Legislation
As a continuation of the previous days discussion on payment problems, here are some recent legislative actions and there current status. The Indiana State Medical Association (ISMA) support is listed as well.
Bill: SB 147 Insurance payments to Health Care Providers
Author: Sen. Beverly Gard, R-Greenfield
ISMA Position: Support
• Final Status: SB 147 was signed by both Senate and House leaders and awaits the governor’s signature. The bill places a two-year time limit on an insurer’s ability to take back money it over-reimburses a provider for health care services.
• In addition, the bill places a two-year limit on a provider’s ability to request additional reimbursement for an underpaid claim. If an insurer adjusts subsequent claims to recoup the overpaid amount, the bill would require the insurer to include detailed information about which patient accounts are affected.
• Sen. Gard authored SB 147 at ISMA’s request – a result of House of Delegates Resolution 05-21. It directed the Government Relations staff to seek legislation establishing a time limit on insurer take-backs.
****This next Bill was very important to physicians and they allowed it to die without a vote. This is one of the reasons that Floyd County Physicians dropped the Aetna contract a few years ago. This clause basically states that if the insurance company has the most patients in the practice, then the physicians guarantee to provide services to this insurance company at the lowest rate of any other company.
Bill: SB 124 Health Provider Reimbursement Agreements
Author: Sen. Beverly Gard, R-Greenfield
ISMA Position: Support
• Final Status: Senate Health and Provider Services Committee chair, Sen. Patricia Miller, R-Indianapolis, did not call a vote for SB 124, which killed the bill.
• SB 124 would have prohibited most favored nation (MFN) clauses in provider agreements. MFN clauses require a participating provider to offer the insurer a reimbursement rate equal to or lower than the lowest reimbursement rate the provider offers another insurer.
• The ISMA opposes MFN clauses because they essentially remove the physician’s right to negotiate in the contracting process. If MFN clauses are permitted in contracts, one or two large insurers could dominate the market.
• The ISMA Government Relations staff will continue to educate legislators during the interim regarding the negative impact of MFN clauses on physician practices.
Bill: HB 1382 – Access to Reimbursement Fee Schedules
Author: Rep. Tim Brown, M.D., R-Crawfordsville
ISMA Position: Support
• Final Status: HB 1382 was not heard in the House during the 2006 session and is dead.
• The bill would have required an insurer or a health maintenance organization, upon request, to make available to a provider the insurer’s or HMO’s reimbursement fee schedule.
• While access to these fee schedules is getting better for currently contracted physicians, other physicians who are not contracted and want to sign into a network are not being given access to the fee schedule before signing a contract.
• This practice is another tactic by the insurance industry to restrict the physician’s ability to maintain a practice and provide quality health care to patients.
• The ISMA likely will pursue legislation on this topic again in the 2007 session.
Bill: HB 1097 – Discount Medical Card Programs
Author: Rep. David Frizzell, R-Indianapolis
ISMA Position: Support
• Final Status: HB 1097 was signed by both House and Senate leaders and now awaits the governor’s signature.
• The bill requires health care discount card companies to register with and be regulated by the Indiana Department of Insurance.
• These companies are currently unregulated by the state. Per ISMA’s request, the bill was amended to require the written consent of each individual provider before being included on the list of participating providers.
Bill: HB 1041 – Health Benefit Mandates
Author: Rep. Jerry Torr, R-Indianapolis
ISMA Position: Oppose
• Final Status: House Insurance Committee Chairman, Rep. Mike Ripley, R-Monroe, did not grant a hearing for HB 1041, which essentially killed the bill.
• HB 1041 would have allowed insurers to write health insurance policies that do not include all state-mandated health care benefits. Such plans would have been available to individuals and employers with no more than 50 employees.
• The bill also would have required the insurer to provide written disclosure acknowledging that the policy does not include all mandated health benefits and a list in summary form of those benefits not covered.
• The bill would have required coverage for at least the following:
Newborn and adopted child coverage
Diabetes
Breast, prostate, colorectal and cancer screenings
You can see that although some progress is being made, there are many more obstacles to overcome. This is why it is imperative that our state and national physician organizations continue to aggressively pursue these Bills.
