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EMS EVOLUTION 2015:
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June 19, 2015

Table of Contents


Key Dates

August 3-5, 2015
EMS EVOLUTION 2015:
Enhance Your Delivery Model, Reimbursement and Shape Best Practices


TEMSA Annual Meeting
La Torretta Lake Resort
Montgomery, TX
 
August 1-3, 2015
TEMSA'S AOR Course:
Join us for TEMSA's AOR course during EMS Evolution 2015


TEMSA Annual Meeting
La Torretta Lake Resort
Montgomery, TX
 

TEMSA's Analysis of the 84th Texas Legislature

Don't forget to join us this August at TEMSA's EMS EVOLUTION 2015 for a review of the Legislature

The 84th Texas Legislature is now complete, and it was a busy inaugural Legislature for TEMSA, which was engaged in over a dozen issues that affected EMS in Texas.

Governor Abbott still has a few days to either accept or veto bills. However, for the most part, we know the final results of the 84th Texas Legislature.  The following is TEMSA's complete analysis.

Meanwhile, please make hotel reservations and register today for TEMSA's Annual Conference, EMS EVOLUTION 2015, this August 3-5 at the La Torretta Lake Resort on Lake Conroe. We will take a complete look at both state and federal policy activities at the conference.

Click here for full details.  And don't forget about the August 1-3 administrator of record (AOR) course at the same venue.

A special "thank you" goes out to our sponsors:

Title Sponsor:


Diamond Sponsors:

Mercedes-Benz of The Woodlands


Platinum Sponsors:



Professional Ambulance Sales and Service

Gold Sponsor:

Medtronic

Silver Sponsors:

ESO Solutions

First Choice Solutions

Fleet Plus - East Texas Medical Center

Health Claims Plus


Koronis Revenue Solutions

The Law Office of Mark Smith

Taylor Healthcare Products

VFIS of Texas


Bronze Sponsor:

Southwest Ambulance Sales
 

Paramedic Licensing Issues: Two Major Bills Passed

Paramedic scope of practices in EDs and interstate licensing compact both passed

Two bills involving licensing issues for paramedics passed out of the Texas Legislature.

Expanded Scope of Practice for Paramaedics - Passed
HB 2020 and SB 1899 have both cleared the Legislature and will expand the scope of practice for paramedics to allow them to provide advance life support in an emergency department under a physician’s supervision. 

Several EMS sunset provisions were amended to SB 1899.  Click here to read the sunset provisions.  

As of June 15, 2015, both bills are sitting on Governor Abbott's desk waiting for consideration.


Interstate Compact License for EMS Personnel - Passed
HB 2498 was signed into law earlier this week and will allow Texas to enter into an interstate compact that recognizes paramedic licenses from other states that have entered into the compact.  The licenses are recognized under certain circumstances.  

A similar measure that would have entered Texas into an interstate licensing compact for physicians failed.

Name Badge IDs in Hospitals - Passed
Governor Abbott allowed SB 1753 to go into law.  The measure requires all providers in a hospital to have their occupation clearly spelled out on the hospital badge ID. Paramedics are not recognized in this legislation. However, since SB 1899/HB 2020 is likely to be signed into law, they will need to be recognized in the rule-making process.
 
SB 1753 is a follow-up from the 2013 Texas Legislature, which required the profession to be on the name badge ID.  However, the Health and Human Services Commission interpreted the 2013 law to indicate that it would be fine for a hospital to only have the initials of the profession on the badge. 
 
Supporters of SB 1753 believed that the 2013 law would confuse patients since the initials appear to be an “alphabet soup.”  Therefore, SB 1753 requires the professions to be spelled out.

New Licensing Home for Various Professions - Passed
A controversy over abortion amendments derailed the Department of State Health Services (DSHS) sunset bill, which proposed to transfer the licensing bodies of x-ray technicians, athletic trainers, orthotists and prosthetists, hearing instrument fitters and dispensers, dieticians, and speech-language pathologists and audiologists to another agency.
 
The Sunset Commission created controversy in the summer of 2014 when it recommended that the license for several professions should be eliminated.  Ultimately, the Sunset Commission agreed that these licenses should be continued, however, they should be moved from under the umbrella of DSHS to either the Texas Medical Board (TMB) or the Texas Department of Licensing and Regulation (TDLR).
 
