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HomeMy WebLinkAboutBC/BS Legislative Status ReportBlue Cross and Blue Shield of Montana Montana Legislative Status Report Mid-Session Break February 26, 2001 The Montana Legislature returns from its transmittal break at 5 p.m., Wednesday, February 28, 2001. The first full floor and committee day will be Thursday, March 1, 2001. The Legislature is scheduled to finish its work on April 24, 2001, the 90th legislative day. Here's a recap of legislation with potential health plan impacts and cost implications to consumers. This list includes legislation that was not introduced, was withdrawn, tabled, or passed transmittal and will be heard in the second House. - - --Hea-1tlr-Ptarrtiability----_ _ _ _- 1. HS 424; an act creating a cause of action for damages against a health carrier or managed care entity that fails to exercise ordinary care in making health care treatment decisions. The bill, known as "Sue Your Health Plan", is carried by Representative Ken Peterson (R-Billings). The Montana Medical Association supports HB 424, as it did last session. The Montana Trial Lawyer's Association testified in support of the legislation. HB 424 was introduced last session with a peer review portion. The lawsuit provisions of last session's bill did not pass. Only eight states have health plan liability legislation such as HB 424. The Congressional Budget office estimates the increased cost of health plan liability would raise insurance premiums by 1.4 to 4.1 percent. Cost increases of 4.1 percent for BCBSMT members would be over $16 million annually. The House added an amendment to the bill requiring that a claim must first be heard by the Montana Medical Legal Panel before a health carrier or managed care entity can be sued. HB 424 was transmitted to the Senate. Regulatory Expansion Susan Good and Allied Citizens for HealthCare Equity (ACHE): Proposals No Longer Being Considered 1. SB 412; an act authorizing joint negotiations by competing physicians. Senator John Cobb (R- Augusta) carried this bill for Susan Good. SB 412 grants physicians very broad antitrust exemptions to form cartels. Oversight of activities and rulemaking was granted to the State Auditor's office with no additional funding or employees to perform the legislation's obligations. In other places where the antitrust exemption has been proposed, the Federal Trade Commission has spoken against the proposals as potentially harmful to consumers. The bill was tabled in the Senate Public Health Committee. 2. SB 413; an act prohibiting a nonprofit corporation from supporting any activities of any for-profit business in which the corporation has an ownership interest. Senator John Cobb (R-Augusta) carried this bill for Susan Good. SB 413 would have impacted all nonprofits doing any business in the state. The bill was assigned to the Senate Public Health Committee, but never heard. 3. SB 414; an act prohibiting an insurer from requiring a health care provider, as a condition of participation in a health benefit plan of the insurer, to participate in any of the insurer's other health benefit plans. Senator John Cobb (R-Augusta), sponsored this bill for Susan Good. It was difficult to figure out how the bill was supposed to work. The Senate Business Committee tabled S13414. 4. SB 415; an act providing for direct payment to health care providers by health insurers, health service corporations, and HMOs. Senator John Cobb (R-Augusta) carried the bill for Susan Good. SB 415 would require health benefit payments to be sent directly to a health care provider whether or not that provider had agreed to accept health benefit reimbursement as full payment and not balance bill, such as other BCBSMT physician provider programs. Those who spoke in opposition to the legislation focused on the cost savings realized from using insurance network providers. The savings to BCBSMT members alone are over $37 million per year. The State of Montana's group plan savings amount to $7.3 million. The bill was tabled in the Senate Business Committee. -_ Other_Proposals No Longer Being Considered 1. SS 422; an act revising definitions for managed care plan networks, was cancelled. The bill, carried by Senator Duane Grimes (R-Clancy) would have clarified that point-of-service health plans are not subject to network adequacy. The 1997 network adequacy laws were designed for gatekeeper (less choice) HMO plans, not full choice point-of-service plans. Mandates HS 406; diabetes mandate was amended in the House to require coverage of outpatient self- management training or education for the treatment of diabetes and a limited benefit for medically necessary equipment and supplies. State and local government employees are included. BCBSMT was influential in getting the original bill amended to provide coverage for those diabetic services we've been providing coverage for the past several years. Representative Kim Gillan (D-Billings) sponsored the bill. HB 406 was transmitted to the Senate. 2. SB 321; an act adding physical therapists to covered providers under any health policy. Senator Dale Mahlum (R-Missoula) sponsored this bill. It is a mandate for services provided by physical -Therapists.- Physical-therapists-said they introduced this bill because-vf problems with commercial insurers. BCBSMT already covers physical therapy services. SB 321 was transmitted to the House. 