Action: April 17, 2017

TMA Action April 17, 2017   News and Insights from Texas Medical Association

Medicine's Priorities Advancing as Legislature Enters Home Stretch
State Calls for More Zika Testing in South Texas
State Again Offers Mosquito Repellent to Fight Zika
Get Free, One-on-One Practice Advice at TexMed 2017
Mitigate and Minimize EHR-Related Safety Hazards
What Makes a Good Practice Website?
A Bad West Nile Season Coming to North Texas?

Texas Franchise Tax Returns Due May 15
Feds Delay Office-Based Lab Financial Reporting
Focus on Member Services: Getting Paid
Physicians, Public Put on Alert as Texas Mumps Cases Reach 20-Year High
Quality Improvement: Practice Awards and Free Webinars
Medicaid Coverage for RSV Treatment Has Ended for This Season
Summit Tackles Innovative Primary Care Models
This Month in Texas Medicine

Medicine's Priorities Advancing as Legislature Enters Home Stretch

Less than a month-and-a-half remains until the Texas Legislature adjourns, and recent weeks provided encouragement for many of medicine's foremost interests in the 2017 session.

As lawmakers in both chambers passed respective budget proposals — which they'll now have to reconcile in a lean budget year — TMA continued working to protect priorities that support its mission of improving the health of all Texans. Meanwhile, a number of important medicine-backed measures have advanced to committee hearings, out of committees, and out of the Senate, providing promising signs for continued progress. Just as encouragingly, some worrisome scope-of-practice measures that TMA opposes have thus far stalled.

Dueling Budgets

The early morning hours of April 7 saw the Texas House conclude a 15-hour debate by approving a $218.2 billion state budget for 2018–19, a figure within overall striking distance of the $217.7 billion budget the Senate approved in March. Now, it's up to the two chambers to reconcile their budget differences.

The House budget included a number of encouraging provisions and amendments for medicine as lawmakers navigated this year's financial constraints. Rep. Armando Walle (D-Houston) stepped up to preserve Medicaid eligibility levels, benefits, and services. Representative Walle won adoption of an amendment to the House budget that prevents the Medicaid "federal flexibility rider" from being used to cut benefits or services or to change Medicaid program eligibility. TMA member physician Rep. J.D. Sheffield, DO (R-Gatesville), and Rep. Four Price (R-Amarillo) signed on to the amendment. Representative Price and Rep. Garnet Coleman (D-Houston) also limited the damage the federal flexibility rider could do to Medicaid, introducing their own amendment to protect "medically necessary services to eligible children." Proposed amendments to cut funding for tobacco cessation, to medicine's relief, didn't make it into the House's final budget.

TMA member Rep. John Zerwas, MD (R-Richmond), introduced one of the most pivotal parts of the House budget, tapping into the state's Economic Stabilization Fund — also known as the rainy day fund — for $2.5 billion. Using the rainy day fund is expected to be one of the biggest sticking points between the House and Senate, whose leader, Lt. Gov. Dan Patrick, is opposed to using the state's economic reserve fund.

The Senate passed its version of the budget on March 28. It includes provisions that would add more than $30 million in funding for graduate medical education expansion; allocate $244 million for mental health and add funding for state hospitals; appropriate $264 million for women's health preventive services; and add $393 million for medical education-related programs. However, the Senate plan also includes a rider reducing Medicaid general-revenue funding by $410 million; would cut staff and services at the Texas Department of State Health Services, including infectious disease and public health preparedness reductions; would cut 25 percent from the Physician Education Loan Repayment Program; and would cut 11 percent from the EMS and Trauma Care Training Program. TMA is working with lawmakers to ensure the cuts to Medicaid do not affect physician payment rates or patient care.

Scope, Protecting Physicians, and Telemedicine

At press time, none of the measures seeking to allow nonphysician practitioners to foray into practicing medicine had made much headway in either chamber. That's good news for medicine and TMA, which is closely tracking every attempt to infringe on the physician's scope of practice. As TMA lobbyist Dan Finch told physicians at this month's First Tuesdays at the Capitol event, "So far, none of the bills have been heard, which is good, and the longer we go without them being heard is good."

