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.

Push Governor Abbott For Prior Auth Relief

(Liability Reform, Public Health) Permanent link

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Prior authorization: Two dreaded words no physician wants to hear, because the process is rarely necessary and often complicated. 

Yet health plans continue to micromanage and interfere with the excellent care you provide patients, second-guess your expertise, waste your resources, and cost your patients precious time and money, while generously padding their own bottom lines. 

When the dust settled on the 2019 Texas Legislature earlier this week, Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) was still standing – carefully negotiated and approved by both chambers. 

The bill helps prevent delays in patient care by providing more transparency for patients and physicians regarding what health plans require for prior authorizations. It also ensures more accountability in health plan utilization reviews for patient care. 

SB 1742 has been sent to Gov. Greg Abbott for his signature, yet it languishes unsigned. And only 17 days remain for the bill to be signed into law. 

It’s time to send a simple message to Governor Abbott: “Sign Senate Bill 1742.” 

“Time is very, very short – a lot shorter, in fact, than we usually have to wait for a decision on a prior authorization request,” TMA President David C. Fleeger, MD, said. “Together, we have an uncompromising and unconflicted regard for our patients’ benefit and best interest. Together, we can make this happen.” 

TMA worked this entire legislative session to relieve some of the burden of prior authorizations. The session is over. The bill passed. Now we just need the governor to sign it. And big insurance is working hard to make sure he doesn’t. 

If you want to get off of the prior authorization merry-go-round, now is the time to make it happen.

Legislative Hotline: Done and Gone; Lawmakers Finish Overall Good Session for Medicine

(Budget, End-of-Life Care, Health Insurance, Liability Reform, Medicaid, Public Health, Scope of Practice, Texas Medical Board, Women’s Health) Permanent link

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UNDER THE ROTUNDA

Monday was the final day of the 86th Legislative session, when the House and Senate gaveled out sine die, which essentially means without a day specified for future meetings.

Technically, lawmakers only had one job during the 140-day session: To approve House Bill 1, by Rep. John Zerwas, MD (R-Richmond), the state’s budget for 2020-21. HB1 was sent to Comptroller Glenn Hegar on Monday for certification, along with Senate Bill 500, by Sen. Jane Nelson (R-Flower Mound), the supplemental spending bill to backfill deficits in the 2018-19 biennial budget.

Lawmakers filed more than 7,000 other bills, of which the Texas Medical Association tracked almost 2,000.

It will take a couple of days to fully digest all of the conference committee reports, corrections, and the voluminous budget.

In the meantime, here is a list of bills important to medicine that made it across the finish line during the closing weekend and will either head to Gov. Greg Abbott’s desk for signature or that he’s already signed. Sunday, June 16 is the deadline for Governor Abbott to sign or veto bills.

Tobacco and Cancer

  • Senate Bill 21 by Sen. Joan Huffman (R-Houston) will raise the minimum age to purchase tobacco and vape products to 21 years, excluding active duty military.
  • House Bill 39 by Representative Zerwas, which will repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, was signed by the governor May 24.

Maternal and Child Health

  • Senate Bill 750, by Sen. Lois Kolkhorst (R-Brenham) will improve maternal access to postpartum care through the Healthy Texas Women Program.
  • Senate Bill 749 by Senator Kolkhorst will establish level-of-care designations for hospitals that provide maternal and neonatal care.
  • House Bill 25 by Rep. Mary Gonzalez (D-Clint) will create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits
  • Senate Bill 355 by Sen. Royce West (D-Dallas) directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care.
  • Senate Bill 952 by Sen. Kirk Watson (D-Austin) will require that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards.
  • House Bill 455 by Rep. Alma Allen (D-Houston) directs the State Board of Education to develop recess policies that encourage outdoor playtime and physical activity.
  • House Bill 448 by Rep. Chris Turner (D-Grand Prairie) will require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds. 

Insurance

  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) will require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process.
  • Senate Bill 1742 by Sen. Jose Menéndez (D-San Antonio) will require health plan directories to clearly identify which physician specialties are in network at network facilities. It also will require greater transparency with prior authorizations and it mandates that utilization reviews be conducted by a physician in the same or similar specialty as the physician requesting approval for a treatment. TMA is urging physicians to contact Governor Abbott and ask him to sign SB 1742. 
  • House Bill 1941 by Rep. Dade Phelan (R-Beaumont) will 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.
  • House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress) will require vastly improved transparency regarding prescription drug costs.
  • House Bill 1584 by Rep. Senfronia Thompson (D-Houston) will prohibit step therapy protocols for stage 4 metastatic breast cancer.
  • House Bill 2041 by Representative Oliverson will require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees.
  • House Bill 3041 by Representative Turner will allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure.
  • House Bill 170 by Rep. Diego Bernal (D-San Antonio) will require health plans to cover diagnostic mammograms at 100%, the same as screening mammograms. 

Texas Medical Board/Professional Liability

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill, will extend the TMB for another 12 years.
  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), will create a complaint process at the TMB for employed physicians to use.
  • House Bill 2362 by Rep. Joe Moody (D-El Paso) will create an exception to the willful and wanton emergency medical care standard if a physician or health care provider negligently causes a stable patient to require emergency medical treatment.

Prescription Monitoring Program/Opioids

  • House Bill 2174 by Representative Zerwas will help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder.
  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) will delay the mandate to check the prescription monitoring program until March 2020 and will require electronic prescribing of opioids unless a waiver is granted.
  • House Bill 3285 by Representative Sheffield will permit telehealth treatment for substance use, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths.
  • Senate Bill 1564 by Senator West will provide Medicaid coverage for medication-assisted treatment.
  • House Bill 2088 by Rep. Jay Dean (R-Longview) will require health care professionals dispensing controlled substance prescriptions to provide written notice of the closest safe disposal location and other safe disposal methods available.  

 Cannabis 

  • House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth) will allow a physician to recommend low-THC cannabis for medical use by a patient with a variety of debilitating medical conditions.

Medicaid

  • Senate Bill 1207 by Sen. Charles Perry (R-Lubbock) will require more explicit prior authorization denial notices and establish an explicit goal to reduce the overall number of prior authorizations in Medicaid.
  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway) will would require Medicaid to cover telemedicine services.

Mental Health

  • Senate Bill 11 by Sen. Larry Taylor (R-Friendswood) addresses school safety, including substance use and mental health services.

Telemedicine

  • House Bill 1063 by Rep. Four Price (R-Amarillo) will require Medicaid to cover home telemonitoring for specific pediatric patients.
  • House Bill 3345 by Representative Price will allow physicians to choose the best platform for providing telemedicine services rather than having health plans dictate the platform. 

Public Health/Long-Term Care

  • Senate Bill 1519 by Senator Kolkhorst will establish a statewide council on long-term care facilities.
  • House Bill 1418, Representative Phelan, which will provide first responders and emergency services personnel with their immunization status when they seek certification or recertification, was signed by the governor.
  • House Bill 1848 by Representative Klick will establish infection control programs in long-term care facilities.
  • House Bill 2050 by Representative Paddie will require written consent for the administration of psychoactive drugs to long-term care facility residents.
  • Senate Bill 384 by Senator Nelson will require all health care facilities to report all health care-affiliated infections. 

Graduate Medical Education/Workforce

  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin) will create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings.
  • House Bill 2261 by Rep. Armando Walle (D-Houston) will increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000.  

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

HEALTHY VISION 2025

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

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

WHAT WE’RE READING

DFW Airport visitors may have been exposed to measles this month, officials say – The Dallas Morning News

Texas on brink of banning surprise medical bills – Houston Chronicle

One In Four Texas Women Of Childbearing Age Doesn’t Have Health Insurance – KUT

Burgess cosponsors VACCINES Act to improve nation’s immunization rates – Ripon Advance

Officials fighting U.S. measles outbreaks threaten to use rare air travel ban – The Washington Post

Correction: This story has been edited to remove House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), from the list of bills headed to Governor Abbott's desk. The bill, which would have required both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, did not make it out of the Senate. Many of the provisions of HB 2327, however, were added to Senate Bill 1742, which is awaiting the governor’s signature. TMA is urging physicians to contact Governor Abbott and ask him to sign SB 1742.

Legislative Hotline: Act Now For Prior Authorization Relief

(TAKE ACTION NOW, Budget, End-of-Life Care, Health Insurance, Liability Reform, Medicaid, Public Health, Scope of Practice, Texas Medical Board, Women’s Health) Permanent link

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ACTION ALERT

Please call Gov. Greg Abbott’s office now at (512) 463-2000 regarding two key health insurance reform bills.

“Tell him to stand with physicians and our patients against insurance company interference,” Texas Medical Association President David Fleeger, MD, said this morning in an email to all members. “Tell the governor to give the go-ahead for strong prior authorization and utilization review protections in Senate Bill 1742 and/or House Bill 2327.”

These bills:

  • Help prevent delays in patient care by providing more transparency for patients and physicians regarding what health plans require for prior authorizations.
  • Ensure more accountability in health plan utilization reviews for patient care.

UNDER THE ROTUNDA

Three days remain in this legislative session. By midnight tonight, the House must accept Senate amendments to House bills or name a conference committee to debate the proposed changes.

By midnight Sunday, both the House and Senate must accept conference committee reports or discharge conference committees and accept amendments added by the opposite chamber.

Numerous TMA-supported bills made it through the legislature Thursday and await Gov. Greg Abbott’s signature:

  • House Bill 2261 by Rep. Armando Walle (D-Houston) 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.
  • Senate Bill 750, by Sen. Lois Kolkhorst (R-Brenham), which would improve maternal access to postpartum care through the Healthy Texas Women Program.
  • Senate Bill 749 by Senator Kolkhorst, which would establish level-of-care designations for hospitals that provide maternal and neonatal care.
  • 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.
  • House Bill 455 by Rep. Alma Allen (D-Houston), which would direct the State Board of Education to develop recess policies that encourage outdoor playtime and physical activity.
  • House Bill 3041 by Rep. Chris Turner (D-Grand Prairie), which would allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure.
  • House Bill 448 by Representative Turner, which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds.
  • House Bill 2050 by Rep. Chris Paddie (R-Marshall), which would require written consent for the administration of psychoactive drugs to long-term care facility residents.
  • Senate Bill 384 by Sen. Jane Nelson (R-Flower Mound), which would require all health care facilities to report all health care-affiliated infections.

 

Meanwhile, these TMA-supported bills are still alive: 

Insurance

  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – is on today’s Senate Calendar for consideration of House amendments. After extensive negotiation, TMA supports this bill.
  • SB 1742 by Sen. Jose Menéndez (D-San Antonio) would require health plan directories to clearly identify which physician specialties are in network at network facilities. The Senate did not accept changes made in the House, and both the House and Senate named conference committee members to reconcile differences. TMA testified in support of this bill. (See Action Alert on this bill.)
  • House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, awaits House agreement with a Senate amendment or the appointment of a conference committee. TMA testified in support of this bill. (See Action Alert on this bill.)
  • House Bill 1941 by Rep. Dade Phelan (R-Beaumont) – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress), which would require vastly improved transparency regarding prescription drug costs, is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 1584 by Rep. Senfronia Thompson (D-Houston), which would prohibit step therapy protocols for stage 4 metastatic breast cancer, is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 2041 by Representative Oliverson, which would require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees, is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.

Maternal and Child Health

  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, awaits the decision of a conference committee. TMA testified in support of this bill last month.
  • Senate Bill 355 by Sen. Royce West (D-Dallas) directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care. The Senate refused to agree with House amendments and requested a conference committee. TMA testified in support of this bill.

Texas Medical Board

  • House Bill 1504 by Representative Paddie, the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, was voted unanimously out of the Senate last week. The House did not accept changes the Senate made to the bill, and named a conference committee to negotiate the differences. The Texas Medical Association testified in support of this bill earlier this session.

Prescription Monitoring Program/Opioids

  • House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) – which would help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder – is set on today’s House Calendar to agree with Senate amendments or request a conference committee. TMA supports this bill.
  • House Bill 3285 by Rep. J.D. Sheffield, DO (R-Gatesville) – which would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths – is set on today’s House Calendar to consider Senate amendments. TMA supports this bill.
  • Senate Bill 1564 by Senator West, which would provide Medicaid coverage for medication-assisted treatment, is set on today’s Senate Calendar for consideration of House amendments. TMA supports this bill.  

Cannabis

  • House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth), which would allow a physician to recommend low-THC cannabis for medical use by a patient with a variety of debilitating medical conditions, is set on today’s House Calendar for consideration of Senate amendments. TMA is closely monitoring this bill.

