Establishes an office of the state medical fund ombudsperson and a medical indemnity fund advisory panel

• Democratic9
• Republican1

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

The Medical Indemnity Fund (MIF) was created in 2011 to provide a fund- ing source for future healthcare costs associated with birth-related neurological injuries and to reduce medical malpractice insurance premi- ums. MIF enrollees have either settled or won a judgment in a malprac- tice action. Rather than receiving damages for future health care costs, the law requires these children to be enrolled in the MIF to cover said costs. A few years after implementation, issues began to arise regarding reimbursement rates, access to care, coverage, and appeals within the fund. Accordingly, the Legislature enacted Ch. 517 of 2016 to address these concerns. Amendments to this Chapter were negotiated (Ch. 4 of 2017) at the behest of the Executive. The final result was legislation that: clarified qualifying health care costs could not be denied on the grounds they may incidentally benefit others in the household; increased reimbursement rates until December 21, 2019; and required a report to be issued by the Executive to the Legislature on or before April 1, 2017 detailing the financial condition of the MIF. The purpose of this report was to educate the Legislature on how to proceed with any future amend- ments to the MIF. On June 12, 2017, two da ys prior to the Senate roundtable on the MIF, said the report was released. At the June 14, 2017 Senate roundtable parents, attorneys, and providers recounted their experiences and challenges with the MIF. One parent, who is a lawyer by trade, testified to the need for a patient advocate to educate and assist parents trying to navigate the MIF. Additionally, many concerns were raised regarding the potential disruption that may be caused by the transition to a new administrator scheduled to occur a few months later. While all were assured by the Departments of Health and Financial Services that there was a plan in the works to ensure a smooth transition, months later complaints began coming in. The new administra- tor was not reimbursing claims, families were unable to obtain supplies, claims were being paid cents on the dollar, families were forced to obtain new providers, and the new administrator was seemingly applying new policy guidelines that were unknown to providers, enrollees, and their families. The families with children enrolled in the MIF struggle with enough challenges to obtain quality care for their child and they should not have to deal with administrative hurdles and changing poli- cies in order to obtain services and supplies needed to keep their child alive. This legislation establishes an ombudsman to serve as a much needed advocate for the MIF families to ensure they are educated and able to access the services, supplies, and modifications to which they are entitled. Another issue raised at the roundtable by many was the need to continue conversations, to take a deeper look into the data, and have an ongoing process to address concerns regarding the functioning of the MIF. Much like the workgroup proposed in the original Chapter from 2016, this legislation establishes a MIF stakeholder advisory panel that will meet at a minimum of twice annually to discuss ongoing issues and make recom- mendations. Together these protections will help ensure the MIF is functioning as originally intended and that families are getting the care they are entitled to and need for their children.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.