Despite a session that many have described as boring and lacking weighty issues, the 77th Texas Legislature adjourned “sine die” May 28, but not before giving final approval to a number of measures important to family physicians and their patients.

The session was dominated by two issues—crafting the state’s budget and redistricting, the once-every-10-years process by which lawmakers reapportion state House and Senate districts as well as congressional districts. Though its influence permeated the debate on virtually every other issue considered by the Legislature this year, lawmakers failed to pass redistricting plans for either the House and Senate or Texas congressional seats.

The task of redistricting now falls to the five-member Legislative Redistricting Board. The panel is made up of acting Lt. Gov. Bill Ratliff, House Speaker Pete Laney, Attorney General John Cornyn, Comptroller Carole Rylander, and Land Commissioner David Dewhurst. All but Speaker Laney are Republicans.

Regardless of the outcome of the LRB maps, all of the redistricting plans likely will end up in court. The Republican and Democratic parties, as well as minority and other groups are already preparing lawsuits to challenge whatever redistricting plans are ultimately approved.

The Legislature also approved a $114 billion state budget. The appropriations bill includes $64.9 billion for health and human services, a 17.1 percent increase over current funding levels. Included in that total is money to simplify the Medicaid enrollment process and to increase Medicaid physician fees by $50 million.

Some 5,600 bills were filed this session and more than 1,300 directly impact health care and physician practice. Highlighted below are some of the key issues TAFP was involved with this session.

Click to go to these issues:

• Medicaid

• Managed care

• Public Health

• Medical Privacy

• Telemedicine

• Scope of Practice

Contact the TAFP Legislative Department:

 Tom Banning, Director of Legislative Affairs

Greg Herzog, 
Legislative Aide

Visit the Member Advocacy section of the Web Site

Medicaid

Faced with a deteriorating Medicaid program, skyrocketing cost overruns and a declining provider base, Legislators focused significant attention on three primary issues: provider reimbursement, simplifying enrollment for children and Medicaid managed care reform.

The Legislature allocated $1.5 billion in new funds to health and human services. Included in Senate Bill 1, the general appropriations bill, was $197 million in general revenue for rate increases for providers, outpatient hospitals, community care services, dental services, HMO and home-based services. Lawmakers earmarked $50 million in new funds for physician and professional services. The $50 million will draw an additional $75 million from the federal government for a total of $125 million for Medicaid fee increases for medical professionals alone.

Senate Bill 43 by Sen. Judith Zaffirini, D-Laredo and Rep. Garnet Coleman, D-Houston, will simplify the enrollment process for children in the Medicaid program. An estimated 600,000 Texas children are considered Medicaid eligible but not enrolled in the program due to significant hurdles in the enrollment process. SB 43 will allow mail-in application and re-certification for the program and a simplified, self-declared assets test that is the same as that used for CHIP, with no additional documents or proof required.

The bill phases in continuous eligibility for children through age 19. It also directs the Texas Health and Human Services Commission to establish a process promoting smooth transitions from Medicaid to CHIP, requires health care orientation for new Medicaid enrollees, and establishes policies to ensure that children get their Texas Health Steps/ EPSDT preventive care services.

Senate Bill 1156, the Medicaid Managed Care Reform Act, also by Sen. Zaffirini and Rep. Garnet Coleman, sought to significantly restructure and reform the Medicaid managed care program. Unfortunately, the bill was vetoed by Gov. Rick Perry.

The bill would have consolidated Medicaid within the Department of Health and Human Services. Currently, the program is spread among six agencies. The bill also included measures to increase efficiency and cut costs that were developed by a special workgroup composed of senators and representatives.

Among cost saving mechanisms HHSC would have been able to pursue were expansion of the primary care case management model for Medicaid managed care, expansion of STAR+PLUS to regions of the state with Medicaid managed care, utilization of co-payments as authorized by federal law, and utilization of disease management for chronic health conditions.

Other provisions of the bill would have required Medicaid managed care plans to simplify and standardize administrative processes and eliminate duplicative requirements, established a workgroup to simplify and standardize the preauthorization process, required HHSC to collect and publish Medicaid managed care complaint data, and directed TDH and HHSC to simplify the enrollment and reporting process for Texas Health Steps/ EPSDT.

Managed care

When you look at Texas’ managed care statutes, they are the envy of other state medical associations, but in terms of new ideas there is not much left to pass. The Legislature passed House Bill 1862 by Rep. Craig Eiland, D-Galveston, with overwhelming, bipartisan support, which would have required health plans to pay legitimate, properly submitted claims owed to physicians within 45 days. Unfortunately, Perry also vetoed this bill. Check out this issue’s cover story beginning on page 32 for more on this.

Lawmakers approved House Bill 606 by Reps. John Smithee, R-Amarillo, and Carlos Uresti, D-San Antonio, and Sen. Jane Nelson, R-Flower Mound, which prohibits managed care plans from implementing mandatory hospitalist programs.

