A rule that would expand a program for patient care coordination failed to clear a legislative subcommittee Wednesday after some legislators complained that the program wouldn't allow advanced-practice nurses to participate on the same footing as doctors.
The rule, proposed by Insurance Commissioner Jay Bradford, would require companies that offer plans on the state's health insurance exchange to participate in the patient-centered medical home program.
Under that program, the state's Medicaid program makes upfront payments to doctors who agree to take steps such as making sure patients get preventive health screenings and providing around-the-clock access to a medical professional.
The Medicaid program pays the doctors an average of $4 per month for each Medicaid recipient under the doctor's care.
The state Insurance Department rule would require insurance companies offering plans on the exchange to contribute payments averaging $5 per month for each of their customers who are assigned to one of the practices participating in the program.
State Department of Human Services spokesman Amy Webb has said the Medicaid program's average payments are lower than the average proposed for companies offering exchange plans because most of the Medicaid recipients are children, who typically have lower health care costs than adults.
Currently, 123 physician practices are enrolled in the patient-centered medical home program, Kate Luck, a spokesman for the Human Services Department, said in an email.
In addition to the Medicaid program, Medicare -- the federal insurance program for the elderly and disabled -- contributes payments to some of the practices.
Arkansas Blue Cross and Blue Shield, QualChoice Health Insurance and Humana also make payments to some of the practices on behalf of customers enrolled in employer plans.
The proposed rule would require Blue Cross and Blue Shield, QualChoice and other companies offering plans on the exchange to make payments on behalf of any of their customers who are assigned to a participating practice that is in the insurer's network of providers.
The exchange plans cover more than 227,000 Arkansans, including more than 187,000 whose premiums are paid by Medicaid under the so-called private option.
Booth Rand, the Insurance Department's managing attorney, said the proposed rule would implement a provision in the 2013 law that created the private option.
The law, Act 1498, requires insurance companies offering plans on the exchange to participate in the state's Payment Improvement Initiative, including "support for patient-centered medical home."
The Medicaid patient-centered medical home program requires the payments to go to a practice led by a physician. An earlier version of the proposed Insurance Department rule regarding the exchange, however, required the companies to make the payments to participating "primary care provider practices," without specifying that the practice must be led by a physician.
In response to complaints by the Arkansas Medical Society and other physician groups, the rule was revised to say the payments must go to participating "primary care physician practices."
Craig Wilson, director of access to quality care at the Arkansas Center for Health Improvement, said the wording change simply clarified the program's requirements.
Addressing members of the Legislative Council's Administrative Rules and Regulations Subcommittee, he added that the rule doesn't prohibit insurance companies from designing their own programs that offer similar payments to practices led by other types of providers, such as advanced-practice nurses.
"All this really does is set a floor" for participation by insurance companies, Wilson said.
Rep. Andrea Lea, R-Russellville, said she preferred "provider neutral" language that would allow advanced-practice nurses to receive the payments.
The state has a shortage of primary-care physicians, she said, and "you've got licensed professionals ready to step up."
Rep. Kim Hammer, R-Benton, also questioned the reason for excluding advanced-practice nurses. He indicated he would oppose allowing the rule to clear the subcommittee.
Wilson said the rule wouldn't prohibit advanced-practice nurses from working as part of a physician-led team that would be eligible for payments.
"The trend, at least in our state and many other states, is that irrespective of the type of provider, we're all moving toward a more team-based care mentality," Wilson said.
The subcommittee's chairman, Rep. Kelley Linck, R-Yellville, said it didn't appear that enough members of the subcommittee were present to vote on the rule. He said the subcommittee would take the issue up again at a meeting Dec. 22.
Also on Wednesday, the subcommittee reviewed an Insurance Department rule meant to ensure that insurance companies maintain adequate networks of providers.
For instance, the rule requires that each customer have access to a primary-care doctor within 30 miles of the customer's home and to a specialist within 60 miles of the customer's home.
Companies that are accredited by certain entities that audit network adequacy are exempt from the requirements.
Zane Chrisman, an attorney specialist with the Insurance Department, said the rule expands to all of the health plans regulated by the department requirements that are already in place for plans on the state's exchange.
Most of the state's insurance companies already meet the requirements, she said.
The rules and regulations subcommittee also reviewed state Board of Health regulations that would require hospitals to more quickly send newborns' blood samples to a state laboratory for testing.
The regulations also would add severe combined immunodeficiency disorders, known as SCIDs, to the list of disorders for which blood samples are screened. Currently the samples are tested for 28 disorders.
Regulations reviewed by the subcommittee go to the full Legislative Council for final review. The council's next meeting is Dec. 19.
Metro on 12/05/2014