The Texas Medical Association had a very productive 2023 Texas legislative session. Of the 8,046 bills filed in 2023, TMA tracked 2,158 (27%). The TMA lobby team and TMA physicians worked to support the main agenda: to protect the practice of medicine and to protect the patient-physician relationship. The TMA’s Council on Legislation established TMA’s Top 10 2023 Legislative Priorities in the fall of 2022. These same legislative priorities will be at or near the top of the list for the Texas legislative session in 2025:
1. Stop scope-of-practice creep. There was a record number (130) of potentially negative scope-of-practice expansion bills filed during the 2023 legislative session. TMA was able to stop all bills from moving forward, thus preserving patients’ access to physician-led team care. Increase GME funding. TMA won GME workforce solutions that expand access to care in the short term and reinforce the workforce long term with investments in 2024-2025 graduate medical education, physician residency programs, and medical school tuition loan repayment.
2. Improve women’s reproductive health: The patient-physician relationship and patient safety relating to the interpretation of Texas abortion statutes were serious concerns of physicians as we entered the 2023 legislative session. A last-minute bill signed by Governor Abbott with the recent interpretation by the Texas Medical Board, provides some further definitions of “exercising reasonable medical judgement” when treating potentially life-threatening complications related to Texas abortion ban laws. Contraceptive measures that passed in 2023 include a bill requiring health plans, including Medicaid, to provide a 12-month supply of contraception at one pharmacy visit after receiving an initial 90-day supply.
3. Increase in physicians’ Medicaid payments: TMA helped pass a 6% rate increase in Medicaid payments to improve access to pediatric and
maternal services. The budget also added a 6% Medicaid payment rate increase for labor and delivery services. Legislators also approved a $50 million grant program for rural hospital maternal health care.
4. Improve coverage for women and children on Medicaid. TMA scored long-awaited wins for maternal health with the extension of postpartum Medicaid coverage from two months to 12 months. Behavioral health services for women and children also received wins, with funding for 2.3 billion for overall mental health services for adults and children. There was also an increase from $25.9 million to $28 million for loan repayment for mental health professionals.
5. Protect 2003 medical liability reforms: preservation of the landmark 2003 Tort Reform Act. The TMA supported legislation that helps to strengthen the Texas Medical Board with an additional $5 million in funding.
6. Protect physician autonomy. Uphold corporate practice protections; despite attempts from corporate entities trying to criminalize the practice of medicine, TMA worked to prevent any new legislation that would erode the patient-physician relationship.
7. Reduce prior authorization hassles: The 2021 gold-card success, the TMA successfully helped pass legislation that restricts insurers from requiring more than one prior authorization for patients with autoimmune and other blood disorders. The TMA also worked to help pass legislation that prohibits the practice of white bagging (insurers requiring physicians to purchase drugs through the health plan’s specialty pharmacy) and helped pass legislation that bans “copay accumulators” (health plans cannot pocket drug manufacturer coupons).
8. Protect vaccine laws. Modernize ImmTrac2; The TMA helped fight off 40 bills that threatened to erode access to childhood vaccinations and others that sought to damage the state’s vaccine infrastructure.
9. Improve network advocacy. Protect Texas/surprise-billing law; The 2023
session ended with the unanimous passage of legislation that will support the state’s network adequacy rules and that tackles the waiver process, which can potentially leave patients unprotected.
10. Ensure regulation and taxing of ecigarettes. TMA scored a huge win, with the Legislature budgeting a $4.3 million increase for nicotine cessation as well as legislation that makes it more difficult to market e-cigarettes to youth. Other public health wins included passing legislation to make naloxone available on all school campuses, budgeting $300 million for CPRIT, and increasing the budget for STI prevention to $30 million.
TMA’s grassroots efforts helped in these hard-fought legislative wins. Four hundred fifty physicians, medical students, and alliance members participated in First Tuesdays at the Capitol during the 2023 legislative session. In doing so, TMA visited all 181 legislative offices during First Tuesdays. TMA members sent 1,700 messages to their legislators via phone or email, 61 TMA physicians testified, and 74 physicians gave live and/or written testimonies.
The 2025 Texas Legislative Crystal Ball
One of the biggest questions as we approach the 2025 legislative session is who will be the 2025 speaker of the House of Representatives. Having survived a close runoff race, past Speaker Dade Phelan appears to have the clearest path to being re-elected speaker for the 2025 legislative
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session. However, since Republicans took over the House of Representatives, no speaker has been elected without some Democratic support. Phelan has voiced his list of upcoming legislative priorities, which include a broad range of policy issues. He has already directed his committee leaders to examine the use of school voucher programs in other states as well as finding ways to drive down property taxes for homeowners. The infighting between Phelan and Lt. Governor Dan Patrick could potentially lead to a very toxic environment within the House of Representatives.
There are potential medical issues that are likely to be debated in the 2025 legislative session:
1. Healthcare Access and Insurance Coverage: Texas has one of the highest uninsured rates in the country. Debate is likely over expanding Medicaid under the Affordable Care Act, with proponents arguing that it would extend coverage to low-income adults currently ineligible. Currently, the proposed changes in Texas Medicaid contracts would shuffle the health plans of 1.8 million low-income Texans, including children, beginning in late 2025.
2. Insurance Market Reforms: Discussion could include measures to stabilize the insurance market through subsidies or reinsurance programs to reduce premiums. HSA incentives might also be in discussions to better promote consumerdriven healthcare.
