April 12, 2021
1. Prior Authorization & Patient Estimate Bills to Be Considered This Week; Austin

2. TOA's Title Sponsor in 2021: MSK Case Studies From TMLT

3. Medicare's Prior Authorization for Spine Codes on July 1; AAOS Comment

4. Bundled Payment Discussion in Austin Last Week

5. Texas Medical Disclosure Panel Legislation: An Innocuous Bill?
6. Medical Billing Tax & Bad Patient Debt Bills Coming This Week in Austin

7. Repayment of Covid-19/Medicare Accelerated Payments Program

8. Texas House Announces Health Priorities; Two Medicaid Expansions

9. Personal Injury Lawsuit Medical Payments: New Bill Version

10. 48 Days Remain in Austin: What Are The MSK Bills This Week?

TOA is now offering two free hours of online CME to fulfill the state's new opioid prescribing CME mandate. Click here to access it. Click here to view the newest CME requirements in Texas.

1. Prior Authorization & Patient Estimate Bills to Be Considered in Austin This Week
The Texas House Insurance Committee will consider two medicine-supported bills by Rep. Greg Bonnen, MD (R-Friendswood) - HB 3459 and HB 4012 - on Tuesday.

HB 3459 - "Gold Card Status"
The bill would require health plans to provide “gold carding” status for commonly approved procedures on a physician-by-physician basis. This would be defined as a physician who performs a procedure at least five times a year and has that procedure approved at least 80 percent of the time, based on the previous calendar year, would not be subject to prior authorization requirements for that procedure, and the exemption would be valid for a year.

The bill would also require peer-to-peer calls to be conducted by a physician of the same or similar specialty as that of the treating physician. In addition, HB 3459 would require physicians who are conducting peer-to-peer calls to be licensed to practice medicine in Texas.
HB 4012 - Health Plan Payment Estimates
The bill would require health plans to provide an itemized estimate of costs to patients prior to an elective surgery.

2. TOA's Title Sponsor for 2021:
MSK Case Studies From TMLT
Thanks to all of TOA's Circle of Champions for 2021.

The following is a look at MSK case studies from TOA's title sponsor for 2021, TMLT:

  • Case Closed: Failure to follow up on MRI test results - click here to view it.

  • Telemedicine in Texas: April 20 and 28 webinars (CME) - click here for more.

  • Do you have a coverage gap? Click here to learn more.
3. Medicare's Two New Prior Authorization Codes for Spine; July 1 Implementation
Medicare will require prior authorization for two new spine service categories performed in the hospital outpatient department setting - cervical fusion with disc removal and implanted spine neurostimulators - beginning on on July 1, and AAOS and other national medical societies recently asked CMS for a delay.

Click here to view the April 7, 2021, letter, which was signed by numerous medical specialty societies, including ophthalmology and other surgical specialties, due to their concern related to future prior authorization within the Medicare program.

Click here to learn more from CMS. Click here to learn more from NASS.
4. Bundled Payment Discussion in Austin Last Week
A Texas House committee considered a bill last Wednesday that would direct the Employees Retirement System of Texas (ERS), which covers nearly 1 million lives, to create a bundled payment program within its health plan.

The legislation, HB 571, is broad: It does not specify what services must be bundled. As a result, it would leave the discretion up to ERS as to what services, if any, to bundle. In addition, ERS does not need legislative authority to create bundles; it is able to do so now on its own.

The bill leaves a number of questions. For example, it would require ERS to work with an outside third party administrator (TPA) to deliver the bundle.
5. Texas Medical Disclosure Panel Legislation: An Innocuous Bill?
Rep. Julie Johnson (D-Carrollton) filed legislation in Austin, HB 2853, to ensure that panel members representing the public is not a registered lobbyist, the spouse of a physician/provider or an individual who works in the health care industry.

HB 2853 passed out of its House committee last week. However, the CRNAs have eyed it as a vehicle to address a rule that requires a CRNA to include the name of the delegating physician on the patient's informed consent disclosure form.

The CRNAs are pushing an amendment to HB 2853 that would require the medical disclosure forms to be sent to the governor's division on anti-competitiveness. The amendment reads:

"...the disclosure panel shall submit any proposed rule or disclosure form affecting market competition in this state to the division established under Chapter 57, Government Code, for review before adoption or implementation."
6. Medical Billing Tax & Bad Patient Debt Bills Coming This Week in Austin
Medical Billing Tax
The Texas House passed the bill to remove the state's medical billing tax, HB 1445, last week. The Senate will now consider the House version, HB 1445, in a Senate committee this week.

