October 2000 Bulletin

In Brief

North Carolina

The governor signed into law prompt payment legislation requiring health plans to pay, deny or demand additional information within 30 days. Interest then begins accumulating at the rate of 18 percent a year. The Insurance Commissioner has the power to impose fines for violations of the prompt payment provisions. Ten states have passed legislation in 2000, addressing the problem of insurers failing to promptly pay providers for services performed. The states are Arizona, Florida, Kentucky, Massachusetts, Michigan, Minnesota, New Hampshire, New Mexico, North Carolina and Tennessee. Legislation is still pending in New Jersey and Ohio.

Florida

The Florida Board of Medicine turned down a proposal by the Florida Medical Association (FMA) to ease the 90-day moratorium on office surgeries that require general anesthesia. The ban was imposed after members became concerned that too many patients were dying or being injured during cosmetic surgery. FMA suggested the ban apply only to some of the specific types of cases in which deaths occurred, such as those involving combinations of abdominoplasty and liposuction. The proposal was rejected by the board by a vote of 8 to 4. FMA previously sought to end the ban through a lawsuit that rejected by an appeals court. The ban will expire in early November. The board asked the state secretary of health to set up a commission to study the issue.

Illinois

Physicians for Responsible Negotiations (PRN), the AMA’s negotiating organization, filed a petition with the National Labor Relations Board, seeking to serve as a collective bargaining unit for more than 160 residents of Lutheran General Hospital in Park Ridge, Ill. It is the PRN’s first attempt to organize residents at a private hospital since the NLRB ruled last November to extend the protections of federal labor laws to residents. Meanwhile, the Chicago Medical Society has formed a collective bargaining unit, known as the Physicians Collective Bargaining Association, to help doctors with their working conditions and negotiations with insurers.

Texas

The United States Court of Appeals for the Fifth Circuit upheld the legality of the Texas right-to-sue law. The court held that ERIA does not preempt the Texas statute providing liability for HMOs. The court limited the applicability of the law to cases in which medical care was actually provided (therefore, the law does not cover decisions to deny care). The HMO can be held vicariously liable for the malpractice of its physicians. This year, bills allowing the right to sue passed in Arizona, Maine, Oklahoma and Washington. Legislation is still pending in Michigan, New Jersey and Pennsylvania. At least 28 states have considered legislation to hold health plans liable for violating a duty of care to the patient. Currently, seven states have right-to-sue legislation.

Connecticut

Connecticut’s first managed care ombudsman, Gerald E. Martens, took office in August. He will advise patients of their rights and guide them through the appeals process. Employers will be required to post a "conspicuously located" notice of the ombudsman’s services.


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