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.

Legislative Hotline: Safety for First Responders, and Preventing Chiropractors From Practicing Neurology

(Budget, Public Health, Scope of Practice, Texas Medical Board) Permanent link

Capitol_Dome

UNDER THE ROTUNDA

A pair of bills that would help first responders during disasters began their journey through the Senate today with hearings in the Senate Health and Human Services Committee. The bills were written by Rep. Dade Phelan (R-Beaumont), whose district was hit particularly hard by Hurricane Harvey in 2017.

House Bill 1256 would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster. House Bill 1418 would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification.

Thomas Kaspar, MD, an infectious disease specialist from Victoria and the incoming chair of the Texas Medical Association’s Committee on Infectious Diseases, testified on behalf of both bills, reminding lawmakers that if they’re not up to date on their immunizations, “first responders risk exposure to and infection by potentially serious or even deadly diseases.”

TMA supports both of these bills.

Senate Bill 1867 by Sen. Juan “Chuy” Hinojosa (D-McAllen), which also was heard in the Senate Health and Human Services Committee today, would add “neuro” to chiropractors’ current statutory scope of practice, which is limited to the musculoskeletal system.

Testifying in opposition to SB 1867 was Sara Austin, MD, an Austin-based neurologist, who informed lawmakers that adding neuro is not merely the addition of the nerves that may connect muscle tissue or bones. “It is the addition of the entire neurological system that includes the brain, spinal cord, and the regulation of many bodily functions beyond chiropractors’ education and training.” TMA strongly opposes this bill.

TMA yesterday issued a legislative alert for all Texas physicians to register their opposition to this bill by calling the committee members.

“The chiropractors are trying to convince the Texas Legislature that they are qualified to diagnose and treat disorders of the nervous system,” said TMA President Doug Curran, MD. “You and I know that’s an absurd idea. We know that such a drastic expansion of chiropractors’ scope of practice is unsupported by their education and training. We know it would be a danger to patient safety.”

BILLS MOVING

TMA is monitoring 1,952 of the 7,771 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. House bills must be out of House committee by Monday, May 6 – the day before our last First Tuesdays of this session – to be considered this session.

As debate shifts from committees to chamber floors, the debate calendars will lengthen as hundreds of bills will be set for consideration each day. Committee meetings will bookend floor sessions and will start to run late into the night. Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving.

TMA is watching each bill, committee substitute, and amendment for any changes. It is not uncommon for revised legislation to prompt a revised position from TMA, particularly when bad bills become better bills through rewriting or amendments. 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.

Below are a few TMA-tracked bills that continue to move through the legislative process:

  • 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 heard in the Senate Health and Human Services Committee without much debate. HB 1504 sponsor Sen. Robert Nichols (R-Jacksonville) pledged to keep the bill “clean” as it moves through the Senate, meaning he will consider the original version of the bill as written by Representative Paddie and will not be accepting amendments. TMA testified in support of HB 1504 last month and continues to closely monitor this bill.
  • Senate Bill 732 by Sen. Bryan Hughes (R-Mineola), which would allow patients to have direct access to physical therapists without a referral by a physician, was heard today in the Senate Business and Commerce Committee. The companion bill, House Bill 29 by Rep. Ina Minjarez (D-San Antonio), has been amended to limit the allowable number of direct access visits and now requires patient acknowledgement that they are not receiving a medical diagnosis, nor is the treatment likely to be covered by insurance. HB 29 was voted out of the House Public Health Committee last week. TMA continues to closely monitor these bills.
  • 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 set for debate on the House floor today. As of press time, the bill had not yet come up for debate. TMA strongly supports this bill.
  • House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform to use for providing telemedicine services to their patients, rather than having health plans dictate the platform, is set for debate on the House floor tomorrow. TMA strongly supports HB 3345.

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

Just as you’d like more direct face-to-face time with your patients, lawmakers find face-to-face time with constituents valuable. But they, too, have limitations. When you schedule an in-person meeting with your legislators, 15 minutes (possibly 20) is a realistic expectation for your meeting. But be aware that chances are good you’ll have to wait when you arrive at your legislator’s office – even for a meeting with a staff member. Build the prospect of delay into your schedule; don’t take it personally. Use the time to relax or chat with a staff member who offers conversation. On the other hand, don’t interrupt a busy staff person or an overworked receptionist trying to cope with ringing telephones. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Linda Porter-Tucci, MD, of Houston. Dr. Porter-Tucci graduated from the Baylor College of Medicine and is a member of both TMA and the Harris County Medical Society.

WHAT WE’RE READING

Pain & Profit: Bills to fix Texas’ broken Medicaid system gain momentum despite pushback from insurers –The Dallas Morning News

Here’s why more young people in Texas are considering suicide – Fort Worth Star-Telegram

Austin rally tackles child mental health and suicide prevention – KXAN-TV

San Antonio ‘at the heart’ of burgeoning kidney disease crisis – San Antonio Express-News

New development aims to boost medical innovation in Austin – KVUE-TV

Stop selling tobacco to Texans 21 and younger [Opinion] Galveston Daily News

Keep Texas at the forefront of the fight against cancer [Opinion] – Austin American-Statesman

 

Legislative Hotline Video: Don’t Penalize Physicians For Protecting Patients

(Budget, Health Insurance, Medicaid, Public Health, Texas Medical Board) Permanent link

Should the state take away physicians’ Medicaid and CHIP payments if they choose not to provide care for any unvaccinated patient? 

This week’s TMA Legislative News Hotline video takes an in-depth look at a bill that would penalize doctors who make this difficult choice to protect their most vulnerable patients. Austin pediatrician Mai Duong, MD, tells us why the bill would be harmful. 

Speaking of Medicaid, TMA President Doug Curran, MD, explains why the Texas should boost the state-federal funding to help these patients, as the House-Senate Budget Conference Committee finalizes the state’s spending plan for the next two years. 

Also, TMA Council on Socioeconomics Chair John Flores, MD, tells us about the benefits of a bill to cut some prior-authorization requirements, and who could be aided by such a plan. He testified in support of the bill, House Bill 3232, this week. 

And we  summarize which top TMA legislative priorities are still in play this session, with a few highlights, including the measure to renew the Texas Medical Board, a balance-billing solution, and the bill to raise the minimum age for sale of tobacco products to 21. 

All of that and more in this week’s TMA Legislative News Hotline video.

Also, make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests, and TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

Legislative Hotline: Another Positive Step For Tobacco Restriction

(Medicaid, Public Health) Permanent link

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UNDER THE ROTUNDA
Typically, when bills are heard in committee for the first time, bill authors will answer questions from fellow legislators, witnesses will testify, and the bill will be left pending.

Bills receiving their first reading in committee are scheduled and posted in advance of the hearing. Bills must be read a second time in committee before they can be voted on, and the second hearing is typically not posted in advance. Instead, those bills are heard as pending business at the discretion of the committee chair.

It’s been a busy week for bills that have been left pending in committee over the past several weeks. Below is an update on the status change of bills important to the house of medicine.

Senate Bill 21 by Sen. Joan Huffman (R-Houston), which would raise the minimum age to purchase tobacco and vape products to 21 years, excluding active duty military, was voted out of the House Committee on Public Health yesterday. It will be heard next on the House floor.

House Bill 1353 by Rep. Tom Oliverson, MD (R-Cypress), which would provide liability protection for physicians who volunteer in the aftermath of disasters, was voted out of the House Judiciary and Civil Jurisprudence Committee late Tuesday and awaits a hearing on the House floor. TMA testified in support of HB 1353 last month.

Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills), which would require baseball-style arbitration for most surprise medical bills, was referred to the House Insurance Committee. It may seem late in the session for a bill to just now arrive in committee, but SB 1264 is a priority bill for its House joint authors, Representative Oliverson and Rep. Trey Martinez Fischer (D-San Antonio), and likely will be heard soon. TMA supports the revised bill.

Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio), which would require health plan directories to clearly identify which physician specialities are in-network at network facilities, was placed on the Senate Local and Uncontested Calendar for Friday, meaning it has little opposition. Its companion bill, House Bill 2630 by Rep. Julie Johnson (D-Carrollton), received preliminary House approval yesterday. It is not uncommon for both bills to continue through the legislative process.

Senate Bill 2316 by Sen. Juan “Chuy” Hinojosa (D-McAllen) would delay the mandate to check the Prescription Drug Monitoring Program (PMP) until March 1, 2020, to allow time for electronic integration of the PMP into physicians’ electronic health records. The bill also would create an advisory committee to the Board of Pharmacy. TMA supports this bill, which was also recommended for the Senate Local and Uncontested Calendar.

BILLS MOVING

TMA is monitoring 1,945 of the 7,751 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 – the day before our last First Tuesdays of this session – to be considered by the Senate this session. 

As debate shifts from committees to chamber floors, the debate calendars will lengthen as hundreds of bills will be set for consideration each day. Committee meetings will bookend floor sessions and will start to run late into the night. Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving. 

TMA is watching each bill, committee substitute, and amendment for any changes. It is not uncommon for revised legislation to prompt a revised position from TMA, particularly when bad bills become better bills through rewriting or amending them. If you have a question about a specific bill, contact the advocacy team in the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT. 

Below are a few TMA-supported bills which continued to move through the legislative process yesterday on the House floor: 

  • 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, yesterday passed the House 144-3. The bill now moves to the Senate. TMA testified on this bill last month.
  • 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, and require opioid-related CME – was amended by Rep. J.D. Sheffield, DO (R-Gatesville) yesterday to specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder. HB 2174 received preliminary approval and must be heard one more time on the House floor before it moves to the Senate.  

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

PHYSICIAN OF THE DAY

Today’s physician of the day is Richard Young, MD, of Fort Worth. Dr. Young graduated from the UT Health San Antonio Long School of Medicine and is a member of both TMA and the Tarrant County Medical Society.