The Senate committee can simply vote out the House's version out of the committee following this week's hearing. The House version can then go to the Senate floor for final passage.

Click here to learn more about the issue.

Bad Debt Collection
A Texas House committee will consider a bill this week, HB 4045, which would:
  • Require health care providers and facilities to post their "gross charges" for uninsured patients.
  • Create an itemized bill within 60 days (on patient request).
  • A limit on the interest rate related to a patient's debt.
  • The sale of a patient's debt to another entity would not be allowed within the first 180 days.
  • Limits would be placed on reporting bad debt to a consumer reporting agency. 

Itemized Billing
A Senate committee will consider SB 2122, which would require that a provider to send an itemized bill prior to attempting to collect any money from the patient. If the provider is not attempting to collect any money from the patient, the provider is not required to send the itemized bill.
7. Repayment of Covid-19/Medicare's Accelerated Payments Program
The repayment of Medicare's Covid-19 Accelerated and Advance Payments began on March 30. Click here to learn more.
8. Texas House Announces Health Priorities; Minor Medicaid Expansion Included
The Texas House announced its priorities for the 87th Legislature at a press conference last week.

Click here to read the Texas Medical Association's analysis of the bills. Click here to read the speaker's press release.

Two Medicaid expansion bills are included:

  • HB 290 - The bill would provide continuity of care for some children on Medicaid. HB 290 is moving through the House. But the Senate companion has not been heard in its committee.
  • HB 133 - The bill would give pregnant women covered under Medicaid an additional 10 months of coverage. The bill is moving through the House. However, a Senate companion has yet to experience movement.

9. New Language for Paid & Incurred Personal Injury Lawsuits & Medical Care
A Texas House committee heard testimony last week on legislation that would change the payments made to physicians and facilities that perform medical work related to paid and incurred (personal injury) cases. SB 207 and HB 1617 are the bills.

Several dozen physicians testified against SB 207 in the Senate committee on March 29 due to the following reasons:

  • The committee substitute for SB 207 was written in a broad manner, and it could all types of payment benchmarks, such as Medicaid and Medicare, to be introduced as evidence.
  • The substitute did not address unnecessary discoveries.
  • Any individual, regardless of the individual's medical expertise, would be able to counter charges under the substitute.

Click here to view the House's substitute language, which was heard in a House committee last week.

The latest version would eliminate discovery for a physician's services if the physician does not charge more than 150 percent of the Workers' Comp fee schedule.
10. 48 Days Remain in Austin: TOA's Checklist of MSK Issues This Week
What Did You Miss?
Click here to view all of TOA's e-mail updates from 2021.

Click here to view TOA's full bill tracker.

Funding for Your PMP Software
The Texas House included funding for the state to once again acquire software licenses so that physicians can integrate the state's prescription monitoring program (PMP) database into EHRs through Appriss.

The funding mechanism will be debated once the House and Senate hold a conference to finalize the state's budget.

In addition, the Texas Senate Committee on Finance will hold a hearing today on SB 1827, which would use part of the attorney general's opioid settlement with drug manufacturers to pay for the physician integration tool for the PMP.

Sports Medicine & Concussions
HB 3449 by Rep. Four Price (R-Amarillo) would allow any health care professional to serve on a school's concussion protocol committee. (Chiropractors were added several years ago.)

In addition, HB 3449 would add physical therapists to the list of individuals who are allowed to pull an athlete from a competition due to a suspected concussion. (Parents, coaches, physicians, nurses and others are on the current list.)

Two Workers' Comp Bills
Two Workers' Comp bills will receive hearings in House committees this week:

HB 4469 by Rep. Cecil Bell (R-Magnolia) would create an option for employers to purchase Workers' Comp and health insurance in one package. The concept is challenging, and it is unlikely to go into law.

HB 3622 by Rep. Cole Hefner (R-Tyler) would encourage TDI-DWC to reinstate several physicians who were removed from the Workers' Comp network before 2007.

Organized Medicine's Message on Opioids
TOA and organized medicine will provide a response to Rep. Four Price (R-Amarillo), the author of two concerning bills related to opioids, this week. One bill would create an informed consent mandate related to opioids. The other bill would give pharmacists the ability to override a physician's judgment.

Click here to send a message to your state lawmakers about opioids and the need to focus on the 2019 laws.

Bobby Hillert | Executive Director
Texas Orthopaedic Association
[email protected] | 214.728.7672 m
Texas Orthopaedic Association www.toa.org