May 11, 2011

TMA Fights for Physicians and Patients in New "Collaborative Arrangements"

TMA Legislative News Hotline

Wednesday, May 11, 2011

Asa Lockhart, MD
Health Care Collaborative: Asa Lockhart, MD, chair of TMA’s Ad Hoc Committee on Accountable Care Organizations testified before the House Public Health Committee this morning in support of Senate Bill 8. The legislation, authored by Sen. Jane Nelson (R-Flower Mound) and sponsored by Rep. Lois Kolkhorst (R-Brenham), would establish a statewide plan for improving quality and increasing efficiency through performance-based measures, test collaborative models between physicians and other health care providers, and require public reporting of preventable readmissions and complications. TMA, the Texas Association of Health Plans, and the Texas Hospital Association have negotiated how the new paradigm in the bill would play out in the real world. As a result of these negotiations, three important provisions have been added to SB 8 to protect physicians and their patients in a collaborative arrangement:
  • Physicians would have an equal say and vote in a collaborative arrangement’s governing board.
  • They also would have due process protections and the ability to participate in more than one collaborative arrangement in their community.
  • The bill also protects Texas’ ban on the corporate practice of medicine and patients.
There is still disagreement regarding the details of these provisions, but TMA is committed to keeping these protections in the bill.

Medicaid Cost-Savings: John Hellerstedt, MD, an Austin pediatrician and chair of the Texas Health and Human Service Commission’s (HHSC’s) Quality-Based Payment Advisory Committee also testified before the House Public Health Committee this morning in support of the SB 7 by Senator Nelson and Representative Kolkhorst. The measure would establish a new Medicaid and Children’s Health Insurance Program (CHIP) Quality-Based Payment Advisory Committee that would:
  • Provide recommendations to the HHSC to improve health outcomes and patient safety, and reduce the incidence of potentially preventable hospitalizations and readmissions;
  • Direct the state to test new payment and delivery systems that provide incentives to physicians and hospitals to develop more coordinated, evidence-driven, cost-effective care;
  • Tie a portion of Medicaid HMO premiums to improved health outcomes and quality; and
  • Implement copayments in Medicaid to reduce unnecessary emergency department use.
Sanctuary Cities and Insurance Reform: The Texas House plowed through a mountain of bills yesterday, including a couple major House bills. It gave final approval for the controversial sanctuary city bill and tentative approval to bills that would reform the Texas Windstorm Insurance Association (TWIA) and continue the operations of the Texas Department of Insurance (TDI). Lawmakers took up more than 40 amendments for both the TWIA bill and 59 for TDI Sunset bill. TMA’s legislation by Rep. Craig Eiland (D-Galveston) to regulate the unethical activity of silent preferred provider organizations that steal physicians’ discounted contracts was amended on to the TDI Sunset bill. Rep. John Zerwas, MD (R-Simonton), also was able to get his bill attached that would give the insurance commissioner authorization to establish a health insurance exchange in Texas if the federal mandate is not eliminated.

House member also passed another insurance-related measure supported by TMA yesterday — House Bill 3017 by Rep. John Smithee (R-Amarillo). The bill would prohibit the use of discretionary clauses in insurance policies.

Interstate Compact: Legislation that would give the state control over the Medicaid and CHIP programs also was tentatively approved yesterday by the Senate Health and Human Services Committee. HB 5 by Representative Kolkorst and Senator Nelson would authorize the state to participate in a multistate compact to help fund and administer Medicaid. If passed, the compact would be submitted to Congress for its consideration. If approved, member states could pursue waivers that would relieve the state of federal mandates regarding Medicaid; CHIP; and all other health care programs, such as mental health and public health services. If successful, Texas likely would receive a block grant based on 2010 state/federal health care spending. Texas would then create its own health care program to replace Medicaid, CHIP, and all the other public health services. TMA wants to ensure that Texas gets its fair share of funding based on the state’s population and demographic changes.

Bill Countdown: The House still has a couple more contentious bills to deal with today. HB 3790 by Rep. Jim Pitts (R-Waxahachie), the state fiscal matter bill, is a critical element in ensuring the adoption of a state budget, as a number of its provisions are assumed in HB 1. Fortunately, the Senate companion, SB 1811 by Sen. Robert Duncan (R-Lubbock), is over from the Senate and could be taken up if the House bill fails to pass. Another critical piece of legislation, HB 400 by Rep. Rob Eissler (R-The Woodlands), would give school districts “flexibility” in dealing with the public school budget crisis. Last Saturday, several unhealthy amendments were attached to the bill that would repeal school-based fitness measurements and coordinated school health education. HB 400 was delayed Saturday and again yesterday after sustaining points of order. The corresponding Senate bill, SB 22 by Sen. Florence Shapiro (R-Plano), is stuck on the Senate Intent Calendar. The House bills, and many others on the General Calendar, have to be heard by midnight Thursday or they die. Stay tuned.

Health Insurance Reform: The Senate also passed two TMA-supported bills this week:
  • HB 1405 by Representative Smithee would require plans that utilize a formulary to continue prescription benefits until the next renewal period if the formulary changes in the middle of the plan year. More important, HB 1405 would allow patients with individual coverage the same appeal rights as patients with small- or large-group health coverage. This means that a refusal or denial of a prescription drug by the health plan or pharmacy benefit manager would be considered an adverse determination and subject to an independent review if the physician has determined the drug is medically necessary.
  • HB 438 by Rep. Senfronia Thompson (D-Houston) would require health plans to cover orally administered anticancer medications at the same level as they provide coverage for other medical or surgical expenses.
The physician of the day at the capitol is Horacio Ramirez, MD, of San Antonio. Dr. Ramirez has practiced family medicine for 32 years. He graduated from The University of California at San Diego School of Medicine in 1976. Dr. Ramirez is a member of TMA and the Bexar County Medical Society.

It’s not too late to save Texas’ children access to health education in public schools. Please contact your state representative, senator, and Lt. Gov. David Dewhurst today. Ask them to not gut successful programs that can help us stop Texas’ terrible obesity epidemic. Ask your representative to “Vote No” on amendments to HB 400 by Representative Eissler that repeal school-based fitness measurements and coordinated school health education. You can use the TMA Grassroots Action Center for talking points and an easy way to send e-mails to your lawmakers. Please act now. The bill has to be heard by midnight Thursday.

Despite Uproar, TX Lawmakers Pursue Medicare Overhaul (Texas Tribune)
House Gives First OK to Medicaid Waiver Plan
(Texas Tribune)
Healthcare law gets friendly hearing in appeals court
(Los Angeles Times)
Pace slows as House bills enter 'end game'
(KVUE Austin [ABC])

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