April 19, 2017

Texas Legislative Digest – Issue 15

Issue 15 – April 17, 2017

• House Passes Budget Bill
• BCBSTX’s Morrow Testifies
• Outlook Improves for Texting Ban
• Insurance Bills Voted Out
• Bills of Interest
• Tidbits
• Timetable

House Passes Budget Bill
The House passed its version of the 2018-2019 budget early on the morning of April 7 with a vote of 131 to 16. The final vote was well above the two-thirds threshold required to tap into the state’s Economic Stabilization Fund, also known as the “rainy day fund,” which will allow the House to use $2.5 billion from the fund in addition to usual revenue sources. The budget allocates $63.2 billion in state and federal funds for the Texas Medicaid program, about $1.4 billion less than the current budget. The House-approved budget anticipates that changes at the federal level will provide enough program flexibility to deliver $1 billion in Medicaid savings. However, if the anticipated savings aren’t realized, legislators may be able to provide supplemental dollars to Medicaid in the following legislative session to make up for any shortfall. This session, the Medicaid shortfall was addressed in the supplemental budget bill, House Bill 2, which provides $2.6 billion in additional Medicaid funding to close the shortfall in the current budget year.

The debate lasted around 15 hours, but there weren’t many surprises related to health and human services programs. The budget provides an additional $1.5 billion for public schools, $500 million to address a shortfall in the health benefits program for retired teachers, and an increase of more than $450 million to address the crises in Child Protective Services and foster care. It also puts more resources toward mental health services and college scholarships, and protects voter-approved funding for transportation improvements. Additionally, lawmakers added funding for Zika-preparedness efforts along the border.

The Senate passed its version of the budget in late March. The bill now heads to a conference committee where differences in the two versions will be worked out. A conference committee is made up of five members from each chamber appointed by the respective presiding officers to resolve the differences between the House and Senate versions when the originating chamber doesn’t agree with the changes made by the opposite chamber.

BCBSTX’S Morrow Testifies
Dr. Robert “Bob” Morrow, Texas Market Strategy President-Southeast Region for Blue Cross and Blue Shield of Texas (BCBSTX), testified in support of House Bill 3124 before the House Insurance committee on April 11. Rep. Lance Gooden (R-Terrell) filed the bill that would allow the release of certain physician-specific comparison data to physicians who are participating in physician-led accountable care organizations (ACOs). Dr. Morrow shared with the committee that BCBSTX and the Texas Medical Association (TMA) agreed that the bill is needed. TMA represents Texas physicians and medical students.

Dr. Morrow testified that the current insurance statute regulates how insurers share quality and cost information with the general public. Since the law is very broad, it inhibits circumstances where BCBSTX wants to share cost information with physicians participating in ACOs. Dr. Morrow went on to explain that the bill seeks an exception to that provision to allow BCBSTX to share cost information with physicians, while at the same time preserves the protections now in the law surrounding the publication of a physician’s cost and quality information to the general public. Following favorable testimony from a TMA representative, HB 3124 was left pending.

Outlook Improves for Texting Ban
On April 7, Sen. Don Huffines (R-Dallas) announced his support for Senate Bill 31 filed by Sen. Judith Zaffirini (D-Laredo) and House Bill 62 by Rep. Tom Craddick (R-Midland), both of which create a statewide ban on texting while driving. Huffine’s support gives the legislation the critical vote it needs to be considered by the full Senate.

A vote on the ban is likely at least two weeks away. HB 62 is expected to become the vehicle for the texting ban, but it must first clear the Senate State Affairs committee. SB 31 has already passed that committee on a 6-3 vote, but has lingered awaiting action on the House bill. Sen. Joan Huffman (R-Houston), the committee chair, is a co-author of the Senate bill as are Sen. José Menéndez (D-San Antonio), Sen. Craig Estes (R-Wichita Falls), and Sen. Charles Perry (R-Lubbock). However, the three committee members who voted “no” on SB 31 — Sen. Charles Schwertner, M.D. (R-Georgetown), Sen. Brian Birdwell (R-Granbury), and Sen. Brandon Creighton (R-Conroe) — have given no indication that they may have changed their minds.

For years, Craddick has advocated for legislation that would penalize drivers who use their phones to text while they are on the road. In 2013 and 2015, Craddick's bill passed the House, but died in the Senate. In 2011, it successfully maneuvered through both chambers only to be vetoed by then Gov. Rick Perry, who said it would “micromanage the behavior of adults.” BCBSTX registered its support of HB 62 when it was considered by the House Transportation committee. Though several property and casualty insurers registered support for the bill, BCBSTX was the only health insurer to do so. Texas is one of only four states that does not have a statewide ban on texting and driving.

Insurance Bills Voted Out
The House Insurance committee met on April 11 and approved several bills of interest to health plans:
 

• House Bill 1296 by Rep. John Frullo (R-Lubbock) will require a health plan to prorate cost-sharing amounts when drugs are prescribed for less than a 30 days’ supply to adjust the timing of patient medication and synchronize the dates that the pharmacy dispenses the drugs.
   
• House Bill 3226 by Rep. Larry Phillips (R-Sherman) would authorize the Texas Department of Insurance to create a temporary high-risk pool or state reinsurance program and access federal funds on an interim basis. The bill would also permit the state to seek a Section 1332 waiver under the Affordable Care Act, which allows states to modify key parts of the health law within its boundaries.
   
• House Bill 3276 by Rep. Tom Oliverson, M.D. (R-Cypress) requires freestanding emergency rooms (FSERs) to inform patients of their network status. This may be done by posting a notice that either lists the health plan provider networks in which the FSER participates or states that the facility is not a participating provider with any health plan.
   
