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    Health Care Doomsday Reauthorization of the TMB andMedical Practice Act

     

    85th Legislative Session Recap

    By Stephanie Triggs 

    May 2, 2017, was the last First Tuesday lobby day of the 85th Texas Legislative Session. TCMS members, including residents and medical students were joined by Alliance members to lobby state senators and representatives—“asks” were made of them and their legislative aides to vote for good bills or against bad bills affecting patients and physicians. 

    The session ended after 140 days on May 29. As usual, there were good, bad and ugly bills relating to health care in the State of Texas. A bill of particular interest was one to reauthorize the Texas Medical Board (TMB) and the Medical Practice Act beyond their scheduled demise of August 29, 2017. Due to a long-brewing feud between the House and Senate over unrelated issues, the bill did not pass. Governor Greg Abbott has called a special session to begin on July 18. Among the 20 items the governor set to be debated in the special session is the reauthorization of the TMB and the Medical Practice Act—the governor clearly stated that lawmakers must reauthorize the TMB before moving on to the other 19 items.

    Budget

    The final budget for the 2018-2019 biennium totals $216.7 billion in all funds which includes $106.8 billion in state general revenue dollars. The budget also draws $1 billion from the Rainy Day Fund. Among items included in the budget related to medicine:
    Medicaid: approved $427 million in general revenue in Medicaid cost-containment (technically the rider applies to all HHSC agencies, but most of the savings would come from Medicaid).
    Graduate Medical Education: added $44 million for GME expansion grants and increased the GME formula funding by $4.3 million. The Family Medicine Residency Program was cut by $6 million, and the Physician Education Loan Repayment Program was cut by $8.4 million.
    Department of State Health Services: roughly $30 million was cut in public health preparedness and reduces funding for immunizations, HIV/AIDS, infectious diseases, chronic disease prevention and the Children with Special Health Care Needs program. 

    Medicine’s Bills Signed by the Governor

    Senate Bill 507 which expands the billing mediation process to all physicians and others providing out-of-network services at certain in-network facilities and expands mediation to out-of-network emergency care situations. Keeps in place the $500 threshold for mediation.
    Senate Bill 680 empowers physicians to override health plans’ step therapy protocols, allowing them to continue prescribing an effective medication even if the insurer’s step therapy plan calls for a change in medication.
    Senate Bill 1107 establishes a statutory definition for telemedicine and clarifies that the standard of care for traditional in-person medical settings also applies to telemedicine services. The bill makes it clearer that telemedicine is not a distinct service, but a tool physicians can use. It also prohibits health plans from excluding telemedicine from coverage just because the care isn’t provided in person.

    House Bill 62 bans texting while driving statewide.

    House Bill 2561 relates to the Physician Drug Monitoring Program (PDMP). It includes initiatives to identify potentially harmful prescribing or dispensing patterns or practices that might suggest drug diversion or “doctor shopping.” Calls for physicians and all other prescribers and dispensers to check the PDMP before prescribing any of the listed classes of medications after September 1, 2019.

    Senate Bill 922 by TCMS member and Texas State Senator Dawn Buckingham, MD allows Medicaid to reimburse school districts and open-enrollment charter schools for telehealth services provided to students.

    Senate Bill 1148, another bill from Dr. Buckingham, prohibits the state from using maintenance of certification (MOC) as a requirement for state licensure or renewal or insurance participation. It permits health facilities to use MOC if hospital medical staff votes it appropriate for their own hospital.

    House Bill 435 allows DSHS to post signs prohibiting handguns at Texas’ 10 state mental health hospitals.

    TMA/TCMS Supported Bills that Did Not Pass

    Senate Bill 1929 that would have continued the Maternal Mortality and Morbidity Task Force at DSHS, which is helping the state identify the causes of Texas’ high and growing rates of maternal mortality and morbidity.
    House Bill 477 would have required health coverage providers to educate consumers purchasing individual health benefit coverage.
    House Bill 1908 would have raised the age to purchase tobacco products from 18 to 21. A compromise in the budget requires HHSC and the comptroller to study how increasing the legal age for purchasing and using tobacco could result in Medicaid savings due to fewer pre-term and low-birth weight births.
    House Bill 2249 AKA the “Parents’ Right to Know” bill, would have required the state to report vaccination exemption-rate data at the more precise school level rather than at the school district level.
    House Bill 2760 would have required updates of health plans’ network directories.
    House Bill 3124 would have allowed physicians in physician-led accountable care organizations to receive any share physician-specific comparison data and information. 

    Bills TMA/TCMS Opposed that Died

    House Bill 1415 would have granted advanced practice registered nurses full, independent practice and prescribing authority without physician supervision.
    Senate Bill 728 would have allowed patients 30 days of direct access to treatment by physical therapists without first being seen by a physician.
    House Bill 719 would have indexed the caps established by the 2003 tort reform law according to changes in the Consumer Price Index.
    House Bill 593 would have allowed psychologists prescribing authority, a practice reserved for medical school-trained physicians.
    Senate Bill 2127 would have prohibited credit report agencies from including a collection amount for certain health care services provided by out-of-network physicians on a credit report.
    House Bill 1675 would have allowed health plans to require physicians to accept virtual credit cards for payment of services rendered.
    House Bill 1070 would have prohibited physicians from refusing to care for a patient based on his or her immunization status.
    House Bill 1124 would have made it easier for parents to opt-out of vaccinating their children.
    House Bill 3476 would have required pre-participation electrocardiograms for all school student athletes, a test that not every student athlete needs and one that could result in false positives, which could ultimately harm students and their parents. 

    Now is the time to gear up for the 2018 elections and fundraising activities. Check out www.texpac.org to see how you can help elect medicine-friendly candidates.|
    Stay tuned for more information regarding the special legislative session and the reauthorization of the Texas Medical Board and Medical Practice Act. 

    For additional information on the 85th Legislature contact Stephanie Triggs, TCMS senior director of physician services and community relations, at striggs@tcms.com or 512-206-1124.