Ultimately, a scaled-down sunset bill, SB 202, cleared the Legislature and addressed these changes.  With the exception of the x-ray technicians, all of the providers mentioned earlier will have their licensing boards transferred to TDLR.
           
 X-ray technicians (medical radiologic technologists) will have their board transferred to the TMB.  A provision was created that would not allow the Medical Radiologic Technologist Board to enact rules that would determine x-ray standards for physician assistants and nurses.  

Expanded Scope for Allied Health Providers - Failed 
Measures that would have expanded scope of practice for various allied health providers failed. The measures that failed included independent practice for nurse practitioners, direct access to patients for physical therapists, and expanded scope ability for chiropractors.

Waiver of Certain Tuition Fees for EMS - Failed
HB 3273 (Rep. Eddie Rodriguez, D-Austin) would have waived certain tuition and laboratory fees for paramedics. The bill received a late committee hearing in the House and ran out of time.

EMS, Emergency & Trauma Issues: TEMSA Members Stayed Busy

Numerous bills would have had a major impact on EMS; two vetoes

Changes to Driver Responsibility Program - Failed
SB 93 (Senator Rodney Ellis, D-Houston) witnessed a late surge in the Senate from both Republicans and Democrats before stalling in the House.  It would have removed the DRP’s provision that takes away a driver’s driver license if they fail to pay the DRP surcharge. HB 1437 (Rep. Sylvester Turner, D-Houston) was a similar concept introduced in the House.

The bills were amended to a larger tax bill, HB 7.  However, the DRP provision was ultimately removed.
 
The EMS and trauma communities objected to SB 93.

Senator Kirk Watson (D-Austin) also introduced a bill that would have altered surcharges associated with the DRP - SB 1922.  It did not receive a committee hearing.

Direct Transport to a Mental Facility - Failed
HB 2711 did not make it out of the House and would have allowed EMS personnel to bypass a hospital emergency department and transport a patient demonstrating mental illness directly to a mental health facility.
 
TEMSA's leadershiop expressed concerns that paramedics were not licensed to diagnosis mental illness, therefore, they would not know when it would be appropriate to transport the patients to mental health facilities. The bill's sponsor indicated that she would like to re-visit the issue during the Legislature's interim.  

Air Ambulance Medicaid Funding - Failed
HB 3077 would have created a provision for air medical ambulance providers to draw down additional federal funds from the federal government.  The measure ultimately stalled in the Senate after it was pointed out that air ambulance providers were making more than ground EMS.

HB 3077 was amended to HB 7.  However, the Senate removed the HB 3077 language before HB 7 was finalized.

Four-Hour Emergency Department Holds - Vetoed
SB 359 cleared the Legislature and would have allowed emergency departments to detain individuals displaying signs of mental illness for four hours.  Governor Abbott vetoed it.

Opioid Antagonist Bills - Passed and Vetoed
Several bills cleared the Legislature and will allow providers to prescribe opioid antagonists to family members or friends who are close to individuals who may suffer from an opioid overdose.
 
SB 1462 was signed into law on June 18th.  HB 225 was vetoed by Governor Abbott because it relates to “Good Samaritan” issues that would have relieved liability to those who may have helped contributed to a drug overdose if they called authorities.

Detention of Individuals with Communicable Diseases - Failed
SB 355 (Senator Jane Nelson, R-Flower Mound) would have given peace officers the ability to detain individuals who are suspected of having certain communicable diseases without a warrant.  The bill did not receive a Senate hearing.

Regional Emergency Dispatch Centers Plus Telemedicine - Passed
HB 479 (Rep. Cecil Bell, R-Magonolia) was signed into law and amends the Health and Safety Code to transfer the administration of the regional emergency medical dispatch resource centers program from the area health education center at The University of Texas Medical Branch at Galveston to the Commission on State Emergency Communications. The bill transfers to the commission all unspent and unobligated funds appropriated by the legislature to The University of Texas Medical Branch at Galveston on behalf of the center to fund the program and authorizes the commission, with the agreement of the center, to accept the transfer of any records, employees, or real or personal property of the center relating to the operation of the program.  

