CHIP reform bill passed by
House Committee
posted 03.08.07
The House Committee on Human Services passed a bill Thursday that would reinstate 12 months’ continuous coverage for enrolled children instead of requiring families to reapply every 6 months for the program. It would also eliminate the asset test put in place four years ago.
Last week, the committee heard testimony on 30 bills dealing with CHIP. TAFP member Roland Goertz, M.D., of Waco, testified on behalf of the Academy, the Primary Care Coalition and TMA during the hearing last week.
“Children are not little adults,” Goertz said. “When I see a small child, they can’t tell me I hurt in my abdomen, or they can’t tell me what disease they have. ... As such, to stay healthy, they need to receive regular, ongoing preventive care.”
Goertz told the committee that CHIP and children’s Medicaid are a good buy for the state. For every dollar spent on Medicaid, the state receives 1 dollar and 54 cents, and for every dollar spent on CHIP, the state gets two dollars and 63 cents.
One concern surrounding the CHIP debate is that the federal government may curtail the benefit at the national level. But a recent letter by three prominent Texas Congressman states that there is a strong desire in Congress to provide the support and funding to make CHIP an effective program for those who need it.
Worries over federal lawsuit complicate health spending deliberations
The House Committee on Appropriations began full-committee deliberations on state health and human services spending this week. Concerns over a federal lawsuit, Frew v. Hawkins, led lawmakers to reconsider plans for Medicaid. U.S. District Judge William Wayne Justice is expected to order the state to improve children’s access to care in the Medicaid program when he hears the case on April 9.
Much of the anticipated reform deals with the lack of physicians taking new Medicaid patients, meaning the state could be forced to significantly increase provider reimbursement rates. Estimates on what the reforms might cost range from $1 billion to $5 billion. Realizing the connection between low reimbursement rates and poor access for patients in the program, the House Appropriations Committee adopted a 10-percent increase in provider reimbursement rates.
That increase and the possible cost of the April ruling has caused many to question proposed spending on other programs, most notably CHIP.
“Everybody’s in this budget trying to basically expand CHIP ... expand this, expand that,” said Senate Finance Committee Chairman Steve Ogden, R-Bryan, according to a report in the Austin-American Statesman. “I think prudence would dictate that we be very cautious about any expansion until we find out what our obligations are under mandatory programs, and we ought to hold some money back. No one thinks the opinion is going to be free.”
Senator files TAFP’s fair contracting bill
TAFP’s efforts to bring a measure of fairness to contracts between physicians and entities that contract for health care services just got an important vote of confidence. Sen. Juan “Chuy” Hinojosa, D-McAllen, has filed the Academy’s fair contracting bill in the Senate.
“Most of us know how time consuming and frustrating it is to fight with our health insurance company, imagine doing this every day, all day long,” Sen Hinojosa said in a March 7 press release. “For most of our physicians, this is a painful reality. Our families need to know that their doctors are spending their time healing them, not hiring lawyers to decipher the contracts they are forced to sign with HMOs.”
SB 1170 would:
- Require full disclosure by health plans of payment terms so physicians can make informed business decisions,
- Mandate that all contracts be written in plain language so that doctors no longer have to retain lawyers to correspond with health plans,
- Prohibit the current practice of health plans imposing new categories of coverage on doctors without their knowledge, and
- Require managed care organizations to notify doctors before unilaterally changing the terms of contracts.
The companion legislation, HB 2016, is being carried by Rep. John Smithee, R-Amarillo.
“Giving family doctors more leverage to negotiate their contracts with managed care organizations will allow them to act in the best interest of their patients,” Sen. Hinojosa said.
Read Sen. Hinojosa’s press statement on fair contracting legislation.
Download TAFP’s Issue Brief on the need for fair and transparent health care contracts.
Committee considers “silent PPOs,” insurance ID cards and physician credentialing
The House Committee on Insurance met late into the night Monday to discuss several bills relating to managed care. Three key bills important to family medicine came in front of the committee. These included a bill by Rep. Craig Eiland, D-Galveston, to regulate “silent PPOs;” a bill by Rep. Beverly Woolley, R-Houston, to provide patient insurance information on a magnetic swipe card; and a bill by Rep. John Zerwas, R-Austin, to expedite credentialing for physicians providing services under managed care plans.
HB 839 by Eiland would prohibit rental network preferred provider organizations from “renting out” a physician’s contracted discounted rates to third-party payers unless the physician grants written permission. Physicians contract with PPOs to stimulate patient volume. In return, the PPO pays a discounted rate to the physician.
