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The committee met to take up and consider new and pending business. This report focuses only on the bills listed below.
 
Pending Business
 
HB 21 – Kacal, Relating to authorizing patients with certain terminal illnesses to access certain investigational drugs, biological products, and devices that are in clinical trials

  • Reported favorably as substituted

 
HB 2171 – Sheffield, Relating to information maintained in the immunization registry with the consent of an individual after the individual becomes an adult.

  • Committee – is the issue from “last time” resolved?
    • Sheffield – If a person ages out of ImmTrac, able to hold information in a “pending adult” database, this information is not accessible by other organizations, and is kept for 1 year before deletion
  • Reported favorably as substituted

 
New Business
 
HB 1263 – Raymond, Relating to the regulation of the practice of physical therapy.
Rep. Richard Raymond, laying out

  • Provides for direct access to Physical Therapists, bypassing physician referral process

 
Chase Bearden, Coalition of Texans with Disabilities, for HB 1263

  • Injured persons know how severe an injury is and if treatment is needed
  • Having faster and direct access can “make a huge change” and prevent more serious problems from developing

 
Allan Besselink, Physical Therapist, Himself, for HB 1263

  • “Perplexing” that patients need PT referrals from providers who have no training in PT
  • Patients may see any number of specialists without referrals, but for some reason PTs are restricted
  • Burden should lie on proving patients shouldn’t have access
  • Rep. Elliott Naishtat – Are PTs licensed and regulated?
    • Absolutely
  • Naishtat – Do you fall under the auspices of the Texas Medical Board?
    • PTs fall under the Occupations Code
  • Naishtat – Are you required to carry liability insurance?
    • Absolutely
  • Sheffield – Majority of PTs definitely do not wish to harm patients, how do we keep patients from falling into unscrupulous hands? I.E. those who would see HB 1263 as a way to exploit patients?
    • Question needs to be phrased in terms of what have we done thus far, currently not concerned about internet diagnostics etc., PTs are the only restricted professional
  • Rep. Garnet Coleman – 46 other states have direct access, are there any reports of problems or abuse?
    • Malpractice insurance claim rates have not changed
  • Coleman – So no rampant problems in these other states?
    • No
  • Coleman – That says a lot about where Texas is in terms of other providers

 
Michael Connors, Texas Physical Therapy Association, for HB 1263

  • Has previously practiced in 2 direct access states, shocking to come to Texas and be restricted from practice
  • PTs are not under Medical Board review, are under review of an independent board, but held to the same standards
  • In many cases patients visit care providers and are immediately referred to PTs
  • Direct access has not resulted in the problems the Texas legislature worries about
  • Rep. Nicole Collier – Can PTs order X-rays?
    • No
  • Collier – Earlier you said imaging is not required for the first six weeks?
    • Overutilization of imaging is a problem
  • Collier – Is there an orthopedic organization?
    • American Association of Orthopedics has the same guidelines
  • Collier – Do PTs go through some sort of orthopedic training?
    • Yes, 8 hours out of 99 total program hours are orthopedic study
  • Collier – So are PTs doctors?
    • Have a doctoral degree, not a “doctor”
  • Collier – Only thing that concerns me is missing diagnoses, i.e. root cause is cancer and time is spent on PT when cancer treatment is needed
    • No diagnosis issues reported, PT board will punish those who operate out of their scope
  • Collier – Does this allow PTs to advertise on billboard and TV?
    • Currently able to do this
  • Collier – Can you give me a copy of the treatment guidelines relating to metastatic conditions
    • Yes, outlines “red flags” that would indicate metastatic issues
  • Collier – Why would I see you instead of a chiropractor?
    • PTs look at conditions very differently from a chiropractor

 
Heather Aguirre, Texas Osteopathic Medical Association, against HB 1263

  • Biggest concern is that HB 1263 would delay proper diagnosis and treatment, PTs are not medical doctors and may not diagnose or treat medical conditions
  • Prior testimony drawing information from 2006 study of PT, PTs were “wrong” 50% of the time in this study
  • Rep. Bill Zedler – What about the fact that they have done this in 46 other states and the US military, if there was a problem someone would have noticed, correct?
    • Each of the other states have differing restrictions, time span and special population restrictions as examples
  • Zedler – Would not some of these states have seen problems?
    • No studies exist from direct access states
  • Zedler – Wouldn’t medical malpractice insurance rates have gone up?
    • I would think so, but not totally sure

