Presented by LSMS Staff to the LAMMICO Defense Counsel Seminar Participants
Legislative Update 2023
LAMMICO| Defense Counsel Seminar 6 October 2023
In a Fiscal Session…
SENATE BILLS
418
Odd year regular sessions are “fiscal” in nature • Appropriations and Capital Outlay • Taxes, fees and fines • Dedications and Issuance of Bonds • Exemptions, exclusions, credits, etc. BUT… • Local issues, constitutional amendments, resolutions PLUS • 5 bills/legislator on any subject Adjourned June 8 @ 6 PM
HOUSE BILLS
1,008
TRACKED BILLS
124
Legislation www.legis.la.gov
Med Mal Matters
HCR 57 by Rep. Edmond Jordan • Requested a study to solicit input, recommendations, and advice from interested stakeholders on the current effectiveness of the medical malpractice limitations to compensation and medical review panels. • Never received hearing
SB 139 Sen. Jimmy Harris • Removed premises liability (general liability). • Prohibited attorney chair from raising the gross negligence standard of care in review panel. • Shifted burden of proving nexus to the physician. • Died in Committee
Scope of Practice HB 471 by Rep. Barbara Frieberg • Allowed RX licensees to give any vaccine to kids 7 and older • Got amended on the Senate Floor by Sen. Jay Morris: • Added PALS requirement • Added Vaccines for Children requirement • Was sent to conference committee where it died as session ended. (3 Votes on 6/8) HB 599 by Rep. Dustin Miller • Started as a mini–Global Signature Authority Bill • Heavily amended with agreement of Rep. Miller • Extends APRN ability to write work excuse for school board employees’ illness to 10 days • Parties agreed to work in the interim on end-of-life documents SR 160 by Sen. Jay Luneau • Urges Boards of Medical Examiners, Nursing and Dentistry to make CPA information publicly available
Abortion Legislation 7 Bills Filed in 2023 RS
LSMS has longstanding policy to remain neutral on abortion legislation unless it impacts patient safety and/or the practice of medicine. Three bills would have clarified issues raised since last year. - HB 461 by Mary DuBuisson would have added a new definition of “non- viable pregnancy” to last year’s abortion exceptions - HB 522 by Aimee Freeman would have redefined abortion, eliminated physician imprisonment in favor of fines when an abortion has been performed, and reduced medical futility certification requirements. - HB 598 by Candace Newell would have amended varying definitions relative to the crime of abortion. None of the bills were passed out of committee.
6
Other Legislation
SB 29 by Sen. Gerald Boudreaux
Relates to removing surgical smoke from operating rooms (ACT 35)
SB 66 by Sen. Fred Mills
Eliminates term “telemedicine” in favor of “telehealth” (ACT 322)
SB 172 by Sen. Brett Allain
Addressed noncompete clauses in physician contracts
HB 548 by Rep. Chris Turner
Focuses on 340B drug pricing program (ACT 358)
HB 648 by Rep. Gabe Firment
Prohibits certain procedures related to altering the sex of a minor child (ACT 466)
Resolutions HCR 83 by Rep. Michael Echols • Creates a task force to conduct research and make recommendations to address the current and future needs of this state to maintain the necessary number and specialty type of physicians to provide health care for our citizens.
HCR 114 by Rep. Kenny Cox • Requests the Louisiana State Board of Medical Examiners to study the potential outcomes of allowing sanctioned physicians to practice under supervision and its impact on the physician shortage.
Prior Authorization
91% of physicians report prior
Process Hurts Patients
authorization has had a somewhat or significant
impact on their patients’ clinical outcomes.
Source: 2021 AMA Prior Authorization Physician Survey Available at: https://www.ama- assn.org/system/files/prior- authorization-survey.pdf
82% of physicians report that prior authorization can lead to treatment abandonment.
Consensus Statement on Improving the Prior Authorization Process
• Released in January 2018 by the AMA, American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association, and Medical Group Management Association • Five reform categories addressed: • Selective application of PA • PA program review and volume adjustment • Transparency and communication regarding PA • Continuity of patient care • Automation to improve transparency and efficiency
Following the Consensus Statement, Progress Has Been Sluggish
84% of physicians report that the number of medical service PAs required has increased over the last five years. Only 9% of physicians report contracting with health plans that offer programs that exempt providers from PA. 65% of physicians report that it is difficult to determine whether a prescription medication requires PA. 88% of physicians report that PA interferes with continuity of patient care. Only 26% of physicians report that their EHR system offers electronic PA for prescription medications; phone is still the most common method.
