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HOUSTON – The Houston Chronicle reports that Texas hospitals like Houston Methodist have devoted big parts of their businesses in recent years to buying up doctors’ practices and rebranding them as part of their outpatient networks. But they may soon have to figure out a different strategy. Under existing federal Medicare rules, hospital-operated outpatient facilities get higher fees than what a traditional doctor’s office would receive for the same procedure or treatment — sometimes double or even five times the amount, according to KFF, formerly known as the Kaiser Family Foundation. Now Congress is considering whether to end the practice as part of a larger effort to reduce the cost of Medicare, the more than $900 billion program that provides healthcare to more than 2.3 million Texans 65 years of age or older. The Congressional Budget Office estimates such reforms could save the federal government up to $100 billion over the next decade, on the back of recent cuts to reimbursement rates for in-hospital care for Medicare patients.

“It would be a big deal for hospitals,” said Kristie Loescher, a healthcare professor at The University of Texas’ McCombs School of Business. “A lot of outpatient care is actually being done in hospitals (and the facilities they operate) and it’s driving a lot of revenue.” Hospitals are lobbying hard to block the reforms, arguing the higher fees are justified by the fact they are required to treat all those who come through their doors, regardless of whether they have insurance or not. Without the extra fees, Texas hospitals would likely be forced to eliminate some outpatient services, hurting access for patients, said John Hawkins, president of the Texas Hospital Association, a trade group. Baylor St. Luke’s Medical Center, for instance, received more than $43 million from Medicare for outpatient care in fiscal year 2023, according to data compiled by the Rand Corporation. Houston Methodist took in more than $140 million. Methodist and other Houston-area hospitals declined or did not respond to requests for comment for this story. “A lot of these systems have expanded their outpatient capability outpatient to provide a pretty high level of care without patients having to go into the medical center,” Hawkins said. “A small (physicians) group wouldn’t necessarily be able to do that.”

WASHINGTON (AP) — The deadly crash of two vintage military planes at a 2022 air show in Texas was caused by a lack of proper planning to keep aircraft separated and relying instead on a “see-and-avoid strategy” by pilots, federal investigators said Monday.

A Bell P-63F fighter was descending and banking to the left when it clipped the left wing of a Boeing B-17G bomber from behind. All six people aboard the World War II-era planes — the pilot of the fighter and the pilot, copilot and three other crew members on the bomber — were killed.

National Transportation Safety Board investigators said Monday that the pilots’ visibility was limited by their flight paths, obstructions in the cockpits, and “the attention demands associated with the air show performance.”

The investigators said the probable cause of the accident was the lack of a briefing on aircraft separation by the show organizer and the “air boss,” who used binoculars and a two-way radio to direct pilots. Instead, they relied “on the air boss’s real-time deconfliction directives and the see-and-avoid strategy for collision avoidance,” investigators said.

The show was put on by the Commemorative Air Force, a nonprofit group dedicated to preserving military aircraft. The group did not immediately respond to a request for comment.

The conclusions hewed closely to preliminary findings that the board issued in late 2022.

Aviation safety experts have said they were surprised that there was no briefing beforehand about keeping planes at separate altitudes, and that such planning occurs at other air shows. A person familiar with the show’s operations that day said pilots were given general directions on altitude during a pre-show briefing, but they did not discuss specific altitudes for each pass that the aircraft would perform.

The NTSB also faulted the Federal Aviation Administration for a lack of guidance for air bosses and air show organizers and requirements to continually evaluate air bosses and oversee their performance. The board said it would publish a final report Thursday.

AUSTIN, Texas (AP) — Six Guatemalans were arrested in Guatemala and in Texas Monday on human smuggling charges linked to a 2021 semitrailer truck crash in Mexico that killed more than 50 migrants, authorities said.

The truck had been packed with at least 160 migrants, many of them Guatemalans, when it crashed into a support for a pedestrian bridge in Tuxtla Gutierrez, the capital of the southern state of Chiapas. The arrests were announced on the three-year anniversary of the accident.

According to an indictment unsealed Monday in Laredo, Texas, Guatemalan authorities arrested Tomas Quino Canil, 36; Alberto Marcario Chitic, 31; Oswaldo Manuel Zavala Quino, 24; and Josefa Quino Canil de Zavala, 42.

