86th Legislative Session Update as of June 16

Bills signed into law

Senate Bill 670 by Sen. Dawn Buckingham, MD (R-Lakeway) requires Medicaid to cover telemedicine services.

Senate Bill 748 by Sen. Lois Kolkhorst (R-Brenham) establishes pregnancy medical homes, high-risk maternal care coordinated service pilot programs, telehealth programs for prenatal and postpartum and creates a dedicated Newborn Screening Preservation Account.

Senate Bill 1264 by Sen. Kelly Hancock (R-North Richland Hills) requires baseball-style arbitration for most surprise medical bills, effectively removing patients from the billing dispute resolution process. Patients who elect to go out-of-network for health care are not covered by this arbitration process.

Senate Bill 1742 by Sen. Jose Menendez (D-San Antonio) requires greater transparency with prior authorizations and mandates that utilization reviews be conducted by a Texas-licensed physician in the same or similar specialty as the physician requesting the service or procedure. It also requires health plan directories to clearly identify which physician specialties are in-network at network facilities.

Senate Bill 1834 by Sen. Carol Alvarado (D-Houston) authorizes a pilot incentive program for Supplemental Nutrition Assistance Program (SNAP) recipients to purchase fruits and vegetables.

House Bill 1 by Rep. John Zerwas, MD (R-Richmond) is the $250 billion state budget for the 2020-21 biennium.  Governor Abbott signed HB 1 with no line-item vetoes. The budget does not include any physician rate increases for Medicaid, and it requires the state to find $350 million in Medicaid savings. The budget does however, increase funding for programs and initiatives that will help improve maternal health, behavioral health, and graduate medical education. 

House Bill 170 by Rep. Diego Bernal (D-San Antonio) requires health plans to cover diagnostic mammograms at 100%, the same as screening mammograms.

House Bill 1063 by Rep. Four Price (R-Amarillo) requires Medicaid to cover home telemonitoring for specific pediatric patients. HB 1063 will prevent families from having to take very ill children to their physician’s office when the necessary care and monitoring can happen from home.

House Bill 1504 by Rep. Chris Paddie (R-Marshall) extends the life of the Texas Medical Board by 12 years – to 2031. The legislation also includes provisions to ensure that dismissed or frivolous complaints or disciplinary actions are removed from physicians’ profiles as quickly as possible. It also allows expedited licensing for physicians who hold a full license and are in good standing in another state.

House Bill 1576 by Rep. Dade Phelan (R-Beaumont) allows Medicaid to contract with a transportation network company, such as Uber or Lyft, for nonemergency transportation to or from a medical appointment.

House Bill 1941 by Rep. Dade Phelan (R-Beaumont) prohibits free-standing emergency facilities from charging “unconscionable” rates, defined as 200% or more of the average charge for the same or substantially similar treatment at a hospital emergency room.

House Bill 2041 by Rep. Tom Oliverson, MD (R-Cypress) requires freestanding emergency room facilities to post conspicuous notices that the facility or the physician might be out of network, along with written disclosure of possible observation and facility fees.

House Bill 2050 by Rep. Chris Paddie (R-Marshall) requires written consent for the administration of psychoactive drugs to patients in long-term care facilities. Frequently, residents in long-term care facilities have limited contact with family members, so allowing one-time written consent will save precious time when medications may need to be provided.

House Bill 2174 by Rep. John Zerwas (R-Richmond) limits the duration of opioid prescriptions, requires electronic prescribing beginning on Jan. 1, 2021, requires opioid-related CME, and prohibits prior authorization for medication-assisted treatment for opioid-use disorder. HB 2174 will help prevent “doctor shopping” by patients seeking opioids for non-therapeutic uses.

House Bill 2261 by Rep. Armando Walle (D-Houston) increases the Physician Education Loan Repayment Program’s allowable repayment assistance amounts by $5,000 each year, bringing the total amount of repayment assistance available to $180,000. The repayment program is designed to encourage new physicians to start their careers in underserved communities by helping them pay off student loans in return for a four-year practice commitment.

House Bill 2362 by Rep. Joe Moody (D-El Paso) ensures that physicians working in emergency rooms who face high-risk obstetrical cases requiring immediate and difficult decisions are protected from unwarranted lawsuits. Notable exceptions to the willful and wanton protection include instances in which the patient’s treatment is unrelated to a medical emergency, and for any physician whose negligent act or omission causes a stable patient to require emergency medical care.

House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress) requires vastly improved transparency regarding prescription drug costs, including posting drug price information on the Health and Human Services Commission’s website and explaining cost increases of greater than 40%.

House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville) delays the mandate to check the prescription monitoring program (PMP) until March 2020. TMA fought hard for the delay to give the PMP time to fully integrate with physicians’ electronic records systems.

