State Update

State House Formal Session Ends with Passage of Modified Cost Bill

The 2007–2008 formal legislative session ended on July 31 with the final passage of a compromise version of the health care cost control bill, which was filed by Senate President Therese Murray last March. Strong advocacy by the MMS and allied specialty societies resulted in far more favorable legislation than the original version. The MMS also worked hard in the final days to prevent passage of legislation that would expand the scope of practice of several allied health professions. The session also recorded gains in expanding health access and protecting the public health.

MMS President Bruce S. Auerbach, M.D., said, “We appreciate that the Legislature listened to many of our concerns during this past session. We will now closely monitor the implementation of these bills to ensure that they support the ability of physicians to provide good health care to their patients.”

Cost Control Bill Modified
The Senate President’s cost control bill was the most comprehensive and contentious health bill under consideration. The Society strongly supported this legislation’s intent to improve access to primary care, expand the use of information technology, and enhance transparency. But the MMS had significant concerns with certain areas of the bill, and made numerous suggestions for improvement — most of which were accepted.

For example, the original bill called for a strict ban on “gifts” from pharmaceutical companies and criminal sanctions against physicians receiving them. The final, more balanced version exempted legitimate physician education and shifted the burden of reporting and compliance to the donor pharmaceutical and medical device manufacturers, not physicians.

The original bill called for an unfunded mandate that all physician offices utilize electronic health records (EHRs) by 2015, and it also required physician competency testing in health information technology (HIT) as a prerequisite for licensure after that time. The final version eliminated the mandate and instead set a goal for a statewide interoperable EHR system by 2015, with funding available to facilitate the process. However, the bill retained the link between licensure and HIT physician competency by 2015. The MMS continues to oppose that link.

Workforce Council Established
Many of the bill’s original provisions in the areas of physician workforce and administrative simplification were retained or enhanced, including a loan forgiveness program and the creation of the Healthcare Workforce Council. The council would be charged with examining disincentives to recruitment and retention across specialties, ranging from existing laws, regulations, and policies to contracting and reimbursement practices. The final version also clarified language that would require all payers — including Medicaid — to use standard claims forms and billing codes by 2012.

Public Health and Safety Gains
The state’s 2009 fiscal year budget included full funding for the successful health reform law, which has already facilitated health insurance coverage for more than 340,000 previously uninsured residents. This required additional revenue, including increased tobacco taxes and assessments on hospitals and health insurers. The approved budget also includes the third year of Medicaid rate increases to physicians, cumulatively raising the payment base by about $80 million. However, it also deferred $4.2 million of this year’s increase, making it payable next year, contingent on pay-for- performance standards.

Other MMS-supported victories this session included the following:

• Extension of mental health coverage mandates to substance abuse, autism, and posttraumatic stress disorder
• Creation of the Office of Health Equity to coordinate efforts to eliminate health disparities
• Adoption of stricter standards for child booster seats in automobiles
• Authorization of DPH guidelines for programs to help victims of violence

Scope-of-Practice Victories
Sometimes success is measured in terms of legislation that didn’t pass. The formal session ended with the MMS and specialty societies again successfully defending medical practice against efforts by allied and alternative health professionals seeking to practice medicine. In the last week of the session, the MMS and its allies withstood strong advances by optometrists, podiatrists, midwives, naturopaths, and nurse anesthetists.

The Legislature will continue to meet in informal sessions for the remainder of the year. During these sessions, the objection of a single legislator will prevent any bill from advancing. Thus, it is anticipated that only non-controversial bills will be enacted between now and the end of the calendar year.

– Steve Shestakofsky