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Government Relations Committee - Session Wrap-up
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For readers of our Government Relations Committee reports, I am going to take this opportunity to review the issues that we have been involved in or have been following that were mentioned in our last report, and summarize the outcome of each of them. Then in future issues, I will go into more detail for some of the more pertinent/interesting bills.

The legislative session ended at midnight on May 29. For the first time that I am aware of, the bill to reauthorize the Texas Medical Board (TMB), which is to sunset on August 31, 2017, failed to pass. That was due to disagreements and infighting between the Senate and the House, which took up so much time that less than half of the usual number of bills that pass each session were able to pass this time. For this reason, Governor Abbott expressly called the legislature back for a special session beginning July 18. Although he has authorized a number of specific items that can be considered during the special session, he has made it clear that the TMB and the Medical Practice Act must be reauthorized before moving on to any other topics.

Once again, 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. We discussed in the last report about the rider in the 897 page senate budget report that Dr. Carrie deMoor found 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. Unfortunately, although it was not in the house budget plan, when the conference committee met to develop a compromise budget plan, the unfair rider was kept in the final budget plan that passed, and the Governor or his staff was made aware of this but did not take it out. Regarding graduate medical education (GME), the budget did add $44 million for GME expansion grants and increased GME funding by $4.3 million. Under the mental health category, the budget put $300 million toward replacement or repair of state hospitals or other inpatient mental health facilities and added $160 million for deferred maintenance; also approved was $67 million for community-based crisis service provisions, $30 million to reduce homelessness and recidivism, and $67.6 million to eliminate adult and child mental health waiting lists.

TCEP sent out a blast e-mail asking our TCEP members to call their senator and representative and oppose SB 316 as written, which called 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. Although this specific bill died in the Calendars committee, the mandate was added as an amendment to HB 2561 which passed with the provision that implementation of the mandate not take effect until after September 1, 2019. This delay provides a chance for revisions to be made in the next legislative session, so I imagine that will become one of our TCEP priorities for 2019.

We have spent a lot of time discussing balance billing, which 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 and is now owed by the patient. Patients often think that emergency care is covered by their insurance, and they are surprised they owe anything at all. We are pleased that SB 507 by Senator Hancock passed as the answer to the balance billing problem at this time. In the 2015 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 asked for mediation if requested of $500 or more, but included covering all physicians in every specialty, as well as including emergency physicians in free standing EDs, and including 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 supported HB 2760 by Representative (and doctor) Greg Bonnen, with companion bill SB 2210 by Hancock, which required health plans to update their directories of physicians every business day; and required the state’s insurance commissioner to examine insurers’ network adequacy every two years. This bill did not pass.

TCEP supported SB 680 (with 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. That bill did pass.

By far what turned out to be the most interesting bill that garnered the most attention from emergency physicians, and most all physicians, including nationally, was SB 1148 by Senator (and doctor) Dawn Buckingham. Her bill as originally introduced prohibited 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 did not have anything to do with initial board certification. The impetus for the bill was that many of the American Board of Medical Specialties (ABMS) boards require (about half have now changed) a high stakes, high security, expensive every ten year recertification exam which does not necessarily reflect the current practice of many physicians and takes the physicians away from patient care for days to prepare and there is no accounting to the diplomates from their boards as to why the test is so expensive and where that money collected by the board is going to. In the final compromise version of the bill that passed, and was signed by the Governor, the bill still prohibits the state from using MOC as a requirement for state licensure or renewal, or insurance participation, but does permit health facilities to use MOC only if the hospital medical staffs vote that it is appropriate for their own hospital. As a direct result of this bill, our TCEP delegation to the ACEP council will be carrying several resolutions to the October council meeting related to national involvement in state legislation, the high stakes MOC exam in American Board of Emergency Medicine (ABEM), financial accountability, and other related issues on behalf of our TCEP members.

TCEP supported HB 1908 (Zerwas) which would raise the legal age to purchase and use tobacco products from 18 to 21 years old. This bill did not pass.

TCEP supported banning texting while driving in HB 62 (Craddick), and this bill passed after ten years of being introduced to the legislature. It will take effect September 1.

TCEP opposed HB 67 and HB 275 that repealed the driver responsibility program because the revenues from these programs go to trauma funding. Those bills did not pass. TCEP opposed HB 719 (Wu) which would raise the caps on noneconomic damages based on price indexing that were passed in the 2003 liability reform and that bill died. TCEP supported SB 896 (Seliger) which asked that powdered alcohol be classified as an alcoholic beverage so that it could be included in the Alcohol Beverage Code and not be available to people under age 21, but that bill died.

TCEP supported SB 1107 (Schwertner) and HB 2697 (Price) which are the telemedicine bills, and this bill passed as SB 1107, and was signed by the Governor. The bill establishes a statutory definition for telemedicine, which includes an in-person medical setting at some point in the care, and makes it clear that telemedicine is not a distinct service but is a tool that physicians may choose to use. It also prohibits insurance plans from excluding coverage.

There were many other bills that the government relations committee, and the TCEP board of directors, discussed and monitored, or supported or opposed, but I had picked these out as being most pertinent to our members to hear about. This past session was a difficult one because we were involved in so many bills and we had both a change in our executive management staff, plus a change in our lobbying team after the legislative session had already begun. Our committee wants to thank Michael Grimes, and his associates Jenna Courtney and Price Ashley, for coming in as our lobbying team and doing a great job on short notice!

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 but you must call or email TCEP for the password to donate. Please call me (713-301-3564) or e-mail me (, or call our executive director, Ken King (1-800-TEX-ACEP) or e-mail him (, if you wish to discuss any of the information in this report.

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