The 2015 Legislature kicked off last month with many new faces, some new money, and familiar issues for the house of medicine.
A wholesale change in leadership brings a new governor and lieutenant governor, Republicans Greg Abbott and Dan Patrick; 30 new House members; and shifts in the committees presiding over many of TMA's issues. This biennium also starts off with a rosier budget picture than last session, which is already shaping up to be good news for TMA's goals of boosting funding for graduate medical education (GME) and women's and mental health care services.
Key committee appointments of House and Senate members from the House of Medicine could play a big role in moving TMA's efforts forward.
On the House side, TMA Alliance member Rep. Susan King (R-Abilene) was appointed chair of the Defense and House Veterans Affairs Committee and member of the Human Services Committee. Rep. John Zerwas, MD (R-Richmond), was appointed chair of the Higher Education Committee and was reappointed to the Public Health Committee. Rep. Greg Bonnen, MD (R-Friendswood), was reassigned to the Appropriations Committee and Insurance Committee. Rep. J.D. Sheffield, DO (R-Gatesville), was newly appointed to Appropriations and reassigned to the Public Health and Rules and Resolutions committees. Rep. Stuart Spitzer, MD (R-Kaufman), was assigned to the County Affairs and Human Services committees.
In the Senate, Sen. Charles Schwertner, MD (R-Georgetown), was appointed chair of the Health and Human Services Committee and a member of the Administration, Business and Commerce, Finance, and State Affairs committees. Sen. Donna Campbell, MD (R-New Braunfels), also was appointed to the Health and Human Services and Administration committees, and to the Education and Intergovernmental Relations committees.
TMA also has good relationships with other friends of medicine holding top posts in both chambers.
In the Senate, former Health and Human Services Committee Chair Sen. Jane Nelson, (R-Flower Mound) now leads the Finance Committee with Vice Chair Sen. Juan "Chuy" Hinojosa (D-Harlingen). Sen. Kevin Eltife (R-Tyler) chairs the Senate Committee on Business and Commerce, with Vice Chair Sen. Brandon Creighton (R-Conroe). Sen. Kel Seliger (R-Amarillo) chairs the Higher Education Committee with Vice Chair Sen. Royce West (D-Dallas); and Senator Schwertner chairs Health and Human Services with Vice Chair Sen. Lois Kolkhorst (R-Brenham).
In the House, Rep. John Otto (R-Dayton) leads the Appropriations Committee with Vice Chair Rep. Sylvester Turner (D-Houston); Rep Myra Crownover (R-Denton) chairs the Public Health Committee with Vice Chair Rep. Elliott Naishtat (D-Austin); Rep. John Frullo (R-Lubbock) chairs the Insurance Committee with Vice Chair Rep. Sergio Munoz (D-Mission); and Representative Zerwas chairs the Higher Education Committee with Vice Chair Donna Howard (D-Austin).
For a complete listing of Texas Senate and House Committees, see http://tma.tips/2015SenateCommittees and http://tma.tips/2015HouseCommittees.
Let the Budget Begin
In early February, Senate and House members began tackling their respective draft budgets after the new Comptroller Glenn Hegar announced $113 billion in state money was available for the 2015-16 biennium, about $12 billion more than last session. The state's Rainy Day Fund has about $7 billion on hand that lawmakers appear reluctant to touch.
Looming in the background, however, are the constitutional spending cap — which stands at roughly $107 billion — and a pending court case that could result in a mandate for more spending on education.
Both chambers unveiled starting budgets: House Bill 1 and Senate Bill 2. HB 1 came in at around $99 billion, about 4 percent above 2014-15 funding levels; SB 2 came in around $101 billion, a 6.6-percent increase. Both versions are expected to include tax cuts, and so far, the Senate's draft includes roughly $4 billion in tax cuts.
"Tax cuts are likely," and physicians may benefit, too, says TMA lobbyist Troy Alexander. TMA is working with other professions to repeal a state occupations tax, a move that could eliminate or reduce the tax added onto physician licensure fees.
TMA officials already see positive signs for GME funding: Both budget bills build on 2013 efforts and again add funding to grow residency slots. "They heard our call," TMA lobbyist Michelle Romero said.
SB 2 sets aside an additional $300 million for mental health infrastructure and $50 million for women's health care services, compared with the last biennium. Also influencing these areas are the Sunset Advisory Commission's recommendations to overhaul the structure of the state's health care agencies.
Both initial budgets take into account money needed for growth in the state Medicaid program, but neither include Medicaid pay increases for physicians or providers. At a press conference Feb. 6, TMA physicians urged lawmakers to address six priority areas harming access to care for Medicaid patients:
- Improve Medicaid payments;
- Cut red tape and administrative hassles;
- Hold Medicaid HMOs accountable for establishing adequate physician networks;
- Restore funding for care of patients dually eligible for Medicare and Medicaid;
- Stop unreasonable and unfair fraud and abuse audits; and
- Find a solution to access federal dollars to ensure working poor adults have access to health care coverage.
On the latter, hospital groups are pushing a state-based plan. But TMA Vice President of Advocacy Darren Whitehurst cautions that a law passed in 2013 requires legislative approval before any state-federal negotiations can take place.
Meanwhile, TMA is looking forward to working with the new Inspector General Stuart W. Bowen Jr., a former aide to George W. Bush as president and governor. The Senate Nominations Committee last week recommended that the full Senate approve his nomination to the post.
