Texas Covered Weekly by TAHP | 06.14.24
A weekly roundup of the news you need. ??
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#TxLege Update
?? The Select Committee on Youth Health & Safety announced two hearings on their charge to study “Behavioral Health Services for At-Risk Youth”.
??? September 18th: Senate Health & Human Services will hold a hearing to hear testimony on Mental Health and Access to Health Care charges (scope of practice issues).
?? September 5th: Senate Finance has posted a hearing to discuss mental health services and inpatient facilities and the implementation of SB 30.
?? The Senate Committee on Business and Commerce has posted hearings for August 27 and October 1. The Committee will likely hear testimony on its AI interim charge at one of these hearings.
?? The House Committee on Insurance met this week to discuss issues related to the property and casualty (P&C) markets, specifically focusing on the future of the homeowners insurance market.
Regulatory Roundup
?? The Texas State Board of Pharmacy has adopted rules relating to the delivery of prescription drugs. The rule places certain requirements, such as temperature control, on drugs shipped by common carrier or directly from pharmacies. The BOP met to discuss the proposal and make changes in response to stakeholder comments, a recap of which is here. The proposal was adopted with minor clarifying changes.
?? Medicaid Biomarker Coverage: TAHP submitted comments to HHSC relating to their proposed Genetic Services Policy. The policy implements SB 989 (88R), which required MCOs and private insurers to cover medically necessary biomarker screening tools. TAHP comments recommended that the agency add language from the bill requiring that the tests predominantly address the issue for which the test is ordered.
?? Psychiatric residential youth treatment facility (PRYTF) rules were proposed to create a voluntary certification program to provide families with additional, quality options for youth and young adults in need of residential care in non-psychiatric hospital settings to implement HB 3121 (87 R). TAHP submitted a comment letter urging the agency to align this licensure with federal requirements so that psychiatric residential treatment for youth can be a covered Medicaid benefit.
?? STAR Health Coordination Adjustments: Telecommunications informal draft for STAR Health Service Coordination Assessments published. The proposal adds a requirement that all STAR Health members receive at least one in-person visit a year, but allows flexibility during disasters. The comment period ends June 13, 2024.
?? Private Equity in Health Care: TAHP submitted comments on an RFI from the FTC, DOJ, and HHS. The request sought public insights on transactions by health systems, private payers, and private equity funds involving health care providers, facilities, or ancillary services.
?? Prohibition of Provider Discrimination Based on Immunization Status draft rules were released for comment. The proposal prevents Medicaid and CHIP providers from refusing to provide health care services to a Medicaid or CHIP recipient based solely on the recipient’s refusal or failure to obtain a vaccine or immunization for a particular infectious or communicable disease. The comment period ends June 25th.
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News
Top Stories of the Week
June 13, 2024, KFF Health News: A KFF Health News/PolitiFact HealthCheck at the time rated Biden’s claim to be “mostly true,” finding a fairly large range of estimates — from 54 million to 135 million — of the number of Americans with preexisting conditions. Estimates on the lower end tend to consider “preexisting conditions” to be more severe chronic conditions such as cancer or cystic fibrosis. Estimates at the spectrum’s higher end include people with more common health problems such as asthma and obesity, and behavioral health disorders such as substance use disorder or depression.
June 11, 2024, KFF Health News: If enacted, the rules would dramatically expand protections for tens of millions of Americans burdened by medical bills they can’t afford. The regulations would also fulfill a pledge by the Biden administration to address the scourge of health care debt, a uniquely American problem that touches an estimated 100 million people, forcing many to make sacrifices such as limiting food, clothing, and other essentials.
Texas Health Care
June 11, 2024, Axios: Texas is not meeting federal requirements to process applications for Medicaid health insurance and food benefits quickly, officials said in letters revealed Monday. Why it matters: Texas has kicked more than a million people off Medicaid for procedural reasons in the last year, many of whom may still be eligible for coverage. Large backlogs can lead to longer waits for people to regain coverage and access health care. Also, delayed Supplemental Nutrition Assistance Program (SNAP) benefits make it harder for families facing food insecurity to eat regular, healthy meals.
National Health Care
June 14, 2024, STAT: Recent court decisions required the Biden administration to make these changes to insurers’ star ratings, many of which came in lower than companies had expected and cost them hundreds of millions of dollars in bonuses. While many companies will regain lost bonuses, no insurers will have to forfeit money from the new calculations, government officials said. The government also is reopening the process for Medicare Advantage insurers to submit their 2025 plans to account for these changes.
June 13, 2024, Axios: Congress is making another attempt at requiring Medicare insurers to speed up reviews of requests to cover treatments after an earlier effort was derailed by its high price tag. Why it matters: A bipartisan bill taking aim at a practice detested by patients and doctors has a much better shot at passage after lawmakers made changes that will slash its cost to the federal government.
June 12, 2024, STAT: The point of prescription drugs is to help people improve their quality of life. When a doctor writes a prescription and sends it along to the pharmacy, oftentimes they’re more focused on the drug’s effectiveness than its cost.?But when a patient picks up that drug, the price they will be asked to pay at the counter takes center stage — and it depends on a complex combination of factors. Is it a brand-name or a generic drug? Does the patient have health insurance? If so, does that insurance cover the drug?
New TAHP Complete Coverages
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Inaugural Healthcare Workforce Task Force Includes TAHP CEO | 6.10
?? Announcement: Governor Greg Abbott and the Texas Higher Education Coordinating Board (THECB) announced the inaugural members of the Healthcare Workforce Task Force. TAHP CEO, Jamie Dudensing, was selected as one of the inaugural members.
?? The big picture: In April, Governor Greg Abbott sent a letter to THECB to create a task force to address health care workforce shortages in order to meet the demands of our growing state and provide students with the tools they need to succeed.
?? Why it matters: State officials project a shortage of over 10,000 physicians and nearly 60,000 registered nurses in the next decade. Without enough health care professionals, Texas patients experience longer wait times, reduced access to preventive care, and increased health disparities, particularly in rural areas.
Protecting Patients: New States Laws Target Surprise Facility Fees | 6.13
?? What’s new: As legislatures wrap-up around the country, three new laws add to a growing list of state patient protections against surprise hospital facility fees — giving other states a path to fighting back for patients.
?? Catch up: Hospital systems are rapidly buying up doctor’s clinics and imposing hospital-level billing. Patients in Texas and around the country have been caught off guard and left on the hook for hundreds in unexpected facility fee charges.
?? Health economist Vivian Ho at Rice University had this to say: “I just find that so disappointing. You know, patients realize health care is complicated and it’s complex. And, you know, they are willing to pay more for a service that has higher value. But in this case, providers have just found a different way to collect more money. It is collecting a facility fee where there’s no additional value over and above what you were getting before when you were paying just the professional fee. It’s just not right.”
?? Why it matters: Surprise facility fees are the latest addition to out of control health care costs that result in higher out-of-pocket spending for patients and increased premiums for employers and families. States are increasingly becoming aware of the need to step in to set limits on abusive provider pricing schemes.
Mark Your Calendar: TAHP Events
TAHP events are designed to bring together health care professionals to share insights, discuss developments, and build strategic partnerships. Be part of the conversation that shapes the future of health care in Texas.
?? November 4-6 | Austin, TX | Texas Covered 2024 Health Care Conference and Expo