LEGISLATIVE REPORT

ACOG, OHIO SECTION

JANUARY 30, 2009

CAROLE J. ROGERS

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HIGHLIGHTS 2008, THE 127^TH GENERAL ASSEMBLY

In 2008 ACOG, Ohio Section was actively involved in monitoring and talking with legislators about 21 bills and provided written and in person testimony on 5 bills. The Healthcare Simplification Act, H.B. 125 supported by the majority of medical organizations, passed and was signed into law by the Governor.  The law established committees, led by the Ohio Department of Insurance (ODI) that have continued to work on issues of claim adjudication, eligibility determination and favored nation clauses for a more efficient insurance contracting process.

ACOG, Ohio Section also testified on fetal burial legislation, S. B. 175.  Despite our opposition, this bill did pass but our testimony and advocacy resulted in changes to the bill that made it a much less burden on a physician’s medical practice.  ACOG, Ohio Section sent a packet of information about the bill to all Ohio ACOG members.

ACOG, Ohio Section conducted its second annual Statehouse Day featuring administration and legislative speakers on healthcare reform and hosting a legislative reception for the general assembly.  We continued to monitor and participate in a number of government administration workgroups and committees on women and children’s healthcare issues and issues that impact on the practice of medicine.

These meetings included briefings on the budget by Governor Strickland and the Director of Ohio Budget and Management (OBM) Pari Sabety and a meeting with the Governor’s new Legislative Director, Kris Long.   ACOG also filed an Amicus Brief in an Ohio Supreme Court case, Roe vs. Planned Parenthood of Southwest Ohio supporting the confidentiality of patient records. The lame duck session was monitored for any last minute health care issues or issues impacting on the practice of medicine.  All legislation from 2007-2008 died when the legislature went sine die on December 3l, 2008.

128^th GENERAL ASSEMBLY

The Democrats won control of the House in the November elections with the alignment now of 53 Democrats and 46 Republicans.  The Republicans retained control of the Senate with 21 Republicans and 12 Democrats.  There are 40 new members and 33 of these are “true” freshmen, members who have never before served in the legislature  The dominant issue for the next five months will be the FY 2010-FY 2011 budget which is the major policy and funding piece of legislation for the state.

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 During January, the House and Senate elected new leadership and established their rules and committees.  The new Speaker of the House is Armond Budish, (D) Beachwood and the new minority leader is Bill Batchelder, (R) Medina. Bill Harris (R) Ashland was re-elected President of the Senate and the new minority leader is Capri Cafaro, (D) Hubbard. The Governor gave his State of the State message to the General Assembly on Wednesday, January 28.  The Executive budget will be released on Monday, February 2.

ACOG BUDGET AGENDA FY 2010-FY 2011

The Governor is proposing a balanced budget, as required by Ohio’s constitution, with no new taxes. This policy decision means severe cuts are necessary due to the grim economic status of Ohio and the nation. The administration has already cut millions of dollars from the current budget to try to keep it balanced through June 2009.  There is a projected $7 billion deficit over the next biennium.  The Governor’s State of the State speech focused on education as the priority. The Governor will use expected Federal funds to fill some gaps in revenue.  It is expected that Rep. Vernon Sykes, (D) Akron will be the new Chair of the House Finance Committee and Sen. John Carey, (R) Wellston will continue to chair the Senate Finance Committee.

Given this economic background, it is unlikely that healthcare providers can obtain any new dollars for services and it is a good time to look at issues that are revenue neutral or that would save the state money.  These issues were discussed at a meeting OSMA held for specialist organizations and at the Coalition of Primary Care Physicians on Friday, January, 23. ACOG, Ohio Section Budget bill recommendations are as follows:

MEDICAID

1.  Keep Medicaid physician reimbursement issue on the table and in discussions with     legislators as a part of healthcare access. 

2.  Apply Ohio’s prompt pay law to Medicaid managed care plans.

3.  Require one statewide formulary for all plans

4.  Stipulate a time frame for prior authorization in plan contacts

5.  Provide an evaluation process of plans from providers

6.  Insure that plans have adequate reserves and are solvent

WOMEN’S HEALTH CARE

1.  Continue to support and provide leadership to obtain a federal waiver to extend family planning services

2.  Maintain funding at the current level for the Ohio Department of Health (ODH) Child and Family Health Services which provides family planning and prenatal care to women who are poor and are uninsured or underinsured.

