Published 7/1/2013
Elizabeth Fassbender

State Legislative Update

As legislative sessions wrap up in many states, budget negotiations and decisions on whether to expand Medicaid under the provisions of the Affordable Care Act may top many agendas. But several states also addressed issues that directly affect orthopaedic medicine, including direct access to physical therapy, physician self-referral, and podiatry scope of practice. The following are highlights from some recent state efforts.

Alabama—Among the issues addressed during the 2013 regular session were prescription drug abuse and scope of practice. A bill that includes a provision prohibiting the state from tying physician licensure to participation in any public or private health plan passed the state senate and was reported favorably out of committee in the House, but time ran out before it could get approved.

Arizona—Gov. Jan Brewer recently called lawmakers into a special session to approve the 2014 budget and a measure allowing Medicaid expansion. Senate passage of the Medicaid expansion was a huge victory for the governor, but getting it through the House proved to be more of a challenge. In fact, Brewer had declared she would not sign any new bills into law until legislators approved the budget and Medicaid bills. The measures were approved on June 13 and sent to Gov. Brewer for her signature.

Arkansas—Gov. Mike Beebe signed HB 1220 into law, allowing the state to move forward with plans to expand Medicaid by using the expansion funds to purchase private insurance for eligible low-income residents and allowing beneficiaries to purchase subsidized coverage through the state’s insurance exchange.

California—The California Orthopaedic Association has been working to defeat AB 1000, a bill that would allow direct access to physical therapy. The bill has passed the California Assembly and is now with the Senate for committee hearings and further debate.

Florida—The Florida Orthopaedic Society successfully assisted surgeons with Medicare Administrative Contractor (MAC) audits. Most audits have been overturned on appeal. Additionally, SB 1792, a broad medical liability reform bill, was recently signed into law by Gov. Rick Scott. The measure clarifies that a physician may consult with legal counsel before serving as a witness in a medical liability action, revises qualifications of experts authorized to testify in medical negligence actions against a specialist, and authorizes defendants to interview a claimant’s treating healthcare provider.

Georgia—The Georgia legislature passed HB 499, the “Physician Shield Act,” which will protect physicians and other healthcare professionals from additional liability suits as a result of national care and practice guidelines derived from the Affordable Care Act (ACA) or established in federal programs. State lawmakers also created a joint committee on
Medicaid reform. Although Gov. Nathan Deal declared the state would defer to a federal exchange, which is expected to launch in January 2014, he seemed to leave the door open for a state exchange if it provided more flexibility.

Iowa—Gov. Terry Branstad signed legislation to expand the state’s Medicaid program to an estimated 150,000 Iowans with funding through the ACA. According to the governor’s spokesperson, previous concerns about the Medicaid expansion were addressed in the deal, which will “serve both patients and taxpayers at a superior level.”

Kansas—The Kansas Orthopaedic Society was successful in including language in the Physical Therapy (PT) Practice Act that would allow hospitals and ambulatory surgical centers to require physician referral for PT along with language requiring physical therapists to notify patients that a PT diagnosis is not a medical diagnosis.

Louisiana—HB 569, a bill that would have allowed direct access to physical therapy, was defeated in committee.

Maryland—The Maryland Orthopaedic Society helped block legislation (HB 746) that would allow podiatrists to perform surgery on acute ankle fractures.

Missouri—Missouri Orthopaedic Society members worked to protect medical liability reform as a part of the Missouri Tort Reform Coalition. The coalition is supporting HB 112/SB 10, an effort to reinstate limits on noneconomic damages. Last summer, the Missouri Supreme Court overturned the state’s limit on noneconomic damages in medical negligence cases by ruling that the cap violated the right to trial by jury.

North Carolina—The North Carolina Orthopaedic Association (NCOA) pushed for HB 177, which would allow more ambulatory surgery centers in the state. The bill is based on the recommendations from a legislative study also supported by the NCOA.

North Dakota—Gov. Jack Dalrymple signed into law HB 1362, which expands the current Medicaid program to include individuals with incomes up to 133 percent of the federal poverty level.

Oregon—The Oregon Orthopaedic Society (OOS) successfully lobbied against bills that prohibited physician ownership of ancillary services. The only bill still alive—SB 683—has been significantly amended so that it no longer prohibits ownership of ancillary services but simply clarifies the physician’s responsibility to inform the patient of his or her financial interests and of the patient’s options. This bill also prohibits the Oregon Health Authority from imposing additional restrictions on physician self-referral. OOS favors this bill as a way to discourage future harmful proposals.

Pennsylvania—The Pennsylvania Orthopaedic Society is currently evaluating workers’ compensation reform, including changes to the fee schedule. According to a recently completed actuarial study, the state’s reimbursement is lower than than in the rest of the nation. They also surveyed surgeons on the importance of drug dispensing.

Rhode Island—The state passed bills (S 2285/H 7228) that would allow physicians and allied health professionals, including physical therapists, to engage in a

South Carolina—The South Carolina Orthopaedic Association has made progress in its lawsuit against the Physical Therapy Board of Examiners. This past fall, a circuit court ruled against the board’s motion to dismiss the case.

Texas—The Texas Orthopaedic Association has been successful in blocking bills that would expand the scope of practice for podiatrists and chiropractors and permit direct access to physical therapy.

Utah—The legislature enacted HB 160, which creates a health reform task force to study options related to Medicaid expansion and Medicaid reform.

Elizabeth Fassbender is the communications specialist in the office of government relations; she can be reached at fassbender@aaos.org

State Legislative Update-Highlighted states (PDF)