Another man, Jorge Agapito Ventura, was arrested at his home in Cleveland, Texas, U.S. authorities said. Guatemalan officials noted a sixth arrest. A sixth name listed on the U.S. federal indictment was blacked out.

The accused were charged with conspiracy, placing life in jeopardy, causing serious bodily injury, and resulting in death.

It was unclear late Monday if those arrested had attorneys in the United States who could comment on their behalf. Justice Department officials did not immediately respond to an email Monday night.

The indictment charges them with conspiring to smuggle migrants from Guatemala through Mexico to the U.S. for payment. In some cases that involved smuggling unaccompanied children, the defendants would provide scripts of what to say if apprehended, the indictment said.

The smugglers would move migrants on foot, inside microbuses, cattle trucks and tractor trailers, the indictment said. It said the smugglers would use Facebook Messenger to request and deliver identification documents to the migrants to get them into the U.S.

“The tragedy that occurred three years ago today in Chiapas is further proof that human smugglers are ruthless, callous and dangerous, intending migrants should not believe their lives,” said U.S. Secretary of Homeland Security Alejandro Mayorkas.

Guatemalan Interior Minister Francisco Jiménez said the defendants were part of a criminal structure called Los Quino, and that U.S. officials had requested extradition of the four arrested in Guatemala.

Authorities executed 15 search warrants across Guatemala on Monday, Jiménez said. He said they had the support of the U.S. and Mexican governments.

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This story has been updated to correct Oswaldo Zavala Quino’s middle name. It is Manuel, not Manuael.

JEFFERSON CITY, Mo. (AP) — As President-elect Donald Trump assembles his administration, Republican governors and lawmakers in some states are already rolling out proposals that could help him carry out his pledge to deport millions of people living in the U.S. illegally.

Lawmakers in a growing number of states are proposing to give local law officers the power to arrest people who entered the country illegally, mirroring recent laws in Texas and elsewhere that have been placed on hold while courts weigh whether they unconstitutionally usurp federal authority.

Other legislation filed ahead of next year’s legislative sessions would require local law enforcement agencies to notify federal immigration officials when they take someone into custody who is in the country illegally, even if the charges have nothing to do with their immigration status. Though not specifically requested by Trump, many of the state proposals would complement his immigration policies.

“We would be finding people who are in violation of this law, and we would be sort of hand-delivering them to the nearest port of deportation so that they could be removed in a safe and orderly fashion,” said Missouri state Sen. Curtis Trent, who is sponsoring one of the proposals.

The U.S. Department of Homeland Security estimates that 11 million unauthorized immigrants were living in the U.S. as of 2022, the latest statistics available. While campaigning, Trump talked about creating “the largest mass deportation program in history” and called for using the National Guard and domestic police forces in the effort.

Some Democratic-led states already are raising resistance. The California Legislature has convened a special session to try to shield people from potential Trump policies, including by boosting legal aid for immigrants facing deportation.

Lawmakers in numerous states are likely to try to thwart or cooperate with Trump’s immigration agenda, Tim Storey, CEO of the National Conference of State Legislatures, said Monday.

In Missouri, Trent’s bill would empower local law officers to arrest people for a new state crime of “improper entry by an alien,” punishable by a fine of up to $100,000 and a court-ordered ride to the U.S. border.

A separate bill by Missouri state Sen.-elect David Gregory would offer a $1,000 reward to informants who tip off police about people in the country illegally and allow private bounty hunters to find and detain them.

Missouri’s Republican Gov.-elect Mike Kehoe hasn’t endorsed a specific legislative plan after campaigning against illegal immigration and the scourge of fentanyl smuggled across the U.S. border. But he told The Associated Press: “If they’re here illegally, it definitely should trigger something more than it does now.”

Immigrant advocacy groups already are raising alarm about some state proposals. Missouri’s proposed bounty system would “create absolute chaos and division,” said Ashley DeAzevedo, president of American Families United, which advocates for U.S. citizens married to foreign nationals.

Although many Americans support a path to citizenship for people living in the U.S. illegally, support for deportation also has grown. More than 4 in 10 voters said most immigrants who are in the U.S. illegally should be deported to the country they came from, according to AP VoteCast, a survey of more than 120,000 voters in this year’s election. That’s up from about 3 in 10 in 2020. More than half of voters said most immigrants in the U.S. illegally should be offered a chance to apply for legal status, down from about 7 in 10 who said this in 2020, according to AP VoteCast.

