Rural Texas Physician

Winter 2016

Rural Texas Physician is a quarterly electronic newsletter catering to physicians in the many rural areas of Texas caring for patients and their communities. TMA’s grassroots membership is the strength of the association. For general inquiries or newsletter comments, email rural@texmed.org.

Medicaid Reenrollment Delayed to Sept. 25

Thanks to advocacy by TMA, Medicaid reenrollment has been delayed to Sept. 25. The previous deadline was March 24. Texas Medicaid encourages all doctors who have not yet submitted a re-enrollment application to begin this process immediately to avoid potential payment disruptions.  The Affordable Care Act requires all Medicaid health professionals to reenroll in the program at least once every five years (some professionals must reenroll more frequently). However, if you initially enrolled or reenrolled on or after Jan. 1, 2013, you will be required to reenroll by the date indicated on your enrollment letter.

The Texas Health and Human Services Commission and TMHP have improved the electronic enrollment portal to make it easier for doctors to complete the reenrollment process. (Physicians newly enrolling in Medicaid can use the portal also.) The enhancements apply to applications submitted through the TMHP website on or after April 26, 2015. 

The improved electronic application process allows you to:      

  • Upload supporting documentation;
  • Sign the enrollment agreement electronically (e-sign);
  • Receive guidance as you work on the application and see more accurate error messages to avoid mistakes;
  • Receive instruction on how to upload documents and submit the application using an e-signature; and 
  • Expedite processing of your application by reducing the need for printing and mailing documents.      

For physicians currently enrolled in Medicaid, the portal will prepopulate the application with demographic data pulled from the physician’s current account.

To be considered fully reenrolled by the Sept. 25 deadline, physicians must receive verification from TMHP that the application has been approved before that date. It currently takes about 32 days for applications to be processed. Thus, physicians should reenroll now to avoid gaps in enrollment. The reenrollment requirement also applies to physician assistants and advanced practice registered nurses.

To use the online application, you must have a TMHP user account and a user name (portal user ID). Refer to the TMHP Website Security Provider Training Manual for instructions on activating a TMHP user account. For more information about Medicaid provider reenrollment, visit the TMHP provider reenrollment page

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Doctors Can Prohibit Handguns in Medical Offices

House Bill 910 by Rep. Larry Phillips (R-Sherman) goes into effect Jan. 1, 2016, and it allows Texans with handgun licenses to openly carry their handguns in a hip or shoulder holster. TMA has received questions regarding whether physicians can post a notice at their practices prohibiting anyone from entering with a handgun — concealed or openly. The answer depends on the type of property the medical office is located on. Generally, a private property owner may post a notice prohibiting the carrying of handguns, but HB 910 contains many requirements. TMA’s white paper, “Prohibiting Concealed or Open Carry Handguns on Private Property,” has more information for physicians.

HB 910 generally authorizes the open carry of handguns (in a shoulder or belt holster) in Texas by anyone with a handgun license. There are exceptions to this — found in Texas Penal Code §§46.03 and 46.035 — including schools, school vehicles, polling places, courts, racetracks, airports, bars, sporting events, amusement parks, churches, nursing homes, and most hospitals (if the hospital or nursing home has given effective notice under Texas Penal Code §30.06 or §30.07).

Private property owners also may prohibit the open carry of handguns orally, with a card or other document, or by posting a sign that reads “Pursuant to Section 30.07, Penal Code (trespass by license holder with an openly carried handgun), a person licensed under Subchapter H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a handgun that is carried openly” in both English and Spanish in contrasting colors with block letters at least one inch in height, clearly visible to the public at entrances to the property.

Also, on Jan. 1, 2016, the language for a sign prohibiting people from carrying a concealed handgun changes. As of that date, the sign must say, “Pursuant to Section 30.06, Penal Code (trespass by license holder with a concealed handgun), a person licensed under Subchapter H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a concealed handgun.” 

Please note: §30.07 of the Penal Code relating to the open carry of handguns requires a sign “at each entrance to the property,” while §30.06 relating to the concealed carry of handguns only requires a sign “displayed in a conspicuous manner clearly visible to the public.”

