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Overview of the 2019 Texas Legislature
Learn More at EMS EVOLUTION This June 17-19
 The Texas Legislature wrapped up its 140-day session earlier this week on Memorial Day. While TEMSA played a visible role through testimony, action alerts, and other means, much of TEMSA's work was behind the scenes. Lawmakers contacted TEMSA on a weekly basis for the organization's input on every issue that affected EMS agencies. A special "thanks" goes out to Craig Holzheauser, TEMSA's lobbyist, for his incredible work with lawmakers.
Many of these issues will be discussed in greater detail at EMS EVOLUTION this June 17-19 at the Horseshoe Bay Resort near Marble Falls. There is still time to register - click here.
Click here to view TEMSA's bill tracker.
Also, thank you to all of the TEMSA members for their membership. TEMSA derives the majority of its revenue from membership dues, which pays for TEMSA's lobbying efforts. Without members' support, TEMSA's work at the Capitol would not be possible.
What's Next?
Governor Abbott will have the ability to either sign or veto the bills that the Legislature passed. Many of these issues will require rules in the regulatory arena, and TEMSA will work on those issues.
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Zoll: Thank You to EVOLUTION'S Title Sponsor
Thank you to Zoll for serving as EMS EVOLUTION's title sponsor. Click here to learn more about Zoll.
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The Driver Responsibility Program Replacement Legislation Passed
HB 2048 by Rep. John Zerwas, MD (R-Richmond)
The Legislature passed the Driver Responsibility Program (DRP) replacement through HB 2048.
HB 2048 will have an effect on EMS funding, and TEMSA will go into further detail about the new formula at EMS EVOLUTION 2019. Chairman Zerwas accepted an amendment proposed by TEMSA that will increase the EMS funding from 2 percent to 3 percent. We'll explain what type of EMS funding increase will happen as a result of the new DRP at EMS EVOLUTION 2019 (there is good news, but it is complicated).
In addition, RACs witnessed an increase from 1 percent to 2 percent.
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Property Tax Increase Threshold Set at 3.5 Percent; Other Budget Issues
The Texas Legislature's only requirement is to set a budget when it meets each odd year. Only one lawmaker in either chamber voted against HB 1: Rep. Jonathan Stickland (R-Bedford).
As for the property tax reform found in SB 2, the Legislature settled on an automatic November election for tax increases greater than 3.5 percent in larger taxing jurisdictions for local city, county, and special taxing districts. There are some important notes:
- The lower threshold does not apply to jurisdictions with a tax rate that is below $100 of value, junior college districts, and hospital districts.
- Smaller taxing units may increase taxes by up to $500,000 before triggering an automatic vote. (However, if the increase is greater than 8 percent, then voters may petition for an election, which is the current law.)
Larger taxing jurisdictions that are affected by the 3.5 percent threshold are allowed to carry over any amounts below 3.5 percent during the three previous years to future years before a trigger happens. For example, if a taxing jurisdiction increased taxes by 2.5 percent in 2020, then the jurisdiction can raise taxes up to 4.5 percent in 2021 before an automatic election is triggered.
TEMSA joined other stakeholders, including local governments and hospital organizations, on the property tax issue.
Medicaid and the Budget
More about the budget's effect on EMS and Medicaid can be found below.
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The Medicaid Supplemental Bills Were Stripped in the Senate
HB 2333 and HB 2409 were amended to the "Uber" Transport Bill
The Texas House added the Medicaid bridge funding bill (to create the STAR Safety Net) and the Medicaid supplemental bill for governmentals to HB 1576, which is the "ride sharing" bill for Medicaid patients. However, the amendment was stripped in the Senate. As a result, HB 2333 and HB 2409 did not pass.
Click here to view the amendment on the House bill. The following is TEMSA's summary of the House bill:
Matt Sorrentino of PCG and Asbel Montes of Acadian will speak on these two initiatives at EMS EVOLUTION 2019 and discuss the next steps in the regulatory process and in the 2021 Texas Legislature.
