The final months of 2018 were a whirlwind beyond the usual frenzied legislative activity of “lame duck” – with Ohio’s legislators staying in session until just days before the Christmas holiday, and returning for more action just days after. This scenario is extremely rare and hasn’t happened in Ohio’s legislature to this extent in decades.
What it means for Ohioans, particularly physicians and their patients, is that more legislation impacting health care made it past the finish line. The Ohio Dermatological Association (ODA) was on-hand during these fast-paced sessions and kept pace with the action to ensure the best possible outcomes for proposals that affect patient care in our state.
Here are the final results of Ohio’s 2018 lame duck legislative session you need to know:
Wins:
• Step Therapy: Physician and patient advocates have achieved a major victory with step therapy reform passing through the Ohio Legislature. The ODA worked for several years to support step therapy reform legislation (SB 56/HB 72) with a large coalition of groups representing the medical community and patients. This month, SB 56 passed out of committee in the Ohio Senate, and was then amended into another health care-related bill. With rapid momentum, the amended proposal subsequently passed through both chambers of the legislature. That bill, SB 265, was signed into law by Governor Kasich on Friday, January 4.
Step therapy reforms included in this legislation will apply to health benefit plans issued or renewed on and after January 1, 2020, as well to the Medicaid program. The reforms:
o Require a step therapy protocol utilized by a health plan issuer to be based on clinical practice guidelines or scientific evidence;
o Require health plan issuers to provide a clear, accessible, and convenient process by which a provider can request a step therapy exemption; and,
o Require health plan issuers to make disclosures with regard to a step therapy protocol.
o Specify circumstances in which a health plan issuer must grant a step therapy exemption.
o Impose deadlines by which a step therapy exemption request or appeal must be either granted or denied by the health plan issuer.
• Tort Reform: The House of Medicine backed tort reform legislation, House Bill 7 sailed through the Senate on December 5, clearing its last major hurdle before becoming law. The legislation, signed by Governor Kasich on December 19, includes numerous medical liability reforms which serve to reduce unnecessary litigation and to provide further clarity, stability and predictability to Ohio’s medical and legal communities.
HB 7 is the result of several years of work and collaboration between the OSMA and the bill’s sponsor, Rep. Bob Cupp (R-Lima), with additional support from several organizations in the health care community, including the Ohio Hospital Association (OHA). The provisions in HB 7 will strengthen Ohio’s existing medical liability statute.
The ODA is thrilled to have closed out the 2018 year and the 132nd General Assembly with this fantastic victory for our physician members.
Defeated:
• APRN Independent Practice: In the fall of 2018, legislation that would eliminate the current requirement that APRNs collaborate with a physician was once again been introduced in the Ohio Legislature. In 2016, after 18 months of working with elected officials and nurses on a similar bill, the bill that was ultimately passed made amenable modifications to the APRN scope of practice, but did not include independent practice authority. The issue returned in HB 726, which sought to fundamentally change how physicians and APRNs work together safely and effectively. Physicians all over the state worked together to prevent HB 726 from advancing forward. The ODA predicts that this issue will be reintroduced this year.
• CRNA Scope of Practice: During this General Assembly, the OSMA and the Ohio Society of Anesthesiologists, the ODA and the entire House of Medicine came together and successfully prevented HB 191, which would grant certified registered nurse anesthetists (CRNAs) undefined practice authority and prescriptive authority in Ohio, from passing through the Legislature. The original proposal contains independent practice provisions, but after revision, the bill instead proposed expansions of scope of practice that were vague and not well-defined. Physicians emphasized that there is no patient care need for change to the scope of practice of CRNAs. Additionally, there were serious concerns about patient safety and coordination of communication in care settings.
HB 191’s companion bill in the Senate (SB 301) and an alternative bill (SB 275) also surfaced. Both the OSMA and the Ohio Society of Anesthesiologists took a position of neutral on the alternative bill introduced in March, seeing it as a suitable compromise as it maintained the key facets of physician-led, team-based care. Neither SB 301 nor SB 275 passed, and this issue is expected to be reintroduced in 2019.
• Insurance Mandates: During the now-past General Assembly, a large coalition of community organizations and health associations, including ODA, expressed opposition to HB 450, which would have established extremely restrictive requirements relating to mandated health benefits already enacted in state law, as well as any future legislation regarding mandated health benefits. This proposal gained significant traction in spring 2018, but thankfully, after rallying the support of other groups in the medical community, we were able to generate enough pressure to halt it from advancing further before the summer recess, and later, from any movement during lame duck.
No mandated benefit has ever been enacted through the Ohio Legislature without a thorough and deliberative process to assess its policy implications. Proponents, interested parties, and opponents have all weighed in on various legislation in every step of the process. Therefore, the opposition coalition believes future legislatures should not be restricted by an arbitrary set of “qualifications” before new proposals can be enacted, as the current legislative process already conducts adequate, careful review of any such proposal.
Looking ahead:
The 133rd General Assembly will convene for its first sessions soon, and Ohio’s new governor, Mike DeWine, will be sworn in this weekend. As mentioned above, it is expected that some of the legislative proposals from the prior General Assembly will be reintroduced. In addition, there will be significant focus on the process of developing the state budget during much of the first few months of 2019. Governor-elect DeWine has emphasized his intentions to implement new plans and projects regarding children’s health, the drug abuse and overdose epidemic, and other matters impacting health care in Ohio. The ODA is looking forward to working with the new administration and the Ohio Legislature in the months to come on these and other important issues facing our state.