Measures to protect physicians from professional interference and maintenance-of-certification (MOC) discrimination earned hearings this month. An MOC measure by TMA physician Sen. Dawn Buckingham, MD (R-Lakeway), earned a hearing on April 11. Senate Bill 1148 would prevent hospitals and health plans from using MOC as the sole determinant for denying privileges or access to a managed care plan panel. Houston neurologist Kim Monday, MD, testified for TMA in support of the legislation. The Texas Hospital Association testified on the bill. The American Board of Medical Specialties testified against it.

And Senate Bill 833 by Sen. Bryan Hughes (R-Mineola) would help protect against nonprofit health corporations that interfere with a physician's professional judgment. TMA is working with Senator Hughes to strengthen the bill by adding protections to prevent retaliatory actions against physicians who advocate for patient care.

On another long-contentious issue, a TMA-supported effort to clarify the role of telemedicine in Texas has earned Senate approval. Senate Bill 1107 by Sen. Charles Schwertner, MD (R-Georgetown), defines a valid practitioner-patient relationship through telemedicine and clarifies that the standard of care remains the same for telemedicine treatment as it does for an in-person visit. SB 1107 passed by a 31-0 vote. One key aspect the bill does not address is the issue of physician payments for telemedicine care.

Sunset and the Prescription Mandate Issue

The issue of how to combat opioid abuse and diversion continues to center around just how to use the state's new prescription drug monitoring program (PDMP), which launched last September. Senate Bill 316 by Sen. Juan "Chuy" Hinojosa (D-McAllen), which addresses those issues, made it out of the Senate last Wednesday. 

The bill incorporates many of TMA's recommendations to use the new and evolving technology the Texas PDMP offers. TMA's list of recommendations includes authorizing the Texas State Board of Pharmacy to alert physicians, other prescribers, and pharmacists when it detects patterns of prescribing and dispensing that may constitute doctor shopping. 

Unlike the sweeping recommendations from the Texas Sunset Advisory Commission to mandate checks for all controlled substances, SB 316 limits the required checks to four classes of controlled substances: opioids, benzodiazepines, barbiturates, and carisoprodol. Beginning Sept. 1, 2018, SB 316 would require physicians to check the PDMP before prescribing a Schedule II medication in any of the listed classes. Mandated checks on prescriptions for all four classes of drugs in Schedules III-V would follow a year later, Sept. 1, 2019. 

House Bill 3040 by Rep. Cindy Burkett (R-Sunnyvale), the Texas Medical Board sunset bill, has been set for a hearing Tuesday in the House Committee on Public Health. The bill currently includes the mandated PDMP check for all controlled substances that are opioids, benzodiazepines, barbiturates, and carisoprodol. Senator Hinojosa is carrying the Senate's version of the TMB sunset legislation.

Progress on the Insurance Front

TMA-backed efforts to hold health plans accountable for surprise bills for out-of-network services earned a major boost in the past month, with one major bill earning approval from the full Senate and another key measure earning a hearing in the House Committee on Insurance. A TMA-supported measure to address insurance companies' potentially detrimental step therapy protocols also made it through one chamber.

On the surprise-medical-bill front, Senate Bill 507 by Sen. Kelly Hancock (R-North Richland Hills) passed the Senate 29-2 on March 28. SB 507 would keep the current $500 threshold for bill mediation, but expand the mediation process to all out-of-network physicians and providers at certain in-network facilities as well as certain in-network facilities where patients receive emergency care. Also, in early April, TMA testified in the House Committee on Insurance in support of House Bill 2760 by Rep. Greg Bonnen, MD (R-Friendswood). HB 2760 would hold insurance companies accountable by requiring them to update their practitioner directories every business day. The measure would also require the plans to remove a terminated physician from the directory within two days and would introduce health plan review requirements for the state's insurance department. Senator Hancock is sponsoring a similar measure, Senate Bill 2210.

The Senate also aligned with TMA and Senator Hancock on April 3 when it passed his Senate Bill 680. That measure would allow physicians to override insurers' step therapy protocols. It would also prohibit insurers from requiring patients to fail more than once on a prescription drug before trying the next step in their drug treatment plan.

