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Connecticut
State Medical Society 2010
Legislative Agenda
Health-Care
Reform
CSMS has played an integral role in
efforts at the state and federal level
to establish meaningful health-care
reform. We continue to assert that
successful health-care reform will be
achieved when everyone has access to
health care services and not just
insurance coverage. Every citizen
deserves access to the highest quality
of appropriate medical care. CSMS will
continue these efforts, seeking to
endorse and work for successful programs
that ensure the availability of medical
services for all Connecticut residents.
Critical components of a comprehensive
reform continue to be:
• Transparency in all transactions
related to patient care and
reimbursement.
• Access must be available statewide and
services and benefits fairly
distributed.
• Quality medical care must be
delivered. Prevention and disease
management must be cornerstones.
• Funding. Comprehensive quality patient
care must be fully funded and allow
funding to follow the patient, resulting
in enhanced portability.
Fairness in
Contracting and Transparency
CSMS continued to make significant
progress in 2009 on this issue,
successfully lobbying for legislation
that limits unilateral changes during
contract periods, expanding the
transparency and availability of fee
schedules and limited insurers’ ability
to inappropriately take back payments
made to physicians. CSMS will continue
its legislative efforts to strengthen
the position of physicians within the
marketplace, allowing them to better
serve their patients and community. The
following will be legislative priorities
for CSMS:
• Enact
state exemptions from federal laws
to allow physicians to negotiate as
a group to strengthen their
contracting abilities. Benefits
would include the ability to seek
opportunities to implement
electronic medical record systems,
cover increased liability insurance
costs and support recruitment of new
physicians.
• Establish stronger statutory
guidelines for acquisitions and
mergers of health insurance
companies
• Establish transparency of medical
costs funded by premium dollars
• Shorten timely payment periods for
clean electronic claims
• Establish a statutory definition
of network adequacy and strengthen
provider directory adequacy
requirements
• Allow for the assignment of
benefits by a patient to the
physician for allowable
out-of-network benefits
• Clarify balance billing laws
• Ensure rating systems and
pay-for-performance measures are
based on sound medical standards
rather than economic factors.
• Oppose the use of tiered and
limited networks.
• Allow physicians to limit panel
size based on insurance payor or
insurance product
• Prohibit insurers from denying
payment for pre-authorized services.
• Prohibit arbitrary bundling and
downcoding
Professional Liability Insurance
Connecticut physicians continue to
struggle with the cost and availability
of professional liability insurance.
Success can be seen in the fact that
almost all policy-makers understand that
successful health-care reform must at a
minimum acknowledge the significant
impact this issue has on the overall
cost and availability of health care.
CSMS has consistently supported
common-sense reforms to our tort system
and to the manner in which such claims
are adjudicated; and it will continue to
do so. Changes to the system that could
prove beneficial are:
• The
establishment of special health
courts.
• Pre-trial screening panels.
• Expansion of pre-trial mediation
requirements
• Immunity for physicians providing
volunteer or pro bono services.
• Expanded protections for
physicians providing mandated care
such as services required under
EMTALA
• Review and strengthening of
peer-review laws.
The current
system is expensive and often negatively
impacts our health care system,
increasing costs through defensive
medicine. CSMS will seek to implement
and support any measure aimed at
mitigating the pressure felt by
physicians through the lack of
availability and affordability of
professional liability insurance. It is
the position of CSMS that due to the
impact the current situation has on
access to care in Connecticut, efforts
to fix this problem must be part of the
overall discussion of health-care
reform.
Scope of
Practice/Proper Use of Medical
Professionals
Connecticut residents deserve the
highest quality of health care delivered
by trained and skilled professionals. We
must work to ensure that non-physician
health-care providers are able to
practice to the fullest of their
ability. However, in the interest of
safety and quality within health care we
must recognize that education and
experience cannot be replaced by
expansion of scope of practice through
legislation.
Physician
Workforce Issues
Connecticut continues to struggle to
recruit and retain skilled physicians.
CSMS will continue to fight for
initiatives to make Connecticut more
attractive to physicians. These include
such items as:
• Reduce
regulations that impede physician
services such as those required by
the Certificate of Need process
• Clearly define “surgery” in state
statute
• Establish student-loan forgiveness
and insurance-premium assistance
programs for new physicians.
• Continue to address ER
overcrowding and boarding issues
Medical Licensure for Uncompensated Care
Legislation should be enacted which
validates other state licenses for
medical providers seeking to provide
uncompensated care in Connecticut on a
limited basis
Criminal Background Check as a Condition
of Medical Licensure
All applicants for medical licensure
should be required to submit to a
criminal background check. The Medical
Examining Board should be granted the
ability to use the results as a criteria
when granting or denying a license.
CSMS is fully prepared to address these
issues during the 2010 session of the
Connecticut General Assembly. In
addition, we will be vigilant in
defending the practice of medicine from
any incursions. For more information or
to provide any comments, please do not
hesitate to contact CSMS Vice President
of Public Policy and Government Affairs
Ken Ferrucci.
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