The House Committee on Insurance met on March 28th to take up bills on the notice here. In order, this report covers: HB 1527 (Oliverson), HB 1587 (Oliverson), HB 1592 (Oliverson), HB 755 (Johnson, Julie), HB 468 (Thierry), HB 895 (Muñoz), HB 1647 (Harris, Cody), HB 3351 (Harris, Caroline), HB 1322 (Buckley), and HB 1696 (Buckley). An archive video of the hearing can be found here.
This report is intended to give you an overview and highlight 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
HB 1039 (E Thompson) voted out to House (9-0)
- CS adopted, clarifies that covered loss must occur at the property
HB 1554 (Raymond) voted out to House (8-1)
HB 1239 (Oliverson) voted out to House (6-3)
- CS adopted, complete CS, addresses stakeholder concerns; removed DEI language & instead focusing on disparate impact analysis
HB 2839 (Smithee) voted out to House (9-0)
HB 109 (Julie Johnson) voted out to House (9-0)
- CS adopted, reduces language on benefits provided through Church Benefits Board
HB 1996 (Hull) voted out to House (9-0)
HB 2188 (Paul) voted out to House (9-0)
HB 1074 (Hull) voted out to Local (9-0)
- CS adopted, includes consumer protection language prohibiting data sharing of data on customer, includes technical correction
Bills on Notice
HB 1527 (Oliverson | et al.) Relating to the relationship between dentists and certain employee benefit plans and health insurers.
- CS laid out
- Chair Oliverson – CS creates procedures and 180 day timeframe for insurance to do cost recovery
- Insurance has also become the arbiter of care through disallow clauses, HB 1527 prevents insurers from denying dental benefit and also the dentist collecting a fee
- Also addresses silent provider networks; requires state regulated dental insurers to follow fair and accurate network leasing laws, gives dentists opportunity to review contract and opt-out
Carl Galant, Texas Dental Association – For
- CS is about fairness & transparency, addresses retroactive denials, disallowable clauses, and silent network leasing
- Sets reasonable time limit of 180 days for recovery, prohibits denying payment and billing patient directly if service was necessary, and requires insurers to conspicuously notify dentists when service can be sold or leased, etc.
Jennifer Cawley, Texas Association of Life & Health Insurers – For
- Submitted language ideas to Chair Oliverson’s office brought from national group that would conform bill more closely to NCOIL model; one provision could be interpreted to cause balance billing
John Pittman, MetLife – On
- Suggesting repealing requirement that payment or reimbursement for noncontract be the same as for contract; Texans should have ability to get discounts for in-network care
HB 1527 left pending
HB 1587 (Oliverson) Relating to the use by insurance companies of separate accounts in connection with life insurance and annuities and certain other benefits.
- Chair Oliverson – Modernizes regulatory process by providing certain exemptions for large-group annuity contracts in a pension buyout contract
- In 2021, Lege expanded list of exempted commercial policies, these annuity contracts often involve negotiated contracts by sophisticated insurers & approval of forms is not required for public safety
- Use of consent orders after agreement has been reached does not provide additional protection for consumers and simply delays transaction
Jennifer Cawley, Texas Association of Life & Health Insurers – For
- Bringing law in line with what Lege has already done on property & casualty insurance
- Most important part of consumer protection is solvency of the agency, TDI is always involved in regulating solvency and bill does nothing to change that
- Chair Oliverson – Other piece is fiduciary responsibility
HB 1587 left pending
HB 1592 (Oliverson | et al.) Relating to the application of balance billing prohibitions and out-of-network dispute resolution procedures to certain self-insured or self-funded employee welfare benefit plans.
- Chair Oliverson – SB 1264 is working and patients are being protected, arbitration effective to allow providers and insurers to work out differences
- Federal rollout has not worked as expected, HB 1592 creates voluntary pathway for ERISA plans to use the arbitration system after filing letter with TDI
Blake Hutson, Texas Association of Health Plans – On
- Agree with movement to stop balance billing, happy to work with Rep. Oliverson
Rep. Oliverson closes
- Narrowly drafted bill, seeks to resolve one tiny issue
HB 1592 left pending
HB 755 (Johnson, Julie | et al.) Relating to prior authorization for prescription drug benefits related to the treatment of chronic and autoimmune diseases.