WHAT WE’RE READING

Blue Cross Blue Shield of Texas: ER docs at 14 DFW hospitals now out of network – WFAA

Feds issue new warning to doctors: Don’t skimp too much on opioid pain pills – USA Today

CMS invites states to test new dual-eligible care models – Modern Healthcare

US measles cases hit highest mark in 25 years – The Associated Press

World health officials take a hard line on screen time for kids. Will busy parents comply? – The Washington Post

Americans are more focused on health costs than Medicare-for-all, poll shows – The Washington Post

Legislative Hotline: Telemedicine Bill Up for Vote Today

(Public Health) Permanent link

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UNDER THE ROTUNDA
Expanding access and payment for telemedicine services is a Texas Medical Association priority this session, and a bill that would improve physicians’ ability to serve their own patients electronically is making steady progress.

House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform to use for providing telemedicine services to their patients, rather than having health plans dictate the platform, is set for debate on the House floor today. It was voted unanimously out of the House Insurance Committee earlier this month. TMA strongly supports HB 3345.

State lawmakers made tremendous progress on telemedicine in 2017, passing a TMA-backed law that defines telemedicine as a way to deliver health care, not just a health care service. The law also clarifies that the standard for telemedicine is the same as an in-person visit.

Also on the House calendar today is House Bill 2174 by Rep. John Zerwas, MD (R-Richmond), which would help physicians address the nationwide opioid crisis by taking steps to prevent “doctor shopping.”

TMA has worked with Representative Zerwas to modify the original bill, and the committee substitute that was heard on the House floor today incorporates changes sought by the house of medicine. Compared to the original version, the substitute:

  • Raises the seven-day limit on opioid prescriptions to 10 days;
  • Requires Schedule II drugs to be prescribed electronically beginning Jan. 1, 2021, which is when Medicare will implement the same requirement, with waivers for physicians who face economic hardship or technical limitations in meeting e-prescription requirements; and
  • Requires physicians to complete two hours of opioid-related CME, which may count as ethics credit. This CME is required one time only.

TMA thanks Representative Zerwas and continues to support HB 2174.

BILLS MOVING

TMA is monitoring 1,945 of the 7,751 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 – the day before our last First Tuesdays of this session – to be considered by the Senate this session. 

As debate shifts from committees to chamber floors, the debate calendars will lengthen as hundreds of bills will be set for consideration each day. Committee meetings will bookend floor sessions and will start to run late into the night. Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving. 

TMA is watching each bill, committee substitute, and amendment for any changes. It is not uncommon for revised legislation to prompt a revised position from TMA, particularly when bad bills become better bills through rewriting or amending them. If you have a question about a specific bill, contact the advocacy team in the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT. 

Below are a few TMA-supported bills continuing to move through the legislative process: 

  • Senate Bill 998 by Sen. Juan “Chuy” Hinojosa (D-McAllen) – 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 – was heard in the Senate Higher Education Committee today and left pending. House Bill 2261 by Rep. Armando Walle (D-Houston), the companion bill, passed the House and awaits action in the Senate Higher Education Committee. Having both versions continue through the process is not uncommon.
  • House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require greater prior authorization transparency, was amended by Representative Zerwas so that it also requires that utilization reviews be conducted by a licensed Texas physician. HB 2327 won preliminary approval in the House yesterday without debate. TMA testified on this bill last month.
  • House Bill 278 by Rep. Tom Oliverson, MD (R-Cypress), which would outline how physicians supervise prescriptive authority agreements with advanced practice registered nurses (APRNs), passed unanimously out of the Senate Health and Human Services Committee with a recommendation that it be set on the Senate Local and Uncontested Calendar.
  • Senate Bill 1519 by Sen. Lois Kolkhorst (R-Brenham) would establish a statewide council on long-term care facilities. In testimony earlier this month supporting the bill, TMA offered two improvements that were included in the version of bill that unanimously passed out of the Senate Health and Human Services Committee yesterday. It will next be heard on the Senate floor.  

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

All politics are local. Know your local legislators. Know if they’re Republican or Democrat, conservative or liberal. Know the committees on which they sit. Those few pieces of information will help you craft a message that will resonate more strongly with your legislator. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Keith Miller, MD, of Center. Dr. Miller graduated from the University of Arkansas for Medical Sciences and is a member of both TMA and the Shelby-Sabine County Medical Society.

WHAT WE’RE READING

Transparency necessary for health care pricing – Houston Chronicle

County Jails Struggle With A New Role As America’s Prime Centers For Opioid Detox – NPR

Disinformation is the new barrier to measles vaccines and it’s deadly: Rosalynn Carter – USA Today

Popular e-cigarette products contaminated with bacterial and fungal toxins, study finds – NBC News

Should the ‘Vaping Age’ Be 21? Drugstores and Lawmakers Say Yes – The New York Times

EHR programming reduced unnecessary GI testing by 46%, study findsBecker’s Hospital Review

Legislative Hotline: Pediatricians Push for Vaccinations

(Budget, Medicaid, Public Health, Women’s Health) Permanent link

Capitol_Dome

UNDER THE ROTUNDA
The House and Senate returned from the long weekend more impassioned than ever, with today’s most vigorous discussion occurring in the Senate Health and Human Services Committee over radically different approaches to immunizations.

Senate Bill 329 by Sen. Kel Seliger (R-Amarillo), known as the Parents’ Right to Know Act, would require school districts to provide student vaccination rates at the campus level. A similar bill filed last session passed the House but never made it out of a Senate committee.

Austin pediatrician Mai Duong, MD, testified in support of the bill, pointing out that despite the availability of immunizations to prevent the spread of infectious diseases, pockets of under-vaccinated communities can lead to outbreaks, like what has been seen with measles recently.

“As a pediatrician, I am entrusted by parents to help protect their child’s health because children are often the most vulnerable to diseases and environmental threats,” said Dr. Duong. “Many of my patients have complex medical conditions that do not allow them to receive vaccinations. When they enter kindergarten, it’s important for their parents to have the information available to make informed decisions on enrollment.”

TMA strongly supports SB 329.

On the other hand, Senate Bill 2351 by Sen. Bob Hall (R-Edgewood) would prohibit physicians from restricting their practice based on a patient’s vaccination status. In addition, SB 2351 would prevent physicians from participating in Medicaid or CHIP if they restrict their practice to treating only vaccinated patients. Dr. Duong testified in strong opposition to this bill.

“Violation of this legislation would lead to removal of all state funding from a health care provider, including Medicaid and CHIP funding, undermining the ability of the low-income population to access care in their community,” Dr. Duong said. “Yet those who refuse to vaccinate tend to reside in higher income areas and utilize commercial insurance instead of qualifying for Medicaid or CHIP.” 

THE BUDGET

The House-Senate budget conference committee held an organizational meeting today and will now delve into the intricacies of their respective plans for the state’s 2020-21 budget. TMA will submit written comments and recommendations on medicine’s priority items for committee members to consider as they negotiate the differences in the two chambers’ budgets bills. 

BILLS MOVING

TMA is monitoring 1,945 of the 7,751 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 – the day before our last First Tuesdays of this session – to be considered by the Senate this session. 

As debate shifts from committees to chamber floors, the debate calendars will lengthen as hundreds of bills will be set for consideration each day. Committee meetings will bookend floor sessions and will start to run late into the night. Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving. 

TMA is watching each bill, committee substitute, and amendment for any changes. It is not uncommon for revised legislation to prompt a revised position from TMA, particularly when bad bills become better bills through rewriting or amending them. If you have a question about a specific bill, contact the advocacy team in the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT. 

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

PHYSICIAN OF THE DAY

Today’s physician of the day is Mary Anne Snyder, DO, of San Antonio. Dr. Snyder graduated from the Kansas City University of Medicine and Biosciences and is a member of both TMA and the Bexar County Medical Society.

WHAT WE’RE READING

U.S. health officials unveil experiment to overhaul primary care – STAT

Cancer Is Especially Dangerous for Immigrants in South Texas. Here's Why.Kaiser Health News

Measles cases surge in U.S. as outbreak approaches record – The Washington Post

At the U.S.-Mexico Border, Volunteer Medics Step in to Care for MigrantsNPR

Social Security and Medicare Funds Face Insolvency, Report FindsThe New York Times

 

Legislative Hotline: A Check-Up on Medicine’s Bills

(Budget, Health Insurance, Medicaid, Public Health, Scope of Practice, Texas Medical Board) Permanent link

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UNDER THE ROTUNDA
With the House and Senate adjourned until tomorrow and just five weeks remaining in this session, below is a recap of the status of numerous bills the house of medicine is tracking.

Maternal Health

House Bill 1110 by Rep. Sarah Davis (R-West University Place), which would require 12 months’ continuous Medicaid coverage for eligible postpartum women and those who have had a miscarriage, was approved by the House Human Services Committee and awaits debate on the House floor. The Texas Medical Association strongly supports this bill. 

House Bill 1589 by Rep. Lina Ortega (D-El Paso), which would require notifying women whose postpartum Medicaid coverage has lapsed that they are eligible for the Healthy Texas Women program, passed the House 144-1 and awaits committee referral in the Senate. TMA supports this bill.

Insurance

House Bill 1278 by Rep. James White (R-Hillister), which would allow free-standing emergency room facilities to treat outpatient and acute care needs, has been voted out of the House Public Health Committee and awaits debate on the House floor. TMA opposes this bill because it crosses a line from solely emergency care into a miniature hospital setup. 

House Bill 2041 by Rep. Tom Oliverson, MD (R-Cypress), which would require free-standing emergency room facilities to post conspicuous notices that they might be out of network, along with written disclosure of possible observation and facility fees, was   voted out of the House Public Health Committee and awaits scheduling for a House floor debate. TMA supports this bill. 

