Legislative MessageAugust 2020
“No one is sure.” This is the refrain that I often hear from policymakers when I ask, “What is the legislative session going to look like during the pandemic?” Over the past several months, many have wondered how legislators, staffers, advocates and members of the general public can safely participate in the legislative process even as the state capitol remains closed. How will TCEP build support, defend against bad policy, and create more opportunity for our members? There are simply no clear answers yet. My current recommendation is that we prepare for the session with special emphasis on establishing and maintaining strong, district-level contact with our legislators. Working closely with our lobbyists and the entire house of medicine, TCEP’s 2021 legislative agenda will emphasize protecting provider pay under a constricted budget. Some issues are familiar, like seeking to enhance last year’s balance billing legislation by improving the out-of-network payment arbitration process. Some, including protecting Medicaid provider rates, will be efforts that stem directly from the economic impact that COVID-19 is having on the state. And still other initiatives will not present themselves until the legislature has determined its policy priorities and the scope of the legislative process when they convene in January. Therefore, TCEP must be prepared to engage at a moment’s notice on the key issues described below, as well as anticipate and react successfully to the uncertain and the unknown. ISSUES ARISING FROM BUDGET CONSTRAINTS COVID-19 has had a severe impact on the state’s budget outlook. Texas Comptroller Glenn Hegar recently announced that state revenues have shifted from a multi-billion dollar surplus to an almost 5 billion dollar shortfall in just a few short months. This has led to proposed expenditure cuts in the current budget and will likely restrict the available revenue for the state’s next two-year budget. We anticipate that Medicaid rates for providers and Graduate Medical Education (GME) expenditures will be on the chopping block. TCEP will seek more dollars directed to emergency care, including increased allocation for payment parity for emergency medicine services provided through telemedicine platforms, which have increased significantly during the current pandemic. IMPROVEMENTS TO SB 1264 When the legislature passed SB 1264 prohibiting balance billing in 2019, TCEP and all facility-based provider groups knew that we had worked hard to craft the best outcome for our members, but that it was not going to be a perfect system immediately. The bill replaced the mediation process for out-of-network billing disputes with an arbitration process overseen by the Texas Department of Insurance (TDI) to end balance billing altogether. I am pleased to report that according to data released from TDI after the first 6 months, providers are winning an overwhelming percentage of arbitration claims, justifying our arguments that health plans have been shortchanging patients and taking advantage of providers in some payment circumstances. However, as is often the case, some of the provisions of the final bill were untested and will require modifications to improve the process. We are working carefully with key legislators, ally groups, and TDI on solutions to make the system more efficient and fairer. DEFINING THE “PRUDENT LAYPERSON STANDARD” For years, health plans have tried to come up with new ways of denying payment for emergency care, including recent efforts to employ retrospective utilization reviews and deterring patients from seeking care in the emergency department through threats of non-payment. TCEP will work to ensure that health plans will be held accountable to the “prudent layperson standard” that is currently in place in order to protect our patients from fear of unforeseen costs associated with seeking emergency care. It is impossible to prepare for every specific policy item we will face. That is why it is imperative that we maximize our relationships with legislators and for our members to engage meaningfully in the lawmaking process, whatever that process may entail. Please keep an eye out for emails in the near future to get involved. Sincerely, |
