Action: Feb. 17, 2015

 TMA Action Feb. 17, 2015   News and Insights from Texas Medical Association

Measles Outbreak Surges to Triple Digits

Dual Eligible Demo Rolls Out March 1
Don't Miss Next Month's Medicaid EHR Attestation Deadline
Save the Date(s) for First Tuesdays
TexMed 2015 Registration Is Now Open — and It’s FREE!
Sign Up Now for TMA Legislative News Hotline
Medicaid Managed Care Expands to Nursing Home Patients March 1

How to Report Asbestosis and Silicosis
Hard Hats for Little Heads: 200,000 Helmets and Counting
Set It and Forget It
Choosing Wisely CME from TMA
Register for This Summer's 3rd Annual Texas Primary Care and Health Home Summit
New Leadership, New Money, Familiar Issues
This Month in Texas Medicine  

Measles Outbreak Surges to Triple Digits

The first measles outbreak of 2015 has grown to 121 cases in 17 states, according to the Centers for Disease Control and Prevention (CDC), with most of those cases associated with a large, ongoing outbreak linked to an amusement park in California. The one measles case reported in Texas so far this year was not linked to the California outbreak, where officials believe an unknown traveler contracted the disease overseas and visited the park while infectious. 

The CDC updates measles case information weekly and notes that the majority of those infected with measles in this outbreak were unvaccinated.

Because measles is still common in many parts of the world and travelers continue to bring the disease back to the United States, public health officials urge physicians and other health care professionals to consider measles when evaluating patients with febrile rash and to ask about a patient's vaccination status, recent travel history, and contact with persons who have febrile rash illness.

Reminders for physicians:

  • Ensure all patients are up-to-date on the measles, mumps, and rubella (MMR) vaccine.
  • Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and conjunctivitis).
  • Ask patients about recent international travel or travel to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
  • Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the Texas Department of State Health Services (DSHS) at (800) 705-8868. Here's a list of local health department contacts in Texas.
  • Obtain specimens for testing from patients with suspected measles, including viral specimens for genotyping, which can help determine the source of the virus.  

For information about collecting and submitting specimens to the DSHS laboratory, visit the DSHS website.

Get TMA's Vaccination Resources for Patients

TMA's Be Wise — ImmunizeSM program offers free vaccination fact sheets to help physicians educate patients and send the message that vaccinations are safe, important, and effective. The childhood vaccination fact sheet includes information about the MMR vaccination. 

Fact sheets also are available on adolescent vaccinations, adult vaccinations, flu, pertussis, human papillomavirus (HPV), and meningococcal disease. To request free copies of these fact sheets for your patients, contact Tammy Wishard, TMA's outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470. Or use the Be Wise order form to request additional educational materials, such as posters for your office. 

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise — Immunize is provided by the TMA Foundation thanks to generous support from H-E-B, TMF Health Quality Institute, Permian Basin Youth Chavarim, and gifts from physicians and their families. 

Be Wise — Immunize is a service mark of the Texas Medical Association.

Dual Eligible Demo Rolls Out March 1

The Texas Health and Human Services Commission (HHSC) will launch its Dual Eligibles Integrated Care Demonstration Project March 1 in six Texas counties. The project is a partnership between Texas and the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing coordinated care to patients enrolled in both Medicare and Medicaid. Texas and CMS will contract with Medicare and Medicaid managed care plans to coordinate patient care across both programs.

Nationally, more than 9.6 million seniors and people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations. Often, medically fragile, dual-eligible patients are typically poorer and sicker than other Medicare beneficiaries and use more health care services. 

The project's objectives include:

  • Making it easier for clients to get care,
  • Promoting independence in the community,
  • Eliminating cost shifting between Medicare and Medicaid, and
  • Achieving cost savings for the state and federal government through improvements in care and coordination. 

More than 165,000 Texas patients in Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant counties qualify for the program and may eventually be covered under the new plan; only patients who opted into the program will be enrolled in March.

Patients will be included in the project if they: 

  • Are age 21 or older;
  • Get Medicare Parts A, B, and D, and are receiving full Medicaid benefits; and
  • Are in the Medicaid STAR+PLUS program, which serves Medicaid clients who have disabilities or get STAR+PLUS Home and Community Based Services waiver services.  

