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The House Committee on Insurance met on April 20 to take up a number of bills. This report focuses on HB 2755 (Lucio III), SB 827 (Kolkhorst), HB 3423 (Morrison), HB 1854 (Anchia), HB 3951 (Cortez), HB 493 (Wu), HB 2988 (Minjarez), and HB 2651 (J Gonzalez). The hearing notice can be found here.

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Vote Outs

  • CSSHB 3899 (Sanford) 5-3
    • CS cleans up language in the filed version
  • HB 2310 (J Gonzalez) 5-4
  • CSHB 573 (Oliverson) 9-0
    • Gonzalez – There was concern by AARP, was this taken care of?
      • Oliverson – Patient advocacy groups that spoke on the bill were content with changes we made
  • CSHB 1460 (Oliverson) 8-1
    • Disclosures cover marketing documents related to subscriptions
  • SB 1448 (Taylor) 9-0
    • Extends Sunset of two select committees
  • HB 3250 (E Thompson) 8-1
  • CSHB 4051 (Frank)
    • CS – patients without benefit plan cannot be charged higher rate
  • CSHB 2545 (Thierry) 9-0
  • HB 1646 (Landgraf) 7-2
  • CSHB 843 (Lopez) 5-4
    • CS – Adds specialized skills training, ABA, & case management
  • CSHB 643 (Raymond) 8-1
    • Oliverson – Has been an agreement
    • CS – Limits applicability to policies $1,500 and under, defines info that must be given to insurance company, insurer cannot be sued for providing info
  • CSHB 3459 (Bonnen) 7-2
    • CS – Lege council draft of filed version

 

HB 2755 (Lucio III) Relating to health benefit coverage for general anesthesia in connection with certain pediatric dental services.

  • CS laid out
  • Lucio – GA not covered for many pediatric patients, often requires very severe symptoms; most plans do not recognize dental pathology as medical need and anesthesia is not covered at all
  • HB 2755 requires GA to be covered for pediatric dental procedures for those under 18, under CS if health insurance covers anesthesia for other procedures, then cannot discriminate against dental procedures
  • CS allows treating medical professional to determine setting, anesthesia to be administered by anesthesiologist or dentist with qualifications

 

Dr. Robert Morgan, Texas Academy of Pediatric Dentistry – For

  • Supports bill, currently have to wait too long for severe symptoms to occur before GA is covered
  • Oliverson – When pediatric dentists is providing anesthesia, does this claim not go through dental services?
    • In some circumstances
  • Oliverson – Asks after
    • Coverage is difficult, often have to go magnanimously to offices and ask for payment
  • Oliverson – Why would you want to include dentists in being able to bill medical when dentist is doing the anesthesia?
    • There are oral maxillofacial surgeons, pediatric dentists often do full residencies in anesthesia; bill would only compensate trained anesthesiologists

 

Luke Bellsnyder, Texas Department of Insurance – Resource

  • Oliverson – There is a funny gap in coverage where a patient is receiving dental care and needing dental services; can the dentists bill for anesthesia under dental insurance if they are prov
    • My understanding is whoever is providing anesthesia would be billing medical plan, not dental
  • Oliverson – Bill purports to make this clear, so my understanding is this isn’t happening
  • Oliverson – Can’t bill dental unless you’re a dental provider, though Medicaid does allow medical providers to be reimbursed for dental services
    • Goal as laid out is to have this paid for by the health plan regardless of who administers
  • Oliverson – Would like further info on this

 

HB 2755 left pending

 

SB 827 (Kolkhorst) Relating to health benefit plan cost-sharing requirements for prescription insulin.

  • CS laid out
  • Lucio – Have reached agreement from stakeholders who are now neutral on bill, relates specifically to making insulin affordable
  • Insulin price has increased 1,000% in last 20 years, costs around $300/vial, but $6 to produce; patients require multiple types of insulin and supplies leading to very high monthly costs
  • CS sets $50 cap on out-of-pocket monthly cost for insulin, health benefit plans must include at least 1 insulin on formulary
  • Compromise language is $50 cap on copay per prescription
  • Oliverson – Know this is part of larger package of bills we’re getting done ensuring medication is affordable for diabetics
  • Oliverson – Companion bill is HB 82

 

Stephen Denny, Self – For

  • Supports bill, ensures access to medication for his son

 

Veronica De La Garza, American Diabetes Association – For

  • Cost of insulin severely impacts medication adherence, lack of adherence has significant impact on subsequent health outcomes
  • Israel – Why have we not been able to break through on cost?
    • Had hearings with federal government, but no progress; taking it to states, not a complete solution, but it is part of the solution

 

Dawn White, Self – For

  • Cost of insulin is very high, support group exists in South Texas; many have to rely on others to obtain insulin
  • Patients are having to choose between necessities and affording insulin

