Archive for the ‘State Law’ Category

Robert A. Berenson, Paul B. Ginsburg and Nicole Kemper3

Faced with declining payment rates, California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout. California’s experience is a cautionary tale for national health reform: It suggests that proposals to promote integrated care through models such as accountable care organizations (ACOs) could lead to higher rates for private payers. Because antitrust policy has proved ineffective in curbing most provider strategies that capitalize on providers’ market power to win higher payments, policy makers need to consider approaches including price caps and all-payer rate setting.

The Ohio Bar Association’s new Subrogation Committee held its first meeting today to try to formulate what the purpose of this committee is. The committee developed a working statement which states as follows: “Parties injured by a wrongdoer often are not receiving full or fair compensation in part because of subrogation laws of Ohio.” The Committee does contain one subrogation attorney Dennis Rehor of Cincinnati Insurance company. The Committee will attempt to reconvene to discuss this statement of principle on April 14th, 2010 at 10:30 A.M. The Ohio Bar Association hopes to have some proposals considered again at its meeting during its yearly convention in Dayton in early May. Ohio subrogation attorneys who are members of the OSBA need to make sure they check the OSBA’s website regularly as they hope to post information regarding the work of this Committee.

President-Elect Kenneth Levine and Amicus Committee Chair Daran Kiefer spent Monday February 22nd in Colorado with several NASP members and industry lobbyists testifying in opposition to House bill 1168. During the eight hours at the Capital, the parties supporting this bill agreed to several amendments. First, the bill was amended to eliminate property, workers’ compensation and auto subrogation from its reach. As for health subrogation, the proposed amendments require the injured party to provide information about the settlement and available limits. The amended bill calls for a rebuttable presumption of “full compensation” when insurance limits are not received. The amended bill also provides that a party’s full compensation value is equal to any jury award. The health subrogation industry will be impacted if this bill passes and becomes law in Colorado. The House Judiciary Committee approved the measure 10-0 with one abstention.

The South Dakota bill would prohibit a subrogated insurer from participating in any recovery for “bodily injury” or “property damage” unless or until the injured party is “made whole”. S.D. Senate bill 169 failed to pass the Senate on February 22, 2010. However, the Senate reconsidered the bill on February 23rd, 2010 which resulted in a tie. The tie was broken by the Senate President and Lt. Governor. The bill now heads to the House for consideration.

The New Hampshire House Judiciary Committee reviewed and recommended a bill recently pertaining to contract, Medicaid or statutory subrogation rights of subrogation for “”reimbursement of medical expenses” against plaintiff’s recovery. The proposed bill requires these subrogated entities to pay costs and attorney fees to the injured party “as justice requires”. The bill does not give any direction on how the court should divide the proceeds other than “as justice requires”. However, the bill does provide a cap and states the insurance carrier, medical provider, or the state shall not be awarded more than two thirds (2/3) of the amount claimed. The bill would apply to health, auto medical payments and worker’s compensation lines of coverage. The effective date of the bill if passed would be January 1st, 2011.

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Bulletin 371

Prosecutors are seeking documents from Anthem, Aetna, Cigna, Blue Shield, Kaiser, Health Net and PacifiCare in a probe of whether they raised rates illegally and denied payment of legitimate claims.

February 25, 2010|By Duke Helfand and Marc Lifsher

Reporting from Sacramento and Los Angeles — The California state attorney general’s office said Thursday that it had subpoenaed financial records of California’s seven largest health insurance companies as part of an investigation into whether they illegally raised customer premiums and denied payment of legitimate claims. Read more

Washington. The state’s domestic partnership law went into effect on Dec. 3, 2009, and has some implications for employers in the state. The law provides that for all purposes, registered domestic partners must be treated the same as married spouses. This means that employment-related benefits must be extended to the registered domestic partner of employees on the same basis as spouses. For more information, visit http://www.sos.wa.gov/corps/domesticpartnerships/Default.aspx.

Utah. The state has proposed legislation that would establish a state risk adjuster board to ensure consumer health risks are spread evenly among private insurers as they increase access to health insurance for 350,000 uninsured Utah residents. The bill, HB294, also would permit businesses in Utah with more than 50 employees to be part of the Web-based exchange for medical insurance and information. For more information, visit http://le.utah.gov/~2009/htmdoc/hbillhtm/HB0294.htm.

Pennsylvania. Premiums for the state’s adultBasic health insurance plan will double in March from $330 per month to $600 per month. In addition, more than 40,000 participants will face new higher out-of-pocket costs, with higher copayments for doctor and emergency room visits and more expensive coinsurance requirements for services including chemotherapy, dialysis, and outpatient surgery. The Pennsylvania Insurance Department cited higher medical service use and escalating health care costs, combined with limited state funding, as the reason for the coverage changes. For more information, visit http://www.portal.state.pa.us/portal/server.pt/community/health_insurance/9189/adultbasic_benefit_chanages/646477.

Minnesota. Starting March 1, the state is going to charge counties extra to cover the cost of health care for their neediest residents. Previously, a $400 million General Assistance Medical Care program was available to help provide coverage for the poorest in the state, but the program is ending in an attempt to balance the budget. State legislators have proposed funding the program through surcharges on hospitals and health groups to draw down federal dollars and would levy a 10% match by counties to share the program’s cost. For more information, visit http://www.health.state.mn.us/.

Maryland. A bill pending in the state would allow young adults to continue enrollment in their parents’ health care plan until age 30. Current law allows dependent individuals to remain on a parent’s plan until they attain age 25. By expanding this to age 30, graduate students, veterans returning to school, and young adults who have been laid off and are seeking employment would be helped. Similar laws exist in New Jersey, New York, and Pennsylvania. For more information, visit http://www.mdinsurance.state.md.us/sa/jsp/Mia.jsp.

Illinois. The Illinois Supreme Court has struck down a medical malpractice law enacted in 2005 that limited monetary damages for pain and suffering to $1 million from hospitals and $500,000 from doctors. The court said the law violates the state’s separation-of-powers clause between the branches of government by allowing lawmakers to interfere with a jury’s right to determine damages. According to the American Medical Association, courts in 16 states have upheld these types of laws, while those in 11 states have overturned them. For more information, visit http://www.state.il.us/court/.

Georgia. Georgia Health Commissioner Rhonda Medows has urged state lawmakers to adopt a tax hike on hospitals and health care plans to help with the state’s Medicaid deficit problem. Beginning on July 1, the state will face a $506 million shortfall in Medicaid funds. The recession has caused enrollment in Medicaid to soar:from Une 2009 to 2010 enrollment has increased 7.7% to more than 1 million people. For more information, visit http://health.state.ga.us/.

Florida. To avoid a legislative mandate on the issue, major health insurers in the state have agreed to pay for care for members diagnosed with cancer who participate in clinical trials. The “Clinical Trials Compact” ensures that cancer patients will receive continued benefits while being treated with experimental drugs and other therapies. Participating insurers are: Blue Cross and Blue Shield of Florida, Humana, Aetna, Cigna, UnitedHealthcare, Vista Healthplans, and AvMed Health Plans. In recent months, there had been a move toward legislation to eventually cover all phases of cancer clinical trials, but the health insurers wanted to avoid a legislative mandate. Florida is the fifth state to use a compact for cancer trials, after Georgia, Michigan, Nebraska, and New Jersey. For more information, visit http://acscan.org/action/fl/updates/693/.