Rural Texas Physician

Summer 2014

Rural Texas Physician is a quarterly electronic newsletter catering to physicians in the many rural areas of Texas caring for patients and their communities. TMA’s grassroots membership is the strength of the association. For general inquiries or newsletter comments, email

STAR+PLUS Expands to Rural Areas

On Sept. 1, the STAR+PLUS Medicaid managed care program will expand to 164 rural counties not currently participating in the model. With this expansion, elderly patients eligible for Medicaid long-term services and supports (LTCSS) and adult patients with disabilities will be required to enroll in a STAR+PLUS plan. Children with disabilities can enroll voluntary.

For patients eligible for all Medicaid services, STAR+PLUS HMOs cover all traditional Medicaid visits, such as doctor visits, emergency care, and hospital services, as well long-term care services. For patients dually eligible for both Medicare and Medicaid, Medicare will continue to provide acute care services, while the STAR+PLUS HMO will provide LTCSS. 

Patients with intellectual and developmental disabilities, including those living in an Intermediate Care Facility or those eligible for certain long-term care services, also will be enrolled in STAR+PLUS for their acute care services, such as doctor visits and hospital care. They may live in a community-based Intermediate Care Facility for Individuals with Intellectual Disabilities or Related Conditions (ICF-IID) or receive services through one of the following ICF-IID waiver programs:  

  • Home and Community-based Services (HCS),
  • Community Living Assistance and Support Services (CLASS),
  • Texas Home Living (TxHmL), or
  • Deaf Blind with Multiple Disabilities (DBMD).   

Nursing facility services were originally scheduled to transition to STAR+PLUS Sept. 1. The Texas Health and Human Services Commission (HHSC) has postponed moving nursing facility residents into STAR+PLUS Medicaid managed care until March 1, 2015. 

For more information, visit HHSC’s Medicaid Managed Care Initiatives page.  

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West Texas Health Information Exchange Grant Funding Available

Developing health information exchange (HIE) infrastructure in Texas has rapidly gained traction due to $28 million in federal Health Information Technology for Economic and Clinical Health (HITECH) funding. Texas uses its share of the federal money to establish HIEs in local communities.

West Texas' white space, a term referring to the areas of the state without local and regional HIE activity, has an opportunity to expand access to HIE services through grant funding available from the Texas Health Services Authority (THSA). Through the West Texas HIE Planning Grant Program, THSA will award up to $300,000 to fund the development of up to four HIE business and operational plans. Awardees' plans will outline a clear path from the current capabilities to access HIE services in West Texas to an operational query-based HIE that is qualified for the Texas HIE Accreditation Program and prepared to connect to HIETexas.

A complete application must be submitted to THSA Chief Executive Officer Tony Gilman,, by Aug. 1. 

The subject line of e-mails related to the grant application should state: "West Texas HIE Planning Grant Program RFA: [Applicant Name] [Option Number]." Access the Request for Applications (RFA) document for more information.

A list of counties that make up the Texas white space region is available online.

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AMA Adopts Telemedicine Policy to Improve Access to Care

At the American Medical Association Annual Meeting in June, the AMA House of Delegates voted to approve a list of guiding principles for ensuring the appropriate coverage of and payment for telemedicine services. 

The guiding principles came from a report developed by the AMA Council on Medical Service. The goals of the report were to protect the patient-physician relationship, support innovation, ensure patient privacy and quality of care, and promote care coordination and communication with a patient’s medical home.

The AMA house added to its policy that a valid patient-physician relationship must be established through a face-to-face physical exam before the telemedical encounter or through a telemedical encounter where a licensed health care provider, acting under the delegation and supervision of the remote physician, is present as a clinical observer. Delegates also decreed that a physician providing telemedicine services must meet the licensure requirements and follow the medical practice laws of the state in which the patient receives the services.

The guiding principles are similar to a telemedicine policy the Federation of State Medical Boards (FSMB) adopted in April.

For more information on the telemedicine report, see the AMA website. Read “Digital Doctor” in the July issue of Texas Medicine for more on the evolution of telemedicine, FSMB’s policy, and telemedicine licensure and credentialing concerns. 

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Central American Refugees Cross Into Texas

TMA’s leadership and members are monitoring the need for humanitarian medical care for the growing number of unaccompanied minors, adults, and families crossing the Texas-Mexico border from Central America. So far, those apprehended by U.S. Border Patrol include more than 30,000 unaccompanied minors from Central America (El Salvador, Honduras, and Guatemala). Estimates indicate the number of unaccompanied minors could grow to 60,000 by the end of the year. Many report they are traveling more than 1,000 miles to escape violence and poverty in their countries.  

TMA is calling on President Barack Obama and Gov. Rick Perry to provide medical aid to the thousands of women and children who have traveled from Central America to Texas. The Texas Department of State Health Services reports that severe crowding in the federal facilities and shelters increases the possibility of the spread of infection. Another concern is the use of state and federal resources that could be needed in the event of a natural disaster such as hurricane.  

