TMA Legislative Hotline

Hotline is a daily electronic newsletter exclusively for TMA members that reports the legislature's latest actions on bills affecting Texas medicine.

Hotline Jan. 21, 2021: Physicians to Have Strong Voice in Texas Senate

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When Lt. Gov. Dan Patrick released the Texas Senate’s committee assignments last week, the Texas Medical Association was pleased to see extensive committee roles carved out for the chamber’s three physician-legislators.

And among the Senate committees that TMA tracks closely, there were few changes in Lieutenant Governor Patrick’s 2021 appointments from the 2019 session.

Two of the three physician-senators – Sen. Dawn Buckingham, MD (R-Lakeway) and Sen. Donna Campbell, MD (R-New Braunfels) – will serve on the Committee on Health & Human Services, the panel medicine watches most closely.  

Sen. Charles Schwertner, MD (R-Georgetown) will chair the Committee on Administration, which during the 2019 session oversaw local issues and Senate business, among other duties. He’ll also sit on the Committee on Finance, the Committee on State Affairs, the Committee on Business & Commerce, and the Committee on Education.

All told, Texas’ three physician-lawmakers will hold 16 committee spots, with each serving in one chair role.

Senator Buckingham will serve as chair of the Committee on Nominations. Her other assignments include spots on the Special Committee on Redistricting, the Committee on Administration, and the Committee on Finance.

Senator Campbell will helm the Committee on Veterans Affairs & Border Security, and also serve on Redistricting, Finance, Business & Commerce, and State Affairs.

The Committee on Health & Human Services will be chaired by Sen. Lois Kolkhorst (R-Brenham) with Vice Chair Rep. Charles Perry (R-Lubbock). Along with Senators Buckingham and Campbell, others on the committee will include Sen. Cesar Blanco (D-El Paso), Sen. Bob Hall (R-Edgewood), Sen. Borris Miles (D-Houston), Sen. Beverly Powell (D-Burleson), and Sen. Kel Seliger (R-Amarillo).

Both the House and the Senate stand adjourned this week and are scheduled to reconvene Tuesday, Jan. 26.

Easy Ways to Get Involved in TMA Advocacy 

The kickoff of the 2021 legislative session last week brings new opportunities to get involved in TMA’s grassroots advocacy efforts at the Capitol.

Your participation is a vital component of our legislative success. Please help strengthen the voice of medicine by joining our advocacy efforts.

Stay up to date on TMA’s progress in the legislature. And take advantage of other opportunities to get involved with our advocacy efforts.

Legislative Hotline Jan. 15: House Adopts Mask Protocol for New Session, Announces Electronic Comment Portal

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UNDER THE ROTUNDA 

The Texas Legislature finished its last business Thursday before a long early vacation, after the House of Representatives adopted rules for the 2021 session, including a mask requirement on the House floor and the option to electronically submit comments.

Rep. Todd Hunter (R-Corpus Christi), one of the authors of the House rules, explained on the floor that the public would have access to a new portal system to submit testimony, if they can’t or don’t want to travel to Austin to testify in person.

“Under the new rules, the public may attend in person. They will have to follow the mask requirements and the health protocol. Two, they may attend through the portal. They also may be attending by invited virtual [testimony],” Representative Hunter said. “We’re doing a pretty good job, and it doesn’t prevent House administration or our offices to work on even a better way.”

Lawmakers may remove their masks when speaking at either the front or back microphones. Committee members can participate in hearings virtually, but must be in the committee room for votes.

So far, the rules contain no provisions requiring COVID-19 testing before entering the House, Representative Hunter explained. He noted that all visitors will have the option to get tested at no expense, and lawmakers will be provided tests so they can require a test from anyone who comes into their office, if they choose.

He said medical experts have determined that “no single health protocol, taken alone” will protect the Capitol from the virus. Tests were “a screen shot in time,” Representative Hunter said, and he noted masks, social distancing, and air purifiers in Capitol offices as other ways to stop the spread of COVID-19.

“These rules don’t contemplate testing because until testing is available in our courthouses and for teachers and administrators in our school houses, we cannot mandate it in the Texas House,” Representative Hunter said. “That is the people’s House. And for us … to prioritize our own health and safety above others would be wrong.”