 
Jamie Dudensing, Texas Association of Health Plans, on HB 1263

  • PPO plans are not required to have a referral
  • Could be some direct implications for Medicaid, could control visit utilization with prior authorization
  • Chair – So why would a self-pay patient be restricted from PT
    • Self-pay is another issue, PPO patients may be affected, i.e. patients may utilize all of their care “visits” via insurance prior to receiving medical care
  • Collier – If someone visits a PT and pays on their own and then subsequently discovers they need medical care, would insurance require additional PT visits?
    • Issue is PPO plans may have 9 or 15 visits, when coverage runs out would need some prior authorization
  • Collier – Just trying to make sure patients will not have to visit PT again
    • Real issue is whether insurance companies are paying for visits
  • Collier – Seems that we are not on the same page, would like to visit later
  • Naishtat – Do you know if these issues have been addressed or resolved in other states or have they presented problems for consumers in other states?
    • Believe that health plans could control visits through prior authorization
  • Zedler – What happens if I go to a direct access PT and call my insurance carrier for a prior authorization?
    • Unsure on this point, PT may bill insurance company for the first visit
  • Zedler – But after that first visit I would need prior authorization?
    • Yes
  • Zedler – Do some other states need prior authorization for direct access PT?
    • Unsure

 
Mark Nordak, Orthopedic Physician, Texas Physical Therapy Association, for HB 1263

  • Chief matter here is one of trust
  • Doctors trust PTs and send “complex cases” to PTs
  • Cost, access, and taking care of patients are the primary factors
  • Zedler – Could this actually speed up process for patients with severe issues as they would be screened by PTs and then sent to a specialist like you?
    • This would likely be the case

 
Raymond closing

  • Would hope HB 1263 would not lead to misdiagnosis of cancer
  • Doctors will not like HB 1263, Senate will be a hard battle

 
Bill left pending
 
HB 764 – Susan King, Relating to the use, collection, and security of health care data collected by the Department of State Health Services.
Rep. Susan King, laying out

  • Texas Health Care Information Collection bill, committee substitute exists
  • This procedure has been in place “for 20 years”
  • Concerns collection of data, how data is used, and security of data
  • HB 764 would inform patients of data collection for the “first time in 20 years”
  • Does not stop information collection, data will still be available through public use processes, but will not be sold without undergoing review
  • Incorporates parts of SB 7
  • Naishtat – Do we know what data about patients is currently collected?
    • Ambulatory centers take name, address, city, social security number, date of birth, admitting diagnosis, procedure, date of entry, method of payment
    • Unsure about data collected in inpatient settings
  • Naishtat – Are you aware of the security procedures?
    • Not aware, but HB 764 is a proactive bill
  • Naishtat – Are there issues concerning the way the agency is appropriately maintaining security standards?
    • Concerned any time “very personal data” is collected
  • Naishtat – Concerning prohibiting sale of data, is the department now selling this data?
    • Yes, anywhere from $300,000-$600,000 a year, if HB 764 passes would be a loss in revenue
  • Rep. Bobby Guerra – Who is the vendor that controls the data?
    • System 13, they compile the data and make it ready for review and inspection by DSHS
  • Guerra – Is there disclosure to the patients when data is sold?
    • At this time, no
    • HB 764 would provide for this disclosure
    • Hospital Association is the biggest entity that sends data
  • Chair – Is the information de-identified?
    • Not when it is sent to the vendor, it is the duty of the vendor to de-identify
    • Important that statute contains directive to de-identify, most important aspect is that patients should be informed
  • Sheffield – Should patients have the right to opt-out?
    • Thought about it, but this would deter the “seamless” path of medical research
  • Rep. Sarah Davis – Procedurally how does this work?
    • Providers notify the patients, would be inappropriate for any other to notify as providers collect the information
  • Davis – And providers are comfortable taking on this step?
    • That is my understanding, concern is not so much that providers are comfortable, but that patients need to know
  • Collier – This bill would remove personally identifying information and would tell a patient where the data is being sent?
    • Correct, patient would know who to contact regarding potential security breaches

 
Nagla Elerian, Department of State Health Services, on HB 764

  • Process for the state getting information on hospital discharges, state has contracted with contractor through a bid process to process claims data
  • Contractor takes standard claims format and turns this into data, security audits are conducted
  • Once data is processed by contractor, data is sent to DSHS, DSHS has its own security measures, cannot access this data without legislative process or IRB approval
  • Data is basically de-identified, cannot identify a single individual out of the data set
  • Sensitive issues such as HIV status are fully de-identified
  • Currently collect around $400,000 for data use

 
Steven Blake, Texas ASC Society, for HB 764

  • HB 764 is a “good improvement” in trying to secure important data
  • HB 764 requires that DPS and FBI are notified in the event of cyber attacks and data breaches
  • Appropriate protocols need to be in place for using such data for research purposes
  • Purchased data could be used to entice patients to facilities

