Transcript Document 717210

2016 LEGISLATIVE UPDATE
Tennessee Medical Association
Advocacy Division
IN FULL DISCLOSURE
• The information used in this CME
activity is based on educational
needs of physicians and developed
independently of commercial
influences.
• This presenter and all content
decision makers have no financial
interest to disclose.
WHAT YOU WILL LEARN
•
•
•
•
Summary of laws enacted in 2016 that
impact your practice and patients.
Summary of bills that did not pass in
2016.
Possible issues for 2017.
Opportunities to get involved in
legislative advocacy.
109th Session By the Numbers
• 2692 bills were introduced in the Senate.
• 2667 bills were introduced in the House.
• 400 bills were closely monitored by TMA’s
government affairs team because they
directly impacted, or potentially impacted,
the practice or business of medicine.
• Here are the highlights…
SECTION 1
NEW LAWS ENACTED IN 2016
E-VERIFY SYSTEM
• PC 692 amends Lawful Employment Act
of 2011, TCA 47-18-2107.
• Employers with 50 or more employees
must use E-Verify system January 1,
2017.
• http://www.everify.com/?s=rw
CHARITABLE CLINICS
• PC 766 amends several Code provisions,
effective 4/19/16.
• Allows “charitable clinics” to employ
dentists, physicians, optometrists, and
psychologists.
• Definition of “charitable clinic” for
physicians is TCA 63-6-204(j).
DIRECT PRIMARY CARE
AGREEMENTS
• PC 996 adds a new part to Title 63,
Chapter 1, effective 7/1/16.
• Allows patients to enter into contracts to
pay for medical treatment outside of the
patient’s health insurance plan.
• Sets out elements that must be in an
agreement.
MEDICAL SPAS
• PC 956 amends TCA 63-6-105, effective
4/27.
• Clarifies what types of entities must register
online with the State as a medical spa.
– Non-physician offices that meet the definition.
– Physician-owned offices that advertises as a
medical spa.
– Physician-owned offices that primarily engage in
elective cosmetic procedures.
• BME can assess an annual registration fee.
PROFESSIONAL
PRIVILEGE TAX
• PC 1010. Notice: Requires Department
of Revenue to provide notice of the tax.
– Not required by mail.
– May be electronic only.
• PC 1024. State advisory commission will
study alternatives, possible phase out or
elimination, or imposition on other
professions.
CON LAW
• PC 1043 amends Title 68, Chapter 11, Part 16.
• MRI in largest counties
– Initiation: no CON
– Additional: no CON
– Pediatric: CON
• MRI everywhere else
– Initiation: CON
– Additional: CON
– Replacement: No CON
CON LAW
• Removes the requirement for a certificate
of need for capital improvements or the
purchase of major medical equipment of
more than $2 million.
X-RAY OPERATORS
• New board to regulate operators of
radiologic imaging and radiation therapy
equipment.
• Limited x-ray machine operator licenses
available.
• Sets out ownership requirements for
businesses in which radiologic imaging
and radiation therapy procedures are
performed.
CMV
• PC 625 amends Title 68, Chapter 5, effective
7/1/16.
• Requires provider who undertakes prenatal
care or care of woman who may become
pregnant to provide women at risk of
contracting CMV with information on CMV.
– Incidence
– Transmission, birth defects, prevention
– Methods of diagnosing
MED STUDENT LIABILITY
• PC 632 gives medical students the same
liability protection as residents for acts
or omissions within the scope of their
training program in a facility.
EXPIRATION OF
“FETAL ASSAULT” LAW
• SB 1629/HB 1660 was filed to extend the
termination date of July 1, 2016, for the
law passed in 2014 that permitted the
prosecution of a woman for assault of a
fetus based on her illegal use of narcotic
drugs while pregnant.
• The bill to extend the law did not pass.
COVERAGE MANDATES
• PC 683 amends Title 56, Chapter 7, Part
10, effective March 24, 2016.
• Future mandated health benefits must
apply across the board.
• Will guarantee fiscal note so most efforts
to mandate coverage of a disease or
procedure will not pass unless covered
in the state budget.
INSURANCE COVERAGE
FOR TELEHEALTH
• PC 990 amends TCA 56-7-1002, effective
1/1/17.
• Requires health plans to reimburse
providers for Dx, consultation, and Tx of an
insured for a covered health care service
provided via telehealth.
• Adds state-contracted crisis service
provider employed by a facility licensed
under Title 33 to definition of “healthcare
services provider.”
INCREMEMENTAL
DISPENSING
• PC 656 amends Title 63, Chapter 10, Part 2,
effective 3/29/16.
• Allows pharmacist to incrementally
dispense maintenance medications up to
the prescribed dose unless the prescriber
specifies otherwise on the prescription.