House Bill 2630 by Rep. Julie Johnson (D-Carrollton), which would require a health plan’s network directory to clearly identify which radiologists, anesthesiologists, pathologists, emergency physicians, neonatologists, and assistant surgeons are in  network at network facilities, is set on the House Calendar for Wednesday. TMA strongly supports this bill and testified in support last month. 

House Bill 2732 by Rep. Dustin Burrows (R-Lubbock) would require physicians to receive from patients a signed disclosure form with an itemized statement of the amounts to be billed for nonemergency medical services before those services are provided. Otherwise, the physician would be prohibited from sending an unpaid bill to a credit reporting agency. While not identical to Representative Burrows’ bill from last session, it is remarkably similar. TMA killed last session’s bill on the floor and strongly opposes this bill. HB 2732 was left pending in the House Business and Industry Committee last week.

Tort Reform

House Bill 765 by Rep. Gene Wu (D-Houston), which would index to inflation the liability caps established by the landmark 2003 tort reform bill, was left pending in the House Judiciary and Civil Jurisprudence Committee last week. TMA strongly opposes this bill.

Scope of Practice

House Bill 912 by Rep. Donna Howard (D-Austin), which would expedite in-state licensing for Advanced Practice Registered Nurses (APRNs), was voted out of the House Public Health Subcommittee on Health Professions and awaits consideration on the House floor. HB 912 is one of few bills passed out of the scope of practice hearing from earlier this month. TMA is closely monitoring this bill. 

House Bill 1622 by Representative Oliverson, which would permit in-office dispensing of non-controlled substance medications, was finally heard in the House Public Health Committee last week and is still pending. TMA supports this bill. 

House Bill 1792 by Rep. Stephanie Klick (R-Fort Worth), which would grant APRNs  “full practice authority” – their term for independent prescribing without delegation, supervision, or limitation – remains pending in the House Public Health Subcommittee on Health Professions. TMA opposes this bill, but does support team-based collaborative care capitalizing on having the right professional provide the right service to the right patient at the right time, with overall direction and coordination by physicians.

Telemedicine

House Bill 871 by Rep. Four Price (R-Amarillo), which would expand the use of telemedicine to rural trauma hospitals, passed the House 136-0 and awaits committee referral in the Senate. TMA supports this bill. 

House Bill 3345, also by Representative Price, would allow physicians to choose the best platform for providing telemedicine services to their patients, rather than having health plans dictate the platform. TMA supports this bill, which is set on the House Calendar for Wednesday. 

Immunizations

Senate Bill 752 by Sen. Joan Huffman (R-Houston), which would provide liability protections for physicians who volunteer in the aftermath of disasters, will be heard in the House Judiciary and Civil Jurisprudence Committee tomorrow. TMA supports this bill. 

House Bill 1256 by Rep. Dade Phelan (R-Beaumont) would allow first responders’ employers to access their immunization records in the Texas Immunization Registry, known as ImmTrac2, during a disaster. Currently, access to the registry is limited to the individual, and a first responder might not be able to check his or her immunization status in an emergency. HB 1256 is pending in the Senate Health and Human Services Committee. TMA testified in support of this bill last month.

Senate Bill 329 by Sen. Kel Seliger (R-Amarillo), known as the Parents’ Right to Know Act, would require school districts to provide student vaccination rates at the school campus level. It has been set for a hearing tomorrow in the Senate Health and Human Services Committee. TMA strongly supports this bill.

Opioids/Prescription Drug Monitoring

Senate Bill 2316 by Sen. Juan “Chuy” Hinojosa (D-McAllen) would delay the mandate to check the Prescription Drug Monitoring Program (PMP) until March 1, 2020, to allow time for electronic integration of the PMP into physicians’ electronic health records. The bill also would create an advisory committee to the Board of Pharmacy. TMA supports this bill, which was approved by the Senate Health and Human Committee and awaits debate on the Senate floor. 

House Bill 2174 by Rep. John Zerwas, MD (R-Richmond), which would mandate electronic prescribing of opioids, set a maximum prescription duration, and require continuing medical education for prescribers – is set on the House floor calendar for Wednesday. 

Graduate Medical Education/Physician Workforce

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 – awaits a hearing in the Senate Higher Education Committee. 

House Bill 4039 by Rep. Chris Turner (D-Grand Prairie) would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots. Texas must have enough residency slots for physicians who study here. TMA strongly supports this bill, which was voted unanimously from the House Higher Education Committee and recommended for the Local and Consent Calendar. 

The House and Senate return to work tomorrow. 

THE BUDGET

All 10 of the budget’s conference committee members have now been named. These representatives will negotiate the differences in the two chambers’ proposed 2020-21 state budgets:

  • Sen. Jane Nelson (R-Flower Mound), chair of the Senate Conference Committee. Senator Nelson chairs the Senate Finance Committee;
  • Senator Huffman, who chairs the Senate State Affairs Committee;
  • Sen. Lois Kolkhorst (R-Brenham), who chairs the Senate Health and Human Services Committee;
  • Sen. Robert Nichols (R-Jacksonville), who chairs the Senate Committee on Transportation;
  • Sen. Larry Taylor (R-Friendswood), who chairs the Senate Education Committee;
  • Representative Zerwas, chair of the House Conference Committee. Representative Zerwas chairs the House Appropriations Committee;
  • Rep. Greg Bonnen, MD (R-Friendswood), who chairs the House Appropriations Subcommittee on Article III, which addresses higher education;
  • Representative Davis, who chairs the Subcommittee on Article II, which addresses health and human services;
  • Representative Walle, who is vice chair for the Subcommittee on Article III; and
  • Rep. Oscar Longoria (D-Mission), who is vice chair of the House Appropriations Committee. 

The conference committee has until late May to distribute a draft of the biennial budget. A top priority remains TMA’s request for a $500 million infusion of new state dollars to increase physicians’ Medicaid payment rates; TMA will submit written comments and recommendations on priority items for medicine early next week. 

Additionally, Speaker Dennis Bonnen (R-Angleton) has named the House members to the conference committee for Senate Bill 500 by Senator Nelson, the supplemental spending bill to backfill deficits in the 2018-19 biennial budget.

GETTING A BILL MOVING

TMA is monitoring 1,943 of the 7,731 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 – two weeks from today – to be considered by the Senate this session. 

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

All politics are local. Know your local legislators. Know if they’re Republican or Democrat, conservative or liberal. Know the committees on which they sit. Those few pieces of information will help you craft a message that will resonate more strongly with your legislator. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Martha Cano, MD, of Weslaco. Dr. Cano graduated from  The University of Texas Medical Branch School of Medicine in Galveston and is a member of both TMA and the Hidalgo-Starr County Medical Society.

WHAT WE’RE READING

Medicaid’s missing children [Opinion] – San Antonio Express-News

It cost what? Medical pricing shrouded in secrecy, leaving patients in the darkHouston Chronicle

Congress to Consider Raising Tobacco-Buying Age to 21 – The Wall Street Journal

FDA Oks 1st Generic Nasal Spray of Overdose Reversal Drug – The Associated Press

Two-Wave US Flu Season Is Now the Longest in a Decade – The Associated Press

Despite Controversy, Mental Health Bills Move Forward At Texas LegislatureTexas Public Radio

It’s Dallas County vs. the West Nile Virus in another round of mosquito ‘Battleship’ – The Dallas Morning News

MD Anderson ousts 3 scientists over concerns about Chinese conflicts of interestHouston Chronicle

                                 

Legislative Hotline: Insurance and Marijuana Bills Moving; Budget Negotiators Named

(Budget, Health Insurance, Public Health) Permanent link

abortion_blog

UNDER THE ROTUNDA
The days are getting longer, both because it’s finally spring – and the legislative session is beginning its final act.

Before the House and Senate adjourned for the long Easter weekend, some bills the Texas Medical Association is watching moved on to the next step in the legislative process.

Yesterday, 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 (PPOs) and exclusive provider organizations (EPOs) at least once every two years – was voted favorably out of the House Insurance Committee. TMA supports this bill and testified in support of it earlier this month.

House Bill 2099 by Rep. Stan Lambert (R-Abilene) also won the approval of the House Insurance Committee. Earlier this month, TMA submitted written testimony in support of the bill, which would prohibit a health plan from changing a patient’s drug coverage upon plan renewal if the patient has been stable on that drug.

Also yesterday, House Bill 1365 by Rep. Eddie Lucio III (D-Brownsville), which would allow a physician to recommend low-THC cannabis for medical use by a patient with a debilitating medical condition, was voted favorably out of the House Public Health Committee. The bill would require that the physician have proper knowledge concerning the medical use of the product as treatment for the patient’s specific condition. In addition, the physician must maintain treatment and monitoring plans.

Although TMA supports adequate and well-controlled studies of marijuana and related cannabinoids for potential medical uses, TMA policy in no way endorses the legalization of recreational marijuana usage.

TMA continues to recommend to lawmakers that the federal government reclassify marijuana as something other than a Schedule I drug, so it can be properly accessed for research. Reclassification also would allow physicians to freely exchange information with patients on the effects and use of marijuana and its derivatives, as well as other unapproved complementary therapies. We will continue to closely monitor the progress of HB 1365.

And late Tuesday, House Bill 1880 by Rep. Sarah Davis (R-West University Place), which would establish time limits for corrections and updates to be made to insurers’ online network directories, was voted favorably from the House Insurance Committee. TMA supports this bill and testified in support last week.

All four bills await scheduling for debate on the House floor.