Medicaid

  • Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, has been referred to conference committee as the Senate did not agree with House amendments. TMA supports this bill.
  • Senate Bill 1207 by Sen. Charles Perry (R-Lubbock) would require more explicit prior authorization denial notices for the Medicaid program and establish an explicit goal to reduce the overall number of prior authorizations. The Senate did not accept House amendments and requested a conference committee. TMA supports this bill.

Mental Health

  • Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), which would address school safety, including substance use and mental health services, also includes many components of Senate Bill 10 by Senator Nelson, which was killed on a point of order. The Senate did not accept the House amendments and requested a conference committee. TMA testified in support of SB 10 and strongly supports SB 11.

Telemedicine

  • House Bill 1063 by Rep. Four Price (R-Amarillo), which would require Medicaid to cover home telemonitoring for specific pediatric patients, is set on today’s House Calendar for consideration of Senate amendments. TMA supports this bill. 

2020-21 State Budget

House Bill 1, by Representative Zerwas, is the $248 billion biennial state budget. Lawmakers on Monday released a draft of their negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26 –Sunday.

Here are some quick highlights and lowlights:

Medicaid

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

Maternal Health

  • Adopts an additional $52 million for women’s health programs, including:
  • $45 million for the Healthy Texas Women program, $15 million of which is contingent on Governor Abbott signing SB 750 to help improve prenatal and postpartum coverage (the Senate agreed with House amendments to SB 750 Thursday);
  • $7 million for the Family Planning Program; and
  • $840,000 more for the Breast and Cervical Cancer Treatment Program.
  • Adds $7 million to implement measures to reduce maternal mortality and morbidity. 

Public Health

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

Behavioral Health

  • Adopts an increase of $50 million to improve community mental health services for adults and an additional $8 million for children’s mental health; and
  • Includes $100 million to establish the Texas Mental Health Care Consortium outlined in Senate Bill 10 by Senator Nelson, amended into SB 11 by Senator Taylor, including $20 million to implement the new Child Psychiatric Access Network and another $43 million to implement the Texas Child Health Access Through Telemedicine program. 

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

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

Final, detailed summaries of the budget documents are expected to be published by the Legislative Budget Board today. The budget will be debated on the House floor Saturday. We will provide a more in-depth analysis once more is known about bills passed or on life support and how they impact preliminary budget agreements.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Cristian Fernandez Falcon, MD, of San Antonio. Dr. Fernandez Falcon graduated from the Universidad Catolica Argentina Facultad de Ciencias Médicas in Buenos Aires and is a member of the Bexar County Medical Society.

WHAT WE’RE READING

Pain & Profit: Big Medicaid reforms snuck out of the Texas House, but will cost-cutting senators get on board? – The Dallas Morning News

Texas insurance giant tells judges brain-damaged baby and mom are stifling company’s free speech – The Dallas Morning News

Drug-price transparency bill likely headed to Gov. Abbott’s desk, stronger than many predicted – Houston Chronicle

Flu Outbreak Prompts Largest Border Detention Center to Stop Processing Migrants – The New York Times

Texas expansion of medical cannabis nears finish line after Senate approval – The Texas Tribune

Medical files found in dumpster in Tomball – Houston Chronicle

A Texas woman’s fight with a health care system she says let her down – Houston Chronicle

North Texas Physicians Honored by the Texas Medical Association – D CEO Healthcare


Legislative Hotline Video: What’s Missing From Texas’ Draft Budget?

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

Lawmakers released their two-year spending plan for 2020-21 this week, but TMA Immediate Past President Doug Curran, MD, says one item that’s not included was greatly needed: A pay hike for doctors who care for Medicaid patients. 

This week's TMA Legislative News Hotline Video summarizes the pros and cons of the budget plan from medicine's perspective, including spending proposals for maternal health, public health, behavioral health, and graduate medical education. 

Debra Patt, MD, TMA Council on Legislation's chair-elect, describes why lawmakers should broaden state policing of insurance network adequacy. She testified in support of a bill proposing that change – one of more than a dozen bills on which we provide a lightning-round status summary in the final full week of the 86th session of the Texas Legislature. 

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: Several Medicine-Friendly Bills Head to Governor

(Budget, End-of-Life Care, Health Insurance, Liability Reform, Medicaid, Public Health, Scope of Practice, Texas Medical Board, Women’s Health) Permanent link

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UNDER THE ROTUNDA

Four days remain in this session. Bills that didn’t receive their final floor debate by midnight last night are dead for this session. We will do a postmortem once all the dust settles next week.

By midnight tomorrow, the House must accept Senate amendments to House bills or name a conference committee to debate the proposed changes.

By midnight Sunday, both the House and Senate must accept conference committee reports or discharge conference committees and accept amendments added by the other chamber.

Several bills supported by the Texas Medical Association made it through the process and await Gov. Greg Abbott’s signature:

  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference.
  • House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years.
  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities.
  • 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.
  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville), which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy.
  • House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or health care provider negligently causes a stable patient to require emergency medical treatment.
  • House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform for providing telemedicine services rather than having health plans dictate the platform.
  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services.
  • Senate Bill 355 by Sen. Royce West (D-Dallas), which directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care.
  • House Bill 170 by Rep. Diego Bernal (D-San Antonio), which would require health plans to cover diagnostic mammograms at 100%, the same as screening mammograms. 

Meanwhile, other TMA-supported bills are still alive:

Maternal Health

  • House Bill 25 by Rep. Mary Gonzalez (D-Clint) would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits. The House refused to accept Senate amendments and appointed a conference committee. TMA testified in support of this bill last month.
  • Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham), which would establish level-of-care designations for hospitals that provide maternal and neonatal care, is on the Senate Calendar awaiting consideration of House amendments. TMA testified in support of this bill.
  • Senate Bill 750, by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, is on the Senate Calendar for consideration of House amendments. The draft state budget allocates $15 million for this program, if SB 750 passes. TMA testified in support of this bill.

Insurance

  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – is on the Senate Calendar for consideration of House amendments. After extensive negotiation, TMA supports this bill.
  • Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) would require health plan directories to clearly identify which physician specialties are in network at network facilities. The Senate did not accept changes made in the House, and named a conference committee. TMA testified in support of this bill.
  • House Bill 1941 by Rep. Dade Phelan (R-Beaumont) – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – was voted out of the Senate 30-1 and heads back to the House for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, was voted out of the Senate 31-0 yesterday and heads back to the House for consideration of a Senate amendment. TMA testified in support of this bill.
  • House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress), which would require vastly improved transparency regarding prescription drug costs, passed the Senate 27-4 yesterday and returns to the House for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 1584 by Rep. Senfronia Thompson (D-Houston), which would prohibit step therapy protocols for stage 4 metastatic breast cancer, passed the Senate 30-1 yesterday and returns to the House for consideration of a Senate amendment. TMA supports this bill.

Texas Medical Board

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall) is the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years. The House did not accept changes the Senate made to the bill and named a conference committee to negotiate the differences. The Texas Medical Association testified in support of this bill earlier this session.

Prescription Monitoring Program/Opioids

  • House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) – which would help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder – was voted out of the Senate yesterday 28-3. The House must now concur on Senate amendments or request a conference committee. TMA supports this bill.
  • House Bill 3285 by Representative Sheffield – which would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths – was voted out of the Senate 31-0 and heads back to the House to consider Senate amendments. TMA supports this bill.  

Medicaid

  • Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, passed the House yesterday 140-4. It now returns to the Senate to consider House amendments. TMA supports this bill.
  • Senate Bill 1207 by Sen. Charles Perry (R-Lubbock), which would require that Medicaid managed care prior authorization reviews be performed by an external medical reviewer, require that clear explanations of denial notices be provided to patients, and establish an explicit goal to reduce the overall number of prior authorizations, was voted out of the House 139-0. Now, the Senate must decide whether to accept House amendments. TMA supports this bill.
  • House Bill 1576 by Representative Phelan, which would allow Medicaid to contract with a transportation network company, such as Uber, for nonemergency transportation to or from a medical appointment, was voted out of the Senate 31-0 and now returns to the House to consider a Senate amendment. TMA supports this bill.

Mental Health

Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), which would address school safety, including substance use and mental health services, also includes many components of Senate Bill 10 by Sen. Jane Nelson (R-Flower Mound), which was killed on a point of order. SB 11 was voted out of the House 135-7 yesterday and now returns to the Senate to consider House amendments.TMA testified in support of SB 10 and strongly supports SB 11. House Joint Resolution 5, the funding mechanism for  HB 10, was not taken up for debate and is dead this session. TMA supported this bill.

Graduate Medical Education/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 – is on today’s House Calendar for consideration of Senate amendments. TMA supports this bill.  

Public Health/Long-Term Care

  • Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, passed yesterday in the House 107-36 and now waits for senators to decide on House amendments. TMA submitted written testimony in support of this bill.
  • House Bill 448 by Rep. Chris Turner (D-Grand Prairie), which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds, is on the House Calendar awaiting consideration of Senate amendments. TMA supports this bill.
  • House Bill 2050 by Representative Paddie, which would require written consent for the administration of psychoactive drugs to long-term care facility residents, is on the House Calendar to consider Senate amendments. TMA supports this bill. 

2020-21 State Budget

Lawmakers on Monday released a draft of their negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26 – Sunday. Here’s a snapshot of the current status of the $248 billion biennial state budget, House Bill 1, by Representative Zerwas.

Medicaid

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

Maternal Health

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

Public Health

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

Behavioral Health

  • Adopts an increase of $50 million to improve community mental health services for adults and an additional $8 million for children’s mental health; and
  • Includes $100 million to establish the Texas Mental Health Care Consortium outlined in SB 11 by Senator Taylor, including $20 million to implement the new Child Psychiatric Access Network and another $43 million to implement the Texas Child Health Access Through Telemedicine program. 

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

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

Final, detailed summaries of the budget documents are expected to be published by the Legislative Budget Board today or Friday. The budget will be debated on the House floor on Saturday. We will provide a more in-depth analysis once more is known about bills passed or on life support and how they impact preliminary budget agreements.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Mark Nadeau, MD, of San Antonio. Dr. Nadeau graduated from the University of Virginia School of Medicine and is a member of the Bexar County Medical Society.

WHAT WE’RE READING

Texas bill to raise smoking age to 21 on its way to governor’s desk – KVUE-TV

This session’s biggest mental health bill got killed on a technicality – then resurrected – The Texas Tribune

Health care tops list of Americans’ top issues in new poll – The Hill

Episiotomies are painful, risky and not routinely recommended. Dozens of hospitals are doing too many. – USA Today

West Nile Virus Confirmed in Addision, County Health Department Says – KXAS-TV

How Community Health Workers at Baylor are Reducing Trips to the Hospital – D CEO Healthcare

Until broadband access improves, telemedicine won’t help rural communities – Reuters

 

Legislative Hotline: Maternal Health Bill Now Awaits Governor’s Approval

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

Capitol_Dome

UNDER THE ROTUNDA

Five days remain in this session, plus a few hours. Every day is now a critical deadline of some sort.

The House and Senate both have until midnight tonight to consider bills in their final debate for passage. To quantify that task and put it into perspective, the Senate alone has more than 610 bills on its agenda today.

By midnight tomorrow, all Senate amendments to House bills must be distributed to House members.

By midnight Friday, the House must act on Senate amendments to House bills, meaning they must accept the proposed changes or name a conference committee to debate the proposed changes.

By midnight Sunday, both the House and Senate must accept conference committee reports or discharge conference committees and accept amendments added by the opposite chamber.

Here’s a roundup of the down-to-the-wire status of medicine’s key bills:

Maternal Health

  • 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, was sent to the governor yesterday. 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.
  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, was voted out of the Senate 30-1 late last week. HB 25 is on today’s House Calendar for them to decide whether to accept the amendments the Senate made to the bill or ask for a conference committee to negotiate the differences. TMA testified in support of this bill last month.
  • SB 750, by Sen. Lois Kolkhorst (R-Brenham), which would improve maternal access to postpartum care through the Healthy Texas Women Program, was voted out of the House yesterday 144-2 and returns to the Senate for consideration of amendments the House added. SB 750 must pass for contingent funding to be allocated. TMA testified in support of this bill.
  • House Bill 1111 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, is on today’s Senate Calendar. TMA supports this bill.

