With less than three weeks left before the Texas Legislature adjourns, time is precious, and every vote advancing medicine’s agenda counts. And the Texas Medical Association got a big win Tuesday afternoon as House lawmakers voted to make insurers provide more transparency on prior authorization.
House Bill 4012 by Rep. Greg Bonnen, MD (R-Friendswood), would require HMO plans to provide a disclosure notice to patients when services are elective and require preauthorization. Among other information, the notice would have to include:
- The name and network status of “the licensed medical facility and any facility-based provider” the HMO expects will bill for the service; and
- An itemized estimate of the payments the HMO will make to the facility and those practitioners, as well as the patient’s financial responsibility, including “any copayment, coinsurance, deductible, or other out-of-pocket amount.”
The vote was 128-17, sending HB 4012 to the Senate.
Telemedicine payment parity
The House was scheduled to consider a telemedicine payment parity measure on Wednesday that would go a long way toward making telemedicine more worth it for physicians and accessible to more patients.
House Bill 980 by Rep. Arthur Fierro (D-El Paso) would require health plans to pay the same for a covered service delivered via telemedicine as they pay for the same service delivered in person. Both state and federal regulations on telemedicine payment were relaxed as a result of the COVID-19 pandemic, but HB 980 would make payment parity permanent for state-regulated plans.
Bolstering “prudent layperson”
Another TMA-priority measure to strengthen the prudent layperson standard in emergency care was also on the House calendar for Wednesday.
House Bill 2241 by Rep. Tom Oliverson, MD (R-Cypress), would prohibit insurers from punishing patients who use their reasonable judgment in making a trip to the emergency department, only to find out their condition wasn’t an emergency. The bill bars the health plans from denying coverage for emergency care resulting from the prudent layperson standard, “regardless of the final diagnosis of the conditions.”
Check out Friday’s Hotline for an update on HB 980 and HB 2241.
Stop the anti-vax folly; stop SB 1669
The anti-vaccination forces that help cook up legislative poison are at it again, and medicine needs your help. Check out TMA’s latest Action Alert to find out what you can do to help the House of Medicine stop Senate Bill 1669 by Sen. Bob Hall (R-Edgewood), which would make life-saving vaccines optional for everyone, including schoolchildren, health care employees, and elderly residents of long-term care facilities. Let lawmakers know that Texas can’t turn back the clock on controlling communicable diseases.