enroll in HTW, and development of clear HTW guidelines for PPD screening and treatment.

Broaden coverage within HTW to cover more comprehensive care for perinatal mood disorders such as postpartum anxiety and postpartum psychosis: Postpartum anxiety is very common and affects up to 20% of women. While postpartum psychosis is rare and affects less than 1% of women, patients with postpartum psychosis can have severe symptoms such as delusions, mood swings, confused thinking, and disorganized behavior which may result in harm to themselves or their infants. Currently only postpartum depression is covered by the HTW program.

Pertinent legislation (Medicaid policy):

• 85(R) HB 2466 (Davis, Sarah): Relating to coverage for certain services related to maternal depression under the Medicaid and child health plan programs. (Public Health Committee – left pending in committee on 4/4)
• 85(R) SB 1257 (Huffman): Relating to coverage for certain services related to maternal depression under the Medicaid and child health plan programs. (Referred to Health and Human Services on 3/13)

Pertinent legislation (Medicaid extension):

• 85(R) HB 2135 (Coleman): Relating to coverage for certain services and the provision of certain information relating to postpartum depression under the medical assistance and CHIP perinatal programs. (Public Health Committee – left pending in committee on 4/4) This bill would require CHIP to cover women for screening and treatment of postpartum depression for 12 months after delivery.
• 85(R) HB 2599 (Farrar): Relating to the Medicaid eligibility of certain women after a pregnancy. (Referred on Public Health on 3/27)
• 85(R) HB 3144 (Thompson, Senfronia): Relating to coverage for certain services relating to postpartum depression under certain health benefit plans and the medical assistance and CHIP perinatal programs. (Referred to Human Services on 3/29)

Pertinent legislation (PPD coverage):

• 85(R) HB 2604 (Farrar): Relating to a strategic plan to address postpartum depression. (Public Health Committee – left pending in committee on 4/4) The strategic plan required under this section must provide strategies to: (1) increase awareness among state-administered program providers who may serve women who are at risk of or are experiencing postpartum depression about the prevalence and effects of depression on outcomes for women and children; (2) establish a referral network of community-based mental health providers and support services addressing postpartum depression; (3) increase women’s access to formal and informal peer support services, including access to certified peer specialists who have received additional training related to postpartum depression; (4) raise public awareness of and reduce the stigma related to partum depression; and (5) leverage sources of funding to support existing community-based postpartum depression screening, referral, treatment, and support services.

Human trafficking (HT) is modern-day slavery, and Texas is a hub for both international and domestic human trafficking. Texas is leading the nation in enacting policies to make it easier to go after the predators who are enslaving and exploiting our children. Now it is time for Texas to strengthen policies to better help the victims of this crime.

DFC has a very active Anti-Human Trafficking Committee. Over the past six years, we have provided education to thousands of health care providers on identifying human trafficking victims. The goal of this education is to identify victims who present to medical care – so that these victims can escape their traffickers and receive the physical and mental health care they need. Between 50-80% of human trafficking victims are seen by health care providers during their captivity. Delay in health care can lead to relapse. Current time to appropriate subspecialty care can be 2-3 months.

We therefore recommend:

• Improve health care access and funding for human trafficking victims by establishing a medical home
• Set aside convictions of victims of human trafficking for non-violent crimes committed as a direct results of trafficking.
• Improve the curriculum of court-ordered programs for consumers of prostitution to highlight child sex trafficking.

