After about a half-day of wrangling by the Texas House of Representatives over the state budget proposal, a revised 2022-23 state funding scheme emerged Thursday, with medicine claiming victories – such as bumps to behavioral health-related hospital funding – and defeats, like a rejected proposal to expand coverage for uninsured Texans.
The House unanimously passed its amended version of the Senate budget bill late Thursday night after debate over about 11 hours and hundreds of proposed amendments. That sends the bill back to the Senate, after which it will all but certainly head to a conference committee to reconcile the two chambers’ visions for passage.
Wins (for now)
A rider by Rep. Stephanie Klick (R-Fort Worth) added $30 million more over the biennium to fund inpatient psychiatric beds in community mental health hospitals, split evenly between rural and urban areas. Before the rider, the proposed budget allocated $138 million for community mental health hospitals for each year of the biennium.
Rep. Trent Ashby (R-Lufkin) then amended Representative Klick’s rider to add more funds for rural-hospital Medicaid payments: about $23.5 million in general revenue for 2022, and a little more than $24 million in general revenue for 2023. In total rural hospitals would receive more than $123 million in state and federal funds for Medicaid services during 2022-23.
Also accepted by the House was an amendment from Rep. Garnet Coleman (D-Houston) to pursue for the second time an extension of Texas’ Medicaid 1115 Transformation Waiver, which provides funding for safety-net hospitals and health systems. The Centers for Medicare & Medicaid Services announced last week that it was withdrawing its approval of a 10-year extension of the waiver, meaning it’s set to expire on Sept. 30, 2022.
Losses (for now)
The waiver pursuit fared better than Representative Coleman’s amendment to pursue a broader Texas Medical Association-supported “Texas solution” to expand coverage in Medicai, which failed by a vote of 80-68. The proposal would have been an impetus for the state to negotiate for morefederal dollars to “maximize the reduction in the number of uninsured residents of this state, promote personal responsibility in health care, increase the efficiency and accessibility of the delivery of health care services in this state, and reduce health care costs to the state.”
The House also allocated only $157 million for the graduate medical education (GME) program, about $42 million short of the funds needed to maintain the state’s preferred ratio of GME spots to medical school graduates in Texas. The Senate previously included the full funding necessary to sustain the program, and TMA will press the conference committee to restore that money in the final budget to help keep Texas medical school graduates in-state.
One other key amendment
Any federal funds for COVID-19 relief that come to Texas after the regular session will have to be meted out in a special session. That came courtesy of an adopted amendment by Rep. Geanie W. Morrison (R-Victoria), which stipulated that money that comes to Texas from “any COVID-19 relief act,” such as the American Rescue Plan Act or the CARES Act will require a session to allocate. That means any federal money that comes in after adjournment in May will require a special session to determine how it’s used.
BILLS ON THE MOVE
At this writing, one of medicine’s priority bills has moved through both the House and the Senate. Others have made encouraging progress, but much work remains for the house of medicine. With 35 days left in the session, here’s some of the progress TMA has made on its 2021 agenda.
Sent to the governor: House Bill 1445 by Rep. Tom Oliverson, MD (R-Cypress) to prevent a tax on outsourced medical billing services that was set to go into effect this October. The tax would subject both patients and physicians to ripple-effect costs. Both the House and Senate signed off on the bill with zero “no” votes.
Passed one chamber: The following measures have each passed their parent chamber and are eligible for consideration on the other side of the Capitol:
- House Bill 4 by Rep. Four Price (R-Amarillo) would make permanent some of the allowances for expanded telemedicine use that were put in place during the COVID-19 pandemic, such as payment for telemedicine for early childhood intervention services and Medicaid waiver programs.
- House Bill 5 by Rep. Trent Ashby (R-Lufkin) would provide for expanded broadband service across Texas. Thus far, HB 5 is the only bill on this list that has gotten a hearing in the opposite chamber.
- House Bill 133 by Rep. Toni Rose (D-Dallas) would provide pregnant women on Medicaid with continuous coverage under the program for 12 months postpartum.
- House Bill 290 by Rep. Philip Cortez (D-San Antonio) would improve continuity of care for children on Medicaid by streamlining eligibility checks.
- House Bill 907 by Rep. Julie Johnson (D-Farmers Branch) severely restricts insurers’ ability to institute prior authorization on prescriptions for autoimmune diseases.
- Senate Bill 248 by Sen. Nathan Johnson (D-Dallas) establishes licensure requirements for retailers selling electronic cigarettes and vaping products, setting up a framework to regulate them in a way similar to other cigarette products.
- Senate Bill 672 by Sen. Dawn Buckingham, MD (R-Lakeway) requires payment for Medicare behavioral health services that are classified as collaborative care.
- Senate Bill 1490 by Sen. Brandon Creighton (R-Conroe), would ensure the availability of clerkships for Texas medical school students by addressing the Texas Higher Education Coordinating Board’s process by which it grants authorization to private, out-of-state medical and other professional schools to operate in the state.
Passed out of committee
Committees have given their signoff to these TMA-supported measures, qualifying them for consideration on the floor of their parent chamber:
- House Bill 1763 by Representative Oliverson to prohibit pharmacy benefit managers from “clawing back” pharmacies’ insurance payments once a claim is complete.
- House Bill 2142 by Rep. Hubert Vo (D-Houston) would require the Texas Department of Insurance to conduct examinations of certain insurers’ prior authorization activities at least annually to make sure health plans are following their obligations under the law.
- House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood) would allow physicians who achieve a certain percentage of prior authorization approvals for a service to be “gold-carded” out of prior auth for that service the following year. The bill also would require utilization reviews to be conducted by physicians of the same or a similar specialty as the doctor who requested approval for the treatment.
Key bills still in committee
Medicine-supported measures that have received a hearing and been left pending in committee thus far include:
- House Bill 980 by Rep. Arthur Fierro (D-El Paso) to establish that health plans must pay for a covered service delivered via telemedicine at the same rate that they pay for the same service in person.
- House Bill 2035 by Representative Johnson would reinforce the prudent-layperson standard in emergency care, making it illegal for utilization review agents to deny a claim based on the final diagnosis.
- House Bill 2943 by Rep. James Frank (R-Wichita Falls) to correct an error in the state’s advance directives law. The bill would enhance patient autonomy in the law regulating in-hospital do-not-resuscitate orders by allowing physicians to honor patients’ wishes if they’re communicated separately to the physician.
- House Bill 4272 by Representative Klick to modernize the state’s immunization registry and allow for disaster immunization records to be retained for at least seven years, and possibly longer with a person’s consent.
Just one First Tuesdays left
Next week brings your last chance to join the virtual “White Coat Takeover” when TMA hosts its final remote First Tuesdays at the Capitol on May 4. By then, only 27 days will remain in this session. Register for free today to get an update from TMA’s lobby team on what issues and bills are still in play, and what you can do to help in the final stretch before the legislature adjourns.
Easy ways to get involved in TMA advocacy
Your participation is a vital component of our legislative success. Join our advocacy efforts today. Besides taking part in First Tuesdays, here are some other ways you can help.
Stay up to date on bills TMA is following closely. And take advantage of other opportunities to get involved with our advocacy efforts.