OCMS and SCMS
2017 Legislative Session Update – March 24
Support Bills:
Ambulatory Surgery Centers – (SB 222 & HB 145)
Summary: Bill extends length of stay in an ASC to 24 hours from the start of the procedure. Creates licensure and regulations for Recovery Care Centers that enable patients to stay up to 72 hours.
Developments: SB 222 was passed as amended by the Senate Health Policy Committee. It was amended to remove the Recovery Care Center language complete. It does leave intact the ASC expansion language.
Progress to Date: SB 222 has passed one committee, and has two committee stops left. HB 145 has passed all three committee and awaits action on the Floor of the House.
On Tap for Next Week: HB 145 will be heard by the Full House on 3/29.
Retroactive Denials – (SB 102 and HB 579)
Summary: Bill prohibits insurance carriers from denying claims for patient ineligibility if they have provided a treatment authorization to the physician.
Developments: SB 102 passed its second committee of reference last week. It has one more committee stop to make before the Floor of the Senate. HB 579 will receive its first committee hearing next week. A strike all amendment is being proposed that changes the language slightly but will require carriers to inform physicians whether the patient is in a grace period. If they fail to do so they cannot retroactively deny. If they inform the physician the patient is in a grace period, the language clarifies that physicians can collect full payment up front from the patient.
Progress to Date: SB 102 has passed two committees and has one left. HB 579 still has three committees to pass.
On Tap for Next Week: HB 579 will be heard on Monday 3/27.
Workers Compensation – (SB 1582 and HB 7085)
Summary: The Legislature is being asked to address the 14.5% increase in workers compensation premiums that took effect last fall based on two Supreme Court rulings that addressed attorney fees and duration of benefits. The FMA is championing decreased litigation through increased access to care and patient choice of treating physician and ancillary services. Our efforts to increase access to care include prior authorization reform and increases in physician expert witness fees and the physician fee schedule.
Developments: HB 7085 was passed by the Insurance & Banking Committee and referred to the Commerce Committee. The House Bill addresses benefits and attorney fees and has some language to address delays in treatment authorizations, but also reduces reimbursement for hospitals and ASCs and does not address physician reimbursement or expert witness fees.
Progress to Date: The Senate Bill has not been heard in any committees as of yet. The House Bill will need to pass the Commerce Committee before it can be heard by the full House.
On Tap for Next Week: No meetings planned currently.
Maintenance of Certification – (SB 1354 and HB 723)
Summary: This legislation will prohibit hospitals from requiring physicians to participate in MOC in order to maintain staff privileges. The bill also prohibits insurance companies from requiring MOC in order to participate in their networks. The bill differentiates between original Board Certification and MOC, so hospitals and insurers can still require initial certification.
Developments: The House bill passed one committee and was removed from its second committee of reference. It has one more committee to pass on the House side.
Progress to Date: SB 1354 has not received a committee hearing as of yet. The House bill is making its way through the process with one more committee to pass before being considered by the Full House.
On Tap for Next Week: No hearings are scheduled on this bill next week as of yet.
Right Medicine, Right Time – Fail First – (SB 530 & HB 877)
Summary: This legislation will provide pathways for physicians to bypass fail first protocols implemented by insurance carriers under certain circumstances. The bill also requires more transparency and advanced notification from insurance carriers that want to implement such protocols.
Developments: NA
Progress to Date: None to Date.
On Tap for Next Week: Both the Senate Bill and House Bill will be heard in their first committees next week.
HMO Accountability: (SB 262 & HB 675)
Summary: This legislation will eliminate immunity of HMOs for being sued for medical negligence. Currently HMOs are protected from liability when making decisions on medical necessity.
Developments: N/A.
Progress to Date: The Senate Bill has passed one committee so far. The House bill has not received a hearing as of yet.
On Tap for Next Week: The Senate Bill is on the agenda for the Senate Judiciary Committee next week.
Direct Primary Care: (SB 240 & HB 161)
Summary: The bill clarifies that a subscription style relationship between a patient and physician for the provision of a menu of primary care services each month is not an Insurance Policy and therefore not subject to insurance regulations.
Developments: SB 240 passed another committee last week, its third committee so far. HB 161 passed its final committee of reference.
Progress to Date: SB 240 has passed 3 our of 4 committees and is waiting for a hearing in its final committee. HB 161 has passed all committees and is waiting consideration by the full House.
On Tap for Next Week: HB 161 will be heard by the full House on 3/29.
Patient Protection from Formulary Changes - (SB 182 & HB 95)
Summary: The bill prohibits an insurance company from changing the drug formulary in the middle of a patient’s contract year.
Developments: None this week.
Progress to Date: SB 182 has passed 2 out of 3 committees of reference. HB 95 has passed 1 out of 4 committees of reference.
On Tap for Next Week: No hearings scheduled as of yet.
Oppose Bills:
PIP Repeal – (SB 156 & HB 1063)
Summary: Legislation has been filed to eliminate PIP which is the automobile no-fault insurance coverage that provides $10K in benefit regardless of who is at fault in an accident. The two bills filed do not replace PIP with any other form of mandated Med-Pay to cover emergency care. The only Mandated Coverage would be Bodily Injury that covers the cost of injuries you do to others when your fault is established. Motorists will have the option to purchase Med Pay and Uninsured Motorist coverage.
Developments: None this past week.
Progress to Date: Neither bill has received a hearing in either chamber as of yet.
On Tap for Next Week: HB 1063 is on the agenda in the Insurance & Banking Committee for Monday March 27th at 12:30 pm.
Telehealth and Independent Practice for Advanced Registered Nurse Practitioners and Physician Assistants – (HB 7011)
Summary: The bill establishes a regulatory and oversight process for Telehealth services. The bill expands the independent scope of practice for ARNPs and PAs.
Developments: None this past week.
Progress to Date: HB 7011 passed Health Quality Subcommittee. It has two additional committee stops before it can be considered by the full House. There is no Senate companion bill.
On Tap for Next Week: Nothing scheduled as of now.
Bills we are Monitoring:
Patient Shared Savings – (SB 528 & HB 449)
Summary: The bill requires insurance companies to provide web access to contracted rates for certain “shoppable procedures and services” for their various providers in the community as well as the average price paid for those same services as noted in the all claims database the state is creating. The bill requires insurance carriers to share 50% of the savings achieved if a patient receives any of these shoppable services from a lower cost provider. The bill enables the patient to have access to the same incentives for utilizing out of network providers.
Developments: The bill passed its 3rd committee of reference in the House.
Progress to Date: HB 449 has passed 3 out of 4 Committees in the House. SB 528 has not received a committee hearing as of yet.
On Tap for Next Week: Nothing scheduled as of yet.