Public Health Hope

Several of TMA's highest-priority public health measures have all made encouraging legislative movement. But tough battles remain for those initiatives: banning texting while driving, raising the tobacco age to 21, and parents' right to know about the number of vaccine exemptions in a public school.

A statewide ban on texting while driving earned the approval of the Texas House on March 16 when House Bill 62 by Rep. Tom Craddick (R-Midland) passed by a 114-32 vote. However, the ban proposal is expected to encounter stiff resistance in the Senate. HB 62's companion measure in that chamber, Senate Bill 31 by Sen. Judith Zaffirini (D-Laredo), made it out of the Senate Committee on State Affairs.

The push for parents' right to know their child's risk to contract a vaccine-preventable disease continued last week when House Bill 2249 by Representative Sheffield earned a hearing from Chair Four Price (R-Amarillo) in the House Committee on Public Health. HB 2249 would make de-identified campus-level immunization data, including exemption data, available to parents and the public. That data would give parents of students who can't be vaccinated ― such as immunocompromised children ― more detailed information than the district-level immunization stats the state currently publicizes. Although there was overwhelming testimony provided by physicians on the importance of vaccinations, there was also testimony and misinformation by parents and children on the other side about their right to choose and about all of the bullying they encounter.

The Public Health Committee also heard the Tobacco 21 measure, House Bill 1908 by Rep. John Zerwas, MD (R-Richmond), in late March. Houston neonatologist Charleta Guillory, MD, testified for TMA at the hearing in support of HB 1908. Dr. Guillory noted in written testimony that on average, 90 percent of adult smokers start smoking in their teen years, and 95 percent begin before age 21. Raising the age required to buy tobacco can significantly improve public health outcomes, she said. TMA is seeing opposition to HB 1908 from the tobacco industry.

Although last year's hysteria over the spread of the Zika virus is in the rearview mirror, much remains for medicine to learn about the mosquito-borne and sexually transmitted illness. That's why TMA is supporting House Bill 3576 by Rep. R.D. "Bobby" Guerra (D-Mission), which would bolster Texas' Zika surveillance system. The House Committee on Public Health heard testimony on HB 3576 last Tuesday, and TMA submitted testimony supporting the bill. 

"HB 3576 will help us ensure Texas has a strong reporting system and ― when necessary ― we can contribute to and increase awareness of new and emerging infectious diseases," TMA said. "This is important since we now fully understand these diseases can be brought to Texas in mere hours."

TMA's final First Tuesdays at the Capitol for this session, scheduled for May 2, gives physicians one last chance to gather en masse and let lawmakers know what issues matter most to them. Register now!

Joey Berlin, associate editor of Texas Medicine, prepared this special supplement to Action.

State Calls for More Zika Testing in South Texas

The Texas Department of State Health Services (DSHS) has expanded its Zika testing criteria for residents of the Lower Rio Grande Valley in an effort to quickly identify and respond to new infections of the mosquito-borne virus.

In a health alert issued April 3, DSHS recommended testing for all residents of Cameron, Hidalgo, Starr, Webb, Willacy, and Zapata counties who have a rash plus at least one other common Zika symptom: fever, joint pain, or conjunctivitis. DSHS continues to recommend that all pregnant women in those counties be tested during the first and second trimester. 

For all other parts of the state, DSHS and the Centers for Disease Control and Prevention guidelines recommend testing for any pregnant woman at possible risk of Zika exposure or for anyone who exhibits three of the four common Zika symptoms and has traveled to an affected area.

More infections are possible this year because of a mild winter that prevented a break in the mosquito season throughout the southernmost areas of the Rio Grande Valley, state health officials said.

"Zika remains a significant health risk to pregnant women and their babies, and it's only a matter of time until we see local transmission here again," DSHS Commissioner John Hellerstedt, MD, said in a news release that accompanied the alert. "We want to cast as wide a net as possible with testing to increase our ability to find and respond to cases, and the Lower Rio Grande Valley remains the part of the state most at risk for Zika transmission."

To ensure that all cases are identified, DSHS said, the ability to pay should not stop people from getting tested, particularly pregnant women.

