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The committee met to take up and consider new and pending business. The committee considered the bills listed below, among others.
 
HB 2467 – Phil King, Relating to the exclusion from the premium and maintenance tax base of federal fees imposed on insurers and other providers under the Patient Protection and Affordable Care Act, and recouped from policyholders, whether separately stated or through rates charged for health care coverage.

  • All insurers that provide health care coverage are subject to a providers fee and are allowed to pass the fee on to consumers
  • This can cause taxable premiums to increase and therefore taxes to increase
  • In effect the state is taxing the tax
  • Fiscal note on the bill shows decreased revenue of $28 million per year
  • There is a committee substitute that is a legislative council draft that is the same as the original bill
  • Cannot eliminate the tax at the federal level but can prevent exacerbation by layering a tax on top of a tax
  • Rep. Greg Bonnen asked how it can be broken out from the premium
    • The way the tax was calculated before ACA will be the way it is calculated now that the ACA is in place
  • Rep. Munoz asked how it would impact MCOs
    • Need a resource witness

 
Susan Bittick, Ryan LLC

  • Support
  • The state has taxed premium receipts for years which worked fine in the past but creates an issue with the ACA
  • Have discussed the issue with TDI and the Comptroller; Comptroller suggested an amendment that would clarify that the exclusion would only apply to the portion of premiums increased in the state
  • Do not like to see tax pyramiding; it has an inflationary effect on goods and services provided
  • Munoz asked about the impact to MCOs
    • Taxes imposed on the insurer on to policy holders; most of them started making rate adjustments in 2013; not aware of the amount being paid in Texas for MCOs and TRS/ERS
  • Rep. Meyer asked if this issue has come about in any other states
    • A number of them have
  • Meyer asked how the state can be sure rates will actually be brought back down
    • Probably a question for TDI

 
Nancy Clark, TDI

  • Resource
  • Meyer asked if there is any way to guarantee rates would decrease if the bill were to pass
    • Her Department doesn’t regulate premiums but can find out

 
King closed

  • The way the fee plus tax works now would be like a state collecting an income tax without a deduction for a federal income tax; not good policy
  • Bonnen noted if the state is paying the fee for an MCO and collecting the tax it shouldn’t be a very big issue for an MCO
  • Need to structure this right to avoid taxing a tax

 
Bill left pending
 
HB 1105 – Senfronia Thompson, Relating to reimbursement under preferred provider benefit plans for services provided by licensed podiatrists.

  • Some insurers arbitrarily reimburse different providers for the same service
  • Bill seeks to require the methodology used to compute amount of reimbursement podiatrists in PPO plans receive to be the same as for physicians providing the same services

 
Leslie Campbell, Texas Podiatric Medical Association

  • Support
  • When insurers discriminate against podiatrists it creates a disincentive to provide services in Texas
  • This drives costs up when providers are not available
  • Discussed the cost and other benefits of seeing a podiatrist over a standard physician for patients seeking care for a diabetic foot ulcer
  • Bonnen asked about the measure of discrepancy
    • For those discriminating carriers the discrepancy is anywhere between 25-50%
  • Bonnen asked how many patients this affects in the business
    • Different based on region; for some providers in Bexar County it could be upwards of 50% of patients
  • Meyer asked about the basis of the discrepancy
    • TDI allows insurers to set their own rates

 
Mark Hannah, Texas Podiatric Medical Association

  • Rep. Bobby Guerra asked what accounts for the discrepancy
    • The legislature mandates protections for podiatrists and has in many cases in the past; legislature mandates that podiatrists be allowed on hospital staffs and that podiatrists be included in PPO plans
  • Bonnen asked if there is parity in Medicare and Medicaid payors
    • Yes

 
Debra Diaz Lara, TDI

  • Resource
  • Rep. Sheets asked if there is data substantiating the claims
    • Not really; there were laws requiring parity but POPO laws came about after those statutes and the law was interpreted such that insurers can set their own rates
  • Paul asked if there is a floor price for any other services
    • There is a similar bill that was passed in the past for therapeutic optometrists and ophthalmologists

 
Bill left pending
 
HB 3133 – Smithee, Relating to notice and availability of mediation for balance billing by a facility-based physician.

