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Aetna Scraps Required Prior Auth for Cataract Surgery - 05/15/2024

Organized medicine’s efforts across the nation to torpedo or curb prior authorization recently got a small but encouraging boost when Aetna rescinded its year-old preauthorization requirement for cataract surgeries.

New Medicare Advantage Rules Aim to Improve Access, Equity - 05/15/2024

 Medicare Advantage enrollees soon may benefit from expanded access to outpatient behavioral health care and more equitable prior authorization policies.  

Texas Senate Interim Charges Underscore TMA Legislative Priorities - 04/29/2024

Scope-of-practice creep and access to mental health care are among the 57 charges Texas Lt. Gov. Dan Patrick recently issued for Senate committees to study ahead of the 2025 legislative session. The Texas Medical Association’s advocacy for medicine-friendly policy also continues apace during the interim, with the association closely monitoring several of these charges.

New Federal Rules Limit Short-Term Insurance Plans, Enhance Protections - 04/17/2024

Following advocacy by the Texas Medical Association, the U.S. departments of Health and Human Services, Labor, and the Treasury recently issued final rules that strengthen consumer protections related to short term, limited duration insurance.

TMA Pushes for Prior Authorization Limits, Clarity - 04/16/2024

After hearing story after story of delays and denials, the Texas Medical Association is pushing the Texas Legislature to sign off on measures that would significantly curb insurers’ ability to require prior authorization on needed care, as well as clarify for both physicians and patients what it means when prior authorization is required.

Cigna Launches Digital Newsroom for Payer Updates - 04/12/2024

Physicians and practice staff looking for updates from one of Texas’ major payers, Cigna Healthcare, can now refer to the company’s new digital newsroom.

CMS to Test Prior Auth Requirements for Certain ASC Procedures - 04/10/2024

Texas physicians soon may encounter new Medicare prior authorization requirements for certain services that double as cosmetic procedures when provided at an ambulatory surgical center.

Shielding the Gold Card Law: TMA Fights to Guarantee Gold Card is Implemented as Intended - 04/09/2024

Texans earned one of its most prolific victories with its prior auth exemption law but still fights to guarantee it's implemented as intended.

TMA Moment in Time: First Tuesdays at the Capitol - 04/09/2024

TMA’s signature advocacy event offers invaluable facetime with lawmakers.

TMA Moment in Time: Texas' First PPO Rules - 04/09/2024

TMA fought to ensure fair regulation of PPOs, which now dominate the health plan market.

TMA to IRS: Direct Primary Care, Health Care-Sharing Ministries Aren’t Insurance - 04/05/2024

The Texas Medical Association is urging the IRS to reconsider a proposed rule that would classify direct primary care (DPC) arrangements and health care-sharing ministries (HSMs) as insurance.

TMA Sues Feds Over Unfair Rule for Surprise Billing Law - 03/22/2024

The Texas Medical Association filed a lawsuit in federal district court in Tyler, Texas, after the Biden administration failed to follow clear direction from Congress about how to implement the dispute resolution process set forth in the No Surprises Act, legislation that was passed in 2020 to protect patients from surprise medical bills.

TDI Proposed Rules for State Network Adequacy Law Raise Strong Concerns - 03/20/2024

After securing network adequacy reform during the 2023 regular state legislative session, the Texas Medical Association has shifted its focus to ensuring the Texas Department of Insurance’s network adequacy rules conform to the plain language and intent of the law.

Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/15/2024

Texas is building an all-payer claims database, which will provide a clearer view of opaque health care costs.

You Write Scripts? You Better Sign Up With the PMP - 02/28/2024

If you don't yet have a user account set up with the state's prescription monitoring program (PMP), known as PMP Aware, now is a good time to get it done.

New Law Prohibits Employer COVID-19 Vaccine Mandates, With Exceptions - 02/28/2024

Thanks to advocacy by the Texas Medical Association, guardrails for patient safety and practice viability are included in a new state law that prohibits employers, including physician offices and health care facilities, from mandating COVID-19 vaccines among employees.

Grassroots Physician Advocacy Fuels Early TEXPAC Win - 02/16/2024

Looking to build on the victory, TMA’s bipartisan political arm has endorsed a long list of medicine-friendly candidates, informed by local physician support and its own rigorous evaluation process. The Texas primary election is on March 5. Read more.

Governor Approves Bill to Reduce Prior Authorization Hassles - 02/14/2024

Care for countless Texas patients will happen more quickly by reducing health insurers’ bureaucratic delays, thanks to a bill Gov. Greg Abbott allowed to become law this weekend. The Texas Medical Association  prioritized curbing health insurers’ onerous prior authorization practices this legislative session, resulting in passage of House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood), and Sen. Dawn Buckingham, MD (R-Lakeway), with considerable support by Sen. Jane Nelson (R-Flower Mound).

Prior Auth Processes to Streamline Under Medicare Advantage, Other Federal Programs - 01/23/2024

Physicians who care for patients enrolled in federal health plans can expect shorter prior authorization response times and other process improvements in coming years, thanks to longstanding advocacy by the Texas Medical Association and others in organized medicine.

Patient Care Protected: TMA Secured Big Legislative Wins With a New Strategy - 01/11/2024

Guided by a set of priorities and girded by grassroots physician advocacy, the Texas Medical Association entered the 2023 legislative session with a laser focused approach and came out hitting targets in every area of medicine’s agenda.

Safety in Statute: State Law Guides Violence Prevention in Health Care - 01/05/2024

A new state law guides violence prevention plans in health care.  

No Prior Auth Required for Generic Asthma Meds Following Medicaid Formulary Change - 12/19/2023

As of Dec. 15, physicians can prescribe generic asthma medications previously listed as non-preferred on the Medicaid preferred drug list without needing prior authorization.

Send TMA Your Prior Authorization Nightmare Stories - 12/11/2023

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ experience with insurance companies’ prior authorization requirements and approval processes.

Closing the Gap: New Texas Network Adequacy Law Tackles Waivers - 12/04/2023

Although Texas has some of the strongest network adequacy rules in the country, poor enforcement and an overused waiver system have weakened physician practice viability and patients’ access to in-network care; thanks to advocacy by the Texas Medical Association, this will soon change.

First Tuesdays at the Capitol Was a Virtual Success - 11/30/2023

Almost 200 physicians, medical students, and alliance advocates logged on to Zoom for the first-ever virtual First Tuesdays at the Capitol on Tuesday, which featured an in-depth briefing on TMA’s legislative agenda for this session.