TMA's 2015 Legislative Victories Build on Past Achievements
Cover Story — August 2015
Tex Med. 2015;111(8):24-42.
By Amy Lynn Sorrel
In a 2015 legislative session marked by new state leaders, new money, and big shifts in how Texas' major health care agencies oversee care delivery, the House of Medicine remained as steady as ever in its mission to ensure physicians can give their patients the best care possible. That resolve paid off in significant victories that build on the Texas Medical Association's 2013 legislative successes.
Graduate medical education (GME) expansion is a prime example, says TMA Immediate Past President Austin I. King, MD. The issue was medicine's top priority in 2015, and thanks to years of advocacy, it was top of mind for lawmakers, too, for the second legislative session in a row.
"We pushed for it, and we got it done. Everything else is secondary. You can talk about the many different ways of delivering medical care. But if you don't have the physicians to do it, it's moot," Dr. King said.
After increasing GME funding levels in 2013, the Texas Legislature infused another $40 million into expanding residency training this session, which could help create 200 or more new positions for medical school graduates on their way to becoming physicians in the nation's fastest-growing state.
TMA and Texas medical schools lit the fire last session, building relationships with and convincing leaders like former Senate Finance Committee Chair Sen. Tommy Williams (R-The Woodlands), who understood that without boosting funding, "we would not be able to keep our students here to be trained and would lose them to other states," Dr. King said.
Sen. Jane Nelson (R-Flower Mound), who took over this session as head of the Senate Finance Committee, and House Higher Education Chair Rep. John Zerwas, MD (R-Richmond), carried the GME torch, making it a priority for the 2016-17 budget and pushing for a bill that will turn the new money into another host of expansion programs.
That kind of commitment, Dr. King says, "is a win for everyone: physicians, our patients, and the state of Texas."
Grassroots Advocacy Pays Off
As this article went to press, a majority of TMA's priority bills either became law or were on their way to Gov. Greg Abbott's desk for signature following House and Senate approval. Important milestones for Texas physicians include:
- Another significant expansion of GME funding and resident training positions and more money for women's health and mental health services;
- Fairer rules governing Medicaid fraud investigations;
- Red-tape reductions, including the elimination of the Department of Public Safety (DPS) controlled substances registration (CSR) permit;
- First-ever regulation of e-cigarettes; and
- A tax break for all licensed physicians.
Key to medicine's success, TMA leaders say, were the relationships physicians built in their hometowns with new and familiar faces in the legislature, bolstered by hundreds of doctors, medical students, and TMA Alliance members who lobbied and testified at the Capitol throughout the session.
TMA Council on Legislation Chair Ray Callas, MD, says those grassroots efforts started when TEXPAC, the association's political arm, went to bat early in one of the most significant election seasons in decades, marked by the departure of Gov. Rick Perry and big turnover at the Capitol and in statewide offices. TEXPAC emerged strong, winning and preserving key seats held by physicians, TMA Alliance members, and other pro-medicine candidates.
Thanks to that groundwork, the many new faces in the legislature and in state leadership were knowledgeable of medicine's issues and kept an open door, says Dr. Callas, a Beaumont anesthesiologist. And even though not all of TMA's bills made it to the finish line, medicine did not lose ground.
With tax cuts threatening TMA's budget priorities, more than 70 dangerous scope-of-practice bills filed, and end-of-life debates resurfacing, "we knew we had some obstacles to face," Dr. Callas said. "But our mind-set going in was we felt very strongly we were committed to doing whatever we had to do to protect the practice of medicine for our patients. Our biggest win was making sure the practice of medicine is still sacred."
An effort to add a pathway for expedited physician licensing did not survive, but TMA kept a slew of scope-of-practice expansions from seeing daylight and successfully warded off attempts to erode state telemedicine rules requiring a physician-patient relationship. TMA negotiated an end-of-life compromise bill, while preserving physicians' ability to protect their patients and exercise their professional ethics. A statewide texting ban failed another session but so did a balance-billing ban, thanks also to a TMA-negotiated compromise.
The biggest disappointments: Despite the House's advancement of a measure to continue paying select primary care physicians at rates that match Medicare per the Affordable Care Act, the plan dissipated in the final weeks of the session in favor of shifting the funds into sweeping tax cuts. ACA increased Medicaid primary care payments to Medicare rates for two years using federal funds, but the pay bump expired Dec. 31, 2014.
