Action: June 1, 2015

 TMA Action June 1, 2015   News and Insights from Texas Medical Association

 Medicine (Mostly) Wins Big in 2015 Legislature
TMB Resource Helps Clarify New Telemedicine Rules
Meaningful Use Hardship Exemption Portal Now Open
New TMA Membership Perk Offers HIPAA Security Compliance Help
Texas Expands Newborn Screening Program
HHSC Launches Policy Feedback Webpage
DSHS Issues Mumps Health Advisory
Consider West Nile Virus
Makena Added to Medicaid, CHIP Formulary Starting June 15
Apply for the TMA Leadership College by July 1
Protect Your Community: Apply for a TMA Vaccination Grant
Help Patients Prepare for Emergencies, Disasters
This Month in Texas Medicine  

Medicine (Mostly) Wins Big in 2015 Legislature

Medicine's advocates walk away from the 2015 Texas Legislature, which ends today, with heads held high. The physicians who contacted their representatives and senators, the dozens who testified before committees, the hundreds who took part in First Tuesdays at the Capitol, and the staff at TMA, county medical societies, and state specialty societies all played important roles.

Physicians won relief from a major practice hassle, big increases in graduate medical education (GME) funding, important changes in Medicaid operations, health insurance reforms, and significant victories in the public health and mental health arenas. Unfortunately, efforts to boost Medicaid payment rates and some other pieces of TMA’s Healthy Vision 2020 plan came up short.

Among the most important victories: 

  • Funding to expand GME slots received a $40 million boost.
  • Texas' Controlled Substances Registration permit will be eliminated as of Sept. 1, 2016.
  • Absolutely none of the proposed dangerous expansions of nonphysician practitioners' scope of practice passed.
  • Two priorities of TMA's Behavioral Health Task Force passed. 
  • E-cigarette sales to minors were outlawed.
  • Physicians' annual $200 occupation tax was repealed.  

TMA stopped several bills that would have banned balance billing for out-of-network services.

On the negative side, the bill banning texting while driving died in the Texas Senate. TMA's bill prohibiting health plans' use of virtual credit cards to pay for health care services didn't make it through the House, and a measure allowing the use of low-THC cannabinoid oil seems likely to get Gov. Greg Abbott's signature.

For more details, look for a special issue of Action later this week and a full wrap-up of the legislative session in the August issue of Texas Medicine.

TMB Resource Helps Clarify New Telemedicine Rules

The Texas Medical Board (TMB) adopted rules April 10 concerning telemedicine and requirements for prescribing drugs and controlled substances. Since then, there has been some confusion regarding the impact of the new rules.

TMB has created a document titled TMB Adopts Rules Expanding Telemedicine Opportunities that outlines the types of telemedicine permitted under the board’s rules, including the use of telemedicine to provide services in remote areas with the assistance of a patient site presenter, such as a licensed vocational nurse or medical assistant. The rules also allow for circumstances in which a site presenter is not required to provide telemedicine services.

The TMB document states, "[t]he rules expand opportunities for patients to interact with their physicians beyond the traditional office visit and clarify that a physician-patient relationship can be established through a 'face-to-face' visit held either in person or via telemedicine. Essentially the only scenario prohibited in Texas is one in which a physician treats an unknown patient using telemedicine, without any objective diagnostic data, and no ability to follow up with the patient."

The TMB document clarifies the new rules do not: 

  • Limit a patient to an in-person visit to establish a physician-patient relationship before receiving treatment; the relationship can also be established via appropriate face-to-face telemedicine.
  • Change traditional on-call coverage used by many physician offices. Physicians, who are in the same medical specialty and provide reciprocal services, may provide on-call telemedicine medical services for each other's active patients.
  • Severely restrict the types of telemedicine scenarios authorized in Texas. The rules expand the scenarios already allowed to include greater access to treatment from a patient's home and greater access to treatment for behavioral and mental health.

According to the rules, physicians may see a patient via telemedicine for the first time — without a prior in-person visit — if the patient is at a location that allows a physician to adequately examine and communicate with the patient in real time with the assistance of technology and a patient site presenter. The new telemedicine rules also permit mental health services to be provided at a patient's home, including residential treatment facilities, nursing homes, jails, detention centers, and assisted living centers, through real-time audio and video technology.