• 85(R) HB 269 (Thompson, Senfronia): Relating to judicial proceedings on a petition to set aside a conviction or an order of expunction of criminal history record information for certain victims of trafficking of persons or compelling prostitution who are convicted of prostitution. (Sent to Calendars on 3/28)
• 85(R) SB 1165 (Garcia): Relating to judicial proceedings on a petition to set aside a conviction or an order of expunction of arrest records and files for certain victims of trafficking of persons or compelling prostitution who are convicted of certain offenses. (Referred to Criminal Justice on 3/9)
• 85(R) HB 29 (Thompson, Senfronia): Relating to prostitution and the trafficking of persons, civil racketeering related to trafficking, the prosecution of and punishment for certain sexual offenses and offenses involving or related to trafficking, reimbursement of certain costs for criminal victims who are children, and the release and reporting of certain information relating to a child; increasing a criminal penalty; creating a criminal offense. (Sent to Calendars on 4/7)
• 85(R) SB 1569 (Huffman): Relating to prostitution and the trafficking of persons, civil racketeering related to trafficking, the prosecution of and punishment for certain sexual offenses and offenses involving or related to trafficking, reimbursement of certain costs for criminal victims who are children, and the release and reporting of certain information relating to a child; increasing a criminal penalty; creating a criminal offense. (Referred to Criminal Justice on 3/21)
• 85(R) HB 2509 (Parker): Relating to the eligibility of certain victims of trafficking of persons for an order of nondisclosure. (Criminal Jurisprudence, scheduled for a hearing on 4/10)
• 85(R) HB 2645 (Thompson, Senfronia): Relating to the development of a program and training for public schools on the prevention of sexual abuse and sex trafficking and participation by the human trafficking prevention task force in that development. (Referred to Public Education on 3/21)
• 85(R) SB 2039 (Zaffirini): Relating to the development of a program and training for public schools on the prevention of sexual abuse and sex trafficking and participation by the human trafficking prevention task force in that development. (Referred to Education on 3/27)
• 85(R) HB 1342 (Parker): Relating to child sexual abuse prevention training for public school students. (Public Education Committee – left pending in Committee on 4/4)
• 85(R) HB 2629 (Thompson, Senfronia): Relating to notice and continuing education requirements regarding human trafficking for certain licensed occupations and establishments. (Referred to Licensing & Administrative Procedures on 3/21)
• 85(R) HB 272 (Thompson, Senfronia): Relating to a required training course on human trafficking for commercial driver’s license applicants. (Transportation – scheduled for a hearing on 4/12)
• 85(R) SB 128 (Garcia): Relating to a required training course on human trafficking for commercial driver’s license applicants. (Voted out of the Senate on 4/3)
• 85(R) HB 2552 (Thompson, Senfronia): Relating to prostitution and trafficking of persons and to certain criminal and civil consequences of that conduct. (Referred to Judiciary & Civil Jurisprudence on 3/31)

Although the growth in the prevalence of childhood obesity in Texas has stabilized in the past decade, it is still alarmingly high, with 23.8% of 4th grade students classified as obese.

Why do we have such a problem with obesity in Texas? There are many reasons – a combination of genes and the environment; our children are consuming increased calories (eating in front of the TV, fast food, sugar-sweetened beverages, fewer fruits and vegetables) and have less activity (less time in school PE, concerns for neighborhood safety, and more TV and video games). We also lack health education and our culture does not always value a healthy lifestyle. What makes things worse in Texas is that almost 50% of our children are living at or near poverty, and we have > 1.3 million households (18.8%) that are food insecure. Poverty and food insecurity are directly linked to increased risk of obesity.

Can we reverse this trend? Absolutely. Other states are making progress (Mississippi, Georgia – to name a couple). And DFC believes that Texas can reverse this dangerous and costly trend by implementing evidence-based policy changes that do the following:

• Increase fresh fruits and vegetables
• Increase physical activity
• Increase breastfeeding initiation, duration, and exclusivity
• Decrease sugar sweetened beverages
• Decrease consumption of calorie dense, nutrient poor foods
• Decrease TV (screen) time

We therefore recommend:

• Have districts develop a locally determined school recess policy and establish a state working group for best practice guidelines on recess
• Provide well-balanced, high-quality meals in schools
• Reimburse health care providers for lifestyle/ obesity counseling

• 85(R) SB 355 (Watson): Relating to the adoption and implementation of a recess policy by public school districts. (Referred to Education on 2/1)
• 85(R) HB 3145 (Deshotel): Relating to the adoption and implementation of a recess policy by public school districts. (Public Education Committee – scheduled for a Committee hearing on 4/11)
• 85(R) HB 2884 (Allen): Relating to health and physical education requirements in public schools. (Public Education Committee – scheduled for a Committee hearing on 4/11)
• 85(R) HB 3606 (Wilson): Relating to the School Health Survey (Education committee hearing on 4/11).
• 85(R) SB 756 (Menéndez): Relating to required coverage for obesity under group health benefit plans. (Referred to Business & Commerce on 2/22)
• 85(R) HB 742 (Farrar): Relating to the promotion of breast-feeding and the prohibition against interference with or restriction of the right to breast-feed; creating a civil action. (Business & Industry Committee hearing on 3/6, left pending in committee)
• 85(R) SB 755 (Menéndez): Relating to the authority of a school district to donate food to a nonprofit organization to be served to students of the district. (Agriculture, Water, & Rural Affairs – hearing on 4/10))

Vaccines save lives. DFC supports immunization as the safest, most effective way to control and eradicate vaccine-preventable diseases in Texas. Thanks to vaccinations, many of the infectious diseases that plagued past generations—like polio, mumps, rubella, diphtheria, tetanus, and H. flu meningitis —have been nearly eradicated. But still, every year, people in Texas die or suffer from vaccine-preventable diseases.

Barriers to immunization access (including lack of insurance coverage, inadequate funding for immunization programs, and poor utilization of Texas’ immunization registry) increase the risk of outbreaks of life-threatening diseases in our communities and endanger the health of Texans and our state’s economic vitality.