HB 2004, which could take some 9-1-1 funds to create a telemedicine project for emergency rural care in west Texas, was added to HB 479.  

Creation of Emergency Communications Districts - Failed
HB 737 (Rep. Jimmie Don Aycock, R-Killeen) would have created emergency communication districts that would have received 100 percent of communications fees for 9-1-1 expenses.  The bill eventually died in the Senate.

Emergency Services District Board Members' Compensation - Vetoed
HB 973 (Rep. Ana Hernandez, D-Houston) passed out of the Legislature and was vetoed by Governor Abbott.  It would have established compensation for board members in counties with a population of 3 million or more (targeted for Houston).

Notice of Hospital/EMS Liens - Failed
HB 1862 (Rep. John Kuempel, R-Seguin) would have amended the way that hospital/EMS liens are delivered to individuals. The measure ultimately died in the House.

Changes to 9-1-1 Funding - Failed
HB 2008 (Rep. Drew Darby, R-San Angelo) would have eliminated the funding from the 9-1-1 equalization surcharge that is currently used to fund RACs, EMS, and trauma hospitals and used the money to fund an EMS telemedicine project (HB 2004).  The bill did not move after concerns were raised by stakeholders.

 

EMS Personnel Issues; Communicable Disease Notification Bills Passed

Full list of bills

Volunteer EMS Carrying Guns - Failed
After an early and rapid passage out of the House, HB 353 (Rep. Ken King, R-Canadian) stalled in the Senate and would have allowed volunteer EMS personnel to carry a concealed handgun.

A similar issue that would have allowed on-duty first responders (HB 3496 by Rep. Mike Schofield, R-Katy) to carry guns if they had a CHL did not receive a House hearing.

Communicable Disease Disclosure - Passed
HB 2646 cleared the Legislature and will provide information to first responders about any communicable diseases that they may have encountered while on the job.  

Emergency Personnel Exposure to Diseases - Passed
SB 1574 (Senator Carlos Uresti, D-San Antonio) is waiting for Governor Abbott's final approval and will require EMS entities to identify an individual who will serve as a the entity's key contact who provides information to the entity's employees/volunteers about any potential diseases that they may have encountered.

The bill also added sovereign immunity protections to hospitals designated as infection control receiving hospitals during outbreaks of contagious diseases when an emergency has been declared.

HB 2770 (Rep. Mando Martinez, D-Weslaco) and SB 1901 (Senator Donna Campbell, R-New Braunfels) were identical measures.

Appeals Related to Work - Passed
HB 1388 (Rep. Dwayne Bohac, R-Houston) was signed into law and adds clarifying language regarding how to determine whether certain cases of MI and stroke occurred as a result of a paramedic’s work.  

Workers' Comp Transport to Scene - Passed
HB 2771 (Rep. Mando Martinez, D-Weslaco) cleared the Legislature and will clarify that driving to an emergency will be considered part of an emergency response provider’s scope of work for purposes of the Texas Workers’ Compensation Act.  Returning from an emergency was removed from the final legislation.  It was signed into law by Governor Abbott.


SOAH Bill Relating to EMS Personnel Terminations - Failed
HB 3488 (Rep. Celia Israel, D-Austin), would have required large municipalities (population of 460,000 or more) to adopt procedures for referring appeals consistent with procedures for administrative hearings or alternative dispute resolution in matters voluntarily referred to the State Office of Administrative Hearings (SOAH) by a governmental entity and any applicable rules adopted by SOAH.  It failed in the House.

Prohibition of Licenses for Volunteer Emergency Response Teams - Failed
SB 289 (Senator Craig Estes, R-Wichita Falls) would have prohibited the state government from requiring licenses or certifications for volunteer firefighters and emergency response teams.  The bill made it out of the Senate and ultimately died in the House.  

Union Payroll Deduction Bill - Failed
SB 1968 (Senator Joan Huffman, R-Houston) would have prevented labor dues from being automatically withheld from paychecks.  The exceptions would have been EMS personnel, firefighters, and law enforcement officers.

The bill eventually died in the House after passing out of the Senate.

MI or Stroke During Term of Employment - Failed
HB 50 (Rep. Mando Martinez, D-Weslaco) would have presumed that an MI or stroke suffered by a firefighter or paramedic at any time during their employment was attributed to their job.  The bill did not make it out of its House committee.

