The decline in death rates from coronary heart disease has slowed since 1990, according to the Centers for Disease Control and Prevention, while 460,000 people died of coronary heart disease in 1998, accounting for one out of every five deaths in the U.S. Forty-four percent of those deaths were due to heart attacks. Cardiovascular disease, including coronary heart disease, strokes and high blood pressure, account for 40 percent of all U.S. deaths, while cancer accounts for one quarter of U.S. deaths and remains the nation's second most common cause of death. (New York Times, 2-15-2001)

Hospitals are reserving scarce doses of adult versions of the vaccine for high-risk burn victims and other severely injured adults, while the shortage has not affected children's versions of the vaccine. Supplies were curtailed when Wyeth-Ayerst Laboratories ceased to make the vaccine last month, leaving the sole remaining manufacturer, Aventis Pasteur, working around the clock to produce more of the millions of doses needed annually, each batch of which takes 11 months to make. FDA officials are looking to overseas ingredient suppliers and are encouraging small drug companies to produce the vaccine. (Associated Press, 2-19-2001)

Madeleine Duvic, M.D. (principal investigator)
Kathleen Hunzicker, M.D. (clinical coordinator)
Joan Breuer-McHam, Ph.D. (data coordinator)

National Alopecia Areata Registry
University of Texas
M.D. Anderson Cancer Center
Department of Dermatology
Box 434, 1515 Holcombe Blvd.
Houston, Texas 77030

713-792-5999
713-794-1491 (fax)
alopeciaregistry@mdanderson.org

Effective October 1, 2000, the daily cost to active duty family members for inpatient care in civilian hospitals under TRICARE Standard and Extra increased from $10.85 to $11.45.

Recently passed legislation eliminates this inpatient rate at both military treatment facilities (MTFs) and civilian hospitals in early 2001 for active duty family members enrolled in Prime. However, it will still apply to military retirees, and their families and survivors.

For more information about other rate increases at MTFs including specific exemptions, log on to the Web site www.dtic.mil/comptroller/rates then go to FY2001 Reimbursable Rates, Tab 1, Medical and Dental Services.

There also has been a slight increase in cost shares for retired military and their families and survivors who use TRICARE Standard for inpatient mental health care or a substance use disorder. TRICARE Standard beneficiaries who get such treatment at a low-volume hospital pay a daily rate of $149, up $5 from last year, or 25 percent of institutional billed charges, whichever total is less. A low-volume hospital is one that treats and discharges fewer than 25 patients in a year. For those who are treated at a high-volume hospital, one that treats and discharges 25 or more patients in a year, the cost share is the same as last year - 25 percent of the hospital's own daily rate.

The inpatient mental health rate is unchanged for active duty family members and military retirees, their families and survivors in TRICARE Prime and Extra.

The TRICARE Standard diagnosis-related group (DRG) daily rate for most civilian non-mental health hospital admissions increased on October 1, 2000, to $401, up from $390 last year. That rate applies only to retired military and their families and survivors who use TRICARE Standard. They either pay that fixed daily rate of $401, or a cost share, which is 25 percent of the hospital's billed charges, whichever is less. However, there is no DRG rate increase for these beneficiaries who use a TRICARE network facility.

TRICARE Management Activity (TMA) is announcing a new simplified co-pay structure for prescription drugs provided to eligible uniformed services beneficiaries through its pharmacy program.

The change in the co-pay structure is in response to direction from Congress last year to streamline the pharmacy benefit through greater use of generic drugs, a simplified set of co-pays and a uniform formulary.

This year, Congress directed the Department of Defense (DoD) to extend its robust pharmacy program to include age 65 and older beneficiaries, who are Medicare-eligible. Called the TRICARE Senior Pharmacy Program, it provides them pharmacy coverage that includes the use of the National Mail Order Pharmacy (NMOP) and retail pharmacies at the same co-pay rate as other eligible beneficiaries. They also can continue to use military treatment facility pharmacies with no co-pays, a benefit that already was available to those who were within driving distance of such a facility. Beneficiaries must be Medicare-eligible and enrolled in Part B if they turn 65 on or after April 1, 2001, to use the Senior Pharmacy Program.

TRICARE's current co-pay structure is extremely complex, and is based on the beneficiary's TRICARE enrollment status, the beneficiary category - such as active duty family members or retirees, and finally - their choice of pharmacy. The new co-pays of $9 and $3 create a single co-pay structure for the entire pharmacy benefit. The amounts will not be finalized until the federal rule making process is complete.

"Basically, all TRICARE beneficiaries will pay a standard $9 co-pay for brand name prescription drugs from the NMOP or a retail network pharmacy. However, beneficiaries will experience substantial savings through the use of generic medications, which will have only a $3 co-pay," explains Dr. H. James T. Sears, executive director of TMA. "While some beneficiaries will see a slight increase in their co-pays for brand name drugs, most will see a reduction in their overall co-pays under this simplified co-pay structure."

If TRICARE Standard beneficiaries use a non-network pharmacy, their co-pay will be $9, or 20 percent of the cost for a 30-day supply, whichever is greater. Applicable deductibles will also apply if the beneficiary uses a non-network pharmacy.

The best value for all beneficiaries remains the military treatment facility pharmacy, where all TRICARE beneficiaries can receive their prescriptions without any out-of-pocket costs.

The new co-pays become effective April 1, and apply to eligible active duty family members, under-65 retirees and their dependents, and all the 65 and over beneficiaries who become eligible for the Senior Pharmacy Program on that same date. Active duty members have no co-pays.

Changing the co-pays to coincide with the start-up of the Senior Pharmacy Program on April 1 will enable most beneficiaries to enjoy cost savings before implementation of the uniform formulary later in the year, and it minimizes changes to the pharmacy benefit over the course of the year.

Information about the new TRICARE Senior Pharmacy Program will be sent to those Medicare-eligible beneficiaries whose addresses and other information is up-to-date in the Defense Enrollment Eligibility Reporting System (DEERS).

