Stories with related Professional Interests

Legislative Hotline: Prescription Monitoring and Professional Liability Bills Highlight Today’s Deliberations - 05/17/2019

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.

Legislative Hotline: Patient-Friendly Insurance Bills Top Today’s Calendar - 05/17/2019

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. TMA 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.

Texas Physicians Fight End-of-Life Bill With Passion - 05/10/2019

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. Hundreds of Texas physicians took up the call, using TMA’s Grassroots Action enter to share very personal and passionate messages with their senators.

Legislative Hotline: First Bill-Killing Deadline Passes, Leaving Mass Casualties - 05/10/2019

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

When the Sausage Starts to Smell - 05/09/2019

Today and tomorrow in the Texas House of Representatives are not for the meek or faint of heart. Sometimes even the boldest of women and men just have to look away.

86th Texas Legislature Letters and Testimonies - 05/07/2019

During this legislative session, TMA councils and committees are locking down and promoting health care policies to ensure Texas’ patients have access to affordable and high quality health care. Here are TMA’s testimonies, comments, and letters to state lawmakers.

Helping Teachers Protect Children From Abuse and Neglect - 04/22/2019

Children with cognitive and other disabilities are at least three times more likely to experience some form of maltreatment, abuse, or neglect than children without special needs. We appreciate Rep. Gonzalez’ proposal, which acknowledges that children with special needs may be at greater risk of abuse and maltreatment – and that this requires a better understanding of the signs and symptoms of abuse.

Closing a Loophole: Medicine Works to Clarify MOC Law - 04/17/2019

It was an important law that gave physicians new life, greatly restricting the discrimination they can face based on their maintenance of certification (MOC) status. And yet, opponents may have found a way to circumvent the 2017 legislature’s Senate Bill 1148.

Medical Debt and Credit Reports - 04/16/2019

While we are working to remove the patient from disputes between the insurance carrier and the physician, simply preventing the physician from seeking payment options for care already rendered despite the patient’s insurance not covering the service is placing the burden and the penalties in the wrong place. For these reasons, we cannot support HB 2732.

Transparency in Prior Auth and Physician Referrals - 04/15/2019

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information on the form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized care. The health plan also should use the information to tell the patient what level of coverage the plan will be provide and what the patient’s financial responsibility will be to all physicians and providers.

Eliminate Prior Auth for In-Network Physicians - 04/15/2019

Prior authorization is often very burdensome and can present a significant impediment to optimal patient care. Prior authorization can cause delays in medically necessary care, which may detrimentally affect patient health and finances. Excessive prior authorization requirements also create administrative hassles for physicians and consume time that otherwise would be devoted to patient care.

Require Timely Updates to Network Directories - 04/12/2019

HB 1880 will help prevent out-of-network bills through proper consumer information but will also help in ensuring insurance companies have adequate networks.  While the bill as substituted does keep the 30 day update for directories intact, it does require that upon notice of contract termination by a health plan that an update must be made to reflect this change, in the directory within two days of the effective date of the change.  Additionally, in an era of more surprise bills due to the narrow networks of health plans, this information being accurate leads to be another tool in the toolbox of consumer protection.

Include Physicians on Long-Term Care Facilities Council - 04/09/2019

TMA strongly supports SB 1519 as it will address Texas’ growing need for best practices in dispute resolution and Medicaid quality-based payment systems in long-term care. However, we urge the chair and this committee to consider two additions to the long-term care council that will strengthen its ability to address medical and infectious disease concerns

Raise Taxes on Vape Products to Decrease Youth Usage - 04/09/2019

HB 4013 and HB 3364 would deposit tax revenues to the state’s general revenue fund, while HB 1144 directs tax revenues to the Children’s Health Insurance Program (CHIP). Evidence shows more smokers favor tobacco taxes when they are not a general revenue raising tool – in a study of current smokers, only 25% favored increasing taxes on cigarettes, but support climbed to 60% if taxes funded health care programs.

