The 144th General Assembly came to a close in the early morning of July 1, 2008. The following recap highlights the bills that MSD monitored closely. All in all the session was a successful one for the physicians of Delaware and their patients.

PROVIDER TAX – In its struggle to resolve the State’s budget deficit, the General Assembly introduced a provider tax for the first time. The proposal is a scheme by which the State would impose a 2-3% tax on hospitals, and then pay them back with Federal Medicaid matching funds that it hoped to receive. A legal opinion obtained by the Delaware Healthcare Association, however, contended that the tax receipts would not be eligible for these matching funds, so the hospitals could very well end up paying the tax without getting reimbursed by the State. The proposal originally included Ambulatory Surgical Centers (ASC) and diagnostic imaging facilities. Due to strong opposition from the Medical Society of Delaware, these facilities were omitted from the legislation. HB 512 was not released from committee and did not get a vote before the end of session, therefore the tax will not be implemented.

COVERAGE FOR ANESTHESIA DURING COLONOSCOPY – HB 319 is the bill House Speaker Terry Spence introduced mandating coverage for anesthesia services during colonoscopies. The original bill was not agreeable to MSD, as well as to other groups, such as Blue Cross Blue Shield of DE. House Amendment 3 contains language agreeable to both MSD and Blue Cross. The bill together with HA 3 passed the General Assembly on the last day of the session and awaits the Governor’s signature.

LICENSURE FOR NON-PHYSICIAN ACUPUNCTURISTS – HB 377 provides for licensing and regulation of non-physician professional acupuncturists. Jeff Meyers, M.D., represented the Society at several meetings held on this bill. Thanks to the work of Doctor Meyers and Vincent Lobo, D.O., representing the Board of Medical Practice, among others, the bill was revised to increase the amount of training required for licensure and to ensure patient safety. The bill passed the General Assembly in early June and has been signed by the Governor.

MATERNAL HEALTH LEGISLATION – House Bill 472 implements our HOD Resolution calling for review of all maternal deaths. It was sponsored by Rep. Diana McWilliams and other members of the General Assembly’s Kids’ Caucus, including House Health Committee Chair, Rep. Pamela Maier. The bill passed the General Assembly on the last day of the session and awaits the Governor’s signature. Legislation implementing our other maternal health HOD Resolution related to HIV screening, SB 305, was introduced in the Senate. Unfortunately, the bill did not gain traction and did not get a vote in the Senate. We will try to introduce it again next year.

MEDICAL RECORDS COPYING RULES -- House Substitute 1 to HB 236 replaces HB 236, which would have instituted a fee schedule in the Delaware Code of copying medical records. MSD proposed several amendments to the bill’s sponsor, Rep. Nancy Wagner, which she accepted and which resulted in the substitute bill. Among the amendments: authorizing the Board of Medical Practice to create a fee schedule by regulation rather than fixing one in statute; requiring a yearly update in the fees; and allowing the cost of postage and shipping to be included in charges. The bill passed the General Assembly and awaits the Governor’s signature.

REDUCED LIABILITY EXPOSURE FOR CLINIC VOLUNTEERS – Charitable medical clinics in Delaware have reported shortages of volunteer physicians to provide care. Feedback from physicians indicates that an impediment to volunteering is the fear of liability suits that could result. HB 400 attempted to remove this barrier by designating these physician volunteers as state employees, whereby the state would defend and indemnify them against any malpractice suits filed for willful and wanton misconduct. The bill was opposed by the trial attorneys’ association, who offered testimony warning against drunk and malicious doctors who would prey upon poor patients. As a result, the bill was tabled by the House Judiciary Committee.

LICENSURE EXEMPTION FOR SECOND OPIONIO PROGRAM – HB 521 amends the Medical Practice Act to allow physicians licensed in states outside Delaware to render medical opinions in Delaware, as part of a second opinion program offered to State employees who subscribe to the State’s group health plan, without first obtaining a Delaware license. The state currently offers the “best Doctor” second opinion to its employees. The bill was introduced by the Board of Medical Practice in response to language inserted into the State budget bill that would have altered the definition of the practice of medicine. The Board’s bill improved on this language by ensuring that the rendering physician will be accountable at least to the medical board in his or her home state. The bill passed the General Assembly and awaits the Governor’s signature.

TAIL COVERAGE PROTECTION FOR VA PHYSICIANS – Senate Bill 269 would prohibit liability insurance carriers from revoking a physician’s tail coverage if he or she comes out of retirement to work at the VA Hospital. It responds to a critical need for physicians at the VA. The bill passed the General Assembly and awaits the Governor’s signature.

