Related Stories

Power PAC: TMA’s Political Action Committee Carries Forward Pro-Medicine Legislation - 09/30/2024

TMA’s political action committee (TEXPAC) is at the tip of the spear to carry forward pro-medicine legislation.

Legislature Examines Children’s Mental Health Ahead of 2025 Session - 09/24/2024

Texas lawmakers have made great strides in their ongoing investment in mental health services and support for children and their families, and that must continue if Texas is to improve such access to care and reduce the risk of behavioral health crises.

Senate Committee Tackles Scope of Practice in Access-to-Care Hearing - 09/23/2024

In a hearing packed with representatives from medicine, nursing, pharmacy, behavioral health, licensing boards, and academia, the Senate Health and Human Services Committee tackled Texas’ health care workforce shortages with the Texas Medical Association delivering its message loud and clear: Expanding scope of practice is not the answer to helping patients in rural and underserved areas.

DSHS Seeks More Funding for Lab, Fighting Maternal Deaths - 09/19/2024

The Texas Department of State Health Services (DSHS) is asking state lawmakers for new or “exceptional” funding to help the agency tackle several important health concerns facing the state, according to Commissioner John Hellerstedt, MD.

TMA Continues Push for Prior Auth Reform Ahead of 2025 Session - 09/17/2024

Three years after the Texas Medical Association spearheaded “gold card” prior authorization exemption legislation, delays and complications with payer approvals continue to adversely affect physicians and patients.

United Launches National ‘Gold Card’ Program - 09/17/2024

UnitedHealthcare announced the launch of what it’s calling a national “gold card” program, which purports to allow physicians to bypass the prior authorization process and is set to begin Oct. 1.

Texas Senate Committee Evaluates Potential AI Legislation - 09/04/2024

As the Texas Legislature considers new regulatory framework for artificial intelligence (AI) heading into the 2025 session, Texas Medical Association leaders are acting to ensure physicians’ knowledge and decision-making are integrated with the technology and not replaced by it.

BCBSTX to Require E/M Codes for Consultation Services - 09/03/2024

Starting Nov. 18, Blue Cross and Blue Shield of Texas will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology codes 99242 – 99245 and 99252 – 99255.

Aetna to Correct G2211 Payment Disparities - 08/28/2024

Aetna will correct erroneously low payments made to physicians for G2211 claims following Texas Medical Association advocacy during a meeting with the payer Aug. 2.

State Plan Tackles Mental Health Coverage - 08/09/2024

Four years after the Texas Legislature passed legislation aimed to improve health plan coverage of mental health conditions and substance use disorders, a state workgroup has released a strategic plan to improve compliance with the law’s protections to put coverage of those treatments on par with other types of health care.

Medicine to Feds: Back Off Prior Authorization Requirements - 08/09/2024

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.

TMA Applauds Appeals Court’s Ruling in Physicians’, Patients’ Favor - 08/06/2024

Statement by G. Ray Callas, MD, TMA president, in response to the U.S Court of Appeals for the Fifth Circuit’s ruling Friday in TMA’s favor. The court affirmed the district court’s decision in an appeal filed by several federal government agencies to TMA’s earlier victory in a lawsuit challenging certain components of the federal agencies’ final rules governing independent dispute resolution for surprise medical bills under the No Surprises Act. TMA argued the case in December 2022 in the U.S. District Court for the Eastern District of Texas. The district court later ruled in TMA’s favor, prompting the federal government appeal.

UHC Expands EZ Claim Pay Service to Certain Texas Medicare Patients - 07/26/2024

As of July 1, UnitedHealthcare has expanded its EZ Claim Pay service to Texas for Medicare Supplement Plan G patients, and for those patients who enroll, physicians won’t need to bill them directly for their Medicare Part B deductible.

G-Code Payment Frustration Persists With Inconsistent Implementation - 06/25/2024

Deepening ongoing physician concerns over Medicare’s add-on code for complex care, two major payers have either reduced payment for G2211 claims or announced plans to stop paying certain claims associated with the code altogether. Read more.

UHC Postpones Higher Liability Coverage Requirements Plan - 06/20/2024

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks. The move comes after the Harris County Medical Society and Texas Medical Association expressed serious concerns about the new policy.

Texas House Interim Charges Prioritize Access to Care - 06/03/2024

In an extension of the 2023 state legislative session, the Texas House remains focused on expanding access among Medicaid, pregnant, and mental health care patients, goals it shares with the Texas Medical Association.

TDI Debuts Network Adequacy Waiver Hearings - 05/24/2024

Physicians soon may hear from the Texas Department of Insurance (TDI) regarding public hearings for health plans seeking a network adequacy waiver. The hearings are required under a new state law championed by TMA to address inadequate networks and an overused waiver process. Read more.

TMA Urges Framework for Innovative Coverage, Cancer Prevention to Senate Committee - 05/21/2024

As the Texas Senate Committee on Health and Human Services begins its interim investigation into alternatives to employer-based health insurance and cancer prevention efforts, TMA offered recommendations to ensure patients have access to high-quality care. Read more.

Aetna Scraps Required Prior Auth for Cataract Surgery - 05/15/2024

Organized medicine’s efforts across the nation to torpedo or curb prior authorization recently got a small but encouraging boost when Aetna rescinded its year-old preauthorization requirement for cataract surgeries.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

 Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.  

Texas Senate Interim Charges Underscore TMA Legislative Priorities - 04/29/2024

Scope-of-practice creep and access to mental health care are among the 57 charges Texas Lt. Gov. Dan Patrick recently issued for Senate committees to study ahead of the 2025 legislative session. The Texas Medical Association’s advocacy for medicine-friendly policy also continues apace during the interim, with the association closely monitoring several of these charges.

New Federal Rules Limit Short-Term Insurance Plans, Enhance Protections - 04/17/2024

Following advocacy by the Texas Medical Association, the U.S. departments of Health and Human Services, Labor, and the Treasury recently issued final rules that strengthen consumer protections related to short term, limited duration insurance.

TMA Pushes for Prior Authorization Limits, Clarity - 04/16/2024

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.

Cigna Launches Digital Newsroom for Payer Updates - 04/12/2024

Physicians and practice staff looking for updates from one of Texas’ major payers, Cigna Healthcare, can now refer to the company’s new digital newsroom.

CMS to Test Prior Auth Requirements for Certain ASC Procedures - 04/10/2024

Texas physicians soon may encounter new Medicare prior authorization requirements for certain services that double as cosmetic procedures when provided at an ambulatory surgical center.