 
King, closing

  • Approval of data for research purposes would increase likely, security of data is covered under HB 764
  • Zerwas – HB 764 strikes a good balance between protecting and utilizing data

 
Bill left pending
 
HB 1212 – Price, Relating to the designation and regulation of abusable synthetic substances, the emergency scheduling of certain controlled substances, and the prosecution and punishment of certain offenses.
Rep. Four Price, laying out

  • Combats problem of synthetic drug use
  • Designed to bind to receptors easily, marketed to minors generally
  • “Fake pot” of particular concern
  • Texas Poison Center has received numerous calls for adverse reactions with an age range of 7-75
  • Several cities have written ordinances against these compounds
  • FDA does not regulate these compounds, typically labeled “not for human consumption” to avoid this regulation
  • Need consistent statewide ability to ban these compounds on emergency basis
  • HB 1212 allows DSHS commissioner to ban substances on an emergency basis for the benefit of public health, several restrictions exist on this ability and many factors determine if ban is appropriate
  • Coleman – HB 1212 is needed, allows response to changing chemical compositions
  • Naishtat – Does HB 1212 create a criminal offence?
    • No, but it does add synthetic drugs to the schedule penalty list

 
Brady Mills, Texas Department of Public Safety Crime Lab, on HB 1212

  • Chair Crownover – Seems to be that focus of HB 1212 is to chase the ever changing formula
  • Correct, each packet can contain multiple chemical compounds
  • Chair – But won’t we always be chasing these changes?
  • Yes

 
Price, closing

  • “Statewide problem,” HB 1212 would help manage chemical compounds that are adjusted “on the fly” to skirt the law

 
Bill left pending
 
HB 1924 – Coleman, Relating to the authority of a psychologist to delegate certain care to an intern.

  • Allows psychologist to enroll in a formal internship and to bill for the care given
  • Zerwas asked if this is similar to what is done in the medical professions; bill on behalf of a person
    • Correct; it is a formal internship and the care being received is under the supervision of a professional

 
James Bray, Texas Psychological Association

  • Support
  • Discussed internship programs
  • Interns would be able to generate income for the office and potentially increase their own pay; would help retire student loan debt
  • Would definitely help to bring more interns to the state by having funds available to create additional slots

 
Meagan Mahoney, DePelchin Children’s Center

  • Support
  • There is a shortage of providers and this bill could help to reduce that shortage

 
Psychology Doctoral Student, UNT

  • Support
  • When students don’t find internships it can cause them financial stress and can cause them to leave the state in search of an internship

 
Charles Walker, Self

  • Support
  • Would provide internship programs with access to non-state revenue to continue internship programs
  • Zerwas: how much could this close the gap
    • Will be a step in the right direction; the number of slots will likely grow

 
CSHB 2023  – Naishtat, Relating to the appointment of a forensic medical director responsible for statewide coordination and oversight of forensic mental health services provided by the Department of State Health Services.

  • Bill would create forensic director position within DSHS in charge of statewide, cross agency coordination and oversight for forensic and competency restoration services for mental health patients awaiting trial
  • Substitute removes the word “medical” from the position title, clarifies the definition of forensic patients, and form a DSHS work group that would submit comprehensive plan for forensic services and work with the new director
  • Without statewide and cross agency coordination, we are not effectively using funds for competency restoration services for forensic patients

 
Lee Johnson, Texas Council of Community Centers, For HB 2023

  • Forensic director position would be important focal point to continue discussions that HB 3793 started last session which created an advisory panel in DSHS
  • Due to significant population growth, there is a growth in the number of mental patients, but there is historically flat funding
  • Bill would use current funds more effectively

 
Katherine Lewis, Disability Rights Texas, For HB 2023

  • Coordination would move the forensic system forward
  • Individuals should be transferred within certain amount of time for constitutional purposes
  • Post discharge placement options (look at) for community safety – position could develop more placement options

 
Kate Murphy, Texas Public Policy Foundation, For HB 2023

  • Forensic director would ensure that we use resources in place to best capability before adding capacity
  • Chair Crownover asks if there is a fiscal impact
    • Rep. Naishtat says there is not fiscal impact but forensic director would receive salary and state would be paying $220 thousand during biennium – does not meet level of requiring fiscal impact note. Funding included as rider in article 11 of HB 1 and in article 2 of senate budget
  • Money saved would more than make up for cost of forensic director (getting people out of forensic beds as soon as possible)

 
Linda Frost, Hogg Foundation for Mental Health, On HB 2023

  • Forensic services are expensive for DSHS
  • Scope of needs requires more coordination and oversight
  • Position would push cross agency coordination
  • Significant cost savings

 
Rep. Naishtat to close

  • Size and complexity of forensic population served by DSHS has grown to extent that efficient statewide and cross agency coordination Is needed to streamline forensic operations and accelerate best practice adoption across the state

 
Bill left pending
 
HB 2079 – Senfronia Thompson, Relating to the designation of May as Postpartum Depression Awareness Month.