  • Mediation has been a very successful process in Texas
  • Current legislation is too limited for mediation
  • Starting to see balance bills at $900 to stay under the $1,000 threshold; bill removes the threshold altogether
  • People receive services and get a balance bill from an assistant surgeon who is out-of-network; adds assistant surgeons to the list of people mediation is available for
  • Bonnen noted he thinks completely eliminating the mediation threshold is probably bad so some floor may be appropriate; have talked with Smithee about this concern in the past
  • Bonnen noted the concern of a patient to receive care from an out-of-network provider in a hospital environment is a legitimate concern; may need a provision regarding disclosure to the patient of expected costs
    • Smithee noted that may be in statute currently; mediation may only apply if some disclosure or agreement has not been made prior to the balance bill

 
Bill Hammond, Texas Association of Business

  • Support
  • Discussed how balance bills work in standard practice
  • Bill is a common sense approach to solving the issue
  • Bonnen asked what a physician should do if they are dissatisfied with the contract offered to them in an attempt to become part of the network
    • Not trying to force doctors into networks; just to protect consumers from a mystery medical bill
  • Bonnen asked what the point of joining a network would be
    • Because the insurance company funnels business to your door
  • Bonnen asked how a doctor determines what they should be paid if out-of-network
    • Not sure; maybe call the insurance company
  • There needs to be a way to protect the consumer; there is no system in place today to protect the consumer if the balance bill is under $1,000

 
Maxine Cooper, Self

  • Support
  • Has frequent visits to ERs because of an MS diagnosis and has received balance bills before

 
Michael Friar, Self

  • Support
  • Discussed a situation where he received a balance bill
  • Health care is not like other consumer services; when a provider tells a patient what care they need a patient has little choice but to seek that care

 
Jamie Dudensing, Texas Association of Health Plans

  • Support
  • Mediation works and should be expanded to all people
  • This bill is limited to out-of-network doctors providing services at in-network hospitals
  • Meyer asked who is tasked with determining network adequacy
    • TDI
  • Meyer asked if they have ever made the determination that a network is not adequate
    • Not sure; many times they give waivers depending on certain factors

 
Mike Amos, Texas Attorney Mediators Coalition

  • Support

 
Isabel Menendez, Texas Radiologic Society; Texas Medical Association

  • Oppose
  • Bill will decrease the incentive for insurers to contract with hospital based physicians
  • It is better for insurers to keep doctors out of network so they can pay whatever they want and leave patients with the rest
  • Meyer asked if the witness has seen TDI take any action regarding an inadequate network
    • No

 
Debbie Plagenhoef, Texas Society of Anesthesiologists

  • Oppose
  • This change will not solve the problem with balance billing
  • This would address a very narrow percentage of balance bills with the listed physicians
  • Mediation is a burden for physicians; there needs to be a solution for the balance business problem but this bill will cause insurers to mediate providers to death
  • This problem should not happen to any patient for a service covered by their health plan but not paid by their health plan

 
Anesthesiologist

  • Oppose
  • Will lead to increased costs for consumers
  • Bonne asked if this is a symptom of a bigger problem; want to provide consumer protection yet a more massive problem has to be dealt with
    • The healthcare system is very complicated

 
Thomas Oliverson, Anesthesiologist

  • Oppose

 
Jennifer Hopper, Self

  • Support

 
Stacey Pogue, CPPP

  • Support
  • From a CPPP study, data shows that for the top three insurers in Texas many hospitals are contracted but none of the ER physicians are contracted
  • Mediation is a very important piece of the billing world because insurers and physicians will never agree on reasonable prices
  • Paul asked if mediation makes insurers contract less with facility based physicians
    • Not sure; mediation is helping to build networks because determinations of what is fair made in mediation set precedent

 
Doug Danseizer, TDI

  • Resource
  • Meyer asked what TDI’s role in determining network adequacy is
    • Rules were written not so long ago regarding what type of providers must be in-network based on the size of the area covered; also determine some type of mileage standard; basic standards are used and sometimes insurers are told they must make changes to their network in order to continue providing a PPO plan; if they tell TDI providers are being unreasonable in contract negotiations then TDI will go talk with the providers
  • Basic standards are also set to determine usual and customary rates