3. Telemedicine: There is the potential for legislation to establish clearer regulations integrating telemedicine into the healthcare system while maintaining patient safety and privacy. Legislators also might consider legislation to ensure that telehealth services are reimbursed on par with in-office visits by retail insurance companies and Medicaid. Efforts to streamline licensure processes for healthcare professionals providing telehealth services is another possible legislative item.
4. Bioethics and Medical Research: The area of “genetic privacy” may see legislation to protect genetic information and data privacy in medical research and healthcare settings.
5. AI and Healthcare: It is highly likely that multiple bills will emerge related to efforts to establish guidelines for the ethical use of artificial intelligence in healthcare, including issues of transparency and accountability. The TMA has recently established a committee on AI to stay in front of this challenging emerging field that is changing faster than we could ever have imagined.
6. Maternal and Child Health: There will undoubtedly be legislation that addresses efforts to improve upon Texas’ low rating in maternal morbidity and mortality by supporting improvements in prenatal and postnatal care. There exists a current group that is fighting for change in current Texas abortion legislation: The Texas Campaign for Mothers. It is a group of mothers, daughters, wives, sisters, and sistersin-laws, as well as physicians, who live in Texas and feel strongly that there is a need to provide relief for Texas mothers and women who want to become mothers and the doctors who care for them. This effort crosses party lines and ideologies. The Texas Campaign for Mothers has four goals in addressing potential changes to abortion legislation in Texas: (1) ensuring the health-of-the-mother exception is meaningful and protects pregnant individuals facing complications; (2) providing women the right to make informed choices in cases of rape, incest, or fatal fetal abnormalities; (3) safeguarding access to IVF; and (4) removing criminal penalties for women with pregnancy complications. ACOG and TAOG serve as resources for any potential 2025 legislative changes. These are just a few of the issues and ongoing concerns in healthcare and medicine that are likely to continue shaping upcoming Texas legislative debates as they seek to address the evolving needs of Texas healthcare and the needs of our patients. DMJ
Fun facts for July:
July 1: Canada Day & International Joke Day, National Postal Workers Day, and National Doctors’ Day
July 2: World UFO Day
July 3: National Eat Beans Day
July 4: USA Independence Day
July 6: National Kissing Day
July 11: National Mojito Day
July 12: National Eat Your Jell-O Day and National Pecan Pie Day
July 14: Bastille Day
July 15: National Gummi Worm Day
July 17: National Hot Dog Day
July 19: National Daiquiri Day
July 21: National Junk Food Day
July 24: National Tequila Day
July 25: National Wine and Cheese Day and National Hot Fudge
Sunday Day
July 27: National Scotch Day
July 29: National Lasagna Day
July 30: National Cheesecake Day
Legal Guidance Regarding Emergency Care LEGAL CORNER
By Brandon Kulwicki, Attorney with Hall, Render, Killian, Heath & Lyman, P.C.
The upcoming legislative session presents two provisions that may trigger the need for legal guidance. The legislative preview indicates that certain lawmakers desire to remove children’s health plans from major Medicaid and insurance contracts, while other lawmakers intend to continuously increase access to mental health services. Regardless of the outcome, providers should be aware of the laws and regulations regarding the treatment of emergency patients, which apply to mental health patients and uninsured children.
Both mental and physical health are covered by the Emergency Medical Treatment & Labor Act. Therefore, regardless of whether the changes from the legislative session are applied, all patients that present to a hospital’s emergency department are legally entitled to receive a medical screening, stabilizing treatment, and, if necessary, transfer to an appropriate care facility without regard to the patient’s ability to pay for such services.
As it pertains to mental health services, providers should be aware that when a patient lacking capacity requires psychiatric evaluation and treatment, the provider must obtain consent from an authorized individual (e.g., POA, conservator, guardian, etc.). If no such person is available, the provider must seek lawful detention of the patient. If the patient leaves against medical advice and poses a substantial risk of harm to themselves or others, a mental health officer should be called. If the patient is onsite and attempting to leave or to harm others, physical restraint may be used when necessary, per facility policies. All actions must be documented in the patient record.
As it pertains to children’s health, minors generally cannot consent to medical, psychological, psychiatric, or surgical care unless legally emancipated. Parents or managing conservators usually provide consent, with either parent able to consent in emergencies. However, for urgent or emergent care needs, providers should not
delay treatment due to lack of consent and should try to contact parents. If parents are unreachable, certain relatives, school officials, and caretakers can consent under Texas law.1 Moreover, in emergency situations, treatment should not be withheld simply because the child does not have adequate health insurance. DMJ
This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, please contact Brandon Kulwicki at (214) 615-2025.
2025 Legislative Preview & First Tuesdays Opportunities
Jon R. Roth, MS, CAE
As we pass the midpoint of 2024 and the primaries and special elections have been settled, we must note some significant changes to the legislative makeup, both at a local and congressional level here in North Texas. Using failed legislative attempts last session to pass the governor’s priority bill on school vouchers and a failed impeachment of Attorney General Ken Paxton as political backdrops heading into the March primaries, we witnessed record spending by the parties to oust incumbent legislators who did not vote for the governor’s voucher bill and others who voted to impeach the attorney general. In many instances, these backed newcomers won over the incumbents, which resulted in more than a dozen legislators being voted out and new governor- and attorney generalbacked candidates winning those seats. This turnover could prove to be challenging for medicine, as we will need to spend significant time and resources educating these new legislators on issues such as scope of practice, prior authorization, health plan challenges, Medicaid, and myriad other items. Here are a few other significant
changes close to home that will impact us going into the next session.