And while more money went to mental health services, Governor Abbott vetoed a measure allowing emergency physicians to protect patients with mental illness who pose a danger to self or others.
TMA President Tom Garcia, MD, called the two decisions "troublesome. But we will continue to fight." Goals like Medicaid parity may take longer than expected to achieve, but he says that does not mean they are out of reach.
Still, overall, Dr. Garcia says, "We did a heck of a lot of good this session, and there's no question the grassroots [physician effort] is what helped us. If we did all this with just 10 percent of TMA members in TEXPAC, imagine what we could do with 100 percent."
GME Boost, Tax Cuts for All
Tax cuts were a major priority for Governor Abbott and House and Senate leaders and largely drove budget negotiations. Meanwhile, the sunset review process — which the legislature uses to regularly evaluate the performance of state agencies, this time, health agencies — steered a number of health care policy decisions. TMA staff continue to pour over extensive bills to overhaul the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Despite the constitutional spending limit, lawmakers had an $8 billion surplus to spend, made possible by a steady upswing in sales and oil and gas tax revenues. About half of the surplus ultimately went into a $3.8 billion comprehensive tax relief package; the other half was interspersed among education, health care, transportation, and border security needs.
Other than losing the Medicaid-Medicare parity increase, TMA officials say the tax relief package did not cut into medicine's budget priorities. As it went to the governor's desk, House Bill 1 spends roughly $210 billion in state and federal money. The 2016-17 budget represents a 6.6-percent increase over 2014-15 spending levels, with "growth in all of TMA's priorities," TMA Lobbyist Michelle Romero said.
Among the recommendations TMA supported:
- $53 million for GME expansion grants, roughly $40 million above 2014-15 funding;
- An additional $50 million for women's health services;
- An $80 million increase in mental health and substance abuse funding; and
- $20 million dedicated to infectious disease surveillance.
Senator Nelson championed GME expansion from the outset, culminating in her sponsorship of Senate Bill 18, along with Representative Zerwas. TMA had a big hand in crafting the legislation, which serves as the major vehicle for the $53 million dedicated to expanding first-year residency slots in the 2016-17 biennium, and helping to reach the TMA and Texas Higher Education Coordinating Board's goal of 1.1 entry-level GME slots per medical school graduate.
Programs can use the money to establish new first-year positions; maintain previously unfilled slots; continue positions started with 2014-15 grant funding; or plan brand-new programs. The legislation also streamlines existing grant programs and ensures more sustainable funding mechanisms, including the establishment of a permanent fund devoted to GME. (See "Room to Grow," May 2015 Texas Medicine, pages 45-50.)
Tennessee Bailey just finished her second year as a medical student at The University of Texas Health Science Center in San Antonio and is "very excited" the new GME money offers her a greater chance of staying in Texas to practice geriatrics — or obstetrics and gynecology, or emergency medicine. "I'm waiting for my third year to elucidate that."
But she's still "nervous" for the graduating classes behind her, now that Texas is building three to six new medical schools. And Texas still ranks low — 43rd out of 50 states — for physician–to-patient ratios.
"Texas has a booming economy, a big population influx, and a lot of new people who are just getting introduced to insurance" through the ACA exchange, Ms. Bailey said. "This is a wonderful preliminary step. But to put in four years of medical school and not have an opportunity to finish our training would be devastating."
The legislature also made a boost to undergraduate medical education funding. (See "Medical Education Wins Big.")
Physicians also came out winners of a $200 annual tax cut, thanks to House Bill 7 by Drew Darby (R-San Angelo) and Sen. Kevin Eltife (R-Tyler). The bill eliminates the annual occupational tax paid by physicians and a dozen other professions.
Senator Nelson and Rep. Dennis Bonnen (R-Angleton) led the fight for an overall tax relief package to cut the state franchise tax rate by 15 percent and, subject to voter approval, provide property tax relief. Physicians also could benefit from a separate measure, Senate Bill 8, allowing businesses with total revenue of $4 million or less to qualify for exemptions from the state franchise tax.
