Texas health care bill highlights

It’s been a busy session for health care legislation in Texas, with several public hearings scheduled for this week on bills that are starting to show momentum.

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Here’s a handful we think are worth paying attention to:

SB 21, which would raise the minimum legal age for purchasing cigarettes, e-cigarettes, and tobacco products from 18 to 21, narrowly passed out of the Senate State Affairs Committee in a bipartisan, 5-4 vote. A House companion bill with the same effect passed out of the House Public Health Committee recently in a unanimous 10-0 vote.

SB 1264 addresses surprise billing, and it passed out of the Senate Business and Commerce Committee in a 7-2 vote.

Note: Surprise billing happens when a patient is billed by an out-of-network provider for the difference between what their insurer reimbursed and what the provider charges. It happens, in some cases, when a patient goes to an out-of-network hospital for emergency care or when an out-of-network provider treats a patient at a hospital that’s in-network.

The bill prohibits out-of-network providers at network hospitals and out-of-network emergency care providers from balance billing, requiring plans to pay “reasonable or agreed-upon amounts” to the providers, according to the bill summary. Providers can dispute those amounts, under the bill, through the Texas Department of Insurance mediation program.

The bill applies to state-regulated plans, while federally-regulated, self-funded plans would be able to opt into the surprise billing mediation process if another bill, SB 1530, or its companion passes.

Sen. Kelly Hancock, author of both Senate bills, said the following about SB 1264 passage out of committee:

“This legislation is a bipartisan, bicameral effort to put patients first. We’re determined to protect Texas patients from contentious, after-care disputes between insurance companies and providers. The health care system is convoluted and has plenty of faults, but this is one thing that’s in our power to fix at the state level, and we need to fix it now.”

Also related to surprise billing is HB 2041, which was recently the subject of a public hearing in the House Public Health Committee. The bill would strengthen requirements for freestanding emergency rooms to post notices stating that providers there may be out-of-network and listing for which plans the facility is in-network. The ERs would have to post the notices online, in addition to several places throughout the physical facilities.

The bill also adds a requirement that specific written information on in-network plans and potential fees be given directly to the patient–in Spanish and in English–before care is given. And, it bans facilities from posting names or logos of plan issuers that are out-of-network.

If a facility violates the requirements, the bill increases the maximum monetary penalty from $5,000 to $25,000.

Another bill “related to unconscionable prices charged by certain health care facilities for medical care,” HB 1941, also addresses freestanding emergency rooms. That bill would allow the Consumer Protection Division of the state Attorney General’s office to take action against freestanding ERs if they charge “unconscionable prices” for services — prices that are at least “200 percent of the average charge for the same or substantially similar care provided to other individuals by a hospital emergency room.” The bill had a public hearing earlier this week in the House Business & Industry Committee.

Bills aimed at PBM reform are also scheduled for public hearing this week. HB 2231 would tighten regulations on the benefit managers. On TribTalk, Carter High of the Alliance of Independent Pharmacists of Texas, writes of 2231 and its companion bill that they would increase oversight and includes other consumer protections:

“The bills also would limit assessments of hidden fees and unreasonable audit practices that result in higher costs to patients,” High writes. “And they would help ensure the rebates paid to PBMs are passed on to patients.”

HB 3388 takes a more drastic approach, In the words of J. David McSwane of The Dallas Morning News, it “fires” the PBMs altogether. That bill enacts a fee-for-service model for prescription drug benefits under Medicaid, CHIP, and any other benefits program administered by the state that provides an outpatient prescription drug benefit.