NOTE: DEERS address change info is available at https://www.tricare.osd.mil/DEERSAddress/

Additional information can be found on the TRICARE Web site at http://www.tricare.osd.mil

Beneficiaries also can use a toll-free telephone number, 1-877-DOD-MEDS (1-877-363-6337), between 7 a.m. and 11 p.m. EST, Monday through Friday, to find out more about their benefits.

ARLINGTON, Va., March 2, 2001 -- Gone are the days when you go to a military treatment facility and see whoever's available. By June, most TRICARE Prime enrollees should know their doctor's name.

TRICARE policy used to be to assign patients to a group of primary care providers. Now, patients are being assigned to an individual to manage their healthcare, said Army Dr. (Lt. Col.) Scott Goodrich, a project officer at the TRICARE Management Activity here.

Following are HHS priority initiatives from the President's "Blueprint for New Beginnings:"

Doubling Resources for the National Institutes of Health (NIH): The 2002 Budget includes a Presidential initiative to double NIH's 1998 funding level by 2003. NIH is working to meet the management challenges that can arise when an agency receives a substantial infusion of resources over a short period of time. NIH is in the process of identifying strategies and policies that could be implemented in 2002 and 2003 and beyond to maximize budgetary and management flexibility in the future. Such strategies could include funding the total costs of an increasing number of new grants in the grant's first year and supporting some one-time activities such as high-priority construction and renovation projects.

Strengthening the Health Care Safety Net: To strengthen the health care safety net for those most in need, the budget recommends a $124 million increase for Community Health Centers. This increase is the first installment for a multi-year initiative to increase the number of community health center sites by 1,200. Community Health Centers, which are a critical component of the American health care safety net, provide health services to roughly 11 million patients, 4.4 million of whom are uninsured, through a network of over 3,000 community-based health care center sites.

Reforming the National Health Service Corps (NHSC): The NHSC management reform will examine the ratio of scholarships to loan repayments, as well as other set-asides, to provide maximum flexibility in placing NHSC providers. The Administration will also seek to amend the Health Professional Shortage Area definition to reflect other non-physician providers practicing in communities, which will enable the NHSC to more accurately define shortage areas and target placements better. To further avoid overlap in the provision of health care, HHS will enhance its coordination with immigration programs, including the J-1 and H-1C visa programs, which review applications for foreign health care providers practicing in underserved communities. The NHSC initiative will also encourage more health care professionals to participate in the NHSC by making scholarship funds tax free.

Increasing Access to Drug Treatment: The President recommends an additional $111 million to increase the availability of substance abuse treatment services. Included in this amount is $100 million for the Substance Abuse and Mental Health Services Administration to help close the treatment gap. The

increase includes $60 million to help states finance treatment to those in need through the Substance Abuse Block Grant, and an additional $40 million will be made available through the Targeted Capacity Expansion grants designed to support a rapid, strategic response to emerging trends in substance abuse.

Supporting the Healthy Communities Innovation Fund Initiative: HHS will allocate approximately $400 million in 2002 funding for existing grant activity for innovations at the local level, including programs to promote comprehensive care through integrated state health care delivery systems for women and children. HHS will increase coordination among these funds to ensure that the best and broadest range of innovative solutions are funded across the country.

Promoting Safe and Stable Families: The budget proposes funding the Promoting Safe and Stable Families program at $505 million in 2002, a $200 million increase over the 2001 level. These additional resources will help states keep children with their biological families, if safe and appropriate, or to place children with adoptive families. The budget also includes a $60 million increase for education and training vouchers to youth who age out of foster care. This initiative, which would be funded through the Independent Living

Program, would provide vouchers worth up to $5,000 for education or training to help these young people develop skills to lead independent and productive lives.

Supporting Maternity Group Homes: The budget recommends providing $33 million in 2002 for maternity group homes, which are community-based, adult-supervised group homes or apartment clusters for teenage mothers and their children. The homes provide safe, stable, nurturing environments for teenage mothers and their children who cannot live with their own families because of abuse, neglect, or other extenuating circumstances.

Encouraging Compassion and Charitable Giving: The President proposes three initiatives to ensure that the Federal Government plays a larger role in providing support to charitable organizations. A compassion capital fund will provide start-up capital and operating funds totaling $67 million in 2002 to qualified charitable organizations that wish to expand or emulate model programs. In addition, a $22 million national fund will support and promote research on "best practices" among charitable organizations in 2002. Also, to encourage states to create state tax credits for contributions to designated charities, the budget will propose legislation to allow states to use Federal Temporary Assistance for Needy Families funds to offset revenue losses.

Providing an Immediate Helping Hand (IHH): As prescription drugs have become an integral part of modern medicine, private health insurance in the United States has changed to incorporate adequate prescription drug insurance. Yet Medicare still does not provide coverage for most drugs as part of its benefit package. As a result, about three in 10 Medicare beneficiaries have no insurance coverage for prescription drugs.

To renew the promise made to our seniors 35 years ago, the President will propose to enact the IHH prescription drug proposal. The IHH proposal provides for immediate funding to states to allow for interim prescription drug coverage for those beneficiaries who need it most. This immediate assistance will gives states the temporary financial support they need to protect beneficiaries with limited incomes or very high drug expenses and no other alternative for drug coverage until Medicare reform is achieved.

The IHH proposal will cover the full cost of drugs for individual Medicare beneficiaries with incomes up to $11,600 who are not eligible for Medicaid or a comprehensive private retiree benefit, and for married couples with incomes up to $15,700 (135 percent of poverty) who do not have access to coverage.

The IHH proposal would begin immediately. Unlike other plans, IHH builds on coverage that is available in over half the states, and under consideration in almost all states. No other proposal would provide interim access to drug coverage for up to 9.5 million of the most vulnerable Medicare beneficiaries

until Medicare reform can be enacted. This would minimize the temporary burden on states. IHH is 100 percent federally funded, with flexibility in how states can choose to establish or enhance drug coverage.