- Julie Johnson – Deals with PAs for autoimmune and chronic disease, patients have the same medications and treatments year-to-year and month-to-month; have worked with stakeholders and reached a place where plans don’t oppose; requires only an annual PA for these patients
- Chair Oliverson – Patients are unique because there is very little change in treatment over time, makes sense to have longer windows for review
- Julie Johnson – also timely administration is important
Blake Hutson, Texas Association of Health Plans – On
- Have been working with Rep. Johnson’s office on language
- Chair Oliverson – Some of the treatments for these conditions involve biologics and biosimilars, this doesn’t take away a plans ability to allow for conversation an annual process or new affordable preparation?
- Yes; PAs are more about safety checks than getting you on a cheaper drug
- Julie Johnson – Thanks TAHP for coming to the table and working on this; will have CS to committee hopefully today or tomorrow
Dr. Pradeep Kumar, Texas Medical Association, Texas Society of Gastroenterology – For
- Legislation is long overdue, PA burdens have increased & can lead to abandoned treatment and adverse events
HB 755 left pending
HB 468 (Thierry) Relating to health benefit plan coverage of hearing aids and cochlear implants for certain individuals.
- Thierry – Cut off for hearing aid and cochlear implants at 18 is difficult, HB 468 covers through age 25
Dr. Haley Owen, Texas Academy of Audiology – For
- Hearing loss has significant impact on people across the state, HB 468 addresses gap critical for young adults
Blake Hutson, Texas Association of Health Plans – On
- Mandate with a cost, but importance of this counterbalances; age 25 is also consistent with ACA
HB 468 left pending
HB 895 (Muñoz, Jr.) Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.
- Muñoz – Prohibits sample audit and extrapolation across the rest of provider’s claims for purposes of determining overpayments; current law has this in place for pharmacy payments
- Process sometimes places unjust burden on providers
Jessica Lynch, Texas Association of Health Plans – Against
- HB 895 prohibits use of tool used to uncover fraud
- Extrapolation is a tool occasionally used to audit large volume of claims
- Highlights instances of large scale fraud, in the commercial space extrapolation helps with efficient and timely detection of fraud; not used on every case, only when large volume must be reviewed
- Chair Oliverson – Bothers me at the deepest level; if you’re using this tool your not actually proving fraud exists, accusing someone of doing something without proof; seems antithetical to right to have case heard, seems anti-American
- Due process does exist, providers can contest at point of sampling and when extrapolation occurs
- What is applied during extrapolation is fraud found
- Chair Oliverson – Right, sort of like charging armed robbery when someone is caught breaking & entering
- Interesting example given castle doctrine
- Chair Oliverson – Haven’t investigated, just assuming pattern of behavior means fraud is done all the time
- Point well taken; while OIG and CMS have used extrapolation over past 75 years they have made sure there was due process, employed by statisticians, etc.
- Chair Oliverson – Loaded accusation to accuse someone of illegal act based on sample
- The fraud has occurred and is extrapolated
- Chair Oliverson – The fraud occurred elsewhere, then you’re assuming fraud is happening everywhere
- Courts have repeatedly upheld that this is effective due process
Dr. Paul Liechty, Chiropractor – For
- HB 895 prohibits extrapolating findings across unreviewed claims; under bill can’t extend error across all claims for overpayment
- Had experience with Aetna where Aetna pulled 10 files from 5 years prior and extrapolated erroneous claims from 6 cases; claims were allowable at the time but not now; also denied claims payment during the time
Rep. Muñoz closes
- Didn’t hear opposition to the bill until today
- Plans aren’t talking about expense to providers while they are fighting erroneous extrapolation
- Want to make sure there is fairness in way issues are handled
HB 895 left pending
HB 1647 (Harris, Cody) Relating to health benefit plan coverage of clinician-administered drugs.
- CS laid out
- Cody Harris – Explains white bagging; aims to stop vertical integration between plans, PBMs, and pharmacies; replacement for buy & bill practice which is the best for the patient
- Under white bagging mandates, providers must dispense drugs via the vertically integrated system, cannot dispense their own drugs; can cause delays in care for oncology patients, complicates storage for infusion drugs, whitebagging moves payment from medical benefit to pharmacy benefit causing higher costs
- CS takes large steps towards rectifying this
Dr. Gury Doshi, Texas Oncology – For
- Physician ownership of infusion drugs has been standard of care for a long time, carefully managed & treatments are able to be adjusted day-of
- Under whitebagging policies infusion drugs will be delivered from a separate pharmacy and be stored separately, contributing to higher costs; drugs that aren’t the right dose will need to be reordered and white bagged drug cannot be re-dispensed or used for another patient
Blake Hutson, Texas Association of Health Plans – On
- Hospitals are getting expensive drugs and marking them up, plans are aiming to address this with white bagging
- Appreciate Rep. Harris working with us to get us neutral on the bill
- A Johnson – Can you explain this in the context of one use eye drops versus big bottle?
