We’re officially in the final week of the Texas Legislature’s 2021 session, and the next few days figure to be a furious storm of finalizing, gear-shifting, and negotiating at the Capitol.
While the Texas Medical Association attempts to give some key legislation that final push toward Gov. Greg Abbott’s desk ahead of adjournment on May 31, at least the state budget proposal he will receive for 2022-23 has come into focus.
The budget agreement: Key pieces
The conference committee charged with reconciling the House’s and Senate’s budget desires into a final package reached an agreement last week. If its version is the one Governor Abbott signs, the House of Medicine will come away with some important victories.
In one of the most important wins, the conference committee recommended the Senate’s proposed funding of $199.1 million for the state’s graduate medical education grant program. That funding level – about $42 million more than the House proposed – will enable the state to maintain its 1.1-to-1 ratio of residency slots per medical school graduate.
Among other budget recommendations of particular import to medicine:
- The House version of the budget had previously included a 7% Medicaid physician payment increase for treating children 3 years old and younger. Instead, conferees decided to direct the Texas Health and Human Services Commission (HHSC) to study the cost-effectiveness of such a payment increase. HHSC will report its findings by Nov. 1, 2022. If it finds such a pediatric payment increase to be cost-effective, HHSC can implement a pilot program for the pay bump beginning in March 2023.
- Overall funding for women’s health would reach $352 million over the biennium, an increase of $10 million.
- Conferees took TMA’s recommendation to increase funding for the Texas HIV Medication Program by $36.3 million. They also recommended adoption of a state directive to, among other things, maximize the availability of federal funds for the program.
- Funding for the Texas Mental Health Care Consortium was increased by more than $19.5 million, to $119 million.
- Conferees left a $350 million Medicaid cost containment proposal in the budget, which could be bad news for medicine. However, the rider directs HHSC to pursue increased use of telehealth as a way to curb costs.
The House and Senate are expected to approve the conference committee’s recommendations this week. However, once the budget hits Governor Abbott’s desk, he could make changes using his line-item veto power.
Bills in the home stretch
In some good news on two TMA-opposed measures, Senate Bill 993 by Sen. Kelly Hancock (R-North Richland Hills) started off as a TMA-opposed bill to allow optometrists to perform eye surgery. But after intense negotiations, a compromise by the Texas Ophthalmological Association and organized optometry resulted in a measure TMA now supports.
The agreement removed all references in the bill to surgery, allows therapeutic optometrists authority to manage mild to moderate glaucoma without co-management by an ophthalmologist, and establishes a rigorous complaint and disciplinary process that requires participation of both ophthalmologists and therapeutic optometrists. The bill was on the House’s Sunday calendar for final approval.
Meanwhile, Senate Bill 917 by Sen. Bryan Hughes (R-Tyler) – a TMA-opposed measure that originally would have required physicians to maintain life-sustaining treatment on a patient indefinitely until the patient could be transferred elsewhere – is no longer able to advance. TMA opposed the measure because its potential requirement to provide medically inappropriate treatment that makes a patient suffer goes against physicians’ creed to “do no harm.”
Here’s an update on other priority bills TMA is trying to get through in this final week:
- House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood), which would allow physicians to “gold card” out of the prior authorization process for certain services, was expected to reach the Senate floor by today. However, the bill was facing stiff opposition from insurers. TMA issued an Action Alert Friday to encourage members to let lawmakers know how important HB 3459 is for curbing preauthorization burdens. The bill also would require utilization reviews to be performed by a Texas-licensed physician in the same or similar specialty as the patient’s physician.
- House Bill 133 by Rep. Toni Rose (D-Dallas), previously a measure to provide one year of continuous Medicaid coverage for women postpartum, has been amended in the Senate to provide just six months of postpartum coverage. TMA hopes to restore the 12-month time frame if the bill passes the Senate and reaches a conference committee.
- House Bill 290 by Rep. Philip Cortez (D-San Antonio) to establish six months of continuous eligibility for children in Medicaid, with an eligibility check for another six months of coverage, was scheduled to be heard last Friday in the Senate Health & Human Services Committee. At press time, TMA was trying to resolve questions it had about a recent amendment to the bill.
- House Bill 4272 to improve the state’s immunization registry passed out of the Senate Health & Human Services Committee last Thursday, sending it to the House floor. However, as on HB 290, language was recently added to the bill – in this case, prohibiting governments and businesses from implementing “vaccine passports.”
- Senate Bill 248 by Sen. Nathan Johnson (D-Dallas) to establish a licensing and regulation framework for e-cigarette dealers was awaiting placement on a House calendar. With time running out, TMA was working to get the bill scheduled.
- At press time, Senate Bill 672 by Sen. Dawn Buckingham, MD (R-Lakeway), to require Medicaid to pay for collaborative care codes was awaiting third reading in the House, upon which it would be eligible for passage and a trip to the governor’s desk.