FALSE CLAIMS ACT REVISIONS – Senate Bill 97 was introduced by the Attorney General’s office and passed the Senate. This legislation purported to bring Delaware’s False Claims Act into compliance with the Federal Deficit Reduction Act. Since Medicaid and other insurance fraud claims are brought under the False Claims Act, there was concern, however, about certain provisions of the bill that 1) appear to expand the AG’s investigative powers, and 2) increase the statute of limitations period, beyond what is required by federal law. MSD was part of a coalition of interested parties, including the Delaware Healthcare Association (the state’s hospital association), long term care facilities, and the pharmaceutical industry, which worked with the Attorney General’s Office to amend the bill. Negotiations continued late into June, and an agreement was reached, but because there was such little time left in the session, the legislation remained in the House Economic Development, Banking and Insurance Committee.

LEGISLATION TO IMPROVE CARE AT DELAWARE PSYCHITRIC CENTER – A package of bills was introduced into the House of Representative in response to negative reports about patient care at the Delaware Psychiatric Center (DPC). A number of these bills passed the House and were referred to the Senate Health and Social Services Committee, but not brought up for a vote in the Senate. These include bills to require reviews of all deaths at the facility, to clarify the role of the Community Legal Aid Society, to require staff members to wear uniforms, to add protections to the Mental Health Bill of Rights, and to extend anti-retaliation rules to DPC. A bill to create a Mental Health Treatment Act dealing with community-based treatment also passed the House and was referred to the Senate Finance Committee. A bill to require that the DPC Director be a Psychiatrist or master’s-level nurse with experience in behavioral health or hospital administration was assigned to the House Appropriations Committee.

PHYSICIAN LICENSURE TASK FORCE – Senate Joint Resolution 12 created a task force to determine ways to shorten the time required for a physician to obtain a license in Delaware. The Medical Society will have representation on this task force. The legislation approving the creation of the task force passed the General Assembly on the last day of the session and awaits the Governor’s signature.

TAMPER-RESIDTANT PRESCRIPTION PADS – SB 321 requires all paper prescriptions to be written on a tamper resistant prescription pad. This is an effort to reduce or eliminate prescription fraud. A committee, to include MSD representatives, will be formed to determine the format and specific criteria to be used on the prescription pad and develop rules and regulations for the implementation of this section. The bill passed the General Assembly June 26 and awaits the Governor’s signature.

INTERNET PHARMACY REGULATION – HB 454 requires that a bona fide professional relationship exist between a practitioner and a patient for whom drugs are prescribed. The bill passed the General Assembly on the last day of the session and awaits the Governor’s signature.

HEALTH INFORMATION NETWORK TASK FORCE – HR 76 created a task force to review the Delaware Health Information Network (DHIN) past performance and current operations. The Medical Society of Delaware will have representation on this task force. The legislation approving the creation of the task force passed the General Assembly on the last day of the session.

TABLED BILLS OPPOSEDBY THE MEDICAL SOCIETY – A number of bills were introduced, but were tabled due to strong opposition from the Medical Society of Delaware, and at times, other organizations. These bills will not become law unless they are re-introduced in another session of the General Assembly. Among those bills are HB 106, legislation to license lay midwives and allow them to legally practice in Delaware; HB 386, a bill to allow pharmacists to therapeutically interchange drugs with a physician’s agreed-upon protocol; SB 177, a single payer universal health insurance coverage proposal; and SB 315, to require data reporting from Ambulatory Surgical Centers.

On Friday, July 11, 2008, Medicare Part B for Delaware will be transitioned to Highmark Medicare Services from TrailBlazer Health Enterprises, LLC. Please go to www.highmarkmedicareservices.com and www.trailblazerhealth.com for the latest information from both carriers. Until the transition date, all Delaware Part B providers must continue using TrailBlazer Health as their Medicare carrier.

This means that regardless of the date of service, all claims processing, customer service, and claim payments will be processed by Highmark Medicare Services beginning as of the operational date of July 11.

It is anticipated that Delaware Medicare providers who receive paper newsletters should receive at least a one-time notification of the transition by mail. It is strongly recommended that you keep current by monitoring Highmark’s and TrailBlazer’s respective websites on a weekly basis, as well as signing up for their respective online notifications through their listservs at: http://www.highmarkmedicareservices.com
/mailinglists.html and http://www.trailblazerhealth.com/ and click on LISTSERVS at top of page.

The Medical Society suggests to those practices who do not have office Internet capabilities to consider going online outside of the office either through home or through local libraries. Waiting for communications through the U.S. mail will potentially delay your Medicare claims submission and reimbursement. At press time, neither CMS or Highmark have announced additional communication contacts other than through the Internet. Please continue to monitor MSD communications for further updates which we will post as soon as we receive them.