Rep. John Smithee, R-Amarillo, has filed House Bill 2016 that would provide more transparency and accountability in contracts between physicians and health plans. The bill would require health plans to disclose their payment terms to physicians and prohibit unfair and egregious contract language. Sen. Juan “Chuy” Hinojosa, D-McAllen, is filing an identical bill in the Senate.

One of TAFP’s top legislative priorities this session is to establish fair and transparent contracting provisions between physicians and managed care plans. Health plans control a significant part of most physicians’ practices, leaving physicians with little ability to walk away from unfair contracts. This imbalance forces physicians to sign take-it-or-leave-it contracts that are not only bad for the physician, but can also be detrimental to patient care.

Although the Academy has had some success in past legislative sessions in winning some managed care battles, most measures directed at health plans and other entities that provide health care coverage are ineffective because they are preempted by the federal Employee Retirement Income Security Act, or ERISA. This is a law that regulates all employee benefit plans in private industry. Any state law that attempts to regulate how such self-funded benefit plans behaves is superseded by ERISA. These plans comprise a majority of the Texas health insurance market.

However, House Bill 2016 addresses the contractual relationship between a physician and a health plan, which should apply to any entity that contracts for health insurance, regardless of ERISA pre-emption.

The bill would:

• prohibit insurers from forcing physicians to waive legislatively enacted rights as part of the contractual agreement;
• require health plans to disclose payment terms;
• require that contracts be written in clear, understandable language;
• require that contracts define the categories of coverage included;
• end the practice of “rental networks” by requiring that all terms of the contract – not just the fee schedule – be intact for a third party to enforce a discounted fee schedule;
• require that physicians receive notice prior to contract amendments;
• prohibit insurers from contractually dictating a physician practice’s payer mix;
• and provide for meaningful enforcement and conflict resolution, allowing arbitration but not barring legal action on the part of physicians.

Nelson announces Medicaid reform bill

Sen. Jane Nelson, R-Lewisville, unveiled her much-anticipated Medicaid reform bill, Senate Bill 10, on March 1, which she says is designed to reform Medicaid and reduce the number of Texans without health insurance.

“This plan will increase access to health care, stabilize our costs and, most importantly, improve the overall health of patients,” Sen. Nelson said at a Capitol press conference. “It focuses heavily on preventive health, transparency and creating more health care options for individuals.”

“TAFP is excited about the thoughtful provisions in this legislation and we look forward to working with the Senator on this critically important issue,” says TAFP’s director of public affairs, Tom Banning.

Academy staff will report more on this bill in next week’s Capitol Update as well as our weekly video Web cast, Capitol Report.

Dukes’ bill creates online Medicaid provider list

Rep. Dawnna Dukes, D-Austin, has filed House Bill 2042, a bill that would establish an online, publicly accessible database showing up-to-date information on which physicians or other health care professionals are accepting new Medicaid patients. This information would allow Medicaid beneficiaries to easily search for health care providers and it would cut down on administrative hassles for primary care physicians referring patients to specialists or for other health care services.

House Insurance to hear managed care bills on March 5

Three important managed care bills will be heard at a meeting of the House Committee on Insurance on Monday, March 5. Those include House Bill 839 by Rep. Craig Eiland, D-Galveston, a bill that would regulate so-called “silent PPOs;” House Bill 522 by Rep. Beverly Woolley, R-Houston, that would require health plans to include certain patient information through a magnetic “swipe” strip on insurance identification cards; and House Bill 1594 by Rep. John Zerwas, R-Austin, which would expedite credentialing for physicians providing services under managed care plans.

Contact your legislators on budget items

House and Senate Committees continue to hammer out spending proposals for the 2008-2009 biennium. They are likely to wrap-up deliberations in the next two weeks and move to conference committee where legislators will make final decisions on Medicaid reimbursement, CHIP enrollment, funding for graduate medical education and more.

Now is the time to contact your legislators and make your voice heard on these important funding issues. Go to the TAFP Web site to download talking points on these and other topics, then call or e-mail your state senator and representative today.

For talking points on GME funding, Medicaid and CHIP, go to the policy initiatives page of the TAFP Web site.

Thanks to these Physicians of the Day

Thanks to the physicians who volunteered their time this week to serve at the Texas Capitol as Physician of the Day. This week’s physicians were Julie Graves-Moy, M.D., of Austin; Francisco Barrera, M.D., of San Antonio; Ron McMurry, M.D., of Jasper; and Hugh Wilson, M.D., of Lubbock.

Spots are still available in April and May. Please contact Kate McCann for more information on how to participate in this service.