Claim Related to Cancer or Asbestosis - Failed
HB 60 (Rep. Mando Martinez, D-Weslaco) would have allowed firefighters or paramedics to claim that cancer or asbestosis was related to a previous exposure while on the job during a specified time period.  The measure did not make it out of its House committee.

First Responder Survivor Benefits and Remarriage - Passed
HB 1094 (Rep. Charlie Geren, R-Fort Worth) cleared the Legislature and is on the governor's desk for final consideration.  It addresses survivor benefits for first responders who were killed in the line of duty by extending the LODD benefits to end of life if not remarried and increasing the LODD one-time payment from $250,000 to $500,000.

Ambulance Issues: Taxes & More

Three tax bills died; list of bills pertaining to ambulances

Ambulance Tax Cuts - Failed
Three bills involving ambulance taxes moved through the Legislature and eventually died in the Senate due to concerns over losing revenue for the state:

  • HB 2731 (Rep. Greg Bonnen, R-Friendswood) would have provided fuel tax relief to non-profit EMS entities.  It made it out of the House, received a Senate hearing, and failed to make it to the Senate floor for a vote.
  • HB 3229 (Rep. John Cyrier, R-Lockhart and Rep. Trent Ashby, R-Lufkin) and HB 4067 (Rep. James White, R-Hillister) would have provided sales tax relief for emergency vehicles.  It failed to make it out of the House.
  • HB 3468 (Rep. Tank Parker, R-Flower Mound) would have provided motor fuels tax relief for emergency vehicles.  It failed to make it out of the House.
Fee Cuts for Various Providers
HB 7 was signed into law and will eliminate a $200 fee that is charged to members of 16 different professions.  It includes physicians, chiropractors, dentists, psychologists, and optometrists.

TEMSA watched HB 7 closely because a number of provisions related to EMS were amended to the bill, including air ambulance funding and a partial repeal of the Driver Responsibility Program. However, these were stripped in the final version.

Removal of Emergency Insignias Before Law Enforcement Vehicle Sales - Passed 
HB 473 (Rep. Helen Giddings, D-Dallas) was signed into law and will require all former law enforcement vehicles that are being sold to the public to have their former law enforcement markings and other items removed. 

HB 72 (Rep. Craig Goldman, R-Fort Worth) was a similar bill that did not make it out of a House committee.

Removal of Emergency Insignias Before Ambulance Sales - Failed
HB 2722 (Rep. Craig Goldman, R-Fort Worth) would have required emergency markings to be removed from ambulances before sales to the general public.  The bill died when time ran out.  

Competitive Bidding for Ambulances - Failed
SB 1377 (Senator Eddie Lucio, D-Brownsville) did not make it out of its Senate committee.  According to the bill author, the bill would have: To strengthen the state's effort to provide the best possible services at the lowest possible price, the Health and Safety Code requires a board of emergency services commissioners to solicit competitive bids on any expenditure over $50,000.  There are a handful of exceptions to this provision, including for the procurement of contracts for ambulance services. Interested parties, however, maintain that opening up ambulance services to the competitive bidding process would ensure that there is openness and transparency in providing the selection of service providers while also providing quality services at the best possible price.
 
S.B. 1377 strikes contracts for ambulance services from the list of items exempt from the competitive bidding process in the Health and Safety Code. By requiring competitive bids for ambulance services, consumers will see significant savings when they must use an ambulance to receive emergency care, along with greater transparency into the contracting process.

Traumatic Brain Injury Training - Passed
HB 1388 (Elliott Naishtat, D-Austin) cleared the Legislature and has been sent to the governor for final consideration.  It will require the Texas Commission on Law Enforcement to establish and maintain a training program on traumatic brain injuries for first responders. To satisfy the requirement, individuals may take an online course. The curriculum must be created by December 31, 2015.

Medicaid and the Budget

Rural hospitals saw the largest budget increases

Budget Review
With a few exceptions, health care providers did not witness Medicaid increases in the budget.  A handful experience cuts.  Click here to read a summary from the Texas Tribune.
 
The biggest issue involving Medicaid is the expiration of the state’s 1115 waiver in November 2016.  Some health care analysts believe the federal government would be more like to renew the waiver if the state’s new budget included Medicaid increases for both hospitals and primary care physicians.
 