THE BUDGET

Lt. Governor Dan Patrick named the Senate members of the budget’s conference committee. These representatives will negotiate with House members named last week on the differences in the two chambers’ proposed 2020-21 state budgets:

  • Sen. Jane Nelson (R-Flower Mound), chair; Senator Nelson chairs the Senate Finance Committee;
  • Sen. Joan Huffman (R-Houston), who chairs the Senate State Affairs Committee;
  • Sen. Lois Kolkhorst (R-Brenham), who chairs the Senate Health and Human Services Committee;
  • Sen. Robert Nichols (R-Jacksonville), who chairs the Senate Committee on Transportation; and
  • Sen. Larry Taylor (R-Friendswood), who chairs the Senate Education Committee. 

The conference committee has until late May to distribute a draft of the biennial budget. A top priority remains TMA’s request for a $500 million infusion of new state dollars to increase physicians’ Medicaid payment rates. TMA will submit written comments and recommendations on other priority items for medicine early next week.

GETTING A BILL MOVING

TMA is monitoring 1,943 of the 7,731 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. 

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

PHYSICIAN OF THE DAY

Today’s physician of the day is Dan Freeland, DO, of Austin. Dr. Freeland graduated from the Kirksville College of Osteopathic Medicine in Missouri and is a member of both TMA and the Travis County Medical Society.

WHAT WE’RE READING

Texas House approves bills to secure future of cancer research agencyKXAN-TV

Texas Senate passes legislation to prevent surprise medical bills with arbitration, mediation – The Texas Tribune

Commentary: Beating cancer meant an uphill battle with my insurer. That must change. – Austin American-Statesman

The ‘brain is something that’s forever’: Concussions are major concern in youth soccer – here’s what is being done to combat them – The Dallas Morning News

Protect trauma funding and save lives [Opinion] – Houston Chronicle

Baby Boy Receiving Treatment After He Was Born Without Skin – The Associated Press, San Antonio Express-News

Telemedicine, Walk-In Clinics Cloud Role of Family Doctor – The Associated Press

When Medical Schools Become Less Diverse – The Atlantic

Republicans reject Democratic attempts to tighten vaccine lawsPolitico

 

Legislative Hotline: Medical Board Sunset, Balance Billing Moving Forward

(Budget, Health Insurance, Public Health, Texas Medical Board) Permanent link

Capitol_Dome

UNDER THE ROTUNDA
As debate and deliberations have shifted from committees to the floor of each chamber, two of the Texas Medical Association’s priority bills have had their turn in the spotlight: continuation of the Texas Medical Board (TMB) and balance billing.

Yesterday, the House gave preliminary approval on a voice vote to an amended TMB Sunset Bill – House Bill 1504 by Rep. Chris Paddie (R-Marshall) – which would extend TMB for another 12 years.

State agencies and programs must be reviewed by the Sunset Advisory Commission at least once every 12 years and, unless the legislature continues the agency, it is abolished.

Presuming HB 1504 passes third reading today, TMA’s efforts would shift to Sen. Robert Nichols’ (R-Jacksonville) Senate Bill 610, the Senate companion, where TMA will seek clarification on expedited licensing, vacating orders, and physician public profile cleanup.

Also yesterday, the Senate 29-2 passed an amended Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills), which would require baseball-style arbitration for most surprise medical bills.

TMA members Sen. Donna Campbell, MD (R-New Braunfels) and Sen. Charles Schwertner, MD (R-Georgetown) dissented, indicating the bill is still a work in progress.

TMA will continue to work with Rep. Tom Oliverson, MD (R-Cypress) as the bill moves through the House on refining the portions of the bill that still require attention, including health plan accountability and regulatory enforcement.

BILLS THAT ARE MOVING

Yesterday, House Bill 39 by Rep. John Zerwas, MD (R-Richmond) – which would repeal the 2023 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years – won preliminary approval from the House with a vote of 125-18. TMA strongly supports this bill. 

Also yesterday, House Joint Resolution 12 by Representative Zerwas, which proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT, received preliminary approval on the House floor with a vote of 130-15. CPRIT will exhaust its initial allotment of $3 billion by 2021; HJR 12 will replenish those funds. TMA strongly supports this bill. 

House Bill 800 by Rep. Donna Howard (D-Austin) would direct the Children’s Health Insurance Program (CHIP) to make contraception available to young women enrolled in the program. With a vote of 81-64, HB 800 received final approval on the House floor yesterday and heads to the Senate. TMA supports this bill. 

House Bill 4068 by Rep. Michelle Beckley (D-Carrollton), which would require vaccination against bacterial meningitis for public school students, passed out of the House Public Health Committee on Monday and awaits scheduling for a House floor hearing. TMA supports this bill.  

GETTING A BILL MOVING

TMA is monitoring 1,943 of the 7,731 bills filed this session. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 2032 by Rep. John Turner (D-Dallas) would establish a health literacy advisory committee that would include physician representation. The advisory committee must develop a long-term plan for increasing state health literacy, including a study on the economic impact of low health literacy. TMA is monitoring this bill. 
  • House Bill 3220 by Rep. Steve Allison (R-San Antonio) would add school psychologists to the list of health professions eligible for the State Mental Health Professionals Loan Repayment Program. The total loan repayment available is $10,000. TMA is monitoring this bill.   

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

Just as patients need to receive the appropriate care at the appropriate time, communication with your legislator must be timely. Make sure you’ve organized your thoughts and arguments – on only one topic per letter – and you’ve sent it in advance of committee or floor debates. Your odds of having an impact are greater if you contact your legislators before their minds are made up. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Katarina Lindley, DO, of Brock. Dr. Lindley graduated from Nova Southeastern University in Florida and is a member of the Parker County Medical Society.

WHAT WE’RE READING

For low-income people, employer health coverage is worse than ACA – Axios

Measles cases are up nearly 300% from last year. This is a global crisis [Opinion] – CNN

Tiger Woods’ road to the Masters Tournament went through a North Texas back treatment center – WFAA-TV

First-year trainee doctors spend little time on patient care – Reuters

One in five physicians use telehealth. Burnout may drive more adoption, survey says – FierceHealthcare

Round Rock students learning the dangers, harmful effects of vaping – KVUE-TV

Legislative Hotline: TMA Pushes Lawmakers To Streamline Prior Auth Requirements

(Budget, Health Insurance, Public Health, Texas Medical Board) Permanent link

May_Runoff

UNDER THE ROTUNDA
With fewer than six weeks remaining in the legislative session, this week is a crucible of sorts: If a bill doesn’t get an initial committee hearing this week, it likely is dead for the session. The Texas Medical Association is pushing today to win committee approval for several bills as well as a successful House floor debate on a critical piece of legislation.

Today in the House Insurance Committee, Little Elm internist John Flores, MD, testified for TMA on a pair of bills that would streamline prior authorization requirements.

House Bill 3232 by Rep. Julie Johnson (D-Carrollton) would prohibit requiring prior authorization if a patient seeks care from an in-network physician.

House Bill 3828 by Rep. Carl Sherman (D-DeSoto) would require health plans to use physician-supplied prior authorization information to inform a patient of the network status of any physician or health care professional who may be involved in the preauthorized care. HB 3828 also would require that, for elective health care services, the referring physician inform the patient that the physician or health care professional to whom the patient is being referred may be out of network.

In testifying about prior authorization, Dr. Flores said the hassles extend well beyond administrative burdens for physicians.

“Prior authorization can cause delays in medically necessary care, which may detrimentally affect a patient’s health and finances,” Dr. Flores said. “Excessive prior authorization requirements also consume time that physicians could otherwise dedicate to patient care.”

In the House Licensing and Administrative Procedures Committee, Austin adolescent medicine physician Maria Monge, MD, testified in support of House Bill 1610 by Rep. Trent Ashby (R-Lufkin.) HB 1610 would ban the manufacture and sale of powdered alcohol.

“The average age of first alcoholic drink is 13 years of age,” Dr. Monge testified. “The consequences of adolescent alcohol consumption are well documented, and powdered alcohol presents a frightening opportunity for adolescents to access, consume, conceal, and overconsume alcohol in potentially new and deadly ways.”

Speaking more of children, in the House Human Services Committee, Austin pediatrician Ryan Lowery, MD, testified in support of House Bill 3541 by Rep. Toni Rose (D-Dallas.) HB 3541 would incentivize the purchase of fruits and vegetables with Supplemental Nutrition Assistance Program (SNAP) benefits.

“In Texas, more than half of SNAP beneficiaries are children,” Dr. Lowery told lawmakers. “Unfortunately, low-income children disproportionately experience obesity.” Texas has the seventh-highest rate of obesity for youth aged 10-17.

On the House floor today, the Texas Medical Board Sunset Bill – House Bill 1504 by Rep. Chris Paddie (R-Marshall) – was scheduled for debate and vote on preliminary approval. Representative Paddie’s office requested that no floor amendments be added – that the bill hew closely to only the sunset issues – to improve the bill’s odds of passing. TMA will work with Sen. Robert Nichols (R-Jacksonville) to refine Senate Bill 610, the Senate companion.

THE BUDGET

Speaker Dennis Bonnen (R-Angleton) has named the House members of the budget’s conference committee. These representatives will negotiate with soon-to-be-named senators on the two chambers’ differences in the proposed 2020-21 state budget:

  • Rep. John Zerwas, MD (R-Richmond), chair; Representative Zerwas chairs the House Appropriations Committee;
  • Rep. Greg Bonnen, MD (R-Friendswood), who chairs the House Appropriations Subcommittee on Article III, which addresses higher education;
  • Rep. Sarah Davis (R-West University Place), who chairs the Subcommittee on Article II, which addresses health and human services;
  • Rep. Armando Walle (D-Houston), who is vice chair for the Subcommittee on Article III; and
  • Rep. Oscar Longoria (D-Mission), who is vice chair of the House Appropriations Committee. 