As stated in a recent TMB press release, a rule summary is expected be published in the Texas Register, and the new rules are scheduled to go into effect June 3, 2015.

Meaningful Use Hardship Exemption Portal Now Open

Physicians who didn't meet meaningful use of electronic health records (EHRs) in 2014 will face a 2-percent penalty in 2016. If you think you are eligible for a 2016 exemption, you must file your exemption request by July 1, 2015. 

The hardship exception applications and instructions for an individual and for multiple Medicare physicians are available on the EHR Incentive Programs website. They outline how to apply and specify the types of circumstances the Centers for Medicare & Medicaid Services (CMS) considers to be barriers to achieving meaningful use.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control;
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use; and
  • Provide supporting documentation for certain hardship exception categories. CMS will review applications to determine whether a hardship exception should be granted. 

You do not need to submit a hardship application if you are: 

  • A newly practicing eligible professional;
  • A hospital-based practitioner who provides more than 90 percent of covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and provides certain observation services using Place of Service 22; or
  • An eligible professional with certain Provider Enrollment, Chain, and Ownership System (PECOS) specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, or 94-Interventional Radiology). 

CMS will use Medicare data to determine your eligibility to be granted a hardship exception automatically. 

Apply by July 1. The application must be submitted electronically or postmarked no later than 11:59 pm ET on July 1, 2015, to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, you must submit a new application for the appropriate year.

Review TMA's one-pager on meaningful use penalties and exemptions. For questions about the meaningful use program and other office technologies, contact TMA's Health Information Technology Department at (800) 880-5720 or by email

In May, the TMA House of Delegates adopted policy directing the association to "urge our congressional delegation to advocate repeal of compulsory electronic health records." The Texas delegation is taking a resolution to next week's meeting of the American Medical Association House of Delegates calling on AMA to "advocate that the U.S. Congress act rapidly to repeal compulsory electronic health records by (1) eliminating all penalties for nonparticipation in the Medicare EHR Incentive Program and (2) eliminating all MIPS [Merit-Based Incentive Payment System] penalties related to noncompliance with meaningful use criteria."

New TMA Membership Perk Offers HIPAA Security Compliance Help

Even though the HIPAA Omnibus Rule passed more than two years ago, HIPAA security compliance remains a top issue and concern for TMA members. To help, TMA Practice Consulting is now offering members discounted access to a new tool that can assist with HIPAA security compliance issues. 

The Online HIPAA Security Manager is now available to TMA members at a group member discount starting at $99 per month. The tool offers HIPAA risk analysis, access to HIPAA experts who identify deficiencies and make recommendations, a dashboard to see risks to security and compliance, automatic documentation of HIPAA activities, online training, and more. For a complete overview of the tool's capabilities, visit the Online HIPAA Security Manager information page.  

The Online HIPAA Security Manager is just one of many discounted services offered through TMA's group discount program. Discounts offered through this program allow you to leverage your membership in the largest state medical association in the country. Available only to TMA members, these programs are an excellent value that can help you save money on products and services you use every day in your practice or in your home.

TMLT Action Ad 4.13   

Texas Expands Newborn Screening Program

The Texas Department of State Health Services (DSHS) formally began screening all babies born in Texas for 24 additional health conditions that can cause serious problems like developmental delays, major illness, or even death.

The addition of the secondary newborn screening conditions means all Texas babies are now screened for 53 rare disorders through a blood test analyzed at the state's public health laboratory in Austin. Hospitals or birthing centers also screen newborns in Texas for hearing loss and critical congenital heart defects.

"Newborn screening in Texas started in 1963 as a small pilot program for just one disorder, PKU [phenylketonuria]," said Susan Tanksley, DSHS laboratory operations manager. "Expanding the program to more than 50 conditions means more babies can receive immediate follow-up, leading to a quick diagnosis and the ability to offer babies lifesaving treatment. Many babies will lead normal lives with early treatment."