 
Debra Diaz Lara, TDI

  • Resource
  • Believe there are 4 or less waivers that have been provided to PPO plans; all waivers were requested based on not having enough providers available; in those cases they have to file an access plan to show how that care will be provided to the insured
  • Bonnen asked if in an assessment of network adequacy, TDI drills down to the level of physician based doctors
    • Yes; TDI looks at the provider list and determines what facilities the providers have privileges with

 
Smithee closed

  • The network adequacy issue is probably what has led us to the problem
  • The problem is with the health plans and the physicians; the consumer is stuck in the middle at no fault of their own

 
Bill left pending
 
HB 2541 – Zerwas, Relating to health benefit plan coverage of certain treatments for enrollees diagnosed with a terminal illness.

  • Protects patients with a terminal illness from being denied coverage based on their diagnosis or projected life expectancy
  • This type of legislation has been passed in 4 or 5 states
  • Will preserve a patient’s right to fight their medical disease with the guidance of their physician

 
Doug Danseizer, TDI

  • Bill wouldn’t change a whole lot; if a service is medically necessary an insurer is required to cover it
  • Prevents insurers from taking a terminal illness into account but they shouldn’t be doing that now

 
Zerwas closed

  •  This is a preemptive effort to ensure patients will not be denied care they determine is in their interest

 
Bill left pending
 
HB 2133 – Raymond, Relating to health benefit plan coverage for certain equipment and supplies associated with diabetes treatment.

  • Munoz laid out the bill
  • Requires that continues glucose monitors and insulin pumps be covered under health plans
  • Does not affect Medicaid/CHIP coverage

 
Anne Newton, Medtronic Diabetes

  • Support
  • Bill ensures patients have access to the current standard of care

 
Witness for Self

  • Support
  • Constant glucose meters and artificial pancreases are crucial in the treatment of a diabetic person

 
Doug Danseizer, TDI

  • Resource
  • Sheets asked what is being covered by plans currently
    • Not sure; they are only required to cover what is currently in statute
  • Sheets asked about the ACA
    • If a state requires coverage that is above and beyond, the carriers must cover the items and impose the cost back to the state
  • Sheets asked about a contingency to resolve the problem regarding creating a cost to the state
    • That is a possibility

 
Bill left pending
 
HB 2348 – Price, Relating to nondiscrimination against physicians in payment for telephone consultation services.

  • Payment parity bill
  • Same bill the committee heard last session
  • If a company provides telemedicine services from some physicians they cannot prevent a Texas physician for providing the same services
  • There is a need to improve patient access across the state; telemedicine is an affordable alternative
  • Attempted to address concerns with health plans to ensure doctors aren’t asking for reimbursement for telephone appointment setting or reminders
  • Bonnen asked if the patient must be contacting their PCP
    • The bill doesn’t go into that
  • If a health plan allows payment for telemedicine services to a specific physician or hotline, the health plan cannot prevent a patient for receiving the same services from a local physician
  • There would have to be some sort of preexisting patient/physician relationship

 
Thomas Kim, TMA

  • Support
  • Telemedicine is becoming more and more useful in medicine; can prevent unnecessary ER visits and assist with prescription refilling
  • Typically contracted telephonic services are provided by physicians with no relationship with the patient

 
Price closed

  • Do not want to get into the business of telling insurers to cover these services or not
  • Just want them to treat all physicians fairly

 
Bill left pending
 
HB 1638 – Smithee, Relating to nonpreferred provider claims under a preferred provider benefit plan related to emergency care.

  • Similar to the last bill Smithee laid out but in regard to emergency care
  • Working with stakeholders on substitute language
  • Hoping to get rid of the arbitration provision and go back to the standard mediation provision
  • Emergency providers are getting a lot of complaints because they are not in-network even though the hospital is; patients do not think they will be getting a balance bill but they do

 
Blake Wyndham, American Cancer Society

  • Support
  • Many times consumers in this situation aren’t aware of their exposure until they receive the bill

Simone Nichols, National Multiple Sclerosis Society

  • Support

 
Jamie Dudensing, TAHP

  • Support
  • Goal is to make sure consumers have access to mediation for balance bills