Longtime friend of medicine Julie Johnson vacated her Texas House seat to run for a congressional seat. After coming through a crowded primary field without a runoff and in what has been a safely democratic seat, she is expected to win her election in November. Physicians in organized medicine look forward to maintaining a strong relationship with her and engaging on issues happening at a federal level.
North Texas legislators, and in collaboration with TMA, education and outreach materials will be shared during these important meetings.
One of just a few physicians in Congress, Congressman Michael Burgess, MD, also announced his retirement after serving 11 terms and gaining significant seniority in the chamber. Also leaving is Congressman Colin Allred, creating the opening for Julie Johnson to run.
At a state level, other changes in North Texas include longtime Representative Stephanie Klick losing her seat, which will create a change in the House Public Health Committee leadership. While sometimes adversarial on issues related to scope of practice, she often aligned with TMA on core public health issues. Also, practicing veterinarian and longtime Representative Lynn Stuckey lost his North Texas seat. Additionally, incumbent and friend of medicine Justin Holland lost his seat in far north/ east Dallas, Collin and Rockwall counties.
With these and other changes, engaging and educating our elected officials on issues important in medicine will be even more imperative. While it may seem early, now is the time to make plans to attend TMA First Tuesdays at the Capitol! These take place during the legislative session the first Tuesday of February, March, April, and May. DCMS will arrange meetings with our
DCMS is proud of the work our member physicians did in the last legislative session, and we have four physicians serving on the TMA Council on Legislation this session: Drs. Mark Casanova, Zachary Jones, Joe Saad, and Roger Khetan. During the last session, DCMS members led on issues related to information blocking and end-of-life care, providing testimony and working alongside the TMA lobby team to craft legislation and meet with stakeholders.
Now is a great time to alert DCMS to any other issues that may arise during the next session or bring forth legislative ideas. Please don’t hesitate to reach out to info@dallascms.org to share what you’re experiencing within your practice. DCMS and TMA stand ready to play defense whenever threats arise to the physician-patient relationship, but where organized medicine often shines is in the ideas that our members bring forward to issues or for advances in practice.
We know the legislative session will likely come with challenges, as we have witnessed over the past two sessions, and we have observed what has happened in other states across the country, but it’s through our collective strength of advocacy as organized medicine that we can bring about positive change. We look forward to your engagement to make a difference in 2025. DMJ
Jon R. Roth, MS, CAE DCMS EVP/CEO
NEW DCMS HEADQUARTERS IN THE HEART OF UPTOWN
CAMPAIGN FOR THE FUTURE
HOUSE CALL
Meet the DCMS Members serving on the Texas Medical Association Council on Legislation
Joe Saad, MD
What first got you engaged with advocacy and legislative issues?
Some 20 years ago, a major healthcare insurance company decided they would no longer pay us for a large portion of the services we provided to our patients. It surprised me that it could make a unilateral decision like that and refuse to negotiate. It turned out that the decision impacted all pathology practices. I enlisted the help of the Texas Society of Pathologists, which then asked the Texas Medical Association for help. Although we were only partially successful in our efforts to roll back the decision, it drove home how important it is to actively advocate for our patients and our profession. We are up against huge odds. Payers have the money and resources to push us around. Unless we work together and utilize all means available to us, especially our legislators, we will not be successful in protecting our patients and practices from onerous laws and regulations. It is very important to be a member of your county and state medical association, but it is more important to be an active member.
What’s one thing you are excited about for the 2025 legislative session?
All of it. It is exciting and exhausting all at the same time. We must protect past gains and continue to advocate for patients and physicians and the sanctity of that relationship. We must educate lawmakers and help them to help us help our patients.
What issue do you think most urgently needs to be addressed that impacts physicians?
Fair payment and access to care. They are related, and Texas needs to do a better job in providing healthcare to its residents. The number of uninsured is unacceptable. They need coverage, and Medicare and Medicaid need to provide payments that cover the cost of providing that care. We also need to rein in abuses by insurance companies that put profits over patients. The regulators need to do their job and the legislators need to hold everyone accountable.
Roger
Khetan, MD
What first got you engaged with advocacy and legislative issues?
I am a middle-aged physician now, but my introduction to advocacy came in 1998 during my chief residency year in Houston. I attended a meeting in San Diego for the ACP and then went to a TMA meeting that year along with Harris County Medical Society where the talk was focused on Medicare reimbursement. I did not realize all the caveats that existed to making a “simple” decision on increasing reimbursement for physicians. I moved to Dallas in 1999, and I met Dr. Rick Synder and Dr. David Winter, who both showed me some of the fun of political advocacy. As they said, you can work 1:1 daily with patients, but the advocacy may be 1:100,000 when you are fighting in DC or Austin for your colleagues and patients, as your voice may be the one to change the tune of the legislature. I have continued with that mantra since; and like others who are very active in the Dallas County Medical Society, I feel like the repeated barrage by physicians to be the leader of the healthcare team and advocate for our patients and colleagues is still one of my top roles. Please note, all of this just stemmed from a tap on my shoulder at the meeting in TMA and ACP in 1998 by several colleagues who are still active in advocacy. It just takes one person to make a difference and show you the importance of advocacy.