  • Establish May as Postpartum depression awareness month
  • Between 69,000 and 79,000 women suffer in Texas each year, but postpartum depression often goes undetected – mothers do not search for help because of stigma
  • More awareness will give public signs to look for since it is common and treatable

 
Mandi Kimball, Children at Risk, For HB 2079

  • Bill will increase visibility and decrease stigma
  • Empower women to seek treatment and let them know where to look for services

 
Beth Thomas, Pregnancy and Postpartum Depression Alliance, For HB 2079

  • Women suffer in anxiety because everybody tells them they should be happy
  • 15%  of women get crippling anxiety and depression

 
Lee Spiller, Citizens Commission on Human Rights, On HB 2079

  • Sympathetic to plight of mothers
  • Insignificant data to support Universal screening for postpartum depression
  • We should protect rights of women who get screened  and diagnosed to not have their children taken from them wrongfully – Andrea Yates was treated heavily
  • Rep. Coleman notes that Andrea Yates husband took her out of the hospital when she killed her kids, so her actions were not related to her treatment. Notes from psychiatrist said she was a danger to self and others
  • Not opposed to idea of bringing attention to postpartum depression, but weary of universal screening

 
Donna Kreuzer, Self, For HB 2079

  • Daughter died from postpartum depression in 2010
  • Not many people are aware of postpartum depression

 
Bill left pending
 
HB 1940 – Senfronia Thompson, Relating to the improvement of oral health care access through the regulation of dental hygiene practitioners, dental hygienists, and dentists in this state.

  • Shortage of access to dental care in Texas
  • 4 million adults 1 million seniors and 2 million kids lacking access to dental care because they cannot find or cannot afford dentist
  • 60 percent of counties do not have adequate dental care and 20% have none at all
  • In 2013 Medicaid paid millions for dental care in emergency rooms which is unacceptable
  • Bill would allow dental hygienists to become dental hygienist practitioners with 2 additional years of education to increase the amount of dental care providers
  • Permissive: Dentists will hire Dental Hygienist Practitioners and decide what they can do

 
Christy Jo Fogarty, Self, For HB 1940

  • Advanced dental therapist in Minnesota, similar to practitioners proposed in bill
  • Permissive law – work as part of dental team with dentist at head of team
  • Rigorous education – 4 year degree as dental hygienist
  • Trained in 15% of the scope of practice of a dentist, but within this scope of practice she is trained to the level of a dentist

 
Patricia Nunn, Self, For HB 1940

  • Associate Clinical professor at TWU, hygienist since 1972
  • Approach is win-win-win for dental hygienists, dentists who have greater freedom to hire providers on team, and Texans who do not have adequate dental care

 
Dr. Karen Walters, Texas Dental Association, Against HB 1940

  • Has been dental assistant, dental hygienist, and dentist – education to become dentist is necessary to give quality care
  • Lesser trained hygiene practitioner would not be qualified for many things the bill allows them to do – prescribe medicine, perform dental extractions
  • Rep. Collier asks if Walters is taking into account the additional training required by the bill
    • Walters does not believe the training would be adequate
  • Rep. Collier asks if dentists do telemedicine. It seems like this bill allows for it
    • Walters does not know of any dentists partaking in telemedicine
  • Rep. Coleman says that 4 years of education to become hygienist plus 2 years to become hygienist practitioner is similar to nurse practitioner. At some point we have to do something to provide access

 
Chase Bearden, Coalition for Texans with Disabilities, For HB 1940

  • People with disabilities skip going to dentists because transportation is an issue and then they end up in the ER with dental issues
  • Bill allows in home treatment to help out the disabled

 
Dr. Richard Black, Texas Dental Association, Against HB 1940

  • In New Mexico and Colorado have failed
  • The patients lacking in dental care are likely the most difficult patients
  • Dental student loan  forgiveness program would be a better solution
  • Tele-dentistry is very questionable until technology gets better