In past sessions, the Texas Legislature has taken significant steps to protect Texans from vaccine-preventable diseases by ensuring college students are protected against meningitis, improving immunization uptake among health care and childcare providers, and ensuring funding for safety net programs. We can do more, however!

Now is the time for Texans to recommit to building a community free of vaccine-preventable diseases. The immunization status of individuals can affect the health of the entire community because vaccine-preventable diseases will re-emerge unless there is a protective shield of immunized individuals to prevent outbreaks. Vaccines are the most effective option for preventing and stopping the spread of infectious disease.

We therefore recommend:

• Increase education and access to cancer preventing vaccines such as HPV vaccine
• Require online education modules for non-medical vaccine exemptions
• Change the Texas immunization registry to an Opt-out registry instead of the obsolete, inefficient Opt-in policy
• Provide rates of unvaccinated children in schools and school districts to assist parental choice
• Neutralize the legal language surrounding vaccine exemptions by changing the wording from “reasons of conscience” to “non-medical exemption”

• 85(R) HB 126 (Davis, Sarah): Relating to an educational module certificate requirement for certain immunization exemptions; authorizing a fee. (Referred to Public Health on 2/13)
• 85(R) HB 120 (Davis, Sarah): Relating to non-medical exemptions from immunization requirements. (Referred to Public Health on 2/13)
• 85(R) HB 107 (Davis, Sarah): Relating to a human papillomavirus immunization report. (Referred to Public Health on 2/13)
• 85(R) HB 243 (Howard): Relating to the immunization data included in and excluded from the immunization registry (Referred to Public Health on 2/13); and 85(R) SB 54 (Zaffirini): Relating to the immunization data included in and excluded from the immunization registry. (Referred to Health and Human Services on 1/24)
• 85(R) HB 2249 (Sheffield): Relating to requirements for and the transparency of epidemiological reports and immunization exemption information and reports (Public Health, committee hearing on 4/11); and 85(R) SB 1010 (Seliger): Relating to requirements for and the transparency of epidemiological reports and immunization exemption information and reports (Referred to Health and Human Services on 3/6).

Reducing infant exposure to secondhand smoke:

• 85(R) HB 2845 (Howard): Relating to increasing awareness of the dangers of exposing children to secondhand smoke. (Referred to Public Health on 3/27)

Changing the minimum age to buy tobacco products to 21 years.

• 85(R) SB 910 (Huffman): Relating to the distribution, possession, purchase, consumption, and receipt of cigarettes, e-cigarettes, and tobacco products; providing penalties. (Referred to State Affairs on 3/1)
• 85(R) HB 1908 (Zerwas, Sheffield, Thompson, Senfronia, Parker, Howard): Relating to the distribution, possession, purchase, consumption, and receipt of cigarettes, e-cigarettes, and tobacco products; providing penalties. (Public Health – left pending in committee on 3/28)
• 85(R) SB 183 (Uresti): Relating to the distribution, possession, purchase, consumption, and receipt of cigarettes, e-cigarettes, and tobacco products; providing penalties. (Referred to State Affairs on 3/6)

While great progress has been made on the state level to keep children safe, more work remains to optimize child safety and injury prevention.

Motor vehicle crashes are the leading killer of children older than 1 year, yet state legislative efforts to improve child passenger safety standards have remained largely stalled in recent years. Missing from many state child passenger laws are requirements for safety seat to be rear-facing seats until age 2 years:

• 85(R) HB 519 (Turner, Chris): Relating to the creation of an offense for failing to secure certain children in a rear-facing child passenger safety seat system. (Referred to Transportation on 2/16)
• 85(R) SB 278 (Zaffirini): Relating to the creation of an offense for failing to secure certain children in a rear-facing child passenger safety seat system. (Passed out of the senate transportation committee on 3/15 – placed on intent calendar on 3/21 but not again placed on intent calendar on 3/27)

75 Texas children drowned in 2015, nearly half of which occurred in pools. As of May 2016, a total of 37 children had drowned in Texas. We need to incentivize the use of pool safety barriers to prevent these tragedies.

• 85(R) HB 1363 (Villalba): Relating to a sales and use tax exemption for certain pool safety barriers. (Referred to Ways & Means on 2/27)

Cyberbullying is a growing threat to Texas youth.

• 85(R) HB 306 (Minjarez): Relating to student harassment, bullying, cyberbullying, injury to or death of a minor; creating a criminal offense. (Referred to Public Education on 2/15)
• 85(R) SB 179 (Menéndez, Zaffirini, Taylor): Relating to student harassment, bullying, cyberbullying, injury to or death of a minor; creating a criminal offense. (State Affairs – left pending in committee on 4/6)