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EMphasis Report for Government Relations Committee (04/2017)
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Hopefully all TCEP members reading our newsletter will have enough interest to keep on reading through this report as well. There is so much information I would like to convey right now, but will shorten my report as best I can! Our committee last met at the annual meeting on March 31.

A reminder of our TCEP legislative priorities this session: Support fair payment for emergency services (balanced billing issue); protect and promote independent freestanding emergency centers as important facilities for emergency care of Texans; preserve tort reform achievements; encourage safe practices with psychiatric patients in the emergency department.

The number one priority of the legislature every 2 years is to pass a budget for the next 2 years. The senate passes their budget first, then the house passes a budget, then a conference committee composed of 5 senators and 5 representatives is assigned to come up with a compromise budget derived from the two already passed. This session, there is about $8 billion dollars difference between the two budgets, and the house budget tends to be a bit friendlier to medicine. One of our committee members, Dr. Carrie deMoor, discovered that in the senate budget known as SB1 (which was 897 pages long), there was a rider that said employees of ERS (Employees Retirement System) should be charged a higher co-pay if they go to a free standing ED for their emergency care, which is blatantly unfair. There was a threat that this rider might be added to the house budget bill at the time that 402 amendments to the house budget were heard, but it was successfully kept out. Now we need to get that rider out of the final budget plan, which means that once the conference committee members are appointed, you will likely get a blast email from TCEP asking all members who are constituents of those committee members to contact them to get that unfair rider out.

Speaking of blast e-mails, you should have recently received one that asked you to call your senator and representative and oppose SB 316 as written, which calls for a mandate to look up the Prescription Drug Monitoring Program (PDMP) website for every single patient who needs prescribed an opioid or benzodiazepine or barbiturate or carisoprodol (Soma), and to explain that this is not practical to do in the emergency department for every patient due to both time constraints and the fact that some diagnoses, such as fractures and passing kidney stones, may need narcotic medication no matter what the PDMP website shows. If you did not make the calls, it may still not be too late to make a difference on this bill if you will call right away, please.

In this session, there was no question that balance billing, or so-called “surprise bills” for patients, was going to be addressed. The balanced bill is the part for the patient to pay after the deductible is met, the co-pay is paid, and for doctors out of network, the difference between what they have billed and what the insurance has paid is owed by the patient. Patients often think that emergency care is covered by their insurance, and they are surprised they owe anything at all. The Texas Medical Association (TMA) has worked diligently with Senator Hancock on SB 507, as the answer to the balance billing problem at this time. Last session, emergency physicians were included with all other hospital physicians in a bill (again by Senator Hancock) that called for mediation if requested by the patient of all balanced bills that were above the threshold of $500. For billing for emergency physicians, it is not common that a balanced bill would be more than $500 anyway. The bill this session still asks for mediation if requested of $500 or more, but now covers all physicians in every specialty, includes emergency physicians in free standing EDs, and includes facility fees. The bill also includes asking insurance companies to improve their narrow networks and better explain to patients about what their insurance covers and how to request mediation. TCEP is monitoring/supporting that bill.

TCEP is supporting HB 2760 by Representative (and doctor) Greg Bonnen, which requires health plans to update their directories of physicians every business day; and requires the state’s insurance commissioner to examine insurers’ network adequacy every two years. Senator Hancock has a companion bill (SB 2210). TCEP is supporting SB 680 and companion HB 1464 that allows physicians to override step therapy protocols, which means that the patient cannot be required to fail on a prescription medication more than once before they can move on to the next step in their drug treatment when the physician already knows what works and does not work for than patient.

SB 1148 by Senator (and doctor) Dawn Buckingham prohibits discrimination against physicians based solely on maintenance of certification (MOC), by saying that a physician cannot be denied licensure or renewal from the Texas Medical Board, and hospitals and insurance plans cannot refuse to allow a doctor on staff or on their insurance plan based on board recertification and MOC status. It does not have anything to do with initial board certification. TCEP neither supports nor opposes this bill because when the members voted about this issue at last year’s business meeting, the vote was very close in favor of support, but many academic members in particular were opposed to it. When our members are closely divided over an issue, we often do not take a stand one way or the other so as not to upset a number of our members. However, there is no reason why any member cannot weigh in personally to their representatives on this issue. For all TMA members to be aware, the TMA is in support of this bill based on the vote of the House of Delegates last year.

TCEP is supporting HB 1908 (Zerwas) and SB 910 (Huffman) which would raise the legal age to purchase and use tobacco products from 18 to 21 years old. Initially I thought this only applied to purchasing tobacco, but reading the bill in detail includes use of tobacco being considered an offense under the age of 21. TCEP is supporting banning texting while driving in HB 62 (Craddick) and SB 67 (Zaffirini). TCEP is opposing HB 67 and HB 275 that repeal the driver responsibility program because the revenues from these programs go to trauma funding. TCEP opposes HB 719 (Wu) which would raise the caps on noneconomic damages based on price indexing that were passed in the 2003 liability reform. TCEP supports SB 896 (Seliger) which asks that powdered alcohol be classified as an alcoholic beverage so that it can be included in the Alcohol Beverage Code and not be available to people under age 21.

TCEP supports funding for graduate medical education (GME) which has been increased somewhat in both the Senate and House budget bills. Fortunately we do have support from Senator Jane Nelson who is head of the Senate Finance Committee, and the head of the House Appropriations Committee is Representative (and doctor) Zerwas, so they will likely make certain that GME funding is at least not decreased and hopefully will continue to increase to reach the goal of 1.1 entry-level residency slots per graduating medical students by the year 2022.

TCEP is supporting SB 1107 (Schwertner) and HB 2697 (Price) which are the telemedicine bills. The bills provide a definition of telemedicine and clarify how a valid practitioner-patient relationship can occur for purposes of telemedicine care, and also clarify that a medically necessary covered service should be paid for regardless for how it is provided.

The TMA states that they are following 1,400 bills related to health care in one way or another. There are numerous other bills I have not mentioned that we have discussed in committee meetings or among the board or in past sessions. Please just text me (713-301-3564) or e-mail (dianafite@mail.com) with questions or comments or about bills not mentioned here.

There is one last “First Tuesday” on May 2. We welcome you to join us in Austin to visit your legislators and staff to brief them about our issues and offer to be a source of information to them. Just contact me or our interim executive director, Dr. Bruce Moskow (1-800-TEX-ACEP), for further information.

As we always remind our TCEP members, we would appreciate you working one shift per year to give to EMPACT (the political action committee for the Texas College of Emergency Physicians). And larger donations are appreciated, of course. We need to fund EMPACT so that we can give donations to legislators, particularly those in positions of importance to our issues or who have helped us out with our bills or with support of our agenda. Our reports emphasize the importance of having a strong voice when it comes to legislation that affects us so directly. We have to help legislators get elected who understand our issues and help us advocate for our patients. EMPACT needs money to accomplish this. Please send your check to TCEP or call 1-800-TEX-ACEP with your credit card information. You can donate with credit card deductions monthly or quarterly if that is helpful. And you have to renew your donation on a yearly basis. You can also donate online at www.tceppac.org but you must call or email TCEP for the password to donate. Please call me (713-301-3564) or e-mail me (dianafite@mail.com) or call our interim executive director, Dr. Bruce Moskow (1-800-TEX-ACEP) or e-mail him (tcep@aol.com), if you wish to discuss any of the information in this report.

Diana Fite, M.D., F.A.C.E.P.
Chair, Government Relations Committee

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