"Testing is available through public health labs for individuals who have no payor source or for whom there is a financial barrier to testing," DSHS said. "If the individual is not covered by private insurance or a third-party payor, testing may be obtained through a DSHS laboratory."

For more information about Zika and other infectious diseases in Texas, see the TMA website.

State Again Offers Mosquito Repellent to Fight Zika

Beginning around May 1, Texas Medicaid and CHIP once again will make mosquito repellent a covered benefit for certain patients to help combat the Zika virus.

The Texas Health and Human Services Commission (HHSC) will offer the mosquito repellent benefit for Zika prevention in 2017 for pregnant women, females aged 10-55, and males aged 14 and older. Compared with last year, the 2017 benefit adds males, at TMA's request, and also increases the age for covered females from 45 to 55. The benefit will be available to eligible individuals through the Medicaid, Medicaid managed care, CHIP, CHIP-Perinatal, Children with Special Health Care Needs (CSHCN), Healthy Texas Women (HTW), and Family Planning programs. 

Agency officials say: 

  • The benefit will end on Dec. 31, 2017. 
  • Individuals can receive one can per prescription fill with up to two cans per month. 
  • The standing order, which was in place for last year's benefit, will be available again for the 2017 benefit. The standing order is only available for eligible clients in Medicaid, CHIP, and HTW. The standing order allows pharmacies to fill prescriptions for repellent without contacting the client's physician or other health care provider. Patients can go directly to the pharmacy and present their YourTexasBenefits card to obtain the repellent.
  • Family Planning program clients can obtain the repellent directly from their clinics.
  • Only CSHCN clients will need a prescription from their physician or provider to obtain the benefit.  

HHSC also released new guidelines for billing for Zika testing. (See "State Calls for More Zika Testing in South Texas" for the latest testing recommendations.)

States are waiting for the Centers for Medicare & Medicaid Services (CMS) to issue a specific Zika testing code. Until then, Texas Medicaid will continue to cover three general lab procedure codes that may be appropriate to use when submitting claims for Zika testing: 87798, 87799, and 86790. 

A Zika specific modifier is currently in development. The agency will issue instructions to attach the new modifier to one of the recommended codes so that those procedures can be tracked as Zika tests. Medicaid will not require prior authorization for Zika testing. There is no Medicaid rate specific to Zika testing; payments will be made at the rates associated with the codes shown above.

On Wednesday, April 12, TMA conducted its second Tele-Town Hall Meeting on Zika. About 450 Texas physicians joined John Hellerstedt, MD, the Department of State Health Services (DSHS) executive commissioner; David Lakey, MD, former DSHS commissioner and current chair of the TMA Council on Science and Public Health; and other experts in the hour-long call. 

Topics included an update on the state's Zika preparedness planning, a briefing on reported Texas Zika cases, and the latest on Zika testing.

If you missed the event or want to review the material covered, check out the recording on TMA's Infectious Disease Resource page

Action TMLT Ad 10.15

Get Free, One-on-One Practice Advice at TexMed 2017

TMA's Practice Consulting experts will be on hand next month at TexMed 2017 to provide free, 15-minute Quick Consults on a variety of practice topics. Bring your questions on such operational issues as health information technology, payment advocacy, human resources, or general practice management. 

During your consult, TMA experts will address your specific needs and concerns, and offer tips on the next steps for your practice. 

Quick Consults will take place in the TMA Member Services booth, number 549. Appointments are limited, so reserve your space today

As always, TexMed 2017, TMA's annual conference, is free to all TMA members as well as first-time nonmember attendees and the staff of TMA members who preregister by April 28. TexMed 2017 will be held May 5–6 at the Marriott Marquis in downtown Houston. 

Mitigate and Minimize EHR-Related Safety Hazards

The Office of the National Coordinator (ONC) for Health Information Technology recently released updated SAFER Guides to help health care organizations assess and optimize the safe use of electronic health records (EHRs).

The updated guides cover the following areas. 

  • High-priority practices,
  • Organizational responsibilities,
  • Contingency planning,
  • System configuration,
  • System interfaces,
  • Patient identification,
  • Computerized provider order entry with decision support,
  • Test results reporting and follow-up, and
  • Clinician communication. 