House Bill 3285 by Rep. J.D. Sheffield, DO (R-Gatesville) permits telehealth treatment for substance-use disorder, develops and implements an opioid misuse public awareness campaign, and collects and analyzes data regarding opioid overdose deaths.

House Bill 3345 by Rep. Four Price (R-Amarillo) allows physicians to choose the best platform for providing services rather than having health plans dictate the platform. HB 3345 complements Senate Bill 1107 from the last 85^th legislative session, which stipulated that services provided via telemedicine are to be covered the same as any other service provided by a physician.

House Bill 3703 by Rep. Stephanie Klick (R-Fort Worth) updates the Compassionate Use Act adopted by the legislature in 2015, broadening the list of symptoms and illnesses for which patients can use low-THC cannabis.

House Bill 3911 by Rep. Hubert Vo (D-Houston) requires the Texas Department of Insurance to examine the network adequacy of preferred provider organizations (PPOs) and exclusive provider organizations (EPOs) at least once every three years. Inadequate or narrow networks contribute to higher costs for patients and frustration for physicians.

Bills that were vetoed

House Bill 448 by Rep. Chris Turner (D-Grand Prairie) would have required transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds. Governor Abbott vetoed this bill, saying it is overly prescriptive and micromanages parents.

House Bill 455 by Rep. Alma Allen (D-Dallas) would have directed the State Board of Education to develop recess policies that encourage outdoor play time and physical activity. While acknowledging the educational and health benefits of recess, Governor Abbott vetoed the bill, saying it’s another mandate and is bureaucracy for bureaucracy’s sake.

Bills allowed to become law without the Governor’s signature

Senate Bill 355 by Sen. Royce West (D-Dallas) directs the Department of Family and Protective Services to create a strategic plan so Texas can access new federal matching funds for services to help children at risk of entering foster care.

Senate Bill 952 by Sen. Kirk Watson (D-Austin) requires that child care facilities’ physical activity, nutrition, and screen time rules comply with American Academy of Pediatrics standards.

House Bill 1584 by Rep. Senfronia Thompson (D-Houston) prohibits step therapy protocols for stage-4 metastatic breast cancer.

Legislative Update for 6-12-19

·       Here’s an update on legislation of importance to medicine that has already been signed into law (as of June 12).

      House Bill 25 by Rep. Mary Gonzalez (D-Clint), creates a pilot program to streamline nonemergent medical transportation services in Medicaid and allow children to accompany their pregnant mothers on doctor’s visits.  The legislation was signed on June 10 and becomes effective on Sept. 1, 2019.

·         House Bill 39 by Rep. John Zerwas (R-Richmond), was signed by the Governor on May 24 and became effective immediately.  The legislation repeals the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extends it by 10 years. 

·         House Bill 1065 by Rep. Trent Ashby (R-Lufkin), creates a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings.  The legislation was signed on June 10 and took effect immediately.

·         House Bill 1256, by Rep. Dade Phelan (R-Beaumont), relates to access by certain persons to a first responder’s immunization history.  The Governor signed the legislation on May 28 and becomes effective on Sept. 1, 2019.

·         House Bill 1418 also by Rep. Phelan, provides first responders and emergency services personnel with their immunization status when they seek certification or recertification.  The bill was signed by the Governor on May 27 and took effect immediately.

·         House Bill 1532 by Rep. Morgan Meyer (R-Dallas), creates a complaint process at the TMB for employed physicians to use.  The bill was signed on June 10 and takes effect on Sept. 1, 2019, except Sec. 162.005(b) of the Occupations Code, which takes effect on Jan. 1, 2020.

·         House Bill 1693 by Rep. John Smithee (R-Amarillo), relates to medical expense affidavits concerning cost and necessity of services.  The legislation was signed on June 10 and takes effect on Sept. 1, 2019.

·         House Bill 1848 by Rep. Stephanie Klick (R-Fort Worth), establishes infection control programs in long-term care facilities.  The legislation was signed on June 10 and becomes effective on Sept. 1, 2019.

·         House Bill 2088 by Rep. Jay Dean (R-Longview), requires health care professionals dispensing controlled substance prescriptions to provide written notice of the closest safe disposal location and other safe disposal methods available.  The legislation was signed on June 10 and takes effect on Sept. 1, 2019.

·         House Bill 2425 by Rep. Kyle Kacal (R-College Station), relates to the authority of physicians to delegate to certain pharmacists the implementation and modification of a patient’s drug therapy. The bill was signed by the Governor on May 24 and becomes effective on Sept. 1, 2019.

·         House Bill 2813 by Rep. Four Price (R-Amarillo), codifies in statute the statewide behavioral health coordinating council that lawmakers established in 2015.  The Governor signed the legislation on June 10 and became effective immediately.