TMA is cautiously optimistic that the house of medicine’s budget concerns will be taken to heart during negotiations. A top priority remains our request for a $500 million infusion of new state dollars to increase physicians’ Medicaid payment rates. 

BILLS THAT ARE MOVING  

The House passed House Bill 10 by Rep. Senfronia Thompson (D-Houston), on third reading today with a vote of 114-32. HB 10 would create the Texas Behavioral Health Research Institute (TBHRI), award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program. The bill now goes to the Senate for committee referral. TMA testified in support of HB 10 in late February. 

Yesterday, Senate Bill 21 by Sen. Joan Huffman (R-Houston) – which would raise the minimum age to purchase tobacco or vape products to 21 years – passed out of the House Public Health Committee on an 8-0 vote. The bill now awaits debate on the House floor. TMA strongly supports this bill and testified in favor of it last month. The companion bill (House Bill 749 by Representative Zerwas) is awaiting a hearing on the House floor. 

Yesterday, Senate Bill 952 by Sen. Kirk Watson (D-Austin) – which would require that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards – was referred to the House Human Services Committee after receiving Senate approval last week. TMA testified in support of this bill in March. 

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,731 bills . TMA is monitoring 1,943 of them. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 800 by Rep. Donna Howard (D-Austin) would direct the Children’s Health Insurance Program to make contraception available to young women in the enrolled program. HB 800 received preliminary approval on the House floor yesterday and awaits third reading. TMA supports this bill. 
  • House Bill 1110 by Representative Davis would require 12 months continuous Medicaid coverage for eligible postpartum and women who have had a miscarriage. This bill is still pending in the House Human Services Committee. TMA supports this bill.   

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

PHYSICIAN OF THE DAY

Today’s physician of the day is Thomas Shima, DO, of Mansfield. Dr. Shima graduated from the Kansas City University of Medicine and Biosciences and is a member of the Tarrant County Medical Society.

WHAT WE’RE READING

CDC reports surge in confirmed cases of measles – Reuters

Rise in suicide attempts in Texas prisons alarms advocates – The Associated Press

The HPV vaccine is important for preteens and teenagers. What about older women? – The Washington Post

Here’s why doctors should worry about the feds’ novel approach to prosecuting health care kickback casesThe Dallas Morning News

Powdered alcohol? Why some want Texas to ban it before it hits store shelves – Fort Worth Star-Telegram

A run to a freestanding emergency room shouldn’t involve a game of billing roulette [Editorial]The Dallas Morning News

Moving to increase legal age for tobacco use wise [Editorial] – Amarillo Globe-News, Lubbock Avalanche-Journal

Legislative Hotline Video: Physicians Fight For Improved Insurance Directories

(End-of-Life Care, Health Insurance, Public Health) Permanent link

Some of Texas medicine’s most familiar faces – and some new ones – lobby lawmakers to support bills beneficial to physicians and their patients in this week’s TMA Legislative News Hotline video. 

“What happened? All of a sudden we were out of network,” says Keller anesthesiologist John Scott, DO, describing the time a health plan suddenly dropped his practice and forced his patients to pay medical bills they assumed their insurance would cover. 

Dr. Scott and Dallas cardiologist Rick Snyder, MD, a TMA Board trustee, each describe the arguments they gave Texas legislative committees in support of measures to shore up insurance networks and to improve their provider directories. 

TMA President Doug Curran, MD, was back in Austin this week too, explaining to lawmakers why backing a Medicaid managed care overhaul bill would help patients and the doctors who care for them. 

Dallas geriatrician Robert Fine, MD, tells us two end-of-life bills not only would be bad for patients, they also could “mandate that physicians violate” their ethical code to first do no harm. One bill could require physicians to continue medically ineffective treatment in end-of-life care situations. 

TMA Council on Legislation member John Carlo, MD, speaks in support of a prior-authorization bill that would scrap that requirement for HIV and AIDS prescription medications. He tells us having a multitude of insurers with different mandates is complicated, and ultimately delays patient care. 

See that and more in this week’s TMA Legislative News Hotline video summary of action at the Capitol.

Also, make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests, and TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

Legislative Hotline: Marijuana and Cannabidiol as Medicine?

(Public Health) Permanent link

Cannabidiol

UNDER THE ROTUNDA
A panel of the House Public Health Committee created to focus on the medical use of marijuana met today, with a full agenda of 10 bills.

Although the Texas Medical Association supports adequate and well-controlled studies of marijuana and related cannabinoids for potential medical uses, TMA policy in no way endorses the legalization of recreational marijuana usage.

The bills up for consideration today run the gamut from an affirmative defense to prosecution and a vast expansion of diagnoses eligible for treatment with these substances.

House Bill 122 by Rep. Gina Hinojosa (D-Austin) says no agency or law enforcement may take action against a physician who discusses marijuana as a treatment option with a patient, or against a physician who makes a statement that, in the physician’s professional opinion, the potential benefits of marijuana use likely outweigh the health risks for the patient.

House Bill 1365 by Rep. Eddie Lucio III (D-Brownsville) would allow a physician to recommend low-THC cannabis for medical use by a patient with a debilitating medical condition, provided the physician has the proper medical knowledge concerning medical use of the product as treatment for the patient’s specific condition. The physician must also maintain treatment and monitoring plans.

TMA continues to recommend to lawmakers that the federal government should reclassify marijuana as something other than a Schedule I drug, so it can be properly accessed for research. Reclassification also would allow physicians to freely exchange information with patients on the effects and use of marijuana and its derivatives, as well as other unapproved complementary therapies.

Some state specialty societies are pushing to remove current restrictions in state law that allow physicians to recommend low-THC cannabis and cannabidiol (CBD) only for specific diseases. Right now, only patients with intractable epilepsy are eligible for CBD use. Physicians must be able to have unfettered conversations with their patients, to  fully understand patient concerns and what medicines and supplemental treatments patients are already taking.

All 10 bills were left pending in the subcommittee. TMA will continue to monitor these bills and the topic in general.

BILLS THAT ARE MOVING

Today, 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 – received preliminary approval on the House floor. TMA testified in support of this bill in early March. 

Yesterday, House Bill 1256 by Rep. Dade Phelan (R-Beaumont) – which would give first responders or their employers access to vaccination records stored in the state’s immunization registry during an emergency – received preliminary approval in the House and awaits a final House vote. TMA strongly supports this bill and testified for it last month. 

Also yesterday, Senate Bill 436 by Sen. Jane Nelson (R-Flower Mound), which directs the Department of State Health Services to develop and implement initiatives to assist pregnant and postpartum women with opioid use disorder and newborns with neonatal abstinence syndrome, passed the Senate without opposition. It now heads to the House. This bill is specifically referring to the TexasAIM Opioid Bundle that evolved out of the Maternal Mortality and Morbidity Task Force and is strongly supported by TMA.

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,693 bills. TMA is monitoring 1,940 of them. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. Six and a half weeks remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • Senate Bill 2132 by Sen. Beverly Powell (D-Burleson) would direct the Health and Human Service Commission to give information on the Healthy Texas Women program to women who are losing Medicaid eligibility after delivery or miscarriage. SB 2132 received uncontested Senate approval yesterday and awaits committee referral in the House. TMA supports this bill. 
  • Senate Bill 384 by Senator Nelson would require all health care facilities to report all health care-associated infections, not just surgical site infections. SB 384 passed the Senate yesterday without dissent and heads to the House. TMA supports this bill.   

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

Just as patients need to receive the appropriate care at the appropriate time, communication with your legislator must be timely. Make sure you’ve organized your thoughts and arguments – on only one topic per letter – and sent it in advance of committee or floor debates. Your odds of having an impact are greater if you contact your legislator before their mind is made up. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Marian Allen, MD, of Spring. Dr. Allen graduated from the Baylor College of Medicine in Houston and is a member of both TMA and the Harris County Medical Society.

WHAT WE’RE READING

Texas Tech Medical School, Under Pressure From Education Dept., Will Stop Using Race in Admissions – The New York Times

Texas could soon increase the legal age to buy tobacco, though active military members might be exemptThe Texas Tribune

US warns docs not to abruptly halt opioid pain treatment – The Washington Post

Doctors urge vaccination to prevent whooping cough outbreak – KVUE-TV

Surgeons, hospital owner convicted in massive kickback scheme involving Forest Park Medical Center – The Dallas Morning News

New York City Is Requiring Vaccinations Against Measles. Can Officials Do That? – The New York Times

One in four Texas women are uninsured – Reform Austin

Legislative Hotline: Senate Passes Tobacco, Budget Bills; Debates Patient Autonomy

(Budget, End-of-Life Care, Medicaid, Public Health, Women’s Health) Permanent link

state-capitol

UNDER THE ROTUNDA
Deciding how to spend the final days and hours of life is highly a personal decision, and it’s one physicians encourage their patients to make long before the need arises. Today, the Senate debated end-of life-bills after voting yesterday to approve its version of the state’s 2020-21 budget and to raise the minimum age to purchase tobacco and vape products.

In the Senate Health and Human Services Committee, Dallas internist Robert Fine, MD, testified on several bills that could subvert the Texas Advance Directive Act, signed into law by then-Gov. George W. Bush in 1999.

Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola) would require hospitals, physicians, nurses, and other health care professionals to provide what physicians believe amounts to medically inappropriate and potentially harmful care for an unlimited period of time.

Dr. Fine explained to lawmakers that requiring care essentially in perpetuity would prolong the dying process, exacerbating suffering for both patients and loved ones. Moreover, by mandating treatment in perpetuity, SB 2089 violates physicians’ personal liberties of conscience and ethics by requiring them to provide care they may believe is medically inappropriate or outside the standard of care. TMA strongly opposes this bill.

