Stories from Texas Medicine, December 2023

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 04/09/2024

The Texas Medical Association supported the patient protections in the federal No Surprises Act but also knew from the beginning that the law's payment arbitration provisions were flawed and could give insurers an advantage.

Shielding the Gold Card Law: TMA Fights to Guarantee Gold Card is Implemented as Intended - 04/09/2024

Texans earned one of its most prolific victories with its prior auth exemption law but still fights to guarantee it's implemented as intended.

RICO Settlements: TMA's Leadership Against Payer Abuses Resulted in Relief, Reform - 04/09/2024

Back in 2001, the Texas Medical Association and the other plaintiffs alleged the nation’s major health plans had conspired to delay and reduce payments to clinicians and hospitals; the resulting lawsuits, brought under the federal Racketeer Influenced and Corrupt Organizations Act (RICO), represented a watershed moment in TMA history.

Widening the Net: New RSV Preventions Can Reduce Seasonal Burden of Disease - 12/04/2023

These new preventive treatments for RSV can help reduce seasonal burden of disease.

Closing the Gap: New Texas Network Adequacy Law Tackles Waivers - 12/04/2023

Although Texas has some of the strongest network adequacy rules in the country, poor enforcement and an overused waiver system have weakened physician practice viability and patients’ access to in-network care; thanks to advocacy by the Texas Medical Association, this will soon change.

Misdirected: Health Plan Directories See Damaging Gaps Awaiting Final Rules - 12/04/2023

Health plan directories see damaging gaps while awaiting No Surprises Act final directory rules – and accountability.

All in Good Faith: No Surprises Act Requires Practices to Provide Good Faith Estimates of Charges - 12/04/2023

No Surprises Act transparency provisions require practices to provide patients good faith estimates of expected charges – on strict timelines