February 2021 • DALLAS MEDICAL JOURNAL 19
to private practice and hospital-based
physicians;
• Expand Regional Advisory Council
capabilities and personnel to manage local
trauma systems, and include private local
physicians in their focus;
• Retain epidemiologists, laboratory
specialists, contact tracers, and other staff
needed during a public health crisis;
• Support up-to-date statewide
electronic case reporting systems for
notifiable conditions to easily identify
outbreaks of disease;
• Require electronic lab reporting
system vendors to prioritize the efficiency,
functionality, and interoperability of their
eCR systems;
• Require laboratories to include
race, ethnicity, gender, and other key
demographic information in their reporting
data to help guide state response; and
• Ensure access to free, convenient
testing for communities of color and
other vulnerable populations, and provide
culturally and language-appropriate
informative resources for these groups,
including the use of community health
workers.
Taxing Medical
Billing Services
Harms Healthcare
Texas has not considered the practice
and provision of medical care and
healthcare services to be taxable.
According to the Texas Occupations
Code §151.002, billing for treatment
performed is part of the practice of
medicine. In response to a 2002 inquiry
regarding medical billing, the Texas
comptroller’s office determined that merely
completing a form for the insured is not
claim processing. The agency stated
claim processing does not begin until an
insurance company receives the claim.
Thus, it concluded, medical billing services
that occur before claim submission
are not taxable. TMA is working with a
coalition of more than 40 organizations
and companies that successfully asked
the comptroller’s office to delay taxation
of billing services until after the legislative
session. The coalition has drafted
language that amends §151.0039(b) of
the Texas Tax Code to ensure pre-claim
work by medical or healthcare billing
companies is not considered taxable as
insurance.
TMA’s Legislative Recommendations
• Amend existing statute to clarify
that medical/healthcare billing is not the
practice of insurance; and
• Prevent taxation on healthcare
services.
Improve Access
to Telemedicine
Services for Texas
Patients
During the COVID-19 public health
emergency, telemedicine has quickly
accelerated and expanded as most
healthcare visits transitioned from in
person to virtual. Gov. Greg Abbott put
in place various waivers that allowed
Medicare and Medicaid payment of inperson
contracted rates for contracted
services provided via telemedicine. Texas
must adapt and ensure telemedicine is a
viable path for patients and physicians in
the near future.
TMA’s Legislative Recommendations
• Ensure covered services provided to a
health-plan-enrolled patient by a contracted
physician are paid at the contracted rate.
The service provided – whether in person
or via telemedicine – should be the choice
of the physician and the patient; and
• Ensure telemedicine, defined by
statute as the practice of medicine,
adheres to licensing and regulatory
standards established by the Medical
Practice Act and enforced by the Texas
Medical Board.
Strengthen Texas’
Physician Workforce
The COVID-19 pandemic had a
devastating and unprecedented impact
on Texas’ physician workforce. Nearly
all of Texas’ 60,000 physicians in active
medical practice were affected, regardless
of medical specialty, practice setting,
or practice type. The damaging effects
were sudden and unexpected, and have
continued through 2020. Texas must grow
the state’s GME capacity to retain its
medical graduates.
TMA’s Legislative Recommendations
• Stabilize physician practice viability
by adopting state policies that restore a
healthy physician practice environment,
including payment policies that enable
physicians to meet costs and stay in
business; minimizing physician practice
interruptions; and ensuring physicians
have strong practice liability protections;
• Continue state support for the
following critical physician workforce
pipeline programs in the state’s 2024-
25 budget: Texas Higher Education
Coordinating Board Budget: State Graduate
Medical Education (GME) Expansion
Grant Program, State Rural Training Track
Grant Program, State Physician Education
Loan Repayment Program, Statewide
Primary Care Preceptorship Program,
Family Medicine Residency Program,
and Joint Admission Medical Program.
Health-Related Institution Bill Patterns
Budget: Formula Funding for State Medical
Education and Formula Funding for GME
Teaching Costs; and
• Maintain robust physician workforce
data collection and analysis activities to
monitor the impact of the pandemic on
physician supply and distribution, and
patient access to medical care. DMJ