The Texas Newborn Screening Program has detected many of the secondary conditions because they share the same substances in the blood as some of the primary newborn screening conditions. The changes, however, will allow for more complete identification, follow-up, and treatment of those conditions and six others that were previously undetectable. Some children diagnosed with secondary conditions will be able to access newborn screening benefits through a DSHS program that provides services for children identified with a newborn screening disorder.

House Bill 1795 prompted the change. The bill, which passed the 2009 legislature, directed DSHS to add the conditions as funding allows. DSHS has determined that it can conduct the additional screenings within its current budget.

Texas operates the largest newborn screening program in the nation, testing approximately 775,000 specimens, or nearly 400,000 babies, annually. The newborn screening tests are done on a blood sample drawn by a simple heel stick within 48 hours of birth and again at one to two weeks of age. The screenings added with the secondary panel will not require any more blood to be drawn. Since 1963, Texas has detected about 13,000 cases of genetic and congenital disorders in babies.

HHSC Launches Policy Feedback Webpage

The Texas Health and Human Services Commission (HHSC) has a new webpage that features a list of proposed Medicaid policy changes. 

Via the webpage, physicians and other medical practitioners, program clients, and the general public can give HHSC direct feedback regarding new medical and dental policies or changes to existing policies.

After reviewing proposed policies or proposed changes to an existing policy, you can email feedback to HHSC.

DSHS Issues Mumps Health Advisory

Two students attending The University of Texas at Austin were diagnosed with mumps last month. The Texas Department of State Health Services (DSHS) issued a health advisory over concern there may be mumps cases appearing in other parts of the state. The advisory encourages physicians to "consider mumps as a diagnosis for any patients presenting with parotitis, orchitis, or other unexplained glandular swelling."

DSHS says a negative immunoglobulin M result does not rule out mumps infection in vaccinated people. Mumps testing is widely available commercially and through the DSHS Laboratory

The DSHS health advisory specifies that in Texas, suspicion of mumps must be reported. Mumps reports should be made to your local health department or by calling (800) 705-8868.

The incubation period for mumps can be as long as 25 days, but DSHS says it is typically 14 to 18 days. The advisory states that people with mumps are infectious three days before to four days after the onset of parotitis. Infected people without mumps symptoms may still be able to transmit the virus, the advisory warns.

TMAIT Action Ad 6.15    

Consider West Nile Virus

The Committee on Infectious Diseases encourages physicians to be prepared for cases of West Nile virus (WNV) in patients. WNV infection in one patient has already been confirmed this season in Harris County, and recent heavy rains throughout the state could make mosquito populations increase.

Most patients with WNV infections are asymptomatic or have mild febrile illness (that often includes headache, myalgia or arthralgia, gastrointestinal symptoms, and a transient maculopapular rash). Some individuals can develop serious neuroinvasive disease. People older than 50 and those with other medical conditions are at higher risk of becoming seriously ill if infected. 

Additional information about WNV is available from the Centers for Disease Control and Prevention (CDC) website or the Texas Department of States Health Services (DSHS) website.

Testing and Reporting

Testing for many arboviruses, including WNV, is available through most commercial labs, the DSHS Laboratory, and CDC. Arbovirus infections, including WNV, must be reported to your local public health authority within one week after identification of a suspected case. Visit the DSHS website for contact information, including regional zoonosis control offices and laboratory services.

Patient Education

Remind your patients they can take simple steps in preventing WNV this spring and summer by following the four D's:  

  • DEET: Use insect repellent when going outside. Approved repellents contain DEET, picaridin, or oil of lemon eucalyptus.
  • Dress: Wear long sleeves and pants when you are outside. 
  • Dusk to Dawn: Limit time outside and take extra care to use protective clothing and repellent from dusk to dawn. 
  • Drain: Empty standing water regularly.  

Share this sign featuring these key messages with patients, and consider posting it in your office.

Makena Added to Medicaid, CHIP Formulary Starting June 15

Starting June 15, Makena, the brand name version of 17P or hydroxyprogesterone caproate, will be on the Texas Health and Human Services Commission (HHSC) Medicaid and Children's Health Insurance Program formulary. Makena will be available in a 120 mg/5 mL dosage as both a medical and pharmacy benefit. HHSC's Vendor Drug Program implemented Makena as a Medicaid pharmacy benefit in an effort to help reduce preterm births by expanding access to the drug.

