Legislative Updates

January 2020

Public Policy Committee Update

The next meeting of the CMA’s Public Policy Committee will be on Thursday, March 19 at 6:00 p.m.. The CMA PAC meeting will begin immediately after the conclusion of the Policy meeting. Other meeting dates for the remainder of 2020 are scheduled for

  • June 24
  • September 17
  • November 12

CMA “Advocacy Day.” The CMA’s Public Policy Committee will be sponsoring its first ever official Advocacy Day for to talk to legislators about issues of concern to CMA physicians.  

  • Monday, March 30 6:00 p.m. Training at CMA offices with State Representative Beth Liston, MD, to help physicians learn about effective interactions with legislators
  • Wednesday, April 1 various times: A day when both the Senate and House are scheduled to be in Session, so legislators will be at the Statehouse. Meetings with individual legislators can be arranged around physicians’ personal availability that day.

More details to follow.  Contact Lisa Oyer (Loyer@ColumbusMedicalAssociation.org) or Malcolm Porter (malcolmjporter@aol.com) if you are interested.

Legislative Update: In January the Ohio General Assembly returned for some limited sessions in advance of the March primary. This year is expected to be a volatile political year with limited session days as the calendar moves towards November. Here is a brief update on selected issues/legislation.

CRNA’s Scope of Practice: HB 224.  This bill moved out of the House Health Committee and was passed last week by the House of Representative by a vote of 94-2. The bill moved forward largely as the result of a compromise provision that provided an option for a supervising physician to opt out of the expanded authority if they believe it is in the best interest of the patient. The bill does not grant authority for CRNA’s to write outpatient prescriptions. As a result of the compromise, major physician groups were neutral on the bill.  The bill has not received any Senate hearings yet.

APRN’s independent practice: HB 177. This bill had hearings in the House Health Committee this month; but remains in the committee for further consideration. Some changes were adopted; however, physician groups were not a part of development of any of the changes and strong concerns remain about the impact on patients and functioning of physician-led patient care teams.

Psychologist prescriptive authority: HB 323. This bill remains in the House Health Committee after having one hearing that featured proponent testimony. Unresolved issues are many, including level of education/training and lack of a formulary, and a collaboration agreement with physicians.

Medication Switching HB 418: Received a proponent hearing in House Health Committee. The bill intends to prevent patients from having medication switched by an insurance company for non-medical reasons during a plan year.

Mental health parity: HB 443. Received an initial sponsor presentation to the House Health Committee. The bill intends to align Ohio statutes with federal law for the levels of required services.

Bills that remain in committee and did not receive hearings in January:

Surprise billing: SB 198 and HB 388. These bills remain in committee in their respective chambers. There is general agreement on removing patients from the middle of a surprise billing situation and eliminate balance billing; however, there are differences on how to resolve payment disagreements between providers and payers. SB 198 is generally supported by providers, including major physician groups. HB 388 is generally support by payers. At the core of the differences is the payment dispute determination via SB 198’s mandatory arbitration provisions vs HB 388’s approach of benchmark pricing.

Price Transparency: SB 97.  This issue has been the subject of considerable activity in recent years, including attempts to address the issue in state budget bills, veto’s by the Governor, and lawsuits by major provider groups, include the OHA and OSMA. This year an attempt at a workable system has emerged from the committee process in the Ohio Senate with broad provider support. The bill unanimously passed the Senate and is in the House Health Committee.

Abortion Regulations: SB 155 and 208. HB 413.The CMA has opposed legislation when there is a lack of scientific evidence to support the proposed policy and/or physician actions that are consistent with standards of care are criminalized. Two such abortion related bills have passed the Senate and are in committee in the House. SB 155 requires physician communication to patients about reversing medication abortions and SB 208, deals with provisions following a live birth after an attempted abortion. HB 413 establishes the basis for murder charges against any physician who provides an abortion. The bill has not received any hearings in committee.

Other bills on the watch list include:

  • Gun regulations: SB 221. In Senate committee, no January hearing.
  • Vaccinations: HB 268. In House committee, no recent hearings.
  • Health education standards: HB 165. In House committee, no recent hearings.
  • Tanning prohibitions for youth: HB 329. In House committee, no January hearing.
  • Science based medicine: HB 407. In House committee, no hearings yet

Prior authorization. Thanks to those practices who completed the comprehensive survey regarding the current prior authorization landscape. Results of the survey were compiled at the end of 2019 and analysis is ongoing. Based on the outcomes of the research will determine whether appropriate next steps will be with the Ohio Department of Insurance, additional legislation, or some other activity. 