Source: 2021 Update: Measuring progress in improving prior authorization. Available at: https://www.ama- assn.org/system/files/p
rior-authorization- reform-progress- update.pdf
Impact on Physicians & their practice
October 2022 Physicians Foundation survey: • 85% report administrative burdens, such as EHRs and prior approval as top 4 challenge • 93% identify simplifying prior authorization as an action that would help ensure high-quality, cost-efficient care
2022 Louisiana Legislation Act 432 (SB 112) by Sen. Robert Mills • Original bill • Paralleled Texas “gold card” bill
• Exception = 80% approval rate by provider (annual review to rescind exemption by peer with IDR available) • Guarantee of payment (with limited exceptions) once approved & a timely pay provision • Pharmaceuticals included • Medicaid and OGB not included • Amended to require insurance companies to develop their own prior authorization relief program which must were filed with LDI in July. • Pharmaceuticals excluded
Act 312 – LSMS Requested Legislation
Rep. Thomas Pressly Began as HB 468 House Insurance 4/26 House Floor Vote (99-0) 5/10 Senate Insurance 5/17 Senate Floor (37-0) 6/4 House Concurrence (100-0) 6/4 Governor’s Signature 6/13 Effective Date 1/1/2024
• Creates an infrastructure with timelines for PA and Utilization Management • Includes a guarantee of payment clause • Establishes a truer peer-to-peer review system • Includes prescription medication
ACT 312 Timelines
AND any prior authorization will be valid for 3 months
ACT 333 – LSMS Requested Legislation
Sen. Jeremy Stine Began as SB 188
Transparency requirement for health insurers: • Annual report on certain prior authorization metrics to the Dept. of Insurance (by quarter) • Annually publish a list of all items, services and medications that require prior authorization • Requires timely updates to these lists Tracks CMS Proposals (1/1/2026)
Senate Insurance
4/26
Senate Floor Vote (36-0)
5/1
House Insurance
5/10
House Floor Vote (102-0)
6/5 6/7 6/8
Sent to Conference
Conference Report Adopted
Governor’s Signature
6/13
Effective Date
1/1/2024
Prior Authorization – Other
ACT 254 by Sen. Kirk Talbot • Began as SB 110 • Establishes the "Cancer Patient's Right to Prompt Coverage Act". • Includes timelines similar to Rep. Pressly’s ACT 312. • For diagnosis and treatment of cancer, requires coverage of services for nationally recognized clinical practice guidelines. • Prohibits denial of coverage of recommended imagining for diagnosis, treatment, appropriate management, restaging… • Effective date of 8/1/2023 – But doesn’t apply to policies until 1/1/2024
SB 164 by Sen. Heather Cloud
• Focuses on the Office of Group Benefits which is the health insurance plan for employees and retirees of the State. • Mandates posting of all services and pharmaceuticals requiring prior authorization. • Failure deems them to no longer require a prior authorization. • Establishes reporting requirements very similar to what is in SB 188 by Sen. Stine. • Fiscal Note had it dually referred. • Ran out of time.
Elections
2023 isn’t over yet politically!
2023 Elections • Entire legislature up for election • All Statewide Offices • Dates • October 14 • November 18 • Term Limited • Governor • Senate President & House Speaker • 15 Representatives & 7 Senators
Qualifying for 2023 Elections was held August 8 to 10. (October 13 and November 18)
7 Statewide Races • 14 Candidates in the Gov’s race • LDH Secretary • New: Governor, Sec. State, Treasurer, Atty. Gen. and Insurance Cmmsnr (Temple) 39 Senate Races • 20 elected w/o opposition (51%) • 12 open seats (31%) • 8 one party races 105 House Races • 48 elected w/o opposition (46%)
• 31 open seats (30%) • 21 one party races
Thank you!
Maria Bowen VP, Gov’t Affairs > mbowen@lsms.org v 225.939.7576
Join The Conversation @LaMedSoc
Louisiana State Medical Society www.lsms.org
Get a health insurance quote from the new LSMS MEWA
Lauren Bailey VP, Legal Affairs > lbailey@lsms.org v 225.235.2865
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