Week 8 Legislative Update

It was an incredibly busy week at the capitol for issues of importance to the medical community. In addition to a highly-successful Physician Day on the Hill on Wednesday, this week also saw floor debate on multiple bills impacting the physician community. Among the issues to see action this week, were the following:

 

Telehealth Parity

On Monday, the House took up and passed HF 2305, which establishes commercial insurance telehealth coverage parity. The bill represents incremental progress in the fight to ensure that practices have assurances, prior to investing in the technology and infrastructure necessary to offer telehealth services, that those services will be covered by commercial insurers if they are a covered service for in-person visits. Following a brief debate and adoption of an amendment to clarify that this coverage parity also extends to mental health services, the House unanimously passed the legislation to the Senate. A Senate subcommittee on the bill is expected to be held soon and the bill appears likely to easily pass that chamber in short order.

 

Opioid Abuse

On Monday, the House took up and unanimously passed HF 2377, the opioid omnibus bill we’ve been telling you about for the past few weeks. As expected, multiple amendments were put forward to expand the breadth of this already extensive piece of legislation. Among these was a proposal by House Democrats to incorporate a variation of the syringe exchange legalization legislative language that is currently moving as standalone bill SF 2294 in the Senate. While attaching this legislative language to a larger piece of legislation that is moving is a common practice, the issue of syringe exchange is one that requires extensive education to ensure legislators understand the importance and benefits of such a measure. Given the standalone bill that is moving in the Senate, advocates for the measure have focused primarily this session on educating Senators and urging passage in that chamber. The House is not ready to take up the issue and, at the urging of the of the syringe exchange advocates, the amendment’s sponsor withdrew his request to allow more time for legislator education.

 

Another amendment that was put forward during the House floor debate incorporated several of IMS’s requests to narrow the breadth and burden of the prescription monitoring program (PMP) use mandate we told you about last week. Under the original bill, all prescribers would have to access the PMP themselves prior to issuing a prescription for any controlled substance. At the urging of IMS, the House amendment clarified and narrowed this mandate so that prescribers’ designated agent accessing the PMP on their behalf could satisfy the PMP use mandate, and that the PMP must only be checked prior to issuing opioid prescriptions. This amendment will allow for continued use of designated agents so as to minimize the workflow impact for physicians in the exam room and eliminate the burden of PMP checks for physicians issuing non-opioid prescriptions.

 

The final amendment of note that was adopted as the House debated HF 2377, was a mandate that the licensing boards adopt rules requiring all licensed providers receive continuing education regarding the CDC opioid prescribing guidelines. Since 2011, the Iowa Board of Medicine (IBM) has mandated that physicians who provide primary care services receive a minimum of two hours of continuing medical education (CME) on chronic pain management every five years. CME courses on the CDC prescribing guidelines are frequently utilized today to comply with this mandate. Since its adoption, the broadly-written IBM mandate has led to significant confusion and inconsistent answers from IBM staff as to which physicians must comply with this CME requirement. In addition, specialties like pediatrics who rarely if ever treat patients with chronic pain, have been required to comply with the mandate. Under the amendment adopted this week all physicians, even those who don’t even have a CSA registration to allow them to prescribe medications, would be required to receive training in the CDC opioid prescribing guidelines. Now that HF 2377 has moved to the Senate, leaders in that chamber are working on their own amendment to the bill. IMS is crafting amendment language to narrow the scope of the CME mandate and will be using this as an opportunity to replace the confusing

 

Pharmacist Statewide Protocols

IMS continued to work behind the scenes this week to halt the amendment from the Iowa Pharmacy Association (IPA) that we told you about last week, which would expand the negotiated pharmacist statewide protocol legislation to allow pharmacists to administer the HPV, Tdap, and meningococcal vaccines to patients as young as 13 years of age. IMS met with leaders in both chambers to voice concern over this proposal and emphasize that the medical community has engaged in good faith attempting to strengthen the existing statutory process for pharmacist immunizations, which maintaining strict controls and reporting mechanisms to communicate immunizations back to a patient’s primary care physician.

 

In recent weeks, IMS has called upon physician leaders from our organization, as well as several other members of Team Doctor, to contact legislators and voice concerns over the IPA amendment. Thanks to these concerted efforts, we have successfully turned the tide in Senate and IPA notified IMS late on Wednesday night that they would not be pursuing the age reduction components of their amendment that were of concern to the medical community. The Senate is expected to take up SF 2322, with a technical amendment, early next week.

 

Behavioral Health

HF 2456, the legislation to implement the Complex Service Needs Workgroup recommendations to strengthen Iowa’s behavioral health system, saw considerable discussion this week. On Tuesday, the House took up and unanimously passed the legislation, which represents more than a year’s worth of work by stakeholders including the physician community, hospitals, mental health providers, patient advocates, and law enforcement. As with the opioid bill, HF 2456 saw multiple amendments filed that sought to refine and expand the scope of the legislation. Among these was a highly-controversial amendment pertaining to domestic violence orders and surrendering firearms. The amendment, while addressing an important issue that merits discussion, would have made HF 2456 significantly more controversial measure and threatened to halt progress on the numerous meaningful reforms included in the Complex Service Needs Workgroup recommendations.

 

At the urging of IMS and other proponents of the workgroup’s recommendations, the amendment’s sponsor reluctantly agreed to withdraw his request so as to not endanger passage of the larger package of reforms. HF 2456 as a clean bill easily passed the House and now moves to the Senate where a similar package, SF 2351, has been referred to the Ways and Means Committee as a backup in the unlikely event that HF 2456 encounter issues clearing the second funnel in a few weeks. HF 2456 is scheduled for a subcommittee hearing on Tuesday and is expected to be taken up by the full Senate Human Resources Committee soon.

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