Medicaid-Medicare Parity Fizzles; Reforms Advance
On the other hand, TMA Vice President for Advocacy Darren Whitehurst expressed extreme disappointment with the decision against reinstating the Medicaid-Medicare parity payments for primary care. The pay raise — originally funded by the federal government in 2013 and 2014 — led to a 5-percent bump in physician Medicaid participation "and keeps us from losing doctors in places we can least afford to lose them," he said.
Governor Abbott and other state leaders announced at the outset of the 2015 legislative session that any kind of Medicaid expansion prescribed by the federal government was a nonstarter.
With health care consistently consuming a third or more of the state budget — and for the first time surpassing education in the 2016-17 budget — Mr. Whitehurst said, "Past legislatures have been equally reluctant to do anything proactive on Medicaid. But we are quickly headed toward crisis if we don't do anything. This [decision] is reflective of work we are going to have to do in the interim to recalibrate the Medicaid program and engage state leadership."
Representative Zerwas says he counts the boost to GME and mental health funding "as a real success. But I do think we passed up some opportunities to deal with Medicaid payment rate issues for physicians."
The 2013 legislative session "put the spotlight on the whole GME issue and was an important part of where we are. We also continued to build on the substantial investments from last session in mental health. And that will go a long way," he said. "But we also have to systematically look at how we deliver mental health care services. That didn't get as much attention this time around, and it's something we need to continue to look at very seriously."
Representative Zerwas says the $460 million Medicaid pay increase "was a big number" that caused consternation among some legislative members. But he also called it "bothersome" that in the final hours of the budget negotiations, conferees still put roughly $300 million into enhancing hospital Medicaid payment rates "without recognizing the importance of keeping the physician network in tact by at least maintaining their [primary care] rates."
Taking away the primary care pay bump, however, also represents a "substantial decrease in rates for those physicians," Representative Zerwas said. "We already have a very fragile network of physicians, and if we compromise that any more, I worry about access to health care for the Medicaid population."
Depending on the service, the parity payments raised primary care physicians' Medicaid pay in Texas by 45 percent to 95 percent, in some cases more than doubling rates, according to TMA research.
Lawmakers also ignored medicine's call to fully restore the 2011 cuts made to coinsurance payments for treating dually eligible Medicare-Medicaid patients.
Ms. Romero says the legislature nevertheless budgeted for costs associated with Medicaid caseload growth.
TMA also won long-sought Medicaid reforms that aim to take away some of the other big reasons doctors don't participate, besides low pay. One big step in that direction was Senate Bill 207 by Sen. Juan "Chuy" Hinojosa (D-McAllen), which outlines clear criteria for Medicaid fraud investigations by the Office of Inspector General (OIG). (See "Fair Play.") The new law builds on TMA-backed Senate Bill 1803, passed in 2013, which paved the way for due process improvements.
"It was a very dysfunctional agency that abused its authority and power in placing payment holds that weren't justified, to the point of driving many providers out of Medicaid," Senator Hinojosa said. "We reformed it. We restructured it. And we put safeguards in place for due process. There's no doubt there's fraud out there. The problem is the OIG targeted the wrong people. We want to make sure we aren't running off our providers who are taking care of these needy people."
Along with these types of improvements, however, the vice chair of the Senate Finance Committee and budget conferee says "we should not walk away" from other opportunities to boost Medicaid funding.
Now that Medicaid has moved almost entirely to managed care, other TMA-backed reforms included in Senate Bill 760 by Sen. Charles Schwertner, MD (R-Georgetown), increase oversight and accountability of Medicaid HMOs' network adequacy.
San Antonio pediatrician Ryan Van Ramshorst, MD, says physicians' firsthand experience suggests Medicaid plans are not holding up their end of the bargain, and shortfalls become an issue when he's done all he can to treat a child and needs to find a specialist. In TMA's 2014 physician survey, 53 percent of physicians reported similar difficulties finding such services.
"I go on the [HMO] websites, and their lists are not up to date. I make five phone calls to doctors on the list, and they are not accepting new patients or any patients at all," said Dr. Van Ramshorst, a member of TMA's Ad Hoc Committee on Medicaid, CHIP, and the Uninsured. "I'm left with the decision to keep managing a patient when I'm not as comfortable as I wish I was. But if I don't, they don't get any care. It goes back to managed care taking taxpayer dollars and doing what they are supposed to do."
