As everyone has probably heard the 86th General Legislative Session is all but a memory. Sine Die fell on Memorial Day, May 27th, as it does every odd numbered year and this year we are happy to report there are a handful of good bills impacting the membership of TAHC&H that passed. This week we are highlighting 3 of those bills. Over the next few weeks we will continue to highlight bills so stay tuned to your weekly newsletter for a Perspective you will only get as a member of TAHC&H.
Electronic Visit Verification (EVV) was a top tier issue for TAHC&H this session. Prior to this legislative session TAHC&H began approaching legislative offices that have worked with us on provider issues with EVV. Senator Dawn Buckingham who passed the EVV legislation (SB 894) last session was happy to assist with this next legislative step. In the House, Representative Stephanie Klick filed the companion. Both legislators sit on the committees of jurisdiction in their respective chamber.
SB 1991 was filed in the Senate and HB 4192 was filed in the House. SB 1991 received a hearing on April 25th in the Senate Health and Human Services Committee. It then was passed out of the Senate with substitute language worked on by TAHC&H on May 1st. The bill then headed to the House. HB 4192 was heard in the House Human Services Committee on April 23rd. It did not move forward and was left pending in committee for the duration of the session. TAHC&H provided oral and written testimony along with a couple TAHC&H members who use EVV at both hearings.
SB 1991 made it through the House Human Services committee and was voted on by the full House and passed. What does SB 1991 do? It further refines the EVV system to ensure that PAS providers, future EVV providers and the State have the flexibility to implement systems that will comply with the requirements of the Federal 21st Century Cures Act (2016), while also reducing unnecessary administrative burdens.
• It allows the provider a choice to use their own proprietary system, whether developed internally or purchased, or the state contracted vendor.
• It repeals the date restriction for use of a proprietary system. This allows HHSC to provide for a choice of system that was prohibited by the arbitrary date. As new provider types and client populations are required to start using EVV because of the Federal 21st Century Cures Act, there will be greater flexibility in the system to allow for more seamless transitions.
• It ensures that HHSC can evaluate the feasibility of ensuring that transaction costs currently paid directly to the state contracted vendor continue to be paid, regardless of whether the provider uses the HHSC contracted system or their own system.
• Establishes due process and notification procedures for recoupment of funds related to EVV transaction data. It requires HHSC and MCOs to ensure that providers have the opportunity to work with the MCO on reconciling any discrepant EVV data, before the managed care organization may recoup from the provider. Additionally, it does not allow the MCO to recoup funds greater than 24 months based on their own internal audit leaving providers without any appeal rights. This was very important to our providers as MCOs have been recouping funds related to EVV data without allowing providers sufficient time to reconcile the data resulting in extended appeals, increased administrative burdens and loss of revenue for providers.
The bill is currently with the Governor for his signature making it law. The bill becomes effective September 1, 2019. TAHC&H will be working closely with HHSC as they move through the implementation process as part of the HHS EVV workgroup.
Next up, the Medicaid benefit that just wouldn’t go away……..Home Telemonitoring, also known as Remote Patient Monitoring (RPM). RPM was originally passed in 2011, however it had a sunset date attached of September 1, 2015. The benefit was slow to roll out at HHSC and didn’t get its official start until April 2014. Stakeholder groups including TAHC&H lobbied and successfully made the case in the 84th Legislative Session that ending the benefit after only being implemented a year would be a great disservice to the patients and the time and effort that went into rolling it out the previous year. The legislature agreed and gave it another 4 years with a new sunset date of September 1, 2019.
With both the Health and Human Service chairmanships changing hands in the House and Senate, the opportunity was ripe for a repeal of the sunset date. TAHC&H collaborated with several other stakeholders and coalesced around a single purpose: removing the sunset provision from statute.
There were a handful of bills filed that addressed the issue:
• HB 1063 by Four Price (companion SB 1518 by Dawn Buckingham) is the one bill that stood out and made it through the entire legislative process. It was heard in the House Human Services committee in which TAHC&H provided oral and written testimony. This bill was supported by Children’s Hospital of Dallas and they pushed very hard to get some new pediatric conditions added to the list of conditions that can be monitored remotely. It added that it is available to pediatric patients that are diagnosed with end-stage solid organ disease, have received an organ transplant, or require mechanical ventilation.
The bill also remedied a piece that was missing in the biennial report that HHSC produces to the legislature on December 1st of an even numbered year. The report did not request that HHSC report on the cost savings that home telemonitoring provides to Medicaid. HB 1063 adds the language that HHSC moving forward will have to report the cost savings for not only home telemonitoring but also telemedicine and telehealth.
