UNDER THE ROTUNDA
T-minus 3: Three days remain in the 85th Texas legislative session.
Budget Bill Close: Word has it lawmakers in both chambers will vote on the budget as early as Saturday. The Conference Committee compromise bill totals $216.7 billion in all funds, and $106.8 billion in state general revenue dollars. It also draws $1 billion from the rainy day fund, an idea embraced by the House Appropriations Committee in House Bill 1. The final budget also utilizes some of the Senate’s accounting idea of delaying payment of transportation dollars until the start of the next biennium, to credit this budget that amount.
A breakdown of what the conference committee did:
- They approved $427 million general revenue in Medicaid cost containment (technically rider applies to all Health and Human Services Commission (HHSC) agencies, but most of the savings will come from Medicaid). $77 million is anticipated to come from reducing the risk margins to Medicaid and Children’s Health Insurance Plan (CHIP) plans.
- They eliminated a separate rider asking HHSC to achieve $1 billion in savings by pursuing federal Medicaid flexibility.
Maternal and Child Health
- They adopted a Senate rider directing HHSC to pursue a Medicaid 1115 women's health waiver, which if approved will provide a 90/10 federal funding match for the Healthy Texas Women’s program, effective 2019.
- They also adopted riders to decrease Medicaid neonatal ICU costs, prevent maternal mortality, screen and treat women for perinatal depression, report postpartum depression screening and treatment, and collaborate with the Maternal Mortality and Morbidity Task Force to study maternal mortality to reduce the incidence.
- They adopted $300 million for replacement or repair of state hospitals or other inpatient mental health facilities, and added $160 million for state hospital deferred maintenance.
- They also approved $67 million for community-based crisis service provisions, $30 million to reduce homelessness and recidivism, and $67.6 million to eliminate adult and child mental health waiting lists.
- Lawmakers added $44 million to for GME expansion grants, and increased GME formula funding by $4.3 million.
- The Family Medicine Residency Program was cut by $6 million, and the Physician Education Loan Repayment Program was reduced by $8.4 million.
Department of State Health Services
- Conferees approved Senate funding levels, $131 million, and directed $219,000 in federal funds to local health departments. The bill imposes a roughly $30 million cut in public health preparedness. It also reduces funding for immunizations, HIV/AIDS, infectious diseases, chronic disease prevention, and the Children with Special Health Care Needs program.
- On the bright side, the compromise plan requires HHSC and the comptroller to study how increasing the legal age from 18 to 21 could result in Medicaid savings by reducing the rates of pre-term and low-birthweight births. TMA and the Texas Public Health Coalition (TPHC) strongly supported a bill to raise the tobacco-use age from 18 to 21, but the bill was one of many that died this session.
Texting-Ban Bill Heads to Governor: House Bill 62 by Rep. Tom Craddick (R-Midland) to ban texting while driving statewide, has been sent to Gov. Greg Abbott, who could sign it into law. Sen. Judith Zaffirini (D-Laredo) is the bill’s Senate sponsor. The House concurred with Senate amendments and enrolled, or finally passed, the bill Sunday night on a 123-17 vote. The measure is a TMA and TPHC priority.
Mental Health Screenings for Adolescents Also to Governor: The House today concurred with the Senate’s amendments to give final passage to House Bill 1600 by Rep. Senfronia Thompson (D-Houston), which would allow Medicaid to pay physicians to conduct mental health screenings during each annual well-child exam, under the Texas Health Steps program. TMA explained in committee testimony that this bill improves the current scenario in which designated Medicaid procedure codes for this screening may be used only once in a young patient’s lifetime (between ages 12 and 18). The bill heads to Governor Abbott’s desk for his signature.
Prescription Drug Monitoring Advances on Another Bill: Today the House concurred on a 131-15 vote with the Senate’s amendments to a bill that includes the prescription drug monitoring program (PDMP) revamp proposal. The bill, House Bill 2561 by Representative Thompson finally passed. The PDMP bill died this session, but lawmakers amended HB 2561 with PDMP initiatives to identify potentially harmful prescribing or dispensing patterns or practices that might suggest drug diversion or “doctor shopping.” The idea is to address people’s misuse of, and addiction to, opioid pain medicines. The prescribing amendment calls for physicians and all other prescribers and dispensers to check the PDMP before prescribing any of the listed classes of medications after Sept. 1, 2019. The implementation data provides TMA with the opportunity to request possible revisions during the 2019 Texas Legislature. HB 2561 will be sent to the governor.
Maternal Depression Screening Progresses to Governor, Too: The House on Thursday agreed to the Senate’s amendments and finally passed House Bill 2466, by Rep. Sarah Davis (R-West University Place), and Sen. Joan Huffman (R-Houston). The bill would require children’s Medicaid and CHIP to cover maternal depression screening for an enrolled child’s mother during a covered well-baby visit or other office visit to a pediatrician or other pediatric provider. The bill also allows pregnant women enrolling in Medicaid to sign up for texts, emails, or phone calls from their Medicaid HMO to receive appointment reminders, as well as health information to maintain a healthy pregnancy. The bill should now head to Governor Abbott to sign.