 
John Davidson, Texas Public Policy Foundation, For HB 1940

  • Similar legislation has worked in Alaska, Minnesota, Maine, and 50 other countries
  • In Minnesota, practices have shown productivity increases and patients served increases – drives down per unit costs
  • TDCJ successfully uses teledentistry
  • Rep. Sheffield asks how a person with no money or insurance will be able to see a dentist or dental hygienist practitioner
    • Increase in productivity would allow dentists to see greater number of patients as in other states

 
David Galea, Texas Society of Anesthesiologists, Against HB 1940

  • Bill would allow dentists to delegate local anesthesia to underqualified persons
  • Anesthesiologist are responsible to be able to help somebody when anesthesiology goes wrong

 
Dr. David Duncan, Texas Dental Association, Against HB 1940

  • “Success” of middle level providers in other countries is deceptive – many countries don’t have dental school, so their situations with middle level providers are not optimal
  • No apparent reduction in disease incidence in these countries
  • In Minnesota, true cost of program was high and it is still government subsidized
  • Does not cut costs to patients – mid-level providers are reimbursed at same rates as dentists “

 
Miryam Bujanda, Methodist Healthcare Ministries, For HB 1940

  • Bill allows for expansion of practices with practitioners and will lower dental costs while increasing access

 
Rita Cammarata, Texas Dental Association and Texas Academy of Pediatric Dentistry, Against HB 1940

  • There are no shortcuts to being properly trained for special needs dentistry
  • Dental school loan repayment

 
Rep. Collier closes on behalf of Rep. Thompson

  • This is not a new idea, mid-level providers have been used in other countries for over a century
  • Some dentists do not feel comfortable testifying against the TDA
  • Dentist decides what DHP can do and where they can do it – they are in control

 
Bill left pending
 
CSHB 1409 – Senfronia Thompson, Relating to the regulation of the practice of dental hygiene.

  • 44 other states allow registered dental hygienists to administer local anesthesia
  • Amend current law to allow dentists to delegate delivery of local anesthesia to hygienists
  • Requires additional education of dental hygienists in order to deliver local anesthesia
  • Substitute requires direct supervision of dentist

 
Patricia Nunn, Self, For HB 1409

  • Limited by law in what we can teach students in dental hygiene programs regarding local anesthesia
  • Education received in other states was extensive and adequate
  • Want to work together with dentists to provide best dental care possible

 
Daniel Cook, Self, For HB 1409

  • Dentist in Texas in California
  • No issues in California with hygienists applying local anesthesia in 36 years

 
John Davidson, TPPF, For HB 1409

  • 44 states allow it and it is a straightforward expansion of scope

 
Rose Gutierrez, Texas Dental Hygienist Association, For HB 1409

  • Dental hygienist who has administered local anesthesia for 15 years without any incidents
  • Course is taught from same book as it is in dentistry school, so the training is adequate

 
John White, Texas Dental Association, Against HB 1409

  • Passes on opportunity to testify, but encourages committee to vote against the bill

 
Jose Cazares, Texas Academy of General Dentistry, Against HB 1409

  • There should be no shortcuts to local anesthesia because giving anesthesia in a tooth is complex
  • Medical emergencies during dental visits are most likely to occur during or shortly after administration of anesthesia
  • This is part of a dentist’s job, not an inconvenience

 
Karen Walters, Texas Dental Association, Against HB 1409

  • Has been assistant, hygienist, and dentist who does not feel she could have administered local anesthesia as a hygienist
  • Does not want shortcuts for hygienists to do the jobs of a dentist

 
David Galea, Texas Society of Anesthesiologists, Against HB 1409

  • Has seen number of events in dentists’ office that have resulted in hospitalizations and deaths

 
Rita Cammarata,Texas Dental , Against HB 1409

  • Dental students have given 200 or more injections by the time they graduate and the training is immensely different from that of hygienists

 
Richard Black, Texas Dental Association, Against HB 1409

  • Texas dental practices are looked up to by other states and we should not allow hygienists to administer local anesthesia

 
Amanda Richardson, TDHA, For HB 1409

  • 53% of dentists are in favor of hygienists administering local anesthesia and law is permissive so the dentists get to make the decision

 
Rep. Collier to close on behalf of Rep. Thompson

  • There is no evidence that it is unsafe for hygienists to administer local anesthesia
  • Allows dentists to see more patients and focus on complicated procedures
  • No state funding necessary

 
Bill left pending
 
CSHB 839 – Naishtat, Relating to presumptive eligibility for the Medicaid and child health plan programs for certain children.

