Legislative Hotline: Physicians Urge Lawmakers to Fix Prior Authorization Hassles
By Jennifer Perkins

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UNDER THE ROTUNDA
As physicians, we don’t want our patients to suffer a financial crisis in the wake of a medical crisis. Yet current insurance industry practices – narrow networks, inaccurate directories, unrelenting prior authorization and utilization review hassles – impede our ability to provide timely care to our patients. That’s the message Texas Medical Association physicians delivered today as they testified on several bills addressing health plans’ coverage issues.

Athens family physician and TMA President Doug Curran, MD, testified in strong support of a pair of bills by Rep. Greg Bonnen, MD (R-Friendswood).

House Bill 2327 would exempt physicians with a demonstrated approval record from many prior authorization requirements. It also would make the prior authorization process more transparent by requiring health plans to inform physicians and patients in advance of the preauthorization process and specific requirements.

“Insurance companies need to stop creating hurdles to maintaining the patient-physician relationship,” Dr. Curran said. “This bill will make the prior authorization process easier to navigate and let us focus more on patient care, not paperwork.”

Representative Bonnen’s House Bill 2387 likewise would strengthen the patient-physician relationship by requiring utilization reviews to be done by a Texas-licensed physician who practices in the same or a similar specialty.

“We think this is imperative to avoid improper denials of service and delays in medically necessary care,” Dr. Curran said.

Austin oncologist Debra Patt, MD, testified in support of House Bill 2520 by Rep. Julie Johnson (D-Carrollton), which would require a health plan, when approving a prior authorization request, to inform patients ahead of time about the network status of physicians or providers who may participate in the procedure and the patient’s expected financial responsibility.

“If a plan requires a physician to go through prior authorization review, the information submitted on the standardized form could be put to good use in helping patients in ways beyond merely obtaining authorization for their medical care,” said Dr. Patt. “If health plans are allowed to create these burdens, then the information physicians must provide to health plans should be used more fully to benefit the patient.”

Dr. Patt also testified in support of House Bill 2408, also by Representative Johnson, which would disallow prior authorization requirements for state-mandated health plan benefits, such as mammograms and prostate cancer screening.

“If by law, a health plan must cover these medical services, it makes little sense to permit health plans to subject these services to their prior authorization process,” Dr. Patt said.

Do you have a prior authorization disaster to share? Send the details (no protected health information, please) to Genevieve Davis, TMA’s associate vice president for payment advocacy.

Representative Johnson also introduced House Bill 2630, which 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 network facilities.

“I often must refer my patients to a facility for necessary care,” Dallas cardiologist Rick Snyder, MD, testified in support of HB 2630. “When making these referrals, the absolute last thing I want to do is refer them to an out-of-network facility because I recognize that this could create a surprise out-of-network balance bill for my patient. This does not help my long-term relationship with the patient and potentially creates unnecessary financial stress for my patient.”

TMA submitted written testimony in support of House Bill 2099 by Rep. Stan Lambert (R-Abilene), which would prohibit a health plan from changing a patient’s drug coverage upon plan renewal if the patient has been stable on that drug.

“Insurance companies often use nonmedical switching to force patients to use a less expensive medication,” TMA’s statement said. “This bill does not require a health plan to change its entire formulary but instead requires modification of the formulary on a patient-by-patient basis.”

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

BILLS THAT ARE MOVING

House Bill 76, which would require school districts to provide student-athletes with information about cardiac arrest and electrocardiogram testing before participating in sports, received preliminary approval on the House floor. TMA will continue to watch progress on this bill. 

House Bill 749, which would raise the minimum age to purchase tobacco and vape products to 21, passed out of the House Public Health Committee unanimously and awaits scheduling for a hearing on the House floor. TMA strongly supports this bill. 

GETTING A BILL MOVING

So far this session, lawmakers have filed 7,526 bills. TMA is monitoring 1,934 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-two 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. 

  • House Bill 1754 by Representative Bonnen would entitle schools to use the funds allocated for safety improvements for student mental health prevention and treatment. TMA supports this bill. 
  • Senate Bill 14 by Sen. Robert Nichols (R-Jacksonville) would allow electric cooperatives to construct, maintain, and operate cables for broadband service, potentially expanding access to telemedicine in rural communities. House Bill 1446 by Rep. John Kuempel (R-Seguin) is the companion. TMA supports these bills.  

HEALTHY VISION 2025

Healthy Vision 2025 – released in late January – is TMA’s all-inclusive, health care roadmap for legislators. 

Want to help spread and promote TMA’s Healthy Vision for Texas? Become a TMA social media ambassador.

TODAY’S GRASSROOTS ADVOCACY TIP

Part of your success as a physician is knowing your patients well so you can provide the care they need. The same is true with legislators: part of their success comes from knowing their constituents and the issues of concern to them. Make contact with your legislators repeatedly, and not just when you need them. Be credible and reasonable, and stay in touch with them during the interim. Get more tips in our Grassroots Advocacy Guide.

PHYSICIAN OF THE DAY

Today’s physician of the day is Mary Anne Snyder, DO, of San Antonio. Dr. Snyder graduated from the Kansas City University of Medicine and Biosciences, and is a member of both TMA and the Bexar County Medical Society.

WHAT WE’RE READING

Cloud of Cancer-Causing Chemical Hangs Over the Houston Channel – Bloomberg News

Edinburg doctor to speak with lawmakers on reducing opioid prescriptions – The Monitor

Texas cancer researchers vying to renew CPRIT beyond its 2023 sunset date – The Cancer Letter

Grieder: Raising the legal age for tobacco sales in Texas is a popular, sensible idea amid rise of ‘vaping’ – Houston Chronicle

Texas can fight the teen e-cigarette epidemic and raise the legal age for tobacco products to 21The Dallas Morning News

The Flu Season Hasn’t Been This Bad This Late in 20 Years – The Wall Street Journal

Last Updated On

March 26, 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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