Health Law Talk Interviews State Representative Thomas Pressly and LSMS’ Maria Bowen

Health Law Talk Presented by Chehardy Sherman Williams

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Intro (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams Health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex health care issues is our job.

Conrad Meyer (00:21):
And good afternoon. Good morning. Whenever you’re listening to this podcast. Welcome to another episode of Health Law Talk here at Chehardy Sherman Williams. Rory Bellina. Conrad Meyer. Good morning, or good afternoon, Rory. Right. Good

Rory Bellina (00:31):
Afternoon. How are y’all?

Conrad Meyer (00:32):
Two of the top healthcare attorneys here in Louisiana. I’m bringing you the latest and greatest on healthcare topics, and today is no exception today. We actually have two special guests on the line right now. Representative Thomas Pressly. Representative Pressly. You there?

Rep. Thomas Pressly (00:48):
I’m here.

Conrad Meyer (00:49):
All right. Fantastic. And in the studio came from all the way from Baton Rouge, Rory, Maria Bowen,

Maria Bowen (00:56):
Quite the drive. Welcome.

Rory Bellina (00:57):
Thank you for coming down.

Conrad Meyer (00:59):
And we wanna thank both of you for being on the show today, because it’s gonna be a very interesting topic or multiple topics actually dealing with the post legislative wrap up of some of the nice bills that came out for the Louisiana State Medical Society. Is that correct?

Maria Bowen (01:13):
That is correct. And thank you for having us.

Conrad Meyer (01:15):
Well, fantastic. Well, for our listeners, what I’d like to do is sort of get both of your backgrounds. So I’m gonna, I’m gonna flip it to Representative Pressly. If you don’t mind telling the folks a little bit about yourself and your background, so they get an idea of who you are. And then I’ll take it to Maria and she can tell about her herself, and then we can start with the the house bills.

Rep. Thomas Pressly (01:35):
Yeah, absolutely. Thanks so much for having me on. Again, I’m Thomas Pressly. I’m the state representative for District six, which includes portions of Shreveport and Bossier City. I got elected in 2019, was fortunate enough to run on a to that year, and then, of course, came in in 2020 and hit the ground running during the middle of, of Covid which was a fascinating time to be in the legislature especially as a, a first, first term first year legislator. And I, in my other job, am a lawyer as well, I clerked for a federal judge coming outta law school at Loyola clerked for Judge Hicks up in Shreveport in the federal court. And have been practicing, practicing civil litigation since since then.

Conrad Meyer (02:23):
Well, thank you very much for that. I think that’s a great intro. And now, Ms. Bowen, tell us a little bit about you. What is it that you do for LSMS?

Maria Bowen (02:31):
So, I am the I like to refer to myself as the resident troublemaker. I am the lobbyist or vice president of Governmental Affairs for the State Medical Society. And I’ve been there just a little longer than Thomas. I started in 2018, I guess. So glad to be here. Thank y’all for having us.

Conrad Meyer (02:49):
Yeah, no, no problem. And today, Rory, what, what do we have on the agenda, because it looks pretty interesting. One, the topic that I think has needed to be addressed for quite some time.

Rory Bellina (02:58):
Yeah, I think today is gonna be a really good episode. We’re gonna talk about a couple of acts that have now been signed by the governor going into effect in January of next year. Also, we’re gonna talk about a couple of things that didn’t quite make it get some opinions on where they went wrong or how they might be revised, and then looking forward into things that might come from Baton Rouge in the future.

Conrad Meyer (03:18):
Great. Absolutely. And with that, I think let’s kick it off to Representative Pressly. Let’s talk about the Act, act three 12. This was sort of your, in your wheelhouse, correct?

Rep. Thomas Pressly (03:28):
Yeah, exactly. So Act three 12 was a, a originally a bill that I sponsored dealing with and, and working closely with the Medical State Medical Society to to handle it. But we were dealing with the prior authorization and utilization management issues that are facing our patients and physicians in the healthcare space that everyone that has gone to a doctor has had to deal with. Basically what we were trying to do is to put some frameworks in place for our, our health insurance companies so that they had a timely process so for an expedited review. Now, there is two business days which are urgent but not emergent situations. And then the standard review is five business days that people have to have a response back from, from their health plan.

And we’re, we’re very excited about that. We also did some language that requires more of a true peer to peer review. So, you know, if you have a, a cardiology issue, for example you’re gonna actually have a the cardiologist will be able to speak to someone in that field which is huge when you’re talking utilization issues in prior authorization, that you actually have a, a true peer to peer. Cuz we all know that that docs ha have an extensive you know, training that they go through and education they go through. And having that true peer to peer is, is gonna be much more favorable for the, for the patient.

Rory Bellina (05:04):
Yeah. Representative Pressly, I, I thank you for that, for that update. I wanna go one step backwards for some of our listeners that might not be clear on how we got here to this peer-to-peer process. So I’m gonna kick it over to Conrad. But Conrad, can you kind of give a quick background on what happens? And Representative Pressly mentioned a peer-to-peer or cardiologist talked to cars, but how do we get there and what, what’s going on from a patient’s perspective with this?

Conrad Meyer (05:28):
So I think it’s also, it’s not just the patients, it’s the physicians too. So cuz physicians, I mean, everybody wants to make sure they get paid and, and the patients wanna make sure that they don’t have any exposure from payment as well. So in order to do that, everyone’s gone through this, you’ve heard of this before, you wanna get a surgery, you gotta get pre-approval. Okay? And, and you go to your, your, your, your physician. They say, oh, I wanna do, we’re gonna do some sort of a

Rory Bellina (05:50):
Stent in

Conrad Meyer (05:51):
Your heart. Cardiology. Yeah. Cardiology. I’m gonna get a stent in my heart. Okay, great. You know, I’m, I’m, my commercial payer has to, that, that we have a pre-auth process, right? And so the what’s happened in the past, at least from the experiences I’ve had, I mean, and maybe you could speak to yours and, and Representative Pressly, I, I’d love to hear what you’ve heard, but you know, you, you get pre-approved and as a patient you think, oh, everything’s fine. I got it pre-approved, I’m ready to go. You go get your, your, your check-in, your, your, your physician, make sure you’re medically cleared, and you go do the procedure. And then suddenly after the procedure, suddenly when the invoice gets paid or the claim gets submitted, there’s a problem. You know, all of a sudden it gets denied. And then now you, in this denial loop, this appeal process and your position sort of in this purgatory land where they’re not now getting paid in a timely manner, even if they’re in network, or even worse if they’re outta network. So you’re kind of stuck. So it, so the pre-approval process or prior auth process from before, before the, the Act three 12, that’s what my experience from representing physicians was. They would get this prior off and somehow it would never hold up. They would get denied, they would never get paid, and suddenly the patient’s now caught in the middle. Does that sound accurate?

Rory Bellina (07:06):
It, it does. And then to take it a step further, that’s when you have to, you know, you typically, it’s your physician or you contact your insurance yourself and you say, I want to appeal this. And they’re gonna say, okay, well this is gonna go to a peer review.