The following audit report has been posted to the Office of Inspector General's Web site. To access the report, go to: http://www.hhs.gov/progorg/oas/cats/hcfa.html

The Court unanimously ruled that federal law preempts state law liability claims alleging fraud against the FDA during the federal agency's regulatory process for marketing clearance for certain medical devices. Chief Justice William Rehnquist said that state law fraud claims inevitably conflict with the FDA's responsibility to police fraud, and that allowing such lawsuits might expose manufacturers of medical devices to unpredictable civil liability. (New York Times, 2-21-2001)

The United Network for Organ Sharing reported a slow growth in the number of organs from deceased donors, while the number of living organ donors more than doubled between 1990 and 1999, and the number of people on the transplant waiting list grew even more rapidly due to advances in medical techniques and an increase in the number of hospitals offering transplantation. In 1999, there were a total of 21,715 transplants performed in the U.S., up 44 percent from 1990, and there were 72,110 people on the national transplant waiting list at the end of 1999, more than three times as many as in 1990. (Associated Press, 2-22- 2001)

The Texas Attorney General's office received its first and only application since the final regulations have been promulgated for the statute, on behalf of eleven physicians from a variety of specialties in Henderson, Texas to jointly negotiate both fee- and non-fee-related aspects of a contract for the Blue Cross POS or BlueChoice PPO/POS plan. Representing the physicians is Linda Davis, Director of Managed Care at Henderson Memorial Hospital. (Physician's News Digest, 2-22-2001)

Texas Cancer Care, a premier medical resource for cancer treatment, has established a nonprofit foundation to increase local participation in cancer research programs. The Cancer Education and Research Foundation of Texas will raise funds for the advancement of cancer education and provide North Texas cancer patients local access to the latest cancer research available. All funds raised by the Foundation will directly fund cancer research programs.

Currently, most of the research into new cancer drug therapies is conducted at large academic hospitals, such as M.D. Anderson at Texas Medical Center in Houston. The establishment of the Foundation means cancer patients can take part in trials closer to home, an important choice for those who often must make the trial's required weekly trips to the doctor.

"The establishment of the Foundation allows us to participate in funded research without any conflict of interest. No clinician personally has financial gain when any patient participates in a study. This makes it perfectly clear to everyone that we are free to do what our patients decide is right for them as individuals," said Ray Page, D.O., Ph. D., the president of the foundation board.

Dr. Page also recognized advantages the Foundation brings to patients who will benefit from the local access to clinical trials. "If a patient can take part in a clinical trial that keeps them from having to drive long distances, then we are offering the best possible care we can - cutting edge treatment near the comfort of their own home. What makes this especially exciting for the residents of North Texas is that the money we raise here will stay here."

The Foundation currently supports research at all Texas Cancer Care locations, including Cleburne, Mineral Wells, Weatherford and three locations in Fort Worth. The Foundation's long-term plans include supporting other cancer research and educational endeavors throughout North Texas.

Texas Cancer Care is a physicians group providing advanced patient-centered care for the treatment of cancer. For more information about the Cancer Education and Research Foundation of Texas, visit www.cerft.org. For more information about Texas Cancer Care, visit www.texascancercare.com.

HB 1577 - Rep. Dawnna Dukes - Relating to medical dispute resolution in certain workers' compensation cases. The Labor Code would be amended by adding the following subsection: "In a review of a medical service under this section, a doctor may not offer an opinion regarding whether the medical service is reasonable and necessary unless the doctor has examined the injured employee within the 12 months preceding the date of offering the opinion."

HB 1578 - Rep. Dawnna Dukes - Relating to medical evidence introduced by a workers' compensation claimant in a contested case hearing. The Labor Code would be amended to stipulate that if a claimant introduces medical evidence from a physician that the claimant sustained an injury and the insurance carrier does not introduce medical evidence from a physician to the contrary, it is presumed that the injury exists. The presumption, however, would not affect the issue of whether the injury occurred in the course and scope of employment.

HB 1676 - Rep. Lon Burnam - Relating to health benefit plan coverage for survivors of traumatic brain injury. This legislation would prohibit certain health benefit plans from limiting or excluding coverage for cognitive therapy, neuropsychological testing or treatment, or community reintegration activities necessary as a result of a traumatic brain injury. Training for precertification personnel of a health benefit plan would also be required.

HB 1688 - Rep. Ruth McClendon - Relating to the possession and self-administration of prescription asthma medicine by public school students while on school property or at a school-related event or activity. This legislation would allow students to possess and self-administer prescription asthma medicine if done in compliance with the prescription or written instructions from the student's physician, a written authorization provided and signed by the parent or guardian, and a written statement from the physician. The written and signed statement from a physician or other health care provider must state that the student has asthma; is capable of self-administering the prescription asthma medicine; name and purpose of the medicine; prescribed dosage; time or circumstances under which the medicine may be administered; and the period for which the medicine is prescribed. The physician's statement would be kept on file in the office of the school nurse or, in the absence of a nurse, in the office of the principal.

HB 1702 - Rep. Rick Green - Relating to immunization and the immunization registry. The Texas Immunization Advisory Committee would be established to assist the board and the department in the development of procedures, guidelines and policies related to immunizations in Texas. The purpose of the committee would be to evaluate the existing immunization program operated by the department and identify needs not met by the program. In addition, the department would be directed to develop and provide an exemption form to a person subject to exclusion from a school or facility because the person declines a required immunization for reasons of conscience or because of a religious belief. The bill also delineates the steps to be taken for exclusion from the registry. Basically, the first time the department receives data for a child, the department must send a written notification to the child's parents disclosing that providers and insurers may be sending the child's immunization information to the department. However, the department may not keep the information if the parent or guardian chooses to exclude the child from the registry.