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Medicaid "Draw Down" Models in Texas
New Hospital LPPFs Passed
The 2019 Texas Legislature passed a number of new local provider participation funds (LPPF) programs for hospitals. The new programs are represented by the blue dots. In addition, several omnibus bills will allow any community to create a hospital LPPF.
Meanwhile, the nursing homes were unsuccessful once again in their attempt to create a Medicaid "draw down" program for nursing homes. At issue is a split in the nursing home industry over the issue.
What's Next for 2021?
Different segments of the health care industry are likely to look at other segments of the health care industry for LPPF-type programs in 2021. For example, could non-emergency transport entities create an LPPF to compliment HB 1576 from the 2019 Texas Legislature? That could be addressed.
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"Surprise Billing" Is Now Banned in Texas. But What About EMS?
EMS Is Not Included; Learn More at EMS EVOLUTION
The Texas Legislature passed what some experts have said is the nation's most significant out-of-network law in the nation. Some of these issues are complicated, and we'll have an extensive breakdown of the new law at EMS EVOLUTION 2019.
To summarize:
- With a few exceptions, SB 1264 prohibits most health care providers from balance billing patients for charges outside of copayments, coinsurance, and deductibles. Just like in 2017, TEMSA explained to lawmakers that EMS agencies must be able to collect fees from patients for services. Otherwise, local communities would have to raise taxes to cover the services. Lawmakers understood this, and, as a result, EMS was exempt from the ban on balance billing by the 2019 Texas Legislature that can be found in SB 1264.
- There was an attempt to bring ERISA plans into Texas' current mediation program. However, that did not happen. (On a side note, Congress is working on its own arbitration plan for out-of-network services related to ERISA. However, it is unclear as to whether or not Congress will pass this.)
- Out-of-network Physicians, mid-level providers, "supplies" and imaging/laboratory services affiliated with the physicians now have a ban on balance billing. Instead, they can go through an arbitration process to dispute a payment.
- Out-of-network facilities (hospitals, ASCs, and freestanding emergency medical centers) fought to be removed from the arbitration process. As a result, they were placed in a mediation process in case they want to dispute a payment. Like physicians, they cannot send a balance bill to a patient. Advanced imaging and laboratory services that are associated with the facility fee will be subject to mediation.
Click here if you want to dig deeper. Attend EMS EVOLUTION this June if you want to dig even deeper.
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Network Insurance Issues: Prompt Pay, Emergency Diversion & Prior Auth
Network Directory Bill Contains Prior Auth/Utilization Review
Network Directory Legislation
SB 1742 will direct the health plans to publish regularly updated network directories by physician specialty and facility. It is pending the governor's consideration.
The Legislature passed a network directory bill - SB 1742 by Sen. Jose Menendez (D-San Antonio), which included amendments that will direct health plans to outline their prior authorization requirements and require health plans to use physicians of a same or similar specialty licensed by the state of Texas to make utilization review determinations. The prior authorization and utilization review amendments were pushed hard by Rep. Greg Bonnen, MD (R-Friendswood), Rep. Julie Johnson (D-Carrollton), and Sen. Dawn Buckingham, MD (R-Lakeway).
Changes to the Prompt Pay Law?
HB 1914 by Rep. Joe Moody (D-El Paso) was filed to create a new formula for determining prompt payments due to the fact that freestanding emergency medical centers (FEMCs) do not necessarily have enough facilities in a network to determine a usual, customary, and reasonable (UCR) standard.
Click here to view the FEMCs' rationale for this bill.
Some physician specialty groups expressed concerns that there were too many unknowns related to this bill. Texas has a successful prompt payment law, and any attempts to change the formula should be approached with extreme caution.
The bill ultimately died in the Senate after making it out of the House.
Prudent Layperson Standard for Emergencies
Several bills were introduced to address a commercial health plan's denial of payment for emergency services in an emergency department that the health plan later deemed "non-emergent" in nature. These bills ultimately failed.