TMA officials are active in national discussions to beef up state network adequacy laws, which have drawn more attention with the advent of the Affordable Care Act insurance exchanges. However, because those conversations have raised the idea of banning balance billing as a way to protect patients from surprise out-of-network costs, the association has a careful eye on efforts at the state level to thwart Texas laws that allow out-of-network physicians to bill for their services, says TMA lobbyist Patricia Kolodzey.
As a potential alternative, TMA officials are vetting and monitoring House Bill 616 by Representative Bonnen. For physicians who choose to file a claim and agree to accept payment based on a state-certified database of geographic-specific provider charges, such as FAIRHealth.org, the bill would require health plans, in some cases, to pay out-of-network doctors an amount equal to the 90th percentile of the database charges. Other payment levels could come into play depending on the amount billed and the robustness of the data for a specific geographic area.
To address other fallout from the ACA exchange, TMA is backing Representative Sheffield's plan to require Texas health plans to disclose on their member identification cards whether patients bought an exchange plan and received a federal subsidy to pay for it. Under federal rules, if patients with subsidized exchange coverage default on their premiums for 90 days, health plans can recoup payments in the latter 60 days of that grace period. Doctors need to be able to communicate with patients about the importance of paying their premiums and to plan treatment accordingly, Ms. Kolodzey says.
Meanwhile, TMA is working to preserve state prompt-pay penalties medicine won in 2003. Health plans are looking to chip away at those fines, now that the ACA did away with the high-risk pool funded by the some of that money.
A package of workers' compensation bills filed also could have broad impact for physicians. Under Senate Bill 262, employers, including physician practices, that don't pay workers' compensation benefits for their employees would have to contribute to a life insurance plan for their workers; Senate Bill 263 would require employers not providing workers' compensation coverage to report on-the-job injuries.
Public health issues also have captured lawmakers' attention following the Ebola outbreak, and TMA is reviewing a broad containment proposal by the Task Force on Infectious Disease Preparedness and Response appointed last year by then-Gov. Rick Perry.
"Physicians agree, there is a big need for change regarding the handling of crises related to infectious disease, and it's a major topic in early session," Mr. Alexander said.
The recent measles outbreak is stirring scrutiny of vaccine exemptions, and TMA hopes to focus attention on consensus recommendations from the Texas Public Health Coalition, whose goals include improvement of immunization access. Other progress on that front: Senate Bill 29 by Sen. Judith Zaffirini (D-Laredo) and House Bill 465 by Rep. Donna Howard (D-Austin) would set up ImmTrac, the state's immunization registry, as an opt-out system versus opt-in, and preserve child vaccination records past age 18, unless removal is requested. Rep. Sarah Davis (R-West University Place) is working on a similar measure.
Already, eight bills regulating e-cigarettes have been filed, and TMA testified in support of Senate Bill 97 by Senator Hinojosa, which would regulate the sale, distribution, possession, use, and advertising of vapor products. "We want to make sure the legislation TMA supports does not inadvertently help the tobacco industry and that we do support legislation that restricts youth access," Mr. Alexander said.
TMA also wants to ensure any legislation requiring the use of auto-injectors of epinephrine in schools, such as Senate Bill 66 by Senator Hinojosa, include liability protections for physicians and school personnel.
New Licensure Compact, Old Scope Issues
Meanwhile, lawmakers are moving to increase access to care with a bill that would expedite the licensure process for out-of-state physicians who meet certain heightened criteria. Senate Bill 190 by Senator Schwertner and its companion, House Bill 661 by Representative Zerwas, introduces the Interstate Medical Licensure Compact, proposed by the Federation of State Medical Boards.
TMA lobbyist Dan Finch says the compact will help facilitate the safe practice of telemedicine in a market increasingly overrun by businesses and insurance companies "pushing telephonic access to doctors who have no relationship to the patient, and who may or may not be licensed in the state of Texas."
Other telemedicine-related bills are expected, some good — like payment parity for physicians providing after-hours care even if they don't contract with insurers to provide telemedicine — and some bad — like companies pushing for unrestricted access to their telephone services.
TMA officials also anticipate the usual flurry of legislation from nonphysicians seeking to expand their scope of practice into the practice of medicine. Already, TMA is on guard to defend Senate Bill 406, last session's landmark agreement with advanced practice registered nurses (APRNs) and physician assistants on a simplified regulatory structure for the delegation and supervision of prescribing privileges. Nurse groups say the law does not adequately address prescribing of Schedule 2 drugs in certain circumstances, such as hospital discharges.
"We believe [SB 406] is working and deserves the opportunity to continue to work," Mr. Finch said.
APRNs are expected to push for independent practice, citing access to care issues. Psychologists and optometrists are back seeking independent prescribing privileges, and chiropractors return with a bill allowing them to issue handicap placards.
TMA also is looking to preserve strides made in 2013 toward a comprehensive bill to help resolve disputes involving end-of-life care.
Record February "First Tuesdays"
Legislators heard all about medicine's agenda through TMA's initial First Tuesdays at the Capitol lobbying event on Feb. 3 with a record turnout for the month. Roughly 350 physicians, medical students, and TMA Alliance members knocked on the doors of their representatives and senators to discuss TMA's legislative priorities. Read more in TMA's Healthy Vision 2020 document.
The next First Tuesdays events will be March 3, April 7, and May 5. Register now!
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
Action, Feb. 17, 2015