• Applies up to a 90-day supply.
• Not allowed for controlled substances.
OPIOID ANTAGONIST
THERAPY
• PC 596 amends TCA 63-10-217, effective
3/10/16.
• Authorizes the State Chief Medical Officer
or local health department to issue a
standing order as part of a pharmacy
collaborative agreement to allow a
pharmacist to dispense naloxone.
• Dispensing pharmacist must complete
training program.
EPINEPHRINE AUTOINJECTORS
• PC 805 adds a new part 5 to Title 68,
Chapter 140, effective 7/1/16.
• Prescriber can prescribe a device to a
location.
• Person at location administering epi-pen
must complete a training program or
receive remote authorization by a
physician.
BINGE EATING
DISORDER
• PC 952, amends TCA 63-6-214(m).
• Legal to prescribe any drug approved by
the FDA for Binge Eating Disorder
(B.E.D.).
• As of now, Vyvanse is only FDA approved
for adult B.E.D.
CONTRACEPTIVES
• PC 942 amends provisions of Title 63,
Chapter 10, Part 2, effective 4/27/16.
• Authorizes pharmacist who undergoes
training to dispense hormonal
contraceptives to adult or emancipated
minor if a collaborative agreement is in
place.
• Board of pharmacy to adopt standardized
procedures.
• Sets out fee structure.
PAIN CLINIC LICENSING
• PC 1033 amends Title 63, Chapter 1, Part
3.
• Pain clinics must be inspected and
licensed by 7/1/17.
• Authorizes unannounced inspections.
• Burden of proof is on practice to prove it
is not a pain clinic.
• Authorizes suspension of treatment,
monitor.
PAIN CLINICS: MEDICAL
DIRECTORS
• PC 829 amends TCA 63-1-301, effective 4/21.
• Sets qualifications for being a medical
director and “pain management specialist”
of a pain clinic.
• Before 7/1/16
– Passage of ABIPP exam, part I.
• After 7/1/16
– Passage of ABIPP exam, parts I and II.
– Maintain ABIPP diplomate status.
IN-OFFICE DISPENSING
• PC 973 amends TCA 63-1-154, effective
4/27.
• Applies to in-office dispensing of opioids
and benzodiazepines.
• Clarifies that it is not limited to workers’
compensation.
• Repeals provision requiring drugs to be
“unit dosed”.
PRESCRIPTION SAFETY
ACT OF 2016
• PC 1002 re-writes Title 53, Chapter 10,
Part 3, effective 4/27/16.
• Reports of controlled drugs dispensed.
• Allows database reports to go in medical
records.
• Specifies when a prescriber must query
the database.
• TMA online Law Guide Topic MUST
reading.
MATERNAL MORTALITY
PUBLIC HEALTH AUTHORITY
• PC 987 adds a new section, TCA 33-3105, effective 1/1/17.
• State team can copy records from any
source to complete a review of a specific
fatality.
• Require persons with direct knowledge
to provide team with information.
• Immunity provided.
PHYSICIAN ASSISTANT
UPDATE
• TCA 68-55-501 amendment allows PAs
who have completed special training to
treat youth concussions.
• Podiatrists may supervise PAs and OPAs.
– Supervision may not be outside of podiatry
scope.
– PA or OPA may only Rx drugs rational to the
practice of podiatry.
ADVANCE PRACTICE
NURSE UPDATE
• Advance Practice Nurses (APNs) are now
referred to as Advance Practice
Registered Nurses (APRNs).
– Physician supervision still required.
– Certificate of fitness to prescribe still
required for APRN prescribers.
• Task force to study APRN scope of
practice; file report.
TENNCARE FRAUD
PENALTIES
• PC 744 amends TCA 71-5-260, effective
7/1/16.
• Increases penalties for TennCare fraud.
– Restitution (already in place).
– Fines depending on first, second, etc.
offense.
– Felony classes upgraded for fraud and Rx
fraud.
COVERAGE
ASSESSMENT
• PC 854 establishes coverage assessment
for hospitals at 4.52%.
• Prohibits MCOs from across the board
reductions in rates in existence on
7/1/16.
• Funds:
– GME up to $50m cap.
– Buyback of benefit limits.
TECHNICAL ADVISORY
GROUPS
• PC 1079, effective 7/1/16.
• Requires TennCare to report
recommendations of TAGs through
implementation of an episode of care.
• Requires TennCare to identify action
taken, or not taken, on TAG
recommendations.
SILENT PPO
• PC 826, effective 7/1/16.
• Bureau of Workers’ Compensation
authorized to investigate WC PPO
complaints.
• Bureau refers results to TN C&I for
possible civil penalty assessment.
SECTION 2
POSSIBLE ISSUES FOR 2017-2018
POSSIBLE ISSUES FOR
2017-2018
• Health insurance expansion; report from
3-Star Healthy Project task force.