Insurance

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

Texas Medical Board/Corporate Practice of Medicine

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

Prescription Monitoring Program/Opioids

  • House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) – which would help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder – was voted out of the Senate yesterday 28-3. The House must now concur in Senate amendments or request a conference committee. TMA supports this bill.
  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) – which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy – is on today’s Senate Local and Uncontested Calendar. TMA supports this bill.
  • House Bill 3285, also by Representative Sheffield – which would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths – is on today’s Senate Calendar. TMA supports this bill.  

Professional Liability

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

Medicaid

  • Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, won preliminary approval in the House late yesterday. The bill awaits final debate today, then will return to the Senate, which must decide to accept amendments made by the House or ask for a conference committee to negotiate the differences. TMA supports this bill.
  • Senate Bill 1207 by Sen. Charles Perry (R-Lubbock), which would require more explicit prior authorization denial notices and establish an explicit goal to reduce the overall number of prior authorizations in the Medicaid managed care program, also won preliminary approval in the House late yesterday. The bill awaits final debate today, then will return to the Senate, which must decide to accept amendments made by the House or ask for a conference committee to negotiate the differences. TMA supports this bill.

Telemedicine

  • House Bill 3345 by Rep. Four Price (R-Amarillo) – which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform – is on today’s Senate Local and Uncontested Calendar. TMA strongly supports this bill.
  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, heads to the governor for his signature. TMA supports this bill.

Mental Health

  • Senate Bill 10 by Senator Nelson – which would create the Texas Mental Health Care Consortium, a collaboration of health-related institutions of higher education and the Statewide Behavioral Health Coordinating Council to improve the effectiveness of and access to behavioral health care for Texas youth – was killed on a point of order in the House late yesterday. However, several components of SB 10 were successfully amended onto Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), which would address school safety, including substance use and mental health services. SB 11 received preliminary approval in the House yesterday at the 11th hour and awaits final approval today. SB 11 must then return to the Senate for acceptance of amendments or to request a conference committee to reconcile differences.TMA testified in support of this bill.
  • House Bill 10 by Rep. Senfronia Thompson (D-Houston) – which would create the Texas Mental and Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program – is on today’s Senate Calendar. TMA submitted written testimony in support of this bill.
  • House Joint Resolution 5, also by Representative Thompson, is the funding mechanism for HB 10. HJR 5 would allocate $100 million in each fiscal year to the Texas mental and behavioral health research fund that HB 10 would establish, as long as the state collects more than $30.5 billion in sales, excise, and use tax revenue in that fiscal year. HJR 5 is set on today’s Senate Calendar. If HJR 5 passes, Texans will vote on the constitutional amendment in November. TMA supports this bill.

Graduate Medical Education/Workforce

  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin), which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings, has passed both chambers. It’s now up to the House to decide what to do about amendments that senators added to the bill. TMA submitted written testimony in support of this bill.
  • House Bill 2261 by Rep. Armando Walle (D-Houston) – which would increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000 – passed out of the Senate on Monday 26-5. House members must now consider the amendments added in the Senate. TMA supports this bill.  

Immunizations/Long-Term Care

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

2020-21 State Budget

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

House Bill 1, by Representative Zerwas, is the $248 billion biennial state budget. Here are some quick highlights and lowlights:

Medicaid

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

Maternal Health

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

Public Health

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

Behavioral Health

  • Adopts an increase of $50 million to improve community mental health services for adults and an additional $8 million for children’s mental health; and
  • Includes $100 million to establish the Texas Mental Health Care Consortium outlined in Senate Bill 10 by Senator Nelson, including $20 million to implement the new Child Psychiatric Access Network and another $43 million to implement the Texas Child Health Access Through Telemedicine program. (SB 10 failed to pass in the House yesterday. Supporters are looking for bills onto which amendments can be made to keep part or all of SB 10 alive.) 

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

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

Final, detailed summaries of the budget documents are expected to be published by the Legislative Budget Board tomorrow or Friday. The budget will be debated on the House floor on Saturday. We will provide a more in-depth analysis once more is known about bills passed or on life support and how they impact preliminary budget agreements.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Lesca Hadley, MD, of Fort Worth. Dr. Hadley graduated from the Texas Tech University Health Sciences Center and is a member of the Johnson County Medical Society.

WHAT WE’RE READING

Measles Outbreaks in U.S. Tick Up – The Wall Street Journal

Texas Falls in Leapfrog’s Hospital Safety Grades, Despite Local Successes – D CEO Healthcare

Texas Medical Assoc. Chooses Houston Physician for President-Elect – Mega Doctor News

McConnell and Kaine unveil bill to raise tobacco age to 21 – Politico

Until broadband access improves, telemedicine won’t help rural communities – Reuters

Maternal Mortality in the US state-by-state – Georgia is No. 1 – Becker’s Hospital Review

Smoke-free parks policy begins June 1 in San Antonio – KENS-TV

Legislative Hotline: At Long Last, Tobacco 21 Bill Heads To Governor

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

Tobacco_Under_21

UNDER THE ROTUNDA

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

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

Governor Abbott has indicated he will sign the bill.

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

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

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

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

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

Telemedicine

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

Graduate Medical Education

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

2020-21 State Budget

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

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

Medicaid

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

Maternal Health

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

Public Health

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

Behavioral Health

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

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

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

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

Texas Medical Board/Corporate Practice of Medicine

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

Prescription Monitoring Program/Opioids

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

Professional Liability

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

Insurance

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

Maternal Health

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

Mental Health

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

Graduate Medical Education/Workforce

  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin), which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings, has passed both chambers. It’s now up to the House to decide what to do about amendments that senators added to the bill. TMA submitted written testimony in support of this bill.
  • House Bill 2261 by Rep. Armando Walle (D-Houston) – which would increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000 – passed out of the Senate yesterday 26-5. House members must now consider the amendments added in the Senate. TMA supports this bill.  

Immunizations/Long-Term Care

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

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

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

WHAT WE’RE READING

In addressing opioid crisis, Texas lawmakers shy away from controversial billsAustin American-Statesman

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

Fort Worth’s Medical School Curriculum to Avoid Burnout and Emphasize EmpathyD CEO Healthcare

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

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

 

Legislative Hotline: Zero Medicaid Rate Increases in Draft State Budget

(Budget, End-of-Life Care, Health Insurance, Liability Reform, Medicaid, Public Health, Scope of Practice, Texas Medical Board, Women’s Health) Permanent link

vote story

UNDER THE ROTUNDA

The final House calendars of the legislative session have been set. The previous 132 days have brought us to the final scene in the biennial legislative saga.

The House and Senate both have until midnight May 22 to consider bills.

Meanwhile, lawmakers have released a draft of their negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26 – next Sunday.

2020-21 State Budget

House Bill 1, by Rep. John Zerwas, MD (R-Richmond), is the $248 billion 2020-21 state budget. House and Senate conference committee members have been working through Articles II and III – health and human services and education, respectively – and released a preliminary budget document. The Legislative Budget Board will finalize that document in the next couple of days, but here are some quick highlights and lowlights:

Medicaid

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

Maternal Health

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

Public Health

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

Behavioral Health

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

Early Childhood Intervention

$31 million more for Early Childhood Intervention programs. 

Graduate Medical Education/Workforce

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

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

Meanwhile, here’s a status check on other bills that continue to move through the legislative process.

Texas Medical Board/Corporate Practice of Medicine

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, was voted unanimously out of the Senate last week. The House must now decide whether to accept changes the Senate made to the bill or request a conference committee to negotiate the differences. The Texas Medical Association testified in support of this bill earlier this session.
  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, was voted out of the Senate Health and Human Services Committee yesterday and awaits debate on the Senate floor. TMA testified in support of this bill in March.

Prescription Monitoring Program/Opioids

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

Professional Liability

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

Insurance

  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – is set on today’s House Calendar. After extensive negotiation, TMA supports this bill.
  • Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio),  which would require health plan directories to clearly identify which physician specialties are in network at network facilities, is eligible today for senators to consider the amendments the House added to the bill. TMA testified in support of this bill.
  • House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill.
  • House Bill 1941 by Rep. Dade Phelan (R-Beaumont) – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – is set on the Senate Calendar for today. TMA supports this bill.
  • House Bill 3041 by Rep. Chris Turner (D-Grand Prairie), which would allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure, was voted out of the Senate Business and Commerce Committee on Friday and awaits debate on the Senate floor. TMA supports this bill.

Maternal Health

  • Senate Bill 436 by Senator Nelson , which directs DSHS to develop and implement initiatives to assist pregnant and postpartum women with opioid use disorder and newborns with neonatal abstinence syndrome, was voted out of the House 146-0 and now heads to the governor. This bill specifically refers to the TexasAIM Opioid Bundle that evolved out of the Maternal Mortality and Morbidity Task Force and is strongly supported by TMA.
  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, was voted out of the Senate 30-1 late last week. The House now must decide whether to accept the amendments the Senate made to the bill or ask for a conference committee to negotiate the differences. TMA testified in support of this bill last month.
  • Senate Bill 749 by Senator Kolkhorst, which would establish level of care designations for hospitals that provide maternal and neonatal care, is set on today’s House Calendar. TMA testified in support of this bill.
  • SB 750, by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, is set on today’s House Calendar. SB 750 must pass for contingent funding to be allocated. TMA testified in support of this bill.
  • House Bill 1111 by Rep. Sarah Davis (R-West University Place) which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, was voted out of the Senate Health and Human Services Committee late Friday and awaits debate on the Senate floor. TMA supports this bill.

Tobacco

  • 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 – is eligible today for senators to consider the amendments the House added to the bill. TMA testified in strong support of SB 21 earlier this session. 

Telemedicine

  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, is eligible today for senators to consider the amendments the House added to the bill. TMA supports this bill.
  • House Bill 3345 by Rep. Four Price (R-Amarillo) – which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform – was voted out of the Senate Business and Commerce Committee on Friday and awaits debate on the Senate floor. TMA strongly supports this bill.

Mental Health

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

Graduate Medical Education/Workforce

  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin), which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings, is set on today’s House Calendar. TMA submitted written testimony in support of this bill.
  • House Bill 2261 by Rep. Armando Walle (D-Houston) – which would increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000 – is set on today’s Senate Calendar. TMA supports this bill.  

Immunizations

  • House Bill 1256 by Representative Phelan, which would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster, was sent to the governor. TMA testified in support of this bill.
  • House Bill 1418, also by Representative Phelan, which would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification, passed the Senate on Thursday and was sent to the governor. TMA testified in support of this bill.
  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth) which would establish infection control programs in long-term care facilities, was voted out of the Senate Health and Human Services Committee last night and awaits debate on the Senate floor. TMA testified in support of this bill. 

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Veronica Escobar, DO, of San Antonio. Dr. Escobar graduated from the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine and is a member of both TMA and the Bexar County Medical Society.

WHAT WE’RE READING

Medicaid and CHIP director to leave the end of May – Modern Healthcare

Amid opioid crisis, Texas becomes first state where life-saving drug is sold online – Dallas Morning News

Fleeger to Lead Texas Medical Association – Vital Record

Blistering Report Details Serious Safety Lapses at St. Luke's in Houston – ProPublica

Don't just blame hospitals and docs for high health spending. Texas keeps dropping the ball. – Dallas Morning News

Enforcement lags as Texas moves to raise smoking age to 21 – Houston Chronicle

Texas Lawmakers On Both Sides Of The Aisle Support Bill To End 'Surprise Medical Bills' – KERA News

 

Legislative Hotline: Prescription Monitoring and Professional Liability Bills Highlight Today’s Deliberations

 Permanent link

1.25 mental health

UNDER THE ROTUNDA

Today is the 130th day of the session. But who’s counting?

The House and Senate both have less than one week to vote on bills, which must be complete by midnight May 22.

Meanwhile, lawmakers are finalizing negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26.

Here’s a status check on numerous bills that continue to move through the legislative process.

Prescription Monitoring Program/Opioids – TMA supports these three bills, which are scheduled for a hearing today in the Senate Health and Human Services Committee:

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

Professional Liability

  • House Bill 2362 by Rep. Joe Moody (D-El Paso) – which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment – is set for a hearing today in the Senate State Affairs Committee. After extensive negotiation and revision, TMA supports the bill.

Insurance

  • Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio), which would require health plan directories to clearly identify which physician specialties are in network at network facilities, is set for final debate on today’s House Calendar. TMA testified in support of this bill.
  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – was heard yesterday in the Senate Business and Commerce Committee and left pending. TMA supports this bill.
  • House Bill 3041 by Rep. Chris Turner (D-Grand Prairie) – which would allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure – was heard yesterday in the Senate Business and Commerce Committee and left pending. TMA supports this bill.