Maria Bowen (07:18):
Well, actually that’s on the front end before you get your prior authorization. What what Conrad’s really talking about is the guarantee of payment, which is on the back end after the service has been provided. Got it. Okay. That is an indication that you did receive the prior authorization and that was included as well in Thomas’s bill. So that is a component that is there, but the actual peer-to-peer review comes prior to the service. Okay. That is generally when a physician seeks prior authorization, prior authorization is denied. Okay. So now they have to go back and request a peer-to-peer before they can actually get the authorization to do the service.

Rory Bellina (07:56):
And what’s been happening in the past when we’ll stick with our cardiology example, a cardiologist wants to get probably the authorization for a patient to put it in a stent. It’s denied. They say, I want a peer to peer what’s happened in the past in your experience.

Maria Bowen (08:08):
So I think what Thomas and I will both tell you is that the stories that we heard throughout this process included everything from a cardiologist trying to teach medicine to a a registered nurse or a pharmacist, or even to a psychiatrist. We’re not just talking about that peer to peer. When you, when you’re dealing with a specialty, your, your psychiatrist doesn’t necessarily know how the heart or a

Conrad Meyer (08:33):
No, they don’t have a clue.

Maria Bowen (08:34):
Correct. So the, the goal was to try and provide someone with the same level of expertise as the physician who is, who has requested, and

Rory Bellina (08:44):
When we use this word peer, we say peer because it’s also a medical provider, but is it really someone that’s advocating for the patient or are they more on the side of the insurance company?

Maria Bowen (08:53):
So the, your physician is on your side, right. The peer that you are dealing with, which by the way could be a non-clinician, you could just get the secretary. It, it just depends on who is available in taking that information or who has been given your case file to call you and do that follow up with. So it, it, you never know who you might have gotten from.

Rory Bellina (09:17):
But are they, I guess, let me rephrase. Are they more or less incentivized to

Maria Bowen (09:22):
Approve your They work for the insurance company. Okay. So you are now paying the insurance company to figure out how to deny you the services for which you have paid for

Conrad Meyer (09:34):
In your premium and, and representative Pressly what from, does that sound accurate? Is that what you’re hearing Boots on the ground as well?

Rep. Thomas Pressly (09:42):
Yeah, that’s exactly what we heard. I mean, that’s certainly, that’s, that’s really why we, one of the big reasons we brought the bill, we wanted to make sure that, you know, when you, when it’s an appeal process, right? When when someone is, is saying their doctor is saying they need a certain procedure, you wanna have somebody that actually knows why that that procedure may or may not be necessary. Right. And, and, and that’s why we wanted a, a more true peer to peer as opposed to having somebody that, you know, isn’t necessarily medically trained or certainly not in that specialty. We heard lots of stories from, from physicians during White Coat Wednesday when they came to the capitol to, to speak about various issues that were facing their industry. This is one of the issues that was brought up. So that was really important that, that they actually have, you know, the opportunity to talk to someone else that has similar credentials as they do.

Rory Bellina (10:37):
So in our example with, with the cardiologist and, and the shunt, I mean, your cardiologist is advocating for you as the patient on why you need this procedure. And the person on the other end of that peer tove might not be a cardiologist. And so this is, this legislation’s very important because even if the person on the other end is working for the insurance company and trying not to allow these to go through or whatever it may be, at least you’re talking to someone in your specialty that you’re speaking the same language and should understand the medical necessity and why you need this.

Rep. Thomas Pressly (11:09):
That’s exactly right.

Conrad Meyer (11:10):
And, and so this, to to kick it back, we’re we, we we’re having this, the, the pre-auth process. This, now this, this chart that I’m looking at here for for three 12, and that’s about the expedited that you mentioned earlier. Representative Pressley standard, the concurrent retrospective, this is all on the front end, correct? Yeah, it’s not, but it’s on the back end.

Maria Bowen (11:28):
And this is where we’re talking about,

Conrad Meyer (11:29):
Because help me understand that. Cause it is confusing if you, if you don’t live this, you’re looking at this like, it’s like, okay, this is a bunch of word salad.

Maria Bowen (11:36):
And I think that’s what happens to most of the patients as well.

Conrad Meyer (11:39):
Because I feel, even though I’m a healthcare lawyer, I’m looking at it like, man, this is kind of word salad. So can, can walk us through this.

Rep. Thomas Pressly (11:44):
All right. So yeah, lemme do that. So you have emergency issues where you go to the emergency room that does not require prior authorization any way, shape or form. The, the issues that are urgent but not emergent, meaning that they need to be, they’re time sensitive issues. Those are now required two business days for the insurance company to say yay or nay, or we need more information. The standard is that you need five days. That’s again, prior to any of the, the issues coming up. So an example would be, you know, a knee surgery, right? Well, the doctor can submit that paperwork and, and say, you know, we need to do this. It’s not urgent, but it’s, you know, we we’re ready, this patient’s ready to have the knee surgery done. So that would be five business days that they were able to delay or, or have a response back to the physician and the patient on whether it was approved or not. And if it’s done either in the two days or the five days, they, it has to remain open. It’s a valid prior authorization for up to a minimum of three months.

Conrad Meyer (12:55):
So they can’t, they can’t claw back. They, they can’t claw back.

Rep. Thomas Pressly (13:00):
They can claw back, but it, it has to remain open for three months. Okay. So if you go and so long as you have that surgery within 90 days,

Conrad Meyer (13:09):
You’re good. It, it’s

Rep. Thomas Pressly (13:10):
Valid and it’s approved. Got it. So a concurrent review is an in-hospital stay. So that’s somebody that’s, that’s in the hospital. Your physician’s saying they need to stay another, another day. And, and the concurrent review, they have to get back to the physician in the hospital within 20 hours to say whether that patient can stay or not, which makes sense, right? I mean, right. That’s, that’s a even more,

Conrad Meyer (13:34):
You got a short fuse

Rep. Thomas Pressly (13:36):
Sensitive issue. Cause you have somebody that’s in the hospital right now. The other, the, the last one is the retrospective review. And that’s really for people that, that have been in the hospital where the service has already been performed. And, and obviously that’s not as time sensitive cause the, the service has already been performed. The person’s likely already out of the hospital and they have 30 days to determine if that was a valid procedure at that point. So that’s really more on the hospital side than it’s on the, on the the doctor’s side.

Maria Bowen (14:09):
And I’m just gonna add to the word salad for I half a second here. The term utilization review. The utilization management review, right. Prior authorization is a part of the utiliz. Oh, you are? Yes. Got it. So when we’re talking about the concurrent review and the retrospective review, those are actually utilization management, not prior authorization.

Conrad Meyer (14:30):
Gotcha. And so, so once we, once we kick it off though and once they, to, to all the examples that everyone’s been talking about here, to give their background once it’s done, like say the knee or the cardiac one that we done once the, once the insurer comes back with its decision, let’s just say they wanna move forward. So we’ve got a pre-op now. All right. How does that segue into guarantee of payment? Like, like on the, on the, on the actual three 12? It, it, I see some things I talk about. You can’t deny it if it’s approved and you can’t, it’s open for certain times and you can’t you know, must have some sort of pro process for adverse determinations. What happens now on the backend that you’ve got the pre-auth and you’ve done it within the time parameters on the front end? Well, how does that work? Representative Pressly? I mean, can, can you shed some light on that?

