STATE LEGISLATIVE UPDATE

As of the end of the month, the following state legislatures were in regular session, recess, skeleton or special session: CA, DC, DE, IL, MA, MI, MS, NH, NJ, NM, OH, OK, PA, and WI. Through September 1st, there have been 156,820 new bills introduced in the states and 37,489 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

The battle over the November tort reform referendums in Washington is heating up. Doctors, hospitals and lawyers are pouring money into this fight, and the total spent on the two ballot initiatives by both sides could top $10 million. Groups supporting the physicians position have raised almost twice as much as those in support of the trial lawyers position, and have spent approximately six times as much.

Physicians in Tennessee are starting early in their push for tort reform in 2006. Physicians are already working to educate lawmakers now, rather than waiting for the General Assembly to convene. Their goal is to achieve liability restrictions similar to those implemented in California thirty years ago. New Jersey has had another attempt at tort reform introduced. Bill NJ S 2762 would, if passed, limit damages in medical malpractice actions.

INSURANCE

Wisconsin has passed a new law (WI AB 259) expanding the list of health care providers subject to health care liability requirements. Previously, most health care providers (including physicians, hospitals, and ACSs) were required to carry insurance with a liability limit of at least $1 million for each occurrence, and at least $3 million for all occurrences. The list will now include for-profit businesses that provide the medical services of physicians or nurse anesthetists, particularly limited liability companies and joint ventures. New Hampshire has seen a bill (NH LSR 2003) introduced that would subsidize malpractice premiums for certain specialties.

Colorado’s major malpractice insurer announced that it will raise malpractice rates by less than three percent. The chairman of the insurer attributed this improvement to recent legislation that helped mitigate Colorado Supreme Court decisions that had undermined Colorado’s curbs on excessive malpractice claims. Pennsylvania’s largest insurer recently announced that it will not raise premiums in 2006. Pennsylvania has passed limited tort reforms, but its state constitution forbids caps on noneconomic damages. A spokesperson for the insurer did not cite reforms as the reason for the premium freeze, though, instead saying that they resulted from previous rate increases, and policy and market adjustments.

REIMBURSEMENT

A law (CA S 634) has passed in California that will impose additional requirements on health insurers that enter into contracts with physicians relative to the processing and payment of claims. This includes requiring the disclosure of specified information (including fee schedules and payment policies) in electronic format to providers annually and when physicians request it. The new law also affects claims deadlines and reimbursement overpayment requests.

Ohio has changed its workers compensation hospital reimbursement formula, for the second time in less than a month. The new plan will base reimbursement on Medicare costs and will impose reimbursement caps. These changes have been met with stiff criticism from the Ohio Hospital Association.

Although a recent court ruling in California gave Governor Schwarzenegger the ability to cut Medi-Cal physician reimbursement rates, the Governor was agreed not to cut rates this year and to work with the California Medical Association to avoid cuts in future years.

A Minnesota judge has struck down a part of that state’s Medicaid copayment law. The judge ruled that Minnesota physicians cannot deny care to low-income Medical Assistance recipients who have failed to make previous copayments.

PATIENT PROTECTION

The Pennsylvania legislature has had a bill (PA H 1942) introduced that would require disclosure of disciplinary actions and malpractice awards, and would require physicians without professional liability insurance to report settlements or arbitration awards. The bill also creates public access to this information.

Apparently the reporting of infections in health care facilities has become the politically popular issue that legislators want to be attached to, at least in New Hampshire. This month, at least five different bills have been introduced on this subject (NH LSR 2037, 2088, 2124, 2166, 2316), from both democrats and republicans.

MISCELLANEOUS

A bill has passed in California (CA A 592) that says physicians will not be subject to discipline for unprofessional conduct for treatment or advice based on alternative or complimentary medicine, provided certain conditions are met.

A battle has been going on in Florida relating to a proposed state rule change that would give pharmacists the authority to change patients’ prescriptions to match their health plan formularies. Physicians say that the proposal increases their liability risk and is unsafe for patients, and that patient safety should trump patient convenience.

In Arizona, the Governor has signed an executive order (AZ EO 28) to speed that state’s adoption of an electronic health record system. The order creates a committee whose goal is to ensure widespread adoption of e-records by 2010, four years ahead of the schedule established by the federal government.

A law in Arkansas (AR H 1193) passed in February has just taken effect. This law makes smoking at hospitals a misdemeanor in the state.