In the demonstration, health plans must provide the full array of Medicaid and Medicare services. This includes any benefits that will be added to the STAR+PLUS service array by March 1, such as nursing facility services, psychosocial mental health rehabilitation, and targeted case management. 

Passive enrollment will begin in April and progress incrementally through August and will apply to 20 percent of nonfacility patients within a county by ZIP code. For example, all dual eligible patients eligible for passive enrollment who live in a pilot county and who are in cohort 1 ZIP codes (see list), will be passively enrolled on April 1 unless they opted out. Enrollment of dual-eligible nursing facility patients will begin Aug. 1 in Bexar and El Paso counties, followed by Harris County nursing facility patients on Sept. 1 and those in remaining counties on Oct. 1.

HHSC has developed a detailed enrollment grid by county to help practices better understand how patients will be assigned to a plan.

Patients may elect to opt out before the pilot begins. If a patient opts out after being enrolled in a plan, then the change will take effect the first of the following month. Physicians cannot steer patients to a particular managed care plan, but can inform patients about the demonstration plan(s), if any, in which they participate. Patients who opt out may also later opt back in.

Patients Still Have a Choice

Patients eligible for the demonstration will be sent introduction letters 90 days before enrollment and additional reminder letters 60 days and 30 days before passive enrollment begins. If a patient is enrolled in a plan whose network does not include their physician(s), continuity of care must be protected for the first 90 days. 

Specifically, the contract between CMS, HHSC, and the plans specifies that a patient's care must not be disrupted when the patient enrolls in a plan: "The STAR+PLUS Medicare and Medicaid Plan (MMP) allows enrollees receiving any services at the time of enrollment to maintain their current providers, including with providers who are not part of the STAR+PLUS MMP's network, and service authorizations, including drugs, for at least up to ninety (90) days after the enrollee's enrollment effective date or until the Plan of Care and/or ISP are updated and agreed to by the enrollee, whichever is earlier."

The contract further states that the STAR+PLUS MMP must ensure continuity of care for new enrollees whose health or behavioral health condition has been treated by specialty care providers or whose health could be placed in jeopardy if medically necessary covered services are disrupted or interrupted.

Visit the HHSC or CMS websites for more information about the project, including the Texas proposal and memorandum of understanding.

To see how CMS will be monitor and evaluate the Texas demonstration project, read Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals.

HHSC website resources include: 

Training Webinar

Feb. 26
2-4 pm

Register for Feb. 26 physician and provider training.

Training Archive: Texas Dual-Eligibles Integrated Care Demonstration Project, Jan. 21, 2015 (offsite link). You must register with Citrix to view this archive. To learn about this archive in other formats, email Heather Kuhlman at HHSC. 

Don't Miss Next Month's Medicaid EHR Attestation Deadline

For physicians who participated in the 2014 Medicaid electronic health record (EHR) incentive program, the deadline to attest to meaningful use is quickly approaching. Physicians hoping to receive the incentive must attest no later than March 16, 2015, by 10:59 pm CT.

For those participating in the Medicare EHR incentive program, review a recent article with information and resources about that deadline.

TMA urges you not to wait until the last minute. You should attest as soon as possible due to the heavy user traffic expected on the Center for Medicare & Medicaid Services (CMS) Registration and Attestation website as the deadline approaches. Give yourself enough time to resolve any issues that may come up during the attestation process.

Consult these resources when preparing for attestation:  

  • Instructions for Medicaid EHR Incentive Program,
  • CMS 2013 Stage 1 Attestation User Guide,
  • CMS 2014 Stage 1 Attestation User Guide,
  • CMS Stage 2 Attestation User Guide,
  • CMS Meaningful Use Attestation Calculator, and
  • CMS Stage 1 Attestation Worksheet.  

For more information about the EHR incentive programs, contact TMA's Health Information Technology Department by telephone at (800) 880-5720 or by email.

To stay up-to-date on all the pending regulatory deadlines that could affect your practice and your patients, check TMA's Deadlines for Doctors at least once a month.

Save the Date(s) for First Tuesdays

First Tuesdays at the Capitol has returned, and the Family of Medicine needs you to be there.