 

Carol Howe, TCU – For

  • SB 827 could help diabetes patients, lack of medication can lead to a large number of medical complications
  • Greatest cost associated with diabetes is when someone has complications
  • Israel – Why do you think marketing expenses are required for insulin?
    • Why the differential between $6 and $300 exists?
  • Israel – I understand marketing is a big part of this, do patients understand they need this medication
    • I think patients understand
  • Middleton – Heard a lot of testimony that cost of manufacturing hasn’t gone up, but why has marketing costs increased so much for easy to understand medication?
    • Don’t understand it either, manufacturers, PBMs, employees, rebates, etc. get decided and negotiated every year and price goes up for consumers within this interaction

 

Reva Verma, American Diabetes Association – For

  • Diabetes is difficult to manage, costs have increased significantly; forced to upgrade employee health plan to lower deductible plan to keep up with cost growth

 

Rep. Lucio closes

  • Misspoke on compromise language, took it from a $50 cap on out of pocket expenses to $25 per prescription
  • Puts negotiation for prices on part of manufacturers and plans

 

SB 827 left pending

 

HB 3423 (Morrison) Relating to coverage for supplemental ultrasound imaging to screen for breast cancer under certain health benefit plans.

  • Morrison – Addressing issues with coverage of ultrasound imaging, lack of coverage con often lead to missing smaller tumors in dense tissue
  • Have seen with women that 3D imaging finds issues earlier

 

HB 3423 left pending

 

HB 1854 (Anchia) Relating to insurance coverage for the disposition of embryonic and fetal tissue remains.

  • Anchia – Parents are often significantly attached to children lost to stillbirth, funerals are an import aspect for the deceased and the survivors
  • HB 1854 extends death benefits to embryonic or fetal remains of 20-week age or more

 

George Glenn Wilcox, Self – For

  • Lost child to stillbirth, child was not covered due to not meeting technical requirements; fully intended to add to insurance plans, funeral costs were considerable

 

Susie Wilcox, Self – For

  • Testifies in support of the bill

 

Abraham Wilcox, Self – For

  • Testifies in support of the bill

 

Jason Wilcox, Self – For

  • Testifies in support of the bill

 

Jennifer Carr-Allmon, Texas Catholic Conference of Bishops – For

  • Supports bill because it seeks to recognize dignity of unborn children; Catholic churches offer free common burial for children, but does not allow for aspects in a full funeral
  • Respect conforms to practice of treating living and dead with dignity, provides greater support to grieving families

 

Rep. Anchia closes

  • Coverage timeline of 14 days is arbitrary, legislature should remediate
  • Passed the House with around 120 votes last session, asks for this to be sent to Local if voted out

 

HB 1854 left pending

 

HB 3951 (Cortez) Relating to health benefit plan coverage for certain tests to detect prostate cancer.

  • Cortez – Ensures men at highest risk of developing prostate cancer can access screenings, applies to men over 50 or those over 40 with history of prostate cancer
  • Studies show that additional cost is negligible

 

Dr. J. Stuart Wolf, Texas Urological Society – For

  • Cares for patients with prostate cancer
  • It is in interest of the state to provide access to prostate cancer screening
  • Provides overview of PSA screening, early prostate cancer has no symptoms, symptoms usually don’t appear until it’s spread to the rest of the body
  • PSA screening is directly linked to detecting metastatic cancer, is similarly or more effective at detecting metastatic cancer than mammography; should be similarly treated, can be a choice under grade C
  • Paul – If it is grade A or B is it mandated?
    • Yes, C means you talk about the benefits and risks
  • Paul – A and B is mandated under ACA?
    • Yes

 

Patrick Bingham, Self – For

  • Diagnosed with prostate cancer at 46; African American men are two times more likely to be diagnosed and die of prostate cancer, military veterans also two times more likely to die
  • Bill will allow men to be screened at no cost, if diagnosed early survival is almost certain

 

HB 3951 left pending

 

HB 493 (Wu) Relating to HIV and AIDS tests and to health benefit plan coverage of HIV and AIDS tests.