HB 1832 by Rep. Julie Johnson (D-Carrollton) and SB 1282 by Sen. Donna Campbell, MD (R-New Braunfels) did not pass. (HB 1832 passed out of the House, but it did not make it out of the Senate.) The bill would have established as an unfair method of competition or an unfair or deceptive act or practice in the business of insurance making health benefit plan coverage for an emergency care claim dependent on a utilization review determination that the patient's medical condition required emergency care.
It also would have required a contract between a Medicaid managed care organization and the Health and Human Services Commission for the organization to provide health care services to recipients to require the organization to comply with the bill's provisions.
HB 3178 by Rep. Rhetta Bowers (D-Garland) would have directed the state of Texas to conduct a study of the denial of claims for emergency care by commercial health plans. However, the bill did not pass.
SB 1054 - Sen. Jose Menendez (D-San Antonio) and HB 4404 - Rep. Rick Miller (R-Sugar Land) - The bill would prohibit health plans from discouraging an insured from using a freestanding emergency medical center. This was pushed by the freestanding emergency medical center industry. The bill did not receive a committee hearing.
Other Network Issues
HB 3999 – Rep. Chris Turner (D-Arlington) – The bill would require facilities to charge first responders and retired first responders the Medicare allowable for a service. Physician offices would be exempt. The bill was heard in committee, but it did not receive a committee vote.
HB 3911 – Rep. Hubert Vo (D-Houston) – The bill would direct the TDI commissioner to conduct a network adequacy examination of PPOs and EPOs every two years. The bill cleared both chambers and was sent to the governor for his consideration.
HB 3041 – Rep. Chris Turner (D-Arlington) – The bill will require a health benefit plan issuer that requires preauthorization as a condition of payment for a medical or health care service to provide a preauthorization renewal process that allows a renewal of an existing preauthorization to be requested at least 60 days before the date the preauthorization expires. The bill requires an issuer that receives a preauthorization renewal request before the existing preauthorization expires to review the request and issue a determination indicating whether the medical or health care service is preauthorized before the existing preauthorization expires, if practicable. The bill establishes the applicability of its provisions. The bill applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2020. The bill cleared both chambers and was sent to the governor for his consideration.
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EMS Personnel
Network Directory Bill Contains Prior Auth/Utilization Review
Vaccines
Two bills related to vaccines for EMS personnel, and the final results represent TEMSA's work on the issue. (The bills would have been very burdensome for EMS agencies in their original form.)
- HB 1256 - Rep. Dade Phelan (R-Beaumont) - The bill would direct the executive commissioner to develop a process to allow direct access to the immunization registry during a disaster response. An amendment will require a first responder to provide written or electronic consent for the immunization registry to be accessed. The bill was sent to the governor for his consideration.
- HB 1418 - Rep. Dade Phelan (R-Beaumont) and SB 829 - Sen. Joan Huffman (R-Houston) - The bill would direct the HHSC commissioner to develop a plan to notify EMS professionals about their immunization history. The bill was sent to the governor for his consideration.
Mental Health Issues for First Responders
Several bills related to mental health concerns and PTSD for first responders were introduced, but only one bill made it all the way to the governor's desk: HB 2143 by Rep. John Turner (D-Dallas). The bill relates to a first responder's Workers' Comp eligibility as a result of PTSD. The bill recognizes PTSD as a cumulative process, not a single event.
EMS Personnel - General Issues
A number of bills that could indirectly affect EMS personnel passed the Legislature. Some of those include:
- HB 1090 – Rep. Cecil Bell (R-Magnolia) – The bill would add emergency response operators and emergency services dispatchers to the list of “first responders." The bill was sent to the governor for his consideration.
- HB 1573 - Rep. John Raney (R-Bryan) and SB 719 - Sen. Pat Fallon (R-Frisco) - The bill would add EMS professionals to the list of first responders whose murder is defined as eligible for capital punishment. The bill was sent to the governor for his consideration.
- HB 2503 - Rep. Kyle Kacal (R-College Station) - The bill relates to workers' compensation death benefit eligibility for certain spouses of first responders killed in the line of duty. The bill was sent to the governor for his consideration.