Senate Committees Announced: The Texas Senate on Friday released its list of committee assignments, with two of the chamber's three physician-legislators – Sen. Dawn Buckingham, MD (R-Lakeway), and Sen. Donna Campbell, MD (R-New Braunfels) – securing spots on the Committee on Health & Human Services. On the panel, to be chaired by Sen. Lois Kolkhorst (R-Brenham) and vice-chaired by Sen. Charles Perry (R-Lubbock), Drs. Buckingham and Campbell will serve alongside Sen. Cesar Blanco (D-El Paso); Sen. Bob Hall (R-Edgewood); Sen. Borris Miles (D-Houston); Sen. Beverly Powell (D-Burleson); and Sen. Kel Seliger (R-Amarillo).

Look for further analysis of this session’s committee assignments, and what they mean for medicine, in next week’s Hotline.

The House and Senate are adjourned until Jan. 26.

BECOME AN ADVOCATE 

There are a number of ways you can get involved with the Texas Medical Association’s advocacy during this session. Visit TMA’s Grassroots Action Center to find out how to become a grassroots advocate for medicine. You also can be part of TMA’s monthly “white coat takeover” – virtually this year – as a participant in First Tuesday’s at the Capitol. For complete information on TMA’s advocacy tools and resources, visit the TMA Texas Legislature page.

Legislative Hotline Jan. 14: Senate Reduces Votes Needed to Debate Bills

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UNDER THE ROTUNDA 

A decrease in the Republican majority in the Senate this session prompted an inevitable discussion Wednesday about the procedure for bringing bills to the floor for debate.

Since 2015, bringing a bill up for discussion required approval from at least 19 senators, or three-fifths of the 31-seat chamber. Yesterday, Sen. Bryan Hughes (R-Mineola) introduced Senate Resolution 2 to reduce the threshold for a supermajority to 18 votes – the number of seats now held by Republicans.

Despite protests from Democrats that this would disenfranchise them from participating in any discussion about which bills to consider, senators approved the change on a party-line vote.

At press time, the House of Representatives still was discussing its rules for session. After the House adjourns today, both chambers will be adjourned until Jan. 26.

Legislative Hotline Jan. 13: House Speaker Chosen as Session Gets Under Way

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Rapid testing tents were set up on the north side of the Texas Capitol on Tuesday morning as the 87th Legislature commenced.

UNDER THE ROTUNDA 

The Texas Legislature on Tuesday gaveled in what’s sure to be one of the most unique sessions in its history, with both the House and the Senate making quick work of their first day before adjourning.

In fact, this will be a quick week for lawmakers, followed by a nearly two-week recess. In what may be one sign of how the COVID-19 pandemic will affect the next four-plus months at the Capitol, both chambers will continue their work today and Thursday, then adjourn until Jan. 26.

A number of the factors that shape each session – such as committee assignments for lawmakers – won’t be determined until after each chamber reconvenes in late January. However, the legislature is squaring away some of its most basic structural business before it quits for the week.

Phelan Chosen as Speaker: The most significant piece of business from Monday’s mostly ceremonial activity was the election of a House speaker. As expected, the lower chamber chose Rep. Dade Phelan (R-Beaumont). He was nominated by Rep. Will Metcalf (R-Conroe), who in part cited his colleague’s “selfless actions” coordinating relief during Hurricane Harvey in 2017.

“He has been asked to step up and lead this body to probably what will be the toughest session any of us have ever experienced,” Representative Metcalf said on the House floor.

Representative Phelan was elected by a 143-2 vote, with four House members abstaining. When he addressed fellow lawmakers for the first time as speaker, he stressed the importance of focusing on education and the detriments to it caused by the pandemic, as well as getting Texans back to work by protecting citizens’ health and safety and revitalizing the economy through reduced regulatory burden.

Rules, or “What Will This Look Like?”: With the pandemic inevitably creating restrictions on the legislature’s normal course of business, both chambers are planning to debate and finalize their rules for this session in the coming days. The Senate plans to finalize its rules today, the House on Thursday.

