STATE LEGISLATIVE UPDATE

JUNE 2003 STATE LEGISLATIVE UPDATE

The cost of health care keeps increasing. In June the Center for Studying Health System Change released a study concluding that spending in 2002 for health care for privately insured citizens increased by 9.6%. That is more than three times the overall inflation rate of 2.7%. Spending on hospitals increased by 5.1%, on prescription drugs by 13.2% and on physician services by 6.5%. The study is at: http://www.healthaffairs.org/WebExclusives/Strunk_Web_Excl_061103.htm.

As of the end of the month, the following state legislatures were in regular session or in recess: CA, MA, MI, NC, NH, NY, OH, OR, PA, RI, and WI. The legislatures in AL, AZ, CT, DE, IL, LA, ME, NV, SC and TX adjourned in June. Through June there have been 163,359 new bills introduced in the states and 31,783 have become law.

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

TORT REFORM

In response to the legislation introduced in Delaware to establish a $250,000 cap on non-economic damages the trial lawyers introduced legislation to limit the hours that residents can work and to eliminate confidential peer review. A compromise reform bill without a cap passed on the last day of session requiring an affidavit of merit be filed with a suit signed by an expert who is Board-certified in the same or similar field as the defendant. The bill also allows plaintiffs to toll the statute of limitations for 90 days so they can investigate whether negligence occurred.

The Florida legislature met in special session to consider Governor's Bush legislation to create a $250,000 cap. The House passed the bill with the cap, while the Senate--backing down somewhat from its previous no cap at all attitude--passed a bill with a $500,000 cap that covers all practitioners, a $500,000 cap that covers all facilities and a $500,000 cap that covers all other defendants. For certain catastrophic injuries the cap would be $2,000,000 for all practitioners, etc. The two houses could not agree on a compromise and the special session adjourned. Governor Bush indicated he will call the legislature back into special session on July 9th.

A bill to limit punitive damages and to restrict how much contingency fees a lawyer can charge passed the Senate in Ohio. Legislation passed the House in Pennsylvania that would allow voluntary binding arbitration in medical liability cases and also includes patient safety provisions. Also in Pennsylvania, the House passed a bill to amend the constitution to allow the legislature to cap non-economic damages. The proposed amendment must still be approved by the Senate twice, by the House once more and then by the voters.

A bill passed both houses in Louisiana that adds on-call physicians to those immunized for gratuitously responding to emergencies in hospitals. Legislation also passed both houses in New Hampshire to overrule a decision by the state Supreme Court that allowed plaintiffs to sue for "loss of opportunity" in medical liability cases. Texas Governor Perry signed a bill providing immunity for physicians who provide school athletic physicals.

The Senate in Nevada rejected a proposed ballot initiative that would have gone before the voters at the same time as the doctors-backed initiative. The doctors' initiative will strengthen the cap on non-economic damages that passed last year and will restrict lawyers' contingency fees. The bill before the legislature would have required the public to vote on the caps as they were enacted last year.

SCOPE OF PRACTICE

A bill was signed in Missouri requiring insurers to provide chiropractic coverage up to 26 office visits per year. The PT direct access bill in Connecticut passed after it was amended to limit direct access to "wellness care." A bill passed the Senate in Oregon that would amend the existing PT direct access statute such that PTs could have indefinite direct access if the patient and PT do not submit a bill for the treatment to an insurer.

A PT direct access bill passed both houses in Louisiana. The bill allows chiropractors to refer to PTs and allows PT direct access "for a previously diagnosed condition . . . for which physical therapy services are appropriate after informing the health care provider rendering the diagnosis. The diagnosis shall have been made within the previous ninety days. The physical therapist shall provide the health care provider who rendered such diagnosis with a plan of care for physical therapy services within the first fifteen days of physical therapy intervention." As passed by the House the physician would have had to approve the plan of care. The bill also tries to limit the liability of the diagnosing physician for conditions that may arise after the physician's diagnosis.

PROMPT PAYMENT

The Tennessee and Alabama Governors signed bills in June to limit recoupment of claims to the first twelve months after the claim has been paid. Governor Perry in Texas signed the prompt pay bill that allows the state by rule to declare what fields on the CMS 1500 must be filled out for the claim to be considered clean. A bill was signed into law in Connecticut that lays out explicitly what fields must be filled out for a claim to be clean.

PRACTICE MANAGEMENT/REIMBURSEMENT

A bill passed both houses in Illinois requiring that physicians see the fee schedule before signing an insurer contract. The previously noted bill in Pennsylvania also included language requiring insurers to provide fee schedules to physicians and mandates that high-risk specialists get reimbursed at least at 110% of Medicare. A bill dealing with the responsibilities of physicians in regard to billing, including banning balance billing, passed both houses in Louisiana.

The Pennsylvania Orthopaedic Society, three orthopaedists, and Independence Blue Cross (IBC) announced a preliminary settlement in the class action lawsuit involving the reimbursement policies of IBC. IBC agreed to disclose the fee schedule to providers, disclose payment policies and procedures, establish a process for provider appeals, and process claims for multiple surgeries (and other procedures) according to "established standards." These changes will provide an additional $40 million to providers over the next two years.