Overview of the

79th Legislative Session

Texas Pediatric Society

• Governor declares public school finance and child and adult protective services emergency issues

• First session after divisive redistricting fight

• Most legislators/statewide officials facing re-election

Legislative Landscape

2003 Legislative SessionMedicine Actively Supported:1. Tort reform2. Prompt Pay3. BME reform

2005 Legislative SessionMedicine Actively Played Defense

Organized Medicine’s Approach

TMA’s Defense Strategy Included:

1. Prevent new tax on physician practices

2. Block prohibition on balance billing

3. Protect physicians’ ownership interests

4. Prevent allied health professionals’ expanded authority beyond their education and training

5. Reform workers’ compensation program

Organized Medicine’s Approach

• Restore Medicaid/CHIP benefits • Maintain children’s Medicaid simplification• Improve physician reimbursement rates• Increase the tax on tobacco products w/

proceeds going to health care• Oppose professional tax on physicians

TPS Priority IssuesImprove Access to Quality Health Care

for Children

• Obesity/Nutrition• Car Seat Safety• Newborn Screening• Immunizations

TPS Priority IssuesImprove the Health and Safety of Children

• Child Protective Services reform

TPS Priority Issues

Improve Child Services

• Budget assumes Medicaid enrollment will grow from 2.8 million to 3.11 million by end FY 2007 (HHSC assumes 3.19 million)

• Restores optional adult benefits including podiatric, vision and mental health services

• Partial restoration of “medically needy” program

Improve Access to Quality Health Care for Children

Medicaid

• Restores Medicaid GME through IGTs

• Creates Medicaid “buy in” program for disabled adults

• No restoration made to the 2.5% cut in physician reimbursement rates from 2003

Improve Access to Quality Health Care for Children

Medicaid

• Funding for 72,000 additional enrollees for 2006-2007

• Brings enrollment to 398,630 by 2007 (HHSC forecasts growth to 434,658)

• Zaffirini rider allows HHSC to transfer funds to meet caseload shortfall before establishing a wait list

Improve Access to Quality Health Care for Children

CHIP

• Restores vision, dental, hospice and mental health services to pre-2003 levels

• Authorizes HHSC to implement enrollment fee instead of monthly premiums

• Creates “perinate” program

Improve Access to Quality Health Care for Children

CHIP

• No restoration made to the 2.5% cut in physician reimbursement rates from 2003

• 12-month continuous eligibility failed

Improve Access to Quality Health Care for Children

CHIP

• Integrated Care Management (ICM) model developed – non capitated plan

• $109 million statewide savings• Tax equity• Maximize Medicaid federal matching dollars• Proven model• Effective patient care• Simplified Administration• Fair Reimbursement

Improve Access to Quality Health Care for Children

Star Plus HMO Set For Expansion

• Coalition included: TPS, TMA, businesses, hospitals, county judges and health care providers

• Legislative leader: Dianne White Delisi (R-Temple) authored HB 1771

• Rider added to Article II of SB 1• Amendment added to SB 1188

Improve Access to Quality Health Care for Children

Integrated Care Management

• ICM an option in 8 urban counties• Star+Plus Medicaid HMOs stopped

Improve Access to Quality Health Care for Children

Integrated Care Management

• Court ruled current funding system unconstitutional

• Property tax relief – Reductions must be offset

Improve Access to Quality Health Care for Children

Taxes

• Doctors pay hidden tax - $1 billion a year in uncompensated care

• Offset any new taxes with credit for services to Medicaid, CHIP and Medicare

• Special session

Improve Access to Quality Health Care for Children

Taxes

SB 42 (Nelson/Delisi) • Requires middle and junior high students to

participate in regular physical activity• Requires schools to report on compliance

with PE and nutrition requirements• Re-establishes the state School Health

Advisory Committee

Improve the Health and Safety of Children

Obesity/Nutrition

HB 984 (Reyna/Duncan) • Requires parents/physicians to develop a

diabetes management and treatment plan for diabetic students seeking care at school

