LEGISLATIVE REPORT

ACOG, OHIO SECTION

July 24, 2009

CAROLE J. ROGERS

STATE BUDGET, H.B.1

We were successful on every one of our agenda items in the House and Senate budgets but then came the news of an additional shortfall of over $3.0 billion dollars in state funds and a new round of cuts followed. After passing interim budget resolutions to comply with Ohio’s constitution, the final budget passed the General Assembly on July 13, passing the House 55-44 and the Senate 17-15.

 A report summarizing the final budget results for ACOG, Ohio Section’s agenda was sent to you by email on July 15.  (If you did not receive this report, please let me know and I will send it out again.)  Since then, I have researched the final budget documents for other items of interest to ACOG, Ohio Section .The issues and language are as follows:

1.  Termination of Provider Agreements:  Contracts can be terminated for a provider convicted of a crime; those with no claims in 2 years; and providers who do not supply an I.D. number. The provider must be notified of termination by certified mail not just regular mail.

2.  Reimbursement cuts:  On July 15, I reported to you about the 3% cuts.  You may be interested to know what this cut saves the state Medicaid program:  FY 2010 savings of $29.4 million with the state share savings of $7.9 million; FY 2011 savings of $51.6 million with the state share of $16.1 million.

3. Oversight:   Moved the oversight of Medicaid Managed Care Provider networks (including oversight of the adequacy of provider panels) from the Ohio Department of Health (ODH) to the Ohio Department of Insurance (ODI). This move is largely supported by the medical community.

4  Health Care Franchise Fees:  Authorizes the Ohio Department of Job and Family Services (ODJFS) to study funding the Medicaid program with health care provider franchise fees and stipulates that if this study is undertaken, a report must be given to the General Assembly. ACOG, Ohio Section will keep a close watch on this provision.

5.  30 Day Prompt Pay:  Applying Ohio’s prompt pay law to Medicaid Managed Health Care Plans language was in the House version of the budget but was eliminated by the Senate and did not make it into the final bill. 

6.  Imaging Services:  There is language authorizing ODJFS to implement evidence based best practice guidelines and protocols for diagnostic imaging services available under the fee for services component of the Medicaid program.  Although I will verify the application of this and other language on imaging services, the language does not seem to apply to Ob-Gyn services, i.e. ultra sound and other in office imaging services. 

7.  Insurance/Health Care Reforms:  Extends coverage to the uninsured with a number of insurance reforms.  Although the Senate deleted most of the Governor’s insurance/health care reforms from the Executive and House budgets, many of them survived in the final version.  They:  reduce the rate insurers can charge people with pre-existing conditions; require employers to offer uninsured employees the opportunity to purchase coverage with pre-tax income through so called Section 125 cafeteria plans;  make permanent the extension of state continuation coverage under Ohio’s “mini-COBRA” program from six to 12 months.; authorize dependent coverage on parent’s health insurance up to age 28.  Most important for ACOG, Ohio Section members, is the appropriation of $10.1 million for improving health information technology. 

8.  Medicaid Dispensing Fees.  The fee for dispensing non-compounded drugs was cut to $1.80 saving the sate $1.7 million in 2010 and $4.6 million in 2011.

9. Medicaid Provider Agreements:   Extends the phase in for time limited Medicaid Provider Agreements from January 2011 to January 2015. Currently, there is no time limit.

10.  Abstinence Funds:  The Senate version of the budget required the administration to apply for Federal abstinence education funds.  This language was in the final budget but was vetoed by Governor Strickland.

11.  Alternative Medicaid Management Systems:  Language authorizing alternative Medicaid management systems supported by OSMA was not in the final budget but language requiring the study of alternative managed care arrangements for Medicaid recipients who are not required to participate in the existing managed care system was added to the charge of the Ohio health Care Coverage and Quality Council. (ACOG member, Dr. Craig Strafford is a member of this Council)

12. Advanced Practice Nurses(APNs) Contracting:  ACOG, Ohio Section along with  other medical organizations signed a letter opposing a proposed budget amendment that would have designated APNs as “primary care providers” authorizing managed care plans to contract with the APNs directly for health care services.  This language was not included in the budget.

LEGISLATION, HOUSE BILLS

There are several bills that ACOG, Ohio Section is monitoring but has not taken a position on as of this report.  These bills include several which require insurance coverage for various conditions, testing/screening and treatment.  These are autism spectrum disorder; diabetes; colorectal exams/lab test; prostate, cervical and ovarian screenings and testing and a bill requiring universal health care coverage.  The bills on cervical and ovarian cancer (H.B. 135 and H.B 136) will be discussed in more detail at the next meeting on September 18.

The following is a summary of the status of bills that ACOG, Ohio Section has taken a position on or will be asked to consider action on at the Sept. 18 meeting.  More detailed information on some of these bills will be emailed to you before the meeting or will be available at the meeting.

H.B. 94:  Prescription Drug Marketing Disclosures:  Requires a manufacture or labeler of dangerous drugs to disclose and report the value, nature, and purpose of any gift to among others a licensed health care professional licensed to prescribe drugs.  Exempt from this provision would be any gift not exceeding $25.00; compensation connected with any clinical trials; and scholarships or other support for medical students, residents and fellows to attend educational, scientific, or policy making conferences of an established professional association.

The bill has had three hearings before the House Health committee and among those testifying was the director of state policy for the Pharmaceutical Research and Manufacturers Association (PhRMA)who testified about the ethical standards that member companies developed and abide by stating that the legislation is not needed. Both PhRMA and the Ohio Promotional Professionals Association, suppliers of market logoed items, also testified in support of the intent of the legislation but thought it had adverse consequences on their industry. ACOG, Ohio Section has an interested party position on this bill.