 
Bruce Moskow, Texas Emergency Practice Alliance

  • On
  • Appreciative of Smithee working with all stakeholders
  • There is no truth to the inference that emergency room providers are changing fees to stay out of mediation; across the country most fees are right at $700-900

 
Scott Holliday, Anesthesiologist/TMA

  • Oppose
  • Emergency room physicians have no choice in the patients they see
  • Often insurers make a take it or leave it offer and purposefully delay negotiations
  • Discussed specific situations where it was difficult to contract with health plans

 
Sharif Zafrin, Anesthesiologist

  • Oppose
  • Bill interferes constitutional right to receive remuneration for a specific service and binds doctors to a discounted rate that would be negotiated by insurers
  • Bill removes incentives for carriers to improve their network

 
Thomas Oliverson, Anesthesiologist

  • Oppose

 
Jennifer Hopper, Self

  • Support
  • Told story of balance billing issue

 
Stacey Pogue, CPPP

  • Support
  • Going to an emergency room almost guarantees a patient will receive a balance bill; especially if they have certain insurers

 
Smithee closed

  • There is clearly an identified problem; if somebody has a better solution the legislature should pass it
  • Bonnen has great ideas about it

 
Bill left pending
 
HB 2172 – Smithee, Relating to coverage of telehealth services or telemedicine medical services under health benefit plans.

  • There are many provider groups for which there is a shortage in the state; telemedicine is helping with that shortage
  • Bill tries to fix some of the issues with telemedicine

 
Thomas Kim, TMA

  • Oppose
  • Telemedicine is generally helpful in situations where there is no other better option
  • Have had to master a new skill set of caring for people at a distance
  • Bill lacks clarity in defining the standard for how a physician/patient relationship is established; main point of contention
  • Bonnen asked if video is incorporated with audio in the initial encounter it would be an agreeable bill
    • Yes

 
Bill Hammond, TAB

  • Support
  • Bonnen asked if TAB would still support if video was added to the initial encounter
    • Would have to talk with Smithee but probably

 
Tara Keppler, Keppler Health Law

  • On the bill
  • Would like the definition for telemedicine to be the same across all statutes

 
Smithee closed

  • Will take suggestions that have been made and deal with those

 
Bill left pending
 
HB 1624 – Smithee, Relating to transparency of certain information related to certain health benefit plan coverage.

  • Committee sub laid out
  • Information online is outdated and hard to access
  • Under current law insurers update provider directories quarterly
  • Bill directs TDI to come up with a template for posting of drug formularies and makes some changes regarding the posting and accuracy of provider directories

 
Blake Wyndham, American Cancer Society

  • Support
  • Cancer patients need up to date information on drug formularies and network providers
  • Would like an amendment to require that formulary costs be expressed in a dollar amount

 
Simone Nichols, National Multiple Sclerosis Society

  • Support
  • People with MS must be informed consumers and information must be readily available

 
Tara Seidenburg, Self

  • Support
  • Echoed previous witness

 
Audra Ray, Self

  • Support
  • It is very important for MS patients to pick a suitable health plan; this information being more accurate and available will help MS patients significantly

 
Stacey Pogue, CPPP

  • Support
  • A great step in the right direction
  • Has done research that shows provider lists are highly inaccurate

 
Dave Bryant, Anesthesiologist

  • Support

 
Doug Danseizer, TDI

  • Resource
  • Bonne concerned about what he has heard about highly inaccurate provider registries; not saying anybody is doing anything wrong on purpose; understands it is hard to do but people need to use accurate data when making these decisions

 
Smithee closed
 
Bill left pending
 
HB 3024 – Guerra, Relating to coordination of dental benefits under certain insurance policies.

  • Seeks to ensure dental patients with more than one insurance policy can receive the full benefit of having two policies
  • Working with TDI and stakeholders on some minor tweaks

 
Jose Casarez, Dental Association

  • Support
  • Requires that a secondary insurer pays the balance on a dental claim based on the full allowable coverage
  • Makes dental care more affordable, cost predictable and accessible

 
Guerra closed
 
Bill left pending
 
HB 1514 – Sheffield, Relating to health insurance identification cards issued by qualified health plan issuers.

