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2021 Texas Legislative Priorities and results

We started the 2021 Texas Legislative session with long list of things we hoped to accomplish. Here’s how the session turned for medicine

Provide Meaningful Health Care Coverage

Texas already had the highest uninsured rate in the nation before the COVID-19 pandemic, and millions more are now unemployed and uninsured. The state budget also was negatively affected by the pandemic, meaning this was an opportunity to expand meaningful coverage for the un and under insured.

The good news for the state budget was that billions of federal dollars are headed to Texas to cover the losses the state suffered. Unfortunately for our priority, this meant there wasn’t much of an incentive to make a major policy change.


  • House Bill 133 by Rep. Toni Rose: Will provide 6 months’ postpartum Medicaid coverage. Effective 9/1/21.
  • House Bill 2658 by Rep. James Frank: Will provide the opportunity for two continuous six-month periods of Medicaid coverage for children. Effective 9/1/21.
  • We tried to pass meaningful Medicaid reform, in the form of Sen. Nathan Johnson’s “Live Well Texas” program to provide health care coverage to uninsured working Texans. Neither his Senate bill nor the companion House bill ever got a hearing in committee.

Preserve Patient Access to Care With Telemedicine Payment Parity


  • House Bill 4 by Representative Price: Requires the state to make telemedicine services available to patients in the Medicaid and CHIP programs. Effective 6/15/21.
  • House Bill 5 by Rep. Trent Ashby: Creates incentives for broadband expansion in underserved parts of the state. Effective 6/15/21.
  • House Bill 1616 by Rep. Bonnen, MD authorizes Texas’ participation in the Interstate Medical Licensure Compact , allowing physicians an easier path to being licensed in multiple states, including for those wanting to practice telemedicine. Effective 9/1/21.

Reduce Health Insurance Prior Authorization Red Tape


  • House Bill 3459 by Representative Bonnen, MD: Would gold card physicians who earn approvals on at least 90% of their preauthorizations on a given service over a six-month period. The new law also requires peer-to-peer calls occurring prior to a utilization review denial to be conducted by a Texas-licensed physician in the same or similar specialty as the physician who requested the service. Effective 9/1/21.

Strengthen Texas’ Public Health Care Infrastructure

The pandemic highlighted numerous areas of weakness in the state’s ability to respond to pandemics. This session, with TMA’s help, lawmakers passed roughly 20 bills that will change the way the state responds to the next pandemic or public health crisis.


  • Senate Bill 969 by Sen. Lois Kolkhorst gives the Texas Department of State Health Services (DSHS) more authority to collect health data during a public health disaster and requires the agency to share that information with the public. Effective 9/1/21.
  • Senate Bill 968 by Sen. Lois Kolkhorst creates a state stockpile of personal protective equipment (PPE) and establishes the office of a state epidemiologist. The new law also regulates how local governments can respond during a declared state of disaster and creates a legislative oversight board to supervise public health disasters. Effective 9/1/21.
  • Senate Bill 1353 by Sen. Boris Miles (D-Houston), which will require DSHS to report immunizations by race, age, and county. DSHS also will be required to recommend ways to decrease inequities in vaccine administration. Effective 6/14/21.
  • Senate Bill 239 by Sen. Beverly Powell (D-Burleson), which directs DSHS to create a system to provide immunization information and make immunization awareness materials available for local health authorities during a disaster. Effective 9/1/21.
  • Senate Bill 437 by Cesar Blanco (D-El Paso), which creates an advisory committee on state planning for PPE reserves made up of health care professionals to ensure community and private practice physicians are considered in allocations. Effective 6/16/21.

    Ensure Patient Safety Through Team-Based Care

    In 2020, both California and Florida enacted independent prescribing for advanced practice registered nurses (APRNs). APRNs and other groups tried their best to push for further unsupervised encroachments into the practice of medicine in Texas.


    • None of the scope of practice bills we opposed made it out of committee.

