UNDER THE ROTUNDA
For a year now, COVID-19 has introduced policymakers to high-wire balancing acts at every turn.
With testimony today, the Texas Medical Association is trying to help the state legislature keep its feet on yet another tightrope: How to balance the emotional-support needs of residents in long-term care facilities with the need to quarantine those elderly and vulnerable residents if they test positive.
Houston geriatrician Hattie Henderson, MD, was scheduled to represent TMA today before the Texas House Human Services Committee to give feedback on House Bill 892 and House Joint Resolution 46 by Rep. James Frank (R-Wichita Falls), the committee’s chair.
As filed, HB 892 would allow residents of nursing or assisted-living facilities to designate at least one “essential caregiver” whom the facility couldn’t prohibit from in-person visitation, even if the resident tests positive for COVID-19. Guidelines from the Texas Health and Human Services Commission would require facilities to, among other things:
- Establish a visitation schedule for the essential caregiver of either two hours per day, or however long it takes for the caregiver to complete his or her tasks.
- Establish “procedures to enable personal contact” between the resident and the caregiver, while requiring social distancing between facility staff and the caregiver.
- Obtain the caregiver’s signed agreement to wear personal protective equipment (PPE) during the visit, complete a health screening before entering the facility, and submit to regular viral testing.
In her written remarks, Dr. Henderson notes that some highly infectious diseases force limited visitation to “mitigate serious community risk.”
“One example of such a disease is Ebola,” she said in written testimony. “Just as we had never heard of COVID-19 before 2020, we do not know what diseases are on the horizon that might be highly contagious and deadly. In these potentially extreme cases, it would be best to allow the attending physician, with the knowledge of the patient and the disease threat, to determine the safety level allowable for visitation.”
Dr. Henderson also wrote that facilities shouldn’t be required to provide PPE to visitors, recalling how the PPE shortage at the beginning of the pandemic created massive difficulties for the medical community.
“Physicians themselves were reusing, disinfecting, and salvaging whatever PPE they could to protect themselves to continue caring for their patients; to require long-term care facilities to provide PPE for everyone could further strain limited resources,” she said in her written remarks. “We recommend visitors be expected to provide their own PPE that meets the appropriate standard need of protection.”
Dr. Henderson also told the committee that TMA “absolutely understands the needle that must be threaded” to balance appropriate infectious disease control with patients’ mental and emotional support needs.
Attacking Prior Auth
A small army of TMA physicians was prepared to testify today before the House Insurance Committee in this session’s first hearing on a TMA-priority measure to curb insurers’ aggravating prior authorization hassles.
House Bill 410 by Rep. Julie Johnson (D-Carrollton) would prohibit prior authorizations on procedures, tests, and diagnostic treatments for which the state requires coverage.
Among several physicians scheduled to testify was Austin oncologist Debra Patt, MD, chair of TMA’s Council on Legislation.
“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 planned to tell the committee. “For the mandated benefits covered in this bill (including mammography, mastectomy, diabetes management, and prostate cancer screenings), prior authorization would seem to serve little purpose other than delaying medically necessary care or deterring a patient from seeking medically-necessary covered care. This is why the physicians of Texas support HB 410.”
Keep Sending TMA Your Prior-Auth Horror Stories
Your personal stories of the impact of prior authorization requirements on your practice and patient care – including any patient harm due to prior authorization request delays or denials – can give TMA the ammunition it needs to fight this problem.
Nothing moves elected officials to action like a slew of real, serious complaints from constituents. As the 2021 Texas Legislature gets under way, TMA plans to collect and publicize prior authorization nightmare stories. We’ll “prime the pump” with stories physicians like you provide and use them to solicit more from the public directly.
Please submit your stories via TMA’s secure email portal. Before submitting your story to us, it is important for you to ensure that your story submission complies with state and federal laws, including, to the extent applicable, the HIPAA privacy rule. HIPAA’s safe harbor list of 18 de-identification requirements, in accordance with Code of Federal Regulations, is available here.
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