CAPITOL UPDATE: With few weeks left in the session, action heats up on
health care issues

New tactic for TAFP’s loan repayment bill

After being passed by the House Committee on Public Health several weeks ago, TAFP’s loan repayment bill has been stuck in the House Calendars Committee awaiting a vote that would put it on the schedule for debate on the House floor. That vote may never come. Powerful interests have lined up against the bill and time is running short.

TAFP and its partner in the effort, the Texas Association of Community Health Clinics, have reworked the bill as an amendment and plan to ask lawmakers to attach it to another loan repayment bill scheduled to be debated by the full House today.

House Bill 2154 by Rep. Al Edwards, D-Houston, would slightly increase some physician licensing fees and establish a dedicated account in the state’s general revenue funds to pay for physician loan repayments. That makes the bill an excellent vehicle to carry the amendment.

The House is currently embroiled in a lengthy debate about the Texas Department of Transportation, so exactly when H.B. 2154 will be called up is anyone’s guess. Stay tuned ….

Senate committee passes instant verification of benefits

Senate State Affairs Committee unanimously passed TAFP’s instant-verification-of-benefits bill this week, sending the measure to the full Senate for debate. H.B. 1342 by Rep. José Menendez, D-San Antonio, and its companion in the Senate, S.B. 863 by Sen. Chris Harris, R-Arlington, would require health plans to provide physicians with information about their patients’ coverage including what services are covered, deductible amounts and estimates of the patients’ out-of-pocket costs at the point of care.

TAFP CEO Tom Banning testified before the committee, telling the senators that the bill will reduce administrative costs, simplify the process and most importantly, give patients the information they need on what their plans cover and what their financial responsibility will be.

“A lot of the large plans … are moving toward real-time claims adjudication, which is really where we want to be,” he said. “We believe this legislation is a good first step to get us there.”

The bill could get a hearing on the Senate floor any day. For more information about the bill and the need for real-time eligibility and coverage verification, check out the cover story of the latest issue of TEXAS FAMILY PHYSICIAN.

TAFP joins physician organizations to petition budget conferees

The budget conference committee comprised of members from both the House and the Senate met this week to begin working out the differences in the two versions of the appropriations bill. TAFP, the Texas Medical Association and the Texas Pediatric Society joined forces to request the conferees consider important health care priorities in their deliberations. These include:

• Reducing the number of uninsured Texans,
• Improving the availability of physician services, which calls for increasing Medicaid and Children’s Health Insurance Program (CHIP) payments,
• Fixing the state’s eligibility system for Medicaid and CHIP,
• Continuing the state’s commitment to improving mental health services, and
• Implementing routine newborn screening for cystic fibrosis.

Read the letter the three organizations sent to the conferees this week.

Budget conferees consider statewide rollout of Medicaid HMO model

The budget conference committee could decide as early as today to include a so-called Medicaid cost-containment strategy in the budget that would eliminate the primary care case management system currently in place for Medicaid beneficiaries in rural and border communities. The strategy would replace PCCM with a plan similar to the HMO Medicaid model, meaning even more of the money the state spends on Medicaid will be diverted from patient care to profits for managed care organizations.

According to an action alert by TMA, the Medicaid cost-containment strategy would:

• Increase the discount paid to out-of-network physicians to 10 percent, from the current 3 percent. That’s 10 percent less than Medicaid rates! This is supposed to save the state about $9.5 million. It’s already tough enough for many patients to find a physician who takes Medicaid—especially a pediatric subspecialist. Imagine what will happen if the state cuts these payments by another 10 percent.
• Eliminate the PCCM system now in place in most rural and border communities and smaller cities. For a savings of not quite $7 million, the rider would require all physicians and hospitals who want to participate in Medicaid to be part of an HMO-like plan called an Exclusive Provider Organization (EPO). Not only would this force all physicians and Medicaid patients to put up with HMO hassles, but it would also cost public hospitals around the state as much as $200 million, including more than $120 million in federal Medicaid funds.
• Implement ultrasound “practice guidelines,” although the rider does not specify who will develop the guidelines or how they will be used.
• Establish “market rates” for community-based Medicaid health plans. Although “market rate” is not defined, it is understood to mean that these plans are required to reduce the payments they make to in-network hospitals and physicians.

This is an urgent issue, especially if you are a constituent of one of the budget conferees listed below. Please consider calling your representative today to express your concern for the Medicaid cost-containment strategy.

House Conferees

• Rep. Jim Pitts (Chair), R-Waxahachie, (512) 463-0516
• Rep. Ruth Jones McClendon, D-San Antonio, (512) 463-0708
• Rep. John Otto, R-Dayton, (512) 463-0570
• Rep. Richard Peña Raymond, D-Laredo, (512) 463-0558
• Rep. John Zerwas, R-Fulshear, (512) 463-0657

Senate Conferees

• Sen. Steve Ogden (Chair), R-Bryan, (512) 463-0105
• Sen. Juan “Chuy” Hinojosa, D-McAllen, (512) 463-0120
• Sen. Florence Shapiro, R-Plano, (512) 463-0108
• Sen. Royce West, D-Dallas, (512) 463-0123
• Sen. Tommy Williams, R-The Woodlands, (512) 463-0104

Senate votes to expand CHIP

This week the Senate passed S.B. 841 by Sen. Kip Averitt, R-Waco, which would establish a sliding-scale premium for the state’s Children’s Health Insurance Program allowing families earning between 200 percent and 300 percent of the federal poverty level to buy in to the program. The bill would create an affordable option for working families to insure their children.

Thanks to the Physicians of the Day

Thank you to the physicians who volunteered as Physicians of the Day this week: PJ Mock, M.D., of La Porte; Michelle Markley, M.D., of Austin; Ajay Gupta, M.D., of Austin; Sandra Worrell, M.D., of Austin; and Maureen Swenson, M.D., of Austin.

Because of the rush of activity in the last month of the 81st Texas Legislative Session, TAFP may need volunteers to serve on Saturdays and Sundays in May. If you are able to serve on a weekend, please contact kmccann@tafp.org. Find more information about the Physician of the Day program on TAFP’s Web site, www.tafp.org/advocacy/physicianoftheday.