TMA Legislative Hotline

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.

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.

A bill to improve the effectiveness of and access to behavioral health care in Texas seemed destined to pass the Texas Legislature as the 2019 session was winding down last month. But late-stage drama nearly upended the effort. 

Senate Bill 10 by Sen. Jane Nelson (R-Flower Mound) would have created the Texas Mental Health Care Consortium. It just needed final approval by the House of Representatives and validation by Gov. Greg Abbott, who previously deemed the issue an emergency priority. However, a point of order raised in the session’s final week killed the bill. 

A maneuver to tack the bill onto another that ultimately passed – Senate Bill 11 – saved it, Texas Medical Association Vice President of Advocacy Darren Whitehurst says. TMA backed SB 10, which will provide community-level health treatment programs, and mental health research. TMA also backed SB 11, which addresses school safety. 

As TMA previously reported, SB 10 was designed to identify children with mental-health needs and direct them to appropriate, timely treatment. The bill was filed partly in response to last year’s Santa Fe High School shooting. 

The governor signed SB 11 (with SB 10’s language included) into law Thursday. 

Watch this and more in today’s TMA Legislative News Hotline video, the sixth in a “top 10” legislative summary series.

UNDER THE ROTUNDA

After several sessions’ trying to protect the health of Texas youth by delaying the onset of smoking and thus nicotine addiction, a bill to raise the minimum age to purchase tobacco and vape products to 21 years is heading to Gov. Greg Abbott’s desk.

The Senate today passed Senate Bill 21 by Sen. Joan Huffman (R-Houston) after concurring with amendments the House added to the bill on a vote of 28-3.

Governor Abbott has indicated he will sign the bill.

The Texas Legislature failed to approve a similar measure in 2017. This year, the bill had bipartisan support in both the House of Representatives and the Senate. The Texas Medical Association testified in strong support of SB 21 earlier this session.

Also on its way to Governor Abbott’s desk today is Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services. Senators concurred 31-0 on amendments the House added to the bill. TMA supports this bill.

Meanwhile, only seven days remain in this session. Every day is now a critical deadline of some sort.

The House and Senate both have until midnight May 22 to consider bills on their final debate for passage.

Here’s a roundup of the status of medicine’s key bills: 

Telemedicine

• House Bill 3345 by Rep. Four Price (R-Amarillo) – which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform – was recommended for the Senate Local and Uncontested Calendar. TMA strongly supports this bill.

Graduate Medical Education

• Senate Bill 1378 by Senator Buckingham, which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, was signed by the governor yesterday. TMA testified in support of this bill.  

2020-21 State Budget

Lawmakers on Monday released a draft of their negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26 – next Sunday. In case you missed yesterday’s brief, here’s a snapshot of the current status of the budget.

House Bill 1, by Representative Zerwas is the $248 billion, 2020-21 state budget. House and Senate conference committee members have been working through Articles II and III – health and human services and education, respectively – and released a preliminary budget document. Here are some quick highlights and lowlights:

Medicaid

• Includes $0 for physician rate increases, despite TMA’s call for a $500 million investment in targeted rate increases in the two-year budget, a long-time TMA priority;
• Increases inpatient rates for rural hospitals and provides for a $500 add-on payment for rural hospitals that provide labor and delivery services; and
• Adopts $350 million in state funds ($900 million total) for Medicaid cost-containment, meaning $350 million in savings in Medicaid must be identified. TMA opposed this cut. 

Maternal Health

• Adopts an additional $52 million for women’s health programs, including:
• $45 million for the Healthy Texas Women program, $15 million of which is contingent on passage of Senate Bill 750 by Sen. Lois Kolkhorst (R-Brenham) to help improve prenatal and postpartum coverage (SB 750 passed the House today and returns to the Senate for consideration of amendments the lower chamber added);
• $7 million for the Family Planning Program; and
• $840,000 more for the Breast and Cervical Cancer Treatment Program.
• Adds $7 million to implement measures to reduce maternal mortality and morbidity. 

Public Health

• Adds new dollars to modernize the state’s public laboratory, including funds to make overdue repairs, replace aging equipment, and retain skilled laboratory staff, as well as to pay for X-ALD genetic screening – all TMA requests; and
• Incorporates TMA recommendations that the Department of State Health Services (DSHS) study the economic costs of responding to vaccine-preventable disease outbreaks and submit a report to the state no later than Sept. 1, 2020. 

Behavioral Health

• Adopts an increase of $50 million to improve community mental health services for adults and an additional $8 million for children’s mental health; and
• Includes $100 million to establish the Texas Mental Health Care Consortium outlined in Senate Bill 10 by Sen. Jane Nelson (R-Flower Mound), including $20 million to implement the new Child Psychiatric Access Network and another $43 million to implement the Texas Child Health Access Through Telemedicine program. (SB 10 is on the House calendar for today.) 