The "White Coat Invasion" has been the key to physicians' successes in the Texas Legislature since the inception of First Tuesdays at the Capitol in 2003. Our senators and representatives listen when their hometown doctors appear in their offices. Our influence is so much greater when physicians and alliance members arrive en masse in the House and Senate galleries. It's time again to bring out Texas medicine's strongest weapon.

Mark your calendar for the remaining 2015 First Tuesdays at the Capitol, and register today:

  • March 3,
  • April 7, and
  • May 5.

Although the Texas Legislature is becoming more hyper-partisan and hyper-political, TMA will continue to work for what's best for patients and their physicians. Medicine's 2015 legislative agenda, based on TMA's Healthy Vision 2020, Second Edition, will focus on:

  • Increasing funding for graduate medical education.
  • Improving physicians' Medicaid and CHIP payments to more appropriately reflect the services they provide to patients.
  • Holding health insurance companies accountable for creating and promoting adequate physician networks.
  • Devising and enacting a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork.
  • Stopping any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills.
  • Promoting government efficiency and accountability by reducing Medicaid red tape.
  • Protecting physicians' ability to charge for their services.
  • Improving the state's public health defense to better respond in a crisis.
  • Preserving Texas' landmark medical liability reforms.
  • Protecting the patient-physician relationship from corporate intrusions.

 TMLT Action Ad 4.13     

TexMed 2015 Registration Is Now Open — and It’s FREE!

Reserve your spot today for TMA's free annual conference, and join thousands of your fellow Texas physicians, as TexMed 2015 arrives in Austin May 1-2 for a weekend of advocacy, education, and collaboration at the Austin Convention Center and Hilton Austin. 

TexMed is TMA's largest event of the year, offering free continuing medical education (CME), an extensive gathering of exhibitors to help with every aspect of your practice, and, because we're in Austin, a special Thursday event at the Capitol.

See all the details and register online.

At TexMed 2015, you can meet with elected officials face-to-face to voice medicine's priorities for the legislative session. There's nothing quite as impactful as thousands of Texas physicians coming together in one place to form one unified voice.

Plus, you can participate in your choice of more than 80 hours of free CME including two general sessions, and you can mingle and network with your colleagues from across the state.

TexMed also provides the platform for business and policy decisions and discussion. The TMA House of Delegates conducts its annual policymaking session and elections in conjunction with TexMed, and many TMA boards, councils, and committees meet, as well. TMA needs your voice and your experience to help develop relevant, meaningful policy that benefits Texas physicians and patients. 

For a full schedule of events, CME, exhibitors, lodging information, fun things to do in and around Austin, and how to get more involved in TMA policy creation, visit the TMA website. Be sure to register and make your hotel reservations today so that you can enjoy this free benefit of your TMA membership.

Sign Up Now for TMA Legislative News Hotline

Want to stay fully informed of the latest happenings of the 2015 Texas Legislature? Subscribe today to TMA Legislative News Hotline.

The hotline is a daily electronic newsletter only for TMA members that reports the legislature's latest news and actions affecting organized medicine. Subscribers receive the newsletter each day the legislature is in session. A weekly recap, which TMA delivers each Sunday, is also available. You can subscribe for the daily or weekly TMA Legislative News Hotline online (members only).

Medicaid Managed Care Expands to Nursing Home Patients March 1

Medicaid patients living in nursing homes will be automatically enrolled March 1 in STAR+ PLUS, the state's Medicaid managed care plan for seniors and people with disabilities. The move will affect 50,000 to 60,000 nursing home patients statewide and is intended to improve quality of care and promote care in the least restrictive, most appropriate setting.

Eligible nursing home patients covered by Medicaid will get acute and long-term care services through STAR+PLUS. Dual-eligible patients, who are covered by both Medicaid and Medicare, will continue to get their acute care services through Medicare and their long-term care services through STAR+PLUS. However, dual-eligible patients living in Bexar, Dallas, El Paso, Harris, Hidalgo, or Tarrant Counties will participate in a pilot project integrating Medicare and Medicaid services into a single plan

The transition will be mandatory for adults aged 21 and older who are in a nursing home, who have been determined eligible for Medicaid, and who meet STAR+PLUS criteria. Children and adults younger than 21 will be excluded. State veterans home residents also will be excluded.

