With roughly six weeks to go in the Texas Legislature, lawmakers near the finish line in drafting a state budget for the next two years with significant improvements over last session that march the House of Medicine closer to accomplishing its goals. With House and Senate committees in full swing as well, TMA is tracking a plethora of bills on the move that could help or hurt medicine's agenda.
"It's too early to determine bill outcomes. But there are some we like, some we don't, and some that are works in progress that we are pushing to good outcomes," TMA Vice President of Advocacy Darren Whitehurst said.
After a marathon session, the House approved its version of the state budget in April, wading through about 300 amendments. The Senate conversely approved its budget with no amendments earlier this week. The Senate and House will appoint conference committees to reconcile the differences between the two drafts.
Despite some gaps between the two versions, TMA lobbyist Michelle Romero says each has its own strengths that increase spending in key TMA priority areas, and the final budget likely will settle in medicine's favor.
The House and Senate budgets stand at roughly $210 billion for 2016-17, a nearly 2-percent increase over the current budget. House Bill 1 has more money for Medicaid and mental health; the Senate plan has more money for graduate medical education (GME) and women's health.
The Senate budget puts $41 million into GME expansions, versus the House's $28.6 million. The vehicle to put the GME expansion money into action, Senate Bill 18, by Senate Finance Committee Chair Jane Nelson (R-Flower Mound), passed the Senate and heads to the House. Rep. John Zerwas, MD (R-Richmond), is expected to pick it up and sponsor a House version. The House and Senate budgets also boost formula funding for medical schools' teaching costs and for primary care programs, albeit at varying levels.
In another preliminary win for medicine, the House Licensing and Administrative Procedures Committee passed a stand-alone bill by Rep. Drew Darby (R-San Angelo), House Bill 2089, to eliminate the $200-a-year occupations tax on physicians and other Texas professions. The measure was also folded into a separate bill, House Bill 7, which seeks to eliminate a number of budget gimmicks and ensure that dedicated funds are used for their intended purposes.
The Senate budget does not, however, include the $460 million rider in the House to increase primary care physicians' Medicaid payments to Medicare rates. But Ms. Romero is optimistic there is opportunity to retain the money in the final version, and says, "In totality, both budgets do more for our issues over last session."
Lawmakers took one step closer to holding Medicaid HMOs more accountable for their network adequacy when Senate Bill 760 by Charles Schwertner, MD (R-Georgetown), cleared the Senate and heads to the House.
Senator Juan "Chuy" Hinojosa's (D-McAllen) Senate Bill 207, which heads to a vote before the full Senate, sets clearer standards for Medicaid fraud investigations by the Office of Inspector General. It clarifies that a "credible allegation of fraud" does not include unintentional technical or clerical errors and requires "probable cause" for payment holds.
Ms. Romero says, "It's a better standard that clarifies things for all parties involved: providers, the state, and SOAH (State Office of Administrative Hearings)," which oversees these cases.
But the red tape for physicians doesn't stop with the Medicaid program, and legislation to help physicians improve overall practice efficiency is moving along.
The House is poised to take action on Senate Bill 195 (by Senator Schwertner) after the Senate approved the move to shift the Prescription Drug Monitoring Program to the Texas State Board of Pharmacy from the Department of Public Safety (DPS). TMA also won a provision in the bill to eliminate the state Controlled Substances Registration permit physicians must get — in addition to their Drug Enforcement Administration license — to prescribe. Ongoing hang-ups in the state process — handled by DPS — have cost many physicians a temporary suspension of their hospital and prescribing privileges.
House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), would help clear up some hassles for physicians dealing with health plans sold in the Affordable Care Act exchange. House Insurance Committee members took up the bill to require health plans to clearly identify exchange plans on members' identification cards with the letters "QHP" and whether that coverage is subsidized with the letters "QHPS." 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.
Consumer groups consider the labeling discriminatory toward patients of certain financial means. But TMA lobbyist Patricia Kolodzey says it's no different than patients carrying a card differentiating Medicaid coverage, and HB 1514 would do nothing to disclose patients' income status. Rather, the bill reduces the administrative burden on physician practices to discern patients' coverage, she says, and allows physicians to communicate with patients about the importance of paying their premiums and to plan treatment accordingly, particularly long-term treatment.
