2015 Legislative Session Update

Transcription

1 2015 Legislative Session Update The 2015 Legislature was one with many new faces, including a whole new slate of statewide elected officials. Lt. Governor Dan Patrick shook up the Senate by shifting Senate committee leadership. Health care legislation now goes before the Senate Health and Senate Business committees both of which had new chairmen. This type of turnover usually means new staff, loss of institutional knowledge, and not much in expectations when it comes to passing legislation. In this case, the Republican and Tea Party groups claim victory when a low number of bills pass, thus demonstrating the limited government used during their campaigns. Fortunately, the budget did pass, which gives Texas the roadmap of how to fund all medical services during the next biennium. For the first time in several years, there was not a special session called immediately after the end of the regular 140 day session. However, it is anticipated that a special session is going to be called sometime in 2016 on the subject of school finance reform.

2 Bills that did PASS Prior to entering the 2015 Legislative Session, fully expected a batch of legislation to be filed on the subjects of transparency, medical bills, balance billing, and network adequacy. Those predictions came true as many provider groups, health insurance plans, and business groups filed legislation all blaming industries other than themselves for being the problem. Legislation in the FEC industry focused on signage, disclosure, transparency, and network status with commercial plans. SB 425 by Schwertner and HB 3475 by Bonnen As filed, these companion bills required the posting of facility fees, network status of the physicians, network status of the facility, and numerous provisions related to mediation. This is the version that members testified against in the Senate Business and Commerce Committee. Schwertner and Bonnen later amended their legislation to remove all of the provisions that previously opposed including mediation. SB 425 was signed by the Governor and now the DSHS will adopt rules in the fall on the remaining posting requirements. SB 481 by Senator Hancock and Representative Smithee As filed, SB 481 reduced the mediation threshold for physician billing from $1,000 down to $0. This bill was expedited through the Senate and had very little opposition during the committee and floor votes. The health plans and business community waged a war against providers, which avoided the real issue of the lack of reimbursement and lack of adequate networks. Once SB 481 hit the House Insurance committee, negotiations kicked into another gear and several strong witnesses were able to testify against the bill with convincing arguments. While any reduction in this threshold is not ideal for the providers, SB 481 ultimately ended up at a $500 threshold, which is much better than $0. SB 1279 by Senators Campbell, Nelson, Uresti and Representative Morrison This piece of legislation, commonly referred to as the Baby Moses FEC bill, was overwhelmingly supported by both chambers in the Legislature. In order to protect infants, SB 1279 added FECs to the list of safe havens where parents of unwanted newborns can drop off their baby. SB 1279 was signed by the Governor, which means parents have more choices to ensure their newborn is left in the hands of an emergency medical professional. The Department of Family and Protective Services will be able to make arrangements for that baby to be picked up from these safe havens and placed with a family looking to adopt. HB 574 by Bonnen and SB 1098 by Campbell This bill is referred to the delisting bill, and also passed both chambers with little opposition. The Governor signed HB 574 and now the Texas Department of Insurance will be able to adopt rules to ensure providers are not delisted from their network status based on referring their patients to other out-of-network providers. SB 195 by Schwertner and Representative Crownover This legislation moves the prescription monitoring program for controlled substances from the Department of Public Safety to the Texas Board of Pharmacy. After the bill becomes effective, the Pharmacy board will handle all controlled substances and the interaction with the Class F pharmacy license. The DPS number will no longer be necessary and the remaining registration will be between DEA/TSBP.

3 Bills that did PASS SB 1753 by Campbell Relating to the identification requirements of certain health care providers associated with a hospital. SB 1753 amends the Health and Safety Code to prescribe the specific occupational designations required to be clearly stated on the photo identification badge of a health care provider holding an applicable license or certificate, and provides direct patient care at a hospital. SB 339 by Eltife Relating to the medical use of low-thc cannabis and the regulation of related organizations and individuals. S.B. 339 amends the Occupations Code to authorize a qualified physician to prescribe low-thc cannabis to a patient with intractable epilepsy, defined by the bill as a seizure disorder in which the patient s seizures have been treated by two or more appropriately chosen and maximally titrated antiepileptic drugs that have failed to control the seizures.

