2009 TMA Legislative Report Card
Declared “one of the big winners” in the November election by the Tennessee Journal, the Tennessee Medical Association followed up 2008 electoral victories with significant wins in the 2009 legislative session. TMA successfully worked to pass:
Favorable changes in Third-Party Reimbursement- PC 462 Limiting recoupment activity to insurance plans or TPAs - PC 462 Silent PPO transparency- PC 466
Insurance Plan transparency- PC 334 MLR clarification & improvements- PC 425 Peer Review immunity for medical groups- PC 46 Expanded Immunity for Volunteer Health Care Providers- PC 581
Reporting Med Mal Payments to DOH- PC 48
Expansion of & immunity for Doc Shopper Reporting- PC 67
Mandatory access to Controlled Substance Database by dispensers- PC 228
Texting while driving- PC 201
TMA successfully worked to stop:
TMA defeats:
NONE, though we were unable to enact rating and tiering legislation ($26 million fiscal note) and smoking in cars when children are present (no legislative desire to address the issue) Note: passage or defeat of legislation is often done working in conjunction with other allies.
Acknowledgment must be made to those who either supported our efforts or took the lead in others.
Third Party Reimbursement: (SB 549 by Norris/HB 749 by Harwell) TMA Position: TMA Legislation
This bill adds language to the statute specifying that only a health insurance entity or its agent that contracts with health care providers or is responsible for paying contracted or non-contracted health care providers may seek to recover any payments made to those health care providers. (This amendment was added as a result of business practices by Franklin-based Health Research Insights, Inc.) The remainder of this legislation holds a successor plan financially responsible if the original health insurer, thought in good faith to be responsible for coverage on the patient, denies payment for eligibility purposes. It extends the timely filing requirements in the provider’s contract with regard to the successor plan and stipulates that the successor plan would be responsible for payment if the service is a covered benefit. The legislation also sets in statute a deadline of no more than 60 days in which the employer must notify the insurance entity of a change in the employee’s insurance status. Finally the legislation provides an opportunity to toll the existing six and 18-month recoupment timeframes set in statute, at the express approval of both parties, in order to make final determinations as to the responsible payer. Duel Effective Dates: June 23, 2009 on recoupment/October 1, 2009 on Third Party Reimbursement Silent PPO (SB 693 by Southerland/HB 1907 by Curtiss) TMA Position: TMA Legislation
STATUS Passed as Public Chapter 466
Enacts the Preferred Provider Organization Transparency Act to bring transparency to the selling of commercial insurance networks and discounts by PPOs. Provisions of the bill include registration of all entities who sell, rent or lease a PPO network (and that are not already licensed) with the Department of Commerce and Insurance, a requirement that all entities who have access to a provider contract abide by all terms and conditions of the direct contract under which they are accessing a discount, contract entities must maintain a website or toll-free telephone number for a provider to call to obtain a list of all third party entities that the contracting entity has provided access to the providers’ contract, EOBs must identify under which provider contract the payor claims they have an express right to access the providers’ health care services and contractual discounts as well as a toll-free number the provider should call for questions concerning the claim. In addition, the legislation also limits to whom a contracting entity may rent, sell or lease a network, gives the provider the ability to refuse a discount to any entity that does not comply with provisions of the law, authorizes the Commissioner of Commerce and Insurance to oversee the enforcement of this act and makes it an unfair trade practice to disregard the law. ERISA plans and ASO arrangements for non-ERISA self-funded entities such as local governments and church plans are exempted from the requirements of the new law.
Effective Date: January 1, 2010
Reporting on med mal cases: (SB 588 by Beavers/HB 419 by S. Jones) TMA Position: TMA Legislation
STATUS: Passed as Public Chapter 48 This Act requires that the Department of Health accept information on a physician’s medical malpractice judgment or settlement from the provider’s medical malpractice carrier in order to update the physician’s profile within 30 days of final payment. The responsibility to assure the profile is updated accurately and timely remains with the physician.
Effective Date: April 9, 2009
Group Practice Peer Review: (SB 442 by Overbey/HB 1451by Coleman) TMA Position: TMA Legislation
STATUS: Passed as Public Chapter 46 This Act provides immunity and confidentiality, previously only available to a committee of a professional association or health care institution, to medical group practices under the medical peer review statute.
Effective Date: April 9, 2009
Doctor Shopping: (SB 408 by Henry/HB 462 by Odom) TMA Position: TMA Legislation
STATUS: Passed as Public Chapter 67 This Act extends the current requirement on TennCare patients to report to law enforcement any patient the physician suspects of doctor shopping. The law does not require the physician to query the state’s Controlled Substance Monitoring Database but, if the physician has good reason to believe the patient is doctor shopping, the provider is mandated to report that information to local law enforcement. The provider is immune from civil action if the report is made in good faith.
Effective Date: July 1, 2009
Access to the Controlled Substance Database: (SB 224 by Stanley/HB 151 by Hensley) TMA Position: TMA Legislation
STATUS: Passed as Public Chapter 228 This Act requires that all entities that dispense controlled substances have on-site electronic access to the controlled substance database at all times that services are being delivered.
Effective Date: January 1, 2010
Medical Malpractice Reform Revisions: (SB 2109 by Overbey/HB 2233 by Coleman) TMA Position: TMA Legislation
STATUS: Passed as Public Chapter 425 This Act establishes a clearer, more definitive notification process which also requires that the plaintiff sign a HIPAA release for health care records of any provider listed in the notice and that the release be included with the notification, a provision not previously in state law. It requires the plaintiff’s Certificate of Good Faith (COGF) to be included with the claim if and when it is filed in exchange for clarifying that the statute of limitations and statute of repose will be extended an additional 120 days (previously up to 90 days) once notice is given. The 2008 law required the COGF to be filed within 90 days of the claim being filed. This provision is designed to eliminate any delays in a plaintiff responding to a defense motion for summary judgment and places another requirementthat, if not met by the plaintiff, could result in the case being dismissed.
Effective Date: July 1, 2009
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