Political Action Committee Summary

Legislative Delegation Screenings for CMA Physicians. All members of the Ohio Houses and half of the Ohio Senate will be on the 2020 ballot. Watch for mid-year dates to be scheduled for any CMA physician to attend screenings and ask questions to all members of the Central Ohio legislative delegation and their opponents.

Ohio Supreme Court. Scheduling conflicts with the two current justices and their two challengers prevented the CMA Supreme Court forum from occurring. Should any CMA member be interested in connecting with one of the individual campaigns, please contact Malcolm Porter (malcolmjporter@aol.com). The OSMA will having its endorsement process in the coming weeks.

September 30, 2019 Legislative/Advocacy Update

Current policy issues that are being addressed include:

  • Science based policy standards for issues like vaccination, education, patient/physician communications, women's health
  • Out-of-Network Billing, or “Surprise Billing”
  • Mental Health Parity
  • Scope of Practice
  • Decreasing Barriers to Treatment for
    Mental Illness & Substance Use Disorders
  • Medical Price Transparency
  • Medicaid
  • Vaping/E-Cigarettes/Smoking Cessation
  • Firearm regulation/safety

March 14, 2019 Legislative/Advocacy Update

State of Ohio Update

The State Board of Pharmacy Files New Compounding Rules

After considerable communication and negotiation back and forth with the Ohio State Medical Association and many different medical specialty societies, the Pharmacy Board has changed it proposed compounding rules to address several physician concerns.

As proposed, now the new compounding rule will 

  • exempt drug reconstitution,
  • exempt drug device preparation,
  • exempt drug dilution (when administered one hour after preparation).    
  • allow physicians to prepare buffered lidocaine under the immediate-use rule and, for buffered lidocaine only, physicians can compound 12-hours in advance of using the lidocaine and NOT have to place a patient specific label on the compounded preparation. 

The rule was also changed to amend the record-keeping rules to make them slightly less onerous.

Attached is a PDF of the filed rules.

Details on the filing are available at http://www.registerofohio.state.oh.us/

Opioid Dispensing Continues to Fall – Down 41% over Past 6 Years

  • OARSS usage dramatically increased in the past 12 months from 90 to 142 million patient reports

Legislative Update

  • SB 23, “Heartbeat Bill” received considerable press coverage as it passed the Ohio Senate this week. Senator Stephanie Kunze (R-Hilliard) and 3 Republican colleagues joined all Democrats in opposition. The bill still contains criminal liability provisions for physicians. The bill is expected to be considered, and passed, by the House of Representatives in the coming weeks. The Senate President is saying the bill is likely to be challenged and may end up at the US Supreme Court.

  • Healthcare Value. The House Health Committee held a hearing this week around issue of “increasing value” in healthcare by promoting competition. While no bills were being considered, legislators discussed issues like price transparency, health savings accounts, telemedicine, alternative health clinics, and patient access to information.

February 1, 2019 - Legislative/Advocacy Update

With November election over, the Ohio Legislature is in its "Lame Duck" session. This term is used to describe the period when there are legislators who did not run for re-election or were defeated, but these legislators are still in office until the end of year. 


This political situation is accentuated by the end of the two-year General Assembly where any legislation that is not passed by both houses of the General Assembly by the end of the year will be thrown out and all proposed legislation must start over from scratch in January of 2019 with the newly elected members of the Legislature for the next two-year period of 2019-2020.

UPDATES ON SOME CURRENT ISSUES OF INTEREST

Tort Reform: House Bill 7.
This bill passed the House earlier in 2018 and now we are pushing to have it clear the Senate and go to Governor Kasich for his signature. HB 7 further helps physicians’ malpractice legal environment, and thus lowers insurance premiums, with several changes. Two examples include

Reducing the universal naming in a lawsuit of all providers involved with a patient by requiring of "an affidavit of merit" for each defendant that is named by the plaintiff

Not allowing expressions of sympathy, empathy or apologies for an undesired health outcome to be used against a physician in a malpractice suit

On Thursday, November 29, the bill passed the Senate Judiciary Committee, chaired by a Franklin County Senator, Kevin Bacon. As we now move to getting the bill scheduled on the floor of the Senate, prospects are encouraging for passage and signature by Governor Kasich in December.

