UNDER THE ROTUNDA
Four days remain in this session. Bills that didn’t receive their final floor debate by midnight last night are dead for this session. We will do a postmortem once all the dust settles next week.
By midnight tomorrow, the House must accept Senate amendments to House bills 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 other chamber.
Several bills supported by the Texas Medical Association made it through the process and await Gov. Greg Abbott’s signature:
- House Bill 1532 by Rep. Morgan Meyer (R-Dallas), which would protect employed physicians’ clinical autonomy and independent medical judgment from hospital administrators’ interference.
- 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.
- House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), which would establish infection control programs in long-term care facilities.
- 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.
- 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.
- 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 health care provider negligently causes a stable patient to require emergency medical treatment.
- 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.
- Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway), which would require Medicaid to cover telemedicine services.
- Senate Bill 355 by Sen. Royce West (D-Dallas), which directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care.
- House Bill 170 by Rep. Diego Bernal (D-San Antonio), which would require health plans to cover diagnostic mammograms at 100%, the same as screening mammograms.
Meanwhile, other TMA-supported bills are still alive:
- House Bill 25 by Rep. Mary Gonzalez (D-Clint) 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. The House refused to accept Senate amendments and appointed a conference committee. TMA testified in support of this bill last month.
- Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham), which would establish level-of-care designations for hospitals that provide maternal and neonatal care, is on the Senate Calendar awaiting consideration of House amendments. TMA testified in support of this bill.
- Senate Bill 750, by Senator Kolkhorst, which would improve maternal access to postpartum care through the Healthy Texas Women Program, is on the Senate Calendar for consideration of House amendments. The draft state budget allocates $15 million for this program, if SB 750 passes. TMA testified in support of 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 – is on the Senate Calendar for consideration of House amendments. 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 made in the House, and named a conference committee. 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 – was voted out of the Senate 30-1 and heads back to the House for consideration of a Senate amendment. 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, was voted out of the Senate 31-0 yesterday and heads back to the House for consideration of a Senate amendment. TMA testified in support of this bill.
- House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress), which would require vastly improved transparency regarding prescription drug costs, passed the Senate 27-4 yesterday and returns to the House for consideration of a Senate amendment. TMA supports this bill.
- House Bill 1584 by Rep. Senfronia Thompson (D-Houston), which would prohibit step therapy protocols for stage 4 metastatic breast cancer, passed the Senate 30-1 yesterday and returns to the House for consideration of a Senate amendment. TMA supports this bill.
Texas Medical Board
- House Bill 1504 by Rep. Chris Paddie (R-Marshall) is the Texas Medical Board (TMB) Sunset bill that would extend the TMB for another 12 years. 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.
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 on Senate amendments or request a conference committee. TMA supports this bill.
- House Bill 3285 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 31-0 and heads back to the House to consider Senate amendments. TMA supports this bill.
- Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, passed the House yesterday 140-4. It now returns to the Senate to consider House amendments. TMA supports this bill.
- Senate Bill 1207 by Sen. Charles Perry (R-Lubbock), which would require that Medicaid managed care prior authorization reviews be performed by an external medical reviewer, require that clear explanations of denial notices be provided to patients, and establish an explicit goal to reduce the overall number of prior authorizations, was voted out of the House 139-0. Now, the Senate must decide whether to accept House amendments. TMA supports this bill.
- House Bill 1576 by Representative Phelan, which would allow Medicaid to contract with a transportation network company, such as Uber, for nonemergency transportation to or from a medical appointment, was voted out of the Senate 31-0 and now returns to the House to consider a Senate amendment. TMA supports this bill.
Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), which would address school safety, including substance use and mental health services, also includes many components of Senate Bill 10 by Sen. Jane Nelson (R-Flower Mound), which was killed on a point of order. SB 11 was voted out of the House 135-7 yesterday and now returns to the Senate to consider House amendments.TMA testified in support of SB 10 and strongly supports SB 11. House Joint Resolution 5, the funding mechanism for HB 10, was not taken up for debate and is dead this session. TMA supported this bill.
Graduate Medical Education/Workforce
- 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 on today’s House Calendar for consideration of Senate amendments. TMA supports this bill.
Public Health/Long-Term Care
- Senate Bill 1519 by Senator Kolkhorst, which would establish a statewide council on long-term care facilities, passed yesterday in the House 107-36 and now waits for senators to decide on House amendments. TMA submitted written testimony in support of this bill.
- House Bill 448 by Rep. Chris Turner (D-Grand Prairie), which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds, is on the House Calendar awaiting consideration of Senate amendments. TMA supports this bill.
- House Bill 2050 by Representative Paddie, which would require written consent for the administration of psychoactive drugs to long-term care facility residents, is on the House Calendar to consider Senate amendments. TMA supports 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. Here’s a snapshot of the current status of the $248 billion biennial state budget, House Bill 1, by Representative Zerwas.
- 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 SB 750 to help improve prenatal and postpartum coverage (SB 750 is on the Senate Calendar 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 SB 11 by Senator Taylor, 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;
- 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 today 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 Mark Nadeau, MD, of San Antonio. Dr. Nadeau graduated from the University of Virginia School of Medicine and is a member of the Bexar County Medical Society.
WHAT WE’RE READING
Texas bill to raise smoking age to 21 on its way to governor’s desk – KVUE-TV
This session’s biggest mental health bill got killed on a technicality – then resurrected – The Texas Tribune
Health care tops list of Americans’ top issues in new poll – The Hill
Episiotomies are painful, risky and not routinely recommended. Dozens of hospitals are doing too many. – USA Today
West Nile Virus Confirmed in Addision, County Health Department Says – KXAS-TV
How Community Health Workers at Baylor are Reducing Trips to the Hospital – D CEO Healthcare
Until broadband access improves, telemedicine won’t help rural communities – Reuters