June 6, 2020
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Legislative Update
On Monday, June 1, 2020, the Regular Legislative Session adjourned sine die and the first Special Session convened - one minute apart. Everyone recognizes that as a state we've been navigating unchartered waters as we have attempted to balance progress with COVID-19 restrictions. For the Legislature, those restrictions equated to a 49-day recess halting business. During those 49-days we lost Rep. Reggie Bagala, the Freshman legislator from Lafourche Parish, to COVID-19 on April 9. We also saw the state's originally proposed budget eviscerated with no real prediction of what a new post-pandemic budget might look like. Even today, as the legislature works towards a new and uncertain budget that must be in place prior to the state's fiscal year end of June 30, questions remain. It's no coincidence that the stated adjournment date and our fiscal year end are the same. In an unusual turn of events, the Legislature called themselves into this Special Session rather than the Governor, as is traditional ( click here to read the announcement). Lawmakers from all sides seem certain that there will be a need for budget changes, as well as, clean up legislation from varying actions that have been or will be required due to COVID-19 in a Fall Special Session.
During the Regular Session, the medical community was engaged with significant legislation: Medical Marijuana
HB 819 by Rep. Larry Bagley broadens medical marijuana options in Louisiana. As the bill passed, any physician licensed by the LSBME may recommend medical marijuana for a patient suffering from any condition for which the physician believes their patient may experience relief. As physicians, you may wish to have your thoughts and policies already in place for when a patient asks you for access to the product.
Scope of Practice
HB 864 by Rep. Barry Ivey would have granted Advanced Practice Registered Nurses independent practice upon proof of three requirements: 1)An unencumbered, unrestricted, and valid registered nurse and advanced practice registered nurse licenses in this state, 2) Experience of no less than two hundred fifty hours in collaborative practice, and 3) Successful completion of academic coursework in physical assessment, advanced pharmacology, and advanced pathophysiology.
HB 864 further would have established "global signature authority" for Advanced Practice Registered Nurses. APRNs used the pandemic to promote this legislation telling lawmakers that due to the emergency order in place they are currently working without the need for a Collaborative Practice Agreement (CPA) and things are just fine without Louisiana's "unnecessary and antiquated rules and regulations."
As a membership, LSMS delivered more than 800 emails to the members of the House Health and Welfare Committee. We thank you all for your support and participation, and we urge you to make sure your information is updated in the VoterVoice system so that you can quickly respond when called upon to take action.
HB 702 by Rep. Larry Bagley was another bill we defeated in 2019. The legislation was introduced at the request of the Physician Assistant community and would have changed their practice model from "supervisory" to "collaborative." After many conversations, the bill's author refused to move it unless the physician community was on board. As we were not on board, he stripped all the scope language out of HB 702 and only left the language granting Physician Assistants the authority to give orders to RNs.
Surprise Billing
HB 283 by Rep. Raymond Crews was the only Surprise Billing legislation that was heard in the Regular Session. While Rep. Crews proposed that the legislation addressed surprise billing in a "fair" manner, it actually trampled your right to contract. HB 283 would have disincentivized insurers to negotiate fairly with you. Rather, it incentivized them to terminate your contract and force you into utilizing the facility's contract with the insurer.
HB 283 was neither fair nor equitable. It was government-coerced contracting which would have eliminated your ability to negotiate a contract on your behalf and forced you to accept obligations from a contract to which you are not a party. The legislation was clearly pro-insurance and anti-Louisiana physician! LSMS members reacted in a very compressed timeframe to flood the floor with messages in under 18 hours. Thank you!
Collateral Source
SB 418 by Sen. Kirk Talbot: The bill includes a number of tort reform pieces, but the collateral source section is the one LSMS was charged by our members to watch closely. Our direction was to ensure that there was nothing akin to rate setting and then disengage, in order to remain effective on other issues. The bill did pass and currently awaits action by the Governor.
Today, essentially everyone has learned to work utilizing Zoom and can accomplish a lot through digital and virtual methods. In order to get public input, it is duty bound by the legislature to offer ways for the public to participate. Yes, we've all thought outside the box to offer new creative methods that provide some access, but it is absolutely not the same as having face-to-face visits with your legislators. They've had to adapt to offer email and other options to any interested party who wants to provide information on legislation. Reach out to your legislators and introduce yourself if you have not and offer to become a resource for them while giving them an easy way to reach you. Share that you are a member of LSMS.
LSMS continues to tirelessly champion our members and the medical profession. We will be there as your voice, and we thank you for putting your trust in your membership.
