Under the dome

By Kate McCann

The 81st Texas Legislative Session convened on Jan. 13, ushering in a new era as the Texas House of Representatives elected Joe Straus, R-San Antonio, as the new Speaker of the House. During the euphoric opening-day ceremonies, Straus pledged to “empower members so that they can do what is right for their constituents and for the people of Texas.”

The atmosphere in the Senate, on the other hand, was plagued by partisan bickering over a proposal to change the Senate’s two-thirds rule—which requires that 21 senators agree to bring up a measure before it can be debated—to a three-fifths rule, which would only require 19 senators to bring a bill to the floor. Since the Senate is split 19 Republicans and 12 Democrats, it didn’t take long for the minority party to cry foul.

Fast-forward through the first few weeks of the session, which are more ceremonial in nature, and by the mid-March filing deadline, lawmakers had filed a record of more than 7,100 bills. Committees were appointed and the Legislative Budget Board filed its proposed base budget for 2010-2011.

The Senate passed its version of the budget in the beginning of April. The $182 billion plan uses $11 billion in federal stimulus funds and includes a small increase in Medicaid provider fees. However, it doesn’t include money to cover more families through the Children’s Health Insurance Program or an extension to 12-month continuous coverage for children in the Medicaid program. The House of Representatives was scheduled to debate its version of the budget on April 17. Following passage of the bill, the Senate and House will go to conference committee to resolve differences in the respective spending proposals.

While a significant number of filed bills deal with health-related issues, TAFP’s top initiatives fall into three categories: physician workforce and loan repayment, managed care reform and instant verification of benefits, and holding the line on scope of practice.

Physician loan repayment

House Bill 1876 by Rep. Warren Chisum, R-Pampa, and Rep. Richard Peña Raymond, D-Laredo, would increase the number of primary care physicians practicing in rural and underserved areas by consolidating the state’s various loan repayment programs under one umbrella and significantly increasing the funding available so that physicians and other health care providers could receive up to $160,000 in loan repayments over four years of service, much like the successful National Health Service Corps program.

Since medical students graduate with an average of $130,000 in debt, this burden leads many to eschew careers in primary care in favor of more lucrative specialties. Texas is projected to need 4,500 more health care providers by 2015 to care for the growing population and TAFP hopes the bill will steer more students toward primary care and toward these physician shortage areas. H.B. 1876 was voted unanimously from the House Committee on Public Health and sent to the House Calendars Committee, which will schedule the bill for House floor debate.

Electronic verification of benefits

H.B. 1342 by Rep. Jose Menendez, D-San Antonio, and its companion, S.B. 863 by Sen. Chris Harris, R-Arlington, would require health insurers to provide instant, electronic verification of coverage to physicians at the point of care. That would include what services are covered and what the patient’s out-of-pocket costs will be so patients and their doctors can have meaningful discussions about treatment options. H.B. 1342 was unanimously passed out of the House Committee on Insurance and sent to the House Calendars Committee, which will set the bill for House floor debate.

Scope of practice

With the six-year moratorium over, the Coalition for Nurses in Advanced Practice is seeking a broad expansion of the scope of practice for advanced practice nurses. Two bills filed this session would give broad prescriptive authority to APNs, virtually stripping all physician supervision of APNs from state law.

H.B. 1107 by Rep. Wayne Christian, R-Center, would give complete independent authority for nurses to practice medicine by allowing the Texas Board of Nursing to grant prescriptive authority to APNs. It would also remove all mention of APNs from the physician delegation statutes in the state Occupations Code.

H.B. 696 by Rep. Rob Orr, R-Burleson, would remove physician prescriptive delegation to APNs. It would institute prescriptive agreements, essentially allowing physicians and APNs to establish their own guidelines for collaboration through unlimited, open-ended contracts with no minimum standard of supervision. According to initial analysis, the bill would allow an APN to treat the full range of health problems—including the prescribing of schedule II pharmaceuticals—in a hospital, office or school as long as he or she is not barred from doing so in the prescriptive agreement. The bill also increases the number of APNs a physician can supervise from three to eight, but if the physician sees fit, he or she may exceed that limit. In essence, the bill allows a physician to enter into prescriptive agreements with an unlimited number of APNs.

Both bills were heard in the House Committee on Public Health on April 14th, and left pending.

With less than six weeks remaining in the 81st session, legislators must act quickly to wrap up the state’s business before sine die on June 1. Keep up with the latest news affecting your patients and your practice through Capitol Report articles and Capitol Update video webcasts. Go to the news section of www.tafp.org to access these legislative news tools.