HB 1704 - Rep. John Smithee - Relating to the establishment and operation of a task force to examine issues regarding expansion of the provision of health benefits to employees of small businesses. The Small Business Health Benefits Task Force would be established to make recommendations to the legislature with respect to improving the availability of group and individual health benefits coverage to employees of small businesses in the state.

HB 1720 - Rep. Kyle Janek - Relating to liens for certain services provided by physicians. At the request of a physician, a hospital would be allowed to include in its lien the physician's charges for emergency care for the first seven days of a patient's hospitalization.

HB 1801 - Rep. Glen Maxey - Relating to the establishment of a home telemedicine pilot program for certain recipients of medical assistance. The Home Telemedicine Pilot Program would be established whereby certain recipients of medical assistance would receive home health care services through telemedicine, in addition to other home health care services for which recipients are eligible. Program participants would have to meet certain eligibility requirements, including being diagnosed with a chronic illness; be under the care of a physician who consents to the participant's receipt of home health care services; and possess the ability to use telemedicine equipment or be assisted by a regular caregiver who is willing and able to use the equipment. No later than December 1, 2004, a report would be submitted to the legislature regarding the program, to include an analysis of the program's cost-effectiveness; the program's effect on the quality of health care received by participants; and recommendations regarding elimination, continuation or expansion of the program.

HB 1862 - Rep. Craig Eiland - Relating to the regulation and prompt payment of health care providers under certain health benefit plans. An HMO or insurer must notify in writing a physician or provider of the need for any attachments desired in good faith for clarification of a clean claim not later than the 20th calendar day after the date the HMO or insurer received the claim. The written notice requesting the attachment must describe with specificity the information requested, provide a detailed description of the reasons why the information is requested, and pertain only to information the HMO or insurer can demonstrate is within the scope of the claim in question. Upon receiving a request, physicians would have 20 calendar days to provide the attachment without tolling the 45-day payment period as defined in this article. The 45-day payment period will be extended by the number of days by which the requested attachment is received by the health plan beyond the 20th day.

HB 1903 - Rep. Sylvester Turner - Relating to verification of coverage by a preferred provider benefit plan or a health maintenance organization. An insurer (or HMO) shall inform a preferred provider (or physician) of whether or not an insured (or enrollee) is covered for a service or benefit if the information is requested before providing the service or benefit. If an insurer or HMO verifies that an insured or enrollee is covered for a service or benefit, the insurer or HMO may not deny payment for the service or benefit unless a written notice of an error in the verification is received by the preferred provider or physician before the service or benefit is provided.

HB 1905 - Rep. Juan Hinojosa - Relating to a cause of action that a health care liability claim is brought in bad faith. The Medical Liability and Insurance Improvement Act of Texas would be amended by adding a new subchapter, "Cause of Action for Bad Faith," to read as follows: "a) A person may bring a cause of action that a health care liability claim is brought in bad faith; b) A health care liability claim is brought in bad faith if it is maintained or filed with reckless disregard as to whether or not reasonable grounds exist for asserting the claim; and c) The person may bring the cause of action as a separate suit or as a counterclaim in the suit involving the health care liability claim." Additionally, the bill notes that a cause of action that a health care liability claim is brought in bad faith may be brought against any claimant or defendant or the attorney of any claimant or defendant.

HB 1908 - Rep. Carl Isett - Relating to disabled parking placards issued to certain pregnant women. This bill would add pregnant women in the third trimester of pregnancy to the listing of those who may be issued disabled parking placards.

HB 1967 - Rep. Manny Najera - Relating to a state prescription drug plan for certain older individuals and individuals who have serious health care conditions. This bill would establish a state prescription drug plan to provide drug benefits to those who are at least 65 years of age or have a serious health care condition. The Health and Human Services Commission would be directed to develop and implement the program and define the eligibility standards, through coordination with each agency necessary for the program's implementation, including the Texas Department of Health, Texas Department of Human Services, and the Texas Department of Insurance. Benefits provided under the prescription drug plan would be coordinated with other benefits for which an enrollee is eligible, including Medicare and Medicaid, so that the prescription drug program benefits would supplement, but not duplicate, the other benefits.

HB 1982 - Rep. David Farabee - Relating to continuation of benefits for prescription drugs under certain group health benefit plans. Group health plans that offer prescription drug benefits to enrollees at the contracted benefit level until the enrollee's plan renewal date are not required to do so if 1) the FDA prohibits the sale or use of the drug, or the use of the drug as prescribed to an enrollee; or 2) the FDA or the drug's manufacturer identifies a side effect, adverse reaction, or other health risk associated with the drug that was unknown at the time the drug was prescribed to the enrollee; or is substantially more severe, as determined under rules adopted by the commissioner, than was believed at the time the drug was prescribed to the enrollee.

HB 2004 - Rep. Glen Maxey - Relating to the medication a patient receives after being furloughed or discharged from inpatient mental health services. The Health and Safety Code would be amended to stipulate that a patient on furlough or discharge must be provided with sufficient medication until the patient can see a physician, if appropriate. The physician responsible for the patient's treatment would be directed to ensure that the patient receives such necessary medication.

HB 2209 - Rep. David Farabee - Relating to the delegation of prescription drug orders to physician assistants and advanced practice nurses who provide health care services at certain alternate practice sites. The Occupations Code would be amended by adding "Alternate practice site," which is defined as a practice location of a physician that is located within 60 miles of the physician's primary practice site and at which medical services similar to those provided at the primary practice site are offered. A physician may not establish more than one qualified alternate practice site by filing with the board an application prescribed by the board. To maintain an alternate practice site's qualification, the delegating physician must: 1) review at least 10 percent of the charts or records of patients treated at the site; 2) be present at the site with a physician assistant or advanced practice nurse at least 20 percent of the time the site is open; 3) when not present at the site, be available by voice communication at any time a physician assistant or advanced practice nurse is providing health care at the site; and 4) complete any reports required by the board.

