Legislative News Updates

NEW LONDON COUNTY MEDICAL ASSOCIATION

LEGISLATIVE REPORT

MAY 2008

From beginning to end the 2008 legislative session was an eventful one. Below is a list of bills that NLCMA monitored and/or advocated on throughout the 2008 legislative session. If you have any questions on the bills listed below or any other issue, please contact the NLCMA office at 860-447-9408.

Extension of the State Physician Profile to Other Health Care Providers Effective January 2010, Public Act 08-109 extends the States physician profiling system to other healthcare providers including dentists, chiropractors, optometrists, podiatrists, naturopaths, dental hygienists, advanced practice registered nurses, and physical therapists. The Act awaits the Governors signature.

Regulation of the Secondary Market in Physician Discounts One of medicines top priorities this year was to regulate the silent PPO market and with the passage of Senate Bill 273, medicine was able to just that. The bill, which now awaits the Governors signature, requires, with some exceptions, a contracting entity (e.g., an entity contracting with a health care provider) that (1) enters into or renews a contract with a health care provider on or after January 1, 2009 and (2) sells, leases, rents, assigns, or grants access to the provider's health care services, discounted rates, or fees, to include a provision in the contract that it can permit a third party (a covered entity) to access the provider's services, discounted rates, or fees. (Bill Analysis for SB 273). The bill specifies (1) requirements with which a contracting entity must comply when it permits such access and (2) that it does not apply in cases involving workers' compensation benefits. (Id.) The bill also requires covered entities that access a provider's services to pay the discounted rates or fees established in the provider's contract with the contracting entity. It specifies that a covered entity's right to access a provider's services, rates, or fees ends when the contract between the contracting entity and the provider terminates, except for any applicable (1) continuity of care requirements or (2) agreements or contractual provisions with the provider. (Id.) Lastly, the bill requires all written and electronic remittance advices (payment notices sent to providers) to clearly identify the name of the (1) covered entity responsible for paying the provider and (2) contracting entity whose payment rates and discounts apply. (Id.) Hospitalization Requirement A bill that would have required that a person be in the hospital for a certain amount of time before payment begins died. The bill created a Catch 22. If the goal from insurers is to be as efficient as possible with hospital admission and get people home as soon as possible, will this efficiency be rewarded by noncoverage of the admission because the patient was not admitted for long enough?

Licensure Renewal Fees Public Act 08-31, which is now law, allows doctors who provide at least 100 hours of free service annually in a mobile health clinic to renew their licenses without charge if they do not practice medicine anywhere else. Last years legislation had already exempted physicians who provide 100 hours of free service in a public health facility (e.g., hospital, community health center, nursing home, mental health facility, group home, school, or public preschool) and do not practice medicine anywhere else from the $450 license renewal fee.

Health Care Claims A bill that would have made it an unfair and deceptive insurance practice for certain entities to offer or provide any financial or other incentive to any person (1) for denying health care claims or (2) based on the number of claims the person denies (Bill Analysis for File Copy 176) died in the Judiciary Committee.

Prohibiting Copays A bill that would prohibit MCOs from requiring physicians to charge a copay for preventive services or imposing a deductible or other out of pocket expenses for such services died. The bill specified that preventive care services excludes any services or benefits intended to treat an existing illness, injury, or condition, but did include: 1. annual physicals and periodic health evaluations, including tests and diagnostic procedures ordered in connection with them; 2. routine prenatal and well-child care; 3. child and adult immunizations; 4. tobacco cessation programs; and 5. obesity weight-loss programs.

Late in the session this bill was stripped of it language and an attempt to amend the health care claims bill (see above) onto it was made. While the amendment was passed by the Senate, the House failed to act on it by the end of the session thereby killing it.

Health Insurance Mandates This year lack of healthcare insurance for so many Connecticut residents was a hot topic at the Capitol. Debate focused on how to offer health care at an affordable rate without stripping the policies of too many benefits. Senate Bill 483 attempted to require the Insurance Commissioner to contract with an independent entity to study the amount and cost of health care benefits in the state, however that bill failed. Other efforts to offer bare bones policies also failed, however two important changes are going to take place.

First, the Charter Oak plan will go into effect without delay. The Charter Oak Plan was created by the Governor and its purpose is to insure any person who has been uninsured for at least six months. There would be a $250 premium regardless of age or health condition. Given this premium it is almost certain that health insurers could not meet it without cutting out certain mandates one of which is mental health parity. Health care advocates, especially mental health care advocates have said having no insurance may be better than the proposed Charter Oak Plan, which may not be as affordable as the Governor has led people to believe. The reason being that the Department of Social Services Commissioner Michael Starkowski has said the state has asked potential bidders to adjust the benefit levels in the plan if they dont think they can meet the $250 per month premium within the proposal. This means theres no guarantee the benefit levels in the RFP would remain once the insurers began offering the plan.

Mental health care advocates, attempted to pass a bill that would have required that the Department of Social Services (DSS) Commissioner ensure that the Charter Oak Health Plan include comprehensive mental health coverage, which must be consistent with the state's mental health parity law as it pertains to group health insurance plans. The bill was not passed. Second, a bill was passed that allows small employers in the state to buy into the state employee health plan. Small employers are people, firms, corporations, limited liability companies, partnerships or associations that actively engaged in business or were self-employed for at least three consecutive months and on at least 50% of its working days during the preceding year, employed no more than 50 eligible employees. The bill has not yet been signed by the Governor. Physician Assistants The bill authorizes physician assistants, as delegated by a supervising physician within the scope of the physician's license, to prescribe and approve the use of durable medical equipment.

Medical Record Copies Currently healthcare providers are allowed to charge no more that forty-five per page, when furnishing a copy of healthcare records. Effective October 1, 2008, that amount is going up to sixty five cents.

Kidney Disease Screening Effective October 1, 2008 physicians will no longer be required to: 1. order a serum creatinine test as part of each patient's routine general medical examination if the patient has not submitted to such test within the one-year period preceding the routine general medical examination; and for each serum creatinine test performed on a patient admitted as an inpatient to a hospital licensed in this state, the ordering provider shall no longer be required to request, at least once during such patient's hospital stay, that the laboratory performing the test include an estimated glomerular filtration rate in the laboratory report if the patient has not submitted to such test within the one-year period preceding such hospitalization. These requirements will be deleted from the statutes effective October 1, 2008.

Medical Loss Ratios Current law requires the Insurance Commissioner, in consultation with the Public Health Commissioner, to develop and annually distribute a consumer report card comparing managed care organizations, including insurers and HMOs that issue managed care products. Attempts were made this session to require that each insurer's and HMO's loss ratio be included in the report care. Unfortunately the bill died on the House Calendar.

Hospital Never Events A bill that would have prohibited hospitals and outpatient surgical facilities from collecting reimbursements from insurance companies and insureds for never event failed.