  • Puts the designation of the plan on the ID card; whether they are part of a qualified health plan and whether they receive a premium subsidy

 
Witness

  • Support
  • Witness discussed the issue regarding the 90 day grace period and the issue it causes providers
  • Some insurance providers (Aetna) already put this information on their ID cards

 
Stacey Pogue, CPPP

  • Oppose
  • Concerned that an indicator of a subsidy has privacy and discrimination issues
  • Sheets asked how a doctor would treat patients differently
    • Just by providing them more education about subsidies and the importance of paying them
  • Why not put the onus on the insurance company to ensure their insured are fully educated
  • Sheets made the point that face to face conversations with the physician are probably more effective than a piece of paper in the mail
  • Bonnen made the point that the best person to discuss the issue with a patient is probably their physician

 
Sheffield closed
 
Bill left pending
 
HB 574 – Bonnen, Relating to the operation of certain managed care plans with respect to health care providers.

  • Bill states that a HMO can’t remove a physician from their contract solely because the physician informs an enrollee of the full range of physicians and providers available to the enrollee, including out-of-network providers
  • Contemplating changes in committee sub regarding concerns from HHSC that the bill could affect the Medicaid program

 
Dan Chepkaskas, Patient Choice Coalition of Texas

  • Support
  • Because of referrals, referring physicians are terminated from their contract
  • Happening quite often
  • Send a chilling effect for people to use their out-of-network benefits
  • Meyer asked why the bill hasn’t passed
    • Got behind some slow moving vehicles
  • Meyer asked about opposition
    • Possibly health plans
    • Bonnen noted he isn’t sure where the plans stand on this one

 
Vem Head, Self

  • Support
  • Do not want physicians penalized for giving their patients options

 
Fiaz Zaman, President, Texas ASC Society

  • Support
  • Physicians are being penalized for doing what is best for their patients

 
Debra Diaz Lara, TDI

  • Munoz asked what tools TDI has to address this issue
    • There is no prohibition currently; TDI does have to give notice and appeals process, etc. but they cannot terminate solely for this reason
  • Need this in statute to give the agency teeth on this matter

 
Bonnen closed

  • Being de-listed can be traumatic to a provider's practice
  • It may not be a huge issue but it is an issue that needs to be dealt with

 
Bill left pending
 
HB 3025 – Farney, Relating to health benefit coverage for prescription drug synchronization.

  • About aligning prescription medication for chronic illnesses so they are all on the same refill schedule
  • Has been proven to increase adherence and avoid complications
  • Poor adherence costs the health care system $291 billion yearly
  • Allows a pharmacist to provide a short fill for a medication to align the refill dates of other medications
  • Allows patient to pay a prorated copay amount
  • Multiple states gave passed this type of law and 19 other states have this type of legislation in the works
  • Guerra asked about a bill to allow three month prescriptions; does it relate
    • Not sure about that bill

 
Jamie Dudensing, TAHP

  • Opposed
  • Supportive of medication synchronization but concerned about the mandates of administrative implementation
  • Have been working with the bill author on a sub or amendment; only concerned about administrative pieces

 
Michelle Driscoll, Texas Pharmacy Association

  • Support
  • Easy way to increase patients’ quality of life
  • Bill would address health plan design barriers that impede patients from easily improving their situation

 
Joe DeSilva, Texas Pharmacy Association

  • Support
  • The bill will save a lot of money because it will increase adherence
  • Workman discussed the issues that he has experienced with his mother attempting to keep up with meds and paying out of pocket to synchronize prescriptions

 
Farney closed

  • Bill is for the consumer

 
Bill left pending
 
HB 963 – Bonnen, Relating to the designation of certain optometrists, therapeutic optometrists, and ophthalmologists as preferred providers.

  • Seeks to ensure optometrists and ophthalmologists can become preferred providers when joining an existing practice
  • Same language that is in statue for other specific providers

 
Tommy Lucas, Texas Optometric Association

  • Support
  • Allows a new doctor who joins an eye care practice to join the provider panel

 
Ron Hopping, Texas Optometric Association

  • Support
  • Has a practice with his wife and his son has joined the practice but cannot get on many of the medical insurance plans that he and his wife are on

 
Bonnen closed
 
HB 616 – Bonnen, Relating to payment of and disclosures related to certain out-of-network provider charges.