HB 2210 - Rep. David Farabee - Relating to the scope of practice of a physician assistant acting in a delegated practice. The Occupations Code would be amended by adding the following: "A physician assistant is the agent of the physician assistant's supervising physician for any medical services that are delegated by that physician and that 1) are within the physician assistant's scope of practice; and 2) are delineated by protocols, practice guidelines, or practice directives established by the supervising physician."

HB 2258 - Rep. Glen Maxey - Relating to the assessment of certain nursing home residents for mental illness or mental retardation. The department would be directed to assess each resident of a nursing home before the resident makes a transition to a community-based care setting, to determine whether the resident has a mental illness or mental retardation. This information would be provided to the Texas Department of Mental Health and Mental Retardation before a resident makes a transition from nursing home to community-based care setting for the purpose of: providing mental health services to a resident after the resident makes the transition; or referring a resident to a local mental health or mental retardation authority or private provider for additional mental health services.

HB 2282 - Rep. Dan Ellis - Relating to certain audits of health benefit plan payments and reimbursements to health care providers. With several exceptions, any payment audit that is conducted by an issuer of a health benefit plan must be conducted within two years from the date that the payments or reimbursements are made to the health care provider.

HB 2287 - Rep. Al Edwards - Relating to the authority of a hospital to share with certain attending physicians reimbursements for services provided to patients under the medical assistance program. The commission, by rule, is directed to prescribe a method by which a hospital that receives reimbursement for services provided to a patient under the medical assistance program may pay a portion of that reimbursement to the patient's attending physician. Attending physician is defined as a physician who is selected by or assigned to a patient and has primary responsibility for the treatment and care of the patient.

HB 2355 - Rep. Dale Tillery - Relating to eligibility of a newborn child for the state child health plan. The Health and Safety Code would be amended by adding the following subsection: "A child who is eligible for health benefits coverage under the child health plan is entitled to benefits for health care services provided to the child from the time of the child's birth if the child applies to enroll in the program not later than the 30th day after the date the child is born."

HB 2382 - Rep. Senfronia Thompson - Relating to coverage under a health benefit plan for prescription contraceptive drugs and devices and related services. Health benefits plans that provide benefits for prescription drugs or devices would be prohibited from excluding prescription contraceptive drugs or devices approved by the FDA.

HB 2421 - Rep. Judy Hawley - Relating to establishing a program to recruit rural medical students for service in rural communities. The Health and Safety Code would be amended by adding a new subchapter entitled, "Rural Physician Recruitment Program," whereby the center would be directed to develop a program to recruit medical school students from rural communities and encourage them to return to rural communities to practice medicine. In keeping with the program, the center would develop a screening process to identify rural students most likely to pursue a career in medicine; establish a rural medicine curriculum; establish a mentoring program for rural students; provide rural students with information about financial aid resources available; and establish a rural practice incentive program.

HB 2423 - Rep. Judy Hawley - Relating to the designation of a hospital as a rural hospital. The commission would be directed to adopt rules that establish a procedure for designating a hospital as a rural hospital in order for the hospital to qualify for federal funds. If a hospital meets the requirements under the rules, the hospital may request that the commission designate it as a rural hospital.

HB 2449 - Rep. Dawnna Dukes - Relating to the certification of maximum medical improvement and the assignment of impairment ratings in workers' compensation cases. This bill states that when an employee receives written notice from a physician certifying maximum medical improvement and assigning an impairment rating, the commission must provide written notice to the employee of his or her right to either contest the certification or impairment rating or both, or to legal representation. In addition, the commission would be directed to reevaluate a certification of maximum medical improvement or an impairment rating made final on receipt of notice from the employee that the employee has experienced a substantial change in condition since the date the certification or impairment rating was made final.

HB 2455 - Rep. Patricia Gray - Relating to the provision of information about patient assistance programs offered by pharmaceutical companies. This legislation would direct pharmaceutical companies that do business in this state and offer a patient assistant program, to inform the department of the existence of the program, the eligibility requirements for the program, the drugs covered, and information such as a telephone number used for applying for the program. The department would subsequently establish a system under which persons could call a toll-free number to obtain information about available patient assistance programs.

HB 2510 - Rep. Norma Chavez - Relating to the establishment of a diabetes research center at the Texas Tech University campus in El Paso. The board of regents of the Texas Tech University System would be authorized to establish the Texas Diabetes Research Center at the El Paso campus of Texas Tech University.

HB 2535 - Rep. Glen Maxey - Relating to the use of single-use surgical devices; providing a penalty. The Health and Safety Code would be amended by adding a subchapter entitled, "Single-use Surgical Devices," whereby reuse of such a device would be prohibited. Single-use surgical device is defined as a cardiac catheter, angioplasty balloon catheter, arthroscopic knee surgery blade, or any other device marketed or sold as a disposable or single-use device, as determined by board rule, to be designed for use in a single surgical procedure to avoid risk of infection from improper sterilization or risk of mechanical failure by subsequent use. An exemption to this subchapter would be a device reprocessed by an entity or person registered with and regulated by the FDA.

HB 2620 - Rep. Toby Goodman - Relating to standardizing contracts, forms, and other documents used in managed care plans. Managed care plans (to include any entity that offers a managed care plan) would be required to use standardized contracts, forms and other documents for routine managed care functions. Standard documents must also be used for contracts, member identification card, referral forms and pre-authorization forms.

HB 2630 - Rep. Arlene Wohlgemuth - Relating to the study of disease management programs for tuberculosis in the Texas-Mexico border region. A pilot study would be established to compare preventative disease management methods for treating tuberculosis with traditional methods of treating the disease. The following outcomes would be measured by the pilot study: school and work absenteeism; hospitalization; impact of the disease on the family; and economic effects of the disease, including income lost as a result of days missed from work and income lost by schools as a result of student absenteeism.

