STATE LEGISLATIVE UPDATE

Big issues in March included various aspects of tort reform, as well as podiatry, physical therapy and payment issues.

As of April 1st, states currently in session are AK, AL, AR, AZ, CA, CO, CT, DC, FL, GA, HI, IA, ID, IN, KS, MA, MD, ME, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, US, VT, WA, WI, and WV. So far, as of March 31st, the states have introduced 125,229 new bills, and 11,184 bills have become laws. 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 at allain@aaos.org (or at 847-384-4336).

TORT REFORM

Once again, the most significant news from the states involves a major tort reform victory, this time from Missouri where sweeping medical malpractice reforms have become law. Among the provisions of the law are new limits on punitive damages and a $350,000 cap on non-economic damages irrespective of the number of defendants. In addition, the new law places limits on joint and several liability and restrictions on venue shopping. Furthermore, it provides civil immunity from damages for physicians who provide volunteer services and makes statements of sympathy by medical providers inadmissible as evidence.

There is other tort-reform related news to announce. In Montana, it has recently become law that statements of sympathy cannot be used against physicians in medical malpractice cases. A new law that creates qualifications for medical malpractice expert witnesses have been passed in Montana, and similar legislation is being considered in Florida and Georgia. Florida is also considering legislation that would make a physician who provides false, deceptive or misleading medical testimony subject to disciplinary action.

Oregon has recently introduced a bill that would require courts to determine the validity of the scientific principles that testimony is based on before allowing it. Virginia has passed a law that requires an expert to certify that the physician deviated from the standard of care before service of process is made. North Dakota passed a similar law requiring a plaintiff to serve an affidavit containing an admissible expert opinion to support a case of professional negligence.

PAYMENT

Virginia has enacted a law that requires health insurers to provide written notice of their downcoding and bundling policies. Missouri has introduced a bill that would prevent an insurer from changing the coding for services without the permission of the health care provider. There is a bill pending in Florida that would limit the ability of insurers to demand repayment of an overpayment.

PODIATRY

A podiatry bill became law in Wyoming, which expands the scope of practice for podiatrists to include the ankle and partial amputation. South Carolina has seen a similar bill introduced. In Idaho, a bill has passed both the house and senate that would also expand podiatrists scope to include the ankle.

PHYSICAL THERAPY

Direct access to physical therapy bills are still being introduced in many states. Texas, Georgia, and New York all saw bills introduced in March that would allow physical therapists to begin treatment of a condition without having that condition diagnosed by a physician. The Georgia and Texas bills would allow unlimited direct access, while the New York bill gives the therapist thirty days, or ten visits, before a physician needs to be consulted. Illinois is considering legislation that will change the definition of physical therapy to include examining, evaluating, and testing individuals and determining a treatment diagnosis.

Attempts to ban physician ownership of physical therapy services, which has recently been a contested issue in South Carolina, has now become an issue for physicians in Nevada. That state has recently had legislation introduced that would not only prevent physicians from having an ownership interest in such a facility, it would prevent anyone who is not a physical therapist from owning any part of a physical therapy service.

JOINT NEGOTIATION

A number of states are considering improvements on this subject. Important legislation that would allow physicians to negotiate jointly with certain health insurance payors has been introduced in Missouri, New York and Pennsylvania.

OTHER ISSUES

Yet another attempt to sever a non-radiologists right to use diagnostic imaging has been introduced, this time in Washington, where a bill was recently introduced that would make it an illegal self referral for an osteopathic physician or surgeon to refer a patient to a MRI, CAT or PET in which the physician has a financial relationship.

In Massachusetts, a bill has been introduced that would revoke the registration of any physician convicted of malpractice.

Arkansas has passed a law an “any willing provider law” that states that a health insurer shall not discriminate against any provider who is located within the geographic coverage area of the health benefit plan and who is willing to meet the terms and conditions for participation established by the health insurer.