The conference committee collectively appointed by both chambers of the Texas Legislature is in the process of negotiating the final 2022-23 state budget. And the Texas Medical Association is in the thick of the action as this year’s legislative session hurtles into its final three weeks.
TMA is working to impart the House of Medicine’s perspective on the 10 budget negotiators, hoping they heed as much as possible of what TMA requested last weekend in a detailed letter to the conference committee.
As is the case every session, the House and Senate have their own versions – and to some extent, their own visions – of what the two-year funding package should look like. Ideas from both visions make sense for the state’s health care future, and both collectively contribute to TMA’s asks of the conferees.
Among those asks, TMA is urging the budget hagglers to support:
- Creating a Blue Ribbon Task Force to explore options to expand health care coverage – either through extension or renewal of the Medicaid 1115 Transformation Waiver or through a separate waiver request – and to examine ways to increase physician payment rates through value-based payment or alternative payment models.
- Fully funding the state’s graduate medical education (GME) grant program at $199.1 million to help the state maintain the target 1.1-to-1 ratio of first-year GME positions to medical school graduates. (Other proposals have committed either $150 million or $157 million to the GME program, which wouldn’t be enough.)
- Increasing funding for the Texas HIV Medication Program by $31.2 million to help account for the rising costs of those medications in recent years.
- Approving $70 million for a 7% payment increase for physicians treating children in Medicaid 3 years old or younger.
- Maintaining level funding for the state’s Early Childhood Intervention program (around $340 million for the biennium) and for tobacco cessation ($18.5 million).
- A report evaluating continuity of care for women who age out of Medicaid and the Children’s Health Insurance Programs to form a clearer picture of the impact the state’s administrative renewal process has on enrollment in women’s health programs.
Medicine’s requests to lawmakers came just ahead of state Comptroller Glenn Hegar’s news that Texas has more money for budgeting than previously thought. Last week, Comptroller Hegar revealed a revised projection that shows about $3.1 billion more is available for the 2022-23 budget than the last projection indicated.
BILLS ON THE MOVE
There’s one completed win for medicine so far – as in, one bill that Gov. Greg Abbott has signed into law. Other major pieces of TMA’s agenda are on a good track to follow. But it’s getting late in the game. Here’s a look at some of medicine’s priority legislation that’s still alive.
Signed by the governor
House Bill 1445 by Rep. Tom Oliverson, MD (R-Cypress), prevents a tax on outsourced medical billing services that was set to go into effect this October. The tax would have subjected both patients and physicians to ripple-effect costs. Governor Abbott signed HB 1445 on April 30, ending a process that featured crucial assistance for medicine by Comptroller Hegar.
Passed both chambers (with a caveat)
House Bill 5 by Rep. Trent Ashby (R-Lufkin) expands broadband service in the state, targeting areas where less than 80% of addresses have access to broadband service. An amended version of HB 5 passed the Senate, and the House didn’t agree to those amendments, so a conference committee must work out the differences.
Passed one chamber
The following measures passed their parent chamber:
House bills
- 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 1646 by Rep. Stan Lambert (R-Abilene) would prohibit insurers from, among other things, adding prior authorization or imposing a step-therapy restriction on a prescription drug, if the insurer already approved the drug the previous plan year and the patient’s physician says the drug is the most appropriate treatment.
- House Bill 1763 by Representative Oliverson would prohibit pharmacy benefit managers from “clawing back” pharmacies’ insurance payments once a claim is complete.
- House Bill 2929 by Rep. Greg Bonnen, MD (R-Friendswood), would add more specificity to the law that prevents insurers from taking “any retaliatory action” against a physician who files a complaint on a patient’s behalf.
- House Bill 3233 by Rep. Joe Moody (D-El Paso) would allow for needle exchange pilot programs to help curb infectious and communicable diseases.
- House Bill 4139 by Rep. Garnet Coleman (D-Dallas) would establish a state office for health equity to examine social determinants of health.
Senate bills
- 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.
- Senate Bill 248 by Sen. Nathan Johnson (D-Dallas) requires electronic cigarette retailers to obtain permits, establishing a framework to regulate vaping products similarly to other cigarette products.
- Senate Bill 672 by Sen. Dawn Buckingham, MD (R-Lakeway), requires payment for Medicaid 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 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. HB 3459 was eligible for final House passage as of last Friday.
- House Bill 4012 by Representative Bonnen would require health plans to disclose prices for certain services requiring preauthorization.
- 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. HB 4272 was eligible for final House passage as of last Friday.