Scope of Practice: House Bill 191 and Senate Bill 301.
These companion bills would expand the scope of practice of Certified Registered Nurse Anesthetists. A number of physician organizations and specialty societies have raised patient care concerns. Central Ohio physicians Drs. Anne Taylor and Robert Derick were among those testifying in opposition.

Limiting Insurance Coverage: House Bill 450. This bill is being promoted by some insurance and business interests as a way to make it more difficult to enact change to Ohio’s health insurance policy requirements for minimum coverages. The House of Medicine coalition of physician and hospital organizations opposes this bill. The attached letter provides detail.

Thanks for Public Policy Co-chairs Drs. Stephanie Costa and Bill Cotton for their leadership on these and many other issues of importance to doctors and our patients.

Coming up on the Public Policy Committee Agenda:

  • A CMA sponsored reception to recognize newly elected State Representative Beth Liston, MD
  • Small group health policy and relationship building meetings with individual legislators
  • Potential health care forums for Central Ohio legislators and physicians
  • Potential CMA support for new, best of class techniques for patients to dispose of unused medications

September 30, 2019 Legislative/Advocacy Update

Current policy issues that are being addressed include:

  • Science based policy standards for issues like vaccination, education, patient/physician communications, women's health
  • Out-of-Network Billing, or “Surprise Billing”
  • Mental Health Parity
  • Scope of Practice
  • Decreasing Barriers to Treatment for
    Mental Illness & Substance Use Disorders
  • Medical Price Transparency
  • Medicaid
  • Vaping/E-Cigarettes/Smoking Cessation
  • Firearm regulation/safety

June 13, 2019 Public Policy Committee Meeting Record

  1. Attending: Bill Cotton, Bob Falcone, John Stechschulte, Kathy Harter, Ean Bett, Mehran Mostafavifar, Mark Bechtel, Doug Weaver, Becca Glowinski, Malcolm Porter, Lisa Oyer

  2. On-Going Legislative Issues Review - see Bill Status Report

** bills marked with stars have received hearings post-budget

HB 165

Health Education Standards

Not receiving hearings: no discussion

HB 177

APRN’s

Not receiving hearings: no discussion

HB 224

CRNA’s

Not receiving hearings: no discussion

HB 268

Vaccination

Not receiving hearings: no discussion

** HB 323

Psychologist Prescription Authority

Oppose

** HB 329

Prohibit Tanning Under 18

Support. Dr. Bechtel talk on behalf of CMA

SB 61

CRNA's 

Not receiving hearings: no discussion

SB 72

Fireworks

Not receiving hearings: no discussion

** SB 97

Price Transparency

Neutral. Appears to be impacting hospitals only.

** SB 198

Surprise Billing

Confirmed ACEP support. CMA supporting as well.

** SB 208 +

Abortion Survival + others

Communicate opposition based on lack of science behind SB155 and SB208 and criminalization of doctors.

SB 221 +

Gun Regulations Proposed by Governor + others

Support need for research. Dr. Mostafavifar to speak for CMA on research issues.

Interest in gun safety proposals that may emerge.

 

Committee discussed and concluded that support for yet to introduced bi-partisan House legislation on LGTBQ rights would be appropriate to support as a way to support patients and access.

Related: discussion was had about the lack of science behind conversion therapy and supporting SB130 which would ban healthcare professionals from engaging in the practice with patients under 18

  1. CMA Board organizational discussion/input: is there a role for CMA re:
    1. Vaping
    2. Mental health access
    3. Women’s health
    4. Addiction
    5. Role of science

Committee members discussed the connections of these issues and ways that they related to CMA and affiliates. Board members Cotton, Mostafavifar and Falcone will share the committee’s discussion with CMA Board.

 Politics/PAC/2020

    1. PAC fund status September event raised $4,100 from 17 contributors
    2. 2020 Central Ohio candidate screening Will replicate past practice. Due to March primary in Presidential election year, we may move the timing up to spring, which would potentially allow more med student participation
    3. 2020 Healthcare information for CMA members Bett talked about upcoming November session. No additional ideas identified at this point.
    4. Background: Medical Malpractice and Ohio Supreme Court There was discussion about the history of tort reform and different political parties’ propensity to support different healthcare positions. There is interest to invite Supreme Court candidate to discuss/hear concerns. Committee does not want to engage in political endorsement process but use the forum as educational only. Likely to try to invite D and R candidates to separate forums.
  1. Emerging Trends on “Medicare for All” – November 7 at 6:00 p.m. Flyers distributed.
  2. Next meeting: December 19? (identified as tentative on calendar)