Rep. Thomas Pressly (15:18):
Yeah. So it, it requires that if you have the preauthorization that the payment be, be provided so long as there wasn’t some sort of fraud in that process Gotcha. Of getting the, the prior authorization. So that will, you know, again, it, it will remain open mm-hmm. for up to 90 days mm-hmm. . So, so long as you have that, that that procedure within the 90 day period then it can’t be denied in that time period.

Conrad Meyer (15:46):
Gotcha. Gotcha. And anyway, in network and outta network guys, is this in network and outta network or just only in network? It’s both. It’s both. Okay. Wow. Okay.

Rory Bellina (15:56):
Maria, what kind of, before we switch over to, to the next topic, what kind of backlash or issues did you, did you face when you brought this before in Baton Rouge? I, I presume the insurance companies were the ones

Conrad Meyer (16:09):
That didn’t like this. I was waiting for that. Yes.

Rory Bellina (16:11):
So what, and Representative Impress, I’d love to hear too, you know, what were the, the,

Conrad Meyer (16:14):
What were the backdoor talks, if you can say that? Oh, I mean, what, what you can say we met,

Rep. Thomas Pressly (16:20):
We met five times during this process with with the insurance companies. Okay. and then certainly with some back and forth. And those were, you know, meetings that were full of lots of people. I mean, they, they were one of the, the bigger behind the scenes meetings that I’ve had, to be perfectly honest with you, I think there were were, you know, somewhere between 12 and 15 lobbyists and officials from different health plans that came, don’t surprise me. And, and tried to, you know, I mean they were pretty adamantly opposed to any type of change. They wanted to use their national standards problem with their national standards is that other states are doing exactly what, what language we put forth and the time periods that we put forth. So I think that was really important that we highlight that to the other members of the legislature mm-hmm. both on the house and Senate side. And, and really it, it was well received that, you know, patients and, and physicians need to be treated in the same way in Louisiana as they are in many other states that are, that are already utilizing similar util utilization management standard.

Conrad Meyer (17:31):
So, so we’re, we’re as usual. We seem to be the last one on the block Right. To come to come to the table very nearly. I mean, like the last one. And, and so let me ask you this, both of you, cuz I know both of you probably did some, some, you know, hand wrangling Right. To get this done. And that’s a nice way putting it, what, what was, I mean, I mean was there any discussion of like, Hey look, insurance companies, like, guess what I mean, you’re just gonna have to get used to either work with us now or get hammered later kind of thing. I maybe, I don’t dunno if you can say that, but, you know, but work, work with us now because, you know, times are changing and we’re way behind and, and, and we need to get things moving for both patients and physician and providers. Was that kind of the message? Or what, what was the message? How did you get this done?

Maria Bowen (18:19):
So, yeah, I

Rep. Thomas Pressly (18:20):
Think, I mean, I think LSMS has done a good job over the last four years during my, my first term is that we’re, we’re trying to do as much as we possibly can on that front. We have been behind. But you had the gold card card standard that was done last year. Mm-Hmm. , this bill was actually initially filed in 2020 by Senator Katrina Jackson or a very similar bill to this one. And unfortunately Covid you know, delayed its enactment. But Senator Jackson was very helpful in the process of getting it through as well. And I think, you know, one of the things that, that we really are on the front of the pack on is the transparency side. And we, we continue to do more to make sure that we’re, we’re, you know, making sure that insurance health plans and insurance companies are, are being held to a standard. And I think you’re gonna continue to see more and more work on that. But is it ever changing issue?

Conrad Meyer (19:18):
And I saw that, so that from a transparency standpoint, the the new now it’s law. It’s law. You’re not a bill anymore. So let’s talk about, so now the current law is, is that they have to put it on their website, right? This sort of, some, some information regarding this. Is that right? I mean, they have to be, you know, sort of like with the, the no surprise act. Right Rory, the transparency there. But now from here, the, the, the, the insurers now the payers have to now put on their website information regarding this prior auth pro. Is that right? That’s

Maria Bowen (19:47):

Conrad Meyer (19:48):
How does that work?

Maria Bowen (19:49):
So and there’s two sort of two pieces of it, right? They have to provide the information both to patients and to their physicians and other providers. But they also have to file quarterly reports. They have to file an annual report broken

Conrad Meyer (20:02):
Down with the doi

Maria Bowen (20:04):
With the Department of insurance. Okay. That is specific to prior authorization. Those services that they do prior au for how many were denied, how many were subsequently approved after a peer-to-peer or anything that that takes you through that process. It, it just, the whole thought process of, of shedding that transparency into other states. What we’re seeing from other states is that just because they have a piece of legislation that is like this, it has, has actually made a significant change in what prior authorizations do occur because they’re having to report it. So it, Thomas is right. We are on the forefront on that. I think there are may be three or four other states that have something as unique as we do that goes as far as we

Rory Bellina (20:48):
Do. And so this is Act 3 33 that we’re now referring to. So Correct. And, and publicizing this, this information, what, what do you see that helping, how do you see that helping the consumer or the patients, either one of you, by having that information published? I mean, I, I presume it’s going to, it’s gonna allow you maybe when you’re picking your, your, your plan to see, you know, which, which payers or,

Conrad Meyer (21:11):
I think it was billed both. It was billed for physicians and patients. So the physicians, I mean, is that true? I mean, you try, that’s true. So, so it’s not just the patients. Cuz if I’m the physician, I mean, if I have to fight prior, prior auth every time I’m trying to do something, that’s a problem. Yeah.

Maria Bowen (21:24):
I’m gonna ask this question.

Rep. Thomas Pressly (21:26):
Well, and I think it’s from a free market perspective, right? It’s gonna hold them accountable, right? Yeah. I mean, you don’t wanna be the first one on the list either. And I also think it, it, it honestly provides LSMs and the, the state legislature a lot more information about, you know, what’s going on, you know, with these pre-authorization requests and denials. And then maybe we have to do more on, on our front as well. I

Conrad Meyer (21:51):
Can, I can promise you that Representative Pressly, I can, I can guarantee you, you know, nobody, nobody reads the data like you’re talking about right now until it happens to them or a close family member of them, then suddenly, right, then suddenly the world has to stop. But I agree with you,

Maria Bowen (22:08):
And that’s the question I would ask of all of us. What, what’s that? Right? The four of us are, are all very much involved in the healthcare world, right? We understand what we’re looking at. We understand what we’re talking about. We all have health insurance policies. Do any of the four of us actually know what our policies cover? I, I don’t. We have

Conrad Meyer (22:24):
Those cheat sheets. You know, we have sheets that say, here’s your deductible and here’s all that. But they’re particularly lying. No,

Maria Bowen (22:29):
You don’t. Right? I mean, we are relying on our physicians to help us wade through a contract that we have executed with a different party.