  • Bill would grant presumptive eligibility (PE) to Medicaid for children leaving juvenile detention facilities
  • Medicaid does not reimburse claims while individual is incarcerated – Texas terminates rather than suspends Medicaid coverage for anybody incarcerated which results in delays in ability to receive health care upon release
  • Presumptive eligibility would allow access to healthcare while they are awaiting coverage to be reinstated
  • Substitute drops CHIP from programs geared at youth because it was originally anticipated that with CHIP there would be a high fiscal note, but there is no actual fiscal implication, so another substitute will be submitted with CHIP reinstated

 
Katherine Barillas, One Voice Texas, For HB 839

  • Past efforts of Texas legislatures have laid infrastructure for tool to fill gap in healthcare coverage
  • Point of PE is to help persons who could face dire consequences without coverage
  • 30 days is a long time to not have mental healthcare coverage as these kids drop off of medication after release from juvenile detention facilities

 
Katharine Ligan, Center for Public Policy Priorities, For HB 839

  • When individuals have coverage, they are more likely to access treatment
  • You don’t want to take people off psychotropic medication cold turkey – they need to be weaned off

 
Lindsey Linder, Texas Criminal Justice Coalition, For HB 839

  • Gaps in services significantly increase risk that youths will reoffend

 
Ryan Van Ramshorst Texas Pediatric Society and Texas Medical Association, For HB 839

  • 18% of youth are involved with juvenile justice system before they turn 18
  • We rank number 49 out of 50 in uninsured kids

 
Rep. Naishtat Closes

  • Vulnerable population
  • Importance of continuity of care which will be cared by Presumptive Eligibility

 
Bill left pending
 
CSHB 1550 – Zerwas, Relating to the administration of epinephrine by pharmacists.

  • Relates to administration to epinephrine by pharmacists
  • Would allow pharmacists to administer epinephrine via an auto ejector in emergency situations
  • Gives individual with means to save a life the ability to do so without restriction from the law
  • Would protect pharmacists from civil damages
  • Committee substitute would protect pharmacist from civil damages unless the act is willfully or wantonly negligent
  • Rep. Guerra asks if bill gives pharmacist a duty to administer epinephrine
    • Cannot answer question
  • Dr. Sheffield asks about costs
    • Costs for auto injector could be recouped

 
Charlotte Weller, Texas Pharmacy Association, For HB 1550

  • Emergency situations in rural towns require quick access to epinephrine; pharmacists may be more reachable than hospitals in emergency situations
  • Pharmacists are faced with decision to break law or save patient’s life

 
Carol Harden Oliver, Self, For HB 1550

  • Bill is permissive, it is not a duty
  • Pharmacies are easier to access than EMS
  • Many pharmacists risk their license to save lives

 
Bill left pending
 
HB 2897 – Sarah Davis, Relating to the identification requirements of certain health care providers associated with a hospital

  • Follow up to SB 945 last session
  • Required hospitals to adopt policy for healthcare providers to wear photo ID badge to help patients know who is in their room and their level of training
  • Rules allowed abbreviations instead of simple terms that patients would understand, so HB 2897 requires specific language instead of abbreviations
  • Texas Hospital Association requested 5 year implementation, but currently the bill would be implemented in January of 2017

 
James Willman, Texas Nurses Association, On HB 2897

  • TNA agrees that patients should know who is providing their care
  • Their concern is over the generic term “nurse” which should be more specific to give public better information about who is providing their care:  “Licensed Vocational Nurse,” “Registered Nurse,” “Nurse Anesthetist,” “Nurse Midwife,” “Nurse Practitioner,” and “Clinical Nurse Specialist”

 
Elizabeth Shillberg, Texas Hospital Association, Against HB 2897

  • Supported SB 945 last session, but there are four concerns to HB 2897
  • First Concern: Up to $300 thousand already spent by Texas Medical Centers to rebadge after last session
  • Second Concern: Nursing Practice Act allows for initials to identify both license and degree
  • Third Concern: Hospitals each year have to do a mandatory hospital licensing survey that goes to DSHS, and in 2014 it shows that 321 thousand employees would be impacted by this bill. Each badge can cost between $5 and $10
  • Fourth Concern: The original four month implementation date is not enough time to rebadge (Rep. Davis said in laying out the bill that she has allowed for implementation on January 17th

 
David Gloyna, Texas Society of Anesthesiologists, For HB 2897

  • Costs are microscopic and patients need to know clearly who they are dealing with
  • Slower implementation would be desirable and the 2017 implementation date would ease some concerns about cost, as small as the cost is

 
Rep. Davis Closing

  • Bill is for truth and transparency for patients
  • We want to work with hospitals, but intent of legislation was clear last session

 
Bill left pending
 
HB 1661 – Guerra, Relating to Medicaid Billing for the service of substitute dentists

