UNDER THE ROTUNDA
Welcome to the first day of the final month of the Texas Legislature’s 2021 session. Expect the flurry of hearings and legislative movement to swirl even faster this week as the House of Medicine and its like-minded lawmakers furiously push for progress ahead of the May 31 finish line.
E-cigarette regulation
The Texas Medical Association’s push to curb youth electronic cigarette use continues Monday in the House Ways & Means Committee. That panel is scheduled to take up Senate Bill 248 by Sen. Nathan Johnson (D-Dallas), which requires e-cigarette retailers to obtain permits, establishing a framework to regulate those products similarly to the way other cigarette products are regulated.
Austin pediatrician Maria Monge, MD, will testify at today’s hearing for TMA, the Texas Pediatric Society, and others. Her written testimony notes that e-cigarettes have been the most commonly used tobacco product among teens since 2015. Along with concerns about nicotine addiction and the known carcinogens used in the liquid solution of e-cigarettes, teens who vape are more likely to become cigarette smokers than nonvaping peers, she wrote.
“Texas has made major progress in addressing tobacco-related deaths. However, with the increase in e-cigarette use and the progression from vaping to smoking, it is estimated that as many as 498,000 Texas teens will die prematurely from smoking if it is not curbed. We cannot move backward in addressing tobacco-related injury and mortality,” Dr. Monge wrote.
SB 248 passed the Senate on April 8. If it gets voted out of House Ways & Means, it will be eligible for a vote on the House floor.
Broadband expansion clears the Capitol
The Senate took a major step Friday afternoon when it gave its signoff to the statewide broadband expansion bill, House Bill 5 by Rep. Trent Ashby (R-Lufkin), which medicine sees as essential to maximizing the reach and effectiveness of telemedicine. The Senate’s approval sends that measure to the governor’s desk.
HB 5 would create a state broadband development office, which would in turn create a program to award financial incentives, including grants and loans, for broadband service expansion. The legislation defines minimum upload and download speeds for broadband service and targets broadband expansion in areas where less than 80% of addresses have access to broadband service.
Protections against insurer retaliation clear House
Also on Friday afternoon, the House gave its approval to boosting protections for physicians from insurer retaliation if doctors file a complaint against a health plan.
House Bill 2929 by Rep. Greg Bonnen, MD (R-Friendswood), would add more specific, prohibited retaliatory activities to existing law, which says health plans can’t take “any retaliatory action” against a physician who files a complaint on a patient’s behalf. Specifically, the bill would bar health plans from implementing penalties in contract negotiations and from engaging in unfair or deceptive contract negotiation practices.
Senate approves bill prohibiting child gender care
Despite TMA’s opposition, a measure that would prohibit gender-affirming health care for children under 18 has passed the Senate.
Senate Bill 1646 by Sen. Charles Perry (R-Lubbock) would generally make it a crime to perform gender-transitioning or gender-reassignment surgery on a child, or to administer “a puberty suppression prescription drug or cross-sex hormone” to a child for gender transitioning or reassignment. It passed its parent chamber on Wednesday 18-12 and is now in the hands of the House.
TMA objected to the bill in April, telling the Senate State Affairs Committee that gender-affirming care is evidence-based and part of comprehensive primary care services. The decision on whether to pursue such care “is personal and involves careful consideration of risks, benefits, and other factors unique to each patient and family,” TMA added.
BILLS ON THE MOVE
HB 5’s passage marks the second TMA-priority bill to clear both chambers. Here’s a progress report on other bills on TMA’s 2021 agenda.
Sent to the governor
House Bill 1445 by Rep. Tom Oliverson, MD (R-Cypress), would 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 the 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 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) would severely restrict insurers’ ability to institute prior authorization on prescriptions for autoimmune diseases.
- House Bill 1763 by Representative Oliverson would prohibit pharmacy benefit managers from “clawing back” pharmacies’ insurance payments once a claim is complete.
- House Bill 3233 by Rep. Joe Moody (D-El Paso) would allow for needle exchange pilot programs to help curb infectious and communicable diseases.
- 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 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 Representative Bonnen 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.
- House Bill 4272 by Rep. Stephanie Klick (R-Fort Worth) would modernize the state’s immunization registry (ImmTrac2) and allow for disaster immunization records to be retained for at least seven years, and possibly longer with a person’s consent.
- Senate Bill 6 by Sen. Kelly Hancock (R-North Richland Hills) would increase liability protections for physicians and other health care workers during a disaster or pandemic. SB 6 cleared the House Judiciary and Civil Jurisprudence Committee last week.
- Senate Bill 672 by Sen. Dawn Buckingham, MD (R-Lakeway), requires payment for Medicaid behavioral health services that are classified as collaborative care.