01/08/2019

Ohio’s Lame Duck Legislative Session 2018 – What Happened & What You Should Know

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 State Medical Association (OSMA) 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:

Tort Reform: The OSMA-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 OSMA is thrilled to have closed out the 2018 year and the 132nd General Assembly with this fantastic victory for our physician members. For more details on HB 7, please see our Health Matters story from December 6, 2018.

Step Therapy: Physician and patient advocates have achieved a major victory with step therapy reform passing through the Ohio Legislature. The OSMA 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:

• Require a step therapy protocol utilized by a health plan issuer to be based on clinical practice guidelines or scientific evidence.
• Require health plan issuers to provide a clear, accessible, and convenient process by which a provider can request a step therapy exemption.
• Require health plan issuers to make disclosures with regard to a step therapy protocol.
• Specify circumstances in which a health plan issuer must grant a step therapy exemption.
• Impose deadlines by which a step therapy exemption request or appeal must be either granted or denied by the health plan issuer.

For more details on this momentous reform legislation, please see our Health Matters story on the step therapy law from December 20, 2018.

Physician Assistants Scope of Practice: The version of SB 259 signed into law on December 19, which makes changes to the scope of practice of physician assistants in Ohio, comes as a result of significant collaborative efforts between the legislative sponsor, the OSMA, the proponents, and other interested parties. When SB 259 was introduced, the OSMA and other interested parties met with the sponsor and the PAs to discuss the changes it would make to current PA practice laws. While the OSMA had no objections to many of the changes in the proposal, at this time, the advocacy team did express a few concerns about a handful of provisions of the bill. Thankfully, the sponsor and proponents were willing to consider these concerns, which resulted in several amendments to the legislation. With these issues addressed, the OSMA was able to take a position of neutrality on SB 259.

The OSMA is committed to evaluating scope of practice proposals through collaborative discussion between all involved parties. During the legislative process, concerns may arise about the implications of scope of practice changes, and using cooperative efforts to address these concerns is the best way to avoid safety risks and other negative impacts upon patients, as well as develop robust legislative proposals with tangible patient care solutions. SB 259 progressed through legislative proceedings fairly smoothly and efficiently using this deliberative, thoughtful and effective approach to scope of practice legislation.

Physical Therapists Scope of Practice: The original version of HB 131 as introduced would have permitted physical therapists to evaluate, diagnose, and determine a treatment plan for a patient, as well as order tests and imaging. Currently, a PT is authorized to assess, but not diagnose a patient’s condition. Several versions of the bill over multiple General Assemblies have met with strong opposition from the physician community, including the OSMA. Physicians argued that allowing PTs to diagnose without the adequate medical education and training to do so would negatively impact patient care.

After years of advocacy work and considerable deliberations on HB 131, in 2018, the OSMA was finally successful in getting significant changes made to the language. The newer version of the bill, which no longer gives PTs the authority to give a patient a medical diagnosis or the ability to order tests and imaging, passed out of both chambers of the Ohio Legislature. The OSMA was able to take a position of neutral on the substitute version of the bill, which was signed into law by Governor Kasich on December 19.

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. The OSMA called upon members to participate in a grassroots advocacy campaign by messaging their elected officials about this bill to ask that they oppose it. Physicians all over the state and the OSMA advocacy team worked together to prevent HB 726 from advancing forward. The OSMA 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 have 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.

Psychologists - Prescriptive Authority: In 2018, the deliberations over HB 326, which would have authorized certain psychologists to prescribe psychotropic drugs for the treatment of drug addiction and mental illnesses, heated up. An alliance of groups in the medical community including the OSMA, the Ohio Academy of Family Physicians, and the Ohio Psychiatric Physicians Association, maintained that psychologists do not possess the proper medical training and education to prescribe drugs to patients. Physician groups believed that the pharmacological training mandated by this legislation for psychologists who wish to prescribe was insufficient and posed a patient safety risk.

During the last sessions of 2018, there were no changes to the bill to address concerns raised. HB 326 did not pass before the end-of-year deadline, but is expected to resurface in 2019. The OSMA and the rest of the coalition opposing this measure are dedicated to working together on a solution, and will continue advocating for physician-led, team-based care.

Insurance Mandates: During the now-past General Assembly, the OSMA and a large coalition of community organizations and health associations 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, the OSMA was 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 OSMA 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 OSMA 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.