Dr. Fine also testified in opposition to Senate Bill 2129 by Sen. Brandon Creighton (R-Conroe), which not only would impose limits on physicians’ professional medical judgment but also allow nonphysicians to determine what is reasonable medical judgment. TMA strongly opposes this bill, too.

Conversely, TMA supports Senate Bill 2355 by Sen. Eddie Lucio, Jr. (D-Brownsville). SB 2355 would require hospitals to establish policies prohibiting members of hospital ethics committees from discriminating against patients with disabilities or from serving on such a committee if they have conflicts of interest.

Dr. Fine stressed the importance of keeping ethics committees a reliable resource for resolving end-of-life care disputes. In the rare event that an ethics committee deliberates on the medical care of a patient, a patient’s disability should not be considered unless it is medically relevant, and ethics committee members should not be constrained by health care or financial conflicts of interest, Dr. Fine testified. The patient’s best interests must be the singular focus of the ethics committee during any review.

Another bill in the committee, Senate Bill 1519 by Sen. Lois Kolkhorst (R-Brenham), would create a statewide council on long-term care facilities. TMA submitted written testimony  recommending the inclusion of both a long-term care facility medical director and an infectious disease or public health physician on the council.

In the Senate Transportation Committee, Houston pediatrician Amelia Averyt, MD, testified  in support of Senate Bill 1524 by Sen. Judith Zaffirini (D-Laredo), which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds.

Dr. Averyt shared some eye-popping statistics with the committee, noting that, “Children under the age of 2 are 75% less likely to die or be severely injured in a crash if they are riding in rear-facing car seats.” TMA also supports the companion bill, HB 448, in the House.

These bills were all left pending.

THE BUDGET

Yesterday, the Senate debated and unanimously approved its version of House Bill 1 by Rep. John Zerwas, MD (R-Richmond), the state’s budget for the 2020-21 biennium. The budget is the only bill that the Texas Legislature is constitutionally required pass. 

Some notable inclusions in the budget:

  • Article II, which covers health and human services, is the largest item in the budget at $85.6 billion.
  • The AIM bundles recommended by the Maternal Mortality and Morbidity Task Force are fully funded.
  • Women’s health programs funding totals $314.6 million, an increase of $35.6 million in all funds from the current biennium.
  • Several requested improvements to the Department of State Health Services’ state lab were funded:
  • $12.8 million for lab repairs;
  • $17 million to replace lost revenue; and
  • $7.7 million for X-ALD gene testing.
  • The addition of $59.1 million will expand outpatient mental health treatment capacity.
  • An additional $4.3 million will go to infectious disease surveillance.
  • Medicaid cost containment mandates are in Rider 19, directing the state to find a savings of at least $350 million through fraud, waste, and abuse detection, and programmatic efficiencies.
  • Medicaid payment rate increases were not explicitly funded, but that request is still included in Article XI, which is akin to a parking lot of issues for later discussion. HB 1 recommends a study of opportunities to increase payments via value-based payment initiatives. 

Next, the House and Senate will appoint conference committee members who will negotiate the final budget to be presented for approval by both chambers. 

BILLS THAT ARE MOVING

Yesterday, an amended Senate Bill 21 by Sen. Joan Huffman (R-Houston) – which would raise the minimum age to purchase tobacco or vape products to 21 years – passed out of the Senate and now heads to the House. The amendment excludes active-duty military between the ages of 18 to 21 years. The companion bill (House Bill 749 by Representative Zerwas) has already passed the House Public Health Committee, so SB 21 should meet with little to no opposition.

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,693 bills. TMA is monitoring 1,940 of them. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. Forty-seven days remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 1501 by Rep. Poncho Nevarez (D-Eagle Pass) would create the Texas Behavioral Health Executive Council and transfer oversight of psychologists, marriage and family therapists, professional counselors, and social workers to the newly created Council. The bill does not expand scope of practice. HB 1501 received preliminary House approval yesterday and awaits third reading. TMA is monitoring this bill. 
  • House Bill 1579 by Rep. Briscoe Cain (R-Houston) would allow the classification of the Texas National Guard and the Texas State Guard as first responders for the purposes of access to vaccination information, allowing them to more readily assist during disasters. HB 1579 passed the House 145-2 yesterday and heads to the Senate. TMA supports this bill.   

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session. 

PHYSICIAN OF THE DAY

Today’s physician of the day is Jackson Griggs, MD, of Waco. Dr. Griggs graduated from the McGovern Medical School at UTHealth in Houston and is a member of both TMA and the McLennan County Medical Society.

WHAT WE’RE READING

Confirmed case of ‘whooping cough’ at area middle school, health officials say – KXAN-TV

Save lives, raise Texas smoking age to 21, and for military too [Opinion] – Waco-Tribune Herald

Bill to Allow Physicians to Distribute Medicine at the Office Takes a Hit – D CEO Healthcare

House bill could raise tobacco purchasing age from 18 to 21 – Waxahachie Daily Light

 

Legislative Hotline: Medicaid Managed Care Needs “Major Tune-up,” TMA Tells Lawmakers

(Budget, End-of-Life Care, Health Insurance, Medicaid, Public Health) Permanent link

Capitol_Dome

UNDER THE ROTUNDA
Less than seven weeks remain in the 2019 legislative session, and lawmakers are now deep into the meaty issues.

In the House Human Services Committee today, TMA President Doug Curran, MD, testified in support of House Bill 4178 by Rep. James Frank (R-Wichita Falls), which would significantly overhaul the Medicaid managed care program.

HB 4178, also referred to as the Medicaid Efficiency Act, would update the fair hearings process, streamline enrollment and coordination of benefits, and simplify the prior authorization process. The bill was left pending in committee.

Dr. Curran testified that in his practice, he sees patients in every Medicaid managed care program and is thus in a position to know what works and what doesn’t in each.

“After a quarter-century of Medicaid managed care, it is time for a major tune-up to ensure the program works for everyone – patients, physicians, health plans, and taxpayers.”

In the House Insurance Committee today, Dallas public health physician and TMA Council on Legislation member John Carlo, MD, testified in support of a pair of bills that TMA supports.

House Bill 2582 by Rep. Eddie Lucio III (D-Brownsville) would require health plans to advise physicians of price changes for the Department of State Health Services-mandated newborn screening tests, and to reimburse physicians for purchasing the tests.

“Texas has one of the most successful and robust newborn screening programs in the entire world,” Dr. Carlo said. “Texas Medicaid pays the state lab directly for babies covered under the program, but screening babies covered under a commercial plan requires the physician to purchase the tests and hope for reimbursement.”

House Bill 3058 by Rep. Julie Johnson (D-Carrollton) would prohibit prior authorization for HIV and AIDS prescription drugs. Dr. Carlo testified about the need for urgency in beginning treatment, noting that today, with timely treatment, surviving HIV/AIDS is likely, not a dream as it was in the past.

On the other side of the rotunda, Dallas cardiologist and TMA Board of Trustees member Rick Snyder, MD, reprised recent testimony in support of more accurate network directories.

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.

“Requiring insurance companies to report online their physician directories at each facility, grouped by specialty, empowers both patients and physicians in the struggle against balance billing events,” Dr. Snyder said.

Bishops Support Advance Directives

TMA works regularly with the Texas Catholic Conference of Bishops, and many other groups, in our efforts to defend the Texas Advance Directives Act (TADA). Every legislative session, this loose coalition works hard to protect patients’ autonomy and dignity at the end of their lives and to ensure physicians and other health care professionals aren’t forced to provide medical care they believe to be inappropriate or that violates their ethical principles. 

Two anti-TADA bills – Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola) and Senate Bill 2129 by Sen. Brandon Creighton (R-Conroe) – are scheduled for a hearing tomorrow in the Senate Health and Human Services Committee. TMA joins the Conference of Bishops and others in opposing both of these bills. We were impressed with the message the bishops are asking Texas Catholics to send to their state senators on that committee, and wanted to share it with you. 

“I oppose these bills because they allow an assault on the dignity of the human person by requiring unnecessary pain and suffering for an incompetent patient at the end of his/her life, when the patient's family is demanding inappropriate medical interventions against the conscience and medical judgment of the physician.”

 BILLS THAT ARE MOVING

Today, House Bill 2261 by Rep. Armando Walle (D-Houston) – which would increase the physician education loan repayment program’s allowable repayment amounts by $5,000 each year, bringing the total amount to $180,000 – passed on third reading 130-17. The bill will now move on to the Senate. TMA strongly supports this bill.

Yesterday, House Bill 1532 by Rep. Morgan Meyer (R-Dallas) – which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference – won unanimous approval from the House Public Health Committee and now awaits debate on the House floor. TMA strongly supports this bill.

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,693 bills. TMA is monitoring 1,940 of them. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. Forty-eight days remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 3345 by Rep. Four Price (R-Amarillo) would allow physicians to choose the best platform to use for providing telemedicine services to their patients, rather than having health plans dictate the platform. TMA supports this bill. 
  • Senate Bill 2316 by Sen. Juan “Chuy” Hinojosa (D-McAllen) would delay the mandate to check the Prescription Drug Monitoring Program until March 1, 2020, to allow time for electronic integration. The bill also would create an advisory committee to the Board of Pharmacy. TMA supports this bill.   

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

Just as you do with your patients, make sure you follow up with your legislator after you’ve had a meeting or phone call. Be persistent but polite, and remind your legislator how important the issue is to you. Ask for an update on where the issue stands, and don’t get dejected if it takes more than one session to address your issue. That is quite common. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is My-Huyen Mary Tran, MD, of Tyler. Dr. Tran graduated from Louisiana State University Health Sciences Center Shreveport and is a member of both TMA and the Smith County Medical Society.