The bill aims to regulate physician payment relationships with “silent PPOs,” or entities that purchase a physician’s discounted rates without the physician’s knowledge and “re-price” rates based on the discount the physician receives from their PPO. In the bill, Eiland says these entities exist “for the sole purpose of trafficking in physician discounts” and he identifies a few examples: insurance brokers, third-party administrators, local or regional PPOs or self-insured employers.
Gary Floyd, M.D., a pediatrician from Fort Worth and a board member of the Primary Care Coalition testified in support of the bill. “We’re asking our consumers, our patients, to take on more responsibility,” he said at the hearing. “When physicians can’t even figure out what they’re going to get paid for any one service or, much less by whom, how do we expect patients to be able to figure out what their share is going to be? Especially when these entities end up disguising so well these discounts, we can’t have accountability without transparency.”
At the hearing, Eiland said his bill would complement the standardized contracting bill by Rep. John Smithee, R-Amarillo, “so that once physicians contract, then they will know who is taking advantage of that contract.”
The need to regulate the trade of physician rates exists because “the unregulated secondary market in physician discounts is not only increasingly sophisticated, but has evolved in a part of the system that lacks transparency,” Eiland states in the bill.
HB 522 by Woolley would require certain patient information to be embedded in an electronic strip on a patient’s health insurance identification card to “reduce transcription errors and promote efficiency in health care,” said Woolley in the hearing. “Physicians will have a better understanding of a patient’s health insurance coverage and patients can see a reduction in the number of unexpected medical bills,” she said. The bill would not apply to Medicaid and CHIP patients and does not specify a manufacturer for the cards.
HB 1594 by Zerwas would expedite a physician’s credentialing process under certain health insurance plans. The bill provides that if a new physician in good standing with the Texas Medical Board joins a practice that has an established contract with a health plan, the new physician would be provisionally credentialed under that plan. Then, any patient who sees the new physician would be able to access in-network rates while the physician is waiting for official credentialing. The bill would work the same way in a solo practice.
If the health plan decides, for whatever reason, to deny credentials to the physician, the practice would be responsible for refunding the health plan. Zerwas hopes the bill will lessen the occurrence of patients facing out-of-network charges for physicians they thought were in their covered network. It also would allow physicians new to a practice to start building their patient base immediately without waiting months on the credentialing process.
The three bills have been left pending by the committee and will be discussed again at a later date.
TAFP fights Anatomical Pathology Legislation
Rep. Dan Gattis, R-Georgetown, has filed legislation that would prohibit billing or being reimbursed for anatomic pathology services unless the physician actually performed the test. TAFP has published a one-page policy brief on this issue on the Policy Initiatives page of the Academy’s Web site. For all talking points, policy briefs and other advocacy resources, go to the Advocacy page of TAFP’s Web site.
Download TAFP Issue Brief: Oppose Anatomical Pathology Legislation, HB 1557
TAFP comments on draft transparency bill
Sen. Robert Duncan, R-Lubbock, recently gave TAFP leadership a sneak peek at a draft of a bill he intends to file that seeks to bring principles of transparency to bear in health care transactions. TAFP President Doug Curran, M.D., commended the senator’s efforts and his intent in a March 8 letter, writing that while the family physicians of Texas believe that “transparency is a keystone of the patient-physician relationship,” the draft bill would have some unintended and damaging consequences.
In the letter, Curran suggests that the “ambiguously defined principle of transparency” should be considered in the context of electronic verification of benefits and patient eligibility. Without access to accurate information at the point-of-service about a patient’s co-pay, co-insurance responsibility, deductibles and covered services, it is impractical for a physician to provide an estimated cost for the visit.
Read the letter from Dr. Doug Curran to Sen. Robert Duncan.
Read about health care transparency in the latest TEXAS FAMILY PHYSICIAN.
Thanks to these Physicians of the Day
Thanks to this week’s Physicians of the Day and resident Physicians of the Day who volunteered their time to serve at the Texas Capitol in the Capitol Health Clinic. Their contribution to legislators, their staffs, their families and other visitors to the Capitol grounds are greatly appreciated by the Academy and the Capitol community. This week’s physicians were Jonathan MacClements, M.D., of Tyler, Audrey Jones, D.O., of Alamo, John Richmond, M.D., and resident Shawn Riley, M.D., of Dallas, and Jorge Duchicela, M.D., and resident David Schnaiderman Torres, M.D., of Weimar.
Open dates are still available in April and May. These include April 9, 10, 16, 23, 24, 25, 26 and 30. For more information on the program, for a list of open dates in May or to sign up, contact Kate McCann at TAFP.