·         House Bill 3041 by Rep. Chris Turner (D-Grand Prairie), allows for renewal of a prior authorization if it expires before the patient receives the medical service or procedure.  The legislation was signed on June 7 and becomes effective on Sept. 1, 2019.

·         House Bill 3552 by Rep. JD Sheffield (R-Gatesville), institutes a required 60-day notification period for reduction or termination of community water fluoridation.

·         Senate Bill 11 by Sen. Larry Taylor (R-Friendswood), addresses school safety, including substance use and mental health services.  The bill was signed on June 6 and became effective immediately.

·         Senate Bill 21 by Sen. Joan Huffman (R-Houston), raises the minimum age to purchase tobacco and vape products to 21 years, exempting active duty military.  The bill was signed on June 7 and becomes effective on Sept. 1, 2019.

·         Senate Bill 384 by Sen. Jane Nelson (R-Flower Mound), requires all health care facilities to report all health care-affiliated infections.  The legislation was signed on June 7 and becomes effective on Sept. 1, 2019.

·         Senate Bill 436 also by Sen. Nelson, provides for improved care for high-risk pregnancies.  The legislation was signed into law on June 7 and took effect immediately.

·         Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham), addresses physician and hospital concerns about how to implement hospital neonatal and maternal level of care designations, which state law previously directed the Department of State Health Services (DSHS) to establish.  The bill was signed on June 10 and took effect immediately.

·         Senate Bill 750 also by Sen. Kolkhorst, improves maternal access to prenatal and postpartum care.  This legislation was also signed on June 10, becoming effective immediately.

·         Senate Bill 752 by Sen. Joan Huffman (R-Houston), relates to the liability of volunteer health care providers and health care institutions for care, assistance or advice provided in relation to a disaster.  The Governor signed the legislation on May 20 and takes effect on Sept. 1, 2019.

·         Senate Bill 1207 by Sen. Charles Perry (R-Lubbock), requires more explicit prior authorization procedures and denial notices for both patients and physicians.  The bill was signed on June 10 and becomes effective on Sept. 1, 2019.

·         Senate Bill 1378, by Sen. Dawn Buckingham (R-Lakeway), relates to meeting the graduate medical education needs of medical degree programs offered or proposed by public institutions of higher education.  The bill was signed by the Governor on May 20 and took effect immediately.

·         Senate Bill 1519 also by Sen. Kolkhorst, establishes a statewide council on long-term care facilities as a permanent advisory committee to the Health and Human Services Commission (HHSC).  The bill was signed by the Governor on June 10 and took effect immediately.

·         Senate Bill 1564 by Sen. Royce West (D-Dallas), requires Medicaid to cover medication-assisted treatment (MAT) for opioid- or substance-use disorder without requiring prior authorization or precertification.  The legislation was signed by the Governor on June 10 and became effective immediately.

AMA Alternate Delegate

Obituary for Basil A. Pruitt, Jr., MD

Basil A. Pruitt, Jr., MD, FACS, FCCM, MCCM, Professor of Surgery and Dr. Ferdinand P. Herff Chair in Surgery, UT Health San Antonio

We are deeply saddened to announce that Basil A. Pruitt, Jr., MD died yesterday afternoon, March 17, 2019. Dr. Pruitt had a major and sustained international impact on the fields of surgery, burn care, trauma and critical care. His contributions in these fields were transformational and directly led to dramatic improvements in patient care marked by improved survival, decreased complications and improved health.

Dr. Pruitt graduated from Harvard College (1952) followed by Medical School at Tufts (1957). He completed his initial surgical training at the Boston City Hospital under the tutelage of C. Gardner Childs (1957-1962). From there he completed his surgical residency at Brooke General Hospital in San Antonio (1964).

From 1967-1968 Dr. Pruitt served as Chief of Surgery and Chief of Professional Services at the busiest evacuation hospital in Vietnam (400 to 500 major operations a month) and then Chief of the Trauma Research Team, where he studied the cardiopulmonary responses to injury in combat casualties.  Dr. Pruitt became the Commander and Director of the U.S. Army Institute of Surgical Research where he served for the next 27 years. He went on to literally change history by revolutionizing the management of trauma, burn and critically ill or injured patients worldwide.

Dr. Pruitt retired from the US Army Medical Corps in 1995 and accepted a faculty position as Professor of Surgery at UT Health San Antonio, where he held the Dr. Ferdinand P. Herff Chair in Surgery. In his role at UT Health San Antonio, Dr. Pruitt has been a cherished, respected and loved mentor and colleague.  He has supported the development of hundreds of residents, students, faculty, staff and leaders at UT Health San Antonio. As a faculty member at UT Health San Antonio, Dr. Pruitt remained an active contributor to the US Army Institute for Surgical Research (USA ISR), and also served as the Editor-in-Chief of the Journal of Trauma for 17 years. 