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

• Provides $157.2 million to preserve the hard-fought ratio of 1.1 first-year Graduate Medical Education (GME) slots for every Texas medical school graduate
• $3 million for community psychiatry workforce expansion; and
• $1.5 million for child and adolescent psychiatry fellowships.
• The Physician Education Loan Repayment Program did not receive any additional funding to restore cuts made in previous sessions; funding is even with the current biennium’s allocation. 

Final, detailed summaries of the budget documents are expected to be published by the Legislative Budget Board late this week. The budget will be debated on the House floor on Saturday. As we delve deeper into the draft documents, we will post more detailed analyses.

Texas Medical Board/Corporate Practice of Medicine

• House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, was voted unanimously out of the Senate last week. The House did not accept changes the Senate made to the bill, and named a conference committee to negotiate the differences. The Texas Medical Association testified in support of this bill earlier this session.
• House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill in March.

Prescription Monitoring Program/Opioids

• House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) – which would help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder – is set on today’s Senate Calendar. TMA supports this bill.
• House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) – which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy – is on today’s Senate Calendar. TMA supports this bill.
• House Bill 3285, also by Representative Sheffield – which would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths – is on today’s Senate Calendar. TMA supports this bill.   

Professional Liability

• House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment, was recommended for the Senate Local and Uncontested Calendar. After extensive negotiation and revision, TMA supports the bill.

Insurance

• Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – received final approval in the House today and now returns to the Senate for consideration of amendments added in the House. Senators can either accept those changes or send the bill to a conference committee to work out the differences. After extensive negotiation, TMA supports this bill.
• Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) would require health plan directories to clearly identify which physician specialties are in network at network facilities. The Senate did not accept changes the House made to the bill, and named a conference committee to negotiate the differences. TMA testified in support of this bill.
• House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill.
• House Bill 1941 by Rep. Dade Phelan (R-Beaumont) – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – is set on the Senate Calendar for today. TMA supports this bill.
• House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, is on today’s Senate Calendar. TMA testified in support of this bill.

Maternal Health

• House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, was voted out of the Senate 30-1 late last week. The House now must decide whether to accept the amendments the Senate made to the bill or ask for a conference committee to negotiate the differences. TMA testified in support of this bill last month.
• Senate Bill 749 by Senator Kolkhorst, which would establish level of care designations for hospitals that provide maternal and neonatal care, received final approval in the House today and returns to the Senate for consideration of amendments the House added. TMA testified in support of this bill.
• SB 750, also by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, received final approval in the House today and returns to the Senate for consideration of amendments the House added. SB 750 must pass for contingent funding to be allocated. TMA testified in support of this bill.
• House Bill 1111 by Rep. Sarah Davis (R-West University Place) which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, is on today’s Senate Calendar. TMA supports this bill.

Mental Health

• Senate Bill 10 by Senator Nelson – which would create the Texas Mental Health Care Consortium, a collaboration of health-related institutions of higher education and the Statewide Behavioral Health Coordinating Council to improve the effectiveness of and access to behavioral health care for Texas youth – is set on today’s House Calendar. TMA testified in support of this bill.

Graduate Medical Education/Workforce

• House Bill 1065 by Rep. Trent Ashby (R-Lufkin), which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings, has passed both chambers. It’s now up to the House to decide what to do about amendments that senators added to the bill. TMA submitted written testimony in support of this bill.
• House Bill 2261 by Rep. Armando Walle (D-Houston) – which would 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 – passed out of the Senate yesterday 26-5. House members must now consider the amendments added in the Senate. TMA supports this bill.  

Immunizations/Long-Term Care

• House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth) which would establish infection control programs in long-term care facilities, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill.
• Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, is set on today’s House Calendar. TMA submitted written testimony in support of this bill.

TMA is watching each bill, committee substitute, and amendment for any changes, or for an opportunity to amend a stalled TMA-supported bill. If you have a question about a specific bill, contact the advocacy team via the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT. 

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Tatiana Cordova, MD, of San Antonio. Dr. Cordova graduated from the UT Health San Antonio Long School of Medicine and is a member of the Bexar County Medical Society.

WHAT WE’RE READING

In addressing opioid crisis, Texas lawmakers shy away from controversial bills – Austin American-Statesman

HHS’ Hargan: Innovators needed to reshape healthcare system – Modern Healthcare

Fort Worth’s Medical School Curriculum to Avoid Burnout and Emphasize Empathy – D CEO Healthcare

Medical cannabis bill clears Texas Senate committee: Can it pass before session ends? – Corpus Christi Caller Times

Texas budget deal includes push to prolong anti-cancer effort championed by Lance Armstrong – The Dallas Morning News