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Tell Congress: Protect Patients, Not Health Plans - 08/16/2019

Our U.S. senators and representatives are back home in Texas for the August recess, and Texas Medical Association President David Fleeger, MD, says their physician-constituents need to contact them to make sure they stop the surprise medical billing epidemic in a way that helps our patients – not big insurance companies.


Gender-Neutral Insurance Rates = Big Savings for Women Physicians - 08/15/2019

To help Texas Medical Association members get the income protection they need, the exclusive TMA Member Long Term Disability Plan, issued by The Prudential Insurance Company of America, uses group rates that are based on age, not gender. Female physicians will find these gender-neutral group rates significantly less expensive than most individual disability plans available in Texas. 


Payers Axe Consultation Codes - 08/07/2019

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


Charting Medicine’s Statehouse Progress: A Successful Legislative Session for Physicians - 08/06/2019

Legislation is just one piece of a healthy Texas. But it’s a big piece, and when the Texas Medical Association told the lawmakers of 2019 how it should fit, those legislators largely shaped it to what physicians and patients need. 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.


New Laws Improve Opioid Prescription Process in Texas - 08/06/2019

The 2019 Texas Legislature enacted three new laws that will change the way physicians prescribe opioids, including House Bill 3284, which delays the mandate for physicians check the state’s prescription monitoring program, known as PMP Aware, for prescriptions tied to opioids, benzodiazepines, barbiturates, and carisoprodol. The bill pushes back the requirement from Sept. 1, 2019, to March 1, 2020.


When Do New Opioid Prescribing Requirements Take Effect? - 08/02/2019

To combat the ongoing opioid crisis, state lawmakers passed several measures that change how physicians and other health care professionals will prescribe opioids. However, provisions of the laws take effect at different times, so prescribers should be aware of the deadlines and effective dates of each requirement. Below is a chart showing when each provision takes effect.


Physician-Legislator Rep. John Zerwas, MD, Steps Down, Joins UT System - 08/02/2019

One of medicine’s long-time and most influential state legislative champions, Rep. John Zerwas, MD (R-Richmond), has been named The University of Texas System’s new executive vice chancellor for health affairs. On Wednesday Representative Zerwas announced that he will step down from elected office as of Sept. 30. He will start his new position Oct. 1.


On Call at the Capitol: TMA's 2019 Legislative Agenda - 08/02/2019

When the 86th Texas Legislature convenes on Jan. 8, TMA will build on its major successes of 2017, renew some of the biggest battles that stalled two years ago, and tackle relatively new ones. Physicians will make their case to a somewhat new makeup of lawmakers as they pursue better Medicaid coverage for postpartum women, insurer accountability for narrow networks, more funding for community mental health, and many other aims.


Out in the Cold: Health Plan Blamed For Major Prompt-Pay Mess - 08/02/2019

Molina Healthcare of Texas isn’t the only insurer to give physicians prompt-pay problems, and it won’t be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it’s hiring staff and making other changes to improve that response.


Respecting the Roles: TMA Battles Another Round of Scope of Practice Bills - 08/02/2019

When nonmedical professionals ask the Texas Legislature for the authority to practice medicine, TMA mounts a full-court press, letting lawmakers know why there are some roles only physicians can fill.


Setting the Record Straight: Supreme Court Curtails TMB for Over-Sanctioning Physician - 08/02/2019

Eight years ago, when he experienced a rare patient death, McAllen family physician Ruben Aleman, MD, signed the death certificate the way Texas physicians had been doing it for years, and the only way he knew how: using pen and paper. That resulted in the Texas Medical Board (TMB) not only coming after him, but accusing him of “unprofessional or dishonorable conduct that is likely to deceive or defraud the public” – words found in the state Medical Practice Act. The Texas Supreme Court recently decided that was an overreach for a physician who simply hadn’t signed up on the state’s electronic death registration system, which at the time was relatively new.