The following is a look at some of the health care initiatives in the state’s 2016-17 budget and several Medicaid bills that were separate from the budget.  

"Ebola" & Texas Emergency Medical Task Force Funding - Budget
The conferees included the funding of the EMTF when the state receives more than a defined amount of "federal ebola funding."  A provision allocates $6.65 million each fiscal year for the purpose of epidemiology surveillance and response, infection disease response training exercises, laboratory response, and communication and coordination.
 
The provision is significant because if DSHS receives federal funds of $20,270,483 or more during the 2016-17 biennium related to ebola, the state funds can then be utilized to fund the Texas Emergency Medical Task Force (TEMTF), diabetes prevention and control, and pediatric asthma management.


It is important to note that the Senate included a provision that would have tied the funding to the passage of SB 538.  The contingency that tied the funding to SB 538 passage was removed in the conference report.

SB 538 would create new capabilities for the state government to address infection disease emergencies.  While the bill passed the Senate, SB 538 was pulled from the House calendar.  Left- and right-leaning groups that have concerns over vaccinations and other public health responses expressed strong opposition to SB 538.

Hospital Budget Funding
Conferees proposed to provide much of the hospital funding through a transfer of trauma funds.  Ultimately, only $5 million of the rural hospital payment is from new general appropriations.  Click here to read an article about the funding from the Texas Tribune.

The following is a breakdown of the three streams of funding for hospitals:

  • Trauma add-on for hospitals: $217 million in all funds ($93 million of which is transferred from the DSHS trauma funds).
  • Funding for safety net hospitals: $299 million in all funds ($128 million of which is transferred from the DSHS trauma funds).
  • Rural hospital outpatient payments: $58 million in all funds ($20 million of which is transferred from the DSHS trauma funds and $5 million of which comes from new general appropriations).  The purpose of this line item is to provide rural hospitals with 100 percent of cost plus inflation. 

Trauma Fund Transfers - Budget
A special provision was included in the conference committee that will require DSHS to transfer certain trauma funds to HHSC for the purposes of an add-on payment for trauma care.  HHSC would be directed to develop a methodology to implement increased reimbursements for trauma care providers.

This provision was contingent upon the passage of HB 7, which is an omnibus bill that includes a number of tax and fee provisions.

Cardiovascular Disease & Stroke Projects - Budget
The conference committee included the House's proposal for $6.5 million in funding for cardiovascular disease and stroke project funding.  $2 million of which will go to the state's cardiovascular disease and stroke council (Stroke/STEMI Data Collection).  The balance will be directed to the University of Texas System for the administration of a statewide stroke clinical research network, Stroke System of Care Coordination (Lone Star Stroke).

Primary Care Physician Payments - Budget
The House budget included a provision that would have increased primary care physician payments to the Medicare level.  However, the conference report removed the provision.  
Click here for details.

Therapy Cuts - Budget
Therapists are facing large Medicaid cuts in a cost containment provision in the budget.  The cost Senate's cost containment rider directs HHSC to find savings by: 

  • Expanding prior authorization and utilization review.
  • Incentivizing appropriate neonatal ICU utilization and coding.
  • Implementing the dual eligible integrated care model.
  • Reforming reimbursement methodology, policies, and utilization for acute care therapy services.
  • Maximizing Medicaid co-payments.
  • Examining fraud, waste, and abuse.

Medicaid OIG Issue - Passed
SB 207 (Senator Chuy Hinojosa, D-McAllen and other sponsors) has cleared the Legislature and addresses the Medicaid Office of Inspector General (OIG).  It will clarify that fraud does not include unintentional technical, clerical, or administrator errors and requires probable cause of fraud for payment holds.

Medicaid Managed Care Payment for Ambulances - Failed
SB 702 (Senator Chuy Hinojosa, D-McAllen) and HB 2773 (Rep. Mando Martinez, D-Weslaco) would have required Medicaid managed care plans to reimburse ambulances at 100 percent of the allowable for Medicaid services.  The bill did not witness movement.  

Medicaid Managed Care Network Adequacy - Passed
SB 760 has cleared the Legislature and will direct the Health and Human Services Commission to create network adequacy standards for Medicaid managed care plans.
 