H.B. 102:  Umbilical Cord Blood Donation:  Requires the ODH to develop and post information about umbilical blood cord donation on a state website.  The Director of ODH will encourage hospitals, birthing centers and obstetricians to provide the free materials to pregnant women.  ACOG took an interested party position on this bill sending a letter to all legislators about legislative mandates on the practice of medicine. We asked for an amendment to the bill deleting designations referring to maternal health care professionals not authorized by the Ohio Revised Code. This amendment passed and is part of the bill.  The immunity provisions of the bill were reviewed and approved by national ACOG.  The bill has passed the House and the Senate Health and Human Services and Aging Committee.

H.B. 122:   Establishes standards for physician designations by health care insurers.  The intent is to protect physicians from unfair labeling and to ensure the rankings are the result of an accurate and verifiable process.  Dr. John Bastulli, vice president for legislative affairs of the Academy of Medicine of Cleveland and Northern Ohio testified before the House Health Committee in favor of the legislation.  Testimony was also provided by OSMA on the need to ensure physicians’ performance information is reliable, meaningful and that insurers should disclose to the public all aspects of their ranking system.

Recommendation:  ACOG, Ohio Section vote to support this bill.

H.B. 185:  Stipulates that a “material amendment” to a health care contract must have the agreement of both parties, the insurer and the physician/provider or it does not become a part of an existing contract.  This bill has passed the House Civil and Commercial Law Committee.  ACOG, Ohio Section is supporting this bill and has sent an email support letter to members of the committee and all members of the House.

H.B. 198:  Creates the Medical Home Model Demonstration Project for evaluating the Medical Home Model of Care as defined by the American Academy of Family Physicians.  The demonstration projects are to be located in the Dayton metropolitan area and Lucas County.  A Council is created to implement and administer the project and the bill specifies that no more than 10 physician practices be selected for participation in each geographic area. 

The bill also creates the Choose Ohio first Scholarship Program for medical students who commit to a post-residency primary care practice in Ohio for at least three years; accept a proportion of Medicaid recipients as patients without restriction, and access specific medical home training opportunities.

The bill appropriates $1,406,000 in 2010 and $2,465,000 in 2011 for the project and $800,000 in 2010 and $600.000 in 2011 to support the development of medical school curricula to prepare primary care physicians in the Medical Home Model of Care.  Several physicians from the American Academy of Family Physicians testified in favor of the bill before the House Health Committee.

Recommendation:  ACOG, Ohio Section discuss bill and adopt a position on Sept. 18.

H. B. 206   Modifies the current law governing prescribing by advanced nurse practitioners (APNs) allowing APNs to prescribe Schedule II drugs.  ACOG, Ohio Section has taken an interested party position on this bill and does not oppose it as long as the prescribing is within the parameters of current law governing the collaborative agreements with physicians. This bill is pending in the House Health Committee, has bi-partisan support and is expected to pass.

LEGISLATION/SENATE BILLS

S.B 37   Increases the excise tax rate on tobacco products to fund the Tobacco Use Prevention Fund.  ACOG, Ohio Section is monitoring this bill which is assigned to the Senate Ways and Means and Economic Development Committee.

S.B. 64   Requires health insurance coverage for colorectal exams and lab test for cancer.  ACOG, Ohio Section is monitoring this bill.

S.B.  86   Grants qualified civil immunity to a physician who provides emergency medical services, first-aid treatment or other emergency professional care in compliance with the federal emergency Medical Treatment and Active Labor Act or as a result of a disaster.  This bill has had several hearings before the Senate Judicial Civil Justice Committee.  Several physicians and medical organizations have testified in favor of the bill and as to be expected the trial lawyers and trial lawyer organizations have testified opposing the bill.  This bill would cover obstetrician/gynecologist when they are on call for emergency room duty.

The American College of Emergency Physicians has asked ACOG, Ohio Section to endorse and support this bill.  Since there have been a number of questions raised by ACOG, Ohio Section members, a more detailed Fact Sheet will be developed and emailed to members before the Sept. 18 meeting to help with the discussion and a vote on the ACOG, Ohio Section position.

S.B. 98  Establishes standards for physicians’ rankings by health care insurers.  This is the same legislation as the companion bill, H. B. 122. (See House bills)

EMERGING ISSUES:

Direct Marketing of Breast and Ovarian Cancer Tests:  You have already received information via email from AOCG, Ohio Section Chair, Dr. Tom Burwinkel, on this subject.  Before our Sept. 18, meeting, I will email you the ACOG materials and other information on this subject that will be helpful to your discussion and deciding on a course of action.

Lay Midwifery:  There is still no bill on this issue but we do know that a bill is being drafted and probably will be introduced this fall. As a follow up to the ACOG, Ohio Section Lobby Day, a letter was sent to all House members asking them to meet with ACOG, Ohio Section members and representatives before signing on to any bill on lay midwives.

I have met with the public liaisons from the Ohio Board of Nursing, the Ohio State Medical Board and the lobbyists for the Ohio Association of Advanced Practice Nurses APNs,(and midwives) and the Ohio Nurses Association.  The good news is that the APNs will oppose legislation to license or certify lay midwives.  Work on this issue with legislators will continue over the remainder of the summer.

For questions and more information email:  cjrogers65@msn.com   614-889-2247 or cell phone:  614-425-6443