Maternal Health

  • 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, is set on the House Calendar today. 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.
  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, was voted out of the Senate 30-1 yesterday. The House now must decide whether to accept the amendments the Senate made to the bill or ask for a conference committee to negotiate the differences. TMA testified in support of this bill last month.

Tobacco

  • 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 – is eligible today for senators to consider the amendments representatives added to the bill. TMA testified in strong support of SB 21 earlier this session.

Telemedicine

  • House Bill 3345 by Rep. Four Price (R-Amarillo) – which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform – was heard in the Senate Business and Commerce Committee yesterday and left pending. TMA strongly supports this bill.

Scope of Practice

  • Senate Bill 2438 by Sen. Jose Rodriguez (D-El Paso), which would allow “full practice” authority for Advanced Practice Registered Nurses (APRNs), was heard in the Senate Business and Commerce Committee yesterday and left pending. TMA opposes this bill  .

Graduate Medical Education/Workforce

  • House Bill 80 by Rep. Lina Ortega (D-El Paso) would have the Texas Higher Education Coordinating Board (THECB) conduct a study and develop an inventory of existing doctoral-level health science education programs. THECB would then issue a report to the legislature with recommendations for establishing new programs and for expanding existing ones. HB 80 was voted out of the Senate 19-12 without amendments and should head next to Gov. Greg Abbott’s desk. TMA supports this bill.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Banafsheh Moshiree Thomas, MD, of Grand Prairie. Dr. Thomas graduated from St. George’s University School of Medicine in Grenada and is a member of the Dallas County Medical Society.

WHAT WE’RE READING

Texas House passed one of the nation’s toughest drug-pricing bills. Is it too good to be true? – Houston Chronicle

Texas Poised to Raise the Legal Smoking Age to 21 – U.S. News & World Report

Senate seeks to extend time in end-of-life hospital disputes – Austin American-Statesman

Voters happy with their healthcare, survey finds, highlighting risks of sweeping reform plans – Washington Examiner

White House Wants Patients to Know Health-Care Prices Up Front – The Wall Street Journal

Texas Health to build $128 million specialty center for women and infants in Denton – The Dallas Morning News

Hope still alive for Medicaid system fixes – The Dallas Morning News

US Birth Rate Continues to Fall – The Associated Press

‘I felt cheated. I felt robbed.’ Central Texas mothers share their experiences with postpartum mood – KVUE-TV

Texas Tech University Health Sciences Center of El Paso awarded telemedicine expansion grant – KVIA-TV


 

Legislative Hotline: Patient-Friendly Insurance Bills Top Today’s Calendar

 Permanent link

Capitol_Dome

UNDER THE ROTUNDA

Today is the 130th day of the 140-day session.

Time is quickly running out for bills to pass. Fortunately, physicians’ priority bills are still moving toward the finish line.

The House and Senate both have less than one week to vote on bills, which must be complete by midnight May 22.

Meanwhile, lawmakers will continue to negotiate the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26. The Texas Medical Association remains steadfast in its request for more funding for Medicaid, women’s health, mental health, and graduate medical education (GME), and will continue to vigorously plead our case.

Bills set on House and Senate calendars occasionally roll over to the next day if time runs out to debate them on the floor, and that happened again yesterday. Here’s a status check on numerous bills that continue to move through the legislative process.

Insurance

  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – is set for a hearing today in the Senate Business and Commerce Committee. TMA supports this bill.
  • Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) – which would require health plan directories to clearly identify which physician specialties are in network at network facilities – is set for floor debate on today’s House Calendar. TMA testified in support of this bill.

Maternal Health

  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, is on today’s Senate Calendar. TMA testified in support of this bill last month.
  • House Bill 1111 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, was heard in the Senate Health and Human Services Committee yesterday and left pending. TMA testified in support of this bill last month.  

Tobacco

  • 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 yesterday 110-36. It now returns to the Senate for consideration of the amendments representatives added to the bill. TMA testified in strong support of SB 21 earlier this session.

Corporate Practice of Medicine

  • 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 heard in the Senate Health and Human Services Committee yesterday and left pending. TMA testified in support of this bill in March.  

Graduate Medical Education/Workforce

  • House Bill 80 by Rep. Lina Ortega (D-El Paso) would have the Texas Higher Education Coordinating Board (THECB) conduct a study and develop an inventory of existing doctoral-level health science education programs. THECB would then issue a report to the legislature with recommendations for establishing new programs and for expanding existing ones. HB 80 is set on today’s Senate Calendar. TMA supports this bill.  

Telemedicine

  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, is set on today’s Senate Items Eligible Calendar for consideration of amendments the House added to the bill. TMA supports this bill.
  • House Bill 871 by Rep. Four Price (R-Amarillo), which would expand the use of telemedicine to rural trauma hospitals, is set on today’s Senate Calendar. TMA supports this bill.

Prescription Monitoring Program/Opioids

  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) –  which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy –  is set for a hearing tomorrow in the Senate Health and Human Services Committee. TMA supports this bill.
  • House Bill 2088 by Rep. Jay Dean (R-Longview), which would require health care professionals dispensing controlled substance prescriptions to provide written notice of the closest safe disposal location and other safe disposal methods available, was heard in the Senate Health and Human Services Committee yesterday and left pending. TMA supports this bill.

Long-Term Care/Immunizations

  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities, was heard in the Senate Health and Human Services Committee yesterday and left pending. TMA testified in support of HB 1848 in March and continues to support the bill.
  • House Bill 1256 by Rep. Dade Phelan (R-Beaumont), which would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster, passed in the yesterday and will now head to the governor. TMA testified in support of this bill last month.
  • House Bill 1418, also by Representative Phelan, which would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification, also won Senate approval yesterday and will now head to the governor. TMA testified in support of this bill last month.

Professional Liability

  • House Bill 2362 by Rep. Joe Moody (D-El Paso) – which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment – is set for a hearing tomorrow in the Senate State Affairs Committee. After extensive negotiation and revision, TMA supports the bill.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Joe Ventimiglia, MD, of Dallas. Dr. Ventimiglia graduated from the Duke University School of Medicine and is a member of both TMA and the Dallas County Medical Society.

Legislative Hotline: Texas Medical Board Sunset and Tobacco 21 Bills Make Progress

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

May_Runoff

UNDER THE ROTUNDA

Today is the 129th day of the session.

In the final 11 days of this session, much of the negotiations to pass or kill bills will happen behind the scenes. The calendar will run out of time, stranding many bills. The Texas Medical Association will keep fighting for physicians’ priority bills until the last minute.

The House and Senate both have one week to vote on bills, which must be complete by midnight May 22.

Meanwhile, lawmakers will continue to negotiate the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26. TMA remains steadfast in its request for more funding for Medicaid, women’s health, mental health, and graduate medical education (GME), and will vigorously plead our case, particularly after comptroller Glenn Hegar on Tuesday revised the state’s revenue estimate for the next two years. The new estimate will give lawmakers an additional $500 million to spend on public programs.

Bills set on House and Senate calendars occasionally roll over to the next day if time runs out to debate them on the floor, and that happened yesterday. Here’s a status check on numerous bills that continue to move through the legislative process.

TMB Sunset/Corporate Practice of Medicine

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, was voted unanimously out of the Senate yesterday. The House must now decide whether to accept changes the Senate made to the bill or request a conference committee to negotiate the differences. TMA testified in support of this bill earlier this session.
  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, will be heard in the Senate Health and Human Services Committee today. TMA testified in support of this bill in March.  

Tobacco and Cancer

  • 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 – passed out of the House with amendments today. The Senate must now decide whether to accept changes the House made to the bill or request a conference committee to negotiate the differences. TMA testified in strong support of SB 21 earlier this session and is optimistic the bill will pass.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, was sent to the governer yesterday.
  • House Joint Resolution 12, also by Representative Zerwas, is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. HJR 12 was filed with the Secretary of State yesterday to be placed on the November ballot. TMA strongly supports this measure.

Graduate Medical Education/Workforce

  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin) – which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings – was voted out of the Senate 29-2 yesterday. It now returns to the House for consideration of amendments senators added to the bill. TMA submitted written testimony in support of this bill earlier this month.

House Bill 80 by Rep. Lina Ortega (D-El Paso) would have the Texas Higher Education Coordinating Board (THECB) conduct a study and develop an inventory of existing doctoral-level health science education programs. THECB would then issue a report to the legislature with recommendations for establishing new programs and for expanding existing ones. HB 80 is set on today’s Senate Calendar. TMA supports this bill.  

Maternal Health

  • House Bill 1111 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, is set for a hearing in the Senate Health and Human Services Committee today. TMA testified in support of this bill last month.
  • House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, is on today’s Senate Calendar. TMA testified in support of this bill last month.

Mental Health

  • House Bill 10 by Rep. Senfronia Thompson (D-Houston) would create the Texas Mental and Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program. It is set on today’s Senate Calendar. TMA submitted written testimony in support of the bill.

Telemedicine

  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, was voted out of the House 138-0 yesterday. It now returns to the Senate for consideration of amendments the House added to the bill. TMA supports this bill.
  • House Bill 871 by Rep. Four Price (R-Amarillo), which would expand the use of telemedicine to rural trauma hospitals, is set on today’s Senate Calendar. TMA supports this bill.
  • House Bill 1960, also by Representative Price – which would create a Governor’s Broadband Council that must include a medical advocacy representative – is on its way to Gov. Greg Abbott’s desk after the House agreed to Senate amendments yesterday. TMA supports this bill.

Prescription Monitoring Program/Opioids

  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) –  which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy –  was referred to the Senate Health and Human Services Committee yesterday and awaits a hearing. TMA supports this bill.
  • House Bill 2088 by Rep. Jay Dean (R-Longview), which would require health care professionals dispensing controlled substance prescriptions to provide written notice of the closest safe disposal location and other safe disposal methods available, is set for a hearing in the Senate Health and Human Services Committee today. TMA supports this bill.

Long-Term Care/Immunizations

  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities, is set for a hearing in the Senate Health and Human Services Committee today. TMA testified in support of HB 1848 in March and continues to support the bill.
  • Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, was voted out of the House Human Services Committee yesterday and awaits debate on the House floor. TMA submitted written testimony in support of the bill last month.
  • House Bill 1256 by Rep. Dade Phelan (R-Beaumont), which would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster, is set on today’s Senate Local and Uncontested Calendar, meaning it faces no opposition. TMA testified in support of this bill last month.
  • House Bill 1418, also by Representative Phelan,  which would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification, also is set on today’s Senate Local and Uncontested Calendar. TMA testified in support of this bill last month.

Insurance

  • Senate Bill 1037 by Sen. Larry Taylor (R-Friendswood) – which would prohibit a credit reporting agency from including on a credit report a collection account for health care services if (1) a consumer was covered by a health benefit plan at the time the out-of-network health care service was incurred; (2) the service was performed by an emergency care provider or facility-based provider; and (3) the collection was for an outstanding balance due to that provider after any applicable copayments, deductibles, and coinsurance – passed 141-0 on the House Local Calendar yesterday. Taking patients out of surprise billing scenarios would render moot the issue of credit reporting for health care. TMA testified against this bill last month.
  • House Bill 1941 by Representative Phelan – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – was voted out of the Senate Business and Commerce Committee yesterday and awaits debate on Senate floor. TMA supports this bill.

End of Life

  • Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola) – which 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 – was voted out of the Senate 22-8-1 yesterday. SB 2089 now heads to the House to await committee referral. TMA continues to vehemently oppose this bill.

Professional Liability

  • House Bill 2362 by Rep. Joe Moody (D-El Paso) – which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment – yesterday was referred to the Senate State Affairs Committee, where it awaits a hearing. After extensive negotiation and revision, TMA supports the bill.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Dana Sprute, MD, of Austin. Dr. Sprute graduated from the UT Health San Antonio Long School of Medicine and is a member of both TMA and the Travis County Medical Society.

WHAT WE’RE READING

The Potentially Lifesaving Difference in How a Gun Is Stored – The New York Times

With cancer rates rising worldwide, oncologist shortage predicted – Reuters  

Rate of type-2 diabetes in children in skyrocketing – KENS-TV

State shouldn’t punish people for being poor [Opinion] – Beaumont Enterprise

Health care’s payment model needs changing before the medical system will improve – Houston Business Journal

Tarrant County Named on Most At Risk List for Measles Outbreaks – KXAS-TV

 

Legislative Hotline: Insurance Bills In the Spotlight Today

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

state-capitol

UNDER THE ROTUNDA

Today is the 128th day of the session.

