TMA Legislative News Hotline: Friday, April 21, 2017

This week’s TMA Legislative News Hotline video covers the Texas Medical Board Sunset Review bill as it moves through the House, a bill allowing physicians to override health insurer’s step-therapy protocols, and a TMA physician who gave some very personal testimony in support of school vaccination rate data. Also this week, there’s TMA-organized push-back against the burdensome maintenance of certification (MOC) process. Watch all of that and more in this week’s episode.



 The biennial House-Senate budget dance took two expected steps — and an unusual pirouette — this week. Although the two chambers’ spending plans for 2018-19 are only about a half-billion dollars apart, how much they spend on what and how they bridge a multi-billion-dollar revenue gap are quite different. That’s not unexpected. The Senate and House always come up with different budgets and then spend the final six weeks or so of the legislative session negotiating the discrepancies. (See TMA’s April 17 “Political Prognosis” for a rundown on how the two plans’ health-related spending proposals contrast.)

The Senate on Tuesday took one of the expected steps. Lt. Gov. Dan Patrick appointed five seasoned budget writers — Finance Committee Chair Jane Nelson (R-Flower Mound) and Sens. Juan “Chuy” Hinojosa (D-McAllen), Joan Huffman (R-Houston), Lois Kolkhorst (R-Brenham), and Charles Schwertner, MD (R-Georgetown) — to the budget conference committee. Then on Thursday House Speaker Joe Straus named Appropriations Committee Chair John Zerwas, MD (R-Richmond), and Reps. Trent Ashby (R-Lufkin), Sarah Davis (R-West University Place), Larry Gonzalez (R-Round Rock), and Oscar Longoria (D-Mission) to the negotiating team. That puts two physicians on the panel that will hammer out the final budget. But …

The House and Senate are sparring over the constitutionality of the Senate proposal to delay until the 2019-20 biennium a $2.5 billion transfer into the state’s highway fund. Senator Nelson last week asked Attorney General Ken Paxton for a ruling on that maneuver. A lawyer in Speaker Straus’ office fired back Tuesday, asking the AG to reject something he called “clearly and unambiguously” unconstitutional. So far, no response from General Paxton.


Texas Medical Board: In the late 1970s, Texas lawmakers initiated the sunset review process for state agencies. What that means is they write an end date into law for each agency. As that date approaches, legislators review the agency, determine if it’s still needed, and modify the governing statute to make corrections. The Texas Medical Board (TMB) and all of the state’s health care licensing agencies are up for sunset review this legislative session.

On Tuesday, the House Public Health Committee took up House Bill 3040 by Rep. Cindy Burkett (R-Sunnyvale), the bill that would extend the life of the TMB by 12 more years and make changes recommended by the Texas Sunset Advisory Commission and others. TMA has long supported a strong, yet fair medical board.

Former TMA Trustee David Teuscher, MD, testified for the association in favor of HB 3040. Dr. Teuscher thanked Representative Burkett for including language that would “provide a physician involved in a quality or standard of care dispute access to the complete copy of each expert report — with the name of the expert reviewer redacted. This addresses allegations that a number of physicians had made that the expert reports have been edited and compiled in such a way that was perceived as unfair to the physician. For TMA it is a matter of fairness and transparency to support such a measure, and we are pleased to see that it is part of this bill.”

Dr. Teuscher asked the committee to strip from HB 3040 a mandate that physicians check the Prescription Drug Monitoring Program (PDMP) before writing any prescription for opioids, benzodiazepines, barbiturates, or carisoprodol. TMA instead supports the general approach in Senate Bill 316, which passed the Senate last week and includes a less-sweeping mandate and a heavier reliance on the newly enhanced PDMP

Dr. Teuscher also testified in the committee against a related measure — House Bill 2747 by Rep. Bill Zedler (R-Arlington). That bill would prohibit TMB from licensing any physician who has been subject to disciplinary action by any licensing entity in the preceding five years. “This broad language does not differentiate between a minor administrative action or a major breach in standard of care or quality of care issues,” Dr. Teuscher said. “On both counts, the current law and rules seem more than adequate to protect the public’s interest, patient safety, and fairness to physicians applying for a Texas medical license.”

Mental Health Screenings for Adolescents: The House Wednesday gave final passage to House Bill 1600 by Rep. Senfronia Thompson (D-Houston), which would allow Medicaid payment to physicians to conduct a mental health screening during each annual well-child exam. During a committee hearing on the bill last month, Pritesh Gandhi, MD, an Austin pediatrician, explained that current Medicaid procedure codes for this screening may be used only once in a young patient’s lifetime (between ages 12 and 18). Dr. Gandhi described two patients under his care, noting in both cases emotional health issues presented themselves more than a year after he first saw each for a well-child exam. “These kids need to be listened to, and when necessary they need help,” he told the committee. The bill now moves to the Senate for consideration.

Surprise Billing: At the House Insurance Committee Tuesday, TMA expressed support for House Bill 477 by Rep. Nicole Collier (D-Fort Worth). It would require insurance agents to educate customers about the copayments, deductibles, coinsurance, networks, and financial responsibilities in and out of network for the health plan they are buying.

Maintenance of Certification: The Senate Business and Commerce Committee voted to approve Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway) and send it to the Senate floor for debate. This bill would prohibit the sole use of maintenance of certification status to credential, license, or pay physicians. Use the TMA Grassroots Action Center to send a quick email to your state senator urging support for this important bill. Houston neurologist Kimberly Monday, MD, testified for TMA in support of the measure earlier this month. The September 2016 issue of Texas Medicine magazine examined the topic and Dr. Monday’s perspective.