Bill Prohibiting Handguns in State Mental Health Hospitals to Governor’s Desk: House Bill 14 by Rep. Andrew Murr (R-Junction) ran into a snag this week, but another piece of legislation came around to save the day. House Bill 435 by Rep. Ken King (R-Canadian) is now the vehicle to allow DSHS to post signs prohibiting handguns at Texas’ 10 state mental health hospitals. In HB 14’s March House Public Health Committee hearing, Clifford Moy, MD, explained that TMA supports the bill, noting this bill closes an unintended loophole in state law prohibiting guns in hospitals that left the state’s mental health hospitals unable to restrict open carry. The Senate added the state hospital language to HB 435, which initially dealt only with another handgun issue, and the House approved the change Friday. It goes to the governor next.
Zika Testing Passes Test: The House unanimously concurred with Senate amendments today to House Bill 3576 by Rep. Bobby Guerra (D-McAllen), finally passing the bill. The measure would shore up the state’s testing and screening capabilities for infectious diseases, such as the Zika virus. TMA told lawmakers physicians support the bill because it upholds a core function of public health. Disease surveillance allows for the implementation of prevention and treatment activities, TMA said. The bill’s next stop is referral to the governor for his signature.
More GME Slots Approved: Today the Senate unanimously approved House amendments to Senate Bill 1066, by Sen. Charles Schwertner, MD (R-Georgetown), and finally passed the bill. The measure requires new medical schools to offer new graduate medical education (GME) positions to keep pace with their medical graduates. TMA testified in February about the importance of having GME slots keep pace with medical school graduates needing a place to continue their study. This bill joins the others en route to the governor.
Maintenance of Certification Bill Heads to Conference Committee: The Senate rejected the amendments the House attached to the maintenance of certification (MOC) bill, Senate Bill 1148 by Sen. Dawn Buckingham, MD (R-Lakeway). The House on Tuesday night removed hospitals from the bill via amendment, meaning hospitals could still use MOC status to determine physicians’ eligibility to practice in their institutions. The House then passed the bill on a 140-4 vote. But late Thursday, the Senate said no to the amendments, and appointed negotiators to meet with House conferees to try to reach a compromise. The Senate conferees include Senator Buckingham, MD; Senator Schwertner, MD; Sen. Donna Campbell, MD (R-New Braunfels); Sen. Van Taylor (R-Plano); and Sen Juan “Chuy” Hinojosa (D-McAllen). House conferees are Rep. Greg Bonnen, MD (R-Friendswood); Rep. Tom Oliverson, MD (R-Cypress); Rep. John Zerwas, MD (R-Richmond); Rep. Four Price (R-Amarillo); and Rep. Garnet Coleman (D-Houston).
As originally written, SB 1148 would have prohibited health plans AND hospitals from using MOC to differentiate among physicians for payment, contracting, or credentialing. It also would have required the TMB to certify alternative MOC programs. In the House version, the bill still prohibits the state from using MOC as a requirement for state licensure or renewal, or insurance participation — but permits health facilities to use MOC.
ACO Bill Passes Senate; Doesn’t Get Far: The Senate on Wednesday passed House Bill 3124 by Rep. Lance Gooden (R-Terrell), 21-10. On Monday, senators added several controversial amendments. HB 3124 would allow doctors in physician-led accountable care organizations (ACO’s) to receive and share physician-specific comparison data and information. The House late Friday rejected the amendments as not germane to the bill and returned it to the Senate.
Bill Reporting Abortion Complications Faces Setback: The House today rejected amendments to a bill we reported on back in March: House Bill 2962 by Rep. Giovanni Capriglione (R-Southlake). The bill would require physicians and health facilities to file a form to report any medical complications following an abortion. The Senate amended the bill this week but the House kicked the bill back to the upper chamber, saying the amendments are not germane to the bill. TMA noted earlier in opposing the measure that it would require a physician who diagnoses a complication following an abortion and/or initiates treatment of a woman following an abortion to report that information to the state — and imposes a penalty for not doing so. This requirement would include an emergency physician with no prior history about the patient. (TMA’s concerns have nothing to do with the issue of abortion, but instead the bill’s intrusion into the patient-physician relationship.)
PHYSICIAN OF THE DAY
The physician of the day at the Capitol is Lesca Hadley, MD, of Cleburne. Dr. Hadley graduated from Texas Tech University Health Sciences Center. She is a member of TMA and the Tarrant County Medical Society.
WHAT WE’RE READING
Abbott signs law targeting surprise medical bills ― Houston Chronicle
Texas Legislature grants doctors, patients the privilege of online office visits ― The Dallas Morning News
Abbott appears undecided on signing texting-while-driving ban ― The Texas Tribune
Gov. Abbott: There is still time to avoid a special session of the Legislature ― The Texas Tribune
Court ruling imperils immunity for physicians in public service ― AMA Wire
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