Each nursing home patient will be assigned a managed care service coordinator whose responsibilities will include meeting with patients every three months, authorizing add-on services and ensuring their delivery, and being involved in care plans.

Physicians and health care providers who are not part of STAR+PLUS will be given the opportunity to join the plan, according to the Texas Health and Human Services Commission, which has directed STAR+PLUS to reach out to those it calls "significant traditional providers," or STPs; physicians and providers are free, however, to contact STAR+PLUS. 

For more information about the transition, go to the HHSC website, or view the plan's highlights.

TMAIT Action Ad Sept 14 

How to Report Asbestosis and Silicosis

The Texas Department of State Health Services (DSHS) last month released a new form for physicians and health care providers to report suspected or confirmed cases of asbestosis or silicosis as required by state law. 

You can find the form on the DSHS website. After completing it, fax the form to the DSHS Environmental and Injury Epidemiology and Toxicology Unit at (512) 776-7222.

You also may report by calling (800) 588-1248. Be sure to include the patient name, date of birth, Social Security number, gender, race, ethnicity, smoking history, occupational history (employer, dates of employment, occupation/job activities), diagnosing physician name, physician address, facility name, and physician city.

If you have questions, contact Emily Hall at DSHS at (512) 776-2652 or by email.

Hard Hats for Little Heads: 200,000 Helmets and Counting

TMA's Hard Hats for Little Heads bike helmet giveaway program reached a huge milestone in 2014 — giving away its 200,000th helmet. Keep the momentum going this year with three great opportunities for a helmet giveaway: Brain Injury Awareness Month in March, Texas Child Safety Month in April, and Bike Month in May.

Hosting a Hard Hats for Little Heads' event is easy and rewarding. TMA provides everything you need: helmets, event signage, promotional flyers, educational handouts, and media relations support. TMA encourages physicians, county medical societies, medical students, and TMA Alliance members to give free helmets to children in your community. 

TMA provides extra free helmets with your helmets purchase. Buy 50 helmets at our cost of $7.60 each, and we'll give you 50 helmets free. The Texas Pediatric Society (TPS) and the Texas Academy of Family Physicians (TAFP) support Hard Hats for Little Heads by purchasing up to 50 helmets for their members to host helmet giveaway events. TMA matches the purchase, so TAFP and TPS members can receive up to 100 helmets at no cost for their giveaways.

Thanks to everyone who sponsored an event in 2014, helping TMA give away a record 36,825 helmets at more than 200 events statewide. Take a look at where Hard Hats has been. If your county isn't represented, put it on the map this year. 

Check out these ideas for events and start planning your event now. To find out more, contact Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.

Hard Hats for Little Heads is made possible through a grant from the TMA Foundation thanks to top donors — Blue Cross and Blue Shield of Texas, Prudential, and two anonymous foundations — and gifts from physicians and their families.

Set It and Forget It

The TMA Foundation's (TMAF’s) Pulse Donor program makes your charitable contributions worry free.

"My monthly donation provides steady, dependable support, which enables the foundation to fund programs that reach more Texans each year in the most impactful way,” said Pulse Donor Gregory R. Johnson, MD, a member of the TMAF Board of Trustees. "It's also an easy way to demonstrate my commitment and support for much needed programs, such as TMA's Minority Scholarship Program and TMAF's General Endowment."

Pulse Donors like Dr. Johnson achieve their vision of a healthier Texas because their recurring giving strengthens TMAF's ability to both fund immediate health improvement programs and plan ahead for program expansions or new opportunities to improve the health of all Texans.

Making your charitable donation to TMAF is more convenient than ever as a Pulse Donor. All you need to decide is the amount of your gift, how frequently you would like it to recur, and which credit card to use. TMAF will send you a yearly statement, which is handy, as TMAF is a 501(c)(3) charitable organization and gifts are tax-deductible to the full extent of federal law. 

Pulse Donors are recognized in TMAF newsletters, annual posters on display at all TMA meetings, and on the TMAF website.

For more information or to become a Pulse Donor, contact TMAF at (800) 880-1300, ext. 1466, email Data Manager Marilyn Anderson, or visit the TMAF website.

Choosing Wisely CME from TMA

Due to the popularity of the Choosing Wisely continuing medical education (CME) webinars, TMA will continue to offer the CME bundle to members. 