Dr. Pruitt’s work as a leader, surgeon and scientist with the USA ISR forged a model where rigorous scientific inquiry was followed by a dogged translation of this science into dramatic care improvements. This is the gem crafted by Dr. Basil A. Pruitt, Jr. This work transformed the fields of burn care, trauma and surgical critical care.

Cumulative Innovative Achievements

Although Dr. Pruitt’s research had a military beginning, the fruits of his labor have been assimilated into civilian medical practice worldwide with associated dramatic reductions in both death and complication rates.

Dr. Pruitt has been internationally recognized with appointments to the NIH study sections, the Veterans Administration Merit Review Board for Surgery, and the Shriners Hospitals Research Advisory Board and Clinical Outcomes Studies Advisory Board. He has also served as a reviewer for the Hong Kong Research Grants Council, the BC Health Research Foundation and Alberta Heritage Foundation, and the NIH for which he has functioned as a special panel member. Over the course of his career he authored over 470 peer reviewed publications, 181 textbook chapters and 15 books and monographs.

Perhaps Dr. Pruitt’s most enduring legacy is his mentorship of a cadre of physicians and scientists who have become international leaders in Medicine.  Among that group are 46 directors of burn centers and units in the United States and abroad, 23 department chairs (including departments of surgery, urology, anesthesiology, plastic surgery, pediatric surgery and medicine), 11 past presidents of the American Burn Association, 2 past presidents of the International Society for Burn Injury, past Presidents of the American Association for the Surgery of Trauma, the past Chair of the American College of Surgeons Committee on Trauma and at least six academic chairs in the Japanese fields of Acute Care Medicine and Surgery.

Dr. Pruitt served for twenty years as the Associate Editor of the Journal of Trauma. Following this he became the Editor-in-Chief of the Journal of Trauma for the next 17 years. Additionally, Dr. Pruitt served as a member of the Editorial Board of 13 other journals, including two published in China and one published in Turkey. He has served as an ad hoc reviewer for an additional 26 journals.

One measure of his stature as an innovator is the recognition by his peers. He was elected as the president of 12 surgical societies:

1. American Burn Association
2. American Association for the Surgery of Trauma
3. Southern Surgical Association
4. American Surgical Association
5. Halsted Society
6. Surgical Infection Society
7. American Trauma Society
8. North American Burn Society
9. Western Surgical Association
10. International Society for Burn Injuries
11. Surgeons Travel Club
12. Shock Society

His awards include 11 honorary memberships, the Metcalfe Award, the Curtis P.Artz Memorial Award, the Harvey Stuart Allen Distinguished Service Award, the Baron Dominique Larrey Award for Surgical Excellence, the National Safety Council’s Surgeons’ Award for Distinguished Service to Safety, an International Honorary Professorship of Surgery at the Third Military Medical College People’s Republic of China, the Danis Award from the Société Internationale de Chirurgie, and the American Surgical Association’s Medallion for Scientific Achievement. In 2000, Dr. Pruitt was recognized with the Distinguished Investigator Award from the American College of Critical Care Medicine along with the G. Whitaker International Burns Prize. The Tanner-Vandeput-Boswick Burn Prize was awarded to him in 2006. In 2007, he accepted the Roswell Park Medal and received a lifetime achievement award from the Society of University Surgeons. As a co-winner of the King Faisal International Prize in Medicine in 2008, Dr. Pruitt was honored in Riyadh, Saudi Arabia. In 2010, he received the Lifetime Achievement Award of the American Burn Association; later that same year, he was inducted as the first foreign honorary member of the Japanese Association for Acute Medicine. In 2015 Dr. Pruitt received the Association of Military Surgeons of the United States Lifetime Achievement Award. In 2017 he was selected as the 2^nd Vice President of the American College of Surgeons and later in the same year, he was honored as an Icon in Surgery by the American College of Surgeons. In 2018 Dr. Pruitt received the BioMed SA Lifetime Achievement Award.

Of burn care peer reviewed articles over the past 55 years, Dr. Pruitt has had the largest number of top cited articles.

Over the past half century, Dr. Basil A. Pruitt, Jr., a great citizen, surgeon, innovator, mentor, and leader, transformed our world through his dogged commitment to science and his service to humanity. Dr. Pruitt’s contributions live on through the work of surgeons, physicians, scientists and organizations he shaped and inspired.  Dr. Pruitt’s mentorship and support has made a real difference in my life and in the lives of our faculty, residents and students. We are forever grateful. Our thoughts and prayers are with his amazing family in this time of loss.

For all the patients who will be treated at a burn center or trauma center today, this week and into the future: each and every one of these patient’s care has been impacted and improved through the lifetime work of Dr. Basil A. Pruitt, Jr.

Services are pending and we will share this information as soon as it is available.

Ronald M. Stewart, MD

Professor and Chair of Surgery

Dr. Witten B. Russ Chair in Surgery

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