2020 Special Session
The first week of the Special Session is coming to an end with just over 60 legislative instruments having been filed. Sen. Kirk Talbot has filed SB 7 focusing on Surprise/Balance Billing. This legislation is backed by the provider community. It has 4 key takeaways:
1. Taking patients out of the middle of insurance payment disputes
2. Allowing negotiations between providers and health plans
3. Providing an Independent Dispute Resolution process
4. Avoiding rate setting
LSMS is working as part of the group seeking to pass this legislation. We believe the bill could be heard in Senate Insurance next week. Please look for upcoming information and calls to action on SB 7. |
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PCF Update
On Thursday, June 4, 2020, the Louisiana Patient's Compensation Fund (PCF) Oversight Board held a regularly scheduled meeting where the firm of Willis Towers & Watson presented their actuarial study and recommendations for 2020 rate changes. Based on current and future estimates related to claims, financial, and investment data, the actuary's report called for physicians, hospitals, dentists and other PCF participants to receive an aggregate rate increase of 16% for 2020. Physicians rate increases, per class, ranged from between 9.9% to 15.5%. However, PCF Board members, acutely aware of the current financial burden placed on physicians, and others, as a result of the COVID-19 pandemic, unanimously voted to forego the recommended rate increases and instead voted to hold rates at current 2019 levels for the 2020 policy year. There will be NO rate increases for 2020! The PCF is financially sound and has invested their reserves (your surcharges) prudently for a rainy day and as such elected to utilize $23M in reserves to cover their estimated revenue shortfall for 2020. This selfless decision will help physicians across the state who are suffering as they try to reestablish their practice and/or patient base to pre COVID-19 levels.
The LSMS would like to publicly thank the four physician members who serve on the PCF Oversight Board - Chris Foret, MD, Chairman (LSMS member since 1998); Luis Alvarado, MD (LSMS member since 1996); Patrick Breaux, MD (LSMS members since 1976) and Corey Hebert, MD.
In May, the LSMS surveyed members regarding their practice or employment experience during the COVID-19 pandemic. Below is a compilation of the results submitted.
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Paycheck Protection Program Flexibility Act Enacted by Congress
Wednesday evening (June 3, 2020), the U.S. Senate approved changes to the Paycheck Protection Program through the Paycheck Protection Program Flexibility Act, which was approved by the House of Representatives last week. The Act is expected to be signed by the President immediately.
The Paycheck Protection Program Flexibility Act provides the following:
- Extends borrowers' "covered period", the time period it has to spend the PPP loan proceeds, from the original 8 weeks (56 days) from loan origination to the earlier of 24 weeks (168 days) from loan origination on December 31, 2020. For PPP loans dated prior to the effective date of the Flexibility Act, borrower may elect to keep the 8-week covered period.
- Eases the requirements of how borrowers spend PPP proceeds by providing that at least 60% of the PPP loan amount must be used for payroll costs in order to receive forgiveness, and up to 40% of the PPP loan amount may be used for non-payroll costs. This expressly modifies the SBA's guidance that at least 75% of the loan proceeds actually spent must be for payroll costs. This lowers the payroll costs percentage and frees up more PPP loan proceeds for non-payroll expenses (i.e., rent, utilities, mortgage interest), but it requires borrowers to actually spend at least 60% of the total loan amount on payroll costs, and the consequence for not doing so may result in forfeiture of forgiveness all together.
- Extends the time period for employers to rehire anyone laid off or furloughed after February 15, 2020, from June 30, 2020 to December 31, 2020, in order to avoid reduction in their loan forgiveness.
- Codifies SBA guidance with respect to the full-time-equivalency (FTE) calculation in the forgiveness process by providing employers do not need to take into account in their FTE calculation during the covered period, employees that they were unable to rehire or replace, if they are able to document those instances.
- Extends the maturity date for any unforgiven portion of a PPP loan from 2 years to a minimum of 5 years, but makes this provision only mandatory to loans applied for after the effective date of the Act. Existing PPP loans with a 2-year maturity date remain unchanged unless the lender and borrower mutually agree otherwise.
- Codifies the SBA's determination that PPP loans accrue interest at a 1% annual rate.
- Extends the period for borrowers to seek forgiveness up to 10-months from the end of the borrower's covered period.
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Digital transformation in the time of COVID-19
The COVID-19 pandemic has fundamentally changed the face of care provision across the world. Telehealth adoption in the US, for instance, has grown around 3,000% since the start of the crisis, taking much of primary care to people's homes rather than being necessarily tied to a doctor's office or hospital; A&E attendance in the UK is at its lowest in reported history as patients steer clear of hospitals for fear of contracting the virus; and hospital trusts have been responding with alternative care solutions such as digital triaging services to ensure that patients are still receiving the treatment they need.
In exclusive interviews with Healthcare IT News, representatives of Cambridge University Hospitals (CUH), University Hospital Southampton (UHS) and tech consultants BJSS discussed how the health crisis has pushed forward digital transformation in UK.
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