UNDER THE ROTUNDA
The work of the 86th Texas Legislature passed its final stage at midnight Sunday, the deadline for Gov. Greg Abbott to to sign, veto, or allow bills to become law without his signature.
Among those he signed this weekend was Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio). This bill requires greater transparency with prior authorizations and mandates that utilization reviews be conducted by a Texas-licensed physician in the same or similar specialty as the physician requesting the service or procedure. It also requires health plan directories to clearly identify which physician specialties are in-network at network facilities.
Thank you to our members who contacted the governor to urge him to sign SB 1742. Your advocacy worked.
The governor also signed House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) which will delay the mandate to check the prescription monitoring program (PMP) until March 2020. The Texas Medical Association fought hard for the delay to give the PMP time to fully integrate with physicians’ electronic records systems. This reduces the hassle involved in using an important clinical tool. HB 3284 also requires electronic prescribing of opioids unless a waiver is granted. Electronic prescribing diminishes the chance of opioids being misused.
The Texas Medical Board (TMB) will not be a political football this year. Governor Abbott signed House Bill 1504 by Rep. Chris Paddie (R-Marshall), which extends the life of the TMB by 12 years – to 2031. In addition, HB 1504 includes provisions to ensure that dismissed or frivolous complaints or disciplinary actions are removed from physicians’ profiles as quickly as possible. It also allows expedited licensing for physicians who hold a full license and are in good standing in another state.
All told, 7,434 bills were filed during the session, which ended May 27. TMA monitored more than 1,900 bills, of which only a handful made it to Governor Abbott.
The outcome of numerous other bills important to medicine is listed below.
Vetoes
Governor Abbott vetoed two bills TMA supported:
House Bill 448 by Rep. Chris Turner (D-Grand Prairie) would have required transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds. Governor Abbott vetoed this bill, saying it is overly prescriptive and micromanages parents.
House Bill 455 by Rep. Alma Allen (D-Dallas) would have directed the State Board of Education to develop recess policies that encourage outdoor play time and physical activity. While acknowledging the educational and health benefits of recess, Governor Abbott vetoed the bill, saying it’s another mandate and is bureaucracy for bureaucracy’s sake.
Budget
House Bill 1, by Rep. John Zerwas, MD (R-Richmond), is the $250 billion 2020-21 biennial budget. Governor Abbott signed HB 1 with no line-item vetoes.
The budget does not include any physician rate increases for Medicaid, and it requires the state to find $350 million in Medicaid savings.
“Physician services have not had any change in payment for 20 years,” TMA Past-President Doug Curran, MD, said. “That’s so wrong. It’s wrong for the patients, it’s wrong for the physicians, and it just makes it impossible for the doctor to continue to see these people that need our help and care.”
However, the budget does increase funding for programs and initiatives that will help improve maternal health, behavioral health, and graduate medical education.
Professional Liability
House Bill 2362 by Rep. Joe Moody (D-El Paso) ensures that physicians working in emergency rooms who face high-risk obstetrical cases requiring immediate and difficult decions are protected from unwarranted lawsuits. Notable exceptions to the willful and wanton protection include instances in which the patient’s treatment is unrelated to a medical emergency, and for any physician whose negligent act or omission causes a stable patient to require emergency medical care. Governor Abbott signed HB 2362.
Mothers and Children
House Bill 170 by Rep. Diego Bernal (D-San Antonio) will require health plans to cover diagnostic mammograms at 100%, the same as screening mammograms. The governor signed this bill.
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. SB 355 was filed without Governor Abbott’s signature, meaning the bill becomes law.
Senate Bill 952 by Sen. Kirk Watson (D-Austin) will require that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards. Governor Abbott filed SB 952 without his signature.
Insurance
Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) will require baseball-style arbitration for most surprise medical bills, effectively removing patients from the billing dispute resolution process. Patients who elect to go out-of-network for health care are not covered by this arbitration process. Governor Abbott signed this bill.
House Bill 1941 by Rep. Dade Phelan (R-Beaumont) will 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. HB 1941 will financially protect patients seeking care in an emergency. Governor Abbott signed this bill.
House Bill 3911 by Rep. Hubert Vo (D-Houston) will require the Texas Department of Insurance to examine the network adequacy of preferred provider organizations (PPOs) and exclusive provider organizations (EPOs) at least once every three years. Inadequate or narrow networks contribute to higher costs for patients and frustration for physicians. Governor Abbott signed this bill.
House Bill 1584 by Rep. Senfronia Thompson (D-Houston) will prohibit step therapy protocols for stage-4 metastatic breast cancer. HB 1584 was filed without signature by the governor.
House Bill 1576 by Representative Phelan will allow Medicaid to contract with a transportation network company, such as Uber or Lyft, for nonemergency transportation to or from a medical appointment. Making it easier to get to the doctor will improve patient compliance with prescriptions and other remedies prescribed by the physician. Governor Abbott signed this bill.
House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress) will require vastly improved transparency regarding prescription drug costs, including posting drug price information on the Health and Human Services Commission’s website and explaining cost increases of greater than 40%. Governor Abbott signed this bill.
House Bill 2041 by Representative Oliverson will 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. Pricing transparency will help patients make more prudent choices for emergency health care. The governor signed this bill.
Opioids
House Bill 2174 by Representative Zerwas limits the duration of opioid prescriptions, requires electronic prescribing beginning on Jan. 1, 2021, requires opioid-related CME, and prohibits prior authorization for medication-assisted treatment for opioid-use disorder. HB 2174 will help prevent “doctor shopping” by patients seeking opioids for non-therapeutic uses. Governor Abbott signed this bill.
House Bill 3285 by Representative Sheffield will permit telehealth treatment for substance-use disorder, develop and implement an opioid misuse public awareness campaign, and collect and analyze data regarding opioid overdose deaths. Governor Abbott signed this bill.
Graduate Medical Education/Workforce
House Bill 2261 by Rep. Armando Walle (D-Houston) will 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. The repayment program is designed to encourage new physicians to start their careers in underserved communities by helping them pay off student loans in return for a four-year practice commitment. Governor Abbott signed this bill.
Telemedicine
House Bill 3345 by Rep. Four Price (R-Amarillo) allows physicians to choose the best platform for providing services rather than having health plans dictate the platform. HB 3345 complements Senate Bill 1107 from the last legislative session, which stipulated that services provided via telemedicine are to be covered the same as any other service provided by a physician. Governor Abbott signed this bill.
Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway) requires Medicaid to cover telemedicine services. Governor Abbott signed this bill.
House Bill 1063 by Representative Price will require Medicaid to cover home telemonitoring for specific pediatric patients. HB 1063 will prevent families from having to take very ill children to their physician’s office when the necessary care and monitoring can happen from home. Governor Abbott signed this bill.
Long-Term Care
House Bill 2050 by Representative Paddie requires written consent for the administration of psychoactive drugs to patients in long-term care facilities. Frequently, residents in long-term care facilities have limited contact with family members, so allowing one-time written consent will save precious time when medications may need to be provided. Governor Abbott signed this bill.
Cannabis
House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth) updates the Compassionate Use Act adopted by the legislature in 2015, broadening the list of symptoms and illnesses for which patients can use low-THC cannabis. Governor Abbott signed this bill.
If you have a question about a specific bill from this legislative session, contact the advocacy team via the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 a.m. to 5:15 p.m. Central Standard Time.
HEALTHY VISION 2025
Healthy Vision 2025 – released in late January – is TMA’s all-inclusive, health care roadmap for legislators during the interim session.
Want to help spread and promote TMA’s Healthy Vision for Texas? Become a TMA social media ambassador.