UNDER THE ROTUNDA
After several sessions’ trying to protect the health of Texas youth by delaying the onset of smoking and thus nicotine addiction, a bill to raise the minimum age to purchase tobacco and vape products to 21 years is heading to Gov. Greg Abbott’s desk.
The Senate today passed Senate Bill 21 by Sen. Joan Huffman (R-Houston) after concurring with amendments the House added to the bill on a vote of 28-3.
Governor Abbott has indicated he will sign the bill.
The Texas Legislature failed to approve a similar measure in 2017. This year, the bill had bipartisan support in both the House of Representatives and the Senate. The Texas Medical Association testified in strong support of SB 21 earlier this session.
Also on its way to Governor Abbott’s desk today is Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services. Senators concurred 31-0 on amendments the House added to the bill. TMA supports this bill.
Meanwhile, only seven days remain in this session. Every day is now a critical deadline of some sort.
The House and Senate both have until midnight May 22 to consider bills on their final debate for passage.
Here’s a roundup of the status of medicine’s key bills:
- 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 recommended for the Senate Local and Uncontested Calendar. TMA strongly supports this bill.
Graduate Medical Education
- Senate Bill 1378 by Senator Buckingham, which would require new medical schools to account for peak class sizes – and not merely inaugural class sizes – when planning residency slots, was signed by the governor yesterday. TMA testified in support of this bill.
2020-21 State Budget
Lawmakers on Monday 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. In case you missed yesterday’s brief, here’s a snapshot of the current status of the budget.
House Bill 1, by Representative Zerwas 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. Here are some quick highlights and lowlights:
- Includes $0 for physician rate increases, despite TMA’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 (SB 750 passed the House today and returns to the Senate for consideration of amendments the lower chamber added);
- $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. (SB 10 is on the House calendar for today.)
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; funding is even with the current biennium’s allocation.
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.
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 did not accept changes the Senate made to the bill, and named 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 recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill in March.
Prescription Monitoring Program/Opioids
- House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) – 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 – is on today’s Senate Calendar. 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 – is on today’s Senate Calendar. 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 – received final approval in the House today and now returns to the Senate for consideration of amendments added in the House. Senators can either accept those changes or send the bill to a conference committee to work out the differences. After extensive negotiation, TMA supports this bill.
- Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) would require health plan directories to clearly identify which physician specialties are in network at network facilities. The Senate did not accept changes the House made to the bill, and named a conference committee to negotiate the differences. 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 2327 by Rep. Greg Bonnen, MD (R-Friendswood), which would require both greater prior authorization transparency and that utilization reviews be conducted by a licensed Texas physician, is on today’s Senate Calendar. TMA testified in support of this bill.
- 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, received final approval in the House today and returns to the Senate for consideration of amendments the House added. TMA testified in support of this bill.
- SB 750, also by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, received final approval in the House today and returns to the Senate for consideration of amendments the House added. 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, is on today’s Senate Calendar. TMA 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 today’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, has passed both chambers. It’s now up to the House to decide what to do about amendments that senators added to the bill. 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 – passed out of the Senate yesterday 26-5. House members must now consider the amendments added in the Senate. TMA supports this bill.
- House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth) which would establish infection control programs in long-term care facilities, was recommended for the Senate Local and Uncontested Calendar. TMA testified in support of this bill.
- Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, is set on today’s House Calendar. TMA submitted written testimony 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 Tatiana Cordova, MD, of San Antonio. Dr. Cordova graduated from the UT Health San Antonio Long School of Medicine and is a member of the Bexar County Medical Society.
WHAT WE’RE READING
In addressing opioid crisis, Texas lawmakers shy away from controversial bills – Austin American-Statesman
HHS’ Hargan: Innovators needed to reshape healthcare system – Modern Healthcare
Fort Worth’s Medical School Curriculum to Avoid Burnout and Emphasize Empathy – D CEO Healthcare
Medical cannabis bill clears Texas Senate committee: Can it pass before session ends? – Corpus Christi Caller Times
Texas budget deal includes push to prolong anti-cancer effort championed by Lance Armstrong – The Dallas Morning News