April 2000 Bulletin

Legislation mandating coverage for bone mass screenings for osteoporosis prevention is pending in nine states. Orthopaedic surgeons in Mississippi were instrumental in having Senate Bill 2730 in the state legislature. This bill mandates coverage for bone mass screenings for estrogen deficient women at clinical risk of osteoporosis, individuals receiving long-term steroid therapy and individuals being monitored to assess the response to or efficacy of approved osteoporosis drug therapies. Other states that have legislation pending mandating bone mass screenings include Florida, Michigan, New Jersey, New York, Ohio, Pennsylvania, Rhode Island and Utah.

The New York bill, which has passed the House, is broader in its coverage. It requires such coverage as is determined by the legally authorized treating health care practitioner in consultation with the patient to be medically appropriate for bone density measurements, drugs and devices.

Civil immunity

Proactive involvement by the medical community also is making a difference in establishing civil immunity for physicians who volunteer their services to patients unable to afford proper care. Fourteen states have statutes on the books providing some sort of immunity from medical malpractice suits for volunteers.

Currently, 10 states are considering legislation to create or strengthen this immunity: Alabama, Connecticut, Michigan, New Jersey, New York, Oklahoma, Pennsylvania, Vermont, Washington and West Virginia.

These statutes generally hold that a physician must offer treatment without gross negligence and willful and wanton disregard. The statute introduced in Oklahoma provides a good example of the broadest type of legislation. The bill provides that "any volunteer professional shall be immune from liability in a civil action on the basis of any act or omission" if:

The statute lists the professionals covered by this act which include physicians, physician’s assistants, nurse practitioners, podiatrists, pharmacists, dentists, attorneys and CPAs. The bill includes limitations to the immunity for actions arising from the operation of motorized transportation in providing the care and for actions prior to and after rendering the care.

The statute in Michigan limits immunity to acts performed in a health facility or entity organized for the sole purpose of delivering care without receiving compensation or in the office of the physician. The Michigan statute also requires that no payment, even for administrative expenses, be taken. Also, in addition to gross negligence and willful and wanton misconduct a physician is liable for acts intended to injure the patient.

Regional solutions

The governors of Vermont, New Hampshire and Maine met to focus on dealing with health care problems by forming regional solutions such as a buying cooperative to negotiate lower prices for prescription drugs, at least for state-administered medical programs. Another option is to meet with insurers as one large entity with 3 million people and synchronized insurance regulations, said Maine Gov. Angus King. A task force appointed by the governors would also weigh inviting the rest of New England states into the group.

New Hampshire

New Hampshire Gov. Jeanne Shaheen signed the HMO Accountability Act. The bill requires medical directors to be doctors, subject to oversight by the state medical board. Earlier attempts to make medical directors liable for treatment decisions failed. The bill also allows patients to appeal to an external board when an HMO refuses to cover care costing more than $400. It also prohibits financial incentives to providers to deny care

Massachusetts

After two months of soliciting proposals to either sell or recapitalize financially ailing Harvard Pilgrim Health Care, the HMO was released from state receivership and will remain nonprofit and locally controlled. The two months of protection from creditors and state oversight gave the company the stability it needed to begin its own recovery. Harvard Pilgrim was put into state receivership Jan. 4 after it discovered its losses for 1999 would total more than $150 million. Later calculations put the losses at $197 million. The fear that the HMO would collapse sent shivers throughout New England. The HMO has 1 million members in Massachusetts and another 130,000 in Maine and New Hampshire.


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