You are currently browsing the monthly archive for April 2010.

As coverage expands under the implementation of the federal health care reform, the role of telemedicine—allowing health care providers to connect to patients and other providers across the country at any time of day via the Internet—is increasingly essential to ensure that access to care is adequate, particularly in rural and underserved areas.  Patient consultations that utilize telemedicine avoid many of the delays experienced in traditional health care delivery and can help to prevent unneeded emergency rooms visits. 

On April 5, Virginia Governor Bob McConnell (R) signed SB 675, which unanimously passed both chambers of the state General Assembly.  The measure requires all health insurers to cover health care services provided via telemedicine (defined as the “use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment”) – excluding audio-only telephone, e-mail or fax transmission.  Virginia is the 12th state to adopt such a mandate. 

Some insurers utilize telemedicine services without a state mandate.  The Blue Cross Blue Shield plan of Hawaii, for instance, recently announced that it will become the first health plan to deploy Online Care Team Edition, an online care system to allow live, on-demand specialist care consultations in primary care provider exam rooms.  The new product moves beyond previous telehealth services—that connect patients at home to doctors via the Internet—by putting primary care physicians at the center of coordinating care.  Through this online medical home, a PCP needing to refer a patient can go online from a regular office computer, find an in-network specialist, and launch a live consultation with the physician.  American Well, the creator of the online system, says this will not only reduce the delay, inconvenience and cost associated with the traditional referral process, but also enhance physician collaboration.

Because physicians often are not reimbursed for time spent on the telephone with insurance companies or responding to patients’ emails, payment for telemedicine services can help to financially stabilize providers, particularly those in small private practices.  For a listing of telemedicine reimbursement mandates by state and additional telemedicine resources, refer to my Telemedicine Reimbursement PDF.


June 1, 2010 — UPDATE: According to a San Jose Mercury News article, in order to plan for and begin implementing the federal health reform legislation, the California Legislature is considering more than 20 bills, of which as many as a dozen may be voted on this week as lawmakers face a deadline to pass bills out of their house of origin.   

The article says, “Lawmakers and the governor’s staff have met with Jon Kingsdale, the executive director of Massachusetts Connector, that state’s health insurance exchange, who will consult with California as it develops its own version.”   

Included in the bills currently being debated are:   

  • SB 890 – Prohibits annual or lifetime benefit limits, establishes a medical loss ratio of 85 percent, and allows for changes in individual health plans or insurers on annual renewal dates.
  • SB 900 – Establishes a state health insurance exchange.
  • SB 1088 – Allows enrollment in parents’ insurance coverage up to age 26.
  • SB 1163 – Requires health insurers to give 180 days written notice of changes in the premium rate or coverage and extends requirements placed on health insurers to deny coverage.
  • AB 1595 – Expands eligibility for Medi-Cal, the state’s Medicaid program.
  • AB 1600 – Establishes mental health parity.
  • AB 1602 – Establishes a state health insurance exchange, eliminates annual and lifetime limits on health care coverage, and allows enrollment in parents’ insurance coverage up to age 26.
  • AB 1825 – Requires coverage of maternity services.
  • AB 1887 – Establishes framework for the operation of California’s temporary high risk pool.
  • AB 2244 – Prohibits denial of coverage based on preexisting conditions.
  • AB 2470 – Imposes specific requirements and standards on health insurers related to the application forms, medical underwriting, and notice and disclosure of rights and responsibilities.
  • AB 2477 – Establishes continuous eligibility for children under Medi-Cal.
  • AB 2578 – Prohibits health insurers from increasing rates without prior approval from the Department of Managed Health Care or the California Department of Insurance.

California is not alone in its efforts to replicate and build upon federal health reform. In Michigan, legislators are considering similar legislation:   

  • HB 6034 – Prohibits denial of coverage based on preexisting conditions, allows enrollment in parents’ insurance coverage up to age 26, and requires that rates are adequate, equitable and not excessive.
  • HB 6035 – Requires continuation of coverage and approval of rate increases.
  • HB 6036 – Allows enrollment in parents’ insurance coverage up to age 26 and limits when a health benefit plan can be changed or cancelled.
  • HB 6037 – Establishes the MI-Health Board to develop a standard guaranteed issue health plan, which will serve as a minimum level of coverage for all health plans in the state.


May 26, 2010 — UPDATE: Governors are continuing to establish the infrastructure needed by their states to implement the new laws and prepare for the new opportunities included in the federal health reform bill.  Most recently, Washington state Governor Christine Gregoire (D) signed an executive order creating a Health Care Cabinet and California Governor Arnold Schwarzenegger (R) established a state Health Care Reform Task Force.   