4 Bills that did NOT PASS 359 by Senator West and Representative Workman This piece of legislation passed, however it received a veto by the Governor. Relating to the authority of a peace officer to apprehend a person for emergency detention and the authority of certain facilities to temporarily detain a person with mental illness. This proposed legislation was filed multiple sessions in a row with 2015 being the first where it passed both chambers. However, the Governor vetoed it on his basis that is raises constitutional concerns and potential erosion of constitutional liberties. However, there is no state definition in the Insurance statutes or within TDI s administrative code. Unfortunately, that allows each commercial plan the ability to define this rate on their own which results in lower reimbursement and no consistency for providers. HB 2757 by Bonnen Relating to prompt payment of physicians and health care providers under contract with certain self-insured health benefit plans. SB 202 (DSHS Sunset) by Senator Schwertner and Representative Four Price The DSHS sunset bill, SB 202, was amended substantially throughout the process. In the end, SB 202 passed, but all of the provisions that were intended to renew DSHS were removed. Therefore, DSHS is scheduled to go through the Sunset process again during the interim and be filed again in the 2017 legislative session. Arbitration, HB 1638 by Representative Smithee and Senator Taylor As filed, this bill would prohibit emergency care providers from sending patient s a bill and force arbitration for any unpaid balance. HB 616 by Bonnen and SB 1097 by Campbell These bills were referred to as the Fair Health legislation and were only able to receive a hearing in the House Insurance Committee. Current law requires out-of-network providers and facilities to be reimbursed at the usual and customary rate. HB 3102 by Frullo Relating to the disclosure by health care practitioners and facilities of patient liability for payment for certain health care services. The bill would amend the Insurance Code and Health and Safety Code to require that health care practitioners and facilities must disclose to a patient the price that will be accepted as payment in full for certain health care services before that service is provided. No fiscal impact is anticipated for the Health and Human Services Commission, and the Department of State Health Services indicates any increase to the volume of complaints resulting from implementation of the bill could be absorbed within current resources. HB 3527 by Bonnen Relating to the requirement that certain medical facilities and physicians give patients a good faith estimate of the expected payment for facility-based health care services before the services are provided.

5 2015 Healthcare Legislation of Interest 1115 Waiver The biggest issue involving Medicaid is the expiration of the state s 1115 waiver in November Some health care analysts believe the federal government would be more like to renew the waiver if the state s new budget included Medicaid increases for both hospitals and primary care physicians. Hospital Funding Conferees have proposed to provide much of the hospital funding through a transfer of trauma funds. Ultimately, only $5 million of the rural hospital payment is from new general appropriations. The following is a breakdown of the three streams of funding for hospitals: Trauma add-on for hospitals: $217 million in all funds ($93 million of which is transferred from the DSHS trauma funds). Funding for safety net hospitals: $299 million in all funds ($128 million of which is transferred from the DSHS trauma funds). Rural hospital outpatient payments: $58 million in all funds ($20 million of which is transferred from the DSHS trauma funds and $5 million of which comes from new general appropriations). The purpose of this line item is to provide rural hospitals with 100 percent of cost plus inflation. Ebola Funding & Texas Emergency Medical Task Force Funding The conferees included the funding of the EMTF when the state receives more than a defined amount of federal ebola funding. It is important to note that the Senate included a provision that would have tied the funding to the passage of SB 538. The contingency that tied the funding to SB 538 passage was removed in the conference report. SB 538 would create new capabilities for the state government to address infection disease emergencies. While the bill passed the Senate, SB 538 has been pulled from the House calendar. Left- and right-leaning groups that have concerns over vaccinations and other public health responses have expressed strong opposition to SB 538. Trauma Fund Transfers A special provision was included in the conference committee that would require DSHS to transfer certain trauma funds to HHSC for the purposes of an add-on payment for trauma care. HHSC would be directed to develop a methodology to implement increased reimbursements for trauma care providers. Cardiovascular Disease & Stroke Projects The conference committee included the House s proposal for $6.5 million in funding for cardiovascular disease and stroke project funding. $2 million of which will go to the state s cardiovascular disease and stroke council (Stroke/ STEMI Data Collection). The balance will be directed to the University of Texas System for the administration of a statewide stroke clinical research network, Stroke System of Care Coordination (Lone Star Stroke). Collection of Emergency Room Data A provision directs DSHS to collect emergency room data, which would then be used to measure and report preventable emergency room visits, including potentially preventable mental health and substance abuse emergency room visits. The results must be disclosed on an annual basis, beginning December 31, 2016.

