Legislative Hotline: Act Now For Prior Authorization Relief
By Jennifer Perkins

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ACTION ALERT

Please call Gov. Greg Abbott’s office now at (512) 463-2000 regarding two key health insurance reform bills.

“Tell him to stand with physicians and our patients against insurance company interference,” Texas Medical Association President David Fleeger, MD, said this morning in an email to all members. “Tell the governor to give the go-ahead for strong prior authorization and utilization review protections in Senate Bill 1742 and/or House Bill 2327.”

These bills:

  • Help prevent delays in patient care by providing more transparency for patients and physicians regarding what health plans require for prior authorizations.
  • Ensure more accountability in health plan utilization reviews for patient care.

UNDER THE ROTUNDA

Three days remain in this legislative session. By midnight tonight, 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 opposite chamber.

Numerous TMA-supported bills made it through the legislature Thursday and await Gov. Greg Abbott’s signature:

  • House Bill 2261 by Rep. Armando Walle (D-Houston) 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.
  • Senate Bill 750, by Sen. Lois Kolkhorst (R-Brenham), which would improve maternal access to postpartum care through the Healthy Texas Women Program.
  • Senate Bill 749 by Senator Kolkhorst, which would establish level-of-care designations for hospitals that provide maternal and neonatal care.
  • Senate Bill 952 by Sen. Kirk Watson (D-Austin), which would require that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards.
  • House Bill 455 by Rep. Alma Allen (D-Houston), which would direct the State Board of Education to develop recess policies that encourage outdoor playtime and physical activity.
  • 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.
  • House Bill 448 by Representative Turner, which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds.
  • House Bill 2050 by Rep. Chris Paddie (R-Marshall), which would require written consent for the administration of psychoactive drugs to long-term care facility residents.
  • Senate Bill 384 by Sen. Jane Nelson (R-Flower Mound), which would require all health care facilities to report all health care-affiliated infections.

 

Meanwhile, these TMA-supported bills are still alive: 

Insurance

  • 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 today’s Senate Calendar for consideration of House amendments. After extensive negotiation, TMA supports this bill.
  • SB 1742 by Sen. Jose Menéndez (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 both the House and Senate named conference committee members to reconcile differences. TMA testified in support of this bill. (See Action Alert on 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, awaits House agreement with a Senate amendment or the appointment of a conference committee. TMA testified in support of this bill. (See Action Alert on 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 today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress), which would require vastly improved transparency regarding prescription drug costs, is set on today’s House Calendar 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, is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.
  • House Bill 2041 by Representative Oliverson, which would require freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees, is set on today’s House Calendar for consideration of a Senate amendment. TMA supports this bill.

Maternal and Child Health

  • 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, awaits the decision of a conference committee. TMA testified in support of this bill last month.
  • Senate Bill 355 by Sen. Royce West (D-Dallas) 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. The Senate refused to agree with House amendments and requested a conference committee. TMA testified in support of this bill.

Texas Medical Board

  • House Bill 1504 by Representative Paddie, 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.

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 House Calendar to agree with Senate amendments or request a conference committee. TMA supports this bill.
  • House Bill 3285 by Rep. J.D. Sheffield, DO (R-Gatesville) – 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 set on today’s House Calendar to consider Senate amendments. TMA supports this bill.
  • Senate Bill 1564 by Senator West, which would provide Medicaid coverage for medication-assisted treatment, is set on today’s Senate Calendar for consideration of House amendments. TMA supports this bill.  

Cannabis

  • House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth), which would allow a physician to recommend low-THC cannabis for medical use by a patient with a variety of debilitating medical conditions, is set on today’s House Calendar for consideration of Senate amendments. TMA is closely monitoring this bill.

Medicaid

  • Senate Bill 1105 by Senator Kolkhorst, which would streamline and improve Medicaid managed care and reduce red tape for both physicians and patients, has been referred to conference committee as the Senate did not agree with House amendments. TMA supports this bill.
  • Senate Bill 1207 by Sen. Charles Perry (R-Lubbock) would require more explicit prior authorization denial notices for the Medicaid program and establish an explicit goal to reduce the overall number of prior authorizations. The Senate did not accept House amendments and requested a conference committee. TMA supports this bill.

Mental Health

  • 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 Senator Nelson, which was killed on a point of order. The Senate did not accept the House amendments and requested a conference committee. TMA testified in support of SB 10 and strongly supports SB 11.

Telemedicine

  • House Bill 1063 by Rep. Four Price (R-Amarillo), which would require Medicaid to cover home telemonitoring for specific pediatric patients, is set on today’s House Calendar for consideration of Senate amendments. TMA supports this bill. 

2020-21 State Budget

House Bill 1, by Representative Zerwas, is the $248 billion biennial 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 are some quick highlights and lowlights:

Medicaid

  • 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. 

Maternal Health

  • 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 Governor Abbott signing SB 750 to help improve prenatal and postpartum coverage (the Senate agreed with House amendments to SB 750 Thursday);
  • $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. 

Public Health

  • 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. 

Behavioral Health

  • 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, amended into 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. The budget will be debated on the House floor 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 Cristian Fernandez Falcon, MD, of San Antonio. Dr. Fernandez Falcon graduated from the Universidad Catolica Argentina Facultad de Ciencias Médicas in Buenos Aires and is a member of the Bexar County Medical Society.

WHAT WE’RE READING

Pain & Profit: Big Medicaid reforms snuck out of the Texas House, but will cost-cutting senators get on board? – The Dallas Morning News

Texas insurance giant tells judges brain-damaged baby and mom are stifling company’s free speech – The Dallas Morning News

Drug-price transparency bill likely headed to Gov. Abbott’s desk, stronger than many predicted – Houston Chronicle

Flu Outbreak Prompts Largest Border Detention Center to Stop Processing Migrants – The New York Times

Texas expansion of medical cannabis nears finish line after Senate approval – The Texas Tribune

Medical files found in dumpster in Tomball – Houston Chronicle

A Texas woman’s fight with a health care system she says let her down – Houston Chronicle

North Texas Physicians Honored by the Texas Medical Association – D CEO Healthcare


Last Updated On

May 24, 2019

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Jennifer Perkins

Advocacy Communication Manager

(512) 370-1469
Jennifer Perkins

Jennifer Perkins, a native Texan and University of Texas Longhorn, has worked in politics, public affairs, and advocacy for more than two decades, covering a litany of subject areas and a number of states, using a marketing-oriented communications style as informed by her MBA. Jennifer has two dogs, is a college football fanatic, loves to entertain, and prefers to be outdoors..

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