With help from Rep. J.D. Shefield, DO (R-Gatesville), left, TMA passed legislation to promote immunizations and help physicians cope with Affordable Care Act exchange plans.


know exactly what the plan is and what their coverage and [payment] portion are before we start them on an expensive medicine. We don’t like surprises, and patients don’t either.”


BALANCE BILLING PRESERVED; SCOPE EXPANSIONS AVERTED Transparency overall was a big theme for lawmakers heading into the session. TMA worked with the National Multiple Sclerosis Society (NMSS) to support


House Bill 1624 by Rep. John Smithee (R-Amarillo) as another layer of health plan accountability and an avenue to help patients make informed choices about their health plan coverage. The measure strengthens requirements for health plans to publicly post on their websites their network directories and drug for- mularies. TMA also collaborated with NMSS on House Bill 1621 by Rep. Greg Bonnen, MD (R-Friendswood). The bill requires health plans to give physicians and patients 30 days’ notice before denying a prescribed drug or intravenous medication. If appealed, health plans and utilization review organizations must provide expedited review by a physician of the same or similar specialty as the prescribing physician. Maneuvers expected to require physicians to publicly post their charges and


adhere to binding quotes went nowhere. Instead, a possible ban on balance bill- ing captured lawmakers’ attention as insurers’ increasing use of questionably thin networks and shrinking maximum allowable amounts for some out-of-net- work services are increasing the frequency and size of the out-of-network bills patients receive. (See “Balance-Billing Ban Back in 2015 Legislature,” May 2015 Texas Medicine, pages 33–38, or www.texmed.org/BalanceBillingBanBackIn 2015Legislature.) Testimony by TMA physicians helped deter a bill to ban balance billing al-


38 TEXAS MEDICINE August 2015


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