• House Bill 1036 by Rep. Senfronia Thompson (D-Houston) would require health plans to cover breast tomosynthesis as a screening procedure under certain health benefit plans.
   
• House Bill 3218 by Phillips allows HMOs to contract with entities such as prescription benefit managers rather than contracting with individual health care providers. This is priority legislation for BCBSTX.

The bills are headed to the Calendars committee where they will be considered for future House debate.

Bills of Interest

• House Bill 1566 by Rep. John Frullo (R-Lubbock), companion to Sen. Kelly Hancock’s Senate Bill 507, was voted favorably out of the House Insurance committee on April 11. The legislation expands mediation protections for members of a preferred provider organization (PPO) plan. Under the change, mediation protections would apply to claims submitted by all out-of-network emergency providers, including freestanding emergency rooms, and out-of-network providers working at a network facility. The mediation process enables health plan members to challenge the balances of surprise medical bills greater than $500 after their out-of-pocket payments have been met. HB 1566 is headed to the House chamber where it will likely meet up with SB 507. BCBSTX is a strong supporter of the mediation process and the legislation.
   
• On April 18, two very similar bills, Senate Bill 2064 by Hancock (R-North Richland Hills) and House Bill 3867 by Rep. John Smithee (R-Amarillo), are scheduled for public hearing by the Senate Business & Commerce and the House Judiciary & Civil Jurisprudence committees, respectively. The legislation grants the Attorney General (AG) authority to protect consumers from unconscionable pricing when they have suffered from a personal medical emergency, similar to protections in declared natural emergencies. At the AG’s discretion, the following protections may be sought: (1) a temporary restraining order, temporary injunction or permanent injunction or (2) monetary penalties of up to $20,000 per violation, unless the victim is an elderly person, in which case the penalty could be as much as $250,000. BCBSTX supports the legislation and company medical director, Dr. Leslie Weisberg, is expected to testify in support of the bills. As filed, Smithee’s bill impacts both FSERs and hospital emergency departments, while Hancock’s bill impacts only FSERs.
   
• Last week, the House Criminal Jurisprudence committee heard public testimony on a bill filed by Rep. Armando Martinez (D-Weslaco). His legislation, House Bill 2583, would make reckless celebratory gunfire a crime. Martinez was hit by a stray bullet shortly after midnight last New Year’s Eve.

Tidbits

• Rep. Todd Hunter (R-Corpus Christi), chair of the House Calendars committee, announced on the House floor on April 12 that the chamber can soon expect to meet Monday through Friday. He further noted Saturday deliberations can be anticipated in the near future.
   
• After serving in the Texas House for more than 25 years, former Rep. Sylvester Turner, a Democrat, was elected Houston mayor in 2015. As a lawmaker, he became known for his wooden abacus, which he would set on the podium as he talked about the state’s priorities when debating the budget. At the time of Turner’s departure from the House, the fate of the abacus was unknown. To the relief of many, it again made an appearance on the podium as Rep. John Zerwas, M.D. (R-Richmond), chair of the House Appropriations committee, began the recent budget debate.
   
• Frequently, celebrities and renown Texas citizens are recognized and honored by the Texas Legislature. However, seldom does a bill conjure up a beloved cartoon character. Senate Bill 1620, authored by Sen. Van Taylor (R-Plano), removes prohibitions on residents raising six or fewer backyard chickens. The bill allows families to choose to have home-raised eggs and eliminates local barriers for students raising chickens for educational purposes. SB 1620 authorizes municipalities to create reasonable requirements so long as six or fewer chickens can be raised. Foghorn Leghorn will be greatly pleased. Taylor represents the Richardson office of BCBSTX in the Texas Senate.
   
• When the budget debate extends late into the night, tempers will occasionally flair. Rep. Jonathon Stickland (R-Bedford) filed an amendment to defund the state’s feral hog abatement program. According to the Texas Department of Agriculture, the estimated 2.6 million wild pigs in Texas cause about $52 million in agricultural damage annually with landowners spending an additional $7 million to control pigs and/or repair damage. Stickland opposes funding the program, which he calls “ridiculous” and a waste of money. His effort didn’t sit well with Rep. Drew Springer (R-Muenster), who represents a rural district north of Fort Worth where feral hogs are a serious problem. In response, Springer attached an amendment to Stickland's proposal that would cut the same amount of funding for the Texas Department of Transportation, but only for roads and highways in Stickland’s hometown of Bedford. Springer and Stickland then confronted each other in the aisle of the House floor and had to be separated by colleagues. Springer’s amendment ultimately passed, 99 to 26, forcing Stickland to withdraw his proposal to which it had been attached.
  
  And the confrontations don’t always end on the House floor. Within a few days of the budget debate, Springer provided this introduction to the Texas Tribune’s weekly podcast about 50 seconds into the broadcast, “This is state Rep. Drew Springer to answer your budget night questions, ‘Pigs get fat and hogs get slaughtered’ and if you mess with the feral hog abatement program, you’ll find yourself in the latter category with the roads a little bumpier near your house.” Stickland will likely respond.

Timetable
April 17 is the 98th day of the 85th Legislature, with 42 days remaining until final adjournment. Important dates related to the legislative session are:

• April 15, 2017   First day that a senator may place five bills on the Senate Intent Calendar
• May 8, 2017     Last day for House Committees to report House Bills
• May 29, 2017   “Sine Die,” last day of 85th Regular Session
• June 18, 2017   Last day governor can sign or veto bills passed during regular session
• Aug. 28, 2017   Date that bills without specific effective dates become law