SB 760 raises current Medicaid access criteria — based on mileage standards used for commercial health plans — to measures using the patient's geographic location and the number and distribution of health professionals within the region, akin to Medicare Advantage plans. TMA believes the new standards are more suitable for low-income populations. The bill would suspend enrollment by health plans if they fail to maintain adequate networks.
Frustrated by the decision not to join other states in continuing the Medicaid-Medicare parity payments, however, Dr. Van Ramshorst said, "We need to change the conversation. Medicaid needs improvements, but it's not a broken program. It's a vital safety net, and combined with CHIP, it's the single largest insurer for kids. We need to do better by the beautiful and vulnerable patients I take care of and otherwise would not have a physician."
TMA still has concerns about parts of the HHSC sunset bill, Senate Bill 200, that call for a consolidation of HHSC, the Department of Assistive and Rehabilitative Services, and the Department of Aging and Disability Services. It also set up the possible elimination of many of the advisory councils that offer an avenue for physician input. TMA continues to analyze provisions in a separate DSHS sunset bill, Senate Bill 202, although lawmakers heeded medicine's call to keep DSHS a separate, stand-alone agency and make other changes that allow it to focus on its core public health functions.
Nevertheless, thanks to hard work before the session and key physician representation, TMA officials say the sunset process yielded a series of preliminary wins that primed medicine for legislative success. Early sunset recommendations, for example, heeded TMA's call for administrative simplification within the Medicaid program, paved the way for the due process improvements in SB 207, and raised awareness among lawmakers of the dangers of scope-of-practice expansions.
Three physicians served on the sunset panel, including past TMA Council on Legislation Chair Dawn Buckingham, MD, along with Sens. Schwertner and Donna Campbell, MD (R-New Braunfels).
"Getting After" the Red Tape
Other key victories for medicine will go a long way to cut the red tape that takes valuable physician time and money away from patient care. "We're getting after it," Dr. King said.
After another multisession effort by TMA, DPS backlogs finally will be a thing of the past, thanks to Senate Bill 195 by Senator Schwertner. Effective Sept. 1, 2016, the state's CSR permit program will cease to exist, and physicians will need only their federal Drug Enforcement Administration registration to prescribe controlled substances.
The CSR backlogs were a nightmare for many physicians who saw their prescribing and hospital privileges — and their patients' care — temporarily suspended because DPS did not process their permits on time. TMA made headway in the 2013 legislative session with a bill to synchronize CSR permit renewal with physicians' medical license renewal as of Jan. 1, 2014. But DPS did not follow through.
As an otolaryngologist treating cancer patients in serious pain, Dr. King says the threat of losing his prescribing ability "would be disastrous."
The CSR elimination is part of a larger shift under SB 195 to move the state's electronic prescription drug monitoring database entirely from DPS to the Texas State Board of Pharmacy. TMA, pharmacy groups, and business groups advocated moving the Prescription Access Texas program to a health-related agency, and the board has until March 1, 2016, to create rules.
"This move will create significant improvements for doctors," TMA Director of Legislative Affairs Dan Finch said. Beyond just a law enforcement tool, the shift "will make the database a better clinical tool with more timely and accurate data." Among other enhancements: electronic alerts of suspicious activity; out-of-state data; and a broadening of physicians' authority to delegate who can access the information. (See "Making Over PAT," March 2015 Texas Medicine, pages 37-41.)
Physicians also will have fewer hassles identifying health plans sold on the federal exchange. TMA-backed House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), requires insurers to clearly differentiate whether patients bought coverage through the ACA marketplace by displaying the letters "QHP" on their plan identification cards. If signed by the governor, the bill takes effect Sept. 1.
Contrary to consumer groups' contention that the legislation labels and discriminates against patients with certain coverage, TMA lobbyist Patricia Kolodzey says the measure gives physicians an opportunity to educate patients about the benefits and limitations of the insurance coverage they purchase. About 85 percent of policies sold on the exchange qualify for a federal 90-day grace period, triggered once a patient with subsidized marketplace coverage misses a premium payment. Health plans must give patients 90 days to catch up, but they can recoup physician payments made in the latter 60 days of that grace period if patients are still delinquent on their premium payments.
Austin neurologist and TMA Council on Legislation member Sara G. Austin, MD, says HB 1514 allows her to communicate with patients about the importance of paying their premiums and to plan treatment accordingly, particularly long-term treatment.