- HB 2348 - Rep. Tracy King (D-Batesville) - The bill relates to the prohibition of certain employment discrimination regarding an employee who is a volunteer emergency responder. This includes a cap of 14 days and will require the emergency to meet certain requirements. The bill was sent to the governor for his consideration.
- HB 2446 - Rep. Valoree Swanson (R-Spring) - The bill would add EMS professionals and firefighters to the list of individuals whose personal information would be made private based under Section 552.117(a), Government Code. Rep. Swanson attended TEMSA's event at the Capitol to discuss her bill with TEMSA. The bill was sent to the governor for his consideration.
- HB 3890 by Rep. Sheryl Cole (D-Austin), which would have provided some tuition assistance to paramedics, ultimately died on the final House calendar when time ran out for consideration.
Guns
After numerous bills related to guns and EMS professionals were filed in 2017, and TEMSA's extensive work on the subject, only one gun issue was filed in 2019. However, HB 1123 by Rep. Dwayne Bohac (R-Houston) did not move.
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General EMS Issues
Another Look at Local Project Grants
Appropriations and Local Project Grants
Rep. Four Price (R-Amarillo) filed HB 1477, which would have restored LPGs for EMS agencies. In addition, Rep. JD Sheffield, DO (R-Gatesville) agreed to fund the bill through the appropriations process. While HB 1477 made it out of the House, it did not witness Senate movement.
Medical Director Protocol
HB 2400 – Rep. Mando Martinez (D-Weslaco) – The bill would require transparency regarding any disagreements between an EMS agency’s medical director treatment protocol and an affiliated first responder’s medical director treatment protocol. While the bill passed out of the House, it died in the Senate.
Texas Division of Emergency Management
SB 1668 – Sen. Lois Kolkhorst (R-Brenham) and HB 2794 – Rep. Geanie Morrison (R-Victoria) – The bill would update the Texas Division of Emergency Management’s new operation at Texas A&M. The bill cleared both chambers and was sent to the governor for his consideration.
GETAC
HB 1869 – Rep. Stephanie Klick (R-Arlington) – The bill would add a registered nurse that is appointed from a list of names recommended by a statewide professional association of emergency nurses to the GETAC advisory council. Sen. Dawn Buckingham, MD (R-Lakeway) amended the bill to add a third-service EMS agency and a paramedic to GETAC. After passing both chambers, the bill is now waiting for the governor's consideration.
Community Paramedicine
HB 3307 by Rep. James White (R-Hillister) was filed to allow ESDs to perform community paramedic work. However, it did not pass.
Volunteer Fire Department Funding
HB 3070 - Rep. Ken King (R-Canadian) - The bill would authorize a VFD to submit a request for emergency assistance from the Rural VFD Assistance Program to repair or replace equipment damaged or lost in responding to a governor-declared state of disaster. It would require the Texas A&M Forest Service to include in the criteria and qualifications for the distribution of VFD assistance funds a department's need for emergency assistance. The bill also would require that at least ten percent of the program's funds in a state fiscal year be dedicated to filling such emergency requests. Finally, if the amount of emergency assistance funds requested in a state fiscal year is less than the amount so dedicated, the bill would authorize any remaining funds to be used for other types of requests for assistance. The bill was sent to the governor for his consideration.
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Medicaid Issues
Ride-Sharing for Non-Emergency Transport
Ride-Sharing for Non-Emergency
Two bills related to non-emergency transports made it to the governor's desk:
- HB 1576 by Rep. Dade Phelan (R-Beaumont) will allow ride-sharing companies to transport patients for non-emergency purposes. Rep. Phelan worked with TEMSA on several concerns. We'll have much more on this issue at EMS EVOLUTION. The bill was pushed by Uber.
- HB 25 by Rep. Mary Gonzalez (D-El Paso) will create a pilot program to allow children to ride with their pregnant mothers to medical appointments.
Response vs. Transport
TEMSA worked with lawmakers to direct HHSC to study response vs. transport payments for EMS agencies in Texas. Click here to learn more.