What’s one thing you are excited about for the 2025 legislative session?
I think the main thing I am excited about this legislative session is trying to cultivate new relationships with a lot of new legislators who may not be up to date on issues (especially scope of practice and the safety of our patients). It is fun meeting new legislators and getting our points across to them before session as well as during session.
What issue do you think most urgently needs to be addressed that impacts physicians?
The biggest issue that we need to keep fighting is the encroachment on scope of practice. We cannot let our guard down, and the number of hours we all trained supersede those of all other specialties, and this includes therapists, pharmacists, podiatrists, optometrists, nurse practitioners, and physician associates. I love working with all of them, but we need to stay focused as the head of the healthcare team, and independent practice is dangerous for our patients when medical decisions are made by those less trained. I mean no harm to any of my friends who are healthcare workers, but a physician needs to be the lead.
Zach Jones, MD
What first got you engaged with advocacy and legislative issues?
I was fortunate to have trained at a residency program that emphasized political advocacy. Oftentimes, due to program politics, advocating for physician-led care is seen as polarizing among clinicians with different levels of training. However, when done properly, residents and attendings can effectively advocate for their profession while maintaining a professional and respectful work environment. I am thankful to my mentors at the UT Houston McGovern Medical School Anesthesia Residency program. They engaged me in a meaningful way that fostered advocacy for both myself and my patients beyond the operating room.
What’s one thing you’re excited about for the 2025 legislative session?
The 2024 spring primaries produced a substantial turnover in elected officials, particularly the state house. This will lead to a shakeup of committee chairs during the 2025 session, and I sense opportunity. New relationships need to be established with legislators who are unfamiliar with the issues that concern the house of medicine. For DCMS members who are new to advocacy, now is the perfect time to schedule a coffee or sit-down meal with a newly elected legislator. They are wanting to learn from constituents about issues they are unfamiliar with, and establishing a rapport at the beginning of someone’s career is the best way to influence and guide their decisions.
What issue do you think most urgently needs to be addressed that impacts physicians?
The vertical integration of healthcare impacts all Texans, and is the most urgent issue we face. The Change Healthcare clearinghouse cyberattack this past March/April halted many physician groups’ ability to process billing overnight, forcing them to scramble to pay their staff and bills. The more consolidation in healthcare, the more vulnerable we are. Now in July, other than superficial congressional hearings, no accountability has been required of United Healthcare’s subsidiary company Change Healthcare. Further, the mass-employment of physicians by Change Healthcare’s parent company Optum (also owned by United Healthcare) further erodes the individual agency I first experienced as a resident, which drew me into the political side of medicine. The high cost of care, the unlevel playing field for physician negotiations, and the systems vulnerability are all due to vertical integration of healthcare.
Mark Casanova, MD
What first got you engaged with advocacy and legislative issues?
I suppose like many, it takes an issue hitting close to home to light the fire of advocacy. For me, personally, this was end-of-life care-related legislative issues … specifically what many of us saw as “threats” to medicine’s ability to provide ethically balanced end-of-life care in nearly impossible situations. For a palliative care physician and clinical ethics consultant like myself, legislative efforts that began in earnest around 2005–2007 “hit very close.to home.” I believe it was during the 2007 legislative session that I testified, along with my mentor, Dr. Robert Fine, before the House Health and Human Services Committee … at 2 in the morning. That experience taught me many things, including how hard our legislators and their staff work. More importantly, it became abundantly clear to me that “our physician voice matters!” Sadly, in some ways, I’ve had the opportunity to testify at almost every legislative session since 2007, before both the Texas House and Senate. Over that time, I developed a better understanding of “the other side’s” perspective. The result was a multi-month negotiation effort, at the behest of key legislative leaders. This led to an omnibus reformation of the Texas Advanced Directives Act (TADA), passing in 2023, which I do truly believe brought the respective stakeholders’ views and values to an improved place of compromise rooted in listening, patience, advocacy, and grace.
What’s one thing you’re excited about for the 2025 legislative session?
I’m not sure if I’m more “excited” or “nervous” in terms of what is to come in the next legislative session. It is the general tendency for medicine to find ourselves in a defensive stance when it comes to legislative issues. To this end, I will personally be keeping my eyes open for potential end-of-life care-related legislation or my other area of interest, public health. My “excitement/ fear” is that I anticipate there to be work to be done …
What issue do you think most urgently needs to be addressed that impacts physicians?
I would have to say Medicare physician payment reform. While this may not be as granular of an issue in the halls of the State Capitol, I do believe if we hope to accomplish something meaningful that is also long overdue, it will have to be an allhands-on-deck approach … with a great deal of grassroots-level advocacy.
Shaping Texas’ Healthcare Future: Insights into the 2025 Legislative Session
By Brandon Kulwicki and Avi Kerendian, Attorneys with Hall, Render, Killian, Heath & Lyman, P.C., and Rachelle Madison, Summer Associate with Hall, Render, Killian, Heath & Lyman, P.C.
The Texas legislative session stands as a pivotal period in the state’s governance, representing a crucial opportunity for lawmakers to shape policy, allocate resources, and address the diverse needs of Texans. As the primary forum for lawmaking at the state level, the session holds immense significance in determining the direction of Texas’ governance and its impact on residents’ lives. The decisions made during the session have far-reaching implications, shaping the legal framework, resource allocation, and quality of life for Texans across various sectors, from healthcare and education to economic development and social services.
