UNDER THE ROTUNDA
Expanded insurance coverage of telemedicine, one year of postpartum coverage for pregnant women in Medicaid, and improved continuity of care for their children – some of the Texas Medical Association’s biggest priorities – are all halfway to approval from the Texas Legislature.
The full House of Representatives on Wednesday passed House Bill 4 by Rep. Four Price (R-Amarillo), which would make permanent some of the allowances for expanded telemedicine use that were put in place during the COVID-19 pandemic. Those include payment for telemedicine for early childhood intervention services and Medicaid waiver programs. HB 4 is one of several TMA-backed measures pursuing both expansion and permanent payment parity for telemedicine services.
And with the passage of House Bill 133 by Rep. Toni Rose (D-Dallas), the House gave its approval to Medicaid coverage for women for no less than 12 months after giving birth. The chamber also passed House Bill 290 by Rep. Philip Cortez (D-San Antonio), which gives children on Medicaid six months of continuous coverage, plus an eligibility check that could qualify the child for an additional six months of coverage.
All three bills are now eligible for consideration by the Senate.
Patient autonomy in DNR decisions
One of TMA’s top experts on end-of-life care appeared before the House Public Health Committee on Wednesday hoping to persuade the committee to right a 4-year-old wrong in state law.
Dallas palliative care specialist Mark Casanova, MD, represented medicine at the Capitol for the second time in as many weeks to convey TMA’s support of House Bill 2943 by Rep. James Frank (R-Wichita Falls), a proposed fix to enhance patient autonomy in the state’s law regulating in-hospital do-not-resuscitate (DNR) orders.
HB 2943 would correct an error in 2017 legislation that currently prevents physicians from honoring patients’ wishes if those wishes are communicated separately to the physician. Dr. Casanova’s written remarks echoed what he told the Senate Health and Human Services Committee last week on a similar but broader measure, Senate Bill 1944 by Sen. Eddie Lucio (D-Brownsville).
“TMA agrees a surrogate should be able to change a do-not-resuscitate … decision he or she personally has shared with the physician,” Dr. Casanova said in his written comments on HB 2943. “However, no one – not the surrogate, not the physician, not the hospital, nor any organization – should be able to undo a patient’s personal decision on a DNR.”
TMA, he added, strongly recommends permitting physicians to act in accordance with a patient’s wishes, however they’re expressed.
“Current law improperly, needlessly, and regrettably compromises patient autonomy,” Dr. Casanova wrote. “It is not unusual for a patient’s own wishes to be different from a family member’s wishes for the patient.”
Property tax reduction for indigent care
In other action on the House floor, the full chamber also passed House Joint Resolution 25 and House Bill 457, both by Rep. Matt Shaheen (R-Plano), to allow a partial county homestead tax exemption for physicians who provide uncompensated care to indigent residents or Medicaid recipients in the county.
In written remarks on the bill last month to the House Ways and Means Committee, TMA said physicians who provide charity care “are providing a service that is valuable directly to the patient and indirectly to Texas taxpayers. In outpatient settings, for example, providing good ambulatory care can prevent bad outcomes for the patient that could become costly inpatient care at taxpayer expense. Few real options are available that address this problem head-on.”
TMA said it appreciated the proposed property tax reduction and Representative Shaheen’s intentions, but said it had questions about “how the system would work and how much effort would be required of both physicians and local jurisdictions.”
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