Medicaid Managed Care Overhaul
A series of reports in the Dallas Morning News investigated Medicaid managed care plans' practices to deny services due to a prior-authorization process. As a result, several bills were introduced to introduce the prior-authorization process.
Ultimately, one bill - SB 1207 by Sen. Charles Perry (R-Lubbock) - passed out of the Legislature and went to the governor for his consideration.
Medicaid and the Budget
Several EMS-related initiatives were included in the budget for Medicaid:
Emergency Medical Services Enhanced Payment Model. Out of funds appropriated above in Strategy B.1.1, Medicaid Contracts & Administration, the Health and Human Services Commission shall conduct a study on the feasibility and cost-effectiveness of establishing an enhanced payment model for non-state government-operated public providers of ground emergency medical transportation services, which includes Medicaid fee-for-service supplemental payments and an enhanced Medicaid Managed Care fee schedule for public ambulance providers.
The report shall also include an analysis of any effect an enhanced payment model for non-state government-operated public providers of ground emergency medical services would have on Uncompensated Care Pool funding and whether providers eligible for the emergency medical services enhanced payment model should continue to be eligible for payments from the Uncompensated Care Pool.
Regional Advisory Council Diversion Evaluation. Out of funds appropriated above in Strategy B.1.1, Medicaid Contracts and Administration, the Health and Human Services Commission (HHSC) shall evaluate the feasibility of requiring trauma service area regional advisory councils to implement a program to allow emergency medical services providers to navigate medically stable psychiatric emergency detention patients to the most appropriate setting. As part of the evaluation, HHSC shall consider the potential for Medicaid cost savings and options for providing reimbursement to the regional advisory councils or emergency medical services providers with those savings. HHSC shall report to the Governor and the Legislative Budget Board on the results of the evaluation, including recommendations, no later than October 31, 2020.
Collection of Emergency Room Data. Out of funds appropriated in Strategy A.1.5, Health Data and Statistics, the Department of State Health Services (DSHS) shall collect emergency room data as set forth in Chapter 108 of the Health and Safety Code. DSHS shall use the data to measure and report potentially preventable emergency room visits, including potentially preventable mental health and substance abuse emergency room visits. DSHS shall submit the results of their findings to the Legislative Budget Board, Governor, Chairs of the Committees in each House with jurisdiction over public health issues, and the Statewide Behavioral Health Coordinating Council on an annual basis on or before December 31 of each year.
Cardiovascular Disease. Out of funds appropriated above in Strategy A.3.1, Chronic Disease Prevention, the Department of State Health Services may expend $514,013 in General Revenue Funds over the 2020-21 biennium for the Stroke/SEMI (St-Segment Elevation Myocardial Infarction) Data Collection for data collection activities.
Health and Human Services Cost Containment. The Health and Human Services Commission (HHSC) shall develop and implement cost containment initiatives to achieve savings of at least $350,000,000 in General Revenue Funds for the 2020-21 biennium throughout the health and human services system. These initiatives shall include increasing fraud, waste, and abuse prevention and detection; seeking to maximize federal flexibility under the Medicaid program in compliance with Government Code, Chapter 537; and achieving other programmatic and administrative efficiencies. HHSC shall provide an annual report on the implementation of cost containment initiatives to the Legislative Budget Board by December 1. It is the intent of the legislature that HHSC shall achieve savings without adjusting amount, scope, or duration of services or otherwise negatively impacting access to care. It is the intent of the legislature that prior to making any changes, HHSC shall consider stakeholder input, including complying with any statutory requirements related to rulemaking and public hearings. This rider shall not be construed as limiting HHSC’s ability to maximize federal flexibility under the Medicaid program, including federal flexibility that may impact amount, scope, or duration or services.
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Air Medical: It Passed
Reciprocity for Air Medical Subscriptions
HB 463 by Rep. Drew Springer (R-Muenster), which will require air ambulance companies to recognize each other's subscriptions, passed out of the Legislature. It is now up for the governor's consideration.
