Medicare discrimination.

2018
STATE OF WYOMING
18LSO-0482
ENGROSSED
2.1

SENATE FILE

NO.
SF0095

Medicare discrimination.

Sponsored by:
Senator(s) Scott and Nethercott and Representative(s) Barlow and Obermueller

A BILL

for

AN ACT relating to the provision of health care; requiring a study of discrimination by the federal Medicare program against Wyoming residents and Wyoming health care providers; requiring a study of Medicare reimbursement rates and related health and health care impacts; requiring a study of the economic impacts of Medicare reimbursement rates; assigning duties to the governor, the state health officer, the department of health, the board of medicine, the Wyoming business council and the Wyoming attorney general; enabling the governor to create a steering committee to coordinate study activities; providing a sunset date; providing an appropriation; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section
1
.

(a)

The following
persons
shall provide reports and analyses for inclusion in th
e f
inal report required by this section
:

(
i
)

With assistance
from department of health staff, the
department of health

shall, based on its
professional knowledge and
other reliable research
, prepare a report
analyzing the following
issues:

(A)

The
effect on
Wyoming
patients
in terms of mortality, mo
rbidity
and general well
‑
being of receiving medical care in the
ir
home community
,
as opposed to
receiving care in
a distant location;

(B)

Identification of the most common, serious
medical conditions
treated in Wyoming’s
larger
communities and identification of those
medical conditions which pose
significant mortality or morbidity risks if treatment becomes unavailable in
a
Wyoming
community and
a patient

is
required to
travel elsewhere to obtain
the
treatment. Consideration shall be given
to
the risks of both travel time under normal travel conditions and
travel
when weather or other factors delay or temporarily prevent safe travel;

(C)

Identification of those
medical treatments
identified
in sub
paragraph (B
) of this
paragraph
which are at risk of being
discontinued
due to Medicare discrimination or
low
reimbursement
s
. The
department of health
may request assistance from the
Wyoming
business council in analyzing the economic issues involved in this determination.

(ii)

Based on its experience and knowledge recruiting physicians and other health care p
roviders
to

Wyoming
,
the
department of health
shall
provide a
statement
, accompanied by available data and analysis, explaining any difficulties
in recruiting physicians and other health

care providers
created by low reimbursements in general, and low Medicare reimbursements in particular
;

(iii)

The Wyoming
b
usiness
c
ouncil shall analyze the following issues:

(A)

Identify the
cost shift
in the noncritical hospital access context

to commercial insurers, self
‑
insured businesses and private payors caused by
Medicare and other payors
who reimburse or pay
less
than
the

costs
incurred by a health

care provider or hospital in providing a service
;

(B)

Identify
how actual costs and charges paid in Wyoming by Medicare and by commercial insurers compare to similar payments made in surrounding states, either for all procedures or for those where a patient is most likely to receive the procedure
out
‑
of
‑
state;

(C)

Identify or estimate total health

care spending for all Wyoming residents and identify how much of that spending occurs
outside of Wyoming.
Identify whether the percentage of out
‑
of
‑
state spending is likely to change and, if so, the
likely
reasons for the change;

(D)

Identify what types of medical care, if any, may become no longer economically viable in Wyoming
as a result of
out
‑
of
‑
state competition. With assistance from
the
department of health
, identify the health risks to Wyoming residents which may result from any reduction in the identified types of medical care.

(iv)

The board of medicine shall provide a report, and provide copies to the
department of health
and
the
Wyoming business council, listing the areas of medical practice that it believes may be at risk of ending
or becoming significantly limited
in Wyoming, or that may
end or
be
come

significantly
limited
in a major portion of Wyoming
,
as a result of
out
‑
of
‑
state competition
. The board shall base its report
on its experience with professional licensure requests and the pe
rsonal judgment of its members;

(v)

The attorney general shall consider and report
to the governor
on the following
:

(A)

Whet
her legal action over Medicare's
low and discriminatory reimbursement practices in Wyoming could provide relief from
the problems created by the low and discriminatory reimbursement practices.
The attorney
general shall
provide
information about
the identity of the proper plaintiff in any legal action;

(B)

Whether legal precedents supporting public utility rate regulation and other regulatory mechanisms have
or could have
any application
to
Medicare
reimbursement rates and could serve as a basis for regulating
Medicare
reimbursement in Wyoming
or requiring fair
Medicare
reimbursement rates
;

(C)

The report required by this paragraph does not require a definitive answer on the subjects reported, but does seek a recommendation as to whether the state should spend the resources necessa
ry to more fully determine if
legal action should be
pursued
.

(b)

The governor shall compile the reports and analyses required by subsection (a) of this section
, together with any recommendations that he may have,
into a single report that shall be provided to the joint labor, health and social services interim committee,
the
joint appropriations committee and to the legislative service office on or before November 1, 2018.
The governor shall
determine if the report will be a final report, or if the report shall be a preliminary report with a final report to be submitte
d on or before November 1, 2019.
In preparing the report, the governor may include or exclude any portion of the analysis provided by the attorney general under paragraph (a)(v) of this section
in order to
comply with the law or not jeopardize any legal claim recommended by the attorney general.

Section 2.

(a)

The governor
:

(
i
)

May cr
eate a steering committee with a membership he deems appropriate to advise on the issues

identified in section 1 of this act
and to help direct any of the duties imposed by section 1 of this act
;

(ii)

May a
ssign to the steering committee or any state agency he deems appropriate the task of managing the development of the report
s
re
quired by section 1 of this act.

Section 3
.

There is appropriated
fifty thousand dollars ($50,000.00)
from the general fund
to the g
overnor
.
This appropriation shall be for the period beginning with the effective date of this act and ending June 30, 2020.
This appropriation shall
only be expended
for
the hiring of
consultant services
deemed by the governor to be
useful in
researching,
developing and presenting the
analyses and
report
s
required by this act, and for assembling, reproducing and distributing the
final
report.
Notwithstanding any other provision of law,
this appropriation shall not be trans
f
erred
or expended for any other purpose and any unexpended, unobligated funds remaining from this appropriation shall revert as provided by law on June 30, 2020.

Section
4
.

This act is effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.

(END)

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SF0095