UNDER THE ROTUNDA
Five days remain in this session, plus a few hours. Every day is now a critical deadline of some sort.
The House and Senate both have until midnight tonight to consider bills in their final debate for passage. To quantify that task and put it into perspective, the Senate alone has more than 610 bills on its agenda today.
By midnight tomorrow, all Senate amendments to House bills must be distributed to House members.
By midnight Friday, the House must act on Senate amendments to House bills, meaning they must accept the proposed changes or name a conference committee to debate the proposed changes.
By midnight Sunday, both the House and Senate must accept conference committee reports or discharge conference committees and accept amendments added by the opposite chamber.
Here’s a roundup of the down-to-the-wire status of medicine’s key bills:
- Senate Bill 436 by Sen. Jane Nelson (R-Flower Mound), which directs the Department of State Health Services to develop and implement initiatives to assist pregnant and postpartum women with opioid use disorder and newborns with neonatal abstinence syndrome, was sent to the governor yesterday. This bill is specifically referring 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. HB 25 is on today’s House Calendar for them to 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.
- SB 750, by Sen. Lois Kolkhorst (R-Brenham), which would improve maternal access to postpartum care through the Healthy Texas Women Program, was voted out of the House yesterday 144-2 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 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 – passed the House unanimously yesterday 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, is on today’s 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% 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.
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. TMA 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, is on today’s 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 – was voted out of the Senate yesterday 28-3. The House must now concur in Senate amendments or request a conference committee. 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 Local and Uncontested 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, is on today’s Senate Local and Uncontested Calendar. After extensive negotiation and revision, TMA supports the bill.
- Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, won preliminary approval in the House late yesterday. The bill awaits final debate today, then will return to the Senate, which must decide to accept amendments made by the House or ask for a conference committee to negotiate the differences. TMA supports this bill.
- Senate Bill 1207 by Sen. Charles Perry (R-Lubbock), which would require more explicit prior authorization denial notices and establish an explicit goal to reduce the overall number of prior authorizations in the Medicaid managed care program, also won preliminary approval in the House late yesterday. The bill awaits final debate today, then will return to the Senate, which must decide to accept amendments made by the House or ask for a conference committee to negotiate the differences. 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 – is on today’s Senate Local and Uncontested Calendar. TMA strongly supports this bill.
- Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services, heads to the governor for his signature. 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 – was killed on a point of order in the House late yesterday. However, several components of SB 10 were successfully amended onto Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), which would address school safety, including substance use and mental health services. SB 11 received preliminary approval in the House yesterday at the 11th hour and awaits final approval today. SB 11 must then return to the Senate for acceptance of amendments or to request a conference committee to reconcile differences.TMA testified in support of this bill.
- House Bill 10 by Rep. Senfronia Thompson (D-Houston) – which would create the Texas Mental and Behavioral Health Research Institute, award grants to increase the number of psychiatric residency positions, and create a child and adolescent psychiatric nursing grant program – is on today’s Senate Calendar. TMA submitted written testimony in support of this bill.
- House Joint Resolution 5, also by Representative Thompson, is the funding mechanism for HB 10. HJR 5 would allocate $100 million in each fiscal year to the Texas mental and behavioral health research fund that HB 10 would establish, as long as the state collects more than $30.5 billion in sales, excise, and use tax revenue in that fiscal year. HJR 5 is set on today’s Senate Calendar. If HJR 5 passes, Texans will vote on the constitutional amendment in November. TMA supports 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 on Monday 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, is on today’s 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.
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 –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 biennial state budget. 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 Senator Kolkhorst to help improve prenatal and postpartum coverage (SB 750 passed the House yesterday 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 Senator Nelson, 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 failed to pass in the House yesterday. Supporters are looking for bills onto which amendments can be made to keep part or all of SB 10 alive.)
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;
- Provides $3 million for community psychiatry workforce expansion; and
- Provides $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 tomorrow or Friday. The budget will be debated on the House floor on Saturday. We will provide a more in-depth analysis once more is known about bills passed or on life support and how they impact preliminary budget agreements.
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 Lesca Hadley, MD, of Fort Worth. Dr. Hadley graduated from the Texas Tech University Health Sciences Center and is a member of the Johnson County Medical Society.
WHAT WE’RE READING
Measles Outbreaks in U.S. Tick Up – The Wall Street Journal
Texas Falls in Leapfrog’s Hospital Safety Grades, Despite Local Successes – D CEO Healthcare
Texas Medical Assoc. Chooses Houston Physician for President-Elect – Mega Doctor News
McConnell and Kaine unveil bill to raise tobacco age to 21 – Politico
Until broadband access improves, telemedicine won’t help rural communities – Reuters
Maternal Mortality in the US state-by-state – Georgia is No. 1 – Becker’s Hospital Review
Smoke-free parks policy begins June 1 in San Antonio – KENS-TV