Page 13 - Layout 1

LEGISLATIVE WRAP-UP

TMA scored on a wide range of goals to improve the state’s med- ization demands.
ical landscape during this year’s session of the Texas Legislature. In On both fronts, medicine scored solid legislative wins that will
public health, the House of Medicine convinced lawmakers that make it easier for patients and physicians to know who’s in network,
raising the age to purchase tobacco to 21 was the right thing for the and provide needed transparency on preauthorization requirements.
state’s present and future. And on surprise billing, medicine turned what could’ve been a dis-
Medicine also successfully persuaded the legislature and Gov. astrous bill into something more palatable.
Greg Abbott to improve insurance network adequacy and directo- Senate Bill 1742 (Menéndez), one of medicine’s biggest legislative
ries, which will help with surprise medical bills. Insurers’ prior au- victories, will require health plans’ directories to clearly identify in-
thorization tactics – which infuriate physicians and delay or derail network physicians, with separate headings required in the directory
patients’ access to needed services and medications – took several to categorize physicians in several different types of specialties, in-
damaging hits in the form of TMA-backed bills that became law. cluding radiologists, anesthesiologists, emergency department physi-
And the 2020-21 budget includes a number of vital funding in- cians, and others.
creases, including a $68 million increase for women’s health pro-
grams, an added $60 million to preserve the state’s healthy ratio of Dallas cardiologist Rick Snyder, MD, says
graduate medical education (GME) slots to medical school gradu- SB 1742 carries four powerful benefits:
ates, and $50 million more for community mental health services. • Simplifies the process for patients to compare different plans,
Those were just a few of the big wins medicine and its friends • Exerts market pressure on insurers to address deficiencies in
delivered, and they helped to offset the disappointments, such as their networks,
the legislature failing to grant the long-overdue Medicaid physician • Makes it easy for patients and family members to make sure all
payment increase that TMA requested. members of a care team are in network, and Allows physicians
“On the whole, it was a good session for us,” said Fort Worth- to see whether a specialist needed to co-manage a patient is in
area pediatrician Jason Terk, MD, who chaired TMA’s Council on network.
Legislation throughout the session. “We got a lot of good things
done, and we can be proud of our advocacy for the progress we “Initially, we’re starting just with the specialties that are most com-
wanted to make in public health, mental health, women’s health, and monly associated with a surprise-billing event; those are the hospi-
GME funding, just to name a few. I am also very proud of our ad- tal-based specialties,” Dr. Snyder said. “So if you’re at Presby
vocacy defending against bills that would have been harmful to our [Presbyterian Hospital in Dallas], for example, and you’re looking
patients and us, the physicians who care for them.” at Blue Cross Blue Shield and you look under ‘anesthesia’ and there’s
TMA chief lobbyist Darren Whitehurst emphasized that success no physicians in network for anesthesia at that hospital, you might
at the Capitol starts with medicine’s grassroots efforts, including the want to look at a different plan. So it empowers the patients when
work physician advocates do during TMA’s monthly First Tuesdays shopping for plans.”
at the Capitol. But he stressed that the work continues even after SB 1742 also requires state-regulated health maintenance organ-
the legislature adjourns. izations (HMOs) and insurers offering preferred provider organi-
“Really, we don’t have a lot of time to look back. We’ve got to zation (PPO) or exclusive provider organization plans to post any
continue to look forward. We’re going to have a busy interim build- prior authorization requirements on the internet; introduces new
ing on the relationships and the work that we did this past session, requirements for those insurers to post notice of prior authorization
and looking forward to the next legislative session,” Mr. Whitehurst changes; creates a joint interim committee to study prior authoriza-
said. “The issues that we face are a lot of the same issues from ses- tion and utilization review during the interim session; and opens the
sion to session. We’ve got to be committed to trying to move for- door for utilization reviews to be conducted earlier in the appeal
ward and to making sure that our doctors are engaged and are process by a Texas-licensed physician in the same or similar specialty
involved as part of a political process.” as the physician requesting treatment approval.
As for balance billing, Senate Bill 1264 (Hancock) initially threat-
Assault on Prior Auth, Bad Networks ened to give health plans disproportionate control over what physi-
TMA went into this session looking to attack insurer network cians would be paid for certain out-of-network care.
inadequacy and health plans’ use of care impeding prior author- But TMA worked with Rep. Tom Oliverson, MD (R-Cypress), to

continued on page 14
visit us at www.bcms.org 13