Makena and the compounded version of 17P will continue to be available as Medicaid medical benefits. As a pharmacy benefit, Makena will require a clinical prior authorization for fee-for-service. Health plans may elect to require a clinical prior authorization. Contact the health plan for specific requirements. 

The rates and fee schedule will not change at this time. The addition of Makena will be reflected in the daily formulary file on June 10, and health plans are expected to adjudicate claims with this drug by June 15. 

For additional information and health plan guidance, visit the Vendor Drug Program website.

For additional information about the medical benefit, visit the Texas Medicaid & Healthcare Partnership (TMHP) website, or call the TMHP Contact Center at (800) 925-9126

HHSC says physicians should encourage patients to use Lumara Health's My Adherence Program, designed to facilitate improved patient compliance with Makena therapy. Each expecting mother who has been prescribed Makena and enrolls (at no additional cost) in My Adherence Program will be paired with a dedicated maternal health nursing specialist who will encourage adherence to the weekly Makena injections, identify barriers, and potentially provide solutions to overcome any problems that may arise during treatment. Call (844) 660-0867 for more information about the My Adherence Program.

Apply for the TMA Leadership College by July 1

TMA is now accepting applications for the TMA Leadership College Class of 2016. The deadline to apply is July 1.

The TMA Leadership College, established in 2010 as part of TMA's effort to ensure strong and sustainable physician leadership within organized medicine, is geared toward active TMA members younger than 40 or who are in the first eight years of practice.

Graduates serve as thought leaders who can close the divide between clinicians and health care policymakers and as trusted leaders within their local communities. Many also receive priority consideration for appointment to TMA councils and committees.

Visit the TMA webpage for full program details, a class schedule, and application.

For more information, contact Christina Shepherd in the TMA Membership Development Department by email or by calling (800) 880-1300, ext. 1443, or (512) 370-1443.

PC Action Ad Nov 13  

Protect Your Community: Apply for a TMA Vaccination Grant

Help protect your community from flu, whooping cough, or other vaccine-preventable diseases with a TMA Be Wise — ImmunizeSM event. To encourage local vaccination events, TMA offers grants of up to $2,500 to TMA members, county medical societies, TMA Alliance chapters, and medical student chapters. Grant applications are due July 1. 

In March, TMA awarded eight local impact grants for events to provide back-to-school, meningococcal, and flu vaccinations. Since 2012, TMA has awarded nearly $74,000 to ensure Texans who are uninsured or underinsured, or who face other obstacles, receive needed vaccinations.

To plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide. If you have questions, contact Tammy Wishard, TMA's outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.

TMA actively works to improve vaccination rates in Texas through its Be Wise — Immunize program. More than 277,000 shots have been given to Texas children, adolescents, and adults since the program began in 2004. 

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.

Help Patients Prepare for Emergencies, Disasters

Physicians can play a significant role in helping patients prepare and respond to disaster situations. Patients, especially those with fragile health, should be counseled on the importance of having a disaster plan in place for themselves and their families. 

In addition, physicians can help their patients prepare by:

This Month in Texas Medicine 


The June issue of Texas Medicine features a cover story on Congress' permanent and immediate repeal of the flawed Sustainable Growth Rate (SGR) formula used for years to pay physicians who see Medicare patients. In the issue, you’ll also find the latest on litigation over the ownership of Knapp Medical Center in Weslaco, information about an initiative aimed at preventing 1 million heart attacks and strokes by 2017, findings from a report that reveals the toll gestational diabetes takes on the state's Medicaid recipients, and vendor contract guidance for physicians in private practice. 

Click to launch the full edition in a new window.

Texas Medicine RSS Feed

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.  

ICD-10 Implementation Compliance   

First-Year Participants' Last Day to Begin 90-day Reporting Period of Meaningful Use for the 2015 Medicare and Medicaid EHR Incentive Programs

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.  

On-Demand Webinars

 Achieving ICD-10 Implementation Success    
ICD-10 Documentation and Auditing: Success Is in the Details
ICD-10 Starts With Physicians 

Conferences and Events

TMA Fall Conference
Sept. 25-26

About Action       

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

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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

February 02, 2017