Conrad Meyer (22:38):
Well, how many of you have heard from physicians? I mean, I mean, Rory and I, I could tell you this right now, have said, I want to practice medicine. I am tired of dealing with paperwork. Please, someone help.

Rory Bellina (22:51):
Yes. Yeah, absolutely. Or, or please help with get, don’t tell me how I need to code this to get it approved. Like I will do the procedure and everyone else handle the arrest.

Conrad Meyer (23:01):

Rep. Thomas Pressly (23:01):
No, I think that’s exactly right. And I, I think physicians are tired of having to deal with it. My dad is a physician in Shreveport. And you know, his staff has gone from you know, being fairly small to growing because of the need to deal with the paperwork cause of health insurance plans. I mean, it just doesn’t make sense from a cost perspective for the patient as well as the plans, honestly. They don’t wanna pay anybody for anything. And it’s, you know, it, it just makes no sense. And, and I really, you, I heard a lot when I filed this bill from physicians that all were saying the exact same thing, which is we’re tired of dealing with paperwork. It’s become a, a bureaucratic burden to practice medicine. We wanna be able to do our job that we’re trained to do, and it doesn’t include filling out the table.

Conrad Meyer (23:53):
And so this includes now we, we’re we’re we kinda segue from Act three 12? That was your, that was your bill And HB 4 68. Now it’s law to Senate Bill 180 8, act 3 33 from Senator Stein. That’s also now law. Correct.

Maria Bowen (24:06):
Both effective 1, 1 24.

Conrad Meyer (24:08):
There we go. So it’s, it’s coming down the pipe. Yes. I mean, it’ll be coming down in the new year. Interesting. So I, I think this is a good opportunity. Now we’re gonna seg into a different area area. Oh, you wanna see one more thing? Maria? Maria has one more thing. Let’s go. What’s, that’s

Maria Bowen (24:22):
Shocking. I I have nothing to say ever.

Conrad Meyer (24:24):
No, you don’t. All right, you’re good.

Maria Bowen (24:26):
I will tell you that if you ever really wanna watch something that’s fascinating, go back and watch Senate Health and Welfare on May the 17th of 2023. That is the day that what happened. This bill was heard

Conrad Meyer (24:37):
Really? Senate on committee. What happened to the committee about

Maria Bowen (24:39):
That? It was fantastic. I’m not gonna tell you what happened. See, I wanna

Conrad Meyer (24:42):
Read, I have go watch it. I want the end of the story. Right.

Maria Bowen (24:46):
Let’s just say Thomas really hit it out the ballpark.

Conrad Meyer (24:48):
So you, you pulled a Tommy White, right? Thomas , is that right? You pulled a Tommy White and then in Omaha, that’s, that’s LSU ference Tommy take, that’s, that’s my that’s my reference to the LSU national Champs. Right. well good. Well then I will have to watch that. You’ll have

Maria Bowen (25:04):
To watch that

Conrad Meyer (25:05):
May 17. I’ll have watch that. All

Rory Bellina (25:06):
Right. So do we want to pivot

Conrad Meyer (25:08):
Over to we are

Rory Bellina (25:09):
House bill 4 71?

Conrad Meyer (25:10):
That’s correct. And I think that deals with, is it the pharmacist bill? That was the Yeah, was the pharmacist. We’re gonna call it what the p pediatric vaccination bill. Is that what we’re calling it? That’s

Maria Bowen (25:20):
What, that’s the easiest way to

Conrad Meyer (25:21):
Explain it, don’t you? I love the way they put terms on it that really don’t even relate to what really, sometimes it’s a pediatric vaccine bill. It’s great. Everyone should love it because it’s pediatric vaccine. But when you peel the onion back, it’s kinda like, well, is it really that? Is it? I don’t know. So what was this, what was this? What happened here?

Maria Bowen (25:38):
Thomas, you wanna start it? Or you want me to start it?

Conrad Meyer (25:41):
I’ll defer to you. Well, you go ahead, .

Rep. Thomas Pressly (25:43):
I’ll jump in.

Conrad Meyer (25:44):
All right. What happened, Maria?

Maria Bowen (25:45):
So for the last several years, we’ve actually seen pharmacists or pharmacies, I’m, I’m gonna probably segue this a little bit into what we’re referring to the corporate practice of medicine as well. Because you’re seeing a lot of national pharmacies try to push down into their pharmacists. They’re a requirement that they actually get more involved in providing healthcare services. Mm-Hmm. , one of those being vaccinations, whether or not you believe in vaccinations. We have laws in this state that require children to get certain vaccines before going to school. A lot of our physicians use that opportunity to actually lay eyes, lay hands on a kid, check ’em for anything from scoliosis to autism, to to whatever they may be screening for at that is age appropriate at the time. Mm-Hmm. , if you take those children out of the pediatric home and you, and you allow a parent to skip that process and just go to a pharmacist for a vaccine because it’s required for your kid to go to school, you’re removing that access to a pia pediatrician to a, to a physician, to someone who can provide a holistic care.

So the last couple of years we have seen national pharmacies in particular try to push down this effort to take those pediatric vaccines and bring them into a pharmacy and provide those shots. This was an effort to do that. Right now, 17 and above can go to a, to a pharmacist and get their vaccine under 17 can and you have many reasons that you don’t want them to do that. You don’t know what contraindications a child may have that’s related to another a prescription that they may be on. A pharmacist can’t see in the background of their medical record. They may not know that a pediatrician skipped a vaccine for a good valid reason. And the first thing that happens to you if you’ve ever gone to get a vaccine within a pharmacy is they said, you, oh, I see where you skipped this one, or you missed this one. Let me catch you up. So you don’t want them placed in the position of having to figure out why my 10 year old doesn’t have that shot. Right. So the whole effort is, is aimed under the terms of, of access to care. But I think we would argue that that’s not, that’s not the best way to do this.

Conrad Meyer (28:02):
So the quality issue is I saying a quality?

Rory Bellina (28:04):
Yeah. I have a basic question for you. Cause I’m, I’m thinking about this from a practical standpoint, Maria,

Conrad Meyer (28:08):
Because you don’t, you represent a lot of pharmacies. I do. I So we have a, we’ve got the enemy in the gates. I’m kidding. So, no,

Rory Bellina (28:15):
Go ahead. You represent a lot of pharmacies. He does. I have a question though, is where does the script come for, for this shot? These immuno, we’ll call it, we’re mainly talking school-wide immunizations. Correct? Like MMR meningitis, the ones that I have three young kids, and so I’m

Conrad Meyer (28:31):
Every Yeah. A Hep B. Is

Rory Bellina (28:32):
That what we’re referring to? There’s no script

Maria Bowen (28:33):
For this. There would not be a prescription underneath this, this legislation. So this, right now, if you want to use a pharmacist to get a vaccine for your child, your physician can give you.

Rory Bellina (28:44):
Okay. That’s what I wanted to ask. So right now, as things stand, which this did not make it all the way, but as things stand, if my child needs a school vaccine, they have to get a prescription for one from a n PPA physician, whoever’s authorized to do

Maria Bowen (29:00):
It. That’s correct.