Lastly, the bill repeals the sunset date that had plagued this benefit for 8 long years. As of September 1, 2019, home telemonitoring will be a permanent benefit and service of Texas Medicaid.
• SB 670 by Dawn Buckingham is the other legislation passed that addresses the repeal of the telemonitoring sunset date. In an effort to ensure its passage, the repeal language for home telemonitoring was amended onto SB 670. This bill is primarily for the telemedicine and telehealth services provided by Texas Medicaid. It too passed and was the safety net in case HB 1063 didn’t make it over the finish line.
• These other bills also had the home telemonitoring repeal language, but did not make it through the legislative process:
o HB 1738 by Ryan Guillen
o HB 2062 by Bobby Guerra
Saving a very important bill for last is one that impacts everyone who is a member of TAHC&H. It has to do with our licensure and is HB 3193 by Gina Hinojosa. This bill changes the date of issuance for a HCSSA license from 2 to 3 years. It does change the fee somewhat for the license, but the legislation caps the maximum amount for a 3 year license in the amount of $2,625. Previously, the maximum amount for the license fee was $2,000.
Now, this sounds like a very simple bill, but nothing is ever simple during our wild Texas legislative session. Senator Nathan Johnson, a freshman from the Dallas Lake Cities area, filed the companion to the bill (SB 1448). SB 1448 did not receive a hearing in the Senate Health and Human Services Committee. HB 3193 passed the house and made its way to the Senate and was then referred to the Senate Health and Human Services Committee. One thing that is important to note is that Senator Charles Schwertner was not selected to continue as chair of this committee. He wasn’t even selected to be a member of the committee. Why is this important to this bill? It’s an interesting story actually.
Last session (and a few sessions before that) Senator Schwertner had filed a bill (SB 933) to raise the penalty from $1000 to $5000 a day on agency’s that were found to have harmed a patient or put a patient in a harmful situation. TAHC&H is definitely supportive of initiatives to ensure agencies always follow the licensure regulations never putting a patient in a harmful situation. However, Senator Schwertner’s bill did nothing to review and amend the “no right to correct” clause for HCSSAs. This is very important if you are considering such a steep increase in penalty. Last session SB 933 didn’t pass.
Moving into this session, TAHC&H approached Senator Schwertner’s office to discuss whether or not he was going to pursue filing the legislation again. His office said no. That brings us back to May 17, 2019 which is the day that HB 3193 was set to be heard in the Senate Health and Human Services committee. Part of TAHC&H’s government affairs team’s responsibilities is monitoring all hearings that have bills of interest. As Senator Johnson laid out HB 3193 in the hearing he announced that he had a committee substitute. This is the moment of “uh oh” we were worried about. Sure enough Senator Schwertner had approached Senator Johnson and asked him to do a committee substitute, which was all of SB 933 from the 85th legislative session. It’s this time in the session where things are moving very fast and legislators and their offices are betting that stakeholders aren’t paying attention because attentions are diverted to something else important like the budget.
Fortunately for TAHC&H members and unfortunately for Senator Schwertner, his bet went south and TAHC&H was paying close attention. TAHC&H staff and your lobby team reached out to Representative Hinojosa’s office and provided the back story of what the amended legislation would now do and the impact it would have on the home health industry. HB 3193 was passed out of the Senate Health and Human Services committee as substituted and passed off the Senate floor. The amended bill returned to the House in which Representative Hinojosa did not concur with the changes to the bill. It then is required to go into conference and the final decisions are made by 5 members of House and 5 members of the Senate. Representative Hinojosa was named the chair of that conference committee as she’s the bill author. She successfully had the Schwertner language removed from the bill returning it to its original language. The bill becomes effective September 1, 2019.
HB 3193 is a great example of a simple bill that can easily get high jacked and turned into a something that would have deep negative impacts. This type of scenario happens more often than not during a legislative session. This is why TAHC&H tracks and follows hundreds of bills during a session because anything that touches Medicaid could easily be amended in a harmful way.
To summarize this week’s highlight of bills we started off with SB 1991 making important changes to the recoupment process for EVV. Next we celebrated HB 1063 that included the repeal of the home telemonitoring sunset date making it a permanent benefit of Texas Medicaid. Lastly, you heard a story of how a very simple bill can easily get high jacked with language that would have had devastating effects. HB 3193 was not the bill to go down that dark path. It ended up passing as it was filed changing the date of issuance for a HCSSA license from 2 to 3 years.
Stay tuned in the coming Perspectives for additional articles highlighting important legislation that was passed during the 86th General Session. Up next, Medicaid managed care.