Testimony of Louis Appel, MD
House Human Service Committee
House Bill 2304
Monday, April 27, 2015
Submitted on behalf of: Texas Medical Association, Texas Pediatric Society, Texas Academy of Family Physicians, Texas Association of Obstetricians and Gynecologists, the American Congress of Obstetricians and Gynecologists-Texas Chapter and Federation of Texas Psychiatry
On behalf of the above named medical societies, thank you for the opportunity to provide input on legislation relating to the sunset of the Health and Human Service Commission.
Over the past 18 months, the Sunset Advisory Commission performed a remarkably thorough review of the agency. The Sunset report to the legislature included numerous recommendations championed by our organizations, including proposals to streamline the Medicaid application and credentialing processes; undertake new initiatives to improve health care quality; and consolidate HHSC and OIG audits of Medicaid managed care plans to reduce duplication and administrative costs on health plans and physicians in their networks
Comments on Committee House Bill 2304
During the Sunset review process, our organizations remained neutral on the proposal to further consolidate the five health and human services agencies. As such, our testimony is ON HB2304. That being said, we strongly support delaying the merger of the Department of State Health Services and Department of Family and Protective Services into the Health and Human Services system until 2019. By its very nature, consolidation is a disruptive process. DSHS and DFPS perform unique functions within the current HHS enterprise. Having more time to integrate these agencies into the new overall structure will ensure there is sufficient stakeholder input into reforms while also avoiding unintended harm to the state’s public health system and the state’s child and adult protective service operations.
We also strongly support several provisions within the bill, among them:
- Section 2.09, Sec. 531.02118, Streamlining Medicaid Provider Enrollment and Credentialing Processes, which reflects our call to reduce Medicaid’s administrative complexity and costs for physicians and other providers;
- Section 2.12, specifying that the OIG shall consult with the HHSC executive commissioner on its jurisdiction over and frequency of audits of Medicaid HMOs and coordinate its activities with HHSC so as to reduce duplication of activities; and
- Section 2.13, Sec. 531.1032, Office of the Inspector General, Criminal History Record Information Check, prohibiting the OIG from conducting criminal history checks on physicians who it has confirmed are in good standing with the Texas Medical Board.
To further strengthen HB2304, we suggest the following amendments:
Relating to stakeholder input:
We strongly support language in the bill specifying that the HHSC commissioner “shall establish and maintain” advisory committees to solicit stakeholder input on a broad range of topics related to the delivery of health and human services. However, the bill does not specify whether or how HHSC will obtain input as to which committees should be established and when. We recommend that HB2304 be amended to specify the process for establishing and abolishing committees, including obtaining stakeholder input on the committees to be established.
Relating to the timeframe for the OIG to make a determination regarding whether an application will be excluded.
Our concern is that the bill provides 10 days for the OIG to determine whether an applicant will be excluded from Medicaid rather than a determination of whether the applicant will be excluded or granted full or limited participation status. We recommend the following:
Sec. 531.1034. TIME TO DETERMINE PROVIDER ELIGIBILITY; PERFORMANCE METRICS. (a) Not later than the 10th day after the date the office receives the complete application of a health care professional seeking to participate in the Medicaid program, the office shall inform the commission or the health care professional, as appropriate, of the office’s determination regarding whether the health care professional should be excluded from participating in the Medicaid program or granted full or limited participation status in the Medicaid program based on: (1) information concerning the licensing status of the health care professional obtained as described by Section 531.1032(a); (2) information contained in the criminal history record information check that is evaluated in accordance with guidelines adopted under Section 531.1032(c); (3) a review of federal databases under Section 531.1033; (4) the pendency of an open investigation by the office; or (5) any other reason the office determines.
Relating to the composition of the Drug Utilization Review (DUR) Board.
State Medicaid programs are required to establish a DUR Board with a roughly equal number of physicians and pharmacists with expertise in prescribing or dispensing outpatient drugs and utilization review. Federal regulations do not stipulate the types of specialties that should be included on the board. HB2304 directs the HHSC executive commissioner to appoint the board in compliance with federal law and to include two representatives of Medicaid HMOs. We do not quibble with the addition of Medicaid HMO representatives, which we believe will provide valuable perspective to the DUR board given that some 80 percent of Medicaid enrollees are now enrolled in managed care. However, it is critically important that the legislature establish guidelines to ensure the DUR board includes physicians that represent Medicaid program’s diverse populations and health care needs. The vast majority of Medicaid enrollees are women and children. All Medicaid HMOs enrollees must select a primary care physician to coordinate their care. As such, we ask that HHSC be directed to specifically include on the board physicians representing pediatrics, obstetrics and gynecology, and primary care. Also, given the prevalence of mental illness and substance abuse within the overall Medicaid population, we strongly support inclusion of a pediatric and adult psychiatrist on the board. We also support adding one consumer representative to the new board.
(c) The executive commissioner shall determine the composition of the board, which must:
(1) comply with applicable federal law, including 42 C.F.R. Section 456.716; and
(2) include two representatives of managed care organizations as nonvoting members, one of whom must be a physician, and one of whom must be a pharmacist;
(3) include at least 17 physicians and pharmacists who:
(A) provide services across the entire population of Medicaid recipients and represent different specialties, including at least one of each of the following types of physicians:
(i) a pediatrician;
(ii) a primary care physician;
(iii) an obstetrician and gynecologist;
(iv) a child and adolescent psychiatrist; and
(v) an adult psychiatrist; and
(B) have experience in either developing or practicing under a preferred drug list; and
(4) include a consumer advocate who represents Medicaid recipients.
Thank you for your consideration.