BILL UPDATE
OIG: Today, the Texas Senate is expected to take up the Medicaid Office of Inspector General (OIG) bill, Senate Bill 207 by Juan “Chuy” Hinojosa (D-McAllen), which improves the OIG’s accountability and institutes fair rules and processes for physicians accused of waste, fraud, or abuse. The bill clarifies that “fraud” does not include unintentional technical, clerical, or administrative errors; requires probable cause of fraud for payment holds; and keeps informal settlement meetings with physicians and other providers under investigation confidential.

Prior Authorization Forms: Remember last legislative session’s efforts to streamline the prescription drug prior-authorization process, requiring all insurers to use one standardized form? Good news! The new standard form finally has been adopted.

Senate Bill 644 by Sen. Joan Huffman (R-Houston) from 2013 required the Texas Department of Insurance (TDI) to adopt a rule creating a standard form that prescribing physicians can use to request prior authorization of prescription drug benefits on patients’ behalf. The rule requires plans to use the standard form and post it on their website. The form and its instruction sheet can be found on TDI’s website. This rule is effective Sept. 1, 2015. Rep. John Zerwas, MD (R-Richmond), was the House sponsor of the measure.

FEDERAL UPDATE
You probably are aware that Congress repealed the Medicare Sustainable Growth Rate (SGR) formula last week, but did you know Texans in Congress saved the day? Several Texas Congressmen played a huge role in getting HR 2, the SGR repeal bill, passed into law. (Here’s the list of supporters — with phone numbers to call.)

First is Rep. Michael Burgess, MD (R-Lewisville), the primary author of the bill and the driving force for SGR repeal since he first was elected to Congress in 2003. Sen. John Cornyn, the Senate majority whip, used his mastery of Senate rules and expert negotiating to get us over the final hurdle in the Senate during Tuesday night’s crucial debate. Reps. Kevin Brady (R-The Woodlands) and Gene Green (D-Houston) cosponsored the bill and kept the wheels on the bus when they threatened to fall off. Rep. Henry Cuellar (D-Laredo) included a provision that protects Texas’ medical liability reforms and ensures that the care standards and guidelines in federal law cannot be used to create new causes of legal action against physicians. These Texas leaders supported the bill if you wish to call and thank them.

PHYSICIAN OF THE DAY
The physician of the day at the Capitol is Dan Freeland, DO, of Lakeway. Dr. Freeland graduated from Kirksville College of Osteopathic Medicine in Jefferson, Mo. He is a member of TMA and the Travis County Medical Society.

WHAT WE ARE READING
$4 billion in health care for poor Texans at risk as doubts rise about Medicaid agreement ― Houston Chronicle
Boehner: 'Conservatives should be happy’ about Medicare 'doc fix' ― The Hill Healthwatch
For Next President, a Way Out of the Health Care Fights? ― Associated Press
The ObamaCare Effect: Hospital Monopolies (Opinion) ― The Wall Street Journal