  • Committee substitute laid out
  • A provider can accept a pricing agreement in a contract with a health plan; providers who are not contracted for pricing must still be paid
  • There is no statutory definition of a methodology for how the out-of-network provider is to be paid; this is generally left up to health plans
  • Legislation addresses the concern over how to determine a more fair strategy for determining what non-contracted providers are paid by health plans
  • There can be a wide discrepancy between what providers are paid for the same service from the same health plan
  • The original bill had a fiscal note which stems from the fact that the bill included government programs
    • Not sure how this can be modeled because assumptions on how providers are paid and assumptions of out-of-network use are made

 
Boyd Yarborough, Elite Surgical Affiliates

  • Support
  • Small to midsize providers are not able to negotiate favorable contract rates
  • Patients end up taking the bulk of this dispute between providers and insurers
  • Bonnen asked

 
Bill Hammond, Texas Association of Business

  • Oppose
  • The bill is an enormous cost driver
  • Would cost employers of Texas $37.5 billion over the next 10 years; assuming a 7% increase
  • More and more Texans will lack insurance as employers give up as health insurance costs rise
  • Bonnen made the point that without this legislation small business will die out

 
Charles Bailey, Texas Hospital Association

  • On the bill
  • The policy question for the legislature should be whether or not the legislature wants to set a payment rate
  • Hospitals and health plans want facility-based physicians to be in the same network

 
Vem Head, Self

  • Support
  • Bill will go a long way in helping patients better understand what they will be paying for and how much it will cost

 
Amy Kyle, Texas Ambulatory Surgery Center Society

  • Support
  • Have been negotiating insurance contracts for the past 8 years; very familiar with the insurance cost to consumers
  • Many people do not understand their own insurance plans and how they work
  • Personally pay a premium for healthcare to be part of a PPO plan; do not want facility choice to be predicated on cost
  • There are uncertainties in contracted rates if small changes are made within the care that is given
  • There is no rhyme or reason to how insurance companies decide what to pay out-of-network providers
  • The bill prevents insurance companies from shifting their cost to consumers

 
Faiz Zaman, Ambulatory Surgery Center Society

  • Support
  • Patients will delay care if they do not know what they are going to pay for it; can be detrimental to their health

 
Jamie Dudensing, TAHP

  • Oppose
  • Bill is government price-setting; sets price based on bills charges which are heavily inflated and vary widely
  • Provider consolidation is one of the reasons why health care costs are going up
  • Bonnen asked what the health plans would say if it was found out that out-of-network reimbursements were lower than contracted rates for in-network providers and the insured is paying more out of pocket in addition to paying a premium for a PPO plan

 
Dan Chepkaskas, Patient Choice Coalition of Texas

  • Support
  • Balance billing is caused by anemic reimbursement and not from high provider charges
  • There are no mandates in this bill
  • Bonnen asked about Fair Health
    • It is basically a data dump; when CPT codes come through the system with billed charges they are aggregated by geographical location

 
Jill Sluter, Texas ASC Society

  • Support
  • Consumers pay more to have out-of-network benefits
  • When carriers pay such low rates for serious cases like spinal surgeries it makes it difficult for ASCs to keep their doors open.

 
Pending Business
 
CSHB 1038 – Sheffield, Relating to insurance coverage for hemophilia medical treatment.

  • Committee substitute reported favorably

 
HB 1947 – Meyer, Relating to the expiration of licenses for insurance agents and adjusters.

  • Bill reported favorably

 
HB 1948 – Meyer, Relating to individual indemnity health insurance.

  • Bill reported favorably to local calendar

 
CSHB 2491 – Pickett, Relating to licensing and appointment of title insurance escrow officers.

  • Committee substitute reported favorably to local calendar

 
HB 3031 – S. Thompson, Relating to the decertification of a certified capital company.

  • Bill reported favorably to local calendar

 
HB 3238 – Frullo, Relating to the regulation of funding agreements, guaranteed investment contracts, and synthetic guaranteed investment contracts issued by a life insurer.

  • Bill reported favorably to local calendar