Most important: how each chamber will conduct its committee hearings and in what manner they may be split between in-person testimony and remote appearances.

Budget Outlook Improves

The only thing the legislature is required by law to do each session is pass a two-year budget. Coming just ahead of Tuesday’s session kickoff was a state revenue budget estimate that looks a little better than the last one Comptroller Glenn Hegar issued.

On Monday, the comptroller’s office released its projection that the state has $112.5 billion available for the 2022-23 budget. It’s a decrease of 0.4% from the state budget currently in effect, but it’s a couple billion more than Comptroller Hegar estimated in July 2020. The comptroller’s office says the decline from the current budget is a direct result of the pandemic. The comptroller also is evaluating whether leftover federal funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act can help fill state budget shortfalls such as in the Medicaid program.

The state’s Economic Stabilization Fund, also known as the rainy day fund, will have a projected balance of $11.6 billion by the end of fiscal year 2023, also an increase. And the projected deficit fell from about $4.6 billion in the last estimate to about $1 billion in the new projection.

TMA’s Top 10 Victories this Legislative Session

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The Texas Medical Association scored on a wide range of goals to improve the state’s medical landscape during this year’s session of the Texas Legislature, which concluded in May. 

Which issues in health care and medicine did lawmakers address, and which were left undone? 

In public health, the House of Medicine convinced lawmakers that raising the age to purchase tobacco to 21 was the right thing for the state’s present and future. 

Medicine also successfully persuaded the legislature and Gov. Greg Abbott to improve insurance network adequacy and directories, which will help with surprise medical bills. Insurers’ prior authorization tactics took several damaging hits in the form of TMA-backed bills that became law. 

And the 2020-21 budget includes a number of vital funding increases, including a $68 million increase for women’s health programs, an added $60 million for graduate medical education (GME) slots, and $50 million more for community mental health services. 

TMA’s vice president of advocacy Darren Whitehurst tells us what we need to know about these victories in the TMA Legislative News Hotline’s Top 10 Issues videos. From maternal health improvements to health insurance reform, these brief videos report on progress achieved and opportunities missed this session. 

TMA’s Top 10:  

The Budget  

Surprise Billing Addressed   

Prior-Authorization Improvement Passes  

Efforts to Curb Opioid Abuse  

Scope of Practice  

Mental and Behavioral Health Legislation  

Maternal Health  

Governor Signs Tobacco Use Age Bill  

Volunteer Liability Protection  

TMB Sunset Bill 

And be sure to check out the entire playlist of legislative coverage of TMA physicians’ efforts to urge lawmakers to pass bills to benefit good patient care.

Legislative Hotline: Governor Signs Key Prior Authorization Bill

(Budget, Health Insurance, Liability Reform, Medicaid, Public Health, Texas Medical Board, Women’s Health) Permanent link

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UNDER THE ROTUNDA

The work of the 86th Texas Legislature passed its final stage at midnight Sunday, the deadline for Gov. Greg Abbott to to sign, veto, or allow bills to become law without his signature.

Among those he signed this weekend was Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio). This bill requires greater transparency with prior authorizations and mandates that utilization reviews be conducted by a Texas-licensed physician in the same or similar specialty as the physician requesting the service or procedure. It also requires health plan directories to clearly identify which physician specialties are in-network at network facilities.

Thank you to our members who contacted the governor to urge him to sign SB 1742. Your advocacy worked.

The governor also signed House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) which will delay the mandate to check the prescription monitoring program (PMP) until March 2020. The Texas Medical Association fought hard for the delay to give the PMP time to fully integrate with physicians’ electronic records systems. This reduces the hassle involved in using an important clinical tool. HB 3284 also requires electronic prescribing of opioids unless a waiver is granted. Electronic prescribing diminishes the chance of opioids being misused.

The Texas Medical Board (TMB) will not be a political football this year. Governor Abbott signed House Bill 1504 by Rep. Chris Paddie (R-Marshall), which extends the life of the TMB by 12 years – to 2031. In addition, HB 1504 includes provisions to ensure that dismissed or frivolous complaints or disciplinary actions are removed from physicians’ profiles as quickly as possible. It also allows expedited licensing for physicians who hold a full license and are in good standing in another state.