Many Republicans point to Texas as a model for immigration enforcement. Its $11 billion Operation Lone Star program has erected razor wire and other barriers along the Mexican border, stationed state troopers and Texas National Guard members in border towns and bused thousands of migrants to Democratic-led “sanctuary cities” such as New York, Chicago, Denver, Philadelphia and Washington. Texas law officers also have made tens of thousands of arrests, including many for trespassing on private property.

Tom Homan, Trump’s “border czar,” visited Texas last month and said its border security tactics can be a model for the Trump administration. Texas Gov. Greg Abbott’s office confirmed that it’s been in regular contact with Trump’s team about strategies.

Following Texas’ lead, Republican-led legislatures in Iowa, Louisiana and Oklahoma passed measures allowing law officers to arrest people who are in the U.S. illegally. Shortly after Trump’s election, Oklahoma Gov. Kevin Stitt announced he was working on a plan to deport some of the more than 500 immigrants currently in Oklahoma prisons who are not legal citizens.

Arizona voters last month also approved a ballot measure letting local police arrest migrants suspected of illegally entering from Mexico, though it won’t kick in until a similar law in Texas or another state has been in effect for 60 consecutive days.

Other Republican state measures seek to boost cooperation between local law officers and federal immigration officials.

Utah Gov. Spencer Cox recently announced an initiative to improve coordination with federal officials to identify undocumented immigrants in the state’s criminal justice system and turn them over for deportation. Cox said there will be “zero tolerance” for “those who demonstrate a threat to public safety while in the country illegally.”

A Georgia law enacted earlier this year requires jailers to check the immigration status of inmates and apply to help enforce federal immigration laws. The measure gained traction after the murder of University of Georgia student Laken Riley. A Venezuelan man who had entered the U.S. illegally was convicted of killing her and sentenced to life in prison.

North Carolina’s Republican-controlled legislature last month overrode a veto by Democratic Gov. Roy Cooper to enact a law directing sheriffs to comply with federal immigration agents’ requests to hold inmates. That came after several Democratic sheriffs from urban counties refused to cooperate with U.S. Immigration and Customs Enforcement.

Other Democratic governors dealing with Republican-led legislatures are pushing back against the potential for sweeping deportation plans. Democratic Kansas Gov. Laura Kelly said she supports deporting people who commit crimes while living in the U.S. illegally, but she won’t send out the National Guard to help enforce federal immigration laws.

Democratic Wisconsin Gov. Tony Evers, who also faces a Republican-led Legislature, said undocumented immigrants “are a really important part of our economy” in sectors such as agriculture and manufacturing.

“Trying to move them out of the country is irrational,” Evers said. “So, we’ll do whatever we can to avoid that.”

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Associated Press polling editor Amelia Thomson-Deveaux in Washington and writers Jeff Amy in Atlanta; John Hanna in Topeka, Kansas; Nadia Lathan in Austin, Texas; Sean Murphy in Oklahoma City; Todd Richmond in Madison, Wisconsin; Gary D. Robertson in Raleigh, North Carolina; and Hannah Schoenbaum in Salt Lake City contributed to this report.

DALLAS – The Dallas Morning News reports that in a study conducted by The Action Network, Texas has been identified as the state with the highest risk of porch piracy, th 29.8% probability of package theft. This result comes just after National Package Protection Day on Wednesday, drawing attention to the issue of package theft across the nation. The findings indicated that 5% of Texans have reported having a package stolen within the last three months. Mail is the most susceptible to be stolen followed by Amazon ackages according to the report. North Carolina ranks as the second-most affected state, with a 14.4% implied probability of porch piracy. Meanwhile, Florida, coming in third, reported a staggering 3,270 cases of theft from residences in the previous year.

