In early May, the House Insurance Committee considered House Bill 1186 by Rep. Hunter Greene. Rep. Greene filed this bill on behalf of the healthcare provider community to allow patients to assign their health insurance benefits to their healthcare provider. Currently, hospitals and dentists have assignment of benefits but other healthcare providers do not. While some health plans honor a patient’s request for assignment of benefits, most of the state’s health plans use it as a strategy to leverage negotiations for physicians to participate in their networks. House Bill 1186 requires the health insurance issuer to honor the document executed by the patient that assigns the patient’s benefit payment to the provider. Proponents of the measure stipulate that assignment of benefits is a voluntary action by patients and increases administrative simplification. It streamlines insurance paperwork for patients, physicians, and health plans. Blue Cross Blue Shield of Louisiana took the lead in opposing House Bill 1186. Opponents, insurers such as Blue Cross Blue Shield of Louisiana, argued that if HB 1186 were to become law, it would cause doctors to leave their networks. Sabrina Heltz stated that doctors in network don’t need Assignment of Benefits and the bill will cause doctors to leave the networks. Further she argued that the bill would further expose consumers to balanced billing. By a vote of 3 to 6, the House Insurance Committee voted down House Bill 1186.

 

At this writing, Senate Bill 514 by Senator Ed Murray has almost made its way completely through the legislative process. This bill makes the Patients Compensation Fund Board and Fund exempt from rate regulation by the Insurance Commissioner. It requires the PCF Oversight Board to conduct an annual actuarial study by a competent insurance actuary. It allows the PCF Oversight Board to determine the surcharge (rates) at their public meetings. Additionally, SB 514 requires that at all times; the PCF shall be maintained such that assets on hand are at least 30 percent of the Fund's outstanding liabilities. As you may recall, the Insurance Commissioner filed for a Declaratory Judgment against the Patient's Compensation Fund. Commissioner Donelon contends that the Office of the Insurance Commissioner should have the authority to set the Fund's rates and to require a much larger amount of surplus than has been maintained since the funds' inception in 1975. Proponents argue that the PCF is not an insurance company but rather a “revolving” fund. Despite the fact that there is an unfunded liability, that becomes an issue only if the Fund were to go “belly up.” If the Patients' Compensation Fund were to go “belly up” then the healthcare system as a whole in Louisiana would face a death spiral as medical malpractice coverage would be either unaffordable or unavailable.

 

The House Insurance Committee met on Wednesday May 5, 2010 and considered House Bill 511 by Rep. Joe Harrison. This measure provides for timely combined medical billing for a single inpatient or outpatient surgery or other medical procedure. Rep. Joe Harrison testified before the Committee and said that this could all be done at the pre-cert process. Rep. Harrison argued that his bill aims to protect consumers who are getting medical bills “six, eight, nine months” following the medical procedure.  He said “It’s very simple” to implement the single medical billing. He said that this problem is ruining the credit of people throughout the country. He said another good reason to do this is because of “Obama Care.” Insurance Committee Chairman Rep. Charles Kleckley gave an example of someone who is going to have knee surgery. He asked if Rep. Harrison envisions that the bill for the radiologist, the orthopedic surgeon, the anesthesiologist, the hospital stay – will all be in one single medical bill. Rep. Harrison retorted “It’s at the point of service.” Speaking in opposition to the bill was Danielle Cromwell with Acadiana Computer Services, a medical billing company; Berkley Durbin, executive director of Medicine Louisiana and Kevin Bridwell with the Louisiana Hospital Association. Danielle cited state laws that afford consumers protections. She said that according to the prompt payment of claims law, health care providers are required to remit their bills to an insurer or MCO within 180 days of the healthcare service. Also there are state laws in effect which require a healthcare provider to report to a credit bureau if a report was made relative to non-payment and then paid later. Kevin Bridwell, Vice President, LHA testified that all these entities have different contracts, different business operations and are different entities. “This bill would be an administrative complication of an epic proportion.” Rep. Page Cortez asked how House Bill 511 would be implemented in the case of an automobile accident were there is no pre-cert. Rep. Kleckley asked how this bill would be implemented if there were (unanticipated) complications. Rep. Harrison said that the people who are making money relative to this problem are the collection agencies. The House Committee on Insurance voted down House Bill 511. 

 

House Bill 984 by Rep. Neal Abramson cleared its first hurdle in the legislative process in early May. This measure clarifies in state law that ambulatory surgery centers (ASC) may enter into “use agreements.” Jake Kohl of Texas based K & S Consulting testified in favor of the bill. He gave an example of an ASC being done with their surgeries by two PM and having the opportunity to enter into lease agreements with another entity to performs surgeries where there is excess capacity. When considered in the House Health and Welfare Committee, a committee member raised the question “What does this do to the ASC licensure?” Erin Rabalais and Kim Humphries of the Department of Health and Hospitals presented information. DHH said that the licensed ASC is still responsible. DHH employees stated that that they won’t be regulating the third party. However, when DHH promulgates the administrative rules, they anticipate including provisions covering patient safety. Proponents of the bill stated that the “use agreement” will spell out all activities that are being done by the third party. House Bill 1473 is the new number assigned to House Bill 984 as it was reported by substitute.