TMA also supports House Bill 1624 by Rep. John Smithee (R-Amarillo) to require health plans to publicly display their network directories and drug formularies on their websites for physicians and patients to check.
"The Flood Gates Are Open"
With committee hearings fully under way, "the flood gates have opened," as TMA lobbyist Dan Finch puts it, and TMA continues to pour over bill filings, amendments, substitutions, and testimony that could undermine medicine's agenda.
As House Insurance Committee hearings went into the wee hours of the morning, TMA physicians testified against an attempt to ban balance billing for emergency care under House Bill 1638 (by Representative Smithee). As filed, the bill would send physicians and health plans to arbitration over costs not covered under patients' insurance. A battle is under way, too, to preserve existing avenues available to patients to resolve billing disputes through mediation. House Bill 3133 (also by Representative Smithee) eliminates the current $1,000 threshold for patients to take balance bills from facility-based physicians to mediation, which could make the process costly for physicians.
TMA physicians testified against any prohibition on balance billing for out-of-network services and emphasized that patients must continue to be the initiators of any requested mediation.
TMA also opposed House Bill 3102 by Rep. John Frullo (R-Lubbock), which, as filed, requires physicians to adhere to a binding quote provided three days in advance of any services and forfeit any additional amounts doctors incur for unanticipated services.
At hearings, Representatives Smithee and Frullo both indicated their bills were a work in progress, Ms. Kolodzey says, and substitute bills were forthcoming. Stay tuned!
That same committee also took up two telemedicine bills — one good for medicine, one bad.
Raising alarm bells, House Bill 2172 (by Representative Smithee) would skirt current Texas Medical Board regulations and permit physicians to diagnose over the telephone without an initial face-to-face visit to establish a patient-physician relationship. On the other hand, TMA is backing a measure — House Bill 2348 by Rep. Four Price (R-Amarillo) — to ensure physicians get paid fairly for services like after-hours phone or telemedical consults by requiring health plans to pay local doctors the same as they would if hiring outside telemedicine vendors for those services.
On the scope-of-practice front, TMA continues to put out fires.
The House Public Health Committee took up House Bill 1263 by Rep. Richard Raymond (D-Laredo) allowing physical therapists to directly treat patients without first seeking a diagnosis and referral from a physician. Also on the committee agenda, House Bill 2602 by Rep. Garnet Coleman (D-Houston) would allow optometrists, advanced practice registered nurses, and physician assistants more leeway to prescribe Schedule 2 drugs under delegation by a physician.
Progress on Public Health
Meanwhile, medicine saw progress on a couple of packages of TMA-backed legislation on public health and end-of-life issues.
The House Public Health Committee voted out a pair of vaccination bills by Representative Sheffield. One changes requirements under the state's immunization registry, ImmTrac, to store childhood vaccination records until age 26 instead of age 18 and ensure they are available past college and into early adulthood. A second bill gives parents the right to know the number of students in their child's school who have opted out of vaccinations.
TMA worked to improve bill language before the Senate's approval of Senator Schwertner's bill, Senate Bill 538, to overhaul and coordinate local and state management of infectious disease emergencies. The Senate Education Committee, meanwhile, approved Senator Hinojosa's bill, Senate Bill 66, requiring schools to stock auto-injectors in schools. At press time, a House hearing was not far behind.
Hearings got under way on legislation tackling end-of-life issues debated for many a session.
As TMA keeps an eye out for threats to physicians' moral conscience and professional ethics, a pair of bills medicine supports got airtime before the House State Affairs Committee: House Bill 2351 by Rep. Patricia Harless (R-Spring) would require hospital ethics committees to adopt a nondiscrimination policy, and House Bill 3074 by Rep. Drew Springer (R-Muenster) classifies artificial nutrition and hydration as ordinary, not extraordinary, care.
Even though the legislature is picking up speed, it's not too late to keep up through the TMA Legislative News Hotline or to make a final push for medicine in person at TMA's First Tuesdays at the Capitol. The last lobbying event is May 5. Register now!
Amy Lynn Sorrel, associate editor of Texas Medicine, prepared this special supplement to Action.
Action, April 15, 2015