UNDER THE ROTUNDA
Stopping modern health insurance’s descent into prior authorization madness will mean detailing for lawmakers every jagged angle that pokes and cuts at the fabric of patient care.
That’s why the Texas Medical Association is sending three physician leaders to Tuesday's House Insurance Committee hearing to address the hassles and care impediments of health plans’ preauthorization requirements.
At its 10:30 am hearing, the committee is scheduled to hear multiple TMA-supported bills to tackle preauthorization and other pressing insurance issues.
Little Elm internist John Flores, MD; Houston internist Lisa Ehrlich, MD; and San Antonio radiologist Ezequiel “Zeke” Silva III, MD, will tell the committee why it’s vital to pass House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The bill would allow physicians who achieve a certain percentage of prior authorization approvals to be “gold-carded” out of prior authorizations the following year. The year after that gold-card year, doctors would once again be evaluated on their preauthorizations for another gold card. Thus they could potentially earn a gold card every other year.
HB 3459 also would require utilization reviews to be conducted by physicians of the same or a similar specialty as the doctor who requested approval for the treatment.
Dr. Silva also will carry the ball for medicine on House Bill 4012, also by Representative Bonnen, which would require health plans to provide cost estimates to the patient on services that require preauthorization.
Also among TMA-supported measures on today’s House Insurance schedule:
- House Bill 2035 by Rep. Julie Johnson (D-Farmers Branch) seeks to reinforce the prudent layperson standard in emergency care. It would require utilization review on emergency care to be performed by a Texas-licensed physician who is board-certified in emergency medicine. HB 2035 also would prohibit the utilization review physician from denying the claim based on the final diagnosis. TMA President Diana Fite, MD, a Houston emergency physician, was scheduled to testify in support of the bill. Dr. Fite testified last week on a different prudent-layperson measure that also seeks to keep the final diagnosis from being a factor in whether insurers approve a claim. She’ll tell the committee that patients shouldn’t have to act as diagnosticians and worry about emergency care being denied when time is of the essence.
- HB 2668 by Rep. Four Price (R-Amarillo) would prohibit copay accumulator programs in prescription drug purchases. In a copay accumulator setup, insurers don’t allow patients to count manufacturers’ coupons toward their deductible and out-of-pocket maximum. Dr. Flores was scheduled to testify in support and tell the committee that copay accumulators hike patients’ out-of-pocket costs, with a particularly negative impact on chronically ill patients and patients who need higher-cost medications.
House Bill 980 by Rep. Arthur Fierro (D-El Paso), a telemedicine payment parity measure that would require health plans to pay for a covered service provided by telemedicine at the same rate the insurer pays for the service delivered in-person. A pair of Austin physicians, family physician Jacob Childers, MD, and psychiatrist Thomas Kim, MD, will testify in support of the measure.
Supporting gender-affirming care for youth
A broad coalition of organized medicine, including TMA, told the Senate State Affairs Committee on Monday to reject a pair of bills that would criminalize gender-affirming health care treatment for transgender youth.
Senate Bill 1646 by Sen. Charles Perry (R-Lubbock) would, among other things, generally make it a crime to perform gender-transitioning or gender-reassignment surgery on a child, or to administer “a puberty suppression prescription drug or cross-sex hormone” to a child for gender transitioning or reassignment. Similarly, Senate Bill 1311 by Sen. Bob Hall (R-Edgewood) would bar performing a list of surgeries for “the purpose of transitioning a child’s biological sex” and would also outlaw prescribing puberty-blocking medication.
Austin pediatrician Marjan Linnell, MD, told the committee in written remarks, “Transgender children are first and foremost, children,” and said medical care for transgender youth is evidence-based and proven to be effective.
“Gender-affirming care is part of the comprehensive, primary care we provide to our patients and should not be criminalized or stigmatized,” she wrote. “This bill rejects thoughtful and effective evidence-based treatment for a vulnerable group of children. It creates barriers that will cause Texas families irreversible harm and increases the risk of negative health outcomes for transgender youth.”
Her testimony represented TMA and several other organizations, including the Texas Pediatric Society and the Texas Academy of Family Physicians. Data show puberty suppression leads to improved mental health and decrease in suicidal thoughts for transgender youth, she added.
“The decision of whether and when to initiate gender-affirmative treatment is personal and involves careful consideration of risks, benefits, and other factors unique to each patient and family,” Dr. Linnell wrote.
Arkansas last week became the first state to outlaw gender-affirming treatment for transgendered youth when its legislature overrode a governor’s veto.
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