3. LC 1031; an act to prohibit insurance discrimination for tempomandibular (TMJ) joint disorders. Requires health insurance policies to include coverage for the diagnosis and treatment of TMJ on the same basis as other joint disorders. The bill was not introduced this session and was defeated last session. Annual expected costs to BCBSMT members, if this bill passed, was over $3 million. Representative Bill Thomas (R-Hobson), a retired dentist and chair of the House Human Services Committee, sponsored the bill. 4. HB 355; an act to require insurance to cover contraceptive drugs, devices and services. Representative Christine Kaufmann (D-Helena) sponsored HB 355. Annual expected costs to BCBSMT members would be approximately $1 per paying member, per month. The bill was defeated in committee and an attempt to bring it to the full House failed. Managed Care HB 458; an act to require managed care medical directors to be licensed Montana physicians. Representative Debby Barrett (R-Dillon) sponsors the bill. The medical directors in BCBSMT plans are all licensed Montana physicians. HB 458 codifies a good business practice. The bill was transmitted to the Senate. Privacy 1. SB 465; an act amending Montana's Insurance Information and Privacy Protection Act. The bill is sponsored by Senator Eve Franklin (D-Great Falls) at the request of the State Auditor. SB 465 was developed with input from the Auditor's Privacy Task Force; a group made up of consumer and insurance industry representatives. The bill addresses problems encountered with last session s privacy faws ari imert- -changes required bye eral privacy enactments (Gramm- Leach-Bliley; Health Insurance Portability and Accountability/HIPAA). SB 465 was transmitted to the House. Uninsured Initiatives 1. SB 338; an act revising the eligibility cap for the state Children's Health Insurance Program (CHIP). Senator Dale Berry (R-Hamilton) sponsored the bill. SB 338 raises the income limit for CHIP families from 150 percent of the federal poverty level to as high as 175 percent - from $25,575 to just under $30,000 for a family of four. The bill has been transmitted to the Senate Finance and Claims Committee. 2. SB 316; an act allowing a five-year tax credit for certain employers who make a health benefit plan available to their employees. The bill is sponsored by Senator Emily Stonington (D- Bozeman). SB 316 was also introduced in the 1999 Legislature but was not enacted. The bill provides a tax credit to employers with less than 10 employees who choose to offer health insurance and had not done so in recent years. The estimated cost of the tax credit bill is $3.7 million for the first year. Underwriting SB 274; an act requiring insurers to disclose specific underwriting information to group health entities such as associations, group purchasing cooperatives, multiple employer welfare arrangements, self-insured groups, or businesses providing group health for its employees. Senator Bob Keenan (R-Bigfork) is the sponsor of this bill. As originally written, the bill required disclosure of information not captured by entity type, such as the amount of reserves set per policy year. SB274 also requires production of the amounts paid to doctors and other health care providers for members of the group as well as breakdowns of use by medical procedure on members. Disclosure of some of this information could violate medical privacy. The bill was amended and transmitted to the House. Montana Comprehensive Health Association (MCHA) 1. SB 310; an act revising comprehensive health association laws. The bill is sponsored by Senator Mignon Waterman (D-Helena) and is the general "housekeeping" bill for the MCHA. The MCHA is Montana's high-risk pool providing individual coverage to uninsurable Montanans, and also provides Montanans leaving group coverage with their portability option under the Federal Health Insurance Portability Accountability Act (HIPAA). The pool has been in existence since 1987. SB 310 was transmitted to the House. 2. SB 315; an act allowing the MCHA to adopt a sliding scale of premium rates for participation of low-income persons in the plan and allowing for the nonreversion of funds appropriated to the MCHA for the 2000-2001 biennium. The bill is sponsored by Senator Eve Franklin (D-Great Falls) -- at the request ofthe State Auditor. SB 315 attempts to provide a sliding scale premium for low income Montanans who qualify for MCHA coverage under current standards. The nonreversion portion of the bill continues an appropriation granted by the 1999 Legislature for the MCHA from the state's tobacco settlement. The bill was sent to the Senate Finance and Claims Committee. 3. SB 441; an act providing for an alternative assessment on stop-loss carriers, excess of loss carriers, the state employee health benefit plan, and the university employee health benefit plan for the MCHA. Senator Chris Christiaens (D-Great Falls) carries this bill. The MCHA is financed through premiums paid by insureds and assessments on carriers in the Montana market, SB 441 expands the funding base to those entities listed in the title, whose member also accesses the HIPAA portability coverage. Assessments against these new entities are not scheduled to be made until July 1, 2003. It is a matter of equity to include other assessment sources to fund the MCHA. The bill was transmitted to the House. All in all, the first half of the legislative session was busy and productive. With costly provider protections and an expensive lawsuit proposal, we continually asked senators and representatives "what does this bill do to make health insurance more affordable?" We will continue to pose that question as we deal with issues like health plan liability (HB 424) and hope we can count on you to contact yourlegisla-6rs concerning your views on legislation. Please feel free to contact us about any questions you may have regarding this publication: Chuck Butler Tanya Ask Susan Witte Vice President Co-CEO Director Gov. and Public Relations Montana Health Gov. and Public Relations BCBSMT BCBSMT BCBSMT (406) 444-8263 (406) 444-8297 (406) 444-8975