• Requires school/parents/physicians to develop individualized health plan

• Texas Diabetes Council required to develop training materials for school staff

Improve the Health and Safety of Children

Obesity/Nutrition

HB 183 (F. Brown/Zaffirini)• Requires children younger than 5 and less

than 36 inches in height to ride in a child safety seat

• Requires DPS to conduct a study on legislative options to improving child passenger safety laws

Improve the Health and Safety of Children

Car Seat Safety

HB 790 (Crownover/Nelson)• Expands screening by November 2006 to

include the 29 disorders recommended in the 2005 ACMG report

• Requires study on the most cost effective method for conducting screening by March 1, 2006

• Allows DSHS to consult with physicians and other stakeholders

Improve the Health and Safety of Children

Newborn Screening

HB 1316 (Zedler/Deuell)• Requires children attending regulated child-

care facilities to receive invasive pneumococcal disease and hepatitis A vaccines

Improve the Health and Safety of Children

Immunizations

HB 1677 (Dukes/Zaffirini)• Requires DSHS to establish a sentinel

surveillance program to identify RSV infection in children and maintain a central database of cases

• Requires doctors and health care facilities to comply with program’s data collection requirements

Improve the Health and Safety of Children

Immunizations

SB 1211 (Dukes/Deuell)• Requires DSHS to include information on

RSV, the importance of preventative activities and prophylaxis for children at risk and immunization when vaccine is recommended and available as part of its regular education program

Improve the Health and Safety of Children

Immunizations

SB 239 (Talton/Janek)• Allows CFRTs to receive death/birth

certificates from the state registrar’s office free of charge

Improve the Health and Safety of Children

Child Fatality Review Teams

SB 316 (Solis/Lucio)• Requires DSHS to develop a pamphlet with

the information hospitals are required to provide new mothers including post-partum depression, immunizations and shaken baby syndrome

• DSHS required to provide draft pamphlet to TPS Child Abuse Committee for review and comment prior to publishing/distributing

Improve the Health and Safety of Children

Prevention of Shaken Baby Syndrome

SB 6 (Hupp/Nelson)

• HHSC must design comprehensive and cost-effective medical services delivery model that includes:

1. Designation of health care facilities as pediatric centers of excellence

2. Identification of a medical home

3. Development of health passports

4. Use of medical advisory committees and review teams to establish treatment guidelines and criteria for review

Improve Child Services Child Protective Services Reform

SB 6 (Hupp/Nelson)• Informed consent required for medical care• Parental notification of significant medical

conditions• Judicial review of medical care• Provision of medical care in an emergency• Consent by foster child at least 16 years of

age• Study of incentives to prescribe psychotropic

drugs

Improve Child Services Child Protective Services Reform

HB 1685 (Dukes)

• Establishes an Interagency Coordinating Council for Building Healthy Families to prevent child abuse and neglect

• Must facilitate communication and policy collaboration between state agencies with programs/services promoting and fostering healthy families

Improve Child Services Child Abuse and Neglect Prevention

• Additional 9.3% decrease in funding beyond the cuts made in 2003

Preceptorship Program

• Insurance plans don’t provide adequate networks for businesses

• Price controls on physicians based on “usual and customary” not the answer

• Health plans shifting cost ─ doubling profits• Mechanisms to prevent overcharging of

physicians currently exist through regulatory and statutory authority

TMA Priority Issues Block Prohibition on Balance Billing

1. Specialty hospitals provide better quality of care

• Improve patient access to care • Keep costs down• Improve quality of health care• Not cherry-picking best patients2. SB 872 (Nelson/Delisi) requires disclosure

and a study of niche hospitals and all hospital infection rates

TMA Priority Issues Protect Physicians’ Ownership Interests

• TMA and 11 medical and specialty societies formed coalition – Patients First

• Illustrate bills were dangerous to patient safety• Fight to keep BME sunset bill, SB 419, clean • Stopped Optometry bills• TSBME reenacted for another 12 years• No amendments added to SB 6 to expand

scope of practice

TMA Priority Issues Prevent Allied Health Professionals’ Expanded Authority

Beyond their Education and Training

Ernie Buck, MD

Legislative Committee, Chair

ebuck@aol.com

(361) 853-3222 office

Carrie Kroll

Director of Advocacy and Health Policy

carrie.kroll@txpeds.org

(512) 370-1516 office

Questions