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LEGISLATIVE
INTRODUCTION

Morbidity. David Lakey, MD, chief medical officer at The University enough GME slots.”
of Texas System and previously chair of TMA’s Maternal Health
Congress, says Medicaid currently covers low-income women for Insurance: Time for accountability
only two months after the birth of a child. TMA’s biggest wins of 2017 came in the insurance realm, laying
The task force has called for a federal waiver that would extend the foundation for more reforms during this year’s session. Victories
coverage to one year, which TMA supports. on balance billing and step therapy were the headliners two years
“We know that moms are at risk during that first year afterwards,” ago; now, it’s time to tackle medicine’s other top-line insurance goals,
Dr. Curran told physicians at one of five tele-town hall meetings including:
on TMA’s legislative agenda in October. “So just increasing avail- • Prior authorization: On medicine’s agenda this year: Relieving
ability of services and care is going to make an enormous difference physicians of the burden to get pre-approval for treatment or
in outcomes.” medication with legislation to ensure prior authorization require-
ments have medical relevancy — and aren’t just a way for health
Among other budget-related items on TMA’s plans to deny care or delay payment.
agenda: • Network adequacy: Medicine will again push for action on two
• Revising eligibility and enrollment systems so adolescent females of the biggest causes of surprise bills: insurers’ narrow networks
who age out of CHIP or children’s Medicaid can enroll seam- and their often out-of-date network directories. TMA will seek
lessly in the state’s Healthy Texas Women program; legislation to mandate that the Texas Department of Insurance
• Ensuring that women who lose their CHIP perinatal coverage (TDI) review insurers’ PPO products, which unlike HMOs and
can connect to the state’s family planning program to avoid gaps EPOs, don’t undergo any proactive review, TMA lobbyist Clay-
in preventive care; ton Stewart says. Also, medicine will again ask to require insurers
• Improving the availability of long-acting reversible contracep- to update their network directories more frequently than the cur-
tives (LARCs); rent mandate to do so every 30 days. “We at least need to know
• Funding for graduate medical education (GME) to maintain the whether or not the physicians are out of network,” Mr. Stewart
target ratio of 1.1 entry-level-positions per medical graduate, said. “That really benefits the patient, but also [would help] be-
which Texas achieved during 2018; and cause TDI a lot of times will use those network directories to
• Expanding the availability of behavioral health services to chil- do a network exam regarding the adequacy of said insurance
dren and adults, including substance use disorder treatment, and company’s network.”
using innovative telemedicine initiatives. TMA also will support • Pharmacy benefit managers (PBMs): Mr. Stewart says PBMs are
funding to expand the capacity of state hospitals and community essentially unregulated. Yet, they’re making health care decisions
mental health services. for patients — such as determining the step therapy protocols
insurers use to keep patients off more expensive medications.
The Texas Women’s Healthcare Coalition’s (TWHC’s) aims for Last session, Mr. Stewart says, many lawmakers weren’t familiar
this session are similar to much of TMA’s women’s health agenda. with PBMs and what they do. That changed with passage of a
Evelyn Delgado, TWHC chair, says LARC availability is a benefit TMA-backed measure that dramatically slashed the amount of
to women who decide they don’t want to be pregnant anytime soon, time an insurer generally has to approve a physician’s override
and a benefit to the state financially. of a step therapy plan. After examining and passing that bill, Mr.
Meanwhile, on GME, the recent boom of new medical schools Stewart says, lawmakers are more versed on PBMs’ role in med-
in Texas makes it continuously important to work for the proper ication. So, TMA expects to see more scrutiny of PBMs during
number of slots for graduates, Dr. Terk says. this session and legislation to introduce more transparency and
“Otherwise, we’re just educating some other state’s physicians,” accountability for them.
he said. “We know that physicians tend to stay where they train. So,
we’re going to need to watch that carefully and make sure that with Public health momentum
the three or four new medical schools that are coming online now Few of medicine’s public health objectives gained traction in the
and in the next couple of years, that we don’t end up in the same 2017 legislative session. However, Dr. Lakey says momentum build-
situation we were in for several years previous, where we didn’t have ing behind some of medicine’s key campaigns could translate to ac-
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