FAIR PLAY
Among other Medicaid reforms, the 2015 Texas Legislature responded to TMA’s call for due process improvements in over- zealous fraud investiga- tions by the Ofice of Inspector General (OIG). Senate Bill 207 by Sena- tor Juan “Chuy” Hinojosa (D-McAllen):
• Clarifies that “fraud” does not include un- intentional technical, clerical, or administra- tive errors;
• Requires probable cause of a credible allegation of fraud for payment holds;
• Requires OIG to give physicians a detailed summary of its evi- dence relating to the allegation;
• Gives OIG 180 days to complete an investiga- tion; and
• Gives physicians 10 days to request a confidential, informal settlement meeting.
decisions. TMA staff continue to pour over extensive bills to overhaul the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS). Despite the constitutional spending limit, lawmakers had an $8 billion sur-
plus to spend, made possible by a steady upswing in sales and oil and gas tax revenues. About half of the surplus ultimately went into a $3.8 billion compre- hensive tax relief package; the other half was interspersed among education, health care, transportation, and border security needs. Other than losing the Medicaid-Medicare parity increase, TMA officials say
the tax relief package did not cut into medicine’s budget priorities. As it went to the governor’s desk, House Bill 1 spends roughly $210 billion in state and fed- eral money. The 2016–17 budget represents a 6.6-percent increase over 2014–15 spending levels, with “growth in all of TMA’s priorities,” TMA Lobbyist Michelle Romero said. Among the recommendations TMA supported:
• $53 million for GME expansion grants, roughly $40 million above 2014–15 funding;
• An additional $50 million for women’s health services; • An $80 million increase in mental health and substance abuse funding; and • $20 million dedicated to infectious disease surveillance.
Senator Nelson championed GME expansion from the outset, culminating in
her sponsorship of Senate Bill 18, along with Representative Zerwas. TMA had a big hand in crafting the legislation, which serves as the major vehicle for the $53 million dedicated to expanding first-year residency slots in the 2016–17 bien- nium, and helping to reach the TMA and Texas Higher Education Coordinating Board’s goal of 1.1 entry-level GME slots per medical school graduate. Programs can use the money to establish new first-year positions; maintain
previously unfilled slots; continue positions started with 2014–15 grant funding; or plan brand-new programs. The legislation also streamlines existing grant pro- grams and ensures more sustainable funding mechanisms, including the estab- lishment of a permanent fund devoted to GME. (See “Room to Grow,” May 2015 Texas Medicine, pages 45–50, or
www.texmed.org/RoomToGrow.) Tennessee Bailey just finished her second year as a medical student at The
University of Texas Health Science Center in San Antonio and is “very excited” the new GME money offers her a greater chance of staying in Texas to practice geriatrics — or obstetrics and gynecology, or emergency medicine. “I’m waiting for my third year to elucidate that.” But she’s still “nervous” for the graduating classes behind her, now that Texas
is building three to six new medical schools. And Texas still ranks low — 43rd out of 50 states — for physician-to-patient ratios. “Texas has a booming economy, a big population influx, and a lot of new peo-
ple who are just getting introduced to insurance” through the ACA exchange, Ms. Bailey said. “This is a wonderful preliminary step. But to put in four years of medical school and not have an opportunity to finish our training would be devastating.” The legislature also made a boost to undergraduate medical education fund-
ing. (See “Medical Education Wins Big,” page 42.) Physicians also came out winners of a $200 annual tax cut, thanks to House
Bill 7 by Drew Darby (R-San Angelo) and Sen. Kevin Eltife (R-Tyler). The bill eliminates the annual occupational tax paid by physicians and a dozen other professions. Senator Nelson and Rep. Dennis Bonnen (R-Angleton) led the fight for an
August 2015 TEXAS MEDICINE 31
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76