All told, 7,434 bills were filed during the session, which ended May 27. TMA monitored more than 1,900 bills, of which only a handful made it to Governor Abbott.

The outcome of numerous other bills important to medicine is listed below.

Vetoes

Governor Abbott vetoed two bills TMA supported: 

House Bill 448 by Rep. Chris Turner (D-Grand Prairie) would have required transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds. Governor Abbott vetoed this bill, saying it is overly prescriptive and micromanages parents.

House Bill 455 by Rep. Alma Allen (D-Dallas) would have directed the State Board of Education to develop recess policies that encourage outdoor play time and physical activity. While acknowledging the educational and health benefits of recess, Governor Abbott vetoed the bill, saying it’s another mandate and is bureaucracy for bureaucracy’s sake.

Budget

House Bill 1, by Rep. John Zerwas, MD (R-Richmond), is the $250 billion 2020-21 biennial budget. Governor Abbott signed HB 1 with no line-item vetoes. 

The budget does not include any physician rate increases for Medicaid, and it requires the state to find $350 million in Medicaid savings. 

“Physician services have not had any change in payment for 20 years,” TMA Past-President Doug Curran, MD, said. “That’s so wrong. It’s wrong for the patients, it’s wrong for the physicians, and it just makes it impossible for the doctor to continue to see these people that need our help and care.” 

However, the budget does increase funding for programs and initiatives that will help improve maternal health, behavioral health, and graduate medical education. 

Professional Liability

House Bill 2362 by Rep. Joe Moody (D-El Paso) ensures that physicians working in emergency rooms who face high-risk obstetrical cases requiring immediate and difficult decions are protected from unwarranted lawsuits. Notable exceptions to the willful and wanton protection include instances in which the patient’s treatment is unrelated to a medical emergency, and for any physician whose negligent act or omission causes a stable patient to require emergency medical care. Governor Abbott signed HB 2362.

Mothers and Children

House Bill 170 by Rep. Diego Bernal (D-San Antonio) will require health plans to cover diagnostic mammograms at 100%, the same as screening mammograms. The governor signed this bill.

Senate Bill 355 by Sen. Royce West (D-Dallas) directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care. SB 355 was filed without Governor Abbott’s signature, meaning the bill becomes law.

Senate Bill 952 by Sen. Kirk Watson (D-Austin) will require that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards. Governor Abbott filed SB 952 without his signature. 

Insurance

Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) will require baseball-style arbitration for most surprise medical bills, effectively removing patients from the billing dispute resolution process. Patients who elect to go out-of-network for health care are not covered by this arbitration process. Governor Abbott signed this bill.

House Bill 1941 by Rep. Dade Phelan (R-Beaumont) will prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200% or more of the average charge for the same or substantially similar treatment at a hospital emergency room. HB 1941 will financially protect patients seeking care in an emergency. Governor Abbott signed this bill.

House Bill 3911 by Rep. Hubert Vo (D-Houston) will require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations (PPOs) and exclusive provider organizations (EPOs) at least once every three years. Inadequate or narrow networks contribute to higher costs for patients and frustration for physicians. Governor Abbott signed this bill.

House Bill 1584 by Rep. Senfronia Thompson (D-Houston) will prohibit step therapy protocols for stage-4 metastatic breast cancer. HB 1584 was filed without signature by the governor.

House Bill 1576 by Representative Phelan will allow Medicaid to contract with a transportation network company, such as Uber or Lyft, for nonemergency transportation to or from a medical appointment. Making it easier to get to the doctor will improve patient compliance with prescriptions and other remedies prescribed by the physician. Governor Abbott signed this bill.

House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress) will require vastly improved transparency regarding prescription drug costs, including posting drug price information on the Health and Human Services Commission’s website and explaining cost increases of greater than 40%. Governor Abbott signed this bill.

House Bill 2041 by Representative Oliverson will require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees. Pricing transparency will help patients make more prudent choices for emergency health care. The governor signed this bill.