Choosing Wisely® is an initiative of the ABIM Foundation that promotes conversations among physicians and patients to ensure delivery of the right care at the right time. 

The Choosing Wisely CME webinars were recorded at TexMed 2014, where TMA's Council on Health Care Quality led a continuing medical education track for physicians about the program. TMA, Choosing Wisely, the TMA Foundation, Blue Cross and Blue Shield of Texas, and TMF Health Quality Institute sponsored the CME quality track. 

The Choosing Wisely CME webinar bundle includes five webinars presented by Texas physicians: 

  • Webinar 1: The Choosing Wisely Campaign;
  • Webinar 2: Oncology and Choosing Wisely;
  • Webinar 3: Choosing Wisely Specialist Panel; 
  • Webinar 4: Choosing Wisely Panel Discussion; and
  • Webinar 5: Choosing Wisely — Patient Activation in Safety: Patient Safety Tools. 

Visit the TMA website to register for your CME and learn about the Choosing Wisely initiative and how it can help you. You can earn 3.75 AMA PRA Category 1 Credits™ and 3.75 ethics credits. In addition to the CME webinars, you'll find helpful resources provided by the Choosing Wisely campaign and TMA, such as the full list of recommendations, videos, patient education materials, and more.

The ABIM Foundation awarded TMA and its philanthropic arm, the TMA Foundation, a grant to advance the Choosing Wisely campaign among Texas physicians. Support for the grant comes from the Robert Wood Johnson Foundation.  

 PC Action Ad June 13

Register for This Summer's 3rd Annual Texas Primary Care and Health Home Summit

Join your colleagues from around Texas at the 2015 Texas Primary Care and Health Home Summit June 18-19 in San Antonio at the Marriott Plaza Hotel. This year's theme, Supporting the Quadruple Aim: The Triple Aim of High Value Patient Care and Provider Joy, focuses on emerging trends in primary care, including value-based contracting, building a successful accountable care organization, practices without walls, and direct primary care.

Other sessions offered include the elements of health homes, using data to improve care, best practices in care transitions and medication adherence, and engaging patients and families in their care. There will be additional break-out sessions on pediatric health homes.

Conference highlights include: 

  • The Opening keynote, "Revitalizing Primary Care: All Hands on Deck!" will be presented by Andrew Morris-Singer, MD, internist and primary care innovator.
  • James (Larry) Holly, MD, a true pioneer in the field of health/medical homes and electronic patient management, will speak on using data to improve care. Dr. Holly has guided the growth of Southeast Texas Medical Associates from one clinic in Beaumont in 1995 to six clinics today.
  • Paul Grundy, MD, founding president of the Patient-Centered Primary Care Collaborative and IBM's Director of Global Healthcare Transformation, will speak on "Primary Care: Where Are We and Where We Should Be Going" to close the conference. 

The conference is presented by the Texas Medical Home Initiative and the Texas Health Institute.

Registration will open Feb. 18. For more information or to register, go the Texas Health Institute summit website; you may read a draft agenda here

New Leadership, New Money, Familiar Issues

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 and

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, 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

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.

This Month in Texas Medicine

The Symposium on Mental Health in the February issue of Texas Medicine will increase all physicians' knowledge of the mental health care system in Texas and provide them with knowledge they can use to better address and manage mental health problems in their patients. Readers of the symposium can earn 2 AMA PRA Category 1 Credits™ (2 credits of education in medical ethics and/or professional responsibility).

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Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.

E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action.

 This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.   

Deadlines for Doctors   

TMA's Deadlines for Doctors alerts you and your staff to upcoming state and federal compliance timelines and offers information on key health policy issues that impact your practice.     

TMA Education Center

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online.  


Medicare 2015: Feb. 3-25
Hope in a Changing World: Feb. 27-28
ICD-10: Will You Just Survive, or Will You Thrive? March 3-26
Commit to Compliance: Meeting the Challenge: May 8

On-Demand Webinars

Prompt Pay and the Revenue Cycle
How to Talk to Patients About Tobacco Cessation
10 Ways to Turn Satisfied Patients Into Loyal Patients 

Conferences and Events

TexMed 2014
May 1-2

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at tmainfo[at]texmed[dot]org.

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Crystal Zuzek, Action editor.

Last Updated On

September 27, 2018