Managed care reform has received attention in both the House and the Senate as bills have passed floor debate, been voted out of committee or are entering the final stages of hearings.

The fair contracting bill, Senate Bill 1170 by Juan “Chuy” Hinojosa, D-McAllen, received a hearing in the Senate State Affairs Committee Thursday. The bill would require full disclosure by health plans of payments terms, mandate that all contracts be written in plain language, prohibit the health plans from imposing new categories of coverage on doctors without their knowledge and require managed care organizations to notify doctors before changing the terms of contracts. SB 1170 is modeled after Colorado’s fair contracting bill that was signed into law on March 30.

TAFP provided written testimony as part of the Primary Care Coalition in support of SB 1170, highlighting the difficulty for physicians to negotiate with managed care plans “when they include egregious language in their contracts” and “control a significant portion of the physicians’ practice income.” The bill was left pending in the Senate committee. Its companion legislation, House Bill 2016 by Rep. John Smithee, R-Amarillo, also came up on Thursday before the House Committee on Insurance, but a vote will be delayed until Monday because of questions about the bill.

Other activity in the House Committee on Insurance included passing House Bill 839 by Rep. Craig Eiland, D-Galveston. The bill would stop third-party payers, called “silent PPOs” from renting out a physician’s contracted rates to other plans without the physician’s consent.

The committee began consideration of a bill that would establish a managed care report card. House Bill 2329 by Rep. Todd Smith, R-Euless, would require health plans to report how much of a patient’s health insurance premium goes toward patient care. The report card would also rate plans on network adequacy and require plans to report anticipated annual profits. Companion legislation in the Senate, Senate Bill 1355 by John Carona, R-Dallas, received a hearing at the Senate State Affairs Committee hearing Thursday and was left pending.

House Bill 1594 by Rep. John Zerwas, M.D., R-Richmond, passed out of the House and will now head to the Senate for approval where it has been assigned to the Senate State Affairs Committee. The bill would allow a physician new to a practice to see patients under the certain health insurance plans while waiting for credentials. This way, the patient would receive in-network rates and the physician could start building his or her patient base immediately. If the health plan denied the physician credentials, the practice would be responsible for reimbursing the plan.

Several other bills came up in the Senate State Affairs hearing and were left pending. Two closely-related bills, Senate Bill 1614 by Robert Duncan, R-Lubbock, and Senate Bill 334 by Chris Harris, R-Arlington, would allow physicians and their staffs to access real-time information about a patient’s health insurance coverage and benefits through the Internet, “smart cards” or other information technologies.

Frances Cason, Insurance Services Manager for Medical Clinic of North Texas, P.A., spoke on behalf of TAFP. “In a perfect world, every single person’s benefits would be checked every single time they walk in the door, but when you do have large patient populations, many, many different health plans, some of the docs see as many as 30 patients a day, you cannot possibly verify benefits on every single patient,” she told the committee.

Access issue briefs on managed care reforms through the Policy Initiatives page in the Advocacy section of the TAFP Web site.

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Agreement in Frew suit means 25-percent raise in Medicaid provider pay

Plaintiffs’ attorneys and key legislators have come to an agreement in a federal lawsuit that threatened to wreak havoc on the state budget. The class action suit, called Frew v. Hawkins, claims that Texas children in the Medicaid program do not have sufficient access to physician services or preventive care.

Under terms of the settlement, the state will increase physician reimbursement in Medicaid by 25 percent. The state will also work to provide more access to Medicaid services for children in underserved areas.

The settlement is expected to cost the state $700 million in general revenue, drawing down an additional $1 billion from the federal government.

The settlement cleared the way for the Senate Finance Committee to pass their version of the state budget. To address the cost of the proposed Frew settlement, the committee passed an amendment to the budget that implements a 0.59-percent cut on all state spending.

U.S. District Judge William Justice will have to review the settlement details before the deal is final, but he likely won’t do that until after the legislative session is over.

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Senate passes budget, details to be worked out in conference committee

The full Senate passed its version of the state budget on Thursday, April 12. The Senate spends about $2 billion more than the House. It leaves between $2 billion and $3 billion unspent for future property tax cuts. Now the budget will go to conference committee where differences between the House and Senate bills will be hammered out.

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House committee debates Medicaid provider database

The House Committee on Human Services heard testimony on a bill this week that would make it easier for Medicaid patients to find physicians. House Bill 2042 by Rep. Dawnna Dukes, D-Austin, would establish a Web-accessible database to provide up-to-date information on what physicians are accepting new Medicaid patients. The measure would cut down on the amount of time physicians and their staff spend when referring patients for specialty services.

Sam Adkins, M.D., director of the family medicine residency program at Austin’s Brackenridge hospital, testified in support of the bill on behalf of the Primary Care Coalition. “If there was a database like this that shows who is and who isn’t taking it, and some kind of reward that would be provided to the folks who are actually taking this, there may be some more coercion for folks to get involved. I think that the specialists I work with here in Austin would be willing if they thought there was some way to limit their individual financial risk in providing for these folks, and if we enable them you know made it easier for them to do that. So this is going to help us and help our patients.”

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TAFP speaks out against reducing physician supervision of NPs

The House Committee on Public Health took up a bill this week that would increase the autonomy of nurse practitioners. House Bill 1096 by Rob Orr, R-Burleson, would enable one physician to oversee six nurse practitioners within 75 miles of the physician’s primary practice. Currently, the ratio is one physician to three nurse practitioners within 60 miles of the physician’s practice.

The bill would also strike the requirement that a supervising physician be onsite with nurse practitioners during 20 percent of the practice’s business hours.

The Convenient Care Association, a group advocating the expansion of retail health clinics, is pushing the bill. RediClinic and Minute Clinic are members of the association.

TAFP provided written testimony as part of the Primary Care Coalition. “We are gravely concerned that HB 1096 sacrifices patients’ safety and quality for questionable convenience,” the letter read. “Texas’ current supervision requirements ensure appropriate supervision and do not create an unnecessarily burdens for patients’ access to care.”

Josie Williams, M.D., a gastroenterologist from College Station, testified against the bill on behalf of the Primary Care Coalition. “When we decrease supervision, we increase unequivocally the risk for error. It is dangerous, it is not wise in our opinion, nor is convenient health worth not being good health.”

The bill was left pending. Stay tuned for developments in the coming weeks.

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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 Gil Grimes, M.D., of Waco; Mark Chassay, M.D., of Austin; Fred Merian, M.D., of Wimberley; and Clark Langley, M.D., of Kilgore.

Spots are still available in April and May and need to be filled as soon as possible to ensure a family physician is on the Capitol grounds each day of the Legislative session. Open days include April 23, 25 and 26 and May 1, 3, 8, 11, 14, 15, 16, 21, 22, 23 and 28. Please contact Kate McCann for more information on how to participate in this service or visit the Physician of the Day page of the TAFP Web site.