HB 2641 - Rep. Dale Tillery - Relating to administrative penalties assessed for certain unmeritorious challenges to workers' compensation claims. The Labor Code would be amended by adding a new subchapter entitled, "Failure to show good cause for contested case hearing; administrative penalty." Basically, if an insurance carrier has not shown good cause to justify an insurance carrier's request for a contested case hearing, the hearing officer would dismiss the contested case hearing and assess an administrative penalty in an amount not to exceed $10,000 against the insurance carrier.

HB 2647 - Rep. Jaime Capelo - Relating to a pilot program of nutrition, preventative health care, and physical activity for certain public school students. The Food for Thought pilot program would be established in consultation with child development experts at Texas A&M University - Corpus Christi, the TDH, and at least one expert in the field of child nutrition, health, or physical education selected by the commissioner. The program would be an interdisciplinary nutrition, preventative health care and physical activity program designed to build lifelong healthy habits in children in grades four, five and six. The Texas A&M University would select the participating schools, to be based upon two factors: the schools must have a high percentage of obese students in the grade levels for which the program is designed; and the schools must be located near the university so that university students can assist in the program.

HB 2648 - Rep. Jaime Capelo - Relating to the administration of epinephrine by certain emergency medical services personnel. The Texas Department of Health would be directed to adopt rules to require that emergency medical services personnel certified as emergency medical technicians or at a higher level of training may administer an epinephrine auto-injector device to another only if the person has successfully completed a training course, approved by the TDH, in the use of the device.

HB 2650 - Rep. Jaime Capelo - Relating to requiring hepatitis C training for registered nurses. Under this legislation, no less than two hours of continuing education relating to hepatitis C would be required in a two-year licensing period. The training component must provide information relating to the prevention, assessment and treatment of hepatitis C.

HB 2670 - Rep. Kyle Janek - Relating to requiring the Texas Department of Health to allow health care providers to use certain vaccines in the vaccines for children program. The TDH would allow each health care provider participating in the vaccines for children program to: 1) select vaccines from the list of all vaccines that are recommended and approved by the federal advisory committee on immunization practices and under contract with the Centers for Disease Control of the U. S. Public Health Service; and 2) use combination vaccines.

HB 2729 - Rep. Patricia Gray - Relating to allowing the donation of certain unused prescription drugs to charitable medical clinics. A convalescent or nursing home or related institution, hospice, hospital, physician, pharmacy, or individual may donate certain unused prescription drugs to a charitable medical clinic. A charitable medical clinic, defined as a clinic that provides medical care without charge or for a substantially reduced charge, may accept and dispense or administer the donated drugs under certain circumstances. Clinics may not accept donated drugs unless 1) the donor certifies that the drugs have been properly stored while in the possession of the donor or of the person for whom the drugs were originally dispensed; 2) the donor provides the clinic with a verifiable address and telephone number; and 3) the person transferring possession of the drugs presents the clinic with photographic identification.

HB 2826 - Rep. John Smithee - Relating to the adoption of a uniform explanation of payment form by the Texas Department of Insurance. The commissioner would be directed to adopt a single uniform explanation of payment form and define the terminology used in that form. Each health carrier would be required to use the adopted form when sending claims payments to providers. The form must contain the information necessary for the provider to be able to determine if the amount of the payment made is correct.

HB 2831 - Rep. John Smithee - Relating to notification to certain health care providers of the standards used by a managed care entity to determine the amount of reimbursement for an out-of-network provider. At the request of a health care provider, a managed care entity would have to provide a written description of the standards it used to determine the amount of reimbursement that an out-of-network provider would receive for goods or services provided to an enrollee in the entity's managed care plan.

HB 2942 - Rep. Jaime Capelo - Relating to the practice of medicine without an annual registration receipt. The Occupations Code would be amended to stipulate that practicing medicine without an annual registration receipt for the current year "30 days after the expiration of the previous year" has the same effect as, and is subject to all penalties of, practicing medicine without a license.

HB 3014 - Rep. John Smithee - Relating to prohibited practices regarding determinations of eligibility for coverage and authorizations for certain services provided by health maintenance organizations or preferred provider plans. HMOs and PPOs would be prohibited from denying payment to physicians based on the enrollee's ineligibility to receive the care or services, or the lack of authorization for the physician to provide the care or services to the enrollee, if the HMO or PPO: 1) failed to respond to a request for verification or eligibility or authorization within 24 hours after the initial request or, in the case of an authorization, a shorter or longer period required or permitted by this act or the Insurance Code; 2) verified the enrollee's eligibility but later determined the eligibility be invalid; or 3) informed the physician or the physician's employee that the care or services were authorized but later determined the authorization to be invalid.

HB 3012 - Sen. John Smithee - Relating to the regulation of physician joint negotiation. This legislation would modify existing laws covering collective bargaining by physicians with health plans by extending allowable negotiations to include fees and prices for services and reimbursement rates, except for Medicaid plans and certain other plans. The bill also changes some of the requirements under which physicians can join together to negotiate.

HB 3041 - Rep. Charlie Geren - Relating to the creation of a missing persons DNA database at University of North Texas Health Science Center, creating an offense for release of confidential information in database and failure to destroy samples. This bill authorizes the board of regents of the University of North Texas to develop at UNTHSC at Fort Worth a DNA database for all cases involving the report of an unidentified deceased person or a high-risk missing person.

HB 3152 - Rep. Jaime Capelo - Relating to due process for physicians, dentists, and podiatrists in hospitals. Section 241.101 (c) of the Health and Safety Code would be amended by adding the following: "A physician, podiatrist, or dentist who is damaged by a failure to follow the due process protections provided by this subsection may bring an action for damages on behalf of the physician, podiatrist, or dentist and others similarly situated. The damages may include 1) actual damages; 2) reasonable court costs and attorney's fees; and 3) other appropriate relief."

HB 3154 - Rep. Jaime Capelo - Relating to the creation of the Texas Asthma and Allergy Council. The Council would be directed to assist with the implementation of the Texas Asthma Plan and the Texas Allergy Plan by continually monitoring and revising the plans; creating a certification process for asthma and allergy educators; compiling related data; assisting public schools in dealing with children with asthma and children with allergies; acting as a repository for asthma and allergy projects; supporting research; and disseminating information.

