October 1999 Bulletin

In Brief

Delaware

Gov. Thomas Carper signed legislation requiring all medical directors of managed care organizations to be licensed to practice medicine in Delaware. The law takes effect Jan. 1, 2000 and states that "any decision to deny a covered service must be made by a physician." Gov. Carper also signed Senate Bill 195, which permits podiatrists to treat the foot and ankle. The bill restricts amputation of the foot to state-licensed podiatrists who have completed an American Podiatric Medical Association accredited surgical residency program or who have been credentialed by the surgical committee of the Joint Committee on Accreditation of Hospitals.

North Carolina

Before adjourning for 1999, the North Carolina legislature passed two important patient protection bills. The governor signed House Bill 344 which enables patients with chronic conditions to have direct access to specialists without first utilizing a primary care physician. Another bill, Senate Bill 345, which awaits action by the governor, requires that physicians reviewing decisions at the request of an insurer be licensed in North Carolina. Several other patient protection bills remain in committee and will carry-over to the 2000 legislative session.

Massachusetts

Despite continued budget problems that have prevented action on most legislation, a comprehensive patient protection bill was passed out of the House in July and sent to a Senate Conference Committee. House Bill 4525 addresses standards for utilization reviews and requirements for plan disclosure, coverage of emergency room visits without prior authorization, continuity of care, and direct access to ob/gyn specialty services. The bill also requires prompt payment of physician claims. A scope of practice bill that permits podiatrists to treat the foot and ankle received a favorable report from the Joint Committee on Health Care and has been referred to the Rules Committee.

Oregon

Oregon Gov. John Kitzhaber signed Senate Bill 606 extending privileges to podiatrists to treat the foot and ankle despite a final plea from orthopaedist John Tongue, MD, to veto the legislation. The bill had been defeated in the Senate, but sponsors of the measure put forth a motion of reconsideration and following a week of intense lobbying, the bill passed 16 to 14. Provisions of the new law require that podiatrists meet the qualifications for ankle surgery established by rule of the Board of Medical Examiners and perform surgeries in ambulatory surgical centers certified by Oregon's Health Division.

New York

The New York legislature took another step towards enacting insurer liability legislation when the Assembly passed AB 1400 and referred it to the Senate Committee on Rules. The bill holds health care organizations liable for "failing or refusing to approve, provide, arrange for, or pay for in a timely manner any health care service it is contractually obligated to do for a person."

Ohio

Tort reform faced a blow when the Ohio Supreme Court struck down Ohio's measure stating that "legislators violated the Ohio Constitution's separation of powers and the ban against including more than one subject in a single bill." A similar decision was handed down in Illinois in 1997. The 1996 tort reform bill capped noneconomic and punitive awards, provided a 15-year limit for filing product-liability claims and limited punitive damages for businesses with more than 25 employees.

Illinois

Legislation creating a patients' bill of rights was signed by Gov. George Ryan. The new measure permits enrollees in managed care plans with chronic conditions to have direct access to a specialist, and creates guidelines for appeal mechanisms when covered treatments are denied.

Pennsylvania

The Pennsylvania legislature recently introduced Senate Bill 1052 authorizing independent health care providers to jointly negotiate with health care insurers. Specifics of the bill closely resemble the recently enacted Texas bill. The bill was introduced to restore the competitive balance in the health care market and ensure continued access to quality patient care. S.B. 1052 permits joint negotiations on nonfee-related matters such as the definition of medical necessity, utilization review criteria, patient referral standards and other administrative procedures. If the Attorney General and Insurance Commissioner determine a health insurer has substantial market power, fee negotiations are allowed.


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