UNDER THE ROTUNDA
The final House calendars of the legislative session have been set. The previous 132 days have brought us to the final scene in the biennial legislative saga.
The House and Senate both have until midnight May 22 to consider bills.
Meanwhile, lawmakers have released a draft of their negotiations on the final 2020-21 state budget; the deadline for agreement between the two chambers is midnight May 26 – next Sunday.
2020-21 State Budget
House Bill 1, by Rep. John Zerwas, MD (R-Richmond), is the $248 billion 2020-21 state budget. House and Senate conference committee members have been working through Articles II and III – health and human services and education, respectively – and released a preliminary budget document. The Legislative Budget Board will finalize that document in the next couple of days, but here are some quick highlights and lowlights:
- Includes $0 for physician rate increases, despite the Texas Medical Association’s call for a $500 million investment in targeted rate increases in the two-year budget, a long-time TMA priority;
- Increases inpatient rates for rural hospitals and provides for a $500 add-on payment for rural hospitals that provide labor and delivery services; and
- Adopts $350 million in state funds ($900 million total) for Medicaid cost-containment, meaning $350 million in savings in Medicaid must be identified. TMA opposed this cut.
- Adopts an additional $52 million for women’s health programs, including:
- $45 million for the Healthy Texas Women program, $15 million of which is contingent on passage of Senate Bill 750 by Sen. Lois Kolkhorst (R-Brenham) to help improve prenatal and postpartum coverage;
- $7 million for the Family Planning Program; and
- $840,000 more for the Breast and Cervical Cancer Treatment Program.
- Adds $7 million to implement measures to reduce maternal mortality and morbidity.
- Adds new dollars to modernize the state’s public laboratory, including funds to make overdue repairs, replace aging equipment, and retain skilled laboratory staff, as well as to pay for X-ALD genetic screening – all TMA requests; and
- Incorporates TMA recommendations that the Department of State Health Services (DSHS) study the economic costs of responding to vaccine-preventable disease outbreaks and submit a report to the state no later than Sept. 1, 2020.
- Adopts an increase of $50 million to improve community mental health services for adults and an additional $8 million for children’s mental health; and
- Includes $100 million to establish the Texas Mental Health Care Consortium outlined in Senate Bill 10 by Sen. Jane Nelson (R-Flower Mound), including $20 million to implement the new Child Psychiatric Access Network and another $43 million to implement the Texas Child Health Access Through Telemedicine program.
Early Childhood Intervention
$31 million more for Early Childhood Intervention programs.
Graduate Medical Education/Workforce
- Provides $157.2 million to preserve the hard-fought ratio of 1.1 first-year Graduate Medical Education (GME) slots for every Texas medical school graduate
- $3 million for community psychiatry workforce expansion; and
- $1.5 million for child and adolescent psychiatry fellowships.
- The Physician Education Loan Repayment Program did not receive any additional funding to restore cuts made in previous sessions.
Final, detailed summaries of the budget documents are expected to be published by the Legislative Budget Board late this week. The budget will be debated on the House floor on Saturday. As we delve deeper into the draft documents, we will post more detailed analyses.
Meanwhile, here’s a status check on other bills that continue to move through the legislative process.
Texas Medical Board/Corporate Practice of Medicine
- House Bill 1504 by Rep. Chris Paddie (R-Marshall), the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years, was voted unanimously out of the Senate last week. The House must now decide whether to accept changes the Senate made to the bill or request a conference committee to negotiate the differences. The Texas Medical Association testified in support of this bill earlier this session.
- House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference, was voted out of the Senate Health and Human Services Committee yesterday and awaits debate on the Senate floor. TMA testified in support of this bill in March.
Prescription Monitoring Program/Opioids
- House Bill 2174 by Representative Zerwas – which would help physicians address the opioid crisis by limiting the duration of opioid prescriptions, require electronic prescribing after Jan. 1, 2021, require opioid-related CME, and specify that prior authorization is prohibited for medication-assisted treatment for opioid use disorder – is set on today’s Senate Calendar. TMA supports this bill.
- House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) – which would require electronic prescribing of opioids unless a waiver is granted, and establish an advisory committee to the State Board of Pharmacy – was voted out of the Senate Health and Human Services Committee last Friday and awaits debate on the Senate floor. TMA supports this bill
- House Bill 3285, also by Representative Sheffield – which would permit telehealth treatment for substance use, provide grants to law enforcement agencies to provide opioid antagonists, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths – was voted out of the Senate Health and Human Services Committee yesterday and awaits debate on the Senate floor. TMA supports this bill.
- House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment, was recommended for the Senate Local and Uncontested Calendar. After extensive negotiation and revision, TMA supports the bill.
- Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) – which would require baseball-style arbitration for most surprise medical bills, removing the patient from the billing dispute and resolution process – is set on today’s House Calendar. After extensive negotiation, TMA supports this bill.
- Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio), which would require health plan directories to clearly identify which physician specialties are in network at network facilities, is eligible today for senators to consider the amendments the House added to the bill. TMA testified in support of this bill.
