Legislative Update – Week 14: Tort Reform Passes!

Date of Publication (April 14, 2017)

Tort Reform

It was another very active week at the capitol for issues of interest to the House of Medicine. Chief among these was the historic House passage of medical liability reform on Wednesday evening. This week’s Issue Analysis looks at the specifics of the final legislation, which is now one procedural vote away from final passage. Over the past few weeks, IMS has been working closely with key legislators and House leadership to secure enough votes for passage of SF 465, with a cap on noneconomic damages intact. Simultaneously, IMS was issuing targeted action alerts to physicians and clinic administrators in the districts of those House members who remained undecided about caps. 

On Wednesday, these concerted efforts paid off. With the adoption of a compromise amendment to keep a $250,000 cap on noneconomic damages, except in the most extreme cases, we were able to secure enough votes for passage of the bill. During Wednesday’s floor debate, Representative Mary Wolfe (D-Clinton) — Ranking Member of the House Judiciary Committee — specifically cited the conversations she had with local physicians and Jay Collier, Chief Administrative Officer for Medical Associates of Clinton, as part of the reason for moving to a position of support for the amended bill. In total, 12 Democrats joined the majority Republicans in voting to pass the amended SF 465, by a vote of 65-32. This marks the first time since 2011 that the full House has passed traditional medical liability reforms. The bill now returns to the Senate for concurrence on the House amendment, before heading to Governor Branstad for signature.

FY18 Budget

The House members of the Health and Human Resources (HHS) Appropriation Subcommittee voted late Thursday to move forward with a $1.766 billion FY18 HHS Budget. This budget is in line with the joint budget targets we reported last week. The vast majority of the ten individual budgets have now been released. Cumulatively, they constitute a reduction in state General Fund spending of approximately $300 million from what was originally planned for FY18 at this time last year. To achieve cuts of this magnitude, legislators are proposing sweeping reductions affecting nearly every state program, including Medicaid. The HHS budget approved on Thursday includes the $30 million in provider rate cuts that we reported last week were under consideration. These are a combination of eliminating the enhanced primary care physician rates and capping coverage for Medicare crossover claims at Medicaid rates. While IMS continues to urge legislators to look elsewhere to achieve the $13 million reduction in state spending achieved by these two payment policy changes, it appears likely these cuts will go into effect July 1, as legislators have limited options to stay within their reduced spending targets.

Bills Head to the Governor

Several bills of interest to IMS have now made their way to the governor’s desk for signature. This week, the following bills were either signed into law or are awaiting the governor’s signature:
  • SF 484 Allowing the Board of Pharmacy to utilize alternate members in certain disciplinary hearing, updating the impaired professionals program, and removing the statutory cap on funding for local controlled substance disposal programs. IMS supports this legislation, which will increase the number of local medication disposal programs and reduce the supply of opioids may be diverted and abused. The bill achieved final passage on Monday and is now awaiting the governor’s signature.
  • SF 250 Mandating that patient mammography result letters include a notification of breast density. While IMS continues to oppose this legislation, the bill does include language we negotiated to minimize the impact of this mandate and allow for greater flexibility as science on this issue evolves. The governor signed this bill on Thursday.
  • HF 233 Creating a prescriber-initiated, step therapy override process to reduce insurance barriers to care. IMS supported this legislation, which lays out four primary ways to override commercial insurance requirements that a patient first fail on other medications before coverage for the prescribed medication is approved. These are if the insurance-preferred medication is contraindicated, the insurance-preferred medication is expected to be ineffective, the patient has previously tried and failed the insurance-preferred medication or a therapeutically-equivalent medication, or the patient is current stable on the prescribed medication. The Senate approved the legislation with a technical amendment on Monday and it achieved final passage on Thursday. This legislation is now awaiting the governor’s signature.

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