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Medical Lawsuits & Personal Injury Cases
A Look at the Willful & Wanton Issue
Medical Lawsuits
This year's legislature witnessed an increase in the amount of activity related to attempting to change the state's 2003 medical liability protection law.
Attempt to Raise the $250,000 Cap - HB 765 by Rep. Gene Wu (D-Houston) would index the state's non-economic damages cap of $250,000. It would be retroactive back to September 1, 2013, and the index for today would be $339,899. However, the bill was killed in committee.
Willful and Wanton Standard - HB 2362 by Rep. Joe Moody (D-El Paso) and Rep. Four Price (R-Amarillo) was written to address the state's existing willful and wanton standards for emergency care in the following circumstances:
- When the patient arrives in either the hospital's emergency department or obstetrical unit in stable condition regardless of whether the patient later suffers an emergency;
- When the patient has been stabilized or is capable of receiving nonemergency treatment even if the patient later suffers an emergency;
- When a patient is treated in an obstetrical unit for a non-obstetric emergency;
- When the patient's treatment is unrelated to the original medical emergency; and
- If the patient's emergency is caused, in whole or in part, by a healthcare provider, regardless of how insignificant the contribution is to the overall emergency.
Organized medicine and other stakeholders opposed HB 2362 in its original form. The Texas Alliance for Patient Access (TAPA), which is made up of physician groups, hospital groups, and other stakeholders, eventually reached a compromise with HB 2362's authors.
According to TAPA:
This agreed language was constructed in response to the Texas Supreme Court's recent Wilson ruling which extends broader protections to obstetricians than the 2003 legislature intended. HB 2362 preserves the most important protections gained in Wilson but addresses a potentially unfair result of that opinion. The heightened willful and wanton standard does not apply:
- When the patient's treatment is unrelated to a medical emergency; and
- for a physician or healthcare provider whose negligent act or negligent omission causes a stable patient to require emergency medical care.
The agreed language protects those that did not cause the emergency, including those that run to a patient at the onset of an emergency to try and save them. Also, HB 2362 protects the willful and wanton standard for healthcare providers treating a pregnant woman that presents directly to the obstetrical suite in an emergent condition.
This bill is a positive result for physicians and healthcare because it preserves the legislature's original intent and important gains in the Wilson case.
Advance Directives Bills Died - Two attacks on advance directives died: the treat until transfer bill (SB 2089) and SB 2129, which would have weakened the dispute resolution process.
Personal Injury
The 2017 Texas Legislature attempted to tie health care provider payments in personal injury cases to a percentage of Medicare. That issue did not return again in 2019. However, we did witness some smaller personal injury bills in 2019.
Plaintiffs & Personal Insurance - HB 3832 would have required plaintiffs to mitigate their personal health insurance for treatment. However, the bill's author did not request a hearing for HB 3832.
Medical Affidavits - HB 1693 by Rep. John Smithee (R-Amarillo), which passed, addresses the filing and controverting of medical affidavits. All sides agreed to this language.
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Facilities: Hospitals & Freestanding Emergency Medical Centers
A Focus on Rural Hospitals
Hospitals
LPPFs - As TEMSA mentioned earlier, hospitals dedicated quite a bit of effort to the LPPF issue.
Neonatal and Maternal Levels of Care Designations - The 2013 Texas Legislature created neonatal and maternal levels of care designations for hospitals. The 2019 Texas Legislature approved legislation to give hospitals an opportunity to challenge their designations.
This is an important issue to follow in case the Texas Legislature decides to create levels of care designations for hospitals in other specialties.
Anti-Trust & Mergers - HB 3301 by Rep. Drew Darby (R-San Angelo), which passed, will give the state of Texas greater authority to approve hospital mergers. The bill would take some authority away from the federal government. This issue is in relation to a hospital merger issue in San Angelo.
Rural Hospital Relief - Texas leads the nation in rural hospital closures, and the 2019 Texas Legislature passed legislation to address it:
- SB 1621 by Sen. Lois Kolkhorst (R-Brenham), which passed, will create a limited services hospital license for rural hospitals. This is pending action by Medicare.