- Interesting point; with infusion drugs, they are shipped in a powdered form, with white bagging they are shipped in enough quantities to address variation
- Waste caused by white bagging is nowhere near wasted cost in markup
- This is direct comparison, marked up product is the same
- A Johnson – So not similar to small eye dropper dose versus big bottle?
- No, everything comes in large supply and is mixed on site
- A Johnson – But cost is the difference?
- Yes
- Paul – on commercial side, mark ups occur; are your examples real examples?
- Yes, everything cited in written material is based on transparency data, typical mark up is about 3x; some hospitals are marking up cancer drugs 634%
- Paul – How are they getting away with that?
- Medicare has a cap, commercial market doesn’t have a cap so this is what happens to prices
- Idea around white bagging is to bring in drugs at a more competitive price
- Chair Oliverson – As I remember hearing this issue presented as a problem last session it was specifically related to clinicians active in outpatient oncology practices with new generation of drugs & statement was made that they needed greater flexibility to adjust doses than current method is allowing
- Chair Oliverson – I feel like this addresses that & impressed that TAHP has worked to get this into a workable place
- Harris has nailed it with the CS
Dr. Binita Patel, Memorial Hermann, Texas Hospital Association – On
- Support the bill, but have concerns with the CS
- Bill does exclude hospitals & they need to be included; hospitals are different from private practice, hospitals employ pharmacists that make the medication
- Memorial Hermann does not allow white bagging currently, legislation coming down where hospitals will need to ensure products are tracked
- Hospitals have charges, but don’t get reimbursed for those; those are negotiated rates with eh payer
- A Johnson – Did you get a chance to testify fully?
- Yes, just wanted to clarify that charge is very different from what the patient and payer pays
Dr. Pradeep Kumar, Texas Medical Association, Texas Society of Gastroenterology – For
- Use infusion drugs as a GI, dosages change and need to be nimble
Rep. Harris closes
- Asks that Hutson’s comment that he nailed the bill be reduced to writing
- Chair Oliverson – Not an easy lift, commend you for working with all stakeholders; challenging issue last session
CS withdrawn, HB 1647 left pending
HB 3351 (Harris, Caroline) Relating to standards required for certain rankings of physicians by health benefit plan issuers.
- Caroline Harris – Introduces 3rd party to rate and provide data to patients, ranks providers on national quality standards
Blake Hutson, Texas Association of Health Plans – For
- A lot of work has been done on price transparency, but same work has not been done on quality transparency side
- Highlights Aetna’s program using nationally recognized standard, publishes ranking online, but aren’t dealing with same hurdles as with state law
- Chair Oliverson – Very interesting idea, agree that we want patient’s to be able to ascertain value, including cost and quality; in the past quality metrics couldn’t reliably be tied to quality
- Chair Oliverson – Concern and caution is that some data you can look at are not necessarily good measures of quality
- State sets out quality standards, may want to look at Code to ensure
- The end of the bill is a little belts & suspenders
- TMA has spoken about reconsideration process where physicians can resubmit
- Chair Oliverson – References Geico commercial with the doctor that’s “just okay;” providers providing low quality should be paid less, providers providing high quality might be paid more
- I don’t think physicians will shy away from that, if you’re doping better and having better outcomes, ultimately you save money
- Caroline Harris – Two of the largest groups for standards do have appeals processes outside of state law
Dr. Pradeep Kumar, Texas Medical Association – Against
- Understand and support attempt, but bill creates imbalanced process that lacks accountability & could create confusion
- Need to have a process to be informed of ranking & process to appeal
- Chair Oliverson – Sympathize with this; I think physicians should be ranked, but concern is the validity of measures used to evaluate physicians
- There are some nuances, e.g. surgeons that do complex surgeries or redo other surgeon’s work; doctor should have opportunity to explain complication rate & ability to appeal
- Caroline Harris – What are your thoughts on ranking physicians in particular areas rather than just outcomes?
- Should have comprehensive way of ranking, should take colleague opinion into account, bed side manner, etc.; physicians should be included and have a way to dissent
The committee recessed for the House floor
Charles Miller, Texas 2036 – For
- Need to rank providers on quality, understand issue of providers wanting fair notice; existing due process standard is overbroad and has prevented work on this in the past
- Chair Oliverson – This is one of the things that needs to be done right the first time otherwise will cause untold harm; want to make sure we have your commitment to help in determining helpful & meaningful criteria for ranking
- Agree, though will have disagreement on what are appropriate standards; important that entities propagating them are unbiased
Tom Denniston, Denniston Data – For
- Highlights Denniston Data, firm working on health care price transparency data with goal of improving quality of care
- Significant amounts spent on health care, need services and processes that drive quality and reduce waste
- Denniston data has ranked providers based on outcomes, adding price transparency helps consumers make best choices & will drive costs down
- Chair Oliverson – Can you talk about appropriate metrics? What are we looking for?