  • Currently physicians have the ability to let other physicians cover for them to treat Medicaid patients
  • HB 1661 would allow dentists to do the same which would help dentists who are out of office for any reason
  • Currently, if you need another dentist to meet with your Medicaid patients, the dentist must be credentialed again for the specific office location – this process can take weeks
  • This could force patients to enter an emergency room which is expensive

 
Dr. Jose Cazares, Texas Academy of General Dentistry, For HB 1661

  • Dentists should have the same courtesy as physician colleagues
  • Dr. Cazares was out two separate times for 8 months a piece within a three year period, and it would have been nice to be able to have a substitute dentist
  • Chair Crownover asks if you can hire another dentist if you have to miss time at work
    • The dentist would need to be certified to practice in your office location
    • The paperwork can take up to 3 months
  • Cazares was out because he broke his leg and had a complication after a surgery

 
Rep. Guerra to close

  • Asks that bill be voted to local and consent calendar

 
Bill left pending
 
HB 3366 – Sheffield, Relating to the reimbursement of prescription drugs under the Medicaid managed care and child health plan programs

  • In rural districts, “mom and pop” pharmacists have concerns over their reimbursement rates
  • Since 2012, pharmacies in Texas who dispense drugs for individuals in Medicaid and CHIP have been reimbursed by pharmacy benefit managers (PBMs) who are under contract with Medicaid managed care organizations.
  • There is very little oversight or regulation on how these payments are calculated, and pharmacists have seen reduced reimbursements, often upwards of 50%
  • PBMs have little transparency with billions of tax dollars flowing through them
  • HB 3366 would establish reimbursement methodology for Medicaid pharmacy benefits based upon CMS-established “National Average Drug Acquisition Cost” (NADAC)
  • HHSC study of NADAC prices has found that publicly available price list is accurate within one percent
  • The reimbursement formula in HB 3366 which includes the NADAC acquisition costs plus a professional fee of $7.93 and 1.97% of the ingredient cost, is the one developed by HHSC with considerable stakeholder input last year
  • This yields an average payment to pharmacies of $10.12 which is what HHSC’s study found is the average cost of dispensing a Medicaid prescription
  • Would alleviate concerns over Maximum Allowable Costs (MAC) which is already incorporated into NADAC
  • Even if overall reimbursements remain flat, it gives “mom and pop” pharmacies predictable reimbursement numbers

 
Andy Vasquez, HHSC, Resource Witness

  • Rep. Sheffield “In the old days, people went by the AWP. What was that?”
    • Average Wholesaler Price is similar to a list price you may see for a product, not generally what is actually paid
  • Rep. Sheffield says it is not used anymore because there are so many generic drugs with a wide price range of drugs. Is this correct?
    • It is still used quite a bit, but it tends to be applied to brand name drugs, but generics which are 70-80% of drugs (by count of drugs dispensed, not by dollars) in Medicaid program are going by MAC
  • Rep. Sheffield asks what MAC is
    • Maximum allowable cost – An insurer does not want to pay for a brand name when there is a cheap generic drug available, so MAC is where insurers decide the maximum they will pay for that type of drug regardless of what the pharmacy actually pays
  • Rep. Sheffield asks what a PBM is
    • Pharmacy Benefits Manager – organization that considers which drugs will be covered, what prior authorizations will be applied to drugs, they are not pharmacies
  • Rep. Sheffield asks who runs PBMs
    • The state does not run PBMs
  • Rep. Sheffield asks if different PBMs have different MAC lists
    • This is very possible because it is set on contract terms between pharmacy and PBMs which gives large pharmacies better negotiation positions than small pharmacies
  • Rep. Sheffield asks who can see MAC lists
    • PBMs consider the MAC lists confidential, so pharmacies can see their own MAC lists, but not their competitors’ lists
  • Rep. Sheffield asks if this is why some of his patients say their insurance companies are forcing them to use a mail away in another state to get their prescriptions
    • In Medicaid this should not happen because there are protections against PBMs using required use of mail order pharmacies, but PBMs can give their clients (the patient) the option to use mail order pharmacies
  • Rep. Sheffield thought PBMs could force insurance companies to have their patients use mail away pharmacies if they want the PBM’s benefits
    • That should not be happening in Medicaid
  • Rep. Sheffield asks how much it costs a pharmacy to complete a Medicaid prescription
    • For a non-specialty pharmacy the average price when weighted by Medicaid volume is about $10.12 per claim
  • Rep. Sheffield asks about the difference in the methodology for NADAC and what we currently have
    • NADAC price is set by CMS and is based on monthly survey of nation-wide pharmacies to see their costs
    • On Fee for service side, this would be used as the portion of the reimbursement to the pharmacy for the ingredient cost
  • Rep. Sheffield asks if NADAC is reimbursing pharmacists below costs
    • It is an average so there may be some pharmacies who are not able to buy that price and some who are – some may make money
  • Rep. Sheffield asks how long Vasquez has been at his job, and if he thinks the NADAC price is better than the current price
    • The NADAC price has advantages in terms of transparency and lets us move away from AWP and has a more frequent update