A common question is whether private property owners will need two signs to cover both the concealed and open carry of handguns, or if one will suffice. The law indicates the language required by the Penal Code may not be altered or combined into one paragraph or sentence. The language must be identical to that in the statute for a private property owner to rely on it as the means for providing notice to handgun license holders. 

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Help Shape the Next Generation of Medicine

The Texas Chapter of the American College of Physicians (TXACP) is seeking physician mentors for the summer 2016 General Internal Medicine Statewide Preceptorship Program (GIMSPP).  

Preceptors open the doors to their practice to provide a medical student personal instruction, training, and supervision for three to four weeks. Students get the opportunity to observe the daily routine of the physician, experiencing the variety the practice of internal medicine provides. For physicians, benefits of preceptorship include:     

  • The opportunity to give back, while rekindling your passion for medicine; 
  • The ability to help advance primary care in Texas; and
  • An enriching experience for the student and preceptor.    

“GIMSPP isn’t just good for the students; it’s good for the preceptors,” said Susan Andrew, MD, of Dickinson, TXACP member and long-standing preceptor.  

Preceptors must be board certified in internal medicine, possess a current Texas medical license with no restrictions from the Texas Medical Board, and practice at least 40 percent to 50 percent general internal medicine apart from any other subspecialties.  

For more information on the program or to download the preceptorship application, visit the TXACP website

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HHSC Holds Information Sessions on STAR Kids Program

The Texas Health and Human Services Commission (HHSC) will conduct information sessions around the state this month and in February to educate doctors and families on the new STAR Kids program. The new managed care program will provide Medicaid benefits to those younger than 21 who have disabilities and who receive a Medicaid waiver or Supplemental Security Income in the Medicaid program.  

Visit the HHSC website for session dates and locations. If you’re unable to attend a session, you can register online for a March 4 webinar from 11 am to 1 pm.  

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Take Action to Avoid a Medicare Meaningful Use Penalty

While Medicaid does not penalize physicians who are not meaningful users of their electronic health record (EHR), Medicare does.  

Physicians participating in the Medicaid meaningful use program must prove 30-percent volume of Medicaid encounters each year to continue participation, and through Medicaid participation, physicians avoid a penalty on their Medicare allowable charges. The meaningful use program allowed physicians to switch between the Medicare and Medicaid meaningful use programs one time before 2014. There are steps physicians need to take if they’re no longer eligible for Medicaid meaningful use but need to take action to prevent a Medicare penalty.  

The Centers for Medicare & Medicaid Services (CMS) has an alternate attestation method for physicians who can’t qualify for a Medicaid payment and who can’t switch back to Medicare, but who still need to attest to meaningful use to avoid the Medicare penalties. Last year, CMS had a paper form to accomplish this. For the 2015 payment year, it will be through the CMS Medicare attestation portal.  

The CMS portal was available for modified Stage 2 meaningful use attestations as of Jan. 4, and physicians have until Feb. 29, 2016, to complete their attestations. TMA recommends you not wait until the last minute in case system problems arise.  

For questions on meaningful use or other practice technologies, contact TMA’s health information technology hotline by email or by calling (800) 880-5720.  

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New Year, Big Savings: Save 20 Percent on CME

The New Year is here, and it’s the perfect time to visit the TMA Education Center. This month, TMA is offering an additional 20 percent off your already discounted member pricing for continuing medical education.  

This sale price includes publications, on-demand webinars, and podcasts. The discount doesn’t apply to live CME programming.  

Dozens of courses are on sale, including popular programs covering ethics, risk management, compliance, and practice operations. Visit the TMA Education Center, and enter coupon code NEWYEAR20 at checkout to start saving. The sale ends Jan. 31. 

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 Save the Date

Mark your calendar for the 2016 TMA Winter Conference Jan. 29-30 at the Hyatt Regency Austin. Check out the General Session agenda and the full list of the business meetings for boards, councils, and committees. Although the special group rate is sold out, you still can make a hotel reservation at the Hyatt Regency Austin. The conference provides an opportunity for physicians and medical students to conduct TMA business, obtain continuing medical education, and network with peers. 

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