"Many of these exchange plans have very narrow networks, and the people who are buying these plans are very new to insurance. They've had a headache for a long time and make an appointment with me but have no idea if I'm in their network, and it's hard for us to tell," she said. "Having it marked clearly lets us know exactly what the plan is and what their coverage and [payment] portion are before we start them on an expensive medicine. We don't like surprises, and patients don't either."
Balance Billing Preserved; Scope Expansions Averted
Transparency overall was a big theme for lawmakers heading into the session.
TMA worked with the National Multiple Sclerosis Society (NMSS) to support House Bill 1624 by Rep. John Smithee (R-Amarillo) as another layer of health plan accountability and an avenue to help patients make informed choices about their health plan coverage. The measure strengthens requirements for health plans to publicly post on their websites their network directories and drug formularies. TMA also collaborated with NMSS on House Bill 1621 by Rep. Greg Bonnen, MD (R-Friendswood). The bill requires health plans to give physicians and patients 30 days' notice before denying a prescribed drug or intravenous medication. If appealed, health plans and utilization review organizations must provide expedited review by a physician of the same or similar specialty as the prescribing physician.
Maneuvers expected to require physicians to publicly post their charges and adhere to binding quotes went nowhere. Instead, a possible ban on balance billing captured lawmakers' attention as insurers' increasing use of questionably thin networks and shrinking maximum allowable amounts for some out-of-network services are increasing the frequency and size of the out-of-network bills patients receive. (See "Balance-Billing Ban Back in 2015 Legislature," May 2015 Texas Medicine, pages 33-38.)
Testimony by TMA physicians helped deter a bill to ban balance billing altogether for emergency services under House Bill 1638 filed by Representative Smithee. With help from Sen. Kelly Hancock (R-North Richland Hills), medicine won a compromise under his Senate Bill 481, which lowers the threshold for patients to initiate mediation over balance bills from $1,000 to $500. As initially proposed, the measure would have eliminated the threshold altogether.
Medicine lost a bid, however, to prohibit health insurance plans from using virtual credit card payments to settle claims for health care services when Senate Bill 1229 by Sen. Kel Seliger (R-Amarillo) failed in the final days of the session. Unless physicians opt out, the electronic payment method can require doctors to pay a fee of up to 5 percent of the claim payment just to get paid for their services, which TMA says amounts to paying physicians below their contracted rate for a service.
In anticipation of another round of scope-of-practice battles, TMA physicians also testified early and often, and TMA leaders say the efforts paid off for patient safety: Absolutely none of the proposed dangerous expansions of midlevel practitioners' scope of practice passed. Among them, TMA warded off bills that would have allowed:
- Nurse practitioners to prescribe independently of physician delegation and to render a medical diagnosis;
- Physical therapists to treat patients without first seeking a diagnosis and referral from a physician;
- Optometrists, advanced practice registered nurses, and physician assistants more leeway to prescribe Schedule 2 drugs; and
- Chiropractors to issue handicap placards and conduct mental and physical examinations of school bus drivers.
"I write handicap permits for people who have neuropathy, which means they can't feel their feet. If you look at the long list of reasons people qualify for a handicap placard, they are severe diseases — pulmonary disease, cardiac disease — things chiropractors don't treat. It doesn't make sense they would be writing them," Dr. Austin said.
In the one good scope bill that passed, House Bill 2020 ensures that emergency medical technicians and licensed paramedics practice under physician supervision.
Following a flurry of last-minute amendments, TMA also is evaluating the impact of provisions in the DSHS sunset bill, SB 202, that transfer licensing and regulation of some health-related occupations — such as midwives, dietitians, and speech pathologists — to the Texas Department of Licensing and Regulation in 2017. The bill transferred to the Texas Medical Board (TMB) programs for medical physicists, medical radiologic technologists, perfusionists, and respiratory care practitioners.
Meanwhile, the Interstate Medical Licensure Compact legislation to make it easier for qualified physicians to obtain licensure across state lines, came up short. House Bill 661 by Representative Zerwas would have created an expedited pathway for licensure without altering state requirements. (See "Caring Across State Lines," March 2015 Texas Medicine, pages 45-48.)
