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Earlier this year, Legacy Community Health’s Government Affairs team set a legislative strategy to improve health outcomes for the communities we serve. Our agenda focused on access to care through telemedicine and transportation services, increasing access to HIV medications and driving the conversation around mental health services in schools. This summary is an overview of successful legislation that will be of importance to our patients and physicians in the coming year.

Telemedicine

ith the passage of Senate Bill 670 (Authored by Senator Buckingham, Representative Price), FQHCs may now provide telemedicine, telehealth and telepharmacy services to Medicaid beneficiaries and receive reimbursement subject to available funds per biennium. Previously, providers at limited Legacy locations had administered telemedicine services for patients in need with Legacy absorbing those costs. SB 670 now provides FQHCs the authorization to bill Texas Medicaid for telemedicine, telehealth and telepharmacy services provided. In addition to reimbursements, SB 670 clarifies that FQHCs can serve as both an originating site and/or a distant site provider, as appropriate. An originating site refers to the location of the patient and distant site refers to the location of the provider.

This means that Legacy Providers in Houston may now provide telemedicine services to patients among Legacy facilities, such as our Beaumont clinic, or at the patient’s home. This bill will go through a rulemaking process to determine reimbursement amounts, but we are excited this legislation will offer new service lines for Legacy patients.

In addition to the FQHC provision in the bill, it also:

  • Expands Managed Care Organization coverage of telemedicine and telehealth services

  • Repeals the requirement for school-based clinics to have a certified patient site presenter that oversees the patient and telemedicine platform throughout the visit, according to standard of care

  • Permits choice of platform for Medicaid providers

  • Encourages care coordination between PCPs and telemedicine physicians in Medicaid

  • Clarifies that direct care by physicians can include telemedicine/telehealth

  • Repeals outdated sections of the law related to telemedicine/telehealth

  • Repeals the expiration date for Medicaid remote patient monitoring benefit and continues the program

HIV Drugs as a protected class

Senate Bill 1283 (Authored by Senator Miles, Representative Wu) provides a “protected class” status for HIV medications administered under the Texas Medicaid Program. A protected class status ensures access to antiretroviral medications immediately following a new diagnosis of Human Immunodeficiency Virus (HIV.) The passage of this legislation will work toward Legacy’s goal of ending the HIV epidemic by prohibiting delays in care through the use of step-therapy and prior authorization in the state’s most vulnerable communities.

Medical And nonmedical transportation

House Bill 1576 (Authored by Representative Phelan, Senator Buckingham) provides an option for a more efficient model for the delivery of certain nonmedical transportation services by including Transportation Network Companies, such as Uber and Lyft, in the Texas Medical Transportation Program. The bill also creates a newly defined category of nonmedical transportation services that will be made available and reimbursed through managed care organization capitation rates. Legacy spearheaded the testimony for this bill, serving as invited testimony in both the House and Senate hearings. This bill will greatly increase efficiency and decrease cost associated with transportation for Medicaid patients.

Medicaid transportation

House Bill 25 (Authored by Representative Gonzalez, Senator Zaffirini) provides a pilot program for transportation coverage for Medicaid beneficiaries traveling to prenatal and postpartum visits. Under current Medicaid guidelines, a Medicaid recipient is not allowed to travel with his or her children to an appointment. This legislation seeks to provide rides for families to an appointment on a pilot basis. This program applies to pregnant women, new mothers and children who are enrolled in the STAR Medicaid program. As Legacy sees over 300 pregnant women a day, this legislation will likely have a positive impact on appointment completion rates and greatly impact the lives of our patients, and we hope to secure this pilot program for patients in Harris County.

University of houston college of medicine

House Bill 829 (Authored by Representative Zerwas, Senator Huffman) establishes the creation of the University of Houston’s College of Medicine. This school will have a focus in producing primary care and behavioral health doctors to fit the needs of the population. This especially affects Legacy, as opportunities for partnerships between Legacy and the college will provide great potential for growth and learning.

children’s mental health

Senate Bill 11 (Authored by Senator Taylor, Representative Bonnen) is a substantial bill containing provisions to ensure safety of students in portable buildings, and to establish a chain of command for final decision-making during emergencies. Most notably, SB 11 creates the Texas Mental Health Care Consortium that serves to provide an oversight committee on school safety and student mental health that will include: representatives of local emergency management and law enforcement offices and departments; certain members of the district’s board of trustees; certain district personnel, including the district’s superintendent and at least one classroom teacher; a representative of a partnering open-enrollment charter school, if applicable; and parents or guardians of enrolled students. This initiative is an important and impactful first step in enhancing the mental health and safety for Texas school students, staff and families.

behavioral health occupational oversight

House Bill 1501 (Authored by Representative Nevarez, Senator Nichols) establishes a Behavioral Health Executive Council (BHEC) that would create an umbrella agency for licensed counselors, social workers, psychologists and marriage and family therapists. The BHEC is comprised of nine members including both public board members and health professionals to oversee behavioral health in the state.

Combating opioid abuse

House Bill 2454 (Authored by Representative Price, Senator Hughes) requires physicians to complete a two-hour opioid training in each of the first two renewal periods following issuance of a license, and then once every eight years to prevent opioid abuse. As opioid addiction remains at epidemic levels across the country, this legislation will serve as a vital tool in the fight to combat improper practice and abuse.

human trafficking

House Bill 2059 (Authored by Representative Blanco, Senator Taylor) requires providers to complete a state approved human trafficking prevention course in order to be eligible for a license (or license renewal.) This legislation will equip health care providers with the training needed to help detect potential victims of human trafficking, a priority for Legacy as many of our clinics are near the I-10 corridor, one of the highest routes of human trafficking in the nation.

workforce

House Bill 2261 (Authored by Representative Walle, Senator Hinojosa) increases the loan repayment maximum from $160,000 to $180,000 for participants in the Physician Education Loan Repayment Program. The program encourages qualified physicians to practice medicine with organizations like Legacy that serve underserved communities.

maternal mortality

Senate Bill 750 (Authored by Senator Kolkhorst, Representative Button) is an extensive maternal mortality bill that seeks to address a wide range of issues related to pregnant women. The bill requires the Health and Human Service Commission to apply for federal dollars from the Centers for Medicare and Medicaid Services that would go toward addressing opioid abuse in prenatal and postpartum care. The bill also directs HHSC to implement strategies to address issues with continuity of care for women who transition from Medicaid and enroll in the Healthy Texas Women program. In addition, the bill requires HHSC to develop and enhance statewide initiatives to address issues of maternal mortality and inform Medicaid managed care organizations on the initiatives they must incorporate, reporting on the progress made with each initiative and each MCO, making said report public. This legislation is of importance to Legacy as we see over 300 pregnant women a day, and seek to bring pregnant women into prenatal care and continue care postpartum.

women’s health

Senate Bill 2132 (Authored by Senator Powell, Representative Button) requires Health and Human Service Commission to inform a postpartum woman of her enrollment in the Texas Healthy Women program and the resources available to her through the program, as well as information about providers who participate in the program and are located near the individual.