A Pretty Good Session!
2006 Legislative Report
by Eric Gally
Many people predicted that the 2006 Maryland General Assembly session would be so bogged down by partisan, election-year bickering, that almost nothing of consequence would actually get done. Fortunately that wasn’t the case for the physician community.
We went to Annapolis intent on altering a landscape that gives health insurers a huge built-in advantage when negotiating contracts with primary care providers. Although we certainly didn’t get everything we wanted, lawmakers were very receptive to our arguments and passed a series of bills that should help our cause. This package of legislation is a good first step forward in our effort to keep insurers honest in their dealings with physicians.
Senate Bill 686/House Bill 1003 tightens the provisions requiring insurers to maintain adequate provider networks and creates reporting requirements that will help the Department of Health and Mental Hygiene and the Maryland Insurance Administration enforce the law. Forcing insurers to maintain adequate provider panels throughout the state will lessen their ability to sign up a couple of providers in a given area and then offer the rest “take it or leave it” contract terms.
Senate Bill 1086/House Bill 897 prohibits insurers from inserting “most favored nation” clauses in contracts that require providers to automatically match terms and conditions that they negotiate with other insurers. Now a provider won’t have to lower reimbursement rates for one insurer just because they accepted that rate from another.
Senate Bill 636/House Bill 574 prevents insurers from hassling providers regarding re-credentialing if the provider changes federal tax id number or switches employers, provided that the new employer is also participating provider.
House Bill 868 prevents insurers from requiring providers to accept workers compensation assignments as a provision for serving on the insurer’s provider panels. This is especially important because some insurers have been farming out their networks to workers compensation providers without the provider’s prior consent or approval.
Lawmakers were also interested in two other provisions in this insurance overhaul package but felt they needed more time to solve the problems correctly. There was broad agreement that something needs to be done regarding adequate reimbursement for non-contracting providers (SB 839/HB 896), but lawmakers didn’t agree in time on a benchmark for setting rates. The physician community argues that billing charges should be paid, just as you would pay any other professional their going rate once they provided services. Other suggestions include setting rates based on 125 to 140 percent of Medicare rates. This issue will be seriously debated during the interim and next session. Another measure forcing insurers to honor patients’ voluntary assignment of benefits (SB 448/HB 1169) will also get strong consideration.
As expected, there wasn’t much consideration of malpractice reform proposals this year. The passage of temporary rate subsidies and Medicaid provider reimbursements in December 2004, coupled with the recent moderation of rate increases, has given legislative leadership all the cover they need to avoid stronger long-term reform for now. Needless to say everyone will be back to the table in a few years when the subsidies expire.
The House of Delegates did pass a bill to fix the apology law (HB 790), but that measure and all other attempts at reform failed in the Senate Judicial Proceedings Committee.
We also had some success this year defeating and altering proposed legislation that could have harmed the physician community. House Bill 626 would have placed a large and inflexible list of requirements for all prescriptions into state law, setting up the potential for providers to be breaking the law if they didn’t include a patient’s age, weight, condition and other requirements on every single prescription. Everyone recognizes the safety concerns surrounding accurate and legible prescribing, but this proposal was way too onerous and we convinced the House Health and Government Operations Committee to shelve it for now.
We were also successful in turning back attempts to create an electronic prescription monitoring program that would have violated the privacy rights of physicians and patients. First we watered down the proposal (SB 333/HB 1287) in the General Assembly and then Gov. Ehrlich agreed with our privacy concerns and vetoed the bill outright. The Federal Government’s desire for all states to have electronic monitoring programs ensures this issue will be around for the foreseeable future.
Our success this session is proof that members of the General Assembly are starting to focus on the obstacles that face family physicians as they struggle to care for their patients, sustain healthy practices and earn a living. We have a long way to go, but we definitely made some progress this year.
Mr. Gally, president of Gally Public Affairs, is the Maryland Academy of Family Physicians government relations consultant.