In Michigan, Governor Jennifer Granholm (D) created a Health Insurance Reform Coordinating Council, New Mexico Governor Bill Richardson (D) set up a Health Care Reform Leadership Team, and launched by Pennsylvania Governor Ed Rendell (D) is a Commonwealth Health Care Reform Implementation Committee and Advisory Committee.   

May 19, 2010 — UPDATE: Despite involvement in a lawsuit against the federal government concerning the constitutionality of the new health reform law, Virginia Secretary of Health and Human Resources Bill Hazel, MD announced the establishment of the state’s Health Care Reform Initiative. Funded from existing resources, this statewide initiative is located within the Office of the Secretary of Health and Human Resources and will serve as the liaison between the Governor’s office, agencies and entities affected by health care reform, lead development of the required Health Insurance Exchange and identify and coordinate grants to fund health care reform. The new program is charged with making recommendations addressing Medicaid reform, insurance reform and health care delivery reform, due to the Governor by September 30, 2010 and annually by January 10 until 2014.   

May 17, 2010 — UPDATE: New York also laid the groundwork to begin implementation. Governor David Paterson (D) recently created the Governor’s Health Care Reform Cabinet, which will advise and make recommendations to the Governor on all aspects of federal health care reform. The Director of State Operations will serve as the chair, with the Deputy Secretary for Health, Medicaid and Oversight and the Deputy Secretary for Labor and Financial Regulation serving as vice-chairs. Included in its responsibilities are identifying deadlines established under federal law; determining with which provisions the state must comply and those that are optional; and assessing the state’s capacity to carry out those provisions.   

April 28, 2010 — UPDATE: Maine joined at least four other states in establishing the infrastructure needed to implement the new federal health reform laws.  Governor John E. Baldacci (D) recently issued an executive order creating the Health Reform Implementation Steering Committee.  Utilizing existing state resources including the Governor’s Office of Health Policy and Finance, State health officials, and the Advisory Council on Health Systems Development, the steering committee will begin the planning to meet requirements under the federal law. The new committee will also work with the Joint Select Committee on Implementation created by the Maine Legislature this session.   

Additional information can be found at AAFP News Now.   


On Tuesday, April 20, Colorado Governor Bill Ritter signed an executive order, creating a new inter-agency task force and naming Lorez Meinhold, the Governor’s healthcare policy expert, as director.  Governor Ritter says, “National reform allows us to accelerate and build on our work to provide higher quality care at lower costs to more Coloradans. Today marks a new chapter for healthcare in Colorado.”   

With similar “ahead-of-the-curve” intentions, Wisconsin Governor Jim Doyle established the state’s Office of Health Care Reform to develop an implementation plan that uses national health care reform to build on Wisconsin’s successful reform efforts and ensure the state’s residents and businesses realize the benefits of reform as soon as possible.  The Governor’s press releases says, “Wisconsin has already developed initial plans for an exchange under Governor Doyle’s leadership, making the state uniquely positioned to be a leader in implementation.”   

Connecticut Governor M. Jodi Rell also announced that she has established a Health Care Reform Cabinet, comprising officials from several state agencies, to ensure that state-administered health programs and other key elements meet the goals and requirements of the recently passed national health care reform law.   

Maryland makes head of the class.  The day after President Obama signed the federal health care reform legislation into law, Governor Martin O’Malley unveiled an executive order creating the Maryland Health Care Reform Coordinating Council to advise the administration on policies and procedures to implement the new federal law as efficiently and effectively as possible.   

However, not all states’ approaches to addressing health reform are alike.  Governor Sean Parnell announced Alaska will join 20 other states in legally challenging the constitutionality of the federal legislation.  According to the National Conference of State Legislatures, 39 states—including the four mentioned above—have filed legislation opposing certain provisions of federal health reform.

A Pennsylvania court ruled 4-1 that the General Assembly cannot use $808 million from the medical liability fund—funded by PA doctors and hospitals—to balance the state’s budget.  The majority opinion says the money collected for the fund is not tax dollars and therefore belongs “to the provider and not generally to the Commonwealth.”

The Wisconsin Supreme Court is considering a similar case, after Governor Doyle transferred $200 million from the Patients Compensation Fund to the Medical Assistance Fund in 2007.  The Wisconsin Medical Society wants the state to return the money to the fund to be used for the original purpose, medical malpractice, rather than as a “revenue raising tool for the state.”  For the past two fiscal years, the fund’s balance has been negative.

In January, the New Hampshire Supreme Court also handed a victory to physicians fighting against the state government’s attempts to solve budget shortfalls by tapping into a state-created medical liability insurance fund.  The court found unconstitutional a state law authorizing the transfer of $110 million from the Medical Malpractice Joint Underwriting Association to the state’s general fund. The money was to be used to expand state health care programs for underserved populations. In his FY 2010-11 budget, Governor John Lynch (D) approved this transfer of what lawmakers considered to be a surplus in the fund.


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