Opioids

House Bill 2174 by Representative Zerwas limits the duration of opioid prescriptions, requires electronic prescribing beginning on Jan. 1, 2021, requires opioid-related CME, and prohibits prior authorization for medication-assisted treatment for opioid-use disorder. HB 2174 will help prevent “doctor shopping” by patients seeking opioids for non-therapeutic uses. Governor Abbott signed this bill.

House Bill 3285 by Representative Sheffield will permit telehealth treatment for substance-use disorder, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths. Governor Abbott signed this bill. 

Graduate Medical Education/Workforce

House Bill 2261 by Rep. Armando Walle (D-Houston) will increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000. The repayment program is designed to encourage new physicians to start their careers in underserved communities by helping them pay off student loans in return for a four-year practice commitment. Governor Abbott signed this bill.  

Telemedicine

House Bill 3345 by Rep. Four Price (R-Amarillo) allows physicians to choose the best platform for providing services rather than having health plans dictate the platform. HB 3345 complements Senate Bill 1107 from the last legislative session, which stipulated that services provided via telemedicine are to be covered the same as any other service provided by a physician. Governor Abbott signed this bill.

Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway) requires Medicaid to cover telemedicine services. Governor Abbott signed this bill.

House Bill 1063 by Representative Price will require Medicaid to cover home telemonitoring for specific pediatric patients. HB 1063 will prevent families from having to take very ill children to their physician’s office when the necessary care and monitoring can happen from home. Governor Abbott signed this bill.

Long-Term Care

House Bill 2050 by Representative Paddie requires written consent for the administration of psychoactive drugs to patients in long-term care facilities. Frequently, residents in long-term care facilities have limited contact with family members, so allowing one-time written consent will save precious time when medications may need to be provided. Governor Abbott signed this bill. 

Cannabis

House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth) updates the Compassionate Use Act adopted by the legislature in 2015, broadening the list of symptoms and illnesses for which patients can use low-THC cannabis. Governor Abbott signed this bill. 

If you have a question about a specific bill from this legislative session, contact the advocacy team via the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 a.m. to 5:15 p.m. Central Standard Time. 

HEALTHY VISION 2025

Healthy Vision 2025 – released in late January – is TMA’s all-inclusive, health care roadmap for legislators during the interim session.

Want to help spread and promote TMA’s Healthy Vision for Texas? Become a TMA social media ambassador.

Beware the Bait-and-Switch of Short-Term Insurance Plans

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Short-term insurance plans were originally intended to be a stopgap solution for people between jobs or who needed temporary coverage for other reasons. But that is changing, and that could be a problem for you or your patients. 

Initially, short-term plans were just that: short-term, or limited to 90 days of coverage. Short-term plans have evolved to provide 364 days of coverage. And short-term plans cost much less than Affordable Care Act (ACA) plans. 

If that all seems too good to be true, that’s because it is. 

Short-term plans essentially provide only catastrophic coverage. They do not cover pre-existing conditions, and they do not cover preventive care. ACA premium subsidies are not available for short-term plans. Yet people still buy the plans. 

For Texas at least, a new state law seeks to prevent the shock and awe that happens when patients attempt to access care covered by short-term plans. 

Senate Bill 1852 by Sen. Angela Paxton (R-McKinney) mandates that short-term plans inform enrollees about the limitations and possible exclusions of short-term coverage, including:No prescription drug coverage;

  • No mental health services;
  • No substance abuse treatment;
  • No maternity care;
  • No hospitalization;
  • No surgery;
  • No emergency health care; and
  • No preventive health care. 

Gov. Greg Abbott signed the bill into law last week. It will take effect Sept. 1. 

SB 1852 requires patients to sign a disclosure form acknowledging what short-term plans do and don’t cover. Expiration of the short-term plan may occur outside of the ACA open-enrollment period, meaning that if patients want to switch to an ACA plan for its more comprehensive coverage, they may not be able to immediately enroll in that plan. 

This can be a sticky wicket for physicians when they must be the bearer of bad news: the short-term plan doesn’t cover the patient’s visit. And since more and more patients are selecting short-term plans instead of full coverage, the Texas Medical Association encourages physicians to verify eligibility before providing services.