While some physicians may not have full control over EHR configuration, it is worth scanning the guides for best practices you can implement. The guides can be used to assess risks within a practice, and each guide contains 10 to 25 recommendations for mitigating or minimizing EHR-related safety hazards.

One of the coauthors of the SAFER Guides is Hardeep Singh, MD, a member of TMA and the Harris County Medical Society. 

In addition to the downloadable version, the content of each SAFER Guide, with interactive references and supporting materials, can be viewed on ONC's website.

Review the entire ONC Health IT Playbook to learn how all team members can work together to make health information technology work for the practice.

For further questions on health information technology, contact the TMA HIT Helpline at (800) 880-5720 or by email.

What Makes a Good Practice Website?

TMA has dozens of resources available to help you answer this question. These include TMA-endorsed vendor Officite, which provides practice websites and online marketing services to TMA physician members at exclusively discounted rates. TMA members can save up to 37 percent on these services.

View the latest Officite article, What Makes a Good Practice Website? for tips on the features every good practice website should have, or attend a free webinar from 1 to 1:30 pm CT on Thursday, April 20: Modern Practice Marketing in 7 Simple Steps.

You may also visit Officite or call (844) 818-1568 to see all they have to offer. 

TMA members can always access these and other member benefit programs by visiting the TMA website.

For more resources and information from TMA on marketing your practice, visit the TMA website, and register for the upcoming TMA seminar Modern Marketing for Five Star Reviews, coming to Austin on July 28.

A Bad West Nile Season Coming to North Texas?

The Dallas County Department of Health and Human Services has detected the year's first West Nile virus-infected mosquitoes in the county and warns that could be a bad sign.

"This is the earliest seasonal appearance of West Nile virus (WNV) detected in mosquito populations in Dallas since environmental surveillance began in 2002," the department said in a health advisory issued April 13. "The abundance of this species of mosquitoes is currently higher than expected this early in the season. One adjacent county has also recently identified their first WNV positive mosquito trap for the season, indicating an early wide distribution of WNV in our local mosquito population."

While no confirmed human cases of WNV disease have been reported in Texas this year, the department points out that such cases typically trail the first report of mosquito infection by several weeks. Dallas County has begun ground spraying for mosquitoes in the areas around where the infected insects were found.

Most cases of WNV disease are mild or asymptomatic, according to the U.S. Centers for Disease Control and Prevention (CDC). Less than 1 percent of those infected will develop serious neuroinvasive disease. 

Physicians in the area should consider WNV in patients whose symptoms are consistent with WNV fever (fever with headache, myalgia, arthralgia, weakness, or rash) or West Nile neuroinvasive disease (fever with aseptic meningitis, encephalitis, or acute flaccid paralysis), the department says.

In 2016, counties across Texas reported cases of WNV disease in humans, especially in the northeast and southeast quadrants of the state.

For more information on diagnosis, testing, reporting, and treating WNV disease, see the CDC website

 TMAIT Action Ad 6.15

Texas Franchise Tax Returns Due May 15

Texas physician practices that are organized as LLPs, LLCs, PAs, or in any other corporate form are subject to the Texas franchise tax. Tax returns (or extension requests) are due May 15.

Businesses that have total revenues of less than $1,110,000 will not owe any tax but must still file an electronic "No tax due" report.

Remember, physician practices may exclude revenues from Medicare, Medicaid, and workers' compensation plans and the cost basis of any charity care they provide from their total revenue before they calculate their tax. TMA obtained those exclusions for physicians when the Texas Legislature rewrote the franchise tax law in 2006.

The Texas Comptroller of Public Accounts reports that it mailed notices of the annual franchise tax report to businesses in January and February. The notice includes the WebFile number assigned to each business. You will need this number to file your report electronically.

If you need more time to file, submit a franchise tax extension request on or before May 15. "Generally, for an extension to be valid, 100 percent of the tax paid on the prior year's report, or 90 percent of the tax that will be due with the current year's report, must be paid on or before May 15," according to the Comptroller's Office. 

You will owe a $50 late filing penalty on reports filed after May 15 if you do not file an extension request, the Comptroller's Office adds.