3.  Maintain funding for the ODH cervical and mammogram screening services

4.  Support presumptive eligibility for pregnant women 5.  Ensure that Federal funds for health information technology that may be coming to Ohio is used, in part, to help physicians convert to electronic records.

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LEGISLATIVE AGENDA 2009

1.  Insurance reforms:  Continue to support a contracting process that is efficient, simplified and transparent;  ensure physician ranking is done on evidence based guidelines for quality care not cost-efficiency;  limit take backs to 6 months and prohibit denial of payment for prior authorized services that have been provided; require standardization process for electronic insurance eligibility verification; require more transparency on insurance rate increases;  require a minimum amount of premiums be spent on health services and give ODI oversight and compliance powers on these issues.

2.  Scope of Practice:  Continue to work with all medical organizations on preserving the physician’s scope of practice.

3.  Medical liability:  Keep this issue before legislators and look for opportunities to secure a shorter statute of limitations for minors.

4.  Language change/Attorney General Review:  Review the current interpretation of the law as prohibiting nurses from helping physicians on abortion procedures; language changes as may be necessary to change this definition/interpretation of statute. 

5.  Access to healthcare:  Continue to work with legislators, all stakeholders and the administration on healthcare reform initiatives especially issues on provider capacity, women’s healthcare, and extended health care coverage.

Many of these issues, especially on insurance reform, are identified as legislative priorities on the OSMA legislative Agenda.  Some of the issues on Medicaid and access to healthcare also were discussed and identified as priorities at the Coalition of Primary Care Physicians at our meeting on January 23, 2009.

PATIENT CENTERED MEDICAL HOME

A medical home is not a new concept and is an approach to medical practice first advocated by the Pediatricians especially for chronically ill children.  The Academy of Family Physicians also has advocated for this method of practice centered on a medical home for all patients.  Recently, the concept has experienced renewed interest by the federal government, the Ohio administration, legislators, managed care plans, and health consumer advocates.  Ohio’s managed care plans recently announced that they are providing “coordinated care” as called for in medical home plans. 

The Coalition of Primary Care Physicians, attended by Dr. Tom Burwinkel and Carole Rogers, discussed this issue at the coalition meeting on Jan. 23.  The Coalition (except for the Ob-Gyns) has produced an education piece for legislators, stakeholders and the public on the medical home. (Information available at the ACOG, Ohio Section meeting 1/29/09.)  The coalition wants to take the lead on this issue in areas such as defining a

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medical home, establishing criteria, supporting pilot projects and helping implement any proposals in Ohio. The Joint Principles of the Patient Centered Medical Home developed in February 2007 by the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association are:  “Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care; Care is coordinated and/or integrated across all elements of the complex health care system and the patient’s community; A personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients; The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals.”

The American College of Obstetricians and Gynecologists has concerns about the medical home and has established a committee to discuss and work on our position on this issue.  Dr. Craig Strafford from Gallipolis is on this committee. Two of the concerns are direct access for women to Ob-Gyn services and any definition that would preclude Ob-Gyns from practicing as a medical home for women.  ACOG, Ohio Section needs to consider this issue and decide on a position that is in compliance with the national ACOG position.

STATEHOUSE DAY/LOBBY DAY

At the last meeting of ACOG, Ohio Section, Council members expressed an interest in sponsoring a lobby day in 2009.  The general consensus seemed to be that in a budget year, odd numbered years, we plan to meet with legislators in their offices instead of planning a day of administrative and legislative speakers.  We need to confirm this option, decide on a date and decide whether to hold a legislative reception.(legislative calendar enclosed)

The meetings with legislators must be held on a Wednesday.  The board meeting and briefing for legislative meetings can be held on Tuesday evening.  If the Council wishes to host a reception, it could be held on Wednesday from 12:30 p.m. to 1:15 p.m. since session is scheduled for both houses at 1:30 p.m.  If there is no reception, we could do legislative briefings early Wednesday morning and have the board meeting at 1:30 p.m.

The cautionary note for the reception is that we must be able to ensure a good attendance from Ob-Gyns from the various geographical areas of the state.