Texas Chapter of the American College of Cardiology

Prelude to the 88^th Texas Legislature

The 88^th Texas Legislature gavels in on Tuesday January 10, 2023.  Much has happened in Texas since the Legislature adjourned the 3^rd Special Session in October which will lead to significant debate during the November 8 General Election and in the 88^th Legislature.

The 87th Legislature Interim

After the Regular Session and 3 Special Sessions in 2021, the interim was slow to start . . . thankfully!  The “interim” officially began when interim charges were issued in both chambers.  There are hot topics already being discussed in the House and Senate committees, including the Uvalde mass shooting, our electric grid, key health insurance legislation passed in 2019 and 2021, and “workforce shortages in health care.” 

There are not any interim charges regarding transgender issues or the US Supreme Court decision to overturn Roe vs. Wade yet, but both will certainly play a significant role in the November 8 General Election and the 88^th Legislature.

Health Insurance Bills

The House Insurance Committee which is Chaired by Rep. Tom Oliverson MD (R-Cypress) has already held two days of hearings on our Texas No Surprise Billing Act, SB 1264, authored by Sen. Kelly Hancock (R-North Richland Hills) and Rep. Tom Oliverson MD (R-Cypress) which passed into law in 2019, and the federal No Surprise Billing Act, as well as our preauthorization “Gold Card” legislation, HB 3459, authored by Rep. Greg Bonnen MD (R-Friendswood) and Sen. Dawn Buckingham MD (R-Lakeway) passed into law in 2021.  TCACC worked to help both SB 1264 and HB 3459 pass into law.

SB 1264 and the Federal No Surprise Billing Act

The health plans testified and stated their desire to rescind SB 1264 which is a much better out-of-network payment process than the federal version.  When the federal government drafted rules for implementation of the federal No Surprise Billing Act it added language which required that the health plans “Qualifying Payment Amount (QPA)” be one factor the arbiters must consider.  The QPA is the median in-network rate for a medical service in a defined geographic area.  The health plans are not required to provide how they determine the QPA.  Congress intentionally did not include QPA in the federal No Surprises Billing Act because it would undermine fairness in determining a fair out-of-network payment for services rendered.  The federal government included QPA in the proposed rules of the federal No Surprises Billing Act, nonetheless.

TMA filed suit against the implementation of these rules and at least temporarily stopped their implementation.  The Texas Chapter of the American College of Cardiology contributed $50,000 to the fund to pay the legal fees to stop the federal rules.  The federal government is attempting to rewrite the rules but also considering appealing the federal court’s decision.  We will keep you posted.

HB 3459 Gold Card

HB 3459 passed with overwhelming approval in both the Texas House and Senate chambers and became effective in September 2021.  However, the law does not take effect until rules are adopted by TDI to implement the law.  

Having strongly supported the legislation and wanting to ensure the rules would reduce the burdens and increase the transparency of health plan preauthorization requirements, the House of Medicine submitted written comments in response to a Request for Information from TDI to use in the implementation of HB 3459.  

On April 7, 2022, the Texas Department of Insurance (TDI) published the long-awaited proposed rules on HB 3459, initiating the formal stage of the rulemaking process.  Some of medicine’s initial suggestions were reflected in TDI’s proposed rules, however there are areas where the department veered away from the actual language and intent of HB 3459.  

Medicine supports one part of the proposed rules, the application of the Gold Card law to prescription drugs, as was intended by the legislation and bill author.  The health plans, however, are strongly opposed to this provision.

Many sections in TDI’s proposed rules are counter to the language of HB 3459.  In addition, many definitions and processes in the rules are unclear and overcomplicated.  The proposed rules create an unreasonable barrier to entry for physicians seeking the preauthorization exemption, the Gold Card, and ignore the language of the new Gold Card statute. 

The House of Medicine is fully engaged in forcing TDI to modify the proposed rules to reflect the language and intent of HB 3459.  Rep. Greg Bonnen MD (R-Friendswood) authored HB 3459 but all the elected physicians supported HB 3459 in the legislative process and are now helping us modify the proposed rules, including Sen. Charles Schwertner MD (R-Georgetown), Sen. Dawn Buckingham MD (R-Lakeway), Sen. Donna Campbell MD (R-New Braunfels), Rep. Tom Oliverson MD (R-Cypress) and of course Rep. Greg Bonnen MD (R-Friendswood).

Workforce Shortages in Health Care

In both the House and Senate, the “workforce shortages in health care” interim charge has been assigned to six different committees in the Texas House and Senate. 

The following committees have received this interim charge:

House Select Committee on Health Care Reform

House Higher Education Committee

House Human Services Committee

House Public Health Committee

Senate Health and Human Services Committee

Senate Higher Education Committee

We have never seen the same health care interim charge assigned to 6 different committees in the House and Senate.  We will be following the “workforce shortages in health care” hearings and discussion in all six committees.  Please notify of us of any workforce shortages in cardiovascular care, and any ideas on how the state can address the shortages.

In Preparation for the 88^th Legislature

The remainder of this year your participation in TCACC advocacy is more critical than ever for us to continue to protect our patients and practices.  This also includes continuing to fight to improve our Texas health insurance laws which help our patients and practices, and prevent the health plans from rigging the in-network and out-of-network rates paid for health care services.

In addition, we will be meeting with the Organ Procurement Organizations to try to reach an agreement to change our laws to improve the donor participation rate in Texas, which continue to lag behind most states and literally every country in Europe.  We will also begin meeting directly with the legislators to garner support for our organ donor bill.  Last session, we filed bill, HB 3701 by Rep. Bobby Guerra (D-McAllen), the Vice-Chair of the House Public Health Committee.  We did pass HB 3701 out of the House Public Health Committee with a unanimous vote, 11 – 0.  Unfortunately, the legislative session was closing, and the clock ran out.

In our advocacy to protect our patients and our practices, to improve our organ donor participation rates in Texas, and continue to improve health insurance laws, we must remain highly focused on the medical evidence and science, standard of care, and accurate data, thereby maintaining our position as the expert.

We will also need to enhance our relationships with the legislators who sit on our key committees, as well as the Governor, Lt. Governor, and the Speaker of the House, and significantly increase our contributions to the HEART PAC. 

As cardiologists, when you engage with your elected officials . . . they listen.  Your position in our society and your role in medicine gives each of you great stature and your voice greater impact.

Please do not hesitate to reach out with any questions and suggestions. 

Hon. Jaime Capelo
TCACC Lobbyist
jc@capelolaw.com
512-626-6763 mobile