Swinging For Fairness: Law Creates New Ballgame for Surprise Billing - 08/02/2019

When Senate Bill 1264 was first introduced in February, insurers had the bases loaded, threatening to score a lopsided surprise-billing victory on one swing. With some deft pitching in the Texas Legislature, medicine worked its way out of the jam. The “baseball-style arbitration” measure by Sen. Kelly Hancock (R-North Richland Hills) isn’t perfect, and like a hitter who’s getting busted inside, physicians will have adjustments to make. But the improved SB 1264 passed with a framework that’s fairer to everyone involved.   


TMB: Back on Track - 08/02/2019

Two years ago during the 2017 regular session, the Texas Legislature put the practice of medicine in the state in serious danger, failing to renew the Texas Medical Board (TMB) and the state’s Medical Practice Act. In 2019 House Bill 1504 by Rep. Chris Paddie (R-Marshall) put TMB back on the standard 12-year sunset cycle, renewing the board through 2031.


Scope of Practice: Shot Down - 08/02/2019

When it comes to shooting down dangerous attempts to expand non-medical practitioners’ scope of practice, TMA’s advocacy army once again proved to be expert marksmen in 2019. Medicine trained its scope on bills that would have allowed nurse practitioners, chiropractors, and optometrists, among others, to wade into the practice of medicine.


Medicaid: Reforms, But No Raise - 08/02/2019

Medicine didn’t get everything it needed from lawmakers for Medicaid, including TMA’s biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians’ efforts to care for the most vulnerable Texans.


Opioids and Pharmacy: PMP Extension Granted - 08/02/2019

When it came to opioids and pharmacy matters, some of the major pieces of medicine’s 2019 agenda came down to something everyone wishes they had more of: time. Physicians need it to get comfortable with a mandate to check the state’s prescription monitoring program (PMP). Patients need it to make sure the pain medications they’re prescribed do what the drugs are supposed to do. The legislature listened, and TMA achieved wins on both counts, as well as on increased transparency from pharmacy benefit managers (PBMs).


Insurance: Network Solutions - 08/02/2019

Charting Medicine’s Statehouse Progress TMA went into this session looking to attack insurer network inadequacy and health plans’ use of care impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it


TMA President: Rulemaking on Surprise Billing Must Be Fair to Docs - 07/31/2019

Now that the Texas Legislature has passed a measure to counteract surprise billing involving many state-regulated plans, it’s time for rulemaking. The Texas Medical Association is working to make sure the Texas Department of Insurance’s eventual rules borne out of Senate Bill 1264 will give physicians a fair shake.


Prescribing Changes in Texas: Know What You Need to Know - 07/23/2019

By now you might know that state lawmakers recently passed a number of changes to how prescriptions for certain pain medications must be written and processed, as part of a larger effort to fight prescription fraud and abuse. TMA will outline what prescribers can expect as a result of these advocacy efforts in a free live webinar on July 31.


Turn to TMA to Resolve Prompt-Pay Issues - 07/22/2019

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Hassle Factor Log program. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.


86th Texas Legislature Letters and Testimonies - 07/19/2019

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.


85th Texas Legislature Testimonies and Letters - 07/19/2019

TMA physician leaders already are working on behalf of their profession and their patients to improve Texas health care system. 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.


Panel Makes Big Change in Draft Federal Surprise Billing Law - 07/17/2019

Thanks to incessant lobbying from physicians, hospitals, organized medicine, and the Physicians Advocacy Institute, a key congressional committee today made significant revisions in a bill to reduce the strain of surprise billing on patients. “This certainly sounds like an improvement,” said Texas Medical Association President David Fleeger, MD, “but the devil will be in the details.”


TMA Pushes to End Surprise Bills – The Right Way - 07/10/2019

TMA’s chief lobbyist is working Capitol Hill this week to pass a bill that spares patients the pain of surprise bills but doesn’t give health insurance companies complete control over what it pays physicians who treat patients out of network.


TMA’s Top 10 Victories this Legislative Session - 07/09/2019

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.  TMA’s Vice President of Advocacy Darren Whitehurst tells us what we need to know about medicine's victories in the TMA Legislative News Hotline’s Top 10 Issues videos.