Rory Bellina (29:00):
Okay. But they could take that script or hear what the proponents of house bill 4 71 and one was the ability to get that paper or eScript and just skip, go into a big box pharmacy, go into the little room on the side and get the shot there.

Maria Bowen (29:16):
That’s correct. You would skip the, you would skip the need for a prescription.

Conrad Meyer (29:20):
It would be like, it would be like going to get vitamins off the shelf. Right?

Rory Bellina (29:23):
. Okay. So there would be no

Conrad Meyer (29:25):
Analysis, no assessment’s,

Rory Bellina (29:26):
Prescription. You would not go in with a paper script.

Maria Bowen (29:28):
That’s right. Okay. And, and today we do have a lot of physicians who work in particular with their independent pharmacists that are, are small in rural areas. A lot of that already happens because it’s much, it’s much more economical for the pharmacist to store vaccines. Right. For five or six physicians than it is for you. Okay. You and I live in, in metropolitan areas, right. When we go, we get our shot from our physician.

Conrad Meyer (29:52):
Correct. So this’s a money grab. This is, this is a money grab, you think, I mean, is this sort of like a money grab or is this a power play? I mean, I mean, I kind of both maybe, but I mean, how much are we talking about in terms of actual dollars? I mean, I don’t know with, with the pbm. I don’t know. I think

Rep. Thomas Pressly (30:05):
It’s a little bit of both. I, and I’ll, I’ll jump in here. I mean, I think one of the big things is you’re not talking, this is not being pushed by independent pharmacies. Right? This is being pushed by the big box pharmacies, right. That we’re all aware of that are on every corner of the state. And, and, you know, the, the, the cost of the vaccine really isn’t that high. The issue is, is they’re getting them into the store. And so it’s what else are you buying? Right? I mean, I think when you, when you look at the actual price of, of the vaccine, there’s really, you know, it’s not negligible prices big of a

Conrad Meyer (30:40):
Kinda like, let’s get, let’s get ’em in here first and then we’ll get ’em to buy the cookies. .

Rep. Thomas Pressly (30:44):
Exactly. Exactly. I think that was part of it. Or the cigarettes.

Conrad Meyer (30:48):
What’s that? The frustrating cigarettes. Right? True. True.

Rep. Thomas Pressly (30:51):
But the frustrating part for this was, you know, they didn’t wanna have any type of requirement for the pharmacist or the pharmacy tech that was giving the shot to have any, you know, standardization of what to do in the case of an emergency. You know, they, they were adamantly opposed to that, and they were also adamantly opposed to allowing kids that are on Medicaid to be able to get the, the, the shots as well. Which begs the question again. So wait,

Conrad Meyer (31:17):
Wait, wait, wait. Did I, did I hear that right? Did I just hear that? Create that So everyone else, but Medicaid can get this,

Rep. Thomas Pressly (31:24):
That that was part of this bill. They were not including the Medicaid kids in the bill. Why? So why mean?

Well, and that begs the question of why are you creating this, this, you know, the classism that’s if you, if you’re actually trying to, to help kids. I mean, those two things seem common sense. They were adamantly opposed to it when it came back. So the way the legislature worked, right? Of course, the, this was a house bill my friend Barbara Fryberg and Barbara brought the bill to committee, then it comes to the house floor. It passed the house floor, originally went to the Senate committee, and then went to the Senate floor, passed there. During that process of being on the Senate side, some amendments were put onto the bill and it had to go back to the house for what’s known as concurrent. Ah. and that means that we agree or we disagree with the amendments that were put on the bill.

Well, Ms. Barbara decided to reject the amendment, which is common practice, and then it goes into a conference report. That conference report it means that there’s, there’s three people from the house and three people from the Senate that get together and review the changes that are agreed to between them to try to come to a resolution. When it came back on concurrent on the house side outta the, the conference report or conference committee, that’s where the real fight was. And it was the last day of session. And, and representative Michael s from Monroe and I kind of tag team were able to keep it from getting past the first time. She then tried to do it again, and it came back a second time. And that’s where it really got interesting, because the, the big the big pharmacies had employed, I don’t know what a dozen Maria Yes.

Lobbyists. and they put, they all put different what’s donor as, as floor notes, which means that, that the lobbyist can put a note on every member of the legislature or on the house side, every member of the, of the house desk. And it said, you know, that when it came back on the second time, it said at the top from one of the big lobbyists, lobbying firms in the state all issues have been resolved, which was just a flat out lie. It, it didn’t address the issues that the floor, that the health community and the, the physician coalition of Louisiana had and, and continued to have as we moved forward on the bill. And I went to the floor for the second time and said, this is just a flat out lie. The, the medical society opposed the Louisiana Academy of Family Physician remains opposed. The American academy of of Pediatrics remained opposed. So

Conrad Meyer (34:16):
Like a court case wouldn’t, they’ve lost all credibility at that point. I mean, if Absolutely Right. So then, then it just dies. That’s why.

Rep. Thomas Pressly (34:23):
And I think that’s why I died. Ah,

Conrad Meyer (34:25):
Okay. All right. There you go.

Rep. Thomas Pressly (34:26):
I really do believe that was a big part of the reason that that bill died.

Rory Bellina (34:29):
So the, the argument for this, or the, the argument for this to have made it further would’ve been that this is going to increase access to

Conrad Meyer (34:40):
That’s immunizations for That’s the argument that, that’s right.

Rory Bellina (34:43):
Was that the, the selling point?

Maria Bowen (34:45):
That was the selling point.

Rory Bellina (34:46):
But they’re not going to allow the Medicaid population to take advantage of

Conrad Meyer (34:50):
This. That, and that’s, doesn’t that sound screwy

Rory Bellina (34:52):
That Well, that it, that sounds counterintuitive because

Conrad Meyer (34:54):
It’s contradictive.

Rory Bellina (34:55):
I think that that’s where the most need probably is.

Maria Bowen (34:57):
Well, there are 50% of the children in the state of Louisiana are, are Medicaid.

Rory Bellina (35:01):
Medicaid. Right. And they’re gonna carve out 50% of the children from being able to,

Conrad Meyer (35:05):
That’s why you take advantage of it. Scratch in your

Maria Bowen (35:07):
Head, the amendments that were put on, on the Senate floor would have required that if you’re going to participate in providing vaccines to pediatric patients, you would be required Okay. To accept Medicaid. And the other amendment that was put on required anyone that was putting a shot in a kid’s arm had to have pediatric advanced lifesaving training

Rory Bellina (35:27):
Pals. Yeah. And they were against that both

Conrad Meyer (35:30):
. Wow. Okay. What does that say? I can’t speak for them, but it’s kind of, you’re kinda looking it on his face. You’re like,

Rory Bellina (35:38):
Really? What’s the, what’s the real goal here? What’s

Conrad Meyer (35:39):
Right? What’s going on? Like,

Rory Bellina (35:41):
Wow. Is it to increase access or is it like, like someone mentioned before of, of getting them in the door to

Maria Bowen (35:48):
No, I think Thomas is right. I think he’s right on that point.