On a side note, the federal government released proposed Medicaid network adequacy standards in May 2015.


 

Commercial Insurance Issues

One bill related to out-of-network balance billing passed

Several bills that focused on the out-of-network billing practices of facility-based physicians (emergency physicians, anesthesiologists, radiologists, pathologists, etc.) were filed.  In the months leading up to the 84th Texas Legislature, we were expecting out-of-network costs related to emergency departments to be addressed.  In addition, we were expecting several bills that would have required health care providers to provide information regarding the prices for their most common services on a Web site to be introduced.

Ultimately, only one bill related to facility-based physicians passed. And no bills related to price transparency mandates passed. However, pricing transparency is expected to be an important issue going into the 85th Texas Legislature.


Balance Billing Informal Teleconference/Mediation - Passed
SB 481 (Senator Kelly Hancock, R-DFW Mid Cities) is the only balance billing legislation that made it out of the Legislature.  Governor Abbott signed it into law on June 16th.

SB 481 will allow patients to enter into an informal teleconference/mediation if they receive a balance bill of $500 or more from an out-of-network facility-based physician. It builds on current law (HB 2256 from the 2009 Legislature) that allows patients to enter into an informal teleconference/mediation if they receive a balance bill of $1,000 or more from an out-of-network facility-based physician.

Other Bills Related to Out-of-Network Emergencies - Failed
HB 1638 (Rep. John Smithee, R-Amarillo), which would have eliminated the ability of an out-of-network providing emergency services to submit a balance bill to a patient, was denied a vote in the House Insurance Committee after organized medicine became engaged.

HB 3102, which was filed by the new House Insurance Committee chair (Rep. John Frullo, R-Lubbock), would have required both providers and facilities to send estimates to patients regarding their estimated costs several business days prior to a service.  Of course, this would have exempted emergency services.  

New York state recently implemented a law that will require commercial health insurance plans to reimburse some emergency services (a limited number of codes) based on a usual, customary, and reasonable (UCR) rate that is a percentage of FAIR Health.

Usual and Customary Stanard Based on FAIR Health - Failed
HB 616 (Rep. Greg Bonnen, R-Friendswood) and SB 1097 (Senator Donna Campbell, R-New Braunfels) would have given out-of-network providers in Texas the option to have their services reimbursed based on a percentage of FAIR Health or their billed charges (in exchange for agreeing to not balance bill).  However, the bill failed in the House Insurance Committee after strong objections from the commercial health insurance plans.  

Prompt Pay Changes - Failed
Blue Cross Blue Shield of Texas and the Texas Medical Association reached an agreement on changes to the state's prompt pay law that would have reduced the amount of penalties awarded.  (It would not have altered the number of days required for a payment.)  
HB 1433 (Rep. John Smithee, R-Amarillo) was defeated in the House committee after strong opposition from the hospitals.

Physician De-Listing - Passed
HB 574 (Rep. Greg Bonnen, R-Friendswood) was signed into law and would prevent commercial health plans from de-listing physicians for referring patients to out-of-network providers or educating patients about out-of-network options.
 
Virtual Credit Card Payments - Failed
SB 1229 would have prohibited health plans from using virtual credit card payments to settle claims for services.  In addition, it would protected providers from a requirement to accept virtual credit card payments and prohibited plans from applying transaction fees to pay providers less than a negotiated contract rate.
 
The bill ultimately died in the House after facing strong opposition from the banking lobby.

Health Plan Network Transparency - Passed
HB 1624 has cleared the Legislature and will require commercial health insurance plans to provide online both their prescription drug formularies and accurate provider directors.

Insurance ID Cards Denoting ACA Exchange Plans - Passed
HB 1514 was signed into law and will add a note to insurance ID cards indicating if a plan was purchased in the Affordable Care Act exchange.  HB 1514 originally would have added an “s” to cards in which patients have received a subsidy for the premium.  However, that provision was removed after controversy in the House.  Instead, all patients with a plan purchased in the ACA exchange, whether they receive a subsidy or not, would have the denotation on their card.  Over 80 percent of all ACA exchange plans are receiving a premium subsidy.
 
