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LEGISLATIVE WRAP-UP

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priority for TMA in this session, and House Bill 2536 (Oliverson) tered to the ground in heaps of feathers, thanks to the House of
made a big dent in that problem. The bill requires PBMs to submit Medicine reminding lawmakers there are certain practices only a
a detailed disclosure report when a drug costing at least $100 for a physician is trained to do.
30-day supply increases in price by 15% or more in one year, or by Take House Bill 2733 (Stephenson). That measure would have
40% or more over three years. expanded the practice of chiropractic beyond its current scope –
defined in the law as the musculoskeletal system – and introduced
Telemedicine Opportunities Expanded the possibility of chiropractors treating the “neuromusculoskeletal”
In 2017, legislators ended a long-running standoff over telemedi- system; in other words, giving chiropractors the authority to treat
cine in Texas by passing a TMA-backed bill that removed the require- the nervous system as well.
ment for having an in-person meeting to establish a patient-physician Austin neurologist Sara Austin, MD, says keeping nervous system
relationship. Instead, it mandates that physicians meet the same stan- treatment as the practice of medicine is a matter of patient safety.
dard of care as that required for an in-person visit. Adding the nervous system to the scope of chiropractic “has the
New laws passed with TMA’s support this year will make telemed- effect of being really confusing to patients,” Dr. Austin said.
icine even more attractive to physicians. One of the most significant “There’s chiropractors now who like to call themselves ‘neurochi-
was House Bill 3345 (Price), which allows physicians to choose the ropractors.’ No one knows what that means, what their training is
platform for providing services to their patients via telemedicine or anything, and they’re actually not supposed to be practicing neu-
rather than having health plans dictate the platform. rology. But they do it anyway. … The public just assumes that means
“We’re really excited about that, because it allows the [physicians] they can take care of the nervous system, which is not true.”
to say, ‘This is what I want to put my patients on,’” said Ogechika
Alozie, MD, an El Paso infectious disease specialist who is vice chair Other troublesome scope-of-practice bills TMA
of TMA’s Committee on Health Information Technology. helped bring down include:
• House Bill 1792 (Klick), which sought full independent practice
Other significant telemedicine bills that passed in and prescribing authority for advanced practice registered
2019 with TMA’s support are: nurses (APRNs) without physician delegation and supervision;
• Senate Bill 670 (Buckingham), which requires Medicaid to cover • House Bill 1798 (Goldman), which would have allowed thera-
telemedicine services; peutic optometrists to perform a number of eye surgeries, in-
• House Bill 1063 (Price), which requires Medicaid to cover home cluding LASIK, and independently manage glaucoma;
telemonitoring for specific pediatric patients; • House Bill 1092 (Zedler), which would have granted independ-
• House Bill 3285 (Sheffield), which permits telehealth treatment ent prescribing authority to psychologists; and
for substance use; • House Bill 927 (White), which would have granted independent
• Senate Bill 749 (Kolkhorst), which allows on-call physicians to practice and prescribing authority to APRNs in health profes-
use telemedicine, if needed; sional shortage areas.
• House Bill 871 (Price), which allows telemedicine to be used in
rural counties and communities to contact an on-call physician Medical Board Put Back on Track
who specializes in emergency medicine; and Two years ago during the 2017 regular session, the legislature put
• SB 11, which establishes a telemedicine program through the the practice of medicine in the state in serious danger, failing to
Child Psychiatry Access Network. renew the Texas Medical Board (TMB) and the state’s Medical Prac-
tice Act.
Scope Expansion Shot Down Among other potentially catastrophic side effects, having no med-
When it comes to shooting down dangerous attempts to expand ical board and no medical practice act would have meant anyone in
nonmedical practitioners’ scope of practice, TMA’s advocacy army Texas could call themselves a physician and practice medicine.
once again proved to be expert marksmen in 2019. Doomsday was averted that year when Governor Abbott called
Medicine trained its scope on bills that would have allowed nurse a special session and lawmakers renewed TMB – but for only two
practitioners, chiropractors, and optometrists, among others, to years instead of 12, as is customary following the Sunset Advisory
wade into the practice of medicine. Those and other bad bills flut- Commission’s intensive review of an agency.

20 San Antonio Medicine • August 2019