STATE LEGISLATIVE UPDATE

As of the end of the month, the following state legislatures were in regular session, recess, veto or special session: CA, DC, DE, IL, MA, MI, NH, NY, NJ, OH, OK, PA, and WI. Through October 27, there have been 160,743 new bills introduced in the states and 37,497 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).

TORT REFORM

In response to the recent court decision overturning caps on non-economic damages in Wisconsin, a number of bills have been introduced to reestablish caps. Two bills (WI A 764, WI A 766) have passed the assembly and are currently being considered by the state senate. A related legislative task force has developed suggestions on how to best restore the cap, but did not come up with a hard figure.

In Tennessee, doctors and lawyers have come together to endorse a pilot program in Chattanooga aimed at reducing unfounded expert witness testimony. This program would allow judges in malpractice cases to select independent experts to conduct pretrial assessments of planned expert witness testimony.

MALPRACTICE INSURANCE

New Hampshire, which approved screening panels for malpractice cases last year, is looking to take more steps. State Senator Peter Burling wants to implement a plan to subsidize malpractice premiums for specialties that currently have high premiums. Pennsylvania already has a similar program to help physicians pay malpractice premiums, and that state’s governor has recently called for extending the program. The governor stated that Pennsylvania has started to turn the corner on the malpractice problem, but two more years of the program will ensure that reforms have a chance to become fully effective.

The Connecticut Insurance Department rejected a 12 percent malpractice rate hike requested by ProMutual, one of the state’s top insurers. The other major writer of malpractice policies in the state had already announced that it would not raise rates next year, and an analysis by an independent actuarial company did not agree with the numbers put out by ProMutual.

A group of state lawmakers in Iowa met to look for solutions to rising costs for medical malpractice insurance. One Republican lawmaker stated the easiest solution would be to get more malpractice carriers into the state. A top insurer in Mississippi announced it will reduce medical liability insurance rates by five percent for next year. The state Insurance Commissioner stated that this reduction was a direct result of 2004 tort reforms.

PHYSICAL THERAPY

In Washington, D.C., a bill (DC B 437) has been introduced that would allow physical therapists to treat patients without a referral from a licensed physician. A bill introduced in Michigan (MI H 5288) would not change that state’s requirement for a prescription before a physical therapist can treat a patient, but it would allow certified nurse practitioners to make such a referral.

PAYMENT

UnitedHealthcare is facing a proposed fine of $2.4 million in Georgia based on violations of that state’s prompt payment laws. The Georgia Insurance Commissioner said up to 80,000 claims had not been paid in a timely manner. United called the fine disproportionately high, and said it disputes the Insurance Department’s calculations.

The state of Illinois has agreed to borrow $1 billion in order to pay off some of the backlog of bills to health care providers. Illinois is believed to owe $1.5 billion to Medicaid providers. The Illinois state treasurer stated concern, though, that borrowing was not the long-term answer to the systemic problem.

HOSPITALS

The Wyoming Hospital Association has met with state lawmakers to order a halt to the licensing of new specialty hospitals. The association wants a ban on licensing specialty hospitals until a study can be done to address their effect. Some Wyoming lawmakers questioned the hospital association’s reasons for wanting to limit competition.

A Georgia commission is considering changing state certificate of need laws to make it easier for general surgeons to open outpatient centers. The current law exempts ambulatory surgical centers practicing a single specialty from needing a CON, but state regulations define general surgery as a multiple specialty, meaning that it doesn’t currently qualify for the exemption.

MISCELLANEOUS

Privatization of duties formerly performed by government workers was predicted to save the Texas Health and Human Services Commission $21.7 million, but a recent audit indicated that it is unclear whether the privatization will save the state any money at all. The auditor criticized the agency for significant errors and omissions in assumptions about what it would cost a private company to perform administrative duties.

The Wyoming Healthcare Commission has recommended that the state spend $41.3 million over the next five years to create a statewide electronic health care record network. The director of the commission stated going electronic would result in a higher-quality, more cost effective system.