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OCMS and SCMS 2017 Legislative Update

Supported 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. HB 145 was passed 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 has one more committee stop to make before the Floor of the Senate. HB 579 has only passed one committee.

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 Commerce Committee and is ready for action by the Full House. 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. The Senate Bill has passed two committees.

Passed the full House today.

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. The Senate bill was amended significantly in the Senate Health Policy Committee. The two versions are very different now and the Senate version has created a bit of controversy that may jeopardize it moving forward.

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: The Senate version is ready for floor action. The House bill has passed only one committee.

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: The Senate Bill has passed one committee so far. The House bill has not received a hearing as of yet.

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: HB 161 was passed by the full House on 3/29. The Senate bill has one committee left, Appropriations.

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: SB 182 has passed all committees as of today. The House Bill has passed 1.

Opposed 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 House bill filed does 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. The Senate Bill does create Mandatory Emergency MedPay. We support the Senate version of the bill since it does mandate MedPay.

Developments: HB 1063 is ready for the action on the Floor. The Senate Bill still has two committees to pass. PASSED HOUSE TODAY

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: This bill is ready to be heard by the House. But the Senate does not have a similar bill.

Controlled Substance Prescribing (SB and HB 557) Summary: Defines "acute pain"; limits prescribing of opioids for acute pain to a 5 day dose in certain circumstances; revises requirements for reporting dispensing of controlled substances; limits exception to reporting requirements for certain facilities dispensing controlled substances; authorizes certain employees of U.S. Department of Veterans Affairs to access certain information in program's database; specifies when revised reporting requirement takes effect.

Developments: HB 557 passed the House on 4/6. SB 840 has passed 1 committee and needs to pass 3 more before it reaches the floor. We have reached an agreement to remove the 5-day prescription limitation in exchange for more physician education on appropriate prescribing. We are finalizing that education language now.

Optometry and Pharmacy Scope of Practice Expansion

Both of these bills appear dead as they have not moved anywhere.

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. The Senate Bill has not received any hearings as of yet.

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