AUSTIN – KUT reports that the Texas Department of Transportation (TxDOT) is asking the federal government to let the state continue to approve its own environmental reviews — a delegated authority intended to fast-track highway projects. The public has until Monday night to weigh in on the arrangement that critics have long skewered as “the fox guarding the hen house.” Since 2014, TxDOT has operated under the agreement with the Federal Highway Administration (FHWA), allowing the state agency to assume responsibility for environmental reviews under the National Environmental Policy Act (NEPA). Those reviews analyze the impact of highway projects on everything from air and water to homes, businesses and historical sites. TxDOT says the sweeping powers delegated to the state streamline efforts to avoid “substantial delays in the delivery of important transportation projects,” shaving months off the environmental review process.

“TxDOT is still subject to the same statutory and regulatory requirements that would apply without NEPA assignment, and our agency takes the responsibility for ensuring compliance with those requirements seriously,” TxDOT spokesperson Adam Hammons said in an e-mail. “Over the past ten years, TxDOT has been subject to multiple audits and monitoring events by FHWA.” One FHWA monitoring report issued this year found TxDOT was in violation of federal regulations related to the installation of traffic noise barriers. The report said the state was making changes to come into compliance. Critics of the arrangement say the self-certification process known as “NEPA assignment” doesn’t result in the rigorous reviews intended under federal law, especially for large-scale projects like the expansion of I-35 through Austin. “The federal government does not have the same vested interest in pushing through these projects that TxDOT does,” said Addie Walker with Reconnect Austin, a group that’s pushed for burying I-35 through Central Austin. “They have a really strong interest in pushing these projects through, and especially with NEPA assignment, no real incentive to slow down, listen to what the community and local and regional governments are saying.”

AUSTIN – KUT reports that new testing results show Austin has little to no traces of forever chemicals in its drinking water. Exposure to these chemicals, also known as per- and polyfluoroalkyl substances or PFAS, have been linked to prostate and kidney cancers, thyroid conditions, decreased fertility and other health problems. PFAS are called “forever chemicals” because they take thousands of years to break down. The chemicals are “bioaccumulative,” meaning they build up in an organism faster than they can be excreted. Over 1 million people in the greater Austin area get their drinking water from the Highland Lakes. Out of the 29 PFAS compounds Austin Water officials tested in the lakes, only faint traces of six were detected. The test results were verified by the Environmental Protection Agency.

Water samples were tested at each of Austin’s three water treatment plants four times over the past year. At the Handcox Water Treatment Plant, none of the tested PFAS compounds were found. PFAS are found in seemingly everything, including clothes, nonstick pans, cosmetics and probably your bloodstream. The EPA announced earlier this year that it would start regulating five of the most dangerous PFAS. So far, almost 50 Texas water systems have reported PFAS levels exceeding the new limits, two of which are in Williamson County. Water systems in Seguin and San Antonio have also reported levels exceeding the limits. The EPA estimated that somewhere between 6% and 10% of all public water systems will fail the new guidelines. But Austin didn’t. Why? Kasi Clay, the water quality manager for Austin Water, said the results are thanks to protections on the Highland Lakes. “Our drinking water is less impacted by industries and activities that can introduce PFAS,” she said. Clay said traces of PFAS found in Austin’s drinking water were so low they were barely even testable.

TERRELL — A police officer was fatally shot Sunday night while conducting a traffic stop in Terrell, Texas, police said.

The officer, 28-year-old Jacob Candanoza, called for a cover unit upon initiating the traffic stop around 11 p.m., the Terrell Police Department said. But before backup could arrive, police said they received two 911 calls about an officer being shot.

Responding officers found Candanoza at the scene with gunshot wounds, according to police.

He was transported to the hospital, where he died, police said.

The suspected shooter was arrested early Monday, police said, but did not immediately disclose his name. Candanoza was able to provide a license plate to dispatchers that aided in the suspect’s capture, Lt. Mary Hauger, spokesperson for the Terrell Police Department said.

Candanoza had joined the Terrell Police Department in July. He served in the Marines from 2014 to 2019 and previously worked for the Dallas County Sheriff’s Office, according to Dallas ABC affiliate WFAA.

“Our deepest condolences go out to his family as they navigate this tragic time,” the Terrell Police Department said in a statement.

Terrell is located about 30 miles east of Dallas.

“Please join Cecilia & me in praying for the family & friends of Officer Jacob Candanoza, who lost his life last night in the line of duty,” Texas Gov. Gregg Abbott wrote on X. “Our hearts go out to his loved ones & to the Terrell Police Department.”