STATE LEGISLATIVE UPDATE

MARCH, 2002 STATE LEGISLATIVE UPDATE

The National Conference of State Legislators released its study entitled 2002 State Health Priorities which found that 42 states listed Medicaid as their number one health issue this year. This is even more impressive when you consider that only 44 state legislatures are meeting this year. Thirty-seven states replied that they will be reviewing the Medicaid reimbursement rates this year. Thirty-one states reported that in 2001 Medicaid spending was higher than budgeted. Only 13 states listed insurer liability as a high priority for 2002.

As of the end of the month, the following state legislatures were in regular session: AK, AL, AZ, CA, CO, CT, DE, HI, GA, IA, IL, KS, KY, MA, MD, ME, MI, MN, MO, MS, NE, NH, NJ, NY, OH, OK, PA, RI, SC, TN, WI, and VT. Louisiana was in special session. During March sessions adjourned in FL, ID, IN, SD, UT, VA, WA, WV and WY. Through March there have been 73,305 new bills introduced in the states (this does not include carry-over bills from last year) and 9,578 have become law.

Some of the bills the Department of Health Policy is tracking are outlined below. If you have any questions please give Jay Fisher a call at 800-346-2267, x4336.

PROMPT PAYMENT

The prompt pay bills in Florida failed to pass before the legislature adjourned. A bill was signed into law in Maine defining undisputed claims as ones "submitted to an insurer on the insurer's standard claim form using the most current published procedural codes with all the required fields completed with correct and complete information in accordance with the insurer's published claims filing requirements." A prompt payment bill passed in Kentucky. The bill clarifies what constitutes a clean claim under Kentucky law and allows physicians to see what they are entitled to be reimbursed for specific procedures under their contract.

The Georgia Insurance Commissioner fined One Health Plan of Georgia, Inc. $200,000 for violating the prompt payment law.

REIMBURSEMENT

An orthopaedic practice in Washington state has filed suit against a Blue Cross/Blue Shield affiliate alleging that the insurer downcodes and bundles claims and delays payment on claims in violation of the profiteering act and consumer protection acts. The plaintiffs are trying to get the suit turned into a class action on behalf of all similarly situated payees.

A bill passed both Houses in New Hampshire lowering the required amount of medical coverage in motor vehicle liability insurance policies from $5,000 to $1,000.

TORT REFORM

In March Jury Verdict Research released a report showing that the median jury award in medical malpractice cases was 43% higher in 2000 than in 1999. The median award increased from $700,000 to $1,000,000. Plaintiffs, though, prevailed in only 38% of the malpractice cases that went to trial (but were successful in 48% of surgical negligence cases). The median settlement in malpractice cases decreased by 16% to $500,000.

Governor Schweiker of Pennsylvania signed into law legislation to address the professional liability insurance premium crisis. The law does not contain the voluntary caps on non-economic damages that were in an earlier version of the bill nor the elimination of joint and several liability. The law does allow for periodic payments of future damages over $100,000 and creates a task force to recommend legislation to counteract venue shopping. Additionally, the bill phases out the CAT fund (the Pennsylvania Medical Professional Liability Catastrophic Loss Fund), a state run entity funded by physicians as a second layer of liability coverage. The CAT fund charges will be reduced yearly with the assistance of money from traffic fines.

SCOPE OF PRACTICE

Last month I mentioned a new law in Massachusetts that allows chiropractors to call themselves chiropractic physicians. I heard from physicians in Massachusetts that this bill was pushed by the medical community to rein in many non-physicians who were calling themselves physicians.

A bill passed in Wisconsin to amend the PT scope of practice. The bill was amended and addresses some concerns raised by the Wisconsin Orthopaedic Society. The definition of diagnosis was changed to read "a judgment that is made after examining the neuromusculoskeletal system or evaluating or studying its symptoms and that utilizes the techniques and science of physical therapy for the purpose of establishing a plan of therapeutic intervention." The legislature also put in the bill current restrictions on PTs using roentgen rays or radium for any purpose, using electricity for surgical purposes, including cauterization, and prescribing drugs or devices.

PATIENT PROTECTIONS

The Kaiser Family Foundation released a study detailing the use of external review mechanisms in the 42 states with such laws. Each year only about 4,000 patients appeal treatment denials to independent arbitrators. Nationwide 45% of the appeals are decided in the patient's favor with Connecticut being the most favorable to patients with a 72% success rate and Arizona and Minnesota being the friendliest to insurers with patients prevailing only 21% of the time.

A bill passed a house in Georgia to require insurers to pay pre-certified claims. The bill also requires plans to have around the clock personnel available to approve emergency treatment.

JOINT NEGOTIATION

The joint negotiation bill that passed the Alaska Senate has been stalled in the House of Representatives. In March the U. S. Federal Trade Comm. testified before a House committee that the proposed bill would hike health care costs due to price fixing and harm patients by reducing access to care.

A joint negotiation bill was introduced in Pennsylvania. The bill in Washington to toughen the joint negotiation law failed to pass before the end of the session.