Dr. Austin Against Bad Chiropractic Bill HB 3441

Testimony:  HB 3441 (Chisum)            

House Licensure/Admin Procedures

 By: Sara Austin MD 

Mister Chairman, members of the committee, I am Doctor Sara Austin. I am a neurologist in Austin and a member of the Texas Medical Association’s Council on Legislation. On behalf of the TMA and our 45,000 physician and medical student members, we are respectfully opposed to House Bill 3441.

Please make no mistake. This is a scope of practice bill and one with far-reaching implications. And while the term “chiropractic” is not mentioned in the bill, the only group to testify on its behalf has been the chiropractors.

This bill would provide that licensing boards, most notably the Board of Chiropractic Examiners, would have a clear and unrestrained ability to usurp the responsibility of the Legislature by allowing the Board itself to define scope of practice. It is the responsibility of the Legislature, in proceedings such as this, to define a profession’s scope. It is the Licensing Agency’s responsibility to take [consider?]statute and legislative intent to determine the rules under which the law is administered.

This bill clearly invests legislative authority in the regulatory agency. At the same time, the bill would prevent any other licensing agency from having the authority to challenge such intrusions by non-licensed individuals into their practice acts.

We believe HB 3441 presents patient safety -- as well as utilization and billing concerns.

Sec. 60.005 (a) would permit a person licensed under Title 3 (which includes 22 different licensed health care professionals) to use the same billing codes used by another person licensed under Title 3.

With only a simple rule adoption – not legislation, for example – the Chiropractic Board could enable a chiropractor to perform any Physical Therapy service…. and bill for it. It is, in effect, the capture of the scope of practice of one licensed professional by another.

Sec. 60.005 (b) and (c), of the Occupations Code are added.

Health plans that reimburse for services under any new rules must pay for services that are provided by chiropractors without limitations if another health care provider is paid for such acts.  The Insurance Code already provides clear and structured language related to different payment amounts based on educational attainment or licensure of a licensed professional. But, taken together, these subsections would circumvent the provisions of the Insurance Code in an effort to increase utilization and amount of payment per service.

Sec. 60.006. RULES. A licensing authority created under Title 3 may adopt rules necessary to enforce this chapter, with regard to persons licensed by the licensing authority.

This language would set the Chiropractic Board free to adopt reimbursement rules and protect its licensees against any legal opposition. Again, using “billing codes” of another licensee is unlimited in this bill. It would open up the billing codes of all licensees, including those of physicians. In addition, the bill (or at least the substitute we have seen) contains no exemptions for workers compensation or for self-insured employers. We believe this will bring new costs to employers who purchase workers compensation insurance as the rules of the Workers Compensation Division could easily be superseded by a rule of the Chiropractic board. In a similar manner, new rules from the Chiropractic board related to payment could also subject self-insured employers to new and increased payment costs.

And finally, Section 60.004, Occupations Code, is added.

This permits a person licensed under Subtitle C, Occupations Code, to form a partnership, professional association, or professional limited liability company with persons licensed under Subtitle B, Occupations Code. The only persons licensed under Subtitle B are physicians.

This provision would circumvent current laws which only provide that individuals with the same license may form such business entities. In the past, podiatrists and optometrists were permitted to form such business entities with physicians. But this bill would include all other entities under Subtitle C.  The need for such a provision, it appears, would be to circumvent the current statutes prohibiting the solicitation of patients under Chapter 102 of the Occupations Code. This could permit access to physician practices and guarantee a patient stream from “partners.” Again, increased utilization will be the likely result as the goal appears to be able to access to the physician’s license and referral stream. The statement in the bill that each profession would continue to be governed by its respective practice act and board is barely adequate as the structure of the business entity easily could, and likely would, give control to one party.

Again, members, we thank you for the opportunity to present our concerns. We stand strongly in opposition to HB 3441.  

82nd Texas Legislature Testimonies 

 

     


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