    Prevent Taxes on Medical Billing Services

    TMA and a coalition of more than 40 organizations and companies successfully worked on a bill that will ensure third-party medical billing services are not subject to sales and use tax, a tax that would negatively impact patient access to care.

    Preserve Funding for Texas’ Medical Residency Programs

    • The Legislature provided enough funding for the Graduate Medical Education program to sustain our goal of 1.1:1 ratio of residency slots for medical school graduates.
    • Senate Bill 1490 by Sen. Brandon Creighton: Regulates clinical clerkship programs by private, out-of-state medical schools to ensure spots for Texas students. Effective 9/1/21.

    Prevent Youth Addiction to Nicotine


    • Senate Bill 248 (Sen. Nathan Johnson) – Requires a license to sell vaping products just like those who sell tobacco products. The new law also brings advertising restrictions in line with tobacco products: Effective 9/1/21.

    Retain Texas’ Landmark Medical Liability Reforms

    Passed in 2003, Texas’ sweeping liability reforms have helped to curb health care lawsuit abuse and ensure Texans have access to high-quality medical care. As in past sessions, TMA vigorously defended against efforts to dilute these important medical liability reforms and even added strength to the existing law with regard to pandemics.


    • Senate Bill 6 by Sen. Kelly Hancock: Provides liability protection for health care professionals during a pandemic or other disaster. Effective 6/14/21.
    • All attempts to dilute our liability protections were defeated.
    2021 Redistricting

    To view how redistricting works, visit https://www.texastribune.org/2020/12/29/texas-redistricting-2021/ .

    What’s Happening in Washington

    Agreement would use Medicare payment cuts to pay for Infrastructure bill

    Under the framework for an Infrastructure bill worked out by President Joe Biden  and a group of Democratic and Republican senators, Medicare reimbursement reductions would help cover the legislation's $1.2 trillion cost. The plan would continue mandatory two percent sequestration cuts to Medicare providers through at least 2031.

    Physicians and other health care providers have endured successions of Medicare reimbursement cuts over the past few decades.

    At the urging of the AMA, AHA and other groups, the federal government paused the automatic cuts derived from the 2013 "budget sequestration" law through the end of 2021 to ease financial pressures on providers caused by the COVID-19 pandemic. However, the cuts are scheduled to resume next year.

    Congress needs to act on telehealth

    The COVID-19 pandemic has impacted the delivery of health care in a number of ways.

    Support making expanded telehealth services permanent.

    During the pandemic, telehealth services emerged as a critical tool to provide care to patients while supporting physical distancing efforts and reducing the spread of COVID-19 and other infectious diseases by avoiding unnecessary outpatient visits. In response, Congress acted to temporarily expand access to Medicare covered telehealth services to all Medicare beneficiaries by authorizing HHS to waive outdated statutory restrictions on where telehealth services may be provided.

    Physicians and patients alike talk about the positive effects of expanded telehealth benefits. It has continued to allow physicians to provide high-quality care using new digital tools.

    Congress needs to act!

    Recently, legislation was introduced in both the House and Senate that, if passed, would make the expanded access to telehealth services permanent. The Telehealth Modernization Act of 2021 (H.R. 1332/S. 368) would lift the rural-only restriction and add any site where a patient is located as a potential originating site and ensure all Medicare beneficiaries may receive covered Medicare telehealth benefits, including at home and via mobile technologies as appropriate, while the CONNECT for Health Act (H.R. 2903/S. 1512) would provide HHS with permanent authority to waive these restrictions, similar to the authority the agency has for the duration of the COVID-19 public health emergency.

    The success of telehealth technology adoption during the COVID-19 public health emergency has made it abundantly clear that Medicare covered telehealth benefits should be available to ALL Medicare patients regardless of where they live or how they access broadband services!

    Please contact your Senators and member of Congress and ask them to support making expanded telehealth services permanent today!!

    Expanded telehealth is working for patients, let’s fight to keep it that way!

    Additional Legislative Resources