As of Aug. 28, 2013, several bills the MSMA advocated for and helped to pass made their way into the Missouri statute books.
The underlying bill of what eventually became this year’s omnibus insurance package simply dealt with insurance reimbursement of telehealth services. Beginning in 2014, insurers are required to reimburse for services delivered via telehealth, and they may not exclude a service solely because it is delivered by telehealth rather than face-to-face. Reimbursement for diagnosis, consultation, and treatment must be the same for telehealth and in-person visits. Furthermore, telehealth services may not be subject to greater co-pays, deductibles, or coinsurance than face-to-face services.
This bill removes the previous physician assistant supervision requirement which mandated physicians record that the physician and physician assistant work together at least 66% of the time. It is replaced with a requirement that they physically practice together at least four hours every fourteen days. It restricts physician assistants from practicing where the physician does not routinely provide care. The physician assistant may not provide care outside fifty miles of the supervising physician, and the physician assistant may not provide care outside their scope or the specialty of the supervising physician.
This provision requires health insurers to credential new provider applicants within 60 business days of receiving a completed credentialing application. Insurers are also required to send providers a notice of receipt of the application within two working days.
Pulse Oximetry Screening
This bill adds pulse oximetry screening to the list of required newborn screenings. It applies to all births, including homebirths. There is a reporting requirement to the Department of Health, and refusals must also be reported to the Department. A section that mandated physicians hand out educational materials to patients was removed from the bill.
In order to offer a cheap option in the soon-to-come insurance exchange, insurance companies lobbied very hard for an exclusive network plan which they believe will help lower costs and meet the price threshold required by the Federal Affordable Care Act. The plans would require all services to be provided in-network, with exceptions for emergency care, mental health, and degenerative disease care. These plans and their restrictions must be disclosed upon enrollment, and the carrier must also offer another plan with an out-of-network option.
Any Willing Provider
For a number of years, MSMA has advocated for open provider networks, where any provider in a network’s geographic region could join as long as he or she abided by the contracted terms. This year we were able to get a modified version past the finish line. The provision applies only to closed or exclusive plans where all services are provided in-network. The physician must also agree to accept 85% of the standard fee schedule, and is subject to the insurer’s normal credentialing requirements.
This act allows a physician to charge for medical records that are furnished electronically, and updates the rate allowed for paper copies. The rate for paper copies is established by the Department of Health each year on February 1st (currently, it is $22.82, plus 53 cents per page). If the records are provided electronically, a physician can elect to charge the paper rate, or $100, whichever is less. The physician can provide the electronic records in whatever format he or she chooses. The physician must already store records electronically and be able to provide them electronically. The bill does not change the ability of physicians to charge for off-site retrieval of records.
Contact MSMA's Jeff Howell, Director of Governmental Relations or call 800-869-6762.