- SB 1444 by Sen. Charles Perry (R-Lubbock), which passed, will create a rural hospital collaborative.
- HB 871 by Rep. Four Price (R-Amarillo), which passed, will allow hospitals located in counties with a population of 30,000 or fewer to use telemedicine to satisfy some of the physician requirements required for a Level IV trauma designation.
Freestanding Emergency Medical Centers
As always, the Legislature addressed several issues related to FEMCs. It is important to understand the differences in the different types of facilities:
- FEMCs refer to the licensed facilities that were created by the 2009 Texas Legislature. Texas is the only state in the nation that offers this license, and Medicare does not recognize it. The vast majority of these bills only focus on FEMCs.
- Some "freestanding ERs" are actually licensed as hospitals, which are recognized by Medicare.
- Some "freestanding ERs" are satellite outpatient facilities of hospitals, and they operate under that hospital's license. For the most part, these facilites are not targeted by these bills.
HB 1112 – Rep. Sarah Davis (R-Houston) – The bill would require freestanding emergency medical centers that have closed to immediately remove their emergency signs. The bill cleared both chambers and was sent to the governor for his consideration.
HB 1278 – Rep. James White (R-Hillister) – The bill would allow freestanding emergency medical centers to perform outpatient services. The bill was voted out of committee, but it was not placed on the House calendar.
SB 850 – Sen. Nathan Johnson (D-Dallas) – The bill would direct HHSC to conduct a study that examines the impact of freestanding emergency medical centers on traditional hospital emergency departments, rural health care, and other segments of the health care industry. The bill did not receive a committee hearing.
SB 866 – Sen. Kirk Watson (D-Austin) and HB 1941 – Rep. Dade Phelan (R-Beaumont) – The bill relates to the “unconscionable prices” charges by freestanding emergency medical centers. HB 1941 passed out of the House.
SB 1054 - Sen. Jose Menendez (D-San Antonio) and HB 4404 - Rep. Rick Miller (R-Sugar Land) - The bill would prohibit health plans from discouraging an insured from using a freestanding emergency medical center. The bill was promoted by the industry. The bill did not receive a committee hearing.
HB 2041 – Rep. Tom Oliverson, MD (R-Spring) – The bill would add additional disclosure patient requirements relating to insurance for freestanding emergency medical centers. The bill cleared both chambers and was sent to the governor for his consideration.
SB 1549 – Sen. Charles Schwertner, MD (R-Georgetown) – The bill would allow the attorney general to prosecute freestanding emergency medical centers that charge an “unconscionable price,” which would be defined as 150 percent of the average charges according to the state’s data. The bill did not receive a committee hearing.
HB 1941 - Rep. Dade Phelan (R-Beaumont) and SB 1941 - Sen. Kirk Watson (D-Austin) - The bill would authorize the attorney general's consumer protection division to bring action against freestanding emergency medical centers (FEMCs) that charge more than 200 percent of the average price offered by similar hospitals and emergency departments in the same region (as defined by the Department of State Health Services' Chapter 108 Health Care Data Collection program). Senator Watson added an amendment to HB 1941 to ensure that it would not affect satellite emergency departments of hospitals. HB 1941 cleared both chambers and was sent to the governor for his consideration.
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Telemedicine
No EMS-Specific Efforts in 2019
The 2017 Texas Legislature witnessed a telemedicine bill that was related to EMS delivered in rural parts of West Texas. The 2019 Legislature did not consider EMS-specific telemedicine efforts. Instead, the focus was building on the 2017 law that allowed many different types of health care services for telemedicine.
The following is a look at the 2019 issues.
Platform of Choice - HB 3345 by Rep. Four Price (R-Amarillo) and Sen. Dawn Buckingham, MD (R-Lakeway), which passed, will allow a physician to use a telemedicine platform of his or her choice for commercial insurance patients. SB 670 by Sen. Buckingham and Rep. Price, which addresses the physician's platform of choice for Medicaid, also passed.
