Governors in five states have issued executive orders and/or signed into law measures affecting out-of-network billing, protections for physician liability and scope of practice.
In Virginia, Gov. Ralph Northam issued a new executive order allowing doctors’ offices and group homes to use out-of-state licensees to provide care and to permit nurse practitioners with two or more years of experience to practice without an agreement with a supervising physician.
New Hampshire’s Gov. Chris Sununu issued Emergency Order No. 30, which also changes the state’s current out-of-network law by allowing carriers to reimburse health care providers for out-of-network emergency services at the in-network rate. The measure is effective April 9, 2020, and remains in effect until rescinded or until the state of emergency is terminated.
In Wisconsin, Gov. Tony Evers signed AB 1038 into law, temporarily revising reimbursement rates related to diagnosis or treatment for COVID-19. The law prohibits carriers from requiring enrollees to pay cost sharing for a service, treatment or supply provided by an in-network provider. The measure mandates that out-of-network providers are reimbursed at 225% of the Medicare reimbursement rate for a similar service, treatment or supply in the same geographic area. The reimbursement rate provision applies during the state of emergency that began on March 12, 2020, to 60 days following the date that the state of emergency terminates.
Liability Protections for Physicians
Connecticut’s Gov. Ned Lamont signed Executive Order No. 7U into law that provides immunity from civil liability to health care professionals and certain facilities supporting the state’s COVID-19 response efforts.
In Massachusetts, Gov. Charlie Baker signed SB 2640 into law. The measure mandates immunity for health care professionals and health care facilities from suit and civil liability for any damages alleged to have occurred in the course of providing health care services during the period of the COVID-19 emergency provided, that:
- The health care facility or health care professional is arranging for or providing health care services pursuant to a COVID-19 emergency rule and in accordance with otherwise applicable law,
- Arranging for or providing care or treatment of the individual was impacted by the health care facility’s or health care professional’s decisions or activities in response to treatment conditions resulting from the COVID-19 outbreak or COVID-19 emergency rules, and
- The health care facility or health care professional is arranging for or providing health care services in good faith.
The measure shall apply to claims based on acts or omissions that occur or have occurred during the effective period of the COVID-19 emergency, declared on March 10, 2020, and until terminated or rescinded.
Minnesota’s Gov. Tim Walz signed into law an amendment to Minnesota Statutes Section 176.011, the state’s occupational disease statute. An employee who contracts COVID-19 is presumed to have an occupational disease arising out of and in the course of employment if:
- The employee was employed as a health care provider in a health care setting with direct COVID-19 patient care or ancillary work in COVID-19 patient units, or
- The employee's contraction of COVID-19 is confirmed by a positive laboratory test or, if a laboratory test was not available for the employee, as diagnosed and documented by the employee's licensed health care provider.
The measure applies to employees as of April 8, 2020, and sunsets on May 1, 2021.
In New York, Gov. Andrew Cuomo signed Executive Order No. 202 that provides immunity for health care providers who deliver medical services supporting the state’s response to the COVID-19 pandemic. The measure was recently extended to sunset on May 7, 2020.
Scope of Practice
Virginia’s Gov. Ralph Northam signed Executive Order No. 57 that will allow nurse practitioners (NPs), who have two or more years of clinical experience, to practice without physician supervision. This measure amends the current law that allowed NPs with five years of practice with a collaborating physician to practice independently. The measure is effective April 17, 2020, through June 10, 2020. The Medical Society of Virginia and specialty medical societies were not offered an opportunity to comment prior to the issuance of the order, and the stakeholders have expressed their concerns on the measure.
In New York, Gov. Andrew Cuomo signed Executive Order No. 202 that temporarily allows physician assistants, specialist assistants and nurse practitioners to provide medical services without physician supervision during the COVID-19 pandemic. The measure sunsets on May 7, 2020. The ACR is strongly concerned about the temporary scope expansion.