A preview into the 2025 legislative session indicates that both the House and the Senate agendas are prioritizing the regulation of healthcare. With the Texas legislative session scheduled to reconvene for its 89th session on January 14, 2025, Lieutenant Governor Dan Patrick and Speaker of the House Dade Phelan have released their interim assignments, providing a comprehensive scope for the priorities lawmakers are directed to investigate for the upcoming legislative session.
Healthcare is a crucial focus for Texas lawmakers due to its impact on public health, economic growth, and social equity. Addressing healthcare issues aligns with lawmakers’ mandate to protect constituents’ well-being and promotes economic stability through investments in healthcare infrastructure and innovation. A few of the interim charges include investigating Medicaid contracts, improving access to mental health care, and monitoring the implementation of legislation addressed by the 88th Legislature.
Proposed Changes to Medicaid Prompts Legislative Response
Texas health officials are considering removing the state’s three largest nonprofit children’s health plans from major Medicaid and children’s health insurance contracts. This move could impact around 1.8 million
low-income families, leading to changes in managed care organizations, a shift toward for-profit companies, and the introduction of new national plans. This proposed change would trigger a massive effort by the state to inform all the families of the change, which would take effect late next year if the plan holds. While the proposed changes have not been finalized yet, it would affect six managed care organizations across the state, along with hindering the healthcare plans of 1.8 million Texans, in late 2025.1
In reaction to the backlash regarding this recent decision, House Speaker Phelan has instructed the Health and Human Services Committee to examine the state’s role in Medicaid contracts and managed care, a matter that has placed pressure on state human services officials due to numerous canceled procurements and leading to lawsuits involving hundreds of billions of dollars.2 Similarly, Lieutenant Governor Patrick has also charged the Health and Human Services Committee with implementing initiatives to improve the general oversight and containment of Medicaid spending.
Senate’s Legislative Charge
With respect to the Senate’s interest in behavioral health, Lieutenant Governor Patrick has charged the Senate with evaluating mental health care access at large. First, the lieutenant governor has charged the Finance Committee with the responsibility of overseeing the execution of Senate Bill 30, which earmarked $2.2 billion for the expansion of mental health services and inpatient facilities throughout Texas. The committee will report on the progress regarding the construction of inpatient facilities while assessing and reporting on the effectiveness of expenditures afforded to mental health services. Additionally, the lieutenant governor has charged the Veterans’ Affairs Committee with examining existing initiatives that offer both direct and indirect mental health support to veterans in Texas; pinpointing obstacles hindering rural veterans’ access to mental health resources; and proposing strategies to enhance mental health accessibility for veterans statewide.
Lastly, the lieutenant governor has charged the Health and Human Services Committee with assessing the care and services presently accessible to the increasing number of Texas children with high-acuity mental and behavioral health needs. The committee is tasked with offering suggestions for enhancing access to care and services for these children that will support family preservation and prevent them from entering the welfare system. 3
In addition, Lieutenant Governor Patrick has also charged the Health and Human Services Committee with evaluating healthcare, health insurance, and cancer prevention while also monitoring the implementation of legislation addressed by the Senate and passed by the 88th Legislature. First, the committee is tasked with assessing the current availability of primary and mental health services. Within this scope, the committee is charged with investigating the potential benefits of regulatory and licensing flexibilities in enhancing access to care, especially in medically underserved regions of Texas, and providing recommendations, if applicable, for improving access to care while upholding patient safety standards. Second, the committee is tasked with analyzing the health insurance landscape in Texas, including non-employer-based options, while also identifying the challenges that Texans encounter while navigating the intricate health insurance market and offering recommendations aimed at facilitating individuals obtaining healthcare coverage. Third, the committee is charged with identifying and proposing strategies to tackle the increasing impact of cancer on Texans by assessing state investments in cancer prevention and screenings, such as “CT,” “MRI,” and “PET” scans. Moreover, the lieutenant governor is prioritizing funding for cancer prevention efforts at the Cancer Prevention and Research Institute of Texas. Finally, the lieutenant governor has charged the committee with monitoring the implementation of legislation such as:
• Senate Bill 7, which prohibits private employers from implementing certain COVID-19 vaccine mandates and au-
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thorizes an administrative penalty;
• Senate Bill 24, which focuses on the powers and responsibilities of the Health and Human Services Committee, including the transfer of specific powers from the Department of Family and Protective Services; Senate Bill 25, which addresses support for nursing-related postsecondary education, including scholarships, loan repayment assistance, and grants to nursing education programs; and
• Senate Bill 26, which concerns local and mental and behavioral health authority audits, as well as reporting services, and programs related to mental and behavioral health.4
Other Topics to Look Out For
Beyond the legislative issues addressed by Lieutenant Governor Patrick, there are additional concerns regarding new proposed rules that could disrupt the healthcare system. Upcoming decisions by the
Texas Medical Board (TMB) will be crucial in determining the prioritization of women’s health, specifically concerning lifesaving abortions and in vitro fertilization (IVF) regulations.