- Tried to make provider ranking system as objective as possible, currently over 1m providers ranked
- Use Medicare data on how often each provider is doing each procedure compared to peers of their specialty; ranked on how often procedures are performed
- Chair Oliverson – Measure of quality is the number of times a provider performs a procedure?
- Yes, practice makes perfect
- Chair Oliverson – How would you apply that to someone being admitted to the hospital? Significant limitations to one-size approach to quality as health care is so individualized and populations differ
- Also report on patient demographics and risk
- Chair Oliverson – Important consideration, each patient is different; can you account for that?
- Not reporting on outcomes because we do not know, but if a procedure is done more than once or is a repeat, that is not a good sign
Shannon Meroney, National Association of Benefits and Insurance Professionals – For
- Overdue, plans have the data but not allowed to put this information out to members
- Would expect physicians to want this, would have guidelines, etc. that are not in place on Yelp, Google
- Caroline Harris – Still have provisions incorporating physicians into the ranking process and methods have to be transparent and valid
- Plans do work to ensure data is a valid and like is compared to like
Rep. Caroline Harris closes
- Medical error is not included on reporting for cause of death as it is not on the death certificate
- Chair Oliverson – Look forward to helping you get this done
HB 3351 left pending
HB 1322 (Buckley) Relating to coordination of vision and eye care benefits under certain insurance policies and vision plans.
- CS laid out
- Buckley – Lays out mechanism for health and vision benefit plan to be coordinated on eye care services; already a statute on coordination of benefits, but only covers medical and dental
- Only applies up to coverage limits for each plan
Dr. Thomas Lucas, Texas Optometric Association – For
- Will allow coordination of medical and vision plan to work together when patient has eye care under both
- Worked with TDI to conform, will likely be one more CS to make tweak for one stakeholder, then will have agreed to bill
HB 1322 left pending
HB 1696 (Buckley | et al.) Relating to the relationship between managed care plans and optometrists, therapeutic optometrists, and ophthalmologists.
- CS laid out
- Buckley – Seeks to ensure Texans will have access to high quality eye care, addresses problems eye care industry has with insurance; industry is being consolidated and vertically integrated currently via insurance owning frame producers, lens producers, etc.
- CS addresses some concerns from the insurance plans
Jennifer Deakins, Texas Optometric Association – For
- Addresses major issues with managed care plans and eye care, especially vision plans
- Chair Oliverson – Why does this bill have ophthalmologists in it? Isn’t it typically covered by medical?
- Used what was currently in the code and kept that consistent, have been working with stakeholders and happy to work with them
- Chair Oliverson – If they don’t need to be in, strong recommendation to take them out
Jay Thompson, Texas Association of Life & Health Insurers – Against
- Opposed to one provision in the bill, objecting Chap. 541 unfair trade practices to enforce bill, allows for private causes of action
- Fine from TDI would be more consistent enforcement than private causes of action, can provide language
Dr. Thomas Lucas, Texas Optometric Association – For
- Previous bill prohibited plans from controlling practice of optometry, but has changed since then and vision plans have continued to try
- Bill will prevent plans from hiding out of network information, would prevent steering of patients, prevents ranking based on how many products purchased from plans, prevents selling of personal data unrelated to claim
- Working with plans and removed any willing provider language
Dr. Alina Sholar, Texas 400, Texas Medical Association – Against
- Have concerns about treatment of optometrists under the bill, e.g. prohibition against treating optometrists differently based one education
- Bill prohibits identifying optometrists and ophthalmologists differently; identifying is not well described and could create false equivalency between physicians and non-physicians
- Bill conflates definitions of products & could erroneously define optometry as the practice of medicine
- Chair Oliverson – Does removing ophthalmologists entirely from the bill address the concern?
- Would address major portion of concern, but wouldn’t address language saying optometrists provide medical products
- Chair Oliverson – But do have co-treatment for glaucoma, so sometimes providing medical products
- Don’t want o open that door any wider
- Cain – Have you spoken to Rep. Buckley’s office?
- Yes, yesterday and earlier this weekend
Rep. Buckley closes
- Currently Medicare and Medicaid reimburse ophthalmologists and optometrists at the same rate; current statute has anti-discrimination language in it
HB 1696 left pending