Conrad Meyer (35:50):
And that’s another question. So this died, right? Yes. You know, rightfully in a, in a very artful way. Right?

Maria Bowen (35:56):
Thomas was so good that

Conrad Meyer (35:57):
Day. That sounds like you Good, you know, you died on the hill. Literally. Yeah. What, what, where are we gonna see this come back? Is the pharmacy board coming back and trying to do this again next year, you think? I mean, I don’t know. Is next year’s a a fiscal or legislative? I don’t even know

Maria Bowen (36:11):
Next year’s Anything?

Conrad Meyer (36:12):
Yes, anything goes Okay.

Rep. Thomas Pressly (36:13):
Anything goes, and, and I’ll be shocked if we don’t see this bill again next year. The, the amount of lobbying that went on and, and honestly, the, the number of lobbyists involved 12. On, on the vaccine side. So

Conrad Meyer (36:28):
How, how many, how many lobbyists does it take to give a shot? Right? 12, obviously 12 lobbyists to give a shot.

Rory Bellina (36:33):
Representative Pressly, what was the, geez. Was, was the Board of Pharmacy involved in this? What was their stake or position?

Maria Bowen (36:40):
They were not,

Rep. Thomas Pressly (36:41):
I’m not sure if they were involved or not. Ok.

Conrad Meyer (36:43):
It wasn’t the board, this was just the industry. Okay. Correct. So I had to be very careful what I say about that.

Rep. Thomas Pressly (36:48):
But it was, but it was really being pushed by the two big box stores. Right. I mean, it was being pushed by CVS and Walgreens, period. Ok, sure.

Rory Bellina (36:56):
Yeah, I I’m just curious. I mean, I, I do a lot of mention that I represent a lot of pharmacies, neither of the two that you just mentioned. No surprise. There’s, there’s a

Conrad Meyer (37:03):
Disclaimer right there. Right, right.

Rory Bellina (37:05):
Rory, I don’t think they’re gonna, they’re gonna choose me. But anyway well, what I’m thinking of is though, I’ve got a really good relationship with the Board of Pharmacy and I work with them.

Conrad Meyer (37:14):
Yeah. So we, we both, they’re great. I know

Rory Bellina (37:15):
Who they’re, they’re great to work with. I’m, I’m curious what their position would’ve been on this, because now

Maria Bowen (37:21):
They’re, they were actually just neutral on this one. They, they have members on, they have licensees. I’m gonna refer to ’em as licensees. Right. They would have licensees on both sides of the issue.

Conrad Meyer (37:30):
I think. I think they would’ve been in a, in a, in a position. Anything that expands the role of a pharmacist in terms of encroaching on the medical Practice Act. I think y’all are getting attacked from all sides here. Yeah. And then

Maria Bowen (37:43):
We are getting attacked from all sides. And then

Conrad Meyer (37:44):
On the, the nursing board, the pharmacy board, the psychology board, the social work board, everybody wants in.

Rory Bellina (37:49):
Yeah. And on the flip side of this, I, I could see that LSB and e having issues with this, cuz now you’re,

Conrad Meyer (37:55):
Well, I know they would. Yeah. I mean yeah. I could tell you right now, they would, I wanna see, you know, the director on the hill there. I’m sure him, he’s gonna have an interesting say on that.

Rory Bellina (38:03):
I would think that the LSME would have a big issue with this.

Conrad Meyer (38:05):

Rep. Thomas Pressly (38:06):
The the other thing though is, I mean, the board itself cannot take a position cause it’s a state entity that our code of ethics in Louisiana requires them to not take an official position now. Gotcha. Their association certainly could have taken a position. But as far as the board itself, they can’t take a

Conrad Meyer (38:22):
Position. Got it. Got it. Thank you. They can only do something after the fact in terms of interpretation of a rule. Is that correct?

Maria Bowen (38:28):
They make the rules generally the legislature directs them to promulgate rule rules. I see. Related to that issue.

Conrad Meyer (38:35):
Something that’s already been made. They, does it have to go through the same legislative process and then the legislator votes to change a rule in place and then the board would’ve input? Or does the board literally at the mercy of the committee or legislature? I mean, I don’t know the answer to that.

Rep. Thomas Pressly (38:51):
So, I mean, certainly the, the, the, the way I think the question I think you’re asking is you know, who approves their rules?

Conrad Meyer (38:59):
Yeah. Who approve. Like, in other words, how does it get, and if I’m an agency, right, and I have oversight of a professional organization of people that provide services, do I, I mean, do, do I have to sit there? I mean, am I, am I like, okay, the legislator tells me, okay, Conrad, you have to make X amount of rules. And so okay, I’ll go write the rules. Or do I say, okay, let us, here’s, here’s what I think the rules should be. Let me give ’em to you. I mean, how does it No,

Rep. Thomas Pressly (39:22):
So, so the way that works is that the legislation that we draft can, can tell them specifically, we want you to, to issue rules on this.

Conrad Meyer (39:30):
I see. Okay.

Rep. Thomas Pressly (39:31):
But the but the statute, the, the law Right. Overrules the, the rules that are created by that, that organization or that that agency.

Conrad Meyer (39:42):

Maria Bowen (39:42):
And the, the Administrative Procedures Act actually lays out how rules are made.

Conrad Meyer (39:47):
We’re going back to, to bar school. With the bar exam, right there

Maria Bowen (39:50):
You have the, you know, you have the notice given the public input. Yeah. All that kind of good stuff. And then ultimately the the legislative committee that has oversight over that particular licensing board or, or discipline board has the ability to review those rules. Got it. If they

Conrad Meyer (40:08):
Want to. Okay. So speaking of rules and oversight, let’s, let’s, let’s segue into our, our last real hard topic here. Corporate practice of medicine. Because all of the things we’re talking about, right? Big box pharmacies, right. Directing vaccinations, you know, health insurance. Health insurance, pre-auth about, you know, cuz I mean, what physician wants to work for free? I mean, I mean, I love physicians, but we all wanna get paid, you know, and, and, and god forbid, your members don’t wanna get stuck with a bill because of a pre-auth gone bad. Right? So, right. So who, who’s actually running the show here and, and really in terms of Louisiana corporate practice of medicine, in other words, we don’t have, this is not, and Rory, correct me if I’m wrong, from our standpoint, cause I’ve been doing this 24 years and, and there’s no corporate practice prohibition in the state.

So there’s no state statute, no regulation that prohibits a corporation from owning or employing pro medical providers in the state. Correct. And the only thing, right, because we learned this years and years ago, right? Was an advisory opinion issued by the board of medical examiners regarding corporate practice, right? Yep. 40 year old definition. That, gosh, Shania, I don’t know how, I mean, is it, is it still even viable? I mean, what are some of the issues, you know, Maria, that you’re seeing here and, and because now from what we talked about earlier, we have maybe it’s time to actually define it in the statute. Maybe it’s time to make a reg on this. What are you seeing from the LSMs point of view? And, and then Thomas representative pro, sorry. I like to kick that to you. So Maria, you first, what are you seeing with this? And in terms of all the things we talked about today, how does this work?