Generally, abortions at any stage of pregnancy are prohibited under Texas statutes.5 However, abortions may be permitted under the strict exception of a medical emergency, which is defined as a “life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.”6 In utilizing this exception, physicians are required to exercise reasonable medical judgment on whether an applicable medical emergency exists that would justify performing an abortion.7 However, the TMB’s proposed rules fail to clarify what specific conditions or scenarios qualify as medical emergencies, except for ectopic pregnancies, which are already covered
under Texas law. This lack of guidance creates significant uncertainty for physicians, who must use their medical judgment under intense legal and ethical pressures, leaving them uncertain about when an abortion could be considered lifesaving. The TMB intends to meet on June 20-21 to discuss whether to approve the proposed rules as they stand or to modify them and seek additional comments.8
Furthermore, the TMB’s proposed rules have been criticized for placing an undue burden on physicians. They require doctors to document whether they first attempted to transfer the patient to another facility to avoid performing a lifesaving abortion. Such detailed record-keeping could delay necessary medical interventions.9 Combined with the ambiguous language about what constitutes a medical emergency, these strict documentation guidelines make it harder for physicians to effectively apply the exception for lifesaving abortions, potentially harming patients.10
Moreover, in February, the Alabama
Supreme Court issued a ruling that frozen embryos created through IVF should be considered children under the state’s Wrongful Death of a Minor Act (Act).11 This decision came from a case that allowed a couple to proceed with their lawsuit after their frozen embryos, stored at a hospital’s fertility clinic, were destroyed. The court’s ruling states that the Act applies to “all unborn children, regardless of their location,” meaning embryos outside the womb are included. This ruling has sparked controversial discussions within the Texas Legislature about “fetal personhood” and access to IVF treatment. In response, Governor Abbott has expressed his support for maintaining access to IVF treatment but did not urge the Legislature to take specific actions to protect it.12 Conversely, U.S. Senator Ted Cruz is actively working to safeguard IVF access. He has filed an IVF Protection Act, which would prevent states that ban IVF from receiving Medicaid funding. While this Act appears promising, its future is uncertain, as the Texas Supreme Court is considering a case that could “upend IVF in Texas.”13 Therefore, the protections of IVF and lifesaving abortions remain uncertain.
Conclusion
The Texas legislative session serves as a critical juncture for addressing the state’s pressing healthcare needs and shaping the future of public health policy. With healthcare is at the forefront of legislative agendas in both the House and the Senate, lawmakers are poised to tackle a range of issues, from Medicaid contracts and mental health access to cancer prevention and insurance market complexities. The proposed initiatives reflect a concerted effort to improve healthcare access, enhance patient outcomes, and bolster the state’s healthcare infrastructure. As the session unfolds, Texans can
anticipate significant legislative action aimed at addressing the diverse healthcare challenges facing the state and ensuring a healthier future for all residents. DMJ
This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, please contact Brandon Kulwicki at (214) 615-2025, Avi Kerendian at (214) 615-2038, or your primary Hall Render contact.
Brandon Kulwicki and Avi Kerendian are attorneys with Hall, Render, Killian, Heath & Lyman, P.C., a national law firm focused exclusively on matters specific to the healthcare industry. Please visit the Hall Render Blog at http://blogs.hallrender. com/ for more information on topics related to healthcare law.
References
1. Karen Brooks Harper, Proposed Changes to State Medicaid Plans Could Shake Up Health Coverage for 1.8 Million Low-Income Texans, THE TEXAS TRIBUNE (Apr. 18, 2024), https:// www.texastribune.org/2024/04/18/ texas-medicaid-provider-contracts/.
2. Joshua Fechter & Robert Downen, Dade Phelan Directs House Leaders to Revisit Vouchers, Property Taxes in the Next Legislative Session, THE TEXAS TRIBUNE (May 8, 2024), https:// www.texastribune.org/2024/05/08/ dade-phelan-texas-house-interimcharges/.
3. Emma Freer, Texas Senate Interim Charges Underscore TMA Legislative Priorities, TEXAS MEDICAL ASSOCIATION (Apr. 29, 2024), https://www. texmed.org/TexasMedicineDetail.
aspx?id=64101.
4. Dan Patrick, 2024 Interim Legislative Charges, THE UNITED STATES OF TEXAS LIEUTENANT GOVERNOR (Apr. 11, 2024), https://www.ltgov.texas.gov/ wp-content/uploads/2024/04/2024Interim-Legislative-Charges.pdf.
5. Tex. Health & Safety Code § 170.002.
6. Tex. Health & Safety Code §§ 171.0124, 171.002(3).
7. Tex. Health & Safety Code § 170A.001(4).
8. Brandon Kulwicki & Avi Kerendian, Navigating the Ambiguity of the Texas Medical Board’s Proposed Rules on Emergency Abortions, HALL RENDER (Mar. 28, 2024), https://www.hallrender. com/2024/03/28/navigating-theambiguity-of-the-texas-medicalboards-proposed-rules-on-emergency-abortions/.
9. Eleanor Klibanoff, New Reporting Requirements for Life-Saving Abortions Worry Some Doctors, THE TEXAS TRIBUNE (Apr. 25, 2024), https:// www.texastribune.org/2024/04/25/ texas-medical-boardabortion/#:~:text=Texas’%20laws%20 allow%20abortions%20to,loss%20 of%20their%20medical%20license.
10. Id.
11. LePage v. Ctr. for Reprod. Med., P.C., Nos. SC-2022-0515, SC-2022-0579, 2024 Ala. LEXIS 60 (2024).
12. Eleanor Klibanoff, Gov. Greg Abbott Signals Support for IVF in Texas After Alabama Ruling, THE TEXAS TRIBUNE (Feb. 26, 2024), https://www. texastribune.org/2024/02/.