WHAT WE’RE READING

Blue Cross Blue Shield of Texas tries new way to trim health costs: Opening its own medical centers  35 – The Dallas Morning News

CDC finds 78 new measles cases as outbreak sprints toward record and experts blame anti-vaxxers  16 – The Washington Post

Facing Escalating Workplace Violence, Hospital Employees Have Had Enough  49 – NPR

Dogs sniff out lung cancer with 97% accuracy, study finds  60 – KVUE

Legislative Hotline: Bill to Raise Tobacco-Purchase Age Moving Forward

 Permanent link

UNDER THE ROTUNDA

After several sessions’ trying to protect the health of youth in Texas by delaying the onset of smoking and thus nicotine addiction, TMA’s Legislative News Hotline video reports medicine is making progress.

Senate Bill 21 by Sen. Joan Huffman (R-Houston) – which raises the minimum age to purchase smoking or vape products from 18 to 21 – squeaked out of the Senate State Affairs Committee this week with a 5-4 vote and now heads to the Senate floor for debate.

Next week in Austin, the Senate will consider SB 21. Please contact your state senator today. Ask him or her to vote in support of SB 21 and protect the health of Texas’ youth.

LEGISLATIVE RECAP VIDEO

Lawmakers unveiled new balance-billing legislation this week, while several physicians testified on key issues such as limiting scope-of-practice expansions, medical liability, and pharmacy benefit managers.

In this week’s TMA Legislative Hotline video, we hear Rep. Tom Oliverson, MD (R-Cypress), and TMA Board Trustee Ray Callas, MD, react to the balance-bill plan that removes patients from mediation and installs arbitration to settle bills. Hint: The bill is promising, but TMA leaders hope lawmakers will improve some elements.

Also in this week’s video, TMA Board Trustee Lindsay Botsford, MD, argues why broadening advanced practice registered nurses’ scope of practice would be a poor idea.

And Austin-area OB/Gyn Moss Hampton, MD, explains why a plan to remove some medical liability protections in emergency care situations would be unfair to physicians.

Also, TMA President Doug Curran, MD, testifies in support of a Medicaid managed care overhaul bill that he says could improve patients’ access to care and help physicians by cutting red tape.

We also list a slew of prior-authorization bills that took one step closer to becoming law, hear support for a bill to protect small children, and even meet a medical student who testified for a bill to help grow doctors in Texas. All of this and more in this week’s TMA Legislative News Hotline video.

 

Legislative Hotline: Reining in Scope Expansion

(Budget, Health Insurance, Public Health, Scope of Practice) Permanent link

HHSC_grants

UNDER THE ROTUNDA
Each session, nonphysician practitioners ask lawmakers to expand their legal scope of practice beyond what their education, training, and skills safely allow. This session, that day was today.

In the House Public Health Subcommittee on the Health Professions, more than a dozen scope-expansion bills were on the agenda, covering almost every nonphysician practitioner from physical therapists to psychologists.

The Texas Medical Association showed strong opposition to the most egregious of the bills, House Bill 1792 by Rep. Stephanie Klick (R-Fort Worth), which would grant advanced practice registered nurses (APRNs) “full practice authority” – their term for independent prescribing without delegation, supervision, or limitation.

TMA supports team-based collaborative care capitalizing on having the right professional provide the right service to the right patient at the right time, with overall direction and coordination by physicians.

TMA Council on Legislation member Dara Grieger, MD, who previously worked as an APRN, testified against the bill.

Dr. Grieger’s testimony focused on the difference in education and training received by physicians and APRNs, the latter of which now is conducted almost entirely online.

“Online schools often require students to find their own preceptors. Often, the clinical experiences are merely shadowing at best,” Dr. Grieger said. “It is not unusual for a student not to show up for clinical hours and merely have the paperwork signed.

“There is little clinical training. The former nurse practitioner in me is appalled and embarrassed by the poor quality of education in these online schools. I believe patients deserve better.”

TMA submitted written testimony in opposition to House Bill 2733 by Rep. Phil Stephenson (R-Wharton), which would expand the statutory definition of chiropractic to include “neuromusculoskeletal,” which is well beyond chiropractors’ education and training.

“Adding the term ‘neuro’ is not merely the addition of the nerves that may connect muscle tissue or bones,” TMA’s testimony states. “It is the addition of the entire neurological system that includes the brain, the spinal cord, and the regulation of many bodily functions – all well beyond chiropractors’ education and training.”

In the House County Affairs Committee, TMA submitted written suggestions to improve House Bill 1722 by Rep. Garnet Coleman (D-Houston.) HB 1722 would allow counties and municipalities to address the spread of blood-borne pathogens that occur with intravenous drug use by instituting sterile syringe service programs.

“Almost every state allows for comprehensive syringe exchange because of the widely recognized evidence that such a program offers intravenous drug users a path to treatment in their community,” TMA's statement says. “For people not ready to go into treatment, the information physicians, public health personnel, and others share on the value of clean needles and syringes – and information about needle exchange – will enable them to better protect themselves and others from infectious diseases.”

Late yesterday, in the House Public Health Committee, New Braunfels family physician Emily Briggs, MD – who also chairs TMA’s Committee on Reproductive, Women’s, and Perinatal Health – testified in strong support of House Bill 1111 by Rep. Sarah Davis (R-West University Place).

HB 1111 would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home (PMH) pilots in Texas. PMHs would provide pregnant women with comprehensive, team-based care, including behavioral health care.

“As a family physician, I care for patients from cradle to the end of life and every age and condition in between, including pregnancy and postpartum care,” Dr. Briggs said. Having coordinated care through a PMH helps both physicians and patients because “knowing the risk factors for each woman helps her obstetrical team establish a care plan specific to her,” she said.

Other states have extensive experience and positive outcomes with this model. TMA will keep you posted on the bill’s progress.

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,665 bills. TMA is monitoring 1,938 of them. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Fifty-three days remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 2594 by Rep. Justin Holland (R-Rockwall) would allow hospice providers to adopt written policies regarding the disposal of a patient’s unused prescription drugs, preventing those drugs from falling into unauthorized hands. TMA supports this bill. 
  • Senate Bill 1140 by Sen. Kirk Watson (D-Austin) would establish an independent review organization to review Medicaid appeals and adverse determinations on the basis of medical necessity. House Bill 3478 by Representative Davis is the companion. TMA supports these bills.  

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session. 

PHYSICIAN OF THE DAY

Today’s physician of the day is Linda Siy, MD, of Bedford. Dr. Siy graduated from the University of Missouri-Kansas City School of Medicine and is a member of both TMA and the Tarrant County Medical Society.

WHAT WE’RE READING

Patient protection against surprise billing moves forward in Texas Senate – Houston Chronicle

Congress Looks to Tackle Surprise Medical Bills – The Wall Street Journal

Will fixes to Texas’ broken Medicaid system live or die? Patient groups, insurers draw battle lines – The Dallas Morning News

Bills would curb denials of Medicaid services for disabled children – Austin American-Statesman

ENTERPRISE EDITORIAL: Medicaid red tape not good for state, children – Beaumont Enterprise

Sick of property taxes? Then expand Medicaid in Texas to address the health care system [Opinion- Op Ed] – The Dallas Morning News

Vaccine advocates push for policies to strengthen Texas immunization rates – Austin American-Statesman

Legislative Hotline: Physicians Urge Lawmakers to Extend CPRIT

(Budget, Health Insurance, Public Health) Permanent link

Zerwas_Bonnen

UNDER THE ROTUNDA
Most of the attention today is focused on the school finance debate on the House floor, but Texas Medical Association members continued advocating on behalf of medicine in committee hearings.

In the House Public Health Committee, TMA submitted written testimony in support of a pair of bills: House Bill 39 by Rep. John Zerwas, MD (R-Richmond) (pictured at left), which would extend the life of the Cancer Prevention Research Institute of Texas (CPRIT); and House Bill 75 by Rep. Ina Minjarez (D-San Antonio), which would protect employees, volunteers, and participants in syringe service programs (SSPs) from drug charges.

HB 39 would allow CPRIT to continue its cancer research  beyond the current 2022 Sunset date, contingent on funding from the legislature. This year, more than 121,000 Texans will be diagnosed with cancer, and 40,000 will die.

HB 75 would ensure that distributing sterile injection equipment, such as hypodermic needles and syringes, to protect public safety is not a criminal act.

“People who inject drugs are at risk of acquiring and transmitting blood-borne infections such as HIV and viral hepatitis through unsafe injection practices,” TMA said in its statement. “These health events are costly to society: the estimated lifetime cost of treating one person with HIV is nearly $400,000, and the average hospital admission for opioid overdose costs $92,400. SSPs (syringe services programs) limit infectious disease transmission by promoting safe injection practices.”

In the House Higher Education Committee, TMA advocacy intern and third-year medical student Ankita Brahmaroutu testified in support of House Bill 2573 by Rep. Oscar Longoria (D-Mission), which would add the The University of Texas at Austin Dell Medical School and the School of Medicine at The University of Texas Rio Grande Valley to the Joint Admission Medical Program (JAMP).

Created in 2001, JAMP guarantees acceptance into a Texas medical school to highly qualified, economically disadvantaged students. It also offers scholarships and summer internships.

“JAMP has proven to be a successful program for improving diversity among the Texas physician workforce , and for giving economically disadvantaged medical students an opportunity they likely would not otherwise have to become a physician,” said Ms. Brahmaroutu, who is a student at the Texas A&M Health Science Center College of Medicine. “JAMP also has special programs that create pipelines for high school students into medicine. Through this pipeline I’ve had the opportunity to mentor students, inspiring each of us.”

On the other side of the rotunda, the Senate Finance Committee unanimously passed its version House Bill 1 by Representative Zerwas, which is the state’s 2020-21 budget. 

Last week, the House passed HB 1 unanimously; it will now wind its way through the Senate. A conference committee will conduct final negotiations.