In the waning days of this session, it is important to remember that it is much easier to stop a bill than to pass one, and frequently bills pass incrementally over several sessions. Perfect must not be the enemy of the good as the calendar winds down.

Having said that, medicine is strategically working every angle to salvage important bills that have stalled in the legislative process.

This week Senate bills will move in the House and vice-versa; the House must hear all Senate bills by midnight May 22. Meanwhile, lawmakers will continue to negotiate the final 2020-21 state budget until the last possible moment. The House and Senate must concur on the budget by midnight May 26.

The Texas Medical Association remains steadfast in its request for more funding for Medicaid, women’s health, mental health, and graduate medical education (GME). We will report developments as they happen.

Bills on House and Senate calendars occasionally roll over to the next day if time runs out to debate them on the floor. Here’s a status check of several bills that continue to move through the legislative process.

Insurance

  • House Bill 2041 by Rep. Tom Oliverson, MD (R-Cypress) – which would require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees – was heard in the Senate Business and Commerce Committee today and left pending. TMA continues to support this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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 was heard in the Senate Business and Commerce Committee today  and left pending. TMA submitted written testimony in support of this bill in March.
  • 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, was heard in the Senate Business and Commerce Committee today and left pending. Austin oncologist Debra Patt, MD, testified in support of this bill today.
  • House Bill 3911 by Rep. Hubert Vo (D-Houston) – which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years – was heard in the Senate Business and Commerce Committee today  and left pending. TMA testified in support of HB 3911 last month.
  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – was voted out of the House Insurance Committee yesterday and awaits a debate on the House floor. SB 1264 continues to be a work in progress as it moves through the legislative process. TMA supports the revised bill and is working with the bill’s authors on improvements to the language.

TMB Sunset/Corporate Practice of Medicine

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, is on the Senate Calendar for today. TMA testified in support of this bill earlier this session.
  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, will be heard in the Senate Health and Human Services Committee tomorrow. TMA testified in support of this bill in March.  

Tobacco

  • 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 – is set for debate in the House today. TMA testified in strong support of SB 21 earlier this session and is cautiously optimistic the bill will pass.

Maternal Health

  • House Bill 1111 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, is set for a hearing in the Senate Health and Human Services Committee tomorrow. TMA testified in support of this bill last month. 
  • Senate Bill 750 by Sen. Lois Kolkhorst (R-Brenham), which would improve maternal access to postpartum care through the Healthy Texas Women Program, was voted out of the House Public Health Committee yesterday and awaits debate on the House floor. TMA testified in support of this bill earlier this session.
  • Senate Bill 436 by Sen. Jane Nelson (R-Flower Mound), which directs the Department of State Health Services (DSHS) to develop and implement initiatives to assist pregnant and postpartum women with opioid-use disorder and newborns with neonatal-abstinence syndrome, was voted out of the House Public Health Committee yesterday and awaits debate on the House floor. This bill specifically refers to the TexasAIM Opioid Bundle that evolved out of the Maternal Mortality and Morbidity Task Force and is strongly supported by TMA.

Mental Health

  • House Bill 10 by Rep. Senfronia Thompson (D-Houston) would create the Texas Mental and Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program. It was voted out of the Senate Health and Human Services Committee yesterday and awaits debate on the Senate floor. TMA submitted written testimony in support of the bill .
  • House Joint Resolution 5, also by Representative Thompson, is the funding mechanism for HB 10. HJR 5 would allocate $100 million in each fiscal year to the Texas mental and behavioral health research fund that HB 10 would establish, as long as the state collects more than $30.5 billion in sales, excise, and use tax revenue in that fiscal year. HJR 5 was heard in the Senate Finance Committee yesterday and left pending. If HJR 5 passes, Texans will vote on the constitutional amendment in November. TMA supports this bill.
  • Senate Bill 10 by Senator Nelson – which would create the Texas Mental Health Care Consortium, a collaboration of health-related institutions of higher education and the Statewide Behavioral Health Coordinating Council to improve the effectiveness of and access to behavioral health care for Texas youth – was voted out of the House Public Health Committee yesterday and awaits a debate on the House floor. TMA testified in support of this bill in early May.

Telemedicine

  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, won preliminary approval in the House yesterday and awaits a final vote today. TMA supports this bill.

Prescription Monitoring Program

  • House Bill 3285 by Rep. J.D. Sheffield, DO (R-Gatesville) would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths. HB 3285 was voted out of the House 119-18 late last week and awaits committee referral in the Senate. TMA supports this bill.

Long-Term Care

  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities, is set for a hearing in the Senate Health and Human Services Committee tomorrow. TMA testified in support of HB 1848 in March and continues to support the bill.
  • Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, is set for a hearing in the House Human Services Committee today. TMA submitted written testimony in support of the bill last month.

Graduate Medical Education

  • 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 – is on today’s Senate Calendar. TMA submitted written testimony in support of this bill earlier this month.
  • Senate Bill 1378 by Senator Buckingham, which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, has been sent to the governor. TMA supported this bill.

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

HEALTHY VISION 2025

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

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Sylvia Garcia-Beach, MD, of  Austin. Dr. Garcia-Beach graduated from the University of Illinois at Chicago College of Medicine and is a member of both TMA and the Travis County Medical Society.

WHAT WE’RE READING

Legislature extends cancer agency; issue is now up to voters – Houston Chronicle

50,000 Texas children a year lose Medicaid over paperwork. A bill to change that died. – Houston Chronicle 

A Republican legislator’s tirade gives a misleading impression of the vaccine choice movement [Opinion]Houston Chronicle

MAPPED: See which Texas districts and private schools have high vaccine exemption rates – KXAN-TV

Leave health care decisions to patient and doctor, not cost-cutting insurance industry [Opinion]  – Fort Worth Star-Telegram

Commentary: Let’s give new Texas moms a lifeline [Opinion] – Austin American-Statesman

Why Racial Gaps In Maternal Mortality Persist – NPR

Health industry to clash over surprise medical bills – The Hill

Report shows costs of medical procedures all over the map – San Antonio Express-News

44 states accuse drug companies of price-fixing – The Hill

 

Legislative Hotline: Insurance, Public Health, Opioids, and Sunset Bills Still Alive With Two Weeks Left in Session

(Budget, End-of-Life Care, Liability Reform, Medicaid, Public Health, Scope of Practice, Texas Medical Board, Women’s Health) Permanent link

Capitol_Dome

UNDER THE ROTUNDA

Today is the 126th day of this session; fourteen days remain. This week Senate bills will move in the House and vice-versa. Meanwhile, lawmakers will continue to negotiate the final 2020-21 state budget until the last possible moment. 

The Texas Medical Association remains steadfast in its request for more funding for Medicaid, women’s health, mental health, and graduate medical education (GME.) We will report developments as they happen.

Friday at midnight was the deadline for House bills to receive final approval in the House, and many bills medicine is tracking are still in the game. Here’s a status check of several bills that continue to move through the legislative process.

TMB Sunset/Corporate Practice of Medicine

  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, is on the Senate Calendar for today. TMA testified in support of this bill earlier this session.  

Maternal Health

  • House Bill 744 by Rep. Toni Rose (D-Dallas), which would allow continued Medicaid coverage for eligible women up to 12 months postpartum, was voted out of the House 87-43 and now heads to the Senate. Medicaid coverage currently expires 60 days after delivery, but the vast majority of maternal deaths occur from 61 to 365 days postpartum. TMA supports this bill.
  • Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham), which would establish level of care designations for hospitals that provide maternal and neonatal care, was voted out of the House Public Health Committee and awaits initial debate on the House floor. TMA supports this bill.  

Mental Health

  • House Bill 10 by Rep. Senfronia Thompson (D-Houston) – which would create the Texas Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program – was voted out of the Senate Health and Human Services Committee and awaits debate on the Senate floor. TMA submitted written testimony in support of the bill.

Tobacco

  • 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 – is set for debate on the House floor tomorrow. TMA testified in strong support of SB 21 earlier this session.

Insurance

  • 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 out of the House 116-18 Friday and heads to the Senate. TMA supports this bill.
  • House Bill 2041 by Rep. Tom Oliverson, MD (R-Cypress ) – which would require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees – is set for a hearing in the Senate Business and Commerce Committee tomorrow. TMA continues to support this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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, is set for debate in the Senate Business and Commerce Committee tomorrow. TMA submitted written testimony in support of this bill in March.
  • House Bill 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, is set for a hearing in the Senate Business and Commerce Committee tomorrow. TMA testified in support of this bill last month.
  • House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years – is set for debate in the Senate Business and Commerce Committee tomorrow. TMA testified in support of HB 3911 last month.
  • Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – continues to be a work in progress as it moves through the legislative process. TMA supports the revised bill and is working with the bill’s authors on improvements to the language.

Telemedicine

  • Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, is set for debate on the House floor today. TMA supports this bill.

Prescription Monitoring Program

  • House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville ) – which would require electronic prescribing of opioids, unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy – was voted out of the House 136-3 and heads to the Senate. 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 (PMP) until March 1, 2020, to allow time for 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 voted out of the House Public Health Committee and awaits debate on the House floor. 

Long-Term Care

  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities, is set for debate in the Senate Health and Human Services Committee tomorrow. TMA testified in support of HB 1848 in March and continues to support the bill.

Graduate Medical Education

  • 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 – is on today’s Senate Calendar. TMA submitted written testimony in support of this bill earlier this month.
  • Senate Bill 1378 by Senator Buckingham, which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, has been sent to the governor. TMA strongly supports this bill.  

Medical Liability

  • House Bill 1693 by Rep. John Smithee (R-Amarillo), which would revise timelines established to submit medical expense affidavits in legal cases, was set for debate in the Senate State Affairs Committee today. TMA supports this bill.  

Bills that didn’t get passed by the deadline on their own can be proposed as amendments to legislation that is moving, a strategy that is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment.

The next major hurdle: the House must consider Senate bills for their initial debate on the House floor by midnight, Tuesday, May 21 – next week.

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. 

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Jocelyn Wilson, MD, of Temple. Dr. Wilson graduated from the Quillen College of Medicine at East Tennessee State University and is a member of both TMA and the Bell County Medical Society.

WHAT WE’RE READING

Travis County among the riskiest locations for measles outbreak, UT study says – KVUE-TV

Many Hospitals Charge Double or Even Triple What Medicare Would Pay – The New York Times

Trump calls on Congress to end ‘surprise medical bills’ – The Associated Press

Mumps cases confirmed in Cameron County – Valley Morning Star

CDC: Hepatitis A Cases Quadruple in 5 Years – MedPage Today

Texas House OKs death penalty ban for severely mentally ill – Austin American-Statesman

 

Legislative Hotline: First Bill-Killing Deadline Passes, Leaving Mass Casualties

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

abortion_blog

UNDER THE ROTUNDA

Today is the 123rd day of this session; 17 days remain. Those 17 days will be a flurry of activity and behind-the-scenes maneuvering to keep bills moving toward passage.

Yesterday was a marathon floor session in the House, and today will be more of the same as bills live or die by the clock. Here’s a status check of several bills important to medicine that continue to move through the legislative process:

  • House Bill 744 by Rep. Toni Rose (D-Dallas), which would allow continued Medicaid coverage for eligible women up to 12 months postpartum, received preliminary approval on the House floor yesterday and awaits a final vote in the House today. Medicaid coverage currently expires 60 days after delivery, but the vast majority of maternal deaths occur from 61 to 365 days postpartum. TMA supports this bill.
  • House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) sunset bill that would extend TMB for another 12 years, is on the Senate Calendar for today. TMA testified in support of this bill earlier this session.
  • 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, received preliminary approval by the House yesterday and awaits final debate. TMA supports this bill.
  • 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, is on today’s Senate Calendar. TMA submitted written testimony in support of this bill earlier this month.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, was voted out of the Senate 29-2 and now heads to the governor. TMA strongly supports this bill.
  • House Joint Resolution 12 also by Representative Zerwas is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. HJR 12 won unanimous approval in the Senate today and will appear on the Nov. 5 general election ballot. TMA strongly supports this measure.
  • Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola), which 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, is set on today’s Senate Intent Calendar. TMA vehemently opposes this bill and encourages you to let your senator know you oppose it, too, by sending a message through TMA’s Grassroots Action Center.
  • Senate Bill 1742 by Sen. José Menéndez (D-San Antonio), which would require health plan directories to clearly identify which physician specialties are in network at network facilities, was voted out of the House Insurance Committee and awaits debate on the House floor. SB 1742’s companion, House Bill 2630 by Rep. Julie Johnson (D-Carrollton), awaits debate in the Senate Business and Commerce Committee.  