"As with many bills, it sometimes takes two or more sessions to come to life. This year, we put it out there for people to understand. It is something that will bring efficiency and cost effectiveness to the whole licensure process, and I think we'll get more success in the 85th legislature," Dr. Zerwas said.
Mr. Finch called the bill failure "a lost opportunity" to boost access to care, including through telemedicine. Now that seven states have joined the compact, put forth by the Federation of State Medical Boards, it is in full operation, and Texas can join at any time.
On the telemedicine front, the legislature also closed the door on an opportunity for physicians to get paid fairly for after-hours phone or telemedical consults. TMA-backed House Bill 2348 by Rep. Four Price (R-Amarillo) would have required health plans to pay local doctors the same as they would if hiring outside telemedicine vendors for those services.
As a handful of other telemedicine bills worked their way through legislative committees, TMA sounded the alarm bells on attempts like House Bill 2172 by Representative Smithee to skirt current medical board regulations and permit physicians to diagnose over the telephone without an initial face-to-face visit to establish a patient-physician relationship. The bill failed.
Left standing, however, were three TMA-supported telemedicine bills:
- House Bill 1878 by Rep. Jodie Laudenberg (R-Parker) requires Medicaid payment for telemedicine services provided in school-based settings;
- House Bill 3519 by Rep. Bobby Guerra (D-Mission) allows Medicaid payment for home telemonitoring of patients with two or more specific medical conditions and a history of frequent hospital admissions and emergency visits; and
- Provisions originally in House Bill 2004 by Representative Darby to pilot-test emergency telemedical consults in rural counties with a population of 50,000 or less ended up in House Bill 479 by Rep. Cecil Bell (R-Magnolia).
TMA, meanwhile, won additional liability protections for physicians sharing electronic health records through health information exchanges, while defending against potential erosions to state tort reforms, confidentiality of TMB complaints, and protections under the Texas Advance Directives Act.
Amid the heated end-of-life care debates that also tend to surface each session, TMA negotiated a compromise under House Bill 3074 by Rep. Drew Springer (R-Muenster) that allows for the provision of artificially administered nutrition and hydration as life-sustaining treatment in certain cases. TMA also negotiated a measure to ensure hospital ethics committees establish policies to handle conflicts of interest; that measure did not pass. Instead, a palliative care and quality of life advisory council established by House Bill 1874 will study an array of issues to increase awareness of and improve access to palliative care.
TMA also supported House Bill 2541 to ensure health plans cover certain treatments for enrollees diagnosed with terminal illnesses, which did not pass; and House Bill 751 to set requirements for prescribing and pharmaceutical substitution of biologic products, which did. Representative Zerwas authored both bills.
Mental Health Bills Vetoed Amid Other Public Health Gains
Texas took another big step forward on public health, starting with early passage of Senate Bill 97 by Senator Hinojosa. The first-time regulation of e-cigarette sales in Texas applies many existing state rules on tobacco cigarettes to vapor products, foremost barring sales of e-cigarettes to minors.
"I'm glad we took a stand; finally, Texas is brought into the mainstream with this issue, and we join a majority of states that now have this language in law," Dr. Van Ramshorst said, pointing to studies showing e-cigarette use among adolescents has tripled in recent years. "Teenagers have the perception e-cigarettes are not as dangerous, and they are actually more likely to use them."
TMA Associate Director of Public Affairs Troy Alexander adds that the budget "significantly strengthened" funding for tobacco cessation and chronic disease prevention, while the Ebola outbreak in Texas led lawmakers to dedicate $20 million to surveillance of infectious diseases. Mental health funding, another shared priority among medicine and lawmakers, got a significant boost over last session for services like outpatient treatment for adults and children, autism intervention, and early treatment to reduce neonatal abstinence syndrome.
Governor Abbott wasted no time, however, taking his veto pen to a top priority of TMA's Behavioral Health Task Force. Senate Bill 359 by Royce West (D-Dallas) would have allowed physicians to initiate a four-hour hold on patients who voluntarily seek emergency care but want to leave even though the doctor believes the patient poses a danger to self or others. Citing "serious constitutional concerns" that "would lay the groundwork for further erosion of constitutional liberties," Governor Abbott vetoed the bill, saying "medical staff have options at their disposal" and "should work closely with law enforcement to help protect mentally ill patients and the public."