BILLS THAT ARE MOVING

Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills), which would institute baseball-style arbitration for disagreements regarding payment for surprise bills based on market-based benchmark data, was voted out of the Senate Business and Commerce Committee 7-2 and awaits a hearing on the Senate floor. TMA supports this newly revised bill. 

House Bill 1418 by Rep. Dade Phelan (R-Beaumont) seeks to ensure emergency services personnel receive up-to-date information about their immunization status when they seek certification or recertification. The House gave its final approval to the bill on a 147-0 vote; it now heads to the Senate where it will await committee referral. 

The House Insurance Committee approved several bills unanimously, setting them on a path to consideration on the House floor.

  • House Bill 2327 and House Bill 2387 by Rep. Greg Bonnen, MD (R-Friendswood) (pictured at right) would require more prior authorization transparency and require utilization reviews to be conducted by a licensed Texas physician, respectively. TMA testified in strong support of these bills last month.
  • Rep. Julie Johnson (D-Carrollton) has four bills TMA supports:
  • House Bill 1832, the “prudent layperson” bill, prohibits health insurance companies from implementing any practice that renders coverage for emergency services dependent upon a final diagnosis.
  • House Bill 2408, prohibits prior authorization requirements for state-mandated health benefits, such as mammograms and prostate cancer screening.
  • House Bill 2520 requires health plans that approve a prior authorization request for elective health care services to tell patients ahead of time about (1) the network status of physicians or providers who may participate in the service and (2) the patient’s expected financial responsibility.
  • House Bill 2630 requires a health plan’s network directory to clearly identify which physicians are in-network at network facilities. 

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,636 bills. TMA is monitoring 1,936 of them. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Fifty-four days remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 2243 by Rep. Tom Oliverson, MD (R-Cypress) would permit a school nurse to administer prescription asthma medicine to a student who has a prescription for that medicine but whose inhaler is not readily available when needed. This will prevent trips to the emergency room. TMA supports this bill. 
  • House Bill 1941 by Representative Phelan 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. TMA supports this bill.   

HEALTHY VISION 2025

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

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

TODAY’S GRASSROOTS ADVOCACY TIP

Just as you do with your patients, make sure you follow up with your legislator after you’ve had a meeting or phone call. Be persistent but polite, and remind your legislator how important the issue is to you. Ask for an update on where the issue stands, and don’t get dejected if it takes more than one session to address your issue. That is quite common. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Lindsay Botsford, MD, of Sugar Land. Dr. Botsford graduated from Baylor College of Medicine and is a member of both TMA and the Harris County Medical Society.

WHAT WE’RE READING

Fight against surprise medical bills gains momentum in Legislature – Houston Chronicle

Trump Says Vote on Healthcare Can Wait Until After 2020 Election – Reuters

Measles count in US this year already more than all of 2018 – The Associated Press

Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds – The New York Times

Texas edges toward raising sales age for tobacco, but some see smoking as a ‘personal liberty’ – The Dallas Morning News

Texas Health, Baylor, and Methodist Among TMF Health Quality Award Winners – D CEO Healthcare

UH College of Medicine Moves Forward in Texas Legislature – University of Houston

 

Legislative Hotline: Insurance Bill Improves Dramatically; White Coat Invasion Returns

(Budget, Health Insurance, Liability Reform, Public Health, Women’s Health) Permanent link

April_2_hotline

UNDER THE ROTUNDA
The Capitol’s hallways were filled with hundreds of physicians, medical students, and Alliance members today during the third First Tuesdays at the Capitol advocacy event.

Meanwhile, in the House Insurance Committee, Beaumont anesthesiologist Ray Callas, MD, testified in support of brand new versions of House Bill 2967 by Rep. Tom Oliverson, MD (R-Cypress) and House Bill 3933 by Rep. Trey Martinez Fischer (D-San Antonio), identical bills that would require baseball-style arbitration for most surprise medical bills. It also would remove the patient completely from the balance bill dispute resolution process.

The new versions were introduced yesterday afternoon at a Capitol news conference involving four key legislators. Last month in a Senate committee, TMA testified strongly against the original version of one of the bills.

“We would like to thank Representatives Tom Oliverson and Trey Martinez Fischer for working with Senators John Whitmire and Kelly Hancock for finding a solution to out-of-network surprise bills,” Dr. Callas said Tuesday. “The bill prevents a physician or provider from sending a bill to the patient  for any remaining cost for services rendered out-of-network, but it provides a quick and simple appeals process for either the carrier or the provider for a dispute over these costs. It completely removes the patient from the middle.”

Dr. Callas also testified in support of 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 (PPOs) and exclusive provider organizations (EPOs) at least once every two years.

“Last year the Texas Society of Anesthesiologists discovered that Humana unilaterally terminated  all private anesthesia group contracts mid-contract,” Dr. Callas said. “This left over 200 facilities in Texas with no anesthesia coverage with Humana, including the children’s hospitals in Austin and San Antonio. It also meant that the only coverage for anesthesia was at academic hospitals in Houston, San Antonio, and the DFW Metroplex. Humana did not notify the Texas Department of Insurance, nor did they update their directories of this huge drop in coverage.”

Austin oncologist Debra Patt, MD, testified in support of House Bill 2231, by Representative Oliverson, which would rein in the pharmacy benefit manager (PBM) program and keep PBMs from interfering with physicians who provide care through pharmaceuticals. Not only would this improve care coordination, but it would save patients money on prescriptions because they wouldn’t be faced with price markups imposed by PBMs.

“To improve patient access and adherence , many community-based cancer clinics, like Texas Oncology, have established medically integrated platforms or practice-based pharmacies,” Dr. Patt said. “The current lack of transparency and accountability in the pharmacy benefit manager system is contributing to the rising cost of treatment in community oncology, specifically, PBMs’ use of retroactive pharmacy price concessions, and PBMs’ practice of steering patients to PBM-owned mail order or specialty pharmacies.”

In the House Human Services Committee, Austin pediatrician Kimberly Avila Edwards, MD, testified in support of House Bill 1808 by Rep. Eddie Lucio, III (D-Brownsville), which would require that child-care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards.

“My role as a pediatrician is extremely rewarding because preventive interventions in the early years have a lasting impact on a child’s life,” Dr. Edwards said. “Being physically active and having a healthy diet before the age of 5 is associated with improved child development and cognitive outcomes.”

TMA President and Athens family physician Doug Curran, MD, testified in strong support of House Bill 2453 by Rep. Sarah Davis (R-West University Place). The extensive Medicaid managed care organization (MCO) oversight proposed by HB 2453 was inspired by last year’s Dallas Morning News series, “Pain & Profit,” which detailed missteps in the program.

“We must not focus exclusively on removing or punishing bad MCOs, but also recognizing and rewarding plans that perform well,” Dr. Curran said. “Strengthening oversight and accountability will also strengthen care coordination, establishing a fairer appeals process, and streamlining redundant administrative procedures.”

HOUSE DEMONSTRATES VACCINES ARE STILL IMPORTANT

House Bill 1418 by Rep. Dade Phelan (R-Beaumont) seeks to ensure emergency services personnel receive up-to-date information about their immunization status when they seek certification or recertification. The House of Representatives gave the bill preliminary approval without dissent. A final House vote is scheduled for today. TMA testified in favor of this bill last month. 

BILLS THAT ARE MOVING

Senate Bill 21 by Sen. Joan Huffman (R-Houston), which would raise the minimum age for purchasing tobacco and vape products to 21, passed out of the Senate State Affairs Committee yesterday on a 5-4 vote and now awaits debate on the Senate floor. TMA strongly supports this bill and testified in favor of it last month. 

House Bill 1849 by Rep. Stephanie Klick (R-Fort Worth) would permit day-care centers to possess and administer epinephrine auto-injectors prescribed by a physician. The bill also would require day-care centers that keep epinephrine auto-injectors on hand to train personnel who will administer them to children. TMA testified in support of this bill last month. The House gave preliminary approval yesterday without dissent. 

House Bill 405 by Rep. Ina Minjarez (D-San Antonio) would designate June as Neonatal Abstinence Syndrome Awareness month. TMA testified in support of this bill last month. It also received preliminary approval with no dissent. 

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,636 bills. TMA is monitoring 1,936 of them. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Fifty-five days remain until sine die. 

BILLS OF NOTE

Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 2306 by Rep. Jon Rosenthal (D-Houston) would call for an interim committee to review the methods the Texas Department of Transportation uses to integrate public health considerations in major highway project planning. TMA and the Texas Public Health Coalition support this bill. 
  • House Bill 1320 by Rep. Joe Moody (D-El Paso) would create mental health courts as an alternative to incarceration for people with nonviolent behavior. TMA supports this bill.  

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session. 

PHYSICIAN OF THE DAY

Today’s physician of the day is John Gibson, MD, of Fort Worth. Dr. Gibson graduated from the UT Southwestern Medical School, and is a member of the Tarrant County Medical Society.

WHAT WE’RE READING

Texas kicks thousands of low-income children off Medicaid over missing paperwork – San Antonio Express-News, Houston Chronicle

Fact-check: About 1 in 4 women of reproductive age in Texas are uninsured – Austin American-Statesman

Legislation seeks remedy for sticker shock at freestanding emergency rooms – Austin American-Statesman

Fixing health care is hard, but ending ‘surprise billing’ should be easy for Texas lawmakers [Opinion – Commentary] – The Dallas Morning News

Commentary: Student mental health bills address many classroom challenges – Austin American-Statesman

University Health System to invest $170 million in new medical record technology – San Antonio Express-News

Tradition-bound healthcare is learning a few things in Austin’s innovation-focused atmosphere – Modern Healthcare

One foot in front of another: East Texas doc is getting her community moving – Thrive Global

Life was sacred to Abilene’s first female physician Virginia Connally, 106 – Abilene Reporter News