HB 3155 - Rep. Jaime Capelo - Relating to the establishment of a Texas Pediatric Diabetes Research Working Group in the Texas Department of Health. Cited as the "Texas Pediatric Diabetes Research Act of 2001," this bill directs the commissioner of the TDH, in consultation with the Texas Diabetes Council, to establish a Pediatric Diabetes Research-Plan Group. Duties of the group shall be to conduct analysis for the purpose of providing advice to the legislature and governor on the development of a plan to investigate the scientific research opportunities for pediatric diabetes in the state; and assess resources, talent and diabetes burden, both economic and health related.

SB 812 - Sen. John Carona - Relating to expanding access to women's health care services. The Human Resources Code would be amended by adding a new subsection, which reads as follows: "The department shall set the income eligibility cap for medical assistance at 185 percent of the federal poverty level for preventive health and family planning services for women." In addition, the department is directed to compile a list of potential funding sources a client can use to help pay for treatment of health problems 1) identified using preventive health services provided to the client under the medical assistance program; and 2) for which the client is not eligible to receive treatment under the program.

SB 940 - Sen. Teel Bivins - Relating to the establishment of the Joint Admission Medical Program to assist certain economically disadvantaged students in preparing for and succeeding in medical school. This legislation would authorize the Joint Admission Medical Program Council, to be composed of one faculty member employed by and representing each of Texas' eight medical schools, to administer the program, which would provide financial and academic support to certain economically disadvantaged students.

SB 1006 - Sen. Leticia Van de Putte - Relating to testing for accidental exposure to hepatitis B or hepatitis C. This bill would add a new subsection in testing for accidental exposure, as noted in Section 81.095 of the Health and Safety Code. The new subsection would apply only in a case of accidental exposure of certified emergency medical services personnel, a firefighter, or any other person who renders assistance at the scene of an emergency or during transport to the hospital to blood or other body fluids of a patient who is transported to a licensed hospital. The hospital receiving the patient, following a report of the exposure incident, shall take reasonable steps to test the patient for hepatitis B or hepatitis C.

SB 1030 - Sen. Jon Lindsay - Relating to the limits on liability for a health care liability claim. The malpractice cap would be extended for individual liability to the collective liability of all the individuals involved.

SB 1041 - Sen. Rodney Ellis - Relating to services provided through telemedicine for children with special health care needs. The Health and Human Services Commission would establish by rule policies that permit reimbursement under the state Medicaid program for services provided through telemedicine to children with special health care needs. The policies must be designed to prevent unnecessary travel and encourage efficient use of telemedicine for these children; and provide for reimbursement of multiple providers of different services who participate in a single telemedicine session for a child with special health care needs.

SB 1084 - Sen. Chris Harris - Relating to requiring hepatitis A vaccines for food service employees. The Texas Department of Health would be authorized to adopt rules relating to required hepatitis A vaccination of persons employed by a food service establishment, retail food store, mobile food unit and roadside food vendor.

SB 1100 - Sen. Mike Moncrief - Relating to nursing home pilot sites to provide research, training, and education in health-related disciplines regarding the care of residents of nursing homes. The Texas Higher Education Coordinating Board would be authorized to select two nursing home pilot sites, to be affiliated with one or more medical and dental units. Each site would offer training programs for physicians, registered nurses, licensed vocational nurses, nursing assistants, nursing home administrators, and nursing home inspectors and students of institutions of higher education degree programs in those disciplines.

SB 1143 - Sen. John Carona - Relating to the credentialing of physicians and providers by health maintenance organizations. This bill would add a new section to the Texas Health Maintenance Organization Act, as follows: In regards to a process for selection and retention of affiliated providers implemented and performed by an HMO, the department: 1) shall not require site visits for initial credentialing to be performed by clinical personnel; 2) shall require an HMO to primary verify that a physician's license to practice, and other required certifications such as DPS, DEA and Medicare, are valid and current at the time of initial credentialing and every recredentialing, but shall not be required to verify validity or currency of license or certificates during the interval between scheduled credentialing as required by NCQA; 3) shall require that when an HMO is conducting site visits, including the evaluation of the quality of encounter notes, the HMO will evaluate a site's accessibility, appearance, space, medical or dental record keeping practices, availability of appointment and confidentiality procedures, but not the appropriateness of equipment; 4) shall not require that site visits be performed in the offices of high volume specialists; 5) shall not require that site visits be performed for recredentialing of any physician or provider; 6) shall not require the HMO to formally recredential physicians and providers more frequently than every three years; and 7) except as otherwise required by law, shall conform to regulations governing credentialing to standards promulgated and periodically revised by the National Committee for Quality Assurance.

SB 1152 - Sen. Leticia Van de Putte - Relating to establishing the Tex Rx plan. The Texas Department of Health would be directed to develop the Tex Rx plan to provide prescription drug benefits for eligible individuals. Eligible persons must be a resident of Texas; not be eligible for Medicaid; be eligible to participate in Medicare; not be covered by a Medicare supplement policy that provides benefits for prescription drugs; and have a net family income that is at or below 200 percent of the federal poverty level.

SB 1297 - Sen. Eddie Lucio - Relating to information that a professional liability insurance carrier or the Texas Board of Medical Examiners may require a physician to provide. Physicians applying or seeking renewal of a professional liability policy would not be required to provide an insurer with information relating to a health care liability claim if a suit is filed on the claim and 1) the suit is dismissed without a settlement being made, or resolution of the claim being made through alternative dispute resolution, including mediation or arbitration, under which the physician becomes liable to pay money to the claimant; or 2) the physician is found not liable for the claim by the court that finally adjudicates the claim. Likewise, a physician who applies for registration would not have to provide the above information to the board.

