Legislative Hotline: It’s Past Time To Hold Insurers Accountable For Inferior Products
By Jennifer Perkins

March_22_Hotline

UNDER THE ROTUNDA
Insurance reform – broadening network access, ensuring accurate directories, preventing the need for balance billing – has long been a Texas Medical Association priority. And yesterday, a bill confronting health plans’ inadequacy head-on took center stage at the Capitol.

Keller pediatrician Jason Terk, MD, who serves at the chair of TMA’s Council on Legislation, testified during the Senate Business and Commerce Committee on two bills.

Dr. Terk testified in opposition to Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) that would give health plans the unilateral power to determine reasonable payments for out-of-network physician services.

In an often tense and contentious exchange with the bill sponsor, Dr. Terk repeatedly reassured the committee that TMA very much supports the need to protect patients from surprise out-of-network bills, but SB 1264 would not accomplish this.

“Much of the value of any health plan network product lies in how robust the network is,” Dr. Terk told lawmakers. “For this reason, we think it is imperative that the legislature ensure health plans are subject to out-of-network payment obligations and a claim dispute resolution process that are sufficient to encourage plans to develop (rather than dismantle) their networks.”

“To be clear, TMA is not opposed to addressing surprise billing. We are, however, opposed to health plans skirting responsibility for the products they sell to our patients.”

Dr. Terk also testified in support of Senate Bill 747 by Sen. Lois Kolkhorst (R-Brenham), which would require the Texas Department of State Health Services (DSHS) to alert physicians to any increase in cost for the state-mandated newborn screening test, and would require health plans to cover any cost increases associated with it.

“Physicians often purchase these screening tests in bulk to have them immediately on hand for newborn patient visits,” Dr. Terk said. “But when new conditions or diagnoses are added to the protocol, the prepurchased screening kits are no longer valid.

“Pediatricians are dedicated to the health of their infant patients and the convenience of providing this second screening in the clinic, but they need to be paid in whole for their participation in this vital program,” Dr. Terk concluded.

These bills were left pending in committee and will be voted on at a later time, most likely next week.

LEGISLATIVE HOTLINE VIDEO

This week’s Legislative Hotline video follows several physicians who spoke out against some key bills, and defended others.

First, watch Dr. Terk argue why Senate Bill 1264 falls short in attempting to address surprise medical bills.

Then hear John Carlo, MD, explain why Senate Bill 21, which would raise the legal age to sell tobacco from 18 to 21, is crucial in protecting young people.  

Also, Medicaid coverage should extend to 12 months postpartum to save lives, Moss Hampton, MD, said in a public health hearing this week.

And TMA Board Trustee Ray Callas, MD, and Harris County Medical Society Immediate Past-President George Santos, MD, each testified in support of bills that would protect physicians who respond to disasters like Hurricane Harvey. 

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,526 bills. TMA is monitoring 1,932 of them, although that will likely grow. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bill referral will be complete next week. Sixty-six days remain in this session; the pace will accelerate and the meetings will lengthen. TMA will be calling on you for grassroots advocacy participation and support. 

BILLS OF NOTE

Here are some bills TMA is watching now. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • Senate Bill 2252 by Sen. Donna Campbell, MD (R-New Braunfels), would require the Texas Department of Insurance (TDI) to conduct a network adequacy examination for preferred provider benefit plans at least every two years. House Bill 3911 by Rep. Hubert Vo (D-Houston) is the companion. TMA supports these bills. 
  • Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) would require a health plan’s network directory to clearly identify which radiologists, anesthesiologists, pathologists, emergency physicians, neonatologists, and assistant surgeons are in-network at in-network facilities. Facilities include ambulatory surgery centers, birthing centers, hospitals, and freestanding emergency rooms. House Bill 2630 by Rep. Julie Johnson (D-Carrollton) is the companion. TMA supports these bills. 
  • Senate Bill 1886 by Senator Kolkhorst would require insurers to provide additional proof that a health plan could not (versus would not) contract with physicians of a certain specialty in an area, after making three materially different offers. This gives TDI another tool to ensure health plans are selling the best networks possible to Texas consumers. House Bill 2962 by Rep. Stan Lambert (R-Abilene) is the companion. TMA supports these bills.  

ARE YOU A LEGISLATIVE JUNKIE?

If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.

TAKE ACTION

TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

  • Tell your senator and representative why you oppose independent practice for APRNs.
  • Register for First Tuesdays at the Capitol – there are two left: April 2 and May 7;
  • Testify before a House or Senate committee;
  • Learn more about TEXPAC, TMA’s bipartisan political action committee;
  • When called to do so, respond to Grassroots Action Center alerts on specific bills via our new VoterVoice app; and/or
  • Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 p.m. each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.

PHYSICIAN OF THE DAY

Today’s physician of the day is Marian Allen, MD, of Spring. Dr. Allen graduated from the Baylor College of Medicine, and is a member of both TMA and the Harris County Medical Society.

WHAT WE’RE READING

Texas Awards $28M Contract for New Medicaid System – Government Technology

Is your child care center safe from measles? Texas won’t say. [Opinion] – Houston Chronicle

Fentanyl-Linked Deaths: The U.S. Opioid Epidemic’s Third Wave – NPR

Expert Opinion: How to Address the Physician Shortage in Booming DFW – D CEO Healthcare

Why the US, And Texas, Need To Catch Up When It Comes To Dementia Care – Texas Standard

The fattest city in America is in Texas, according to this list – WFAA-TV

Last Updated On

March 22, 2019

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Jennifer Perkins

Advocacy Communication Manager

(512) 370-1469
Jennifer Perkins

Jennifer Perkins, a native Texan and University of Texas Longhorn, has worked in politics, public affairs, and advocacy for more than two decades, covering a litany of subject areas and a number of states, using a marketing-oriented communications style as informed by her MBA. Jennifer has two dogs, is a college football fanatic, loves to entertain, and prefers to be outdoors..

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