STATE LEGISLATIVE UPDATE

The statehouses of all fifty states and the District of Columbia are in session this year, so there will likely be a great deal of legislative activity. Big issues on the horizon in 2005 include Medicaid cuts, tort reform, and direct access to physical therapy.

As of the end of the month, the following state legislatures were in regular session: AK, AL, AR, AZ, CA, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NY, OH, OR, PA, RI, SC, SD, TN, TX, US, UT, VA, VT, WA, WI, and WY. WV was in special session. Through January 21st, there have been 26,070 new bills introduced in the states and 262 bills have become law.

Some of the bills the Department of Health Policy is tracking are outlined below. If you have any questions please contact Bruce Allain at allain@aaos.org (or at 847-384-4336).

MEDICAID

With many states still facing serious budget shortfalls, and with health care expenses growing at a rapid pace, a number of states are looking at making serious cuts in Medicaid coverage. This, of course, will mean even more patients needing medical care, but without medical coverage, showing up at physician's offices. Interestingly, a few states, including Delaware, Hawaii, and New Mexico have actually introduced legislation to increase Medicaid reimbursement rates.

TORT REFORM

The biggest legislative news in January came out of Maryland, where a bill addressing medical tort reform passed over the veto of that state's governor. The bill's cap on damages was not as low as many would like, but the bill does include mediation and expert witness provisions. A significant number of other states are looking at measures that would reform the medical malpractice system. States that have introduced bills that would place some sort of cap on damages include: Arkansas, Connecticut, Georgia, Hawaii, Iowa, Maryland, Minnesota, Mississippi, New Jersey South Carolina, Virginia, and Vermont.

In addition, other states have had bills introduced which would make other reforms to the tort system. These include attempts to create better expert witness qualifications in Arizona, Connecticut, Illinois, Montana, South Carolina, Washington and Wyoming. Also on the tort reform radar are "good faith" requirements, which require an expert to certify that a malpractice claim has merit before it can be filed (or before process can be served). Efforts to create such a requirement, or to strengthen existing measures, have been introduced in Connecticut, Georgia, Illinois, Virginia, and Wyoming. A variety of other attempts to reform various aspects of the medical tort system are also bouncing around the states.

SCOPE OF PRACTICE

Physical therapy issues continue to be a major concern. So far, Indiana, Minnesota, Mississippi, Nebraska, North Dakota and Washington have all had bills introduced to give physical therapists more direct access to patients, or to alter physical therapists' scope of practice. It is expected that more states will introduce direct access legislation in the near future. Interestingly, in its literature, the American Physical Therapy Association claims they have direct access in 48 states. The intelligent reader might ask: if physical therapists already have direct access in 48 states, why does APTA feel the need to keep introducing these bills?

Many states are considering an expansion of health care coverage to require payment for the services of podiatrists, chiropractors, and/or physical therapists. These states include: Connecticut, Hawaii, Iowa, Mississippi, and Texas. Equal payment bills are also arising, where the law would require podiatrists, chiropractors, and/or physical therapists to be reimbursed at the same rate as physicians. Legislatures looking at measures that would require insurance to reimburse at least some non-MD providers equally include: Connecticut, Iowa, Missouri, South Carolina and Texas. New Mexico is considering a bill that would require Medicaid to pay the same for chiropractic services as for services provided by an MD.

Connecticut, South Carolina and Wyoming are considering bills that would expand the scope of practice for podiatrists.

PATIENT PROTECTION

Bills that require the reporting of rates of infections acquired at health care facilities are also very popular with state legislators this year. States that have recently introduced such legislation include: Colorado, Connecticut, Delaware, Hawaii, Iowa, Indiana, Kentucky, Maryland, Minnesota, Mississippi, New York, Oregon, Rhode Island, Tennessee, Virginia, and Washington.

INSURANCE AND PAYMENT ISSUES

Arizona, Connecticut, Nebraska, New York, Oklahoma, and Virginia all are currently considering legislation that would improve the payment of insurance claims. In Florida, a group of 4,500 physicians have been given the right to pursue a class action suit against an HMO accused of regular downcoding and refusal to pay valid claims.