STATE LEGISLATIVE UPDATE

December, far from being a quiet end to the legislative year, is instead being highlighted by preparations for 2006 legislative battles, and the early introduction of many bills that will be considered in the upcoming year. Some of the bills the department of Socioeconomic & State Society Affairs is tracking are outlined below. If you have any questions, please contact Bruce Allain allain@aaos.org (or at 847-384-4336).

MEDICAL LIABILITY PREMIUMS

Missouri is considering three new pieces of legislation (MO H 1046, MO H 1087, and MO S 698) that would affect malpractice insurance premiums. The first would require premiums to be based on average judgments in the county where the physician practices, and the second would require insurers to report premiums, premium changes, losses, and other information to the state. The last of the three would allow physicians to take a tax credit for a portion of any increases in malpractice insurance premiums, would require that rates not be excessive or unfair, and that any increase in premiums of fifteen percent or more would require approval.

New Hampshire has had legislation introduced (NH H 1299) that would create a commission to study laws in states with low malpractice insurance rates so that the state can decide how best to develop future legislation. A committee in Vermont has just released the results of a similar study. While the committee’s members were highly divided on the issues, the report concluded that malpractice caps would affect insurance costs for health care providers, but did not directly urge the state to adopt caps.

PROFESSIONAL LIABILITY

In New Jersey, a bill (NJ S 2910) was introduced with the intent of creating a medical malpractice court. Vermont has seen the introduction of a bill (VT S 198) that would create an expression of sympathy law for the state.

Legislative leaders in Oregon are looking at drafting legislation that would clarify that all malpractice claims must be reported. Currently, some of the state’s biggest players (such as Kaiser Permanente and Oregon Health & Science University) have claimed that existing reporting requirements do not apply to them, resulting in a gap of over ten years in the state’s ability to track malpractice claims.

At least three malpractice carriers in West Virginia are looking to reduce what they charge for premiums as a result of reforms passed in the last five years. The state’s insurance commissioner gave a great deal of the credit to a law that requires a doctor to sign off on malpractice suits before they can be filed. In 2003, West Virginia also passed a non-economic damages cap of $500,000.

INSURANCE CONTRACTS

A bill introduced in Indiana (IN S 124) would prevent payors from including certain types of terms in their contracts with providers, including provisions that prevent providers from receiving lower payment rates from other providers. Missouri has had legislation (MO S 599) introduced which would allow for physicians to negotiate jointly on non-fee-related matters.

TRAUMA CARE

A recently released study has indicated that almost half of the emergency room care provided in Florida is uncompensated. The president of the Florida College of Emergency Physicians noted the possibility that emergency care could deteriorate from the lack of funding and resources. In 2003, Texas passed a law to help fund trauma care in the state. The law earmarked a percentage of money collected from fines levied against reckless or intoxicated drivers to go to help reimburse trauma facilities. But that program is in jeopardy as the Texas Speaker of the House, Republican Tom Craddick, has indicated that it would be fiscally irresponsible to use all of the funds for trauma centers. Health care officials have stated that removing the funds from the trauma system could result in some hospitals getting out of trauma care entirely.

MISCELLANEOUS

In Florida, a bill (FL H 575) has been introduced that would reform the state’s scope of practice for podiatrists. Currently, the law says podiatrists can treat ailments of the foot and leg; the new language would limit podiatrists to the foot and ankle.

A report from California has pointed out a major road block in the development of specialty hospitals. Not the usual certificate of need problems, but rather a shortage of health officials needed to conduct initial inspections before a facility can be licensed. Delays in getting inspected are sometimes up to a year and can result in hundreds of thousands of dollars in losses.

Florida is about to begin a test program where many Medicaid beneficiaries will now get their health benefits through private managed care systems, such as HMOs. Some physicians view this as an positive opportunity, while others have noted that this could further reduce the access to health care by adding layers of bureaucracy that will deter even more physicians from participating.