Feds Delay Office-Based Lab Financial Reporting

The Centers for Medicare & Medicaid Services (CMS) has pushed back to May 30 the deadline for physician office-based laboratories to meet new financial reporting requirements.

The original deadline of March 31 had been put in place last year as part of the Protecting Access to Medicare Act, which required that Medicare payments for tests on the Clinical Laboratory Fee Schedule (CLFS) be based on rates paid by private payers. The new CLFS rate system, which will be determined by the reports from applicable laboratories, is slated to take effect Jan. 1, 2018.

The "enforcement discretion," as announced by CMS on March 30, was requested by seven medical associations, including the American Medical Association.

"Industry feedback suggests that many reporting entities will not be able to submit a complete set of applicable information to CMS by the March 31, 2017, deadline, and that such entities require additional time to review collected data, address any issues identified during such review, and compile the data into CMS's required reporting format," CMS said in a statement. "This 60-day enforcement discretion period is the maximum amount of time CMS can permit to still have sufficient time to calculate the CLFS payment rates scheduled to go into effect on January 1, 2018."

Under the rule, the penalty for failure to report or for each misrepresentation or omission in reporting will be up to $10,000 per day, adjusted for inflation. 

For more information, visit the CMS website

Focus on Member Services: Getting Paid

TMA's Hassle Factor Log program recouped more than $1.8 million in unpaid insurance claims for physician members last year. If you have unresolved payment issues, know that your TMA membership gives you access to help to get you paid. 

The Hassle Factor Log program is a free benefit that helps resolve insurance-related payment problems. TMA meets regularly with the Centers for Medicare & Medicaid Services (CMS), Texas Medicaid, and large insurers to discuss specific issues that members bring to our attention. 

TMA offers these additional services to help you get paid for your hard work:  

  • Free billing and coding hotline ― Use this go-to resource for answers to your billing and coding questions. Email or call (800) 880-1300, ext. 1414, for assistance. 
  • Coding and documentation reviewTMA's certified coders and auditors will review your coding and records to determine whether your practice is following payers' guidelines for appropriate billing.
  • Free Quick Consults ― Staff experts will be at TexMed 2017 (May 5–6 in Houston) to offer free, 15-minute consults on a variety of topics, including reimbursement and payment help. Remember, TexMed is free for all members and your office staff. 
  • Education and continuing medical education (CME) ― TMA offers detailed practice e-tips, white papers, CME (discounted for members), and FAQs on getting paid fairly. 
  • Discounted, endorsed vendorsTMA endorsed vendors such as I.C. System and TransFirst offer discounts on products and services designed to save your practice money.  

For more information on all the ways TMA can help you get paid, visit the TMA website

Physicians, Public Put on Alert as Texas Mumps Cases Reach 20-Year High

State health officials are advising physicians and providers to stay on alert for mumps as statewide cases of the highly contagious disease reach a 20-year high.

Officials are investigating multiple cases throughout Texas, including one involving possible exposures on South Padre Island, a popular spring break destination, the Texas Department of State Health Services (DSHS) said in an alert.

Texas has had 221 cases of the disease already this year, compared with a record high of 234 for all of 1994, according the DSHS.

Texas officials were alerted to the possible exposures on South Padre Island when another state health department reported a patient with mumps who had traveled to the Gulf Coast barrier island during spring break.

"DSHS alerted other states and has been notified of 13 mumps cases in people who traveled to South Padre Island between March 8 and March 22 from six states, including two cases from Texas," DSHS said in a news release announcing the alert. "Health care providers should consider mumps in patients with compatible symptoms and ask them about travel out of state, to South Padre Island from March 8 to 22, or about any possible exposure to someone with mumps."

Mumps is spread through coughing, sneezing, and sharing cups and utensils. The mumps vaccine is the most effective way of avoiding the disease, but it is also important that people cover their mouth and nose when sneezing or coughing, wash their hands with soap and water frequently, and not share food and drinks.

Symptoms usually develop 16 to 18 days after exposure and include swollen or tender salivary glands, swollen or tender testicles, low-grade fever, tiredness, and muscle aches. People who think they have the disease should contact their physician and stay home while they are contagious ― five days after swollen glands occur.