Require Network Directory Accuracy - 04/09/2019

The basic product of a health insurance company is a comprehensive facility and physician network for the covered members. Balance billing events most commonly occur when a patient is receiving care at an in-network facility by an out-of network physician. The problem for both patients and physicians is not being able to easily match up the in-network facilities with in-network specialists. While I can find for a given city what physicians are in network, and what facilities are in network, there is no easy or uniform way to cross-reference the in-network facilities with in-network, facility-based physicians who provide services there.

Legislative Hotline: Bill to Raise Tobacco-Purchase Age Moving Forward - 04/05/2019

Lawmakers unveiled new balance-billing legislation this week, while several physicians testified on key issues such as limiting scope-of-practice expansions, medical liability, and pharmacy benefit managers. All of this and more in this week’s TMA Legislative News Hotline video.

Pharmacy Benefit Management System Needs Reform - 04/02/2019

Coordination between the doctor and the pharmacy such as in a medically integrated pharmacy becomes very important when using oral therapies that are high cost and have potentially high toxicity.

Enforce Network Adequacy - 04/02/2019

The median number of managed care contracts a physician has continues to decline. Physicians want to be in-network. When in network they receive a patient base for care, they do not have to chase down their payments, and a health plan is subject to prompt pay penalties. We believe Representative Vo’s bill will assist in strengthening network adequacy oversight and ensure the patients of Texas are receiving the coverage for which they are paying.

Protecting Patients From Balance Bills - 04/02/2019

The committee substitute will hold harmless patients for expenses beyond their copay, coinsurance. and deductible for all emergency care and situations where a patient may receive a surprise bill for physician services, facility fees or diagnostic testing or imaging, and for special medical services ordered by an in-network physician.

Strengthen Medicaid MCO Oversight and Improve Access to Care - 04/02/2019

Over the past six months, leaders from TMA, the Texas Hospital Association, Texas Association of Health Plans, and Texas Association of Community Health Plans have met monthly to identify opportunities to reform Medicaid. While we do not always sing Kumbaya, we have developed a better understanding of the root causes of many of problems facing the program. And many problems are much more complex than we first realized, such as simplifying Medicaid prior authorizations.

Prohibit Step Therapy in Metastatic Cancer - 04/02/2019

In some diseases, step therapy may not have severe consequences when patients’ symptoms are less controlled or a disease has moderate control. Metastatic cancer therapy requires protection from these utilization management techniques as the consequences of less control are grave.

Secure Patients’ Protected Health Information - Senate Bill 944 - 03/26/2019

Like the authors of this legislation, TMA is an ardent supporter of protecting patient privacy. TMA believes that with the following recommendations, Senate Bill 944 will provide parity and consistency in current statute regarding a physician’s absolute requirements to protect a Texan’s confidential, protected health information (PHI) under state and federal privacy laws, particularly given the potential that under House Bill 2189 more covered entities (although not fully governmental entities) could fall under the purview of Chapter 552.

Prohibit PA on Mandated Benefits - 03/26/2019

HB 2408 recognizes the many negative effects of prior authorization requirements and takes the commonsense approach of prohibiting prior authorization requirements with regard to certain services that are part of a plan’s mandated benefits under state law. If a health plan must cover these medical services by law, it makes little sense to permit the plan to subject these services to its prior authorization process. With regard to the mandated benefits covered in this bill, prior authorization would seem to serve little purpose other than delaying medically necessary care or deterring a patient from seeking medically necessary covered care.

Prevent Non-Medical Switching by Plans - 03/25/2019

HB 2099 protects the sanctity of the patient-physician relationship.  Physicians must be able to use their prescription pad for just that – writing medically appropriate and necessary prescriptions. Health plans should not use the physician’s prescription pad as a “suggestion” pad. Physicians must be allowed to treat their patients in a manner that is best for the patient (not the insurer).

Plan Directories Should Cross-Reference Physician Network Status - 03/25/2019

As a physician, I rely on online health plan network directories to see not only my own network status but also that of physicians and facilities I refer patients to for additional care and treatment. While I can find what physicians are in network and what facilities are in network, there is no easy or uniform way to cross-reference the facilities at which the facility-based physicians provide services.