Telemedicine for Hospitals - HB 871 by Rep. Price, which passed, will allow a hospital located in a county with a population of 30,000 or less to use telemedicine to meet requirements required to be a Level IV trauma facility.
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Prescription Drugs
Drug Pricing, Opioids & More
The 2019 Texas Legislature addressed numerous issues related to prescription drugs. The following is a look at some of the initiatives.
Drug Pricing
HB 2536 by Rep. Tom Oliverson, MD (R-Cypress), which passed, will require drug companies to submit reports to the state of Texas when their drug prices increase by 40 percent over a three-year-period or at least 15 percent in the previous calendar year. It is now waiting for the governor's consideration.
Pharmaceutical Benefit Managers (PBMs)
The Legislature also witnessed numerous bills that were aimed at PBMs.
Opioids and Controlled Substances
After numerous interim studies, the Texas Legislature ultimately passed several bills related to controlled substances and opioids. The new initiatives include:
- Ten-day limits on opioid prescriptions (HB 2174 by Rep. John Zerwas, MD, R-Richmond).
- Continuing medical education for physicians who prescribe opioids. (HB 2174.)
- Mandatory e-prescribing for Schedule II controlled substances beginning in 2021, which matches Medicare's mandate. (HB 2174.)
- A statewide opioid education program and a database of opioid overdoses. (HB 3285 by Rep. JD Sheffield, DO, R-Gatesville.)
- A delay until March 1, 2020, for physicians to check the state's prescription monitoring program. (HB 3284 by Rep. Sheffield.)
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Public Health Issues
SB 340 - Sen. Joan Huffman (R-Houston) and HB 1449 - Rep. Phil King (R-Weatherford) - The bill would create a grant assistance program to assist law enforcement agencies with the purchase of opioid antagonists. SB 340 cleared both chambers and was sent to the governor for his consideration.
HB 496 - Rep. Barbara Gervin-Hawkins (D-San Antonio) - The bill would create a "stop the bleed" program in public schools. The bill cleared both chambers and was sent to the governor for his consideration.
HB 87 - Rep. Ina Minjarez (D-San Antonio) - The bill would add "distracted driving" to the list of information that DPS must provide to minors who are applying for driver's licenses.
HB 1078 - Rep. Tom Oliverson, MD (R-Spring) - The bill would waive certain driver's license and concealed handgun fees for individuals who hold a certification in cardiopulmonary resuscitation. The bill cleared both chambers and was sent to the governor for his consideration.
HB 1307 - Rep. Gina Hinojosa (D-Austin) - The bill would create an electronic disaster case management system by the Texas Division of Emergency Management. The bill cleared both chambers and was sent to the governor for his consideration.
HB 448 - Rep. Chris Turner (D-Arlington) - This bill will create a new rear-facing car seat law in Texas. TEMSA lent its support. Click here to learn more. The bill cleared both chambers and was send to the governor.
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TEMSA's Career Center; Submit Your Job Postings
Click here to visit TEMSA's career center.
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TEMSA's Listserv Is Active
Open to Texas EMS Agencies
TEMSA has created a listserv for Texas EMS agencies to utilize as an online forum for conducting informal conversations with other members of the EMS industry. If you would like to join, simply reply to this e-mail, and TEMSA will add you to it.
Keep in mind the following key considerations:
1. The posts are to remain in the forum, and they can't be shared outside of it.
2. All posts/emails will be monitored by TEMSA staff and board members, who will serve as moderators.
3. All posts/emails should maintain professional attitudes and demeanor at all times. Failure to do so will result in a moderator terminating your post, and removing you from the group.
4. All posts/emails should be pertinent to EMS in Texas, and should not advertise services for sale. If a post is looking for recommendations for a vendor, such recommendations should be done off list through person to person email.
5. All posts/emails should have a signature naming the person writing the post and the agency/company they represent.
6. Opinions expressed on this list are the those of the author and do not represent the official position of TEMSA or it's members.
7. Keep in mind that every response that you make will be sent to the entire forum.
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