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Texas legislature action

by Michael E. Speer, MD

The Texas Pediatric Society reports a number of victories in the 2001 Legislative session in the areas of children’s and pediatricians’ advocacy. Two of the main priorities of the Texas Pediatric Society (TPS) that were passed involve Medicaid.

1. Increase the Medicaid reimbursement rate. A cross sampling of the reimbursement rates under Medicaid versus the actual cost of providing the service was developed by four TPS members to demonstrate that a pediatrician who sees children under the Medicaid and CHIP programs loses money on every office visit. This report showed the linkage between access to care for children and the reimbursement rates to physicians. As a result of the report, plus pediatrician testimony, the Senate Finance and the House Appropriations Committees approved $50 million to go directly to the most commonly used Medicaid codes. Beginning September 1, 2001, the reimbursement rate for an EPSDT screening increased from $49 to $70.

2. Simplify the Medicaid enrollment process for children. The current enrollment process for Medicaid is cumbersome and time–consuming. As a result, many children are left without any sort of coverage. Under Senate Bill 43, the face-to-face interview requirement is removed, the documentation requirements for the assets test is removed, and children up to age 19 are permitted 12-month continuous eligibility.

Other notable legislative victories included strengthening the child car restraint requirements and a graduated driver’s licensing program. Now the safety seat requirement is for children up to five years old or 36 inches, and the seat belt requirement is to age 17. The graduated driver’s licensing program passed with restrictions on driving at night and multiple passengers in the car during a minor’s first six months of holding a license unless driving on private property.

Some issues will need more work, notably the prompt pay legislation. House Bill 1862 would have provided the teeth that the Texas Department of Insurance (TDI) needed to enforce prompt pay provisions, as well as set strict, clear provisions with which insurance companies would be forced to comply. Although the bill was passed in the House and Senate with a good deal of support, Governor Perry vetoed the bill stating such legislation would lead to more litigation.

TPS also attempted to address problems with the immunization registry that lead to an incomplete registry with little usable information. Under the TPS supported legislation, the “opt-in” process would change to “opt-out.” The House bill stalled in committee; the Senate version passed the Senate but was stopped in the House Public Health Committee.

A full report of the legislative session is available from the Texas Pediatric Society Web site.