  • CS laid out
  • Wu – CS puts language into compliance with federal law, per TDI
  • Straightforward bill about testing for AIDs, AIDs has multiple vectors of transmission, rate of AIDs infection is much higher in the South
  • Testing can help inform those who are positive and can help prevent the spread
  • Provides for test during blood tests, opt out possible
  • Insurance isn’t thrilled due to cost, but there is a cost for HIV treatment as well; not covering the testing, but will cover extremely expensive treatments
  • Oliverson – So your bill says that a health care provider can take a sample of blood and test for AIDs with a consent, unless they opt out
    • Correct
  • Oliverson – Watch me through the thought process about HIV tests, one thing to have the option, but this bill assumes provider has permission to do this test
    • I understand there is a philosophical difference in how we’re looking at things, part of the reason for this path is because people are wary of routine testing
    • HIPAA still applies for spouses, etc., doctor does not get to release the info unilaterally; could lead to spouses wanting to inform due to concern of spread
    • Saying cost of bill is outweighed by benefits
  • Paul – You want them to do this test automatically, what about for much more serious issues like heart conditions, diabetes, etc.; should we do the same tests?
    • Absolutely
    • My doctor offers these tests as part of the regular battery of tests
  • Paul – This is something your doctor thinks you need
    • Those in the high risk categories get tested, remainder often don’t think they have a risk
  • Paul – Doctors should be assessing risk
    • Test for other issues can also be much more invasive, AIDs testing is very simple
  • Paul – Diabetes tests are very simple, not often done

 

James Lee, Legacy Community Health – For

  • DSHS estimates 16k Texans who are living with HIV and do not know
  • Language related to plan coverage is important, bill normalizes testing, allows providers to test at-risk individuals as appropriate
  • Romero – Of the people HIV positive, are they overwhelming covered by insurance?
    • Often coming from underserved communities, lifetime cost can be $380k
    • Those getting tested sooner tend to have cheaper cost
  • Romero – So these uninsured individuals will go to county hospitals for treatment and we’re talking about $400k for treatment
  • Israel – 16k individuals with HIV who don’t know they have it
    • Normalizing HIV testing can halt help mitigate spread of HIV

 

January Fox, Prism Health North Texas – For

  • DSHS reported over 100k were living with HIV in 2018, thanks to treatments available HIV is another chronic & manageable disease, but is very expensive
  • Those entering care at progressed stage of disease see much higher costs
  • Lack of testing continuity disproportionately affects black women
  • Standardizing testing with opt out would be a major benefit
  • Oliverson – What is the makeup of your patient population?
    • Very few Medicaid clients, largely uninsured
    • A portion of the clinic deals with PREP preventative, those patients are insured
  • Oliverson – Important to point out that this wouldn’t apply to Medicaid or self-funded plan, so really only affects fully-insured commercial products
    • True, but trying to get rid of clients

 

Rep. Wu closes

  • Will keep working on it, understand this doesn’t cover all populations, but if this is a battle then need to fight ever point and reduce transmissions
  • One big difference between heart disease, etc. is that those aren’t transmissible; parents can pass HIV onto children, etc.

 

HB 493 left pending

 

HB 1356 (Gervin-Hawkins) Relating to health benefit plan coverage for hair prostheses for cancer patients.

  • Gervin-Hawkins – Requires plans to provide $100 in coverage for wigs for cancer patients, many patients plan for hair loss and ask doctors for wigs hoping they will be covered
  • Want to ensure patients are supported, cost of coverage should not be high and shouldn’t be controversial

 

Valerie DeBill, League of Women Voters – For

  • Important for well-being and positive self-image of patients, urge approval of bill

 

HB 1356 left pending

 

HB 2988 (Minjarez) Relating to copayments required by a health maintenance organization or preferred provider benefit plan for visiting physical therapists.

  • Israel – Cannot require higher copays for physical therapist office visits

 

Mike Geelhoed, Texas Physical Therapy Association – For

  • PTs are now able to see patients directly without referral, should be classified as primary provider for purposes of insurance copays, seeing higher copays for specialty visits
  • Oliverson – I get where you’re going with this, but you’re not primary care, not total care; I understand we have direct access, but this is limited to certain number of visits
    • 10 or 15 business days in certain limits
  • Oliverson – Have you thought of bifurcating this with respect to access? What if it goes beyond 10 business days? What if it was a referral under the standard method?
    • More about cost to patient and compliance with therapy that we’re concerned about

 

HB 2988 left pending

 

HB 2651 (J Gonzalez) Relating to health benefit plan coverage of prescription contraceptive drugs.

  • Gonzalez – Prescription contraceptive drugs are limited to 1 or 3 months, no valid medical reasoning
  • Would allow for a 12 month supply after initial 3 month supply, CDC recommends 12 month supply as it decreases risk of unintended pregnancies

 

HB 2651 left pending

 

HB 3922 (Oliverson) Relating to information provided by health care providers and hospitals to certain patients regarding pharmaceutical manufacturer patient assistance programs for insulin.

  • CS laid out
  • Oliverson – Programs are available through all manufacturers that provide insulin for low-income Texans who need access to insulin, issues we found during the interim is that there are a great number of people who qualify and don’t sign up, possibly not aware programs exist
  • HB 3922 would require providers who are likely to come into contact with these patients to make information about these programs available to them
  • CS is the lege council version

 

HB 3922 left pending