If a House bill hadn’t had its initial debate on the House floor by midnight yesterday, it is dead for this session. Among yesterday’s casualties:

  • House Bill 2732 by Rep. Dustin Burrows (R-Lubbock) would have required 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. TMA opposed this bill.
  • House Bill 4013 by Rep. Rick Miller (R-Sugar Land) would have created a new retail tax on e-cigarettes and vape products. The proceeds of the tax would have been dedicated to improving enforcement of current law that prohibits minors from buying these products. TMA and the Texas Public Health Coalition supported this bill.  

Bills that didn’t get passed by the deadline on their own, however, can be proposed as amendments to legislation that is moving, a strategy that is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment.

The next major hurdle: The House must consider most House bills and House Consent Calendar bills for their final debate by midnight, Friday, May 10 – tonight.

The Senate deadlines come later this month.

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.

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Larry Kravitz, MD, of Austin. Dr. Kravitz graduated from the George Washington University School of Medicine and is a member of both TMA and the Travis County Medical Society.

WHAT WE’RE READING

HB 1110 may expand Medicaid for women to a year after delivery [Opinion] – San Antonio Express-News

Bill taxing e-cigs, vapes dies in Texas House after Big Tobacco, Gov. Greg Abbott push late changes – The Dallas Morning News

Report: Reluctance To Vaccinate Hurting Texas’ Ability To Respond To Public Health Threats – Houston Public Media

Why so many primary-care doctors across America are closing their doors – MarketWatch

Texas House to debate bills tackling opioid crisis – KXAN-TV

Texas Mulls Telehealth Pilot for Early Childhood Intervention Services – mHealthIntelligence

CDC: 1.1 million more Americans lost health insurance coverage in 2018 – USA TODAY

Walmart raises age to buy tobacco to 21The Hill

Vaccines are ‘sorcery’? How one Texas legislator is hurting public health [Opinion] – The Dallas Morning News

Trump pushes to end surprise medical billing for hospital care – The Washington Post

Texas Physicians Fight End-of-Life Bill With Passion

(TAKE ACTION NOW, End-of-Life Care) Permanent link

1.30 curran

When the Texas Medical Association urged members to ask their state senators to vote “no” on a key bill regarding treatment disputes at the end of life, they didn’t hold back.

“I believe the whole thing is motivated by a lack of faith in physicians and a desire to impose one group's political will on everyone else without their say so,” Mary Elizabeth Paulk, MD, wrote in an email to Sen. Nathan Johnson (D-Dallas). “This is just wrong.”

Dr. Paulk wasn’t alone. Hundreds of Texas physicians took up the call, using TMA’s Grassroots Action enter to share very personal and passionate messages with their senators.

The outpouring came in response to a TMA action alert against Senate Bill 2089. That bill would require hospitals, physicians, nurses, and other health care professionals to provide medically inappropriate and potentially harmful care for an unlimited period of time.

“Deciding how to spend the final days and hours of life is a highly personal decision, and it’s one we encourage our patients to make long before the need arises,” TMA President Doug Curran, MD, wrote in the alert. “Requiring care in perpetuity would prolong the dying process, exacerbate suffering for both patients and loved ones, and violate the standard of care to do no harm.”

When writing their lawmakers, some physicians shared personal stories of their experiences; excerpts of some of those emails are below:

“SB 2089 takes decisionmaking about dying patients out of the hands of ethicists and physicians who have spent their lives dedicated to training and study so that we understand how best to provide care in exactly these kinds of situations. … When I think of the amount of suffering this bill is going to cause for patients, families, hospitals, and our health system as a whole, I am overwhelmed with sadness.”

- Faith Holmes, MD, to Sen. Donna Campbell (R-New Braunfels) 

“In all honesty there isn't going to be another physician who will accept the transfer. So the patient will be on life support indefinitely without the physician in the current hospital being able to withdraw care. In effect, the first physician could not withdraw care, but a second physician will not likely accept, and therefore, the first physician will be legally obligated to continue care for the patient on life support indefinitely.”

- Amber van den Raadt, DO, to Lt. Gov. Dan Patrick  

“During my intern year, I had a patient with metastatic breast cancer who was only in her 50s. Unfortunately, her cancer was so aggressive that she had now begun to develop fluid buildup (ascites) due to liver failure and later developed renal failure. Because of this, she also had a tremendous amount of acid build-up in her body. She had a husband and two children, and we went above and beyond extraordinary measures trying to save her life as they continued to want aggressive care. Throughout the final stages of our aggressive treatment, I felt sick to my stomach, because it was obvious our interventions were doing more harm than good, and the patient was clearly suffering.”

- Nitya Kumar, MD, to Sen. Borris Miles (D-Houston)

“End-of-life issues are not something that can be legislated in the fashion proposed in SB 2089. These things have to be individualized by patients, families, and their physicians. … It is foolhardy for legislators to presume to know what is correct on an individual basis from a global perspective. Perhaps God can do that but not the Texas Senate. Please keep the state rational and vote against this bill and any others like it that see the light of day.”

- Vik Wall, MD, to Sen. Kel Seliger (R-Amarillo)

TMA is vehemently opposed to SB 2089 by Sen. Bryan Hughes (R-Mineola), which is currently poised for debate on the Senate floor. TMA continues to encourage you to help stop it from making any further progress.

Please contact your state senator today and ask him or her to oppose SB 2089.

Legislative Hotline: Maternal Health, Network Directories, Cancer Research Bills Up for Debate Today

(Budget, Public Health) Permanent link

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UNDER THE ROTUNDA

Today is the 122nd day of this session; 18 days remain.

Here’s a status check of several bills important to medicine that continue to move through the legislative process:

  • House Bill 744 by Rep. Toni Rose (D-Dallas), which would allow continued Medicaid coverage for eligible women up to 12 months postpartum, is set on today’s House Calendar. Medicaid coverage currently expires 60 days after delivery, but the vast majority of maternal deaths occur from 61 to 365 days postpartum. TMA supports this bill.
  • 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, is set on the House Calendar for today. TMA supports this bill.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, is set on the Senate Local Calendar for tomorrow. TMA strongly supports this bill.
  • House Joint Resolution 12 also by Representative Zerwas, is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. HJR 12 is set on the Senate Intent Calendar for today. TMA strongly supports this measure.
  • House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform, received final approval by the House 135-1 yesterday. HB 3345 awaits committee referral in the Senate. TMA strongly supports this bill.
  • House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment, received final approval on the House floor yesterday with a 107-36 vote. It awaits committee referral in the Senate. After extensive negotiation and revision, TMA and the Texas Alliance for Patient Access agreed to support this bill.
  • 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 – was voted out of the Senate Higher Education Committee and awaits debate on the Senate floor. TMA submitted written testimony in support of this bill earlier this 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. HB 2732 is set on today’s House Calendar. TMA opposes this bill.
  • Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola), which 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, is on today’s Senate Intent Calendar. TMA vehemently opposes this bill and encourages you to let your senator know you oppose it, too, by sending a message through TMA’s Grassroots Action Center.  

If a bill hasn’t passed out of committee by now, it is likely dead for this session. But legislative zombies aren’t uncommon creatures. Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving, a strategy that is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment.

The next major hurdles: House bills must have won initial approval on the House floor by midnight tonight.

Tomorrow, Friday, May 10, is the deadline for the House to consider most House bills and House Consent Calendar bills for their final debate. Bills on the House Local Calendar have more time. The Senate deadlines come later this month.

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. 

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Lawrence Gibbs, MD, of Mansfield. Dr. Gibbs graduated from the University of Pittsburgh School of Medicine and is a member of both TMA and the Dallas County Medical Society.

WHAT WE’RE READING

Mothers dying needlessly: CDC says most pregnancy-related deaths can be prevented – USA TODAY

Cortez: Ensuring Health Coverage for Texas Children [Opinion] – Rio Grande Guardian

Feds Want To Show Health Care Costs On Your Phone, But That Could Take Years – Kaiser Health News

Texas House passes second, more limited bill expanding access to medical cannabis – The Texas Tribune

Severe alcohol-related liver disease on the rise, study finds – NBC News

Smallpox Was Eradicated, So Why Not Measles? –  Houston Public Media

 

When the Sausage Starts to Smell

(Public Health) Permanent link

 Legislature_Blog

Are you ready for some chubs? How about a little POO? 

No, we’re not talking bait fish nor a diminutive for the ‘60s Twist-master. Not a typo for a stuffed bear nor the stuff of excrement. 

It’s a civics lesson … or the warped civics that happens in Austin for precisely 140 days leading up to Memorial Day every odd-numbered year. Today in the Texas House of Representatives is not for the meek or faint of heart. Sometimes even the boldest of women and men just have to look away. 

And say you’re an important piece of legislation riding the very caboose of the train that the House Calendars Committee has assembled. Say you’re House Bill 1335, a bill to set up behavioral health centers in public schools, a bill written in the aftermath of the Santa Fe High School shooting last May. Like some of the 10 students and teachers killed in that massacre, you don’t stand a chance. 

So what’s all the fuss about today? And what about those chubs and POOs? 

Well, it’s all about the rules. Yes, this seemingly chaotic sausage kitchen does have rules. Lots of rules. The House writes its own rules (most of them; some are in the constitution, but we don’t have time for that right now), and your representatives voted to adopt those rules way back in January. Way back when today's marathon calendar was but a distant foreboding. 

Most pertinent right now among those rules is this one: For a contested House bill to become law, it must at least have won preliminary approval on the House floor by the 122nd day of the 140-day session. That 122nd day ends at midnight, Central Time, on Thursday, May 9. If a bill doesn’t pass that gauntlet today, it’s curtains. (Uncontested bills get one extra day to remain in play.) 

Today’s House calendar contains exactly 158 pieces of legislation, arranged by the Calendars Committee in the order by which they’ll be considered. That list includes 67 bills leftover from yesterday’s calendar, leftover even though the House worked until a little past 11 pm yesterday. 

House Bill 1335 – you remember, the one that sets up behavioral health centers in public schools – is No. 158 on the list. Highly unlikely it would make it through by midnight even if the chamber were working efficiently. 

But the chamber isn’t working efficiently. It’s not supposed to. The rules and traditions purposefully make it easier to defeat a bill than to pass one. Ensuring that inefficiency are the chubs and the POOs. Since the easiest way to kill a bill is to prevent it from ever coming up for a vote, lawmakers who don’t like one or more bills sitting in the maybe-we’ll-get-to-it part of the calendar purposefully slow the whole train down with chubs and POOs. 

If you’re watching the session in person or via the streaming feed and you notice a lot of questions being asked about seemingly minor bills … and you notice that the questioners are taking lots of time asking and explaining their questions and then questioning the answers … and you notice the same representatives showing up over and over again to ask those questions … that’s chubbing. 

Per House rules, questioners each have 10 minutes to engage in debate with a bill’s authors or supporters. Expert chubbers know how to use every one of those minutes, all 600 seconds, asking and re-asking until the speaker slams the gavel and intones, “The gentleman’s (or gentlelady’s) time has expired.” A good tag-team chub can last a half hour or longer, sending more and more bills at the end of the calendar to the legislative graveyard. 

And then there’s a POO – or point of order. Any member of the House can “call” a point of order on a bill. Basically a POO challenges that bill’s legitimacy. A POO alleges that the bill’s route from filing to committee hearing to the calendar somehow violated a House rule. 

Quite frequently, a lawmaker will call a POO in order to kill the bill that’s actually up for debate on the House floor. Since it takes quite a bit of time from when the assassin says, “Point of order!” until the speaker and his team evaluate the claim amid the arcana of House rules and the speaker declares, “Point of order is well taken and sustained,” or “Point of order is overruled,” a well-timed and well-argued POO can turn into a champion chub. 

If all of this sounds fascinating to you, and you tune in to the House feed all the wy until midnight and then you feel as empty as when you’ve binge-watched every available episode of some nasty Netflix series, fear not.

The whole process gets a reprise on Tuesday, May 21. That’s the 134th day of the session, and every legislative junkie knows that midnight on day 134 is the very last minute for a Senate bill to win preliminary approval on the House floor. 

More chubbing. More POOs. Another nauseating visit to the Jimmy Dean processing plant.

Texas Physicians Unite To Protect Patient Care

(Public Health) Permanent link

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Medicine needed help at the Capitol, and Texas physicians answered the call.

