State Update

Rick Frank OHA State Policy and Advocacy 1

State of Ohio’s Budget

• Actual spending in State Fiscal Year 2012 was $372 million below estimated spending – SFY 2012 came to a close on June 30, 2012 • $235 million was transferred into the state budget stabilization fund – Prior balance before transfer was 89 cents.

• Ohio’s unemployment rate lowest since October, 2008 2

Questions?

Rick Frank, Director of State Policy & Advocacy ( [email protected]

) 614-221-7614 3

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Pace of the 129

th

Assembly General

Break-neck speed – Of Budget years are typically reserved for symbolic measures that can be used for election: • To date 931 bills have been introduced • 142 (15%) of those bill have been passed and enacted – Many pieces of legislation dealing with health care issues.

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Priority Health Care Legislation

• Mid-Biennial Budget Review (MBR) • Duplicative Data Reporting • Infectious Waste Law Reform • Surgical Techs • Patient Continuity of Care • State False Claims Act • Authentication of Verbal Orders • CRNA Scope of Practice • PA Scope of Practice 5

Other Legislation

• Genetic Counselor Licensure • Stroke System of Care • ER Physician Immunity • Circulating Nurses • Breast Reconstruction 6

Mid-Biennial Budget Review (MBR)

• Started as a move towards annual operating budgets • Eventually was broken into 9 different pieces of legislation • Main MBR contained a number of health care related provisions.

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Ohio Infectious Waste Law Reform

• Substantial Revisions to Ohio Infectious Waste Statutes – Eliminates unnecessary requirements for labeling, packaging and transportation of infectious waste – Simplifies the way hospitals must register with the Ohio EPA – Modernizes definitions such as infectious waste and sharps – Reduces the OEPA fee 8

Duplicative Data Reporting (OHA Initiative)

• Streamlines and eliminates duplicative data reporting • Eliminates the Hospital Measures Advisory Council (HMAC) • Replace with true quality data from hospitals 9

Surgical Technologists

• Would establish minimum requirements for STs, including: Graduation from accredited ST program; National certification exam; CE • Bill would eliminate OTJ of STs • Problems for small/rural hospitals: – Workforce/recruitment challenges – On call requirements of bylaws and ACOG, others • Other problems : – No data to support need for legislation – No data to support improvement in quality – OTJ seems to produce qualified STs – Increasing costs w/o improving quality – No national quality orgs. require certification 10

Patient Continuity of Care

• Bill requires employer to do one of following upon termination of physician’s employment for any reason: – Send notice of termination to each patient who received services from physician in 2-year period preceding termination; or – Provide physician a list of patients and contact information • Notice must be sent w/in 10 business days of termination and include: physician’s name and new contact info (if known); date physician will/did cease practice; contact info for another physician employed by employer • Except: – Physicians who render services on episodic basis and do not expect to see patient again for related services • OHA and Members working with Legislature 11

False Claims Act

• Being pushed hard by AG DeWine • Very similar to Federal FCA: – Whistleblower brings case on behalf of state – State can choose to intervene – Huge penalties: Up to $11,000/claim; treble damages – No “intent to defraud” necessary • OHA working with Ohio Alliance for Civil Justice June 4, 2012 12

Authentication of Verbal Orders

• Would require hospitals to have policy to require authentication of verbal orders: – w/in 30 days if hospital has “read back and verify” policy – w/in 48 hours if hospital does not have such a policy • Under convoluted series of federal regs, OHA at one time thought state legislation was preferred • However, an imminent federal reg cleans this up and renders state bill unnecessary – Federal reg will defer to hospital policy to determine timeliness of authentication 13

CRNA Scope of Practice

• Bill would authorize a CRNA to issue medication orders under which CRNA directs a RN, LPN, or RT to administer certain drugs in perioperative setting.

– CRNAs are already authorized to perform this function themselves; – Bill would allow them to delegate that function • Strong OHA member support from large and small • Strong opposition from OSMA /Anesthesiologists 14

PA Scope of Practice

• Bill expands PA scope of practice to, for example, grant them authority to: – Prescribe Schedule II drugs (in MBR too) – Pronounce death – Prescribe PT and OT – Insert and remove chest tubes – Write DNR orders 15

Other Enacted Legislation

• •

State Budget

– Contained many provisions that impacted hospitals and health care

APN Prescriptive Authority

– APNs authorized to prescribe Schedule II drugs in various health care settings, including hospitals, entities owned/controlled by hospitals/health systems, SNFs, ASCs, hospice, others •

Regulation of “Pill Mills”

– Licensure requirement for “pain management clinics” – OHA secured exemption for hospital/system owned clinics – OHA has so far successfully opposed imposition of certain practice standards that apply in licensed pain clinics 16

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Other Legislation

Genetic Counselor Licensure

– Requires genetic counselors to be licensed by OSMB; mainly AMCs and Children’s Hospitals

Stroke System of Care

– Establish stroke system similar to trauma; data reporting;

ER Physician Immunity

– Qualified immunity for ER physicians in disasters and when in compliance with EMTALA; OHA seeking amendment to include hospitals

Circulating Nurses

– Requires CN for most invasive procedures

Breast Reconstruction

– Requires hospital to provide info on reconstruction 17

Medicaid Managed Care

• New Medicaid Managed Care Companies were selected on April 6 th • All were selected for Statewide • Appeals resulted in further changes • Still in the court system 18

Affordable Care Act

• United States Supreme Court has ruled the Federal Affordable Care Act as Constitutional.

– Two main Issues remain • Implementation of state Insurance exchange or federal exchange • Implementation of Medicaid expansion 19

States with Enacted Insurance Exchanges

15 STATES (and DC)

MEDICAID EXPANSION

States that will participate or are leaning toward participation

13 STATES (and DC)

MEDICAID EXPANSION

States that are

NOT

participating or are leaning that way

10 STATES

And then there are all the rest

OHA Board of Trustees

Including Ohio

May 8, 2012 23

Questions?

Rick Frank, Director of State Policy & Advocacy ( [email protected]

) 614-221-7614 24