Several federal agencies — U.S. Border Patrol, Federal Emergency Management Agency, and U.S. Department of Health & Human Services Office of Refugee Resettlement — are responsible for the care of those entering the country without documentation. Within 72 hours of apprehension, an unaccompanied minor must be transferred to the custody of the Office of Refugee Resettlement. These minors are then relocated to federal facilities, such as Lackland Air Force Base in San Antonio or other shelters, to receive health screenings and other support. 

While the United States routinely maintains resources, including shelter and public health services for apprehended immigrants, the number of those crossing the Texas border far exceeds available resources. TMA members in South Texas report children are being held in extremely crowded conditions. Those adults and families who have family members in the United States can be released from custody. This population appears to be straining local public and charitable resources as they are spending days waiting for transportation to other parts of the United States to join other family members.  

Physicians with an interest in providing support to local charitable groups should read “Charitable Immunity,” TMA’s white paper on provisions associated with physician liability during a public health emergency.  

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Free TMA Publication Teaches Business Basics

Thanks to a generous grant from The Physicians Foundation, you can download TMA’s newest publication, Business Basics for Physicians, free.

Business Basics for Physicians guides you through essential business skills such as hiring and managing staff, developing a budget, crafting administrative policies and procedures, and promoting your practice. It takes a close look at accounting basics and financial management, long- and short-term business planning, working with payers, and using new technologies. 

Equip yourself with the knowledge and skills you need to ensure your practice’s longevity. Download your free e-pub today.

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Choose an EHR With TMA's Product Evaluation Tool

Need help finding the right EHR for your practice? TMA physician members have overwhelmingly indicated to us they need help when it comes to health information technology. They specifically want help with electronic health record (EHR) selection. TMA is here to help, with a tool on the TMA website.

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Keep Records When Attesting to Meaningful Use

TMA has learned of yet another snag in the Medicare and Medicaid electronic health record (EHR) incentive programs. A successful attestation submission may be voided if the submitter logs back in to the Centers for Medicare & Medicaid Services (CMS) attestation portal postsubmission. Any edits made postsubmission — even something as small as hitting the space bar — could void the original submission.

For more information, visit the TMA website

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Free Bike Helmets for Pediatricians, Family Physicians

The Texas Pediatric Society (TPS) and the Texas Academy of Family Physicians (TAFP) support TMA’s Hard Hats for Little Heads program by purchasing up to 50 helmets for their members to host helmet giveaway events. TMA matches the purchase so TAFP and TPS members receive up to 100 helmets at no cost for their giveaways.

Hard Hats for Little Heads is celebrating 20 years of keeping kids safe. In celebration of that milestone, the program wants to set a new record of giving away 34,000 helmets. Help with meeting the goal by signing up for a Hard Hats event today. 

Hosting a Hard Hats for Little Heads event is easy and rewarding. TMA provides everything you need: free helmets, banners, event signage, promotional flyers, educational handouts, and media relations support. Hard Hats will provide up to five anniversary t-shirts for volunteers for free.

Here are some great opportunities for hosting a helmet giveaway: 

  1. Back-to-school events or giveaways in connection with your local school. 
  2. Summer and fall health fairs. 
  3. October, during TMA’s statewide Hard Hats giveaway. We need more than 50 events lined up to meet our 5,000 helmet giveaway goal during that month.
  4. During the December holidays in conjunction with local bike giveaways.  

Email TMA’s outreach coordinator, or call (800) 880-1300, ext. 1470, or (512) 370-1470 to learn more about hosting an event. Be sure to mention if you’re a TAFP or TPS member.

Hard Hats for Little Heads is made possible through a grant from the TMA Foundation thanks to top donors — Blue Cross and Blue Shield of Texas, Prudential, and two anonymous foundations — and generous gifts from physicians and their families, and friends of medicine. 

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Save These Dates!  

Mark your calendar for TMA Fall Conference Sept. 12-13 at Hyatt Regency Lost Pines Resort & Spa in Bastrop. The conference provides an opportunity for physicians and medical students to conduct TMA business, obtain continuing medical education, and network with peers. 

This year, the conference visits a new venue just 30 minutes from downtown Austin. Situated on the banks of the Lower Colorado River, the Lost Pines Resort combines the natural beauty revered by early Native Americans with the colorful, regional history and culture of the Lost Pines Region for a true Texas wilderness escape. In addition to conference events, attendees can enjoy a variety of amenities including golf, spa time, horseback riding, hiking, archery, tennis, and the water park.

TMA’s special room rate is $199 for single or double occupancy. Reserve a room by calling (888) 421-1442 and asking for the TMA Fall Conference discount, or reserve your room online. The deadline to receive this special rate is Thursday, Aug. 21. Sleeping rooms are subject to a 7-percent occupancy tax rate. Local sales tax is 6.75 percent.

 Register online today. The conference is a free benefit for members. Contact the TMA Knowledge Center at (800) 880-7955 or with questions. 

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