 
Dwayne Gallagher, Texas Independent Pharmacies Association, For HB 3366

  • Formula in bill as filed was determined by HHSC to result in average payment of the pharmacists to dispense Medicaid bill
  • This would cost all funds to the Medicaid program $118.7 million per year which means that pharmacists are currently losing $118.7 million per year
  • Want to find route that would end up without a fiscal note
  • NADAC is completely transparent  and is updated weekly because generic pharmaceuticals are volatile and difficult to keep up with
  • NADAC is predictable and fair – reimbursement will still be below cost, but it will be predictable

 
Jamie Dudensing, Texas Association of Health Plans, Against HB 3366

  • HB 3366 would undo transparency changes implemented in the last session
  • The current system allows for transparent pricing, due process to challenge MAC prices, pharmacy protections and open access for patients
  • Pharmacies get paid closer to Medicaid rates than other providers
  • Bill sets reimbursement rates in statute which is usually reserved for appropriations committee
  • The real problem since the carve-in is the transparency issue in MAC pricing, but that was addressed in last session. This bill would undo these steps.
  • NADAC is a new voluntary survey, so the information is not reliable and does not take into account rebates or discounts
  • Rep. Sheffield asks if Dudensing belives managed care means better care
    • Dudensing does, a study in the last 6 months shows that managed care gives people access to care that they have not had in the past
    • STAR+ reduced ER visits
  • Rep. Sheffield replies that he could not disagree more about managed care being better care
  • Rep. Blanco recalls that Dudensing stated pharmacies can challenge MAC prices and that PBMs have different MAC lists, are the lists confidential?
    • They are proprietary, so one company would not share MAC lists with another company because they spend a lot of money in trying to have a competitive list
    • The pharmacies can see their MAC list pricing at any time online for Medicaid
  • Rep. Blanco asks if a rural city pharmacist could see the difference in their pricing from that of an urban pharmacist
    • MAC list takes into account what the cost of the drug is for each specific location
  • Rep. Zedler asks if the PBM tells the pharmacy what they can charge?
    • No, the PBM reimburses the pharmacy
  • Rep. Zedler asks how some pharmacies lose money while other pharmacies are not
    • Some pharmacies are better at purchasing and acquiring drugs, but as far as MAC price goes, they have the necessary available information
  • Chair Crownover asks how difficult it is to challenge the price
    • Andy Vasquez may be better at answering that question

 
John Heel, Pharmacy Buying Association, Texas TrueCare Pharmacies, For HB 3366

  • Pharmacies saw large reductions in reimbursement under managed care, and the average cost to dispense is between $10 and $14
  • This bill would result in more equitable rates for pharmacies

 
Larry McClellan, Texas Independent Pharmacies Association, For HB 3366

  • Owns and operates 4 pharmacies in West Texas
  • Biggest threat to pharmacies are low reimbursement rates
  • When prices go up, it takes PBMs months to raise reimbursement rates, but when prices drop, reimbursement rates fall overnight
  • AWP price is obsolete and there is usually no relationship to acquisition costs
  • No other business signs contracts with a clause that they have no access to and no knowledge of like MAC prices
  • We need transparency in prescription drug pricing – PBMs are left to their own devices
  • HB 3366 is a great start

 
Jeff Warnckin, Texas Independent Pharmacies Association, For HB 3366

  • Some of biggest problems facing pharmacy are low and inaccurate reimbursement namely those under Medicaid managed care
  • Average cost of dispensing Medicaid prescription at $10.12 and pharmacies receive less than that for reimbursement
  • NADAC would be beneficial and transparent
  • Pharmacies would still receive reimbursement under costs, but they would be closer and more predictable
  • MAC appeals are pain for pharmacists and usually get rejected

 
Rep. Sheffield to close

  • Bad day for medicine when big business gets involved
  • HB 3366 does not ask for special treatment for certain pharmacies, it asks for equal treatment from PDMs
  • We are in a state with less legislation, but there are times when legislation is necessary and called for to insure our free enterprise system

 
Bill left pending