Over the past four months, almost 1,300 Texas doctors, medical students, and Texas Medical Association Alliance members came to Austin for TMA’s First Tuesdays at the Capitol advocacy events.

Yesterday was the final First Tuesdays of the 2019 legislative session, and about 300 TMA members met with their lawmakers face to face.

Since it began in 2003, the “White Coat Invasion” has been an effective way to ensure that state lawmakers work to keep Texas medicine-friendly. Our senators and representatives listen when their hometown doctors appear in lawmakers’ offices.

There are still several ways to advocate for medicine between now and May 27, the final day of the regular session:

  • When called to do so, respond to Grassroots Action Center alerts on specific bills via our new VoterVoice app.
  • Join TMA Leading Advocates, TMA’s exclusive Facebook group for legislative advocacy open only to TMA and TMA Alliance members, and TMA and county medical society staff. 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.

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. 

Images by Matt Lemke

 

 

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Legislative Hotline: Disaster Liability Protection Bill Goes to Governor

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

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 UNDER THE ROTUNDA

Today is the 121st day of this session; nineteen days remain.

Here’s a status check of several bills important to medicine that continue to move through the legislative process:

  • Senate Bill 752 by Sen. Joan Huffman (R-Houston), which would provide liability protection for physicians who volunteer in the aftermath of a disaster, received unanimous approval on the House floor yesterday. It now heads to Gov. Greg Abbott for his signature. TMA strongly supports this bill.
  • House Bill 1256 by Rep. Dade Phelan (R-Beaumont), which would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster, passed out of the Senate Health and Human Services Committee unanimously and heads to the Senate Local and Uncontested Calendar. TMA testified in support of this bill last month.
  • House Bill 1418, also by Representative Phelan, would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification. HB 1418 also passed the Senate Health and Human Services Committee unanimously and heads to the Local and Uncontested Calendar. TMA testified in support of this bill last month. Presuming HB 1256 and HB 1418 are passed from the Senate Local and Consent Calendar, as expected, they will head to the governor for his signature.
  • House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform, received preliminary approval on the House floor yesterday. It awaits final approval, which should come this week. TMA strongly supports this bill.
  • House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment, received preliminary approval on the House floor yesterday and awaits a final vote. After extensive negotiation and revision, TMA and the Texas Alliance for Patient Access agreed to support this bill.
  • 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 variety of debilitating medical conditions, received final House approval 128-20 yesterday. 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, and that the physician maintain treatment and monitoring plans. HB 1365 now heads to the Senate. A similar measure, House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth) won preliminary approval in the House this morning, 133-10. TMA is closely monitoring both of these bills.
  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – was voted out of the House 113-35 and heads to the Senate. TMA supports this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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, received final approval 126-20 in the House and now heads to the Senate. TMA submitted written testimony in support of this bill in March.  

If a bill hasn’t passed out of committee by now, it is likely dead for this session. But legislative zombies aren’t uncommon creatures. Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving, a strategy that is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment.

The next major hurdles: House bills must have had their initial debate on the House floor by midnight, Thursday, May 9 – tomorrow.

Friday, May 10, is the deadline for the House to consider most House bills for their final debate. Bills on the House Local and Consent Calendar have more time. The Senate deadlines come later this month.

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. 

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 Erica Swegler, MD, of Austin. Dr. Swegler graduated from the McGovern Medical School at UTHealth in Houston and is a member of both TMA and the Travis County Medical Society.

WHAT WE’RE READING

Texas House passes bill to vastly expand access to medical cannabisThe Texas Tribune

Despite measles outbreak, Texas vaccine exemptions up againHouston Chronicle

Heart Problems Are Killing More Americans – Even Younger Ones. Here’s How to Reduce Your Risk – TIME

Catalyst Health Network Expands to East Texas, Adding More Than 100 PhysiciansD CEO Healthcare

Texas lawmaker (and doctor) wants to study state’s physician shortageKXAN-TV

For first time, US sees employed physicians outnumber self-employed, AMA study shows – Becker’s Hospital Review

Texas lawmaker calls vaccines 'sorcery,' verbally attacks prominent advocate – Houston Chronicle

Legislative Hotline: Final White Coat Invasion of the Session – Impactful as Always

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

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UNDER THE ROTUNDA

Today was the final First Tuesdays at the Capitol advocacy event of the legislative session, and during the white coat invasion Texas Medical Association and TMA Alliance members were well informed for their visits with lawmakers on bills that TMA is both pushing and fighting.

Fewer than three weeks remain in this session. If a bill hasn’t been passed out of committee by now, it is likely dead. Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving, but that strategy is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment. That is not a hard and fast rule, but it is a common occurrence.

The next hurdle: House bills must have had their initial debate on the House floor by the end of the day Thursday, May 9. Then bills repeat the process in the Senate.

Here’s a quick recap of several bills important to medicine:

  • House Bill 10 by Rep. Senfronia Thompson (D-Houston), which would create the Texas Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program, was heard in the Senate Health and Human  Services Committee earlier today. TMA submitted written testimony in support of the bill.
  • 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 variety of debilitating medical conditions, was debated on the House floor yesterday evening. 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, and that the physician maintain treatment and monitoring plans. HB 1365 received preliminary approval 121-23 with no discussion and awaits its final vote on the House floor. TMA is closely monitoring this bill.
  • House Joint Resolution 12, by Rep. John Zerwas, MD (R-Richmond) is the funding mechanism for House Bill 39, also by Representative Zerwas, which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. TMA supports this measure, which was voted unanimously out of the Senate Finance Committee earlier today. The measure will be heard on the full Senate floor. 
  • Senate Bill 752 by Sen. Joan Huffman (R-Houston), which would provide liability protection for physicians who volunteer in the aftermath of a disaster, received preliminary approval on a voice vote on the House floor yesterday evening, and now awaits a final vote. TMA strongly supports this bill.
  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – received preliminary House approval yesterday evening and awaits a final vote. TMA supports this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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, received preliminary approval 130-6 on the House floor last evening. HB 2099 should easily pass the House and will then head to the Senate, where it will be referred for a committee hearing. TMA submitted written testimony in support of this bill in March.

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. 

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

PHYSICIAN OF THE DAY

Today’s physician of the day is John Green III, MD, of San Antonio. Dr. Green graduated from the McGovern Medical School at UTHealth in Houston and is a member of both TMA and the Bexar County Medical Society.

WHAT WE’RE READING

U.S. reports 60 new measles cases in worst outbreak since 1994 – Reuters

Measles outbreaks happen when vaccinations stop [Opinion] – San Antonio Express-News

Amid measles crisis, Texas bills targeting vaccine issues slow to move – Austin American-Statesman

About 1 in 4 women of reproductive age don’t have health insurance – Houston Chronicle

Black Maternal Mortality: Clinical Instinct Vs Racism – MedPage Today

Guidelines to treat leading cause of maternal deaths focus on heart disease – Houston Chronicle

Report: Substance Abuse Death Rates in North Texas Outpacing State and National Averages – D CEO Healthcare

The Texas-Led Challenge to Obamacare Is Moving Quickly. Here’s What That Means. – KUT

 

Legislative Hotline: Join Us For the Final First Tuesdays of the Session Tomorrow

(Budget, Health Insurance, Public Health) Permanent link

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UNDER THE ROTUNDA

Tomorrow is the final First Tuesdays advocacy event of the legislative session, and the white coat invasion will be well informed for their visits with lawmakers on bills that the Texas Medical Association is both supporting and opposing.

Twenty-one days remain in this legislative session. To put into perspective how quickly bills that originated in the House must move to have a chance to become law this session, they must be out of committee today, and have had their initial debate on the House floor by the end of the day Thursday, May 9. Then the process repeats in the Senate.

Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving.

Time is of the essence to get bills passed this session. Here’s a quick recap of several bills important to medicine:

  • House Bill 10 by Rep. Senfronia Thompson (D-Houston), which would create the Texas Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program, is set for debate in the Senate Health and Human Services Committee tomorrow.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, is set on the Senate Local and Uncontested Calendar, where it is expected to face little to no opposition. TMA continues to strongly support this bill.
  • House Joint Resolution 12, also by Representative Zerwas, is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. TMA supports this bill, which is set for debate in the Senate Finance Committee tomorrow.
  • 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, is set for debate on the House floor today. The bill would also require that the physician have proper knowledge concerning the medical use of the product as treatment for the patient’s specific condition, and that the physician maintain treatment and monitoring plans. TMA is closely monitoring this bill.
  • Senate Bill 1378, by Sen. Dawn Buckingham, MD (R-Lakeway), which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, was voted out of the House 140-0 late last week.
  • House Bill 278 by Rep. Tom Oliverson, MD (R-Cypress), which would outline how physicians supervise prescriptive authority agreements with advanced practice registered nurses, was voted unanimously out of the Senate 31-0 and now heads to the governor. TMA supports this bill.
  • Senate Bill 1519 by Sen. Lois Kolkhorst (R-Brenham), which would establish a statewide council on long-term care facilities, was voted out of the Senate unanimously and has been received in the House, where it will next be referred to committee. TMA submitted written testimony in support of the bill last month.
  • 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, is pending in the Senate Higher Education Committee. HB 1065’s companion, Senate Bill 1084 by Senator Kolkhorst is also in the Senate Higher Education Committee.
  • 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. Its companion bill, Senate Bill 998 by Sen. Juan “Chuy” Hinojosa (D-McAllen), is pending in the same committee.
  • House Bill 1353 by Representative Oliverson, which would provide liability protection for physicians who volunteer in the aftermath of a disaster, was set for debate on the House floor today. The bill was still pending at press time. TMA supports HB 1353. Senate Bill 752 by Sen. Joan Huffman (R-Houston), which is nearly identical to HB 1353, was voted out of the House Judiciary and Civil Jurisprudence Committee last week and will be heard next on the House floor. Having both bills continue to work through the process is not uncommon. TMA supports both.
  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – was set on the House Calendar today. TMA supports this bill.
  • House Bill 1879 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to identify and auto-enroll in the Healthy Texas Women Program women who lose eligibility for Medicaid or CHIP Perinatal due to age, was voted out of the House Public Health Committee last week and heads next to the House floor for debate. TMA strongly supports this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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, was set for debate on the House floor today. TMA submitted written testimony in support of this bill in March.

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. 

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

PHYSICIAN OF THE DAY

Today’s physician of the day is Janey Wang, MD, of San Antonio. Dr. Wang graduated from Akademia Medyczna Lodz in Poland and is a member of both TMA and the Bexar County Medical Society.

WHAT WE’RE READING

House OKs more billing transparency at freestanding ERs – Austin American-Statesman

Gov. Greg Abbott signs bill creating University of Houston medical school – The Texas Tribune

With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters? – Kaiser Health News

Health insurance deductibles soar, leaving Americans with unaffordable bills – Los Angeles Times

Most Americans grateful for their job’s health coverage, but still struggle with healthcare costs – Becker’s Hospital Review

Cocaine Deaths Up in US, and Opioids Are a Big Part of It – The Associated Press

Insys Co-Founder, Former Employees Convicted of Opioid Conspiracy – The Wall Street Journal

Fort Worth doctor who helped pass Safe Haven laws in Texas and nationwide dies at 88 –Fort Worth Star-Telegram

Brain scans show promise in spotting suicidal thoughts – CBS News

 

Legislative Hotline: Governor Signs Bill Creating New Medical School

(Public Health) Permanent link

vote story

UNDER THE ROTUNDA

Twenty-four days remain in this legislative session. To put into perspective how quickly House bills must move to have a chance to become law this session, they must be out of committee by Monday, May 6, and have had their initial debate on the House floor by the end of the day Thursday, May 9. Then the process repeats in the Senate.

Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving.

Time is indeed running short to get bills passed this session.

One bill with no reason to worry about timelines is House Bill 826 by Rep. John Zerwas, MD (R-Richmond), which creates the University of Houston College of Medicine. Gov. Greg Abbott signed the bill into law Thursday, after it was unanimously approved by the Senate. The new medical school, which will be the 14th in Texas, will welcome its inaugural class in the fall of 2020.

The House passed a similar bill last month creating the Sam Houston State University College of Osteopathic Medicine. House Bill 2867, by Rep. Will Metcalf (R-Conroe) and Rep. Tom Oliverson, MD, (R-Cypress), has not yet been taken up by the Senate.

