AAOS Bulletin - August, 2006

In Brief

Arizona

A bill that would have made it more difficult for plaintiffs to win professional liability suits against emergency room physicians has been vetoed by Gov. Janet Napolitano (D). The measure would have raised the evidentiary burden needed for a plaintiff to win a case from a “preponderance” of the evidence to “clear and convincing” evidence. The governor vetoed the bill, in part, over questions about its constitutionality and because she felt that no evidence had been provided to show that this type of legislation would help to ease physician shortages in emergency rooms.

Colorado

Gov. Bill Owens (R) vetoed a bill that would have made Colorado the first state to require a comprehensive, standard heath care contract between health plans and physicians. The bill contained clauses that would have allowed physicians to opt out of contract provisions and to insist on binding arbitration. The Colorado Medical Association said the bill was needed to create a level playing field and to prohibit certain unfair contracting provisions currently being used.

Gov. Owens also vetoed a bill that would have extended whistle-blower protection to physicians and other health care workers who report unsafe practices in the workplace. Under the measure, hospitals would have been prevented from taking disciplinary action against individuals in retaliation for making a report or disclosure.

Georgia

Although Georgia enacted a $350,000 cap on noneconomic damages in February of 2005, six insurers in the state have significantly raised their medical liability premiums since then—some by more than a third. The state’s largest insurer, MAG Mutual, froze its rates after the malpractice measures took effect, and has promised state officials that it will cut premiums by 10 percent once a legal challenge reaches the state’s Supreme Court and the law is affirmed. According to Georgia’s insurance commissioner, smaller insurers are raising their rates to “catch up” to the premiums being charged by MAG.

Maryland

Maryland has passed a law that will prevent insurance payers from including language in provider contracts that allows for automatic rate reductions if a provider accepts a lower rate from another payer. The law also forbids carriers from including language that prohibits physicians from offering services to another carrier’s patients at a lower rate.

Mississippi

To ensure that medical experts are honest and ethical, the Mississippi State Board of Medical Licensure has adopted new expert witness standards. Mississippi physicians found to be in violation of the standards could face fines, or even lose their licenses. Out-of-state physicians could be prohibited from giving further testimony, and their state medical boards could be notified of the violations. (For more information, see the professional compliance report.)

New York

Over a recent six-month period, 21 health plans have been fined a total of more than a quarter of a million dollars under New York’s prompt payment law, according to state regulators. Since the law was enacted in 1997, the state has levied approximately $6.5 million in fines, helping to encourage plans to pay physicians in a timely manner.

Oklahoma

New legislation signed by Gov. Brad Henry (D) will expand the number of people covered under “Insure Oklahoma”—a program that helps small businesses provide health insurance to their employees. Previously, employers with up to 25 employees were eligible for assistance. The new law will expand the program’s eligibility to businesses with up to 50 workers.

South Carolina

Last year, a court case upheld the state attorney general’s opinion that South Carolina’s physical therapy board has the right to revoke the licenses of physical therapists who work for referring physicians. The case is now being appealed, but the issue was almost settled on a legislative level in May, when a bill was amended to include language that would have reestablished the right of physical therapists to work for physicians. The amendment was considered, but ultimately rejected by the state legislature.

The eventual settlement of this issue will come later this year when the South Carolina Supreme Court makes its decision on the appeal of the case. The court heard oral arguments in June; a decision is expected soon.

Tennessee

Tennessee recently passed legislation that will provide many of the state’s nearly 600,000 uninsured workers with basic health care coverage. The new plan, called “Cover Tennessee,” provides coverage for the “most-needed services”—including doctors’ visits, pharmacy and basic hospitalization. Premiums for the optional health plan will average about $150 a month, and will be divided among employers, employees and the state. Although the program is primarily targeted at the working uninsured, children and people with serious health problems are covered as well. This program was the top priority for Gov. Phil Bresden (D) this legislative session.

Vermont

After both sides made significant compromises, a comprehensive health care bill was signed into law that is expected to extend coverage to as much as 96 percent of Vermont’s population by 2010. Currently, slightly less than 90 percent of the state’s residents have health insurance. The new insurance plan will be privately run, but the state will provide subsidies for individuals who cannot afford it. Vermont will pay for the subsidies with an increase in the cigarette tax and a fee on employers who do not provide insurance for their workers.

This roundup was prepared by Bruce Allain, JD, a legislative analyst in the department of socioeconomic and state society affairs. He can be reached at allain@aaos.org


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