Bill: SB 147 Insurance payments to Health Care Providers
Author: Sen. Beverly Gard, R-Greenfield
ISMA Position: Support
• Final Status: SB 147 was signed by both Senate and House leaders and awaits the governor’s signature. The bill places a two-year time limit on an insurer’s ability to take back money it over-reimburses a provider for health care services.
• In addition, the bill places a two-year limit on a provider’s ability to request additional reimbursement for an underpaid claim. If an insurer adjusts subsequent claims to recoup the overpaid amount, the bill would require the insurer to include detailed information about which patient accounts are affected.
• Sen. Gard authored SB 147 at ISMA’s request – a result of House of Delegates Resolution 05-21. It directed the Government Relations staff to seek legislation establishing a time limit on insurer take-backs.
****This next Bill was very important to physicians and they allowed it to die without a vote. This is one of the reasons that Floyd County Physicians dropped the Aetna contract a few years ago. This clause basically states that if the insurance company has the most patients in the practice, then the physicians guarantee to provide services to this insurance company at the lowest rate of any other company.
Bill: SB 124 Health Provider Reimbursement Agreements
Author: Sen. Beverly Gard, R-Greenfield
ISMA Position: Support
• Final Status: Senate Health and Provider Services Committee chair, Sen. Patricia Miller, R-Indianapolis, did not call a vote for SB 124, which killed the bill.
• SB 124 would have prohibited most favored nation (MFN) clauses in provider agreements. MFN clauses require a participating provider to offer the insurer a reimbursement rate equal to or lower than the lowest reimbursement rate the provider offers another insurer.
• The ISMA opposes MFN clauses because they essentially remove the physician’s right to negotiate in the contracting process. If MFN clauses are permitted in contracts, one or two large insurers could dominate the market.
• The ISMA Government Relations staff will continue to educate legislators during the interim regarding the negative impact of MFN clauses on physician practices.
Bill: HB 1382 – Access to Reimbursement Fee Schedules
Author: Rep. Tim Brown, M.D., R-Crawfordsville
ISMA Position: Support
• Final Status: HB 1382 was not heard in the House during the 2006 session and is dead.
• The bill would have required an insurer or a health maintenance organization, upon request, to make available to a provider the insurer’s or HMO’s reimbursement fee schedule.
• While access to these fee schedules is getting better for currently contracted physicians, other physicians who are not contracted and want to sign into a network are not being given access to the fee schedule before signing a contract.
• This practice is another tactic by the insurance industry to restrict the physician’s ability to maintain a practice and provide quality health care to patients.
• The ISMA likely will pursue legislation on this topic again in the 2007 session.
Bill: HB 1097 – Discount Medical Card Programs
Author: Rep. David Frizzell, R-Indianapolis
ISMA Position: Support
• Final Status: HB 1097 was signed by both House and Senate leaders and now awaits the governor’s signature.
• The bill requires health care discount card companies to register with and be regulated by the Indiana Department of Insurance.
• These companies are currently unregulated by the state. Per ISMA’s request, the bill was amended to require the written consent of each individual provider before being included on the list of participating providers.
Bill: HB 1041 – Health Benefit Mandates
Author: Rep. Jerry Torr, R-Indianapolis
ISMA Position: Oppose
• Final Status: House Insurance Committee Chairman, Rep. Mike Ripley, R-Monroe, did not grant a hearing for HB 1041, which essentially killed the bill.
• HB 1041 would have allowed insurers to write health insurance policies that do not include all state-mandated health care benefits. Such plans would have been available to individuals and employers with no more than 50 employees.
• The bill also would have required the insurer to provide written disclosure acknowledging that the policy does not include all mandated health benefits and a list in summary form of those benefits not covered.
• The bill would have required coverage for at least the following:
Newborn and adopted child coverage
Diabetes
Breast, prostate, colorectal and cancer screenings
You can see that although some progress is being made, there are many more obstacles to overcome. This is why it is imperative that our state and national physician organizations continue to aggressively pursue these Bills.
posted by Anonymous at 6:10 AM
2 Comments:
If we could do that without it being considered collusion, it would be a wonderful idea.
General Motors loses money on every car it makes in the United States.
I understand the issue of providing services for less than the cost of the services. On the other hand, there aren't all that many professions that are so heavily subsidized by government. At least doctors and hospitals have a guaranteed income stream from Medicare and Medicaid if they wish to participate in the programs. If those programs didn't exist, would many of those patients go without care or would they have care provided with even less income to the providers?
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