Supporters indicated that HB 1514 was important because it would allow providers to identify which patients have an exchange plan and educate them about the importance of paying their premiums so that they do not lose coverage.

 

Advance Directives: One New Change

Major issue in 2013 was quieter in 2015

Advance directives led to a major debate in 2013 and helped lead to the primary defeat of then-Senator Bob Deuell (R-Greenville).  However, it was a quieter issue in the 2015 Legislature.

A dozen bills relating to advance directives were filed.  Ultimately, only one – HB 3074 (Rep. Drew Springer, R-Muenster) – was signed into law.  HB 3074:

  • Amends the Texas Advance Directives Act to require that artificial nutrition and hydration be provided to a patient unless it: hastens the patient’s death; exacerbates life-threatening medical problems not outweighed by the medical benefit; causes substantial irremediable pain that cannot be relieved and is not outweighed by medical benefit; is medically ineffective in prolonging life; or is in conflict with the patient’s documented wishes.
  • Requires the continued provision of life-sustaining treatment for up to 10 days from the time the patient is given both the hospital ethics committee’s written decision that the continuance of treatment is not appropriate and the patient’s medical record.
  • Amends current law relating to the provision of artificially administered nutrition and hydration and life-sustaining treatment.

Telemedicine: EMS Project Passed

Summary of HB 2004 and other telemedicine bills

Numerous bills involving telemedicine bills were filed in the 84thTexas Legislature.  However, they were mostly limited to issues that would be allowed under the Texas Medical Board’s rules.  No issues involving the Teladoc model passed out of the Legislature.  HB 2172 related to the Teladoc model and was left pending in a House committee.

We did witness one bill that involved telemedicine for EMS.  
HB 2004 was amended to HB 479 and sent to the governor for final consideration.  HB 2004 creates funding for an emergency telemedicine project in west Texas, which will be managed by Texas Tech.  In this scenario, an appropriate health professional, such as a paramedic, would be with the patient while a physician is providing telemedicine from a remote location.

The following is a summary of the telemedicine bills:

  • HB 1623 (SB 1885 Senate companion) would have required Medicaid reimbursement for telemedicine to ensure that services are available to chronic patients with chronic or complex medical needs who are being concurrently treated by at least three medical specialists, who are medically dependent on technology, who are diagnosed with end-stage solid organ disease, or who require mechanical ventilation.  The bill did not make it out of the Legislature.
  • HB 1878 (SB 1689 Senate companion) will ensure that a primary care physician providing telemedicine medical service for school-based Medicaid work would be reimbursed even if the primary care physician is not the student’s primary physician.  The bill has cleared both chambers.
  • HB 2082 (SB 1886 Senate companion) is similar to HB 1623 and did not clear the Legislature.
  • HB 2250 is similar to the Teladoc model and would have allowed a physician providing telemedicine services to determine if the presence of a physician or health professional would be required at the site where the patient is receiving the services.  The bill did not receive a House hearing.
  • HB 3444 (SB 1177 Senate companion) would have altered the state’s current rules governing telemedicine by allowing telemedicine to occur if a patient had a face-to-face with another physician or several other options.  The bill did not receive a committee hearing in either chamber.
  • HB 3476 would have created telemedicine pilot projects within the Teacher Retirement System and Employee Retirement System.  It did not make it out of the Legislature.
  • HB 3519 (SB 1471 Senate companion) has cleared both chambers and will extend the Sunset date for Medicaid reimbursement for home telemonitoring services to September 1, 2019.  The current date is September 1, 2015.  It will involve two or more specific medical conditions and a history of frequent hospital admissions or emergency department visits.

Freestanding ERs: Major Challenges Defeated

SB 425 will require additional disclosure to patients

Freestanding ERs were expecting major legislative challenges leading up to the 84th Legislature.  SB 425 (Senator Charles Schwertner, R-Georgetown) would have required freestanding ERs to disclose to patients the network status of every physician practicing in the facility and create a mediation process for balance bills.

Those provisions were ultimately stripped from the final version, which was signed into law.  SB 425 will require freestanding ERs - both licensed freestanding emergency medical centers licensed by DSHS and satellite hospital facilities - to provide several disclosures to patients, including one that indicates that the facility charges rates that are similar to those found in traditional hospital emergency departments.

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