It is legislative season again.  I am always nervous between January and May of each year, as you never know what the various state legislatures might put in place for Workers’ Compensation.  This year is no exception, as legislators and commissioners are out to “tweak” the system again in various states.

In my home state of Tennessee, SB 3886, has both a House and Senate bill for consideration.  This bill is making its way through the process, and is rumored to have support of the Lt. Governor.  To summarize the bill very quickly, it basically says that a workers’ compensation PPO in Tennessee must be able to produce a workers’ compensation contract between the provider and PPO on demand.  Also, the contract must be between the PPO and the provider, and that contract cannot be assigned to another entity including another PPO.  Thus, a PPO in Tennessee could not lease any other PPO; instead, they would have to be direct contracted in the state.  For example, if Coventry or Focus are not directly contracted in any given county or MSA, they could not lease another network to fill in that gap.

The word on the street is that this bill has legs.  As always, only time will tell.  But, I do know that providers in Tennessee are really tired of bill disputes when it involves lease networks.

In the state of Texas, new rules for “medical billing and processing” is underway which seems to indicate that providers are going to have to be informed of exactly who is accessing them under the voluntary and informal system.  This of course is outside of the HCN model that Texas has adopted.  Some PPOs already inform their providers of anyone accessing them via website or other electronic means.  Proposed 133.4 would require electronic notification to the providers of who is accessing them for discounts on a quarterly basis.  There is also an “800” number requirement for providers to call into.

For Texas, these proposed rule changes are 35 pages of legal speak, that will require a lot of interpretation.  Yet, it seems the intent is that providers need to know who is accessing them.  My understanding is that these proposed rules/regs will probably go into effect.  Stay tuned.

Both Texas and Tennessee seem to have the same intent, which is to eliminate silent PPOs in workers’ compensation and to provide the medical provider with assurance that there discount to a PPO is being given for the stated purpose.  By the time May gets here, who knows what will have passed in these two states or any other, but hold on its always a wild ride this time of year.

This entry was posted on Friday, March 7th, 2008 at 10:06 am and is filed under Healthcare, Workers' Compensation. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.