An amendment was added to a Senate bill by Rep. Kyle Janek, M.D., R-Houston, requiring HMOs to update credentialing standards to stay in compliance with National Committee for Quality Assurance standards. The new credentialing provision requires HMOs to verify the validity of a physician’s medical license at the date of initial credentialing and at each re-credentialing, sets standards for site visits, and requires the Texas Department of Insurance to promulgate rules relating to the process by which an HMO selects or deselects physicians to comply with NCQA standards.

The measure also requires the Commissioner of Insurance to adopt a standardized form for verification of credentials and requires the Texas State Board of Medical Examiners to study establishing a standardized credentials verification program.

Public health

Legislators gave the nod to Senate Bill 19, by Sen. Jane Nelson, R-Flower Mound, which authorizes the State Board of Education to require school districts to offer 30 minutes of physical activity per day. The bill also requires the Texas Education Agency to make available to each school district a coordinated health program designed to prevent obesity, cardiovascular disease, and Type II diabetes in elementary school students.

After years of trying to pass a graduated drivers license bill, Texas Legislators finally passed Senate Bill 577 by Sen. Teel Bivins, R-Amarillo, and Rep. Joe Driver, R-Garland. The bill requires teenagers to gain more experience behind the wheel before driving. Under SB 577, an instruction permit must be held for six months prior to applying for a driver’s license. During that period, the driver must be accompanied by a passenger 21 years or older. The bill also prohibits drivers under the age of 18 from operating a vehicle between the hours of midnight and 5 a.m. except for transportation related to employment, school activity or a medical emergency. The person may not drive with more than one passenger under age 21 other than a family member.

Medical privacy

The Legislature passed Senate Bill 11 by Sen. Nelson and Rep. Patty Gray, D-Galveston, which bans the release of individual patient information for marketing purposes without the patient’s consent. SB 11 prevents the transfer of patient data from health entities to marketing or advertising entities without the patient’s consent and directs the TDI to adopt rules consistent with federal guidelines governing the release of patient-specific data by health plans and insurance companies. It also gives patients the right to know how entities use their medical information in the form of an easy-to-understand public notice, establishes privacy standards for medical research efforts and authorizes the Texas Attorney General’s office to impose administrative penalties up to $250,000 per violation.

Finally, SB 11 gives individuals the right to sue to stop the release of information and seek injunctive relief but not punitive damages. It also gives patients the right to inspect their medical records and provides a mechanism to correct errors in their files.

Telemedicine

TAFP was instrumental in the drafting and passage of Senate Bill 768, the omnibus telemedicine bill, by Sen. Mike Moncrief, D-Fort Worth, and Rep. Glen Maxey, D-Austin. The bill instills uniform definitions of telemedicine and telehealth across numerous codes in state law and defines telemedicine medical services as a physician-directed medical act, which can only be carried out by a licensed health care professional acting under the direction of a physician. The bill also expands reimbursement for telemedicine services, protects existing health care systems and medical relationships, and sets quality of care and supervisory standards.

Scope of practice

In the closing week of the session, without benefit of a public hearing or any discussions with organized medicine, pharmacy, particularly the chain drug stores, secretly conspired and successfully amended a seemingly benign Senate bill on the House floor that:

• repealed the legal requirement that a pharmacist dispense as directed by a physician;

• repealed the current two-line prescription form and empowered the Board of Pharmacy to write rules relating to the “formatting” and “security” requirements for a new prescriptions form;

• required all Texas prescription forms to conform with a federal Medicaid regulation (a payment standard that requires a physician to hand write on the prescription form “brand necessary” in order for a pharmacist to get reimbursed at a higher rate than for a multi-source drug) and;

• legalized pre-printed prescription forms.

TAFP led the fight to get the bill to conference committee, where the legal requirement that a pharmacist dispense as written was reinstated, but other provisions were essentially left in tact. The implementation of the changes now heads negotiated rule making with all impacted regulatory Boards—pharmacy, physicians, dentists, podiatry, etc.

An agreement was reached with the nurses and physician assistants on a bill to amend the Medical Practice Act and the Physician Assistant Practice Act to designate the PA as an agent of the supervising physician when performing delegated medical acts. The agreement would also allow physician-based collaborative model for prescriptive authority. This would allow the delegating physician the option of placing an APN/PA with delegated prescriptive authority in one alternate site separate from the delegating physicians’ primary practice site.

These are only a few of the issues TAFP was involved with this session. Other issues included workers comp, graduate medical education, and a host of others. For a more detailed analysis of health care legislation passed this legislative session, check out the member advocacy section at www.tafp.org.

Despite the many successes this session, there is plenty of unfinished business that will have to be addressed over the interim and in the 78th Texas Legislature, which convenes in January 2003. Among the issues that are likely to be at the forefront is meaningful prompt pay legislation, requiring standardized contracts between health plans and physicians, funding for graduate medical education, addressing the mounting medical malpractice insurance crisis, and looking at various funding options to pay for state services (a.k.a.—a tax bill).