6 2015 Healthcare Legislation of Interest Infection Disease (Ebola) Funding A provision allocates $6.65 million each fiscal year for the purpose of epidemiology surveillance and response, infection disease response training exercises, laboratory response, and communication and coordination. The provision is significant because if DSHS receives federal funds of $20,270,483 or more during the biennium related to ebola, the state funds can then be utilized to fund the Texas Emergency Medical Task Force (TEMTF), diabetes prevention and control, and pediatric asthma management. Medicaid Managed Care Organization Network Adequacy Report The budget includes a provision that will require HHSC to report to the Legislature no later than September 1, 2016 a report that contains the number of final disciplinary orders or corrective action plans imposed by HHSC over the past five years based on Medicaid managed care network adequacy violations. The budget also includes a provision that would outline the number of single case agreements between any Medicaid or CHIP managed care organization and a provider over the past five years. Medicaid Managed Care Networks SB 760 has cleared the Legislature and will direct the Health and Human Services Commission to create network adequacy standards for Medicaid managed care plans. Expanded Scope of Practice for Paramedics HB 2020 and SB 1899 have both cleared the Legislature and will expand the scope of practice for paramedics to allow them to provide advance life support in an emergency department under a physician s supervision. Several EMS sunset provisions were amended to one of the bills. Direct Transport to a Mental Facility HB 2711 did not make it out of the House and would have allowed EMS personnel to bypass a hospital emergency department and transport a patient demonstrating mental illness directly to a mental health facility. The EMS industry expressed concerns that paramedics were not licensed to diagnosis mental illness; therefore, they would not know when it would be appropriate to transport the patients to mental health facilities. Insurance ID Cards Denoting ACA Exchange Plans HB 1514 has cleared both chambers and would add a note to insurance ID cards indicating if a plan was purchased in the Affordable Care Act exchange. HB 1514 originally would have added an s to cards in which patients have received a subsidy for the premium. However, that provision was removed after controversy in the House. Instead, all patients with a plan purchased in the ACA exchange, whether they receive a subsidy or not, would have the denotation on their card. Over 80 percent of all ACA exchange plans are receiving a premium subsidy. Telemedicine A lawsuit filed by Teladoc to challenge the Texas Medical Board s spring 2015 rule regarding the concept of physicians diagnosing and offering prescriptions over the telephone or has captured the attention of the telemedicine issue. Numerous bills involving telemedicine bills were filed in the 84th Texas Legislature. However, they were mostly limited to issues that would be allowed under the Texas Medical Board s rules. No issues involving the Teladoc model passed out of the Legislature. HB 2172 related to the Teladoc model and was left pending in a House committee.

7 2015 Healthcare Legislation of Interest Prompt Pay Changes HB 1433 would have changed the amount of penalties awarded to providers for prompt pay violations by commercial health insurance plans. The Texas Medical Association and Blue Cross Blue Shield of Texas agreed to the changes. However, after strong objection from hospitals, they did not receive enough support to make it out of committee. Guns in Health Care Facilities HB 805 did not make it out of the House and would have allowed concealed handguns on the premise of any health care facility that receives public money. Biosimilar Substitution HB 751 (SB 751 Senate companion) has cleared the Legislature and will allow physicians to retain the authority to use Dispense as Written to ensure that a biosimilar has not been unknowingly substituted for a biologic product. Opioid Antagonist Legislation Several bills cleared the Legislature and will allow providers to prescribe opioid antagonists to family members or friends who are close to individuals who may suffer from an opioid overdose. Air Ambulance Medicaid Funding HB 3077 would have created a provision for air medical ambulance providers to draw down additional federal funds from the federal government. The measure ultimately stalled in the Senate after it was pointed out that air ambulance providers were making more than ground EMS. Interstate Compact License for EMS Personnel HB 2498 cleared the Legislature and will allow Texas to enter into an interstate compact that recognizes paramedic licenses from other states that have entered into the compact. The licenses are recognized under certain circumstances. Epinephrine Injectors in Schools SB 66 was signed into law by the governor and will allow schools to stock epinephrine auto-injectors to respond to allergic reactions. Statistics on the 140th day Monday, June 1, 2015 House Metric 84R 83R Diff % Bills Filed % Bills Passed % Joint Resolutions Filed % Joint Resolutions Passed % Senate Metric 84R 83R Diff % Bills Filed % Bills Passed % Joint Resolutions Filed % Joint Resolutions Passed %