STATE LEGISLATIVE UPDATE

Despite the recent attention garnered by bills relating to imaging use, physical therapists, and tort reform, May was a month dominated by less dramatic issues, including a number of items relating to insurance payment and expanding the immunity of physicians volunteering their services.

As of May 20th, states currently in regular session are CA, CT, DC, DE, IL, LA, MA, MI, NC, NE, NH, NJ, NV, NY, OH, OR, RI, SC, TX, US, VT, WI. States currently having special sessions are California, Maine and Mississippi. This year, as of May 19th, 143,390 new bills have been introduced in the states, and 23,569 of those 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 contact Bruce Allain at allain@aaos.org (or at 847-384-4336).

VOLUNTEERING

There was action this month on a number of bills that relate to providing protection from lawsuits for physicians volunteering their time. Georgia passed a law that provides immunity to health care professionals who contract to provide free medical services to underserved populations as agents of the state. In Tennessee, it is now law that health care providers have exemption from civil liability for volunteer service to medical clinics offering free care, except in cases of gross negligence. The New Jersey Legislature has introduced a bill that would provide immunity from civil liability to volunteer health care professionals providing patient care or treatment at nonprofit freestanding clinics, and would provide immunity to those clinics with respect to the care or treatment provided by the health care professionals.

CHIROPRACTORS

A number of bills were introduced in April relating to chiropractors. Michigan is currently considering a bill that would change the focus of chiropractic service from the spinal column to the entire musculoskeletal system. The legislation also would allow chiropractors to make differential diagnoses, and use advanced diagnostic imaging technology. Two bills that allow for reimbursement of chiropractic services at the same rate as physician services under workers compensation have been introduced in New York, and Louisiana has had legislation introduced that would mandate HMO coverage of chiropractic services.

INSURANCE PAYMENT

Utah has a new law that has made changes in the relationship between physicians and insurance payors. The law specifies when a participating physician in an HMO or PPO may bring an action for enforcement of payment and prohibits an insurer from taking adverse action against a contracted provider when an insured decides to access health care outside the provider network. In Washington, recently passed legislation limits both health insurance overpayment recovery practices for overpayments made to physicians, and the ability of physicians to request additional payment from the insurer.

Other states have recently had bills introduced that deal with this topic. New Jersey is currently considering a bill that would create a process for physicians to resolve disputes with insurance carriers over claims processing or payment. New Jersey also has a bill in the works that limits the period for reimbursement for overpayment on health claims and establishes a claims appeal process. Legislation that would create new limits on insurers seeking refunds from physicians has also been introduced in New York. Pennsylvania has seen legislation introduced that would require insurers to cover positron emissions tomography scans.

TORT REFORM

New Jersey had bills introduced in May that would cap noneconomic damages in medical malpractice actions arising from emergency care at $250,000. West Virginia had two bills pass into law that affect physicians’ exposure to civil liability. One bill relieves health care providers of liability where an injury results from a prescribed drug or medical device, the other bill provides that expressions of apology, responsibility, sympathy, condolence or a general sense of benevolence made by a health care provider to a patient cannot be used against that provider as evidence of admission of liability.

MISCELLANEOUS

In May, Montana passed legislation that makes it a civil offense for a physician to issue a written prescription on which the name of the drug, dosage, instructions or identifiers of the prescribing doctor cannot be determined. A new law in Washington greatly expands the scope of service for physical therapists to include, among other things, the ability to determine a diagnosis for patients. Washington also passed a law that creates a task force to review that state’s certificate of need program. This review includes reviewing the scope of facilities, services, and capital expenditures that should be subject to a certificate of need.

Legislation has been introduced in the District of Columbia that touches on a broad range of issues. Among other things, the bill being considered would: give additional immunity to medical volunteers, develop an adverse medical incidents reporting system, require a certificate of merit in medical liability actions, and would place a cap on noneconomic damages.