Maria Bowen (41:52):
So first off not being an attorney or a physician, I’m just gonna share with you what I hear from my physicians, which is that I am being told how to practice medicine and that is not right. I’m the one who has to write the prescription or decide what that treatment plan looks like. I should not have to pull back or say, I, I can’t give you that medication because your PBM doesn’t cover it. If I know that that medication is the one that you should be on, maybe you have done the fail first protocol and you’ve already been there, done that, and that medication is working for you, why should you have to step back every year and start over again? All of that it falls under what, you know, the normal layperson thinks of when you, when you’re talking about the corporate practice of medicine.

I don’t think we have any set definition. I don’t think anybody views that as the same definition. It’s a little bit different to everyone, which in and of itself should share that there’s a problem. Right? Because nobody knows what they’re actually addressing. So I think our challenge is going to be to figure out what is the corporate practice of medicine and does that take you a step back? What is the practice of medicine? Who can do what, what are, is it because you are diagnosing? Is that what makes you be someone who is practicing medicine? Is it because you develop a treatment plan? What is that role that then is being taken away from your, your knowledge, your years of experience in how you’re treating patients and, and should you have to bow down to those entities that don’t have a medical license. So I think that’s gonna be the next frontier that we have to look at. And I, I think it’s gonna be a very broad topic. I think it’s gonna be lots of debate. I think it’s gonna be a lot of teeth grinding over who’s right on what definition you should adhere to.

Rory Bellina (43:53):
Yeah. And I’m just thinking of all the layers about this cuz when I, when I hear someone ask about Louisiana or, or a physician from outta state asking about Louisiana being a CPO m State, right. Obviously the answer is that, you know, it’s allowed here and we use the term corporate. It could be any sort of legal entity can employ you. But, but I think of it as so much more than that. I, I think of it as the, the, the new resident who is going to a, a big hospital or a new system and has trained under one device and is now being told he has to use a different device or he can only order these certain type of implants. Or the, the example you gave with the, with the prescription. I mean it just, it touches so many everything areas that I

Conrad Meyer (44:36):
I Well it’s not just system though. I mean, you’re talking about payer decisions on pre-auth, right? Right. You’re talking about system in terms of streamlining efficiencies of process cuz you know, they do that. Sure. You know, I mean, I mean I, we talked about this, I mean, when I was an administrator, right? I mean we had the surgical suite had, I can’t tell you tell you how many surgical sets of instruments because everybody wanted their own set, wanted their own right. Wanted their own set. And that’s just not economically feasible. So, so I mean this, this could touch a lot of areas.

Rory Bellina (45:05):
Yeah. I mean Representative Pressly, I, I, I applaud you. If you could come up with a depo deposition and, and reign this in on what is the corporate practice of medicine? Cause it, it, it just touches, it touches everything.

Conrad Meyer (45:16):
It does, it does.

Rep. Thomas Pressly (45:17):
No, you’re, I mean, you’re spot on. It, it absolutely touches everything. But I think the, the bottom line is, you know, we’ve, we’ve gotta trust our physicians to, to do what’s right. They, they are trained, they’re educated in a way that, that no other you know, MBA that’s running a hospital is, is trained, right? I mean they, I I just don’t believe that that corporate entities should be allowed to exercise professional medical judgment on behalf of their physician and medical professionals generally. Right? Right. I mean, I, I think you, you see this and, and you see this attack on our physician community generally that just, it continues to get more and more every year. I mean, you saw it from a nurse practitioner standpoint trying to say we should have the same rights as as, as doctors. And, and really, you know, open up fully the practice of medicine. You same thing with the, the, the PAs , not prior authorization, but physicians assistants. Right. or, or trying to just be PAs.

Rory Bellina (46:19):
We’ve done episodes both of,

Conrad Meyer (46:21):
We, we have, I mean that, that’s, that’s, that’s not German. I mean we’ve done this before with mid-levels on apps. So I mean that, that was a major discussion about in terms of autonomy. But

Rory Bellina (46:31):
Is it the, the struggle that I’m having and I’m not advocating for, for the hospitals, but I, you know, if we define what is the practice? Is the practice of medicine you, how you touch and interact with the patient? Or does it extend to, well I’m Dr. Rory and I want this brand of laser and if you don’t buy it for me hospital, you’re practicing medicine and saying that I can have the laser that I need no matter how much it costs, where do we draw the line there?

Conrad Meyer (46:59):
That’s a good, well, you know what, let me ask you this cuz I’m now you and I are gonna get crossfires. So, so let me, let me say this. I don’t know if it’s a laser more than that. You know, like, cuz I’m sure, you know, we can look at the functionality of a certain laser and say, does it accomplish, does one, does one laser accomplish what the other one does? Do we dislike the fact that maybe it’s a green one versus a red one? I don’t know. I’m not a laser guy. Right? Same class of laser, same, whatever, I don’t know. But more of, how about on the pre-auth side? Okay. Think about that. Right. You know, beforehand, before this law came into effect, right? If I’m Dr. Rory, or sorry, Dr. Conrad, right? And I’m asking for approval to take my patient for a procedure and I got some, you know, I don’t know, I’m, I guess I’m gonna try to use a nice word for it, right? Some representative of a payer on the other line and I don’t know who they are and I don’t know if they’re reading from some screen with some preloaded answer, right? Like,

Maria Bowen (47:55):
You don’t know if they’re human

Conrad Meyer (47:56):
Anymore. I don’t even know tpt for all I know that’s saying, you know, you know, four hours later, you know, and it says deny like what does that mean? I mean, and, and suddenly I’m like, well wait a minute. Wait, I, what do you mean I’m a de denied. I have to do this for my patient and now you’re stuck and like, you’re like, oh, wait a minute. So who’s making the medical call here? Who, where’s the medical autonomy?

Maria Bowen (48:17):
That’s the big question. Well,

Rep. Thomas Pressly (48:18):
And I think that’s, you know, that’s the important thing in, in my, or one of the important parts of, of the utilization management management standard, bringing it back full circle on the bill that we did. Right? I think that’s why you need that truer peer to peer review where you do know that it’s somebody that has the same experience that you do. Yeah. and you can explain to them the necessity of whatever the, the need is. So, you know, on, on that front, I think it, it makes a lot of sense on the, on the hospital front. I think it’s a a different, more complex story probably for another podcast at another time.

Conrad Meyer (48:52):
Yeah, yeah. No, I agree with that.

Rory Bellina (48:53):
Cause I, I just can’t wrap my head around defining,

Conrad Meyer (48:57):
But we did though.

Rory Bellina (48:57):
I, but how do you define what is the practice?

Conrad Meyer (48:59):
But we did, it’s always been the medical, you know, it it, it’s always been the medical decision making process, the autonomy of the provider. That’s to me, and you and I have had this battle, you know, where it’s, it’s, it’s always the medical, if you have free autonomy in your medical decision making process, then you are not governed by that corporate entity.

