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LEGISLATIVE WRAP-UP

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Sam Houston State University College of Osteopathic Medicine in or the uninsured,” Dr. Curran said. “If we don’t do that, we’re going
Conroe, both of which will open in 2020. to see the Texas economy begin to suffer. And that’s probably going
TMA also achieved an important goal with passage of Senate Bill to happen within the next three or four years, especially if we have
1378 (Buckingham), which requires new public medical schools to an economic downturn. We’ve got to convince our legislators in this
plan for the GME needs of their target class size. Previously, interim that they have got to address the issues of lack of access
schools had to plan only for their inaugural class size, which is often both in Medicaid and [with] the uninsured and the underinsured.”
considerably smaller. However, following a year in which negative media attention put
Legislators provided $762 million over two years to support the Texas Medicaid’s managed care companies under intense focus, sev-
education of medical students, an increase of $12.8 million, and eral important reform bills earned passage. Senate Bill 1207 (Perry)
$98.5 in GME funding, an increase of $8.4 million. They also asked introduces new requirements to hold Medicaid managed care or-
the Texas Higher Education Coordinating Board to study shortages ganizations (MCOs) accountable for prior authorization decisions.
of physicians and other health professionals. The bill requires MCOs to:
• Provide an explicit clinical reason for a prior authorization de-
Other education bill highlights: nial,
• House Bill 2261 (Walle) increases the Physician Education Loan • Provide a specific list of the documentation required to com-
Repayment Program’s allowable repayment assistance amounts plete a request for prior authorization, and
by $5,000 each year. This raises the total repayment assistance • Give the requesting physician the chance to speak to a medical
available from $160,000 to $180,000. director within the same or similar specialty who has experience
• House Bill 1065 (Ashby) creates a grant program to develop treating the same population as the patient.
residency training tracks to prepare physicians for rural and un-
derserved settings. However, lawmakers did not appropriate The bill also establishes a process for patients to request an inde-
any funds for the program. pendent review of an MCO’s denial of care or reduction of serv-
ices, and requires MCOs to maintain an up-to-date catalogue of
Much Work Still to Do for Medicaid Pay Hike prior authorization requirements on their websites. Round Rock pe-
Medicine didn’t get everything it needed from lawmakers for diatrician Maria Scranton, MD, chair of TMA’s Select Committee
Medicaid, including TMA’s biggest and boldest ask of the 2019 ses- on Medicaid, CHIP, and the Uninsured, says the requirement for
sion. Still, progress TMA achieved on managed care reform and MCOs to “make it clear exactly what the problem is” for prior au-
other facets of Medicaid will advance physicians’ efforts to care for thorization was a major victory.
the most vulnerable Texans. “Part of the problem with Medicaid is that the paperwork and
Those wins collectively softened the impact of one of the ses- the administrative responsibilities are so high that first of all, you’re
sion’s greatest disappointments for medicine: The legislature pro- not getting that much money in the first place,” she said. “But now,
vided no new funding for Medicaid physician payments. TMA had if you’re having to hire people to help you do all of this stuff, then
requested $500 million in general revenue to give physicians their it’s really taking away [from patient care]. So if you could eliminate
first meaningful Medicaid increase in decades. Nor did lawmakers some of the paperwork burden, in some ways that would be like a
follow through on medicine’s request to extend comprehensive small raise.”
postpartum coverage
Doug Curran, MD, who was TMA president at the beginning of Other promising Medicaid wins:
the session, designated improving physician Medicaid payments as • Senate Bill 1096 (Perry) will ensure that children who partici-
his top priority. He called the legislature’s inaction “hurtful to our pate in STAR Kids, an MCO model for medically complex and
people” and said medicine must continue advocating for change be- frail children, will have uninterrupted access to established med-
fore the next session. ications by heavily restricting the use of prior authorization for
“Just like a physician who is taking care of a patient and the pa- prescription drugs.
tient is not doing what they’re supposed to be doing … we must • House Bill 25 (Gonzalez) will establish a pilot program to trans-
tell our legislators that we’ve got to reach out and change some of port pregnant and postpartum women to and from medical ap-
the stuff that’s going on in Medicaid, and [with] the underinsured pointments, with their children in tow.

18 San Antonio Medicine • August 2019