A diverse coalition of homeschool advocates, scientologists, political activists, and antivaccination groups urged the veto, saying SB 359 conflicts with individual and parental rights, including the right to refuse medical treatment.
"The governor should have reached out to physicians and other medical personnel who provide care in the real world of our emergency rooms before vetoing this legislation. They would have told him about the patients they encounter who pose a real danger to themselves or to those around them," Dr. Garcia said in response.
The governor also vetoed House Bill 225, a TMA-backed bill offering "Good Samaritan" legal protections for drug users who remain on the scene after requesting emergency services for someone who overdoses. He suggested it would invite "misuse by habitual drug abusers and drug dealers."
SB 359 and HB 225 represented two or more sessions of work by TMA's Behavioral Health Task Force, and a coalition that includes TMA, the Texas Hospital Association, the Texas Society of Psychiatric Physicians, and the Texas Pediatric Society.
"Why are we shifting this over to the criminal justice system, when we already have precedent for limited restrictions of liberty based on medical conditions that pose a danger to the person or others? We see it with infectious diseases. We see it with measles. We see it with Ebola," task force Chair Leslie Secrest, MD, said of SB 359. "This would have allowed us more time to evaluate the patient, and then go to a mental illness court to allow the patient to continue treatment in the hospital on a voluntary basis. It builds in something the criminal justice system doesn't do as quickly. Unless the person committed a crime, I can't convince a peace officer that the patient is a danger to self or others."
Similarly, Dr. Secrest says the HB 225 veto puts the criminal justice system ahead of patient lives, when other states with similar Good Samaritan protections have dramatically reduced opioid-related deaths. The bill was narrowly crafted, he says, whereas the governor's veto "says we are not going to look out for teens who routinely die from substance experimentation, people with chronic pain who sometimes get into difficult situations, compared to the small group of people the governor is concerned about. We are turning our backs on people we can save in the meantime."
Heated testimony by antivaccination groups deterred TMA-backed House Bill 2474 by Representative Sheffield to give parents the right to know the number of students in their child's school who have opted out of vaccinations. Dr. Van Ramshorst says some lawmakers' push to eliminate all vaccine exemptions "unfortunately did a disservice to the whole issue and the importance of protecting kids with compromised immune systems."
But with help from physician legislators like Representative Sheffield, as well as Sen. Judith Zaffirini (D-Laredo), medicine's message prevailed in passing what Dr. Van Ramshorst described as "common sense legislation" on immunizations. House Bill 2171 requires the state's immunization registry, ImmTrac, to store childhood vaccination records until age 26 instead of age 18, ensuring the records are available past college and into early adulthood, and to promote easier access to that information.
Read more details about TMA's legislative progress in "Youth Safeguards, Budget Boons."
Amy Lynn Sorrel can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
Medical Education Wins Big
Building on 2013 successes and recognizing physician workforce shortages, the Texas Legislature gave another significant boost to undergraduate and graduate medical education (GME) funding in 2015, including:
- $53 million for new GME expansion grant programs, a $40 million increase over 2014-15 funding levels;
- $7 million for primary care physician pipeline programs: $4 million — or 31 percent — above current funding for the existing family medicine residency program, and $3 million to restart the Statewide Primary Care Preceptorship Program;
- A $20 million or 22-percent increase in biennial per-resident, or "formula," funding;
- Steady funding for the primary care physician workforce innovations grant program;
- An additional $50 million or 3-percent biennial increase in medical student formula funding;
- Maintained funding for the Texas Physician Education Loan Repayment Program;
- A new loan repayment program for psychiatrists and other mental health professionals; and
- Additional money for mental health workforce training programs in underserved areas.
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Among other Medicaid reforms, the 2015 Texas Legislature responded to TMA's call for due process improvements in overzealous fraud investigations by the Office of Inspector General (OIG). Senate Bill 207 by Senator Juan "Chuy" Hinojosa (D-McAllen):
- Clarifies that "fraud" does not include unintentional technical, clerical, or administrative errors;
- Requires probable cause of a credible allegation of fraud for payment holds;
- Requires OIG to give physicians a detailed summary of its evidence relating to the allegation;
- Gives OIG 180 days to complete an investigation; and
- Gives physicians 10 days to request a confidential, informal settlement meeting.
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