TMA has been busy submitting comments on proposed Texas Medical Board (TMB) rules. TMA President Tom Garcia, MD, signed three separate comment letters, which pertain to out-of-network claim dispute resolution; a monitoring, proctoring, or supervising physician/professional's recommendation for competency assessment; and visiting physician temporary permits.
TMB is in the process of updating its rules to reflect the changes in state law made by Senate Bill 481 by Sen. Kelly Hancock (R-North Richland Hills). The bill lowers the threshold for patients to initiate mediation for certain claims for services provided by out-of-network, facility-based physicians at in-network hospitals from $1,000 to $500 (after copayments, deductibles, and coinsurance). As initially proposed, the bill would have eliminated the threshold altogether, which TMA successfully fought to change.
Additionally, the bill, as passed, amended the definition of "facility-based physicians" to include assistant surgeons. The bill also required that billing statements contain a "conspicuous, plain-language explanation" of the mandatory mediation process (when available).
In its comments, TMA contends the scope of the rules is broadened inappropriately by the current definition of "facility" in TMB rules. The board rules define a facility as a "hospital, emergency clinic, outpatient clinic, birthing center, ambulatory surgical center, or other facility providing health care services." TMA says the definition "goes far beyond hospitals (i.e., the only type of 'facility' to which the mediation process established under Chapter 1467, Insurance Code actually applies)."
TMA concludes by stating "that utilizing a definition of 'facility' … that extends beyond hospitals would be problematic for physicians and patients, alike. Since all the provisions in Subchapter J, Chapter 187 of the Board rules relate to the mediation process established under Chapter 1467 of the Insurance Code, the definition of 'facility' in the 22 TAC §187.87 needs to accurately reflect the circumstances when mediation is available under that law (i.e., for certain claims for services provided by certain out-of-network hospital-based physicians at in-network hospitals). To do otherwise would lead to physician confusion regarding the mandates of the law and patient confusion regarding the circumstances when mediation is available."
At its Dec. 4 meeting, TMB voted to adopt the rule as published but directed staff to research some of the issues raised in TMA's letter ahead of the next TMB meeting in March.
Competency Assessment Rules
In TMA's comments on TMB's proposed rule concerning a monitoring, proctoring, or supervising physician/professional's recommendation for competency assessment, the association says the rule "does not go far enough in terms of what must happen before a physician is subject to a competency evaluation." In the comments, Dr. Garcia describes competency hearings as "costly," adding they "interfere with the operations of a physician's medical practice and can be embarrassing and stigmatizing for a physician's reputation."
"While TMA acknowledges that competency evaluations may play a role in protecting the public health and welfare, TMA strongly opposes the imposition of competency evaluations without appropriate due process," Dr. Garcia wrote.
TMA says TMB's informal settlement conference (ISC) provides an appropriate mechanism for determining whether a competency evaluation is necessary. Holding an ISC prior to ordering a competency evaluation, TMA explains, would allow the monitor and the doctor "to present evidence and allow the panel to make an informed determination of whether a competency evaluation is warranted."
At its Dec. 4 meeting, TMB voted to adopt the rule as published, with the understanding that physicians be able to respond in writing to the Disciplinary Process and Review Committee chair regarding any recommendation by a monitor that a competency exam be ordered. TMA requested this in its comment letter.
Temporary Permit Rules
TMA also weighed in on proposed TMB rules concerning visiting physician temporary permits. The proposed rules would prohibit a supervising physician from having "an investigation or proceeding pending against the applicant for the restriction, cancellation, suspension, revocation, or other discipline of the applicant's medical license, permit, or authority to practice medicine." TMA recommends the term "applicant" be changed to "supervising physician" in the rules.
TMA says visiting physicians with a temporary permit should be able to be supervised by any physician with an unrestricted Texas license. "TMA believes that this new proposal, if adopted, would prevent many competent physicians from acting in a supervisory capacity," Dr. Garcia wrote. "TMA recommends that proposed sections 172.5(a)(2)(C)(ii) and 172.5(b)(1)(B)(ii) be deleted."
At its Dec. 4 meeting, TMB adopted the changes to the rules as published but with TMA's suggestion to change "applicant" to "supervising physician."
Action, Dec. 15, 2015