Advocacy Week Information

The Maryland General Assembly is a 90 day session that runs from  January 11 – April 10, 2023. Throughout the 90-day session the Chapter and our lobbying team work to promote our goals, objectives and point of view on the issues important to our profession and the communities we serve.

• 2023 Legislative Profile and Priorities
  
  

The Maryland legislative committees that address health and insurance related issues are:

• House of Representatives Health and Government Operations Committee (HGO)
• Senate Finance Committee (Finance)

APTAMD is part of a coalition that has drafted new legislation to address administrative burden and delays with prior authorizations.

Legislation Regarding Patient-Centered Care Titled:  Health Insurance – Reform Utilization Review Techniques
(HB0305 Hearing 2/16 | SB0308 Hearing 2/15) |  Summary

SB308/HB305 will improve the prior authorization process by adding transparency, aligning standards and increasing accountability of the insurers See APTA Infographic.

Health insurance carriers engage in a process known as “utilization review,” which is a system where the carrier reviews a practitioner’s request that a patient receive a certain health care service to determine if the service is medically necessary. The two most common types are “prior authorization,” which is requesting approval in advance from the carrier and “step therapy,” where the patient must try and fail on other medications (often less expensive) before “stepping up” to another medication.

This legislation would reform prior authorization by:

1. Require evidence-based, peer reviewed criteria as the standard of care developed by an organization that works directly with health care providers or a professional medical specialty society.
2. Mandate that a physician which made or participated in the adverse decision notify the insured’s physician or health care practitioner prior to making the adverse decision and be available to discuss the basis for the denial and the medical necessity of the health care service rather than deny care and then allow for a peer-to-peer meeting after the fact.
3. Study how to standardize electronic systems across all carriers (rather than each carrier having their own system) with the same data points and using a single point of entry, such as CRISP.
4. Study the feasibility of implementing a “gold card” standard in Maryland, which would exempt health care practitioners who meet certain standards from prior authorization standards.

The Data –Ultimate Outcome of Denied Claims
■ 13.08% of filed claims are denied
■ 66.14% of denied claims are appealed
■ 52.34% of appealed denials are overturned

Hearings
■ Senate Bill 308 – Health Insurance – Utilization Review – Revisions – HEARING February 15th –Senator Kathy Klausmeier (D) – Baltimore County
■ House Bill 305 – Health Insurance – Utilization Review – Revisions – HEARING February 16th –Delegate Ken Kerr (D) – Frederick County

Sponsors
House of Representatives: Delegates Kerr, Shetty, Charkoudian, Conaway, Crutchfield, Edelson, Embry, Guyton, Guzzone, Kaufman, Palakovich Carr, Reznik, Ruth, Simpson, Smith, Solomon, Terrasa, Vogel, and Wells. Assigned to: Health and Government Operations

Senate: Senator Katherine Klausmeier and Senator Stephen Hershey. Assigned to: Senate Finance Committee

Preserve Telehealth Access Act of 2023 (Senate Bill 534)
(Senator Gile (D) – Anne Arundel County)
Hearing Scheduled for Feb 22, 2023

We are advocating for extending the study and the extension to June 2025:

• The inclusion of certain audio only telephone conversations under the definition of “telehealth”
• Maintaining reimbursement for telehealth services at the same rate as an in person visit, and
• Preserve coverage of telehealth by the Maryland Medical Assistance Program and certain insurers, non profit health service plans, and health maintenance organizations

Increase Access to PT Services: Research on Telerehabilitation 

Other bills we are tracking

Keep Us Informed of Any Meetings or Communication with Legislators
Meeting with your legislator can be a powerful way to get your message across, as well as to listen to any health care related questions or concerns your legislator may have. It is a great way to build a relationship between APTA of Maryland and the legislator. Please consider contacting the Chapter first for more detailed information prior to your meeting including current cosponsors or existing relationships with your legislator. 

Legislation Action Center
APTA members can login to send prewritten letters to their legislators. The Legislative Action Center contains letters for current state and federal issues. Members can also find practice visit resources and a schedule of local town hall meetings with their legislators under the “Grassroots Resources” tab.

Patient Action Center
Patients and nonmembers can send prewritten letters to their members of Congress. The Patient Action Center contains letters focused on the patient impact of certain federal issues and bills. Learn more about the benefits of physical therapy at ChoosePT.com.

The APTA Maryland annual physical therapy advocacy week in Annapolis was created to help connect our physical therapy professionals and students with their legislators, and to mentor a new cadre of advocates.

We all have a story and experiences to share. We don’t all have to know the ins and outs of advocacy and politics. The important thing is to make a connection with your legislators, so they understand our priorities as a profession.

Advocacy Day Goals
 Educate the legislators on issues of importance to physical therapist professionals and their patients

• Begin what may develop into a long term professional relationship between legislators and physical therapy professionals and students
• Empower students and new professionals to engage in conversation with legislators
  What you can do as your groups’ mentor to enhance the advocacy experience
• Model professionalism
• Encourage the members in your group to do the talking and fill in as needed
• Recognize you may have a mix of PT and PTA professionals and students
• Recognize students and new professionals anxiety and discomfort
• In between appointments: go into session and observe proceedings; take a tour of the state house;write thank you notes to legislators and their staff;