Emerging Trends from the States-May 2008

CALIFORNIA

The California Department of Managed Health Care last week began a series of public hearings on draft regulations that would bar physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay, the Los Angeles Times reports. Gov. Arnold Schwarzenegger (R) in 2006 ordered state regulators to ban the practice, but DMHC has not been able to reach a compromise. The agency this spring proposed outlawing the practice and drafted the regulations.

LOUISIANA

Louisiana Senate Bill 530 was engrossed by the State Senate on May 6, 2008 and has been sent to the Louisiana House of Representatives. The bill would limit the liability of medical personnel who, in good faith and regardless of compensation, render or fail to render emergency care, health care services, or first aid during a declared state of emergency. Should the bill pass, providers rendering medical care during such a state of emergency would not be liable for any civil damages or injury as a result of any act or omission related to rendering of or failure to render services, unless the damages or injury was caused by gross negligence or willful misconduct. The bill is currently pending in the House Appropriations Committee.

VERMONT

The Vermont House Government Operations Committee Bill signed H.867 into law on May 14, 2008.  H.867 states that any insurance company currently providing reimbursement for orthopaedic physical medicine services performed by licensed health care professionals will be legally obligated to provide reimbursement for those services when administered by a Vermont-licensed certified athletic trainer (ATC) under a physicians' referral.  This inability to discriminate against ATC's applies to all third-party payers providing reimbursement for health care services in

Vermont

and includes state-managed health insurance such as Medicaid and the Catamount Health Plan.  The specific wording of H.867 can be found at this link. Insurance companies are required to comply by July 1, 2008.

In addition to the inability to deny third-party reimbursement for clinical AT services, this bill also officially separates the professions of athletic training and physical therapy in the orthopaedic rehabilitation clinical setting by removing the "assistive personnel" language from the “Physical Therapy Practice Act,” helping to solidify ATC’s as stand-alone health care professionals working under the direction of a physician in the clinical setting and as physician extenders.  This change will be effective as of July 1, 2009, and all referrals to an ATC must state “Athletic Training” or “AT/PT” if the physician feels the patient is appropriate for either rehab professional.