SB 1467 - Sen. Mike Moncrief - Relating to coverage for tests for the detection of colorectal cancer under certain health benefit plans. The Insurance Code would be amended by adding a new article entitled, "Coverage of Certain Tests for Detection of Colorectal Cancer." A health benefit plan that provides benefits for diagnostic medical procedures would be required to provide coverage for enrollees who are 50 years or older for expenses incurred in conducting a medically recognized diagnostic exam for the detection of colorectal cancer. Minimum benefits must include a fecal occult blood test, performed annually; a flexible sigmoidoscopy with hemoccult of the stool, performed every five years; and a colonoscopy performed every 10 years.

SB 1587 - Sen. Mike Moncrief - Relating to alternative dispute resolution procedures for proposals for legislation to change or clarify the permissible scope of practice of a health care profession. A new chapter entitled, "Alternative Dispute Resolution Procedures for Health Care Profession Draft Legislation" would be added to the Civil Practice and Remedies Code. The legislation states that the chair of any committee of the senate or house of representatives may require that the committee postpone consideration of health care profession draft legislation until after an alternative dispute resolution proceeding relating to the draft legislation is conducted. A health care professional group that seeks the enactment of health care profession draft legislation may choose any appropriate alternative dispute resolution procedure, including mediation by the Center for Public Policy Dispute Resolution at The University of Texas School of Law. In the case of such mediation, all health care profession groups would be notified and invited to participate in the proceedings. Issues to be considered by an alternative dispute resolution proceeding would include: 1) a definition of the problem and why legislation is necessary to address the problem; 2) the benefit to the public; 3) any harm to the public; and 4) the extent to which the public can be confident that the change of scope of practice will be competent in relation to the change or clarification in scope of practice. Upon complete of the proceeding, the mediator would send a report to the parties concerned; the lieutenant governor; the speaker of the house of representatives; and house of representatives whose jurisdiction relates to change or clarification sought by the health care profession draft legislation.

* Robert G. Maul, D.O., FACGP, of Lubbock, was elected vice president of the American College of General Practitioners in Osteopathic Medicine and Surgery.

* Texas College of Osteopathic Medicine honored Dallas Southwest Osteopathic Physicians, Inc., for its support of the college's continuing medical education program. DSWOP was recognized for providing grants to TCOM for operating expenses of its continuing medical education program.

* The American Board of Quality Assurance and Utilization Review Physicians announced the certification of Christopher S. Angelo, D.O., of Houston.

* As of April 1991, the Registration Department of the Texas State Board of Medical Examiners reported the following totals for active licensed D.O.s practicing with Texas licenses: in-state - 1,667; out-of-state - 733; total - 2,400.

On February 22, 2001, the Drug Enforcement Agency (DEA) held a meeting on the topic of Electronic Prescriptions for Controlled Substances.

The purpose of this meeting was to discuss and exchange ideas concerning the development of an electronic prescription initiative. The DEA is working closely with the Department of Veterans Affairs, representatives of the health care industry, and associations on this project.

DEA plans to release an interim or proposed rule on this next month or early April, with the final rule being issued in June 2001. Depending on the information contained in the rule, AOA may want to comment on this issue. We will keep you informed when we have further information.

If you have further questions or need further information, please feel free to contact me via email at ajeansonne@aoa-net.org or phone at (202) 414-0151.

(Washington, DC) - Legislation introduced in the Senate and House takes a positive step to address critical problems associated with the overwhelming and intrusive regulatory burden the Health Care Financing Administration (HCFA) places upon osteopathic physicians (D.O.s), says the American Osteopathic Association (AOA).

According to the AOA, the legislation's enactment will help ensure D.O.s are able to provide patients with the highest standards of quality care by allowing osteopathic physicians to once again practice medicine without the threat of onerous HCFA oversight and encroachment. "D.O.s are increasingly attacked with burdensome federal regulations that ultimately force paperwork over patient care," says Dr. Krpan. "This mal-distribution of time is evident in physicians' practices nationwide and has an impact on care."

Specifically the bill:

The AOA, which represents 44,000 osteopathic physicians (D.O.s) nationwide, promotes public health, encourages scientific research and is the accrediting agency for all osteopathic medical schools and health care facilities. Access the AOA's Web site at www.aoa-net.org for more information on the AOA's policy positions.

* D.O. on Capitol Hill Day - April 26, 2001

* AOA House of Delegates - July 13-15, 2001 - Fairmont Hotel, Chicago, Illinois

* 2001 AOA Convention, October 21-15, 2001

* 2001 NOM Week/Leadership Summit Meeting - November 15-18 - St. Louis, Missouri

(The above dates are subject to change.)

The AOA's Department of Communications is seeking D.O.s who can be a healthcare resource concerning "End of Life Care." The theme for National Osteopathic Medicine Week 2001 has been selected, "End of Life Care" and the AOA has begun the process of gathering osteopathic healthcare sources for the new kit.

If interested in serving as a healthcare source for one of the topics in this year's kit, physicians should contact Kelletta Blackburn, Marketing Communications Coordinator, with your name; mailing address; work phone, e-mail address; fax number; specialty area; the topic you would like to be interviewed about; and the best means of contacting you.

Once the AOA receives your intent to participate, you will be contacted regarding a day and time to schedule a telephone interview. The interview will not last longer than 30 minutes and you will be forwarded the list of questions beforehand.

NOM Week 2001 Topics

• Advanced Directives
• Advances in Pain Management
• Cultural Sensitivity and the Final Stages of Life
• Spirituality and End of Life Care
• Talking to Children Who Have a Serious Illness
• Caring For Those With Serious Long-term Sports Injuries
• Support for Caregivers
• Organ Donation
• Financing Long-Term Care
• Choosing Long-Term Care Options
• Talking to Children About the Serious Illness of a Parent

To sign up, please contact Kelletta Blackburn, Marketing Communications Coordinator; 312-202-8045; by fax at 312-202-8345; or by e-mail at kblackburn@aoa-net.org.