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.

TMA’s Top 10 Victories this Legislative Session

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

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

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

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

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

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

TMA’s Top 10:  

The Budget  

Surprise Billing Addressed   

Prior-Authorization Improvement Passes  

Efforts to Curb Opioid Abuse  

Scope of Practice  

Mental and Behavioral Health Legislation  

Maternal Health  

Governor Signs Tobacco Use Age Bill  

Volunteer Liability Protection  

TMB Sunset Bill 

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

Legislative Hotline: Governor Signs Key Prior Authorization Bill

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

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UNDER THE ROTUNDA

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

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

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

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

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

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

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

Vetoes

Governor Abbott vetoed two bills TMA supported: 

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

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

Budget

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

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

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

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

Professional Liability

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

Mothers and Children

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

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

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

Insurance

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

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

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

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

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

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

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

Opioids

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

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

Graduate Medical Education/Workforce

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

Telemedicine

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

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

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

Long-Term Care

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

Cannabis

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

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

HEALTHY VISION 2025

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

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

Legislative Top 10: Law Gives Liability Protections to Physicians Who Respond to Disasters

(Liability Reform, Public Health) Permanent link

The Texas Legislature passed a bill this session to allow physicians and health care providers to voluntarily respond to disasters without fear of medical liability. 

Today’s Texas Medical Association Legislative Hotline video examines that bill, Senate Bill 752, which aims to clear the minds of physician volunteers like those who rushed to provide care after Hurricane Harvey in 2017. SB 752 was sponsored by Sen. Joan Huffman (R-Houston). Gov. Greg Abbott signed the bill in May, and it takes effect Sept. 1. 

“If you’re volunteering your services … you shouldn’t be subject to liability as long as you’re doing your best in providing those services,” TMA Vice President of Advocacy Darren Whitehurst said. 

See this and more in today’s TMA Legislative News Hotline video, the ninth in our “Top 10” legislative summary series.

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: 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

Hotline_Capitol_Walking

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