Physicians and providers are required to report suspected cases to their local health department or by calling (800) 705-8868 within one business day.  

PC Action Ad May 13

Quality Improvement: Practice Awards and Free Webinars

TMA, the Texas Osteopathic Medical Association (TOMA), and the TMF Health Quality Institute are collaborating again to provide the Physician Practice Quality Improvement Award program. The award formally recognizes physician practices for their dedication and commitment to providing high-quality patient care and improving outcomes. 

Apply online by June 10. Winning practices will be recognized through a media outreach campaign as well as announcements in journals and at meetings hosted by TMA and TOMA.

The TMF Health Quality Institute is also offering free, live webinars later this month through its new Quality Payment Program Network. Registration is required for each webinar. 

Join these webinars to learn about Medicare's new Quality Payment Program and the no-cost technical assistance TMF is providing to help physician practices effectively transition to the Merit-Based Incentive Payment System.

Medicaid Coverage for RSV Treatment Has Ended for This Season

Friday, April 14, marked the end of the 2016–17 respiratory syncytial virus (RSV) season for all counties in Texas, the Texas Health and Human Services Commission (HHSC) announced. HHSC issued no extensions for any parts of the state this season based on recommendations from the Texas Pediatric Society RSV Task Force.

Coverage of Synagis (palivizumab) for RSV ended April 14 for people enrolled in Medicaid (both traditional and managed care) and the Children with Special Health Care Needs (CSHCN) Services program. Pharmacy claims and prior authorization requests are no longer being accepted or reviewed.

The start and end of the RSV season in Texas each year is based on an individual's county of residence. RSV appears earlier in some counties and remains active later in other counties. HHSC uses RSV statistics from prior years plus regular virology reports to determine the season's start and end dates for each region.

RSV causes respiratory tract infections and serious lung disease in infants and children. During the season, Synagis (palivizumab) is available with prior authorization for treating high-risk patients enrolled in Medicaid or in the CSHCN Services program.

Summit Tackles Innovative Primary Care Models

Where is primary care going and are you going there with it?

Those are the two basic questions the fifth annual Texas Primary Care and Health Home Summit will answer May 11–12 at the Sheraton Gunter Hotel in San Antonio.

The summit will offer tips and ideas to physicians who've already turned their practice into a primary care medical home (PCMH) or accountable care organization (ACO) as well as those who are just beginning to consider such a move.

Online registration is open.

"The goal of the summit is to provide opportunities for participants to hear from practitioners who have been successful in making transformational changes to their practices," summit organizers said. "An overarching goal is to offer practical, tangible, and useful tips and tools to help practices at all stages of their transformation."

Topics on the agenda range from telehealth to pediatric health to mental health to community health, and will cover clinical, business, and compliance issues. Speakers include Carlos Jaen, MD, a widely published authority on the PCMH who has been involved in medical home evaluations since the earliest days of the movement, and Michael Barr, MD, executive vice president of the Quality Measurement and Research Group of the National Committee for Quality Assurance. Pre-summit sessions on the morning of May 11 include a reprise of the popular "Health Home 101" for those who want to learn ― or review ― the basics.

As in years past, TMA is one of several organizations sponsoring the summit.

Continuing medical education credits will be available. This live activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership between the Texas Academy of Family Physicians (TAFP) and the Texas Health Institute. TAFP is accredited by ACCME to provide continuing medical education for physicians. TAFP designates this live activity for a maximum of 10.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This Month in Texas Medicine

The April issue of Texas Medicine features a cover story on potential Medicaid reforms. Questions abound as to what capped Medicaid funding would look like and what effect it would have on the current Medicaid-eligible population, covered services, and physician payments. The April issue also includes coverage of TMA's HPV Work Group and its plans to improve HPV vaccine rates, the latest rule change on resident duty hours, and problems encountered when physicians change electronic health record vendors. A Journal article examines the relationship of mental health to alcohol and substance use among Texas college students.

Check out our digital edition

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. 

Medicaid EHR Incentive Program Attestation Deadline for 2016 Participation

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.  


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Last Updated On

April 17, 2017