[ Rural Community Health System | Relief for Rural Physicians | Telemedicine ]
Rural Community Health System
Despite widespread legislative support for the Rural Community Health System, and the system's tenacious lobbying efforts, the RCHS' efforts to secure state funding unfortunately failed during the closing days of the 1999 legislative session. Nine members of the appropriations conference committee, which is responsible for reconciling funding differences between the Senate and the House budget committees, supported allocating initial start-up dollars to the RCHS. However, opposition from the chair of the House Appropriations Committee defeated the proposal. Rep Junell's opposition stemmed from his concerns about managed care plans generally and the financial feasibility of the RCHS more specifically.
The RCHS was established by the legislature in 1997 as an alternative to urban-based health care delivery systems operating in rural communities. The goal of the system, which is led by an 18-member board comprising rural physicians, hospital administrators, employers, and community leaders, is to preserve access to local services, clinical autonomy, and, most importantly, health care dollars within rural communities. TMA, Texas Academy of Family Physicians, Texas Hospital Association, and many other organizations strongly supported the RCHS' enabling legislation, as well as the system's funding request.
To work out concerns about the system's structure, Chairman Junell offered to meet with the RCHS board over the next 18 months to discuss delivery system options that will allow rural communities to better harness existing health care resources and to successfully respond to managed care.
The RCHS did pass HB 1194 by Rep. Sylvester Turner (D-Houston) and Sen. Troy Fraser (R-Horseshoe Bay), a clean-up bill eliminating the requirement for the RCHS to be formed as an HMO and clarifying that the RCHS board may appoint advisory committees rather than require their formation. The bill also stipulates that should the RCHS decide to become a regulated HMO, the commissioner of insurance has the authority to make exceptions for distance, mileage, and network adequacy provisions. As a rural health system, the RCHS would need this flexibility to establish itself in sparsely populated regions of the state.
Despite this setback, the RCHS continues to pursue its original vision. The board, working with a respected health care consulting firm, has developed a business and marketing plan. The plan will be used as a foundation for discussions with Rep. Junell and other legislators interested in new rural delivery system options. Additionally, to underwrite its initial capital costs, the board is pursuing grants from various national foundations.
Relief for Rural Physicians
Lawmakers failed to pass SB 381 by Senator Madla or its companion, HB 2953 by Rep. Patricia Gray (D-Galveston), which would have established a visiting physician program for rural areas. However, legislation reauthorizing the Center for Rural Health Initiatives charges the center with carrying out an interim study on this topic. By Nov. 1, 2000, the center is to conduct a study to assess the need, potential utilization, reimbursement issues, and training requirements for participants in a program to provide temporary coverage of rural physicians who are attending CME or taking vacation time. The study will involve representatives of academic health centers, TMA, Texas Osteopathic Medical Association and rural communities.
Mirroring growing interest in telemedicine by patients and policymakers, myriad bills were filed expanding the use and availability of telemedical consultations. Legislation ranged from requiring telemedicine coverage for Medicaid EPSDT visits to broadening services within the prison population as a way to control medical costs. Despite widespread interest, however, most of the bills stalled in committee, reflecting legislators' apprehension about passing bills with unknown consequences on health care quality and cost.
To further evaluate where, when, and by whom telemedicine is appropriate, it is anticipated that the House Public Health Committee will further study this issue during the interim session. Additionally, the HHSC Sunset bill included a provision directing the agency to form an advisory committee to review telemedical reimbursement methodology.
Rural Health staff contacts:
Marcia Collins, Medical Education: (512) 370-1451
Helen Kent Davis, Governmental Affairs: (512) 370-1401
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