• Balance billing.
• Removing health care liability cases from
civil justice system.
• Report from APRN scope task force.
• Physician-assisted suicide.
• Medical marijuana.
SECTION 3
ADVOCACY OPPORTUNITIES
FEEDBACK FROM
PRACTICES
• Payer Accountability – By Senator Bo Watson (R - Hixson) and
Representative Jon Lundberg (R - Bristol) - Provides financial
stability for physician practices by requiring insurance companies
to honor compensation provisions of their contracts for the term
of the agreement.
• Do you like this bill?
– If so, TMA needs your real-life examples
• What was the payer’s policy change?
• How much expected revenue did you lose?
• Ancillary fallout? Lost jobs? Cutbacks in service? Having
to outsource? Etc.?
• E-mail [email protected]
FEEDBACK FROM
PRACTICES
• Balance Billing – Farm Bureau and the rest of the health insurance
industry wants to put the onus on you to provide written notice that
patients you put in the hospital for pre-approved or elective
procedures and treatments, including imaging, may see providers
that are not in network. They don’t want you to be able to balance
bill patients on top of the low ass reimbursements they pay.
• Do you have time and are you the best equipped with information
to do this?
– No!
• Do you want to lose your ability to balance bill out-of-network
patients?
– No, you don’t!
– You need to take action!
GRASSROOTS
tnmed.org/grassroots
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Dialogues in the
District
Doctor of the Day
Legislative calls
to action
IMPACT
DAY ON THE HILL:
MARCH 7, 2017
What’s your
PITCH?
• Show support for issues that affect YOUR doctors,
practice, and patients.
• Attending Day on the Hill gives YOU an
opportunity to hear from TMA lobbyists who
represent physicians every day.
• Watch committee meetings on hot issues related
to your profession.
All politics are local
GRASSROOTS
tnmed.org/grassroots
• Legislators’ continued success depends on you,
their constituents. They are willing and eager to
listen to you, an EXPERT on healthcare.
• On average, 300 pieces of legislation filed by the
General Assembly annually affect the practice of
medicine in Tennessee. Elected officials need to be
educated by PRACTICE MANAGERS on how issues
affect the day-to-day operations.
All politics are local
GRASSROOTS
tnmed.org/grassroots
• TMA’s strength comes from membership. For every
physician who is not a TMA member, it weakens
our “one voice” message on the Hill.
• Lobbyists can carry a message but YOU, as friends
and constituents, are KEY to showing policy makers
how important issued are to the medical
community.
All politics are local
GRASSROOTS
tnmed.org/grassroots
If you would like to become a key contact for
TMA’s grassroots initiative, learn more about
advocacy, or be a Doctor of the Day on the
Hill…
Contact:
Rebecca Lofty
[email protected] | 615.460.1659
@tnmedonthehill
In the words of the late Robert Kirkpatrick,
MD, former TMA President, Memphis…
“Follow the Money”
Protect the Future of Medicine
• The key to success is an
engaged TMA advocacy effort
and a strong PAC.
• The landscape of the Tennessee
General Assembly has changed.
TMA must have physician
involvement if we are going to
protect your profession.
Keep Friends in the Legislature
• IMPACT is how we ensure we have enough friends in
the Legislature to pass/defeat legislation
• IMPACT is underfunded. Trial Lawyers give to LIFT
(Lawyers Involved For Tennessee) PAC $17 to $1 for
TMA
• Lawmakers have tremendous respect for TMA. By
growing IMPACT, they may fear us as well.
IMPACT is Crucial for Legislative Success
• IMPACT is our best opportunity to
ensure that we elect/re-elect lawmakers
who are friends of medicine.
• You may not like politics but make no
mistake, YOU ARE IN MEDICINE,
THEREFORE YOU ARE IN POLITICS.
Ready to Join the Fight?
 Join TMA
 Donate to IMPACT!
 Corporate donations
 Individual donations
 Sign up and SHOW UP for DAY ON THE
HILL 2017
 Volunteer in our Grassroots Program
 Sign up for Doctor of the Day at the
General Assembly
USEFUL INFORMATION
TMA Govt. Affairs Team
Yarnell Beatty – Vice President,
Advocacy
[email protected]
Julie Griffin – Dir. of Government
Affairs
[email protected]
Katie Hitt – Asst. Dir. of Gov’t Affairs
[email protected]
Rebecca Lofty – Grassroots
Coordinator
[email protected]
Kelley Mathis – Leg. Specialist/IMPACT
[email protected]
TMA Phone Numbers
(800) 659-1862
(615) 385-2100
TMA Website
tnmed.org
Tennessee General Assembly
capitol.tn.gov
QUESTIONS?