Ensuring there are enough residency spots for graduating medical students is an extremely important part of the equation. Below are the graduate medical eduation (GME) bills that have traction at this point in the session:

  • 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, is pending in the Senate Higher Education Committee. HB 1065’s companion, Senate Bill 1084 by Sen. Lois Kolkhorst (R-Brenham), is also in the Senate Higher Education Committee.
  • 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. Its companion bill, Senate Bill 998 by Sen. Juan “Chuy” Hinojosa (D-McAllen), is pending in the same committee.
  • House Bill 4039 by Rep. Chris Turner (D-Grand Prairie), which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, is set on today’s House Local and Consent Calendar. Senate Bill 1378, by Sen. Dawn Buckingham, MD (R-Lakeway), also is pending on the House Local and Consent Calendar.

BILLS MOVING

Several of the other bills medicine is tracking continue to make legislative progress. Below is an update on a few bills the Texas Medical Association is following:

  • House Bill 39 by Representative Zerwas, which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, passed out of the Senate Committee on Administration Wednesday. It will next be heard on the Senate floor. TMA continues to strongly support this bill.
  • House Joint Resolution 12, also by Representative Zerwas, is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. TMA supports this bill, which is set for debate in the Senate Finance Committee on May 6.
  • House Bill 278 by Representative Oliverson, which would outline how physicians supervise prescriptive authority agreements with advanced practice registered nurses, was set on today’s Senate Local and Uncontested Calendar, meaning it faces little to no opposition. TMA supports this bill.
  • House Bill 1353 by Representative Oliverson, which would provide liability protection for physicians who volunteer in the aftermath of a disaster, was set for debate on the House floor today. The bill was still pending at press time. TMA supports HB 1353. Senate Bill 752 by Senator Joan Huffman (R-Houston), which is nearly identical to HB 1353, was voted out of the House Judiciary and Civil Jurisprudence Committee earlier this week and will be heard next on the House floor. Having both bills continue to work through the process is not uncommon. TMA supports both.
  • House Bill 1832 by Rep. Julie Johnson (D-Carrollton) – which would prohibit health plan coverage of an emergency care claim dependent on utilization review, protecting the prudent layperson standard – was set on the House Calendar today. TMA supports this bill.
  • House Bill 1879 by Rep. Sarah Davis (R-West University Place), which would direct the Health and Human Services Commission (HHSC) to identify and auto-enroll in the Healthy Texas Women Program women who lose eligibility for Medicaid or CHIP Perinatal due to age, was voted out of the House Public Health Committee earlier this week and heads next to the House floor for debate. TMA strongly supports this bill.
  • House Bill 2099 by Rep. Stan Lambert (R-Abilene), 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, was set for debate on the House floor today. TMA submitted written testimony in support of this bill in March.
  • Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, was set on the Senate Local and Uncontested Calendar for today, meaning it faces little to no opposition. TMA submitted written testimony in support of the bill last month.

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. 

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 Zaiba Jetpuri, DO, of Richardson. Dr. Jetpuri graduated from the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine and is a member of both TMA and the Dallas County Medical Society.

WHAT WE’RE READING

Study: Texas rate of uninsured children double national average – Houston Chronicle

Dell Med students are administering free whooping cough vaccines to medically underserved areas in Austin – The Daily Texan

Commentary: Medication stability means stability for mental health patients and communities [Opinion]Austin American-Statesman

Trump Administration Now Urges Court to Strike Down Entire Health Law – The Wall Street Journal

Mental health diversion program to expand in Houston area – The Associated Press

Nearly half of physicians think EHRs have decreased quality of care, survey finds – Becker’s Hospital Review

Correction: This story has been updated to say that the the University of Houston College of Medicine will be Texas' 14th medical school.

Legislative Video Hotline: Medicine Pushes Back Against Expanding Chiropractors’ Scope

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

Chiropractors would be able to treat the neurological system, including the brain and spinal cord, under a bill drawing medicine’s ire. In this week’s TMA Legislative News Hotline video report, Austin neurologist Sara Austin, MD, tells us why this move would be unsafe for patients. 

This week’s video summary also lists the flurry of bills that are moving through the legislature. 

Fortunately most of those bills are TMA legislative priorities to improve health insurance, Medicaid coverage, and support physicians’ clinical autonomy. 

Victoria infectious disease specialist Thomas Kaspar, MD, explains the benefits of two bills that would help physicians and other first responders who want to rush to provide care during disasters such as Hurricane Harvey. 

However, lawmakers are considering other bills that could be extremely harmful to patients, including a measure to undo the advance directives act. The proposal would force physicians to treat a dying patient until transfer, potentially subjecting patients to suffering with medically inappropriate care. 

And what do a game-show theme song and state representative look-alikes have in common? See the answer in this week’s Hotline video recap, as lawmakers show their funny side this week.   

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: Help Stop Bad End-of-Life Bill From Moving Forward

(Budget, End-of-Life Care, Health Insurance, Public Health, Scope of Practice, Texas Medical Board) Permanent link

HHSC_grants

ALERT ON END-OF-LIFE BILL: PLEASE ACT NOW

Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola) – which 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 – could come up in the Texas Senate as soon as today.

The Texas Medical Association is vehemently opposed to this bill and encourages you to help us stop the bill from making any further progress. Please contact your  state senator today and ask him or her to oppose SB 2089.

Specifically, SB 2089 would:

  • Require a hospital – even after its committee of medical ethicists and physicians, under the dispute resolution process, determines further treatment would harm the patient – to continue providing medical interventions until the patient is transferred to another facility that is willing to provide medical interventions.
  • Prolong and increase suffering for our patients and their loved ones without medical benefit.
  • Force physicians to perform painful medical interventions indefinitely on terminally ill patients.
  • Require treatments such as artificial nutrition and hydration, even if the hydration is harming the patient, as in the case of an already fluid-overloaded patient with renal failure or heart failure who can’t be dialyzed.
  • Negatively impact acceptance of transferred critically ill patients. Physicians at tertiary care centers may be reluctant to accept critically ill patients from smaller hospitals if doing so commits the physician and facility to open-ended and indefinite interventions irrespective of the physician’s reasonable medical judgment that the interventions are harmful to the patient and are medically inappropriate. 

The current Texas Advance Directives Act (TADA) provides a fair, rational process for resolving such disputes without arbitrarily forcing physicians or family members to abandon their consciences. We must preserve TADA and stop SB 2089.

BILLS MOVING

House bills must be out of committee by Monday, May 6 – the day before our last First Tuesdays this year – to be considered on the House floor this session. Then the process repeats in the other chamber. Time is indeed running short to get bills passed this session.

Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving.

Some of the numerous bills medicine is tracking made progress yesterday in a lengthy floor session. Below is an update on a few bills TMA is tracking:

  • House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every two years – received preliminary approval on the House floor yesterday with a 110-27 vote. TMA testified in support of HB 3911 last month.
  • House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, received near-unanimous approval on the House floor yesterday with a vote of 144-2. The bill now heads to the Senate. TMA testified in support of HB 1532 in March.
  • House Bill 2453 by Rep. Sarah Davis (R-West University Place), which would expand state oversight of Medicaid managed care organizations, was voted out of the House Human Services Committee yesterday and awaits a hearing on the House floor. TMA testified in strong support of this bill last month.
  • House Bill 342 by Rep. Philip Cortez (D-San Antonio), which would provide 12 months’ continuous coverage for children on Medicaid – as is already in place for the Children’s Health Insurance Program (CHIP) – was voted out of the House Human Services Committee on Tuesday and awaits debate on the House floor. TMA testified in support of HB 342 in March and continues to strongly support this bill.
  • Senate Bill 752 by Sen. Joan Huffman (R-Houston), 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 yesterday and awaits a hearing on the House floor. TMA continues to support this bill.
  • House Bill 1273 by Rep. Bill Zedler (R-Arlington), which would prohibit the denial of payment for preauthorized services, yesterday received preliminary approval from the House on a voice vote. TMA supports this bill.
  • House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities, received preliminary approval yesterday on a 142-2 vote. TMA testified in support of HB 1848 in March and continues to support the bill.
  • House Bill 2041 by Rep. Tom Oliverson, MD (R-Cypress), which would require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees, received preliminary approval on the House floor yesterday with a vote of 131-5. TMA continues to support this bill.
  • House Bill 3041 by Rep. Chris Turner (D-Grand Prarie), which would allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure, received preliminary approval on the House floor yesterday with a vote of 79-58. TMA supports this bill.
  • House Bill 4039 by Representative Turner of Grand Prarie, which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, will be on the House Local and Consent Calendar tomorrow, meaning it faces little to no opposition. TMA continues to support HB 4039.

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.

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 Namita Bhardwaj, MD, of Houston. Dr. Bhardwaj graduated from the Ross University School of Medicine in Barbados and is a member of both TMA and the Harris County Medical Society.

WHAT WE’RE READING

US lawmakers push bipartisan bill to raise the federal minimum buying age for tobacco to 21 – CNBC

Texas, Fort Worth youth at risk of suicide need help, perspective [Opinion]Fort Worth Star-Telegram

UT Southwestern is on pace to get an important funding victory from the Texas Legislature [Opinion] – The Dallas Morning News

The ER Doc-Blue Cross Blue Shield Conflict is More Complicated Than It SeemsD CEO Healthcare

Is Measles Here to Stay? – NPR

Two ways Texas can save money and reduce teen pregnancies [Opinion]TribTalk

For our state hospitals, we need to go all the way [Opinion]TribTalk

Legislative Hotline: Working to Keep Balance Billing Reform Moving

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

May_Runoff

UNDER THE ROTUNDA
Most of yesterday’s high profile action took place on the House and Senate floors, but one of the most important bills for the Texas Medical Association is still being negotiated behind the scenes.

Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills), which would require baseball-style arbitration for most surprise medical bills, is currently awaiting a hearing in the House Insurance Committee. SB 1264 seeks to end the problem of surprise or balance billing for patients by removing them from the process altogether. It would implement an arbitration process in which health plans and physicians work out billing differences using market rate benchmarks.

TMA strongly supports the arbitration process because it uses benchmarks based on market rates. However, TMA continues to work with the bill authors – Senators Hancock and John Whitmire (D-Houston); and Reps. Tom Oliverson, MD (R-Cypress), and Trey Martinez Fischer (D-San Antonio) – to get the best arbitration process that is fair to patients and physicians. Recommendations have been submitted to the authors to address medicine's concerns with potential barriers to utilization of the arbitration process, such as a quick time frame to resolve an arbitration, ensuring physicians have the information necessary to collect allowed amounts from the patient, and ensuring enforcement on all parties. TMA has full faith in the authors that once these clarifications are made, a bill everyone supports will pass this session.

ALERT ON END-OF-LIFE BILL

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. The Senate Health and Human Services Committee approved SB 2089 yesterday.

TMA is vehemently opposed to this bill and issued a legislative alert earlier today to stop the bill from making any further progress. Please contact Lt. Gov. Dan Patrick today and ask him to not bring SB 2089 up for debate on the Senate floor.

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.

Bills that haven’t yet moved out of committee may be proposed as amendments to legislation that is moving.

A long debate on property taxes consumed the vast majority of the time on the House floor yesterday, so not many of the bills medicine is tracking made any progress. Below is an update on a few TMA-tracked bills:

  • House Bill 2387 by Rep. Greg Bonnen, MD (R-Friendswood), which would require that utilization reviews be conducted by a Texas-licensed physician and that prior authorization processes be more transparent, passed the House 141-0 yesterday and heads to the Senate for deliberation. TMA testified in support of HB 2387 in late March and continues to strongly support this bill.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would allow the Cancer Prevention and Research Institute of Texas (CPRIT) to continue its cancer research beyond 2022, was set for a hearing in the Senate Administration Committee today. As of press time, the bill had not yet come up. TMA strongly supports this bill.
  • 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, is set for a hearing today in the Senate Higher Education Committee. TMA testified in support of HB 1065 in early March.

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. 

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 David Palafox, MD, of El Paso. Dr. Palafox graduated from the Texas Tech University Health Sciences Center School of Medicine and is a member of both TMA and the El Paso County Medical Society.

WHAT WE’RE READING

Despite Insurer Pushback, Bill to Protect Poor and Disabled Texans Clears Committee – D CEO Healthcare

Measles Cases Surpass 700 as Outbreak Continues Unabated – The New York Times

Study: Kids’ Suicides Spiked After Netflix’s ‘13 Reasons’ – The Associated Press

Huge step in HIV fight is happening in San Antonio – KENS-TV

Why does the country’s largest tobacco company support raising the smoking age? – KXAN-TV

Time for Texas to ban powdered alcohol [Opinion] – San Antonio Express-News

Searching for a bipartisan solution to runaway prescription drug price hikes [Opinion] – Corpus Christi Caller-Times