UNDER THE ROTUNDA
The House Human Services Committee this morning OK’d legislation supporting TMA’s longstanding goals to extend Medicaid coverage for both pregnant women and children.
House Bill 133 by Rep. Toni Rose (D-Dallas) would extend coverage for pregnant women to 12 months postpartum, while House Bill 290 by Rep. Philip Cortez (D-San Antonio) would do the same for children through two six-month periods of continuous eligibility. The committee unanimously approved both bills, making them eligible for consideration by the full House.
The advance of these two bills follows recent TMA testimony on each by Houston obstetrician-gynecologist Lisa Hollier, MD. Dr. Hollier spoke in support of HB 133 at the committee’s March 23 hearing and testified in support of HB 290 last week.
TMA Supports Bills to Stop Bad Health Plan Behavior
Fear of retaliation can keep physicians from filing complaints against a health plan, and doctors need stronger protections against potentially vengeful insurers, a San Antonio radiologist planned to tell the Texas House Insurance Committee today.
Zeke Silva, MD, was scheduled to testify for the Texas Medical Association in support of House Bill 2929 by Rep. Greg Bonnen, MD (R-Friendswood), which would bolster the state’s insurance code by adding more specificity about what would constitute a health plan’s illegal revenge tour.
Under existing law, health plans can’t take “any retaliatory action” against physicians who file a reasonable complaint against the health plan on behalf of a patient. The law specifically mentions that insurers aren’t allowed to terminate those physicians’ network participation and can’t refuse to renew the physician’s contract.
HB 2929 would further protect physicians by adding two more insurer no-no’s to that list: implementing “measurable penalties to the contract negotiation process” and engaging in unfair or deceptive contract negotiation practices.
TMA believes those amendments are necessary to protect physicians and other practitioners who seek to file complaints against health plans.
“Prudent layperson” protection
Another key TMA-backed bill aimed at stopping questionable health-plan behavior is on today’s House Insurance docket. House Bill 2241 by Rep. Tom Oliverson, MD (R-Cypress), chair of the committee, aims to reinforce the “prudent layperson” standard in emergency care. TMA President Diana Fite, MD, a Houston emergency physician, was scheduled to testify in support of the bill, which would make sure health plans can’t refuse to pay a claim if a patient makes a reasonable decision to seek emergency care for a condition that didn’t turn out to be a serious threat to their health.
Texas’ prudent-layperson standard ensures patients “possessing an average knowledge of medicine and health” have coverage if they seek emergency care believing their condition places their health in serious jeopardy. While existing law already requires insurers to focus on the symptoms a patient presents with, HB 2241 would strengthen the prudent-layperson standard by explicitly stating it must be followed “regardless of the final diagnosis of the conditions.”
Dr. Fite planned to tell the committee that patients acting prudently in making an emergency department trip shouldn’t have to be concerned about whether their health plan will cover the care.
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