13.Eleanor Klibanoff, Ted Cruz Files Bill to Protect IVF, THE TEXAS TRIBUNE (May. 20, 2024), https://www.texastribune. org/2024/05/20/ted-cruz-texas-ivf/.
New Leaders In Dallas Medicine
Zaheer Ahmed, MD Hematology/Oncology
Simmy Aloor, MD Pediatrics
Melanie Anderson, MD Emergency Medicine
Kelly Aschenbeck, MD Dermatology
Lee Babbel, DO Anesthesiology
Alexis Barina, MD Internal Medicine
Anna Cabeca, DO Obstetrics and Gynecology
Mengchen Cao, MD Emergency Medicine
Ripple Chokshi, MD Anesthesiology
Frances Cobb, MD Obstetrics and Gynecology
Justin Comer, MD Physical Medicine & Rehabilitation
Chandana Ravikumar, DO Neonatal-Perinatal Medicine
Jesse Christ Rayan, MD Radiology
Dheeraj Reddy, MD Hematology/Oncology
Essa Riaz, MD Anesthesiology
Migdalia Saloum, MD Anesthesiology
Sharon Sandell, MD Pediatrics
Stephanie Saxton-Daniels, MD Dermatology
Shiraj Sen, MD Hematology/Oncology
Michael Short, MD Family Medicine
Manavjot Sidhu, MD Cardiovascular Disease
Christopher Skillern, MD Emergency Medicine
Erica Solis, DO Pediatrics
David Spann, MD Anesthesiology
Hitham Tayoun, MD Pathology, Anatomical/ Clinical
Aminidhan Thakkar, MD Emergency Medicine
Denny Thomas, DO Emergency Medicine
Eric Tretter, MD Anesthesiology
Shamita Trivedi, DO Endo, Diabetes & Metabolism
Sara Valek, MD Anesthesiology
Moncy Varkey, DO Family Medicine
Christopher Wang, MD Anesthesiology
Bethany Williams, DO Anesthesiology
Andrea Wolf, MD Pediatrics
Hani Yousif, MD Internal Medicine
Review of the State of Texas 2024 Interim Legislative Charges
By Dallas County Medical Society
As part of the legislative process, leadership such as the governor and lieutenant governor may release Interim Legislative Charges. These interim charges, along with their eventual session priorities, indicate areas in which they hope to see legislative attention throughout interim activities and the session. These charges may serve as a directive for committees to investigate, analyze, and propose solutions to pressing state matters.
The Dallas County Medical Society (DCMS), along with TMA, is mindful of these stated priorities in understanding the legislative environment and areas of focus. By reviewing the charges, the DCMS and TMA will aim to identify healthcare issues and priorities that align with our mission to promote the well-being of patients and the medical community, as well as identifying areas for which we may have concerns. As always, through
collaboration with state legislators and other stakeholders, DCMS and TMA will seek to advocate for policies that improve healthcare access and quality in Dallas County and throughout Texas. Our proactive approach ensures that the voices of healthcare professionals and patients are represented in the legislative process. The charges related to healthcare published in the official document are as follows and solely represent the priorities of Lt. Gov. Dan Patrick in preparation for the 89th Legislature.
Health and Human Services Committee
Children’s Mental Health: Review care and services currently available to the growing population of Texas children with high-acuity mental and behavioral health needs. Make recommendations to improve access to care and services for these children that will support fam-
ily preservation and prevent them from entering the child welfare system.
• Access to Healthcare: Evaluate current access to primary and mental health care. Examine whether regulatory and licensing flexibilities could improve access to care, particularly in medically underserved areas of Texas. Make recommendations, if any, to improve access to care while maintaining patient safety.
• Health Insurance: Examine the Texas health insurance market and alternatives to employer-based insurance. Identify barriers Texans face when navigating a complex health insurance market. Make recommendations that help individuals obtain healthcare coverage.
• Cancer Prevention: Identify and recommend ways to address the growing impact of cancer on Texans by evaluating state investments in cancer prevention and screenings, including, but not limited
to, “CT,” “MRI,” and “PET” scans. Study and make recommendations on funding adequacy for prevention efforts at the Cancer Prevention and Research Institute of Texas.
• Monitoring: Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services and passed by the 88th Legislature, as well as relevant agencies and programs under the committee’s jurisdiction. Specifically, make recommendations for any legislation needed to improve, enhance, or complete implementation of the following:
1. Senate Bill 7, Third Called Special Session, relating to prohibiting a private employer from adopting or enforcing certain COVID-19 vaccine mandates and authorizing an administrative penalty;
Senate Bill 24, relating to the powers and duties of the Health and Human Services Commission and the transfer to the commission of certain powers and duties from the Department of Family and Protective Services;
2. Senate Bill 25, addressing support for nursing-related postsecondary education, including scholarships to nursing students, loan repayment assistance to nurses and nursing faculty, and grants to nursing education programs;
3. Senate Bill 26, relating to local mental health authority and local behavioral health authority audits and mental and behavioral health reporting, services, and programs;
4. Senate Bill 1849, relating to an interagency reportable con-
duct search engine, standards for a person’s removal from the employee misconduct registry and for eligibility for certification as certain Texas Juvenile Justice Department officers and employees, and the use of certain information by certain state agencies to conduct background checks;
5. Initiatives to reduce Medicaid fraud, waste, and abuse, as well as other cost containment strategies; and
6. Medicaid managed care oversight and accountability. DMJ
Internal Medicine
Internal Medicine/Family Medicine/ HIV Medicine
Donald A Graneto, MD (Family Medicine/HIV Medicine)
William A Hays, MD (Internal Medicine/HIV Medicine)
Taylor Schmidt, MD (Internal Medicine/HIV Medicine)
At Compass Real Estate, the Thai Klam Team is your trusted partner in turning real estate dreams into reality. With a mission to deliver an exceptional home buying and selling experience, we transform clients into lifelong friends. With decades of expertise, our top real estate agents specialize in assisting �rst-time home buyers, investment property seekers, commercial real estate clients, and relocation for families planning their next move.