Maria Bowen (49:23):
I, I don’t know that a physician cares what color scrubs they wear, right? No. They just care that they get to provide actual medical care

Conrad Meyer (49:30):
To the patients. Yes. Well, I’m interested to see, I mean, and y’all think that’s gonna be flushed out in the next session?

Maria Bowen (49:36):
Well, I think we’ll start the conversation.

Conrad Meyer (49:38):
I would love to hear the backstory behind this because it, it not only affects you mm-hmm. , but from what Rory and I do with our clients, it is it, we’re on the front lines. So, so we get to ask this question. I mean, how many times, Rory, have you been asked a question. I wanna start a company. I am a non-physician. Can I employ physicians? How often have you heard that? A lot. A lot. Ton. We’ve heard that a ton. And I always say, of course you can. And then I’ve had even the, the broader question, I know you’ve had this and, and this is food for thought Maria and even representative Pressly. I’m a mid-level, I’m an np, I’m a pa and I’m gonna start a company and I’m want to employ physicians. Can I do that?

Rory Bellina (50:18):
We just had that

Conrad Meyer (50:18):
Come up. We just had that, that’s come up numerous times, you know? And the answer is, well, yeah, you can, but how you structure that agreement is very, very, very serious. You can’t just, you can’t control everything. That’s the problem. Yep. So as it stands right now, so if we get this on the books, in other words, if we finally, after how many, what decades, finally have a state regulation or some statute that defines what C P O M means, I wanna be a part of that. I wanna hear about that. That’s for sure. That’s gonna affect everybody.

Maria Bowen (50:50):
Indeed. It will,

Conrad Meyer (50:51):
You know, any food, how,

Maria Bowen (50:52):
How long it will take us to get through this process.

Conrad Meyer (50:57):
Well, you know, that’s a whole nother story. And you know what, that’s a whole nother podcast. So I, you know, any final thoughts? Representative Pressly, I wanna thank you for coming on, but I wanted to give you the last minute. Any final thoughts on, on 3 12, 3 33 and some of the things we talked about going forward?

Rep. Thomas Pressly (51:14):
Yeah, no, I just wanna say I appreciate the opportunity to be on. I think that, that we had a really good session for the physician community as well as our patient community in, in Louisiana. These bills are going to be effective beginning January 1st, 2024. So we’re excited to see, you know, what the results of those are gonna be. But again, I think when you, when you couple these two bills with the Gold Card bill that was passed last, last year you know, I I really feel like we, we are headed in the right direction on utilization review and, and the process of, of making sure that our patients can get the, the healthcare services that they need.

Conrad Meyer (51:54):
Absolutely. And, and Maria, last words, final thoughts from the LSMS Tower in Baton Rouge. I

Maria Bowen (52:00):
Am very appreciative that y’all allowed us to come play with you today. Any, and I thank Thomas for everything that he did this session. Any,

Conrad Meyer (52:08):
Any peek behind the curtain before we go on. Yes. Can what y’all in mind for next session? Can you, can you, can you open the Pandora’s box or the bag of secrets can let us know, can we, I

Maria Bowen (52:17):
Think we’re gonna have to deal with elections before we go there. Ah,

Conrad Meyer (52:20):
Ah, we have those

Rep. Thomas Pressly (52:21):
Coming up that’s focus focused on the fall policy matters and, and elections really do matter. So encourage everybody to go vote on October the 14th for your state house, your state senators, as well as all of our statewide elected officials.

Conrad Meyer (52:34):
Well, that’s great. Well, look, we wanna thank you very much both of you, Maria, representative Pressly, thank you very much for coming on the show today and for all the listeners out there, hopefully you had a great, a great time listening to this very, very informative episode. For all you listeners out there, if you have any questions, any comments, please drop us a line. Rory Belina and Conrad Meyer here at Chehardy Sherman, and thank you for another episode of Health Law Talk. See you next time. Enjoy.

Intro (52:58):
Thanks for listening to this episode of Health Law Talk, presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends, Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney-client relationship reference.

Welcome to another engaging episode of “Health Law Talk,” the podcast show where we delve into the intricacies of healthcare law and the challenges faced by providers.

In this highly anticipated episode, “Health Law Talk” brings you an in-depth post-legislative update directly from the Louisiana State Medical Society (LSMS). Our esteemed guests, Maria Bowen and Representative Thomas A. Pressly, share invaluable insights on the recent bills and laws passed by the legislature and signed into law by Governor Edwards.

Discover the key efforts made by the LSMS to establish a fair balance between providers and payors, focusing specifically on prior authorization standards for utilization review processes and transparency requirements for health plans. Gain a comprehensive understanding of Act 312 and Act 333, the groundbreaking laws signed by Governor Edwards after the 2023 legislative session, and their profound impact on providers.

Engage in a captivating discussion as our expert guests delve into the nuances of these new laws and their implications for healthcare providers across Louisiana. Learn how the prior authorization process will be transformed, enhancing efficiency, reducing administrative burden, and fostering greater transparency.

“Health Law Talk” is your trusted source for exploring the intricate landscape of healthcare law and policy. Our hosts, board certified in healthcare law, and special guests share insightful legal expertise and thought-provoking analysis to empower healthcare professionals, policymakers, and patients.

Please spread the word and join us in uncovering the impact of Act 312 and Act 333 on prior authorization processes. Share this exciting news with your colleagues, friends, and anyone passionate about shaping healthcare policy.

#HealthLawTalk #PostLegislativeUpdate #LSMS #LouisianaHealthcare #PriorAuthorization #TransparencyInHealthcare #HealthcarePolicy

Health Law Talk, presented by the Chehardy Sherman Williams law firm, one of the largest full service law firms in the Greater New Orleans area, is a regular podcast focusing on the expansive area of healthcare law. Attorneys Rory Bellina, Conrad Meyer and George Mueller will address various legal issues and current events surrounding healthcare topics. The attorneys are here to answer your legal questions, create a discussion on various healthcare topics, as well as bring in subject matter experts and guests to join the conversation.

We handle everything from regulatory and compliance check-ups to employment matters, Medicare and Medicaid issues to state and federal fraud and abuse regulations. Our healthcare attorneys are always staying up to date on the latest state and federal regulations to ensure that our knowledge is always accurate.

Our team has the expertise to assist you with compliance matters, HIPAA violations, payor contracts and employee negotiations, practice and entity formation, and insurance reimbursement issues, in addition to the full spectrum of other healthcare related issues.

Chehardy Sherman Williams, founded in the Greater New Orleans area, has been a leading law firm serving Southeastern Louisiana since 1989.

We put decades of legal practice to work for our clients and provide more personalized services to achieve their desired results. From businesses and individuals across more than ten practice areas, we can provide more experience and more representation.

We can help resolve a wide range of complex legal issues in all courts, including parish, state, and federal branches. Our attorneys have represented cases across Louisiana and the country. Armed with a profound and comprehensive knowledge of the legal system, we are devoted to protecting your legal rights while upholding the highest standards of the justice system.

We are consistently recognized as leaders in the industry, earning local and national accolades for results, service, and commitment.

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