Physical Therapists’ Scope of Practice: Dr. Teuscher testified Tuesday in the House Public Health Committee against House Bill 2118 by Rep. Stephanie Klick (R-Fort Worth). That bill would allow physical therapists to treat patients for 30 days without a referral. You can use the TMA Grassroots Action Center to write your state legislators in opposition to HB 2118 and its Senate companion, Senate Bill 728. Lawmakers need to hear from physicians why a medical diagnosis is the critical and essential first step to healing.

Medicaid and CHIP Eligibility: TMA and a host of state specialty societies Tuesday told the House Public Health Committee of medicine’s strong concerns with House Bill 3634 by Rep. Greg Bonnen, MD (R-Friendswood). The bill would erect new barriers to enrollment within the Medicaid and Children’s Health Insurance (CHIP) programs. It also would direct the Texas Health and Human Services Commission to pursue Medicaid block grant funding from the federal government that would reduce federal regulations on the program. (For more on block grants, see “Change Around the Block?” the cover story in this month’s Texas Medicine magazine.) TMA, the Texas Pediatric Society, the Texas Academy of Family Physicians, the Texas Association of Obstetricians and Gynecologists, and the Texas chapter of the American Congress of Obstetricians and Gynecologists testified in writing on HB 3634.

More Health Insurance Bills: TMA had six more insurance bills under its watch on Tuesday: 

  • We told the House Insurance Committee that TMA supports House Bill 2077 by Representative Bonnen. That measure requires health insurers to report to the Texas Department of Insurance how it calculates out-of-network payments. Medicine would like to see an audit provision added to the bill.
  • Dr. Teuscher told the Insurance Committee that TMA supports the concept of House Bill 2942 by Rep. Sergio Muñoz Jr. (D-Palmview) to enhance the adequacy of health plan networks, but we have concerns with some of the language in the bill.
  • Dr. Teuscher, again, was at the Insurance Committee witness stand to discuss the pros and cons of House Bill 2900 by Representative Muñoz, which calls for timely delivery of preventive care services.
  • You guessed it, Dr. Teuscher testified at the Insurance Committee on a proposal from Committee Chair Larry Phillips (R-Sherman) to authorize catastrophic health care insurance plans.
  • Finally, in the Senate Business & Commerce Committee, TMA monitored two bills that could regulate the charges and information provided by freestanding emergency departments: Senate Bill 2064 by Sen. Kelly Hancock (R-North Richland Hills) and Senate Bill 2240 by Sen. Larry Taylor (R-Friendswood). And, no, Dr. Teuscher wasn’t able to find time to work that committee as well. 

Medicaid Vendor Drug Program: Thursday, the Senate voted to approve Senate Bill 1922 by Senator Schwertner to revamp the Medicaid Vendor Drug Program (VDP). In late-March testimony in favor of the measure, TMA’s Committee on Medicaid, CHIP, and the Uninsured Chair Ryan Van Ramshorst, MD, described the program as “byzantine, rigid, exasperating, and mind-boggling.” He said the system needed fixing because it delays or complicates patients’ care, sometimes leading to patient harm, added costs, or both. 

CPRIT’s Sun Shines On: Wednesday the Senate passed Senate Bill 224, Sen. Kirk Watson’s (D-Austin) Cancer Prevention Research Institute of Texas (CPRIT) sunset bill, on a 23-8 vote. The bill extends the sunset date of the cancer research organization from 2021 to 2023, while also adding two years to its eligibility to allocate funds, to 2022. The bill now moves to the House for consideration.

The Texas Cancer Partnership, a group of cancer-fighting organizations — including the Texas Public Health Coalition, and therefore TMA — submitted a letter supporting CPRIT’s extension.

“While we believe the private and nonprofit sectors play an important role in funding cancer research and programs, we also firmly believe that investments by state and federal government institutions are critically important to leverage in the fight against cancer,” the letter reads. “The Texas Cancer Partnership is united in the belief that CPRIT is one of the most significant catalysts for progress against cancer anywhere in the world and the state of Texas has become a global leader in the effort to eliminate cancer.” 

CPS Child Exams: The House Committee on Human Services Monday held a hearing on Senate Bill 11 by Senator Schwertner, which would implement broad reforms to the beleaguered Texas Department of Family and Protective Service system (child protective services). TMA supports the bill.

One part of the bill addresses health care provided to children who enter the system. SB 11 stipulates such children must receive a medical examination within the first three days after entering the conservatorship of the state. It also directs the state to develop guidelines to aid physicians in performing these examinations. In a comment letter, TMA urged the committee to ensure those guidelines would not create a standard of care and make it mandatory to rigidly follow these guidelines in every exam, which would replace the physician’s professional medical judgment.


Tell ‘Em What You Think: Visit TMA’s Grassroots Action Center for an easy way to contact your state representative and senator on key bills. Action alerts are posted on scope of practice issues, the Parents’ Right to Know bill on vaccine exemptions, and mandatory maintenance of certification. One click takes you to a set of talking points you can use to compose a quick email that goes right to the Capitol.

First Tuesdays: Plan now to attend the final First Tuesdays at the Capitol lobby day, on May 2. Register today to join your colleagues in Austin for the final legislative push for bills to help you deliver good patient care. 

TMA’s Agenda: TMA’s “2017 Prescription to Keep Texas Healthy” legislative agenda describes TMA’s top-priority issues this session in a concise, bulleted layout for discussions with your lawmakers.


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