When it comes to buying, selling, or leasing a home, the Thai Klam Team offers unparalleled real estate knowledge and expertise. We understand the complexities of the real estate market and are here to guide you through every step of the process. Whether you’re a seasoned real estate investor, a �rst-time home buyer, or searching for your dream property, our team customizes our services to meet your unique needs.
What sets the Thai Klam Team apart is our commitment to a clientcentric approach. We recognize that each client has unique real estate goals and circumstances. Our team takes the time to understand your speci�c needs, whether it’s �nding an investment property, purchasing a new home, or achieving a lifelong dream. We proudly serve a diverse clientele, including doctors, executives, and professionals across various industries, offering real estate solutions tailored to their demanding careers and lifestyles.
The Thai Klam Team understands that relocating as a medical professional involves unique challenges. Whether you’re a doctor moving to a new city for a job opportunity or a physician seeking to settle closer to family, our team offers specialized relocation assistance tailored to meet your needs.
Our relocation assistance services for doctors include personal-
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Our dedication to our clients goes beyond closing the deal. We believe in fostering lasting relationships, transforming our clients into lifelong friends. As your trusted real estate partners, we’re here for you even after the transaction is complete. Our goal is to exceed your expectations, ensuring a seamless and remarkable real estate experience.
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in the Dallas Medical Journal Physician Network
Purchase an annual ad in our Physician Network pages for only $600-$1,200 for the year! Contact Lindsey Dawson for more information on ad sizes and placement.
email: lindsey@dallas-cms.org
Meet Monty Felts with The Hallasan Group at CrossCountry Mortgage, your experienced and established loan expert, with a proven track record of closing over $100 million in home loans.
Monty leads a team with the #1 mortgage company in the nation and he can close your loan in all 50 states!
With multiple private doctor loan programs, Monty can provide options no one else can!
Need a speedy loan closing? No worries, Monty can work his magic and get it done in as little as 14 days!
With Monty by your side, you’re not just another client; you’re part of a personalized journey. Expect prompt follow-up, quick pre-approvals, and a direct client hotline available every day of the week. Even after closing, Monty’s ongoing follow-up ensures you have someone to rely on whenever you need anything. Monty provides an AI specialized tool at no-cost for all clients to know everything about their home’s value on a daily basis (visit his website to sign up). With Monty and his team, you’ll experience home financing with a personal touch, making your dreams a reality and building generational wealth. Monty will personally call the Listing Agent on every offer you make and provide a guarantee, which will more than double the chances of your offer being the winner!
Any Agent Can Sell You Disability Insurance.
FEW CAN ADVISE YOU WELL.
Experience
TMA Insurance Trust’s agents have been advising and guiding Texas physicians through the complexities of properly protecting their incomes with disability insurance for seventy years. We recognize the importance of maintaining your income if you can’t practice due to illness or injury – and what it means to you, your family and your future. We are uniquely positioned to build the best income protection solution for your situation.
We have advised thousands of physicians across multiple generations on the best ways to protect their incomes. This has afforded us with knowledge and experience that you can benefit from. You see, to us you are unique, but your situation is not.
Strategy
Are you just starting your career, or looking to increase your disability benefits? Should I consider a group plan or an individual policy? Do I need a short term or long term plan? Should I keep my current policy or replace it? Is there a benefit to stacking multiple policies? We are planning for a family; what are my considerations? How can I protect my salary as it grows over time or when it is higher than the limits companies will underwrite? We have answers and will devise a personalized income protection strategy for your situation and budget.
Products
As a full-service insurance agency, we work with the leading individual disability insurance companies in Texas. And we developed TMA member plans with “Own Occupation” coverage so we have the product flexibility to protect more of your income affordably. Some of these plans come with discounts and there are additional savings for TMA members. Having this breadth of products and savings affords us more opportunities to enact the best possible income protection plan for you.
Focus
Unlike other insurance agents and brokers, our advisors do not receive any sales-based commissions. This ensures that our advice and recommendations are unbiased and focused solely on meeting your needs.
TMA Insurance Trust is well positioned to help you protect your income. Call an experienced advisor today and begin this important conversation. They can be reached Monday to Friday at 800-880-8181 between the hours of 8:00 AM and 5:00 PM CST, or by scanning the QR code with your mobile device. If you prefer, you can visit us online at tmait.org It will be our pleasure to serve you.
SCAN TO CALL
Join 250,000+ professionals who get free Continuing Medical Education (CME) with Texas Health Steps Online Provider Education. Choose from over 50 CME courses developed by trusted Texas experts, for experts like you. Quick courses and case studies on topics such as Medicaid guidelines, ethics and mental health, and more are all available 24/7.
