Related Stories

Medicaid, CHIP Postpartum Coverage Extension Will Take Effect March 1 - 02/08/2024

After a multi-session advocacy effort by the Texas Medical Association, specialty societies, and women’s health advocates, Texans who are enrolled in Medicaid or the Children’s Health Insurance Program and who are pregnant or become pregnant will see their postpartum coverage automatically extended starting March 1.


Prior Auth Processes to Streamline Under Medicare Advantage, Other Federal Programs - 01/23/2024

Physicians who care for patients enrolled in federal health plans can expect shorter prior authorization response times and other process improvements in coming years, thanks to longstanding advocacy by the Texas Medical Association and others in organized medicine.


Spending Growth Rate for Physician Services Slows - 01/09/2024

Although spending on physician and clinical services increased 2.7% year-over-year to $884.9 billion in 2022, the spending growth rate fell, due in part to a slowdown in the use of such services and in physician prices. In comparison, spending on physicians and clinical services grew 5.3% in 2021.


No Prior Auth Required for Generic Asthma Meds Following Medicaid Formulary Change - 12/19/2023

As of Dec. 15, physicians can prescribe generic asthma medications previously listed as non-preferred on the Medicaid preferred drug list without needing prior authorization.


Shielding the Gold Card Law: TMA Fights to Guarantee Gold Card is Implemented as Intended - 12/12/2023

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


Send TMA Your Prior Authorization Nightmare Stories - 12/11/2023

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ experience with insurance companies’ prior authorization requirements and approval processes.


On the Mend: Maternal Care Wins Encourage Better Outcomes in Texas - 11/05/2023

Twelve months of postpartum coverage and other maternal wins encourage physicians for better outcomes.


First Steps: TMA Secures Medicaid Physician Rate Increases With Hopes for Momentum - 11/05/2023

TMA helped secure the first Medicaid physician rate increases in decades in hopes it will build momentum for future gains.


Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care - 11/02/2023

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years.


Coming Unwound: Mass Disenrollments Hurt Patients and Physicians Alike - 11/02/2023

The end of continuous Medicaid eligibility has led to mass disenrollments, hurting patients and physicians alike.


Reminder: Revalidate Your Medicare and Medicaid Enrollment - 09/25/2023

Starting Nov. 1, physicians must use a revised Medicare enrollment application. On the Medicaid front, physicians who were due to re-up their enrollment during the COVID-19 public health emergency get a grace period to complete this requirement, but all physicians must review and update their practice addresses. Read more.


TMA Pushes Back Against Planned Vaccine Payment Cuts - 09/06/2023

As the influenza virus continues to spread statewide, the Texas Medical Association and other specialty societies have taken a stand against a plan to cut by almost 36 percent payments to physicians who administer a flu vaccine in their offices.


Zika Reminder: Mosquito Repellent Covered Under Medicaid - 09/06/2023

To protect against Zika, mosquito repellent prescriptions are covered through Medicaid and other state programs, including the Children’s Health Insurance Program.


How to Identify Dual-Eligible Patients - 08/23/2023

The Centers for Medicare & Medicaid Services has been working to rein improper billing of Qualified Medicare Beneficiary program-enrolled patients, who have both Medicare and Medicaid coverage. You can verify patient status in several ways.  


United Will Eliminate Prior Authorization Requirements for Certain Procedures - 08/11/2023

Physicians have long complained about onerous prior authorization requirements, which often delay care and sometimes have catastrophic consequences. One payer seems to be listening.


Medicaid Drops Thousands of Texans; Many Still Qualify - 08/07/2023

Texas’ effort to “unwind” continuous Medicaid coverage – a pandemic-era benefit – has resulted in a steep coverage cliff. State officials and advocates urge physicians to help soften patients’ falls. Read more.


Federal Prior Auth Bill Filed in Congress - 07/25/2023

U.S. Rep. Michael C. Burgess, MD (R-Lewisville), is following his fellow Texas physicians’ lead on curbing insurers’ hassle-laden prior authorization burdens, introducing a federal bill similar to the “gold-card” law the Texas Medical Association proposed and championed into law at the state level.


Mastering Quality Reporting: Ease the Challenge of Quality Reporting - 07/10/2023

Understanding the maze of quality reporting pathways may help ease the challenge.


Physician-Led Results: Medicaid Rate Increase - 06/28/2023

Texas physicians aimed to win a focused Medicaid rate increase in this year’s Texas legislative session, one designed to improve coverage for children and young mothers. For the first time in more than a decade, they got it.


Physician-Led Results: Insurance - 06/21/2023

TMA can count several insurance-related legislative wins this session, including an additional prior authorization reform for vulnerable patients and new protections against bad health plan practices for patients and physicians alike.


United Ties New “Advance Notification” of GI Procedures to Gold-Carding - 06/12/2023

Rather than go through with its controversial prior authorization policy for gastroenterology endoscopy procedures on June 1, UnitedHealthcare (UHC) announced an equally concerning “advanced notification” pilot program requiring early notification and the submission of substitute documentation for certain gastrointestinal procedures.


TMA Joins Fight Against Prior Auth for Gastroenterology Services - 05/15/2023

The Texas Medical Association joined roughly 200 national and state medical specialty societies, patient organizations, foundations, and physician groups in a widespread call urging UnitedHealthcare (UHC) to halt its nationwide policy requiring prior authorization for gastroenterology endoscopy services that take place on or after June 1.


CMS Proposal Could Alleviate Prior Auth Stress in Federal Programs - 04/26/2023

The Texas Medical Association’s years of lobbying for prior authorization reform paid off with the passage of Texas’ “gold-card” law in 2021. Now the framework is gaining traction at the federal level, where a proposal would ease onerous preapproval requirements under certain public health plans.


Survey: Physicians Overwhelmingly Say Prior Authorizations Lead to Waste, Patient Harm - 03/29/2023

Amid the Texas Medical Association's ongoing advocacy for prior authorization reforms at state and federal levels, yet another survey underscores the patient and financial harms that result from these onerous requirements.


United To Require Prior Auth for Gastroenterology Services - 03/28/2023

Citing overutilization, a new nationwide UnitedHealthCare policy piles on to physicians’ prior authorization hassles, now requiring preappovals for many gastroenterology endoscopy services that take place on or after June 1.