- House Bill 3911 by Rep. Hubert Vo (D-Houston), which would require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations and exclusive provider organizations at least once every three years, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill.
- House Bill 1941 by Rep. Dade Phelan (R-Beaumont) – which would prohibit free-standing emergency facilities from charging “unconscionable” rates, defined as 200 percent or more of the average charge for the same or substantially similar treatment at a hospital emergency room – is set on the Senate Calendar for today. TMA supports this bill.
- House Bill 3041 by Rep. Chris Turner (D-Grand Prairie), which would allow for renewal of a prior authorization if it expires before the patient receives the medical service or procedure, was voted out of the Senate Business and Commerce Committee on Friday and awaits debate on the Senate floor. TMA supports this bill.
- Senate Bill 436 by Senator Nelson , which directs DSHS to develop and implement initiatives to assist pregnant and postpartum women with opioid use disorder and newborns with neonatal abstinence syndrome, was voted out of the House 146-0 and now heads to the governor. This bill specifically refers to the TexasAIM Opioid Bundle that evolved out of the Maternal Mortality and Morbidity Task Force and is strongly supported by TMA.
- House Bill 25 by Rep. Mary Gonzalez (D-Clint), which would create a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits, was voted out of the Senate 30-1 late last week. The House now must decide whether to accept the amendments the Senate made to the bill or ask for a conference committee to negotiate the differences. TMA testified in support of this bill last month.
- Senate Bill 749 by Senator Kolkhorst, which would establish level of care designations for hospitals that provide maternal and neonatal care, is set on today’s House Calendar. TMA testified in support of this bill.
- SB 750, by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, is set on today’s House Calendar. SB 750 must pass for contingent funding to be allocated. TMA testified in support of this bill.
- House Bill 1111 by Rep. Sarah Davis (R-West University Place) which would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home pilots in Texas, was voted out of the Senate Health and Human Services Committee late Friday and awaits debate on the Senate floor. TMA supports this bill.
- Senate Bill 21 by Sen. Joan Huffman (R-Houston) – which would raise the minimum age to purchase tobacco and vape products to 21 years, excluding active duty military – is eligible today for senators to consider the amendments the House added to the bill. TMA testified in strong support of SB 21 earlier this session.
- Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, is eligible today for senators to consider the amendments the House added to the bill. TMA supports this bill.
- House Bill 3345 by Rep. Four Price (R-Amarillo) – which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform – was voted out of the Senate Business and Commerce Committee on Friday and awaits debate on the Senate floor. TMA strongly supports this bill.
- Senate Bill 10 by Senator Nelson – which would create the Texas Mental Health Care Consortium, a collaboration of health-related institutions of higher education and the Statewide Behavioral Health Coordinating Council to improve the effectiveness of and access to behavioral health care for Texas youth – is set on tomorrow’s House Calendar. TMA testified in support of this bill.
Graduate Medical Education/Workforce
- House Bill 1065 by Rep. Trent Ashby (R-Lufkin), which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings, is set on today’s House Calendar. TMA submitted written testimony in support of this bill.
- House Bill 2261 by Rep. Armando Walle (D-Houston) – which would increase the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000 – is set on today’s Senate Calendar. TMA supports this bill.
- House Bill 1256 by Representative Phelan, which would grant first responders and their employers access to first responders’ vaccination records on the statewide immunization registry during a disaster, was sent to the governor. TMA testified in support of this bill.
- House Bill 1418, also by Representative Phelan, which would provide first responders and emergency services personnel with their immunization status when they seek certification or recertification, passed the Senate on Thursday and was sent to the governor. TMA testified in support of this bill.
- House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth) which would establish infection control programs in long-term care facilities, was voted out of the Senate Health and Human Services Committee last night and awaits debate on the Senate floor. TMA testified in support of this bill.
TMA is watching each bill, committee substitute, and amendment for any changes, or for an opportunity to amend a stalled TMA-supported bill. If you have a question about a specific bill, contact the advocacy team via the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT.
HEALTHY VISION 2025
Healthy Vision 2025 – released in late January – is TMA’s all-inclusive, health care roadmap for legislators during the regular legislative session and the quickly approaching interim.
Want to help spread and promote TMA’s Healthy Vision for Texas? Become a TMA social media ambassador.
PHYSICIAN OF THE DAY
Today’s physician of the day is Veronica Escobar, DO, of San Antonio. Dr. Escobar graduated from the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine and is a member of both TMA and the Bexar County Medical Society.
WHAT WE’RE READING
Medicaid and CHIP director to leave the end of May – Modern Healthcare
Amid opioid crisis, Texas becomes first state where life-saving drug is sold online – Dallas Morning News
Fleeger to Lead Texas Medical Association – Vital Record
Blistering Report Details Serious Safety Lapses at St. Luke's in Houston – ProPublica
Don't just blame hospitals and docs for high health spending. Texas keeps dropping the ball. – Dallas Morning News
Enforcement lags as Texas moves to raise smoking age to 21 – Houston Chronicle
Texas Lawmakers On Both Sides Of The Aisle Support Bill To End 'Surprise Medical Bills' – KERA News