The Pennsylvania legislature introduced Senate Bill
5, "The Lawsuit Abuse Reform Act." The legislation is
a comprehensive tort reform measure that repeals joint and several
liability, limits the recovery of punitive damages, enacts a statute
of repose against manufacturers for defective products, protects
innocent product sellers and provides for agreements to arbitrate.
Collaborative efforts between business and physicians have resulted
in the formation of the Pennsylvania Civil Justice Coalition,
which leads in the efforts to enact this legislation.
Although currently in recess, Delaware legislators
still have the option of pre-filing legislation in anticipation
of next year's session. Senate Bill 251 was recently introduced
and referred to the Senate Committee on Health and Social Services
and establishes standards for the "prompt, fair and equitable
settlement of claims." The bill requires insurers to pay
claims within 30 days of receipt. The legislature reconvenes Jan.
11, 2000 and will take up debate on the bill at that time.
Based on the types of bills recently pre-filed in
advance of the 2000 session, Florida legislators will continue
debate on health care topics next year. House Bill 291 creates
the "Managed Care Organization Accountability Act of 2000,"
and requires managed care plans to exercise ordinary care when
making health care treatment decisions. Senate Bill 282 also addresses
insurer liability as well as independent review procedures. Florida
legislators do not meet again until March 2000.
After a long recess, the Michigan legislature introduced
several bills addressing the prompt payment of physician claims.
Senate Bill 694 provides definitions for "clean claim,"
and "health care payer" and establishes civil penalties
for noncompliance. The legislation requires payment of clean claims
submitted electronically within 30 days and within 45 days for
hard copies. Senate Bill 695 addresses timely payment in workers'
compensation cases. The bills have been referred to the Senate
Committee on Health Policy. In addition, legislators introduced
House Bill 5063, which establishes civil immunity of volunteer
New Jersey legislators have until the end of the
year to act on bills that remain in committee as well as address
several new bills that have been introduced in the past month.
With the introduction of Senate Bill 2135, New Jersey becomes
the fourth state to address the controversial topic of joint negotiations
by health care providers. The bill describes permitted and prohibited
negotiations and expressly prohibits physician strikes. Third-party
representatives perform the negotiations upon approval from the
state attorney general. Legislators also will soon debate requirements
for standards of care in managed care plans. Assembly Bill 3421
requires health insurers to cover treatment ordered by health
care providers based on generally accepted standards of health
care practice, while Assembly Bill 3429 prohibits hospitals from
denying admission to patients based on a patient's managed care
coverage. The bill also requires managed care organizations to
cover legitimate emergency health care.
The Wisconsin governor signed the state budget that creates an ombudsman in the state insurance commissioner's office to handle complaints against HMOs. The state Insurance Committee approved a bill which would allow patients who are denied certain medical, experimental or prescription drug treatments to appeal to third-party panels.
The Wisconsin Assembly introduced legislation to
greatly expand access to specialty care. According to the provisions
of Assembly Bill 520, patients can appeal managed care decisions
and seek out the services of specialist physicians without a referral.
This bill remains in the Assembly Health Committee. A similar
bill, Senate Bill 258, has been introduced and referred to the
Senate Committee on Health, Utilities, Veterans and Military Affairs.
Under regulations that took effect Nov. 11, Washington
health care providers should expect more timely payment of their
claims. According to the newly adopted rules, insurers are now
required to pay documented "clean" claims within 30
days. All claims must be paid within 60 days. Insurers that fail
to pay within the established time limits will be assessed a 12
percent annum interest fine on late payments. Deborah Senn, Washington
Insurance Commissioner, has also advised insurers to "immediately
take steps to improve communications with their providers."
She suggested insurers provide an explanation about why a claim
is being rejected and to include health care providers in the
development of utilization standards.
In a decision sure to impact on the insurer liability
debate, on Sept. 30, the Illinois Supreme Court determined that
a case involving the right of patients to sue managed care plans
may move forward. The Court did not rule on the merits of the
case, but rather determined the case may go to trial based on
the presumption that HMOs "cannot be allowed to claim that
the physician is solely responsible for the harm that results
from treatment delayed or denied." The case involves a woman
that died after her managed care plan denied a test for mouth
pain that later resulted in cancer.
California Gov. Gray Davis signed legislation that
makes California the first state to require hospitals to meet
fixed nurse-to-patient ratios in an effort to force higher quality
care. The new ratios will be set by the California Department
of Health Services and will take effect in 2002. Currently, the
agency sets ratios only for operating rooms, critical care units
and newborn intensive care units.
Jennifer Kunde is a legislative analyst in the AAOS health policy department.