State House News: April 29 - May 6
Doctors of the Day
Thanks to Mark Salley, MD (Columbia) for his volunteer service at the State House last week!
MD Legislator Introduces Medicaid Expansion Legislation
Rep. Kris Crawford, MD (R-Florence) introduced H. 4095, “Truth in Health Financing and Responsible Consumer Health Care Act”, last week calling for acceptance of federal funds for the expansion of Medicaid under the federal Affordable Care Act (ACA), but proposes using the money to create medical savings accounts for the state’s uninsured population.
Rep. Crawford’s bill would commit the state to the program for three years through 2016, the idea being to gather data and assess how well the plan works before deciding to pursue it beyond an initial three year period. The proposed program would be administered by SC DHHS and run through managed-care organizations contracted with the state.
If passed, the bill would require the state to obtain waivers from the federal government to be able to utilize ACA expansion funds in a different way than originally intended.
This contentious issue has drawn partisan debate for many months, with Gov. Haley and many Republicans contending that expansion is ultimately too expensive and will not adequately solve the state’s health and access problems, while Democrats say full expansion would bring needed coverage to hundreds of thousands of citizens and create many health care jobs in the state, a position also maintained by the SC Hospital Association.
H.4095, while being introduced just weeks before the end of the legislative session, is very unlikely to pass this year, has been referred to the House Ways & Means Committee for discussion.
Concussion Bill Amended and Advanced in Senate Subcommittee
S.565 (Fair) and its House companion bill, H.3061 (McCoy), were heard in a Senate Education subcommittee last Wednesday morning. Both bills require DHEC to post best practices, model policies and national standards in an effort to educate coaches, parents, athletes and volunteers in concussion safety, recognition and management. The bills also address scenarios in which high school athletes need to be evaluated after sustaining a concussion.
With some amendments conceptually adopted, physicians making return to play determinations would need continuing medical education courses in concussion evaluation and management, as would athletic trainers, nurse practitioners, physician assistants, and possibly EMTs. Final details of the amendment will be worked out prior to full committee, but out of deference to the National Football League (the bills’ main proponents) and legislative support, the bill was reported favorably out of subcommittee.
PA Bill Sent to Governor for Approval
An SCMA-supported bill broadening the scope of practice for physician assistants, S.448 (Alexander), received third and final reading in the Senate last week. Rep. Kris Crawford, MD, who sponsored the House companion bill (H.3618), was able to recall the Senate version from committee and place it on the House calendar, thereby bypassing the House committee process in order to pass the bill by the end of session.
The bill was approved by the House on Thursday by a unanimous vote of 105-0. After a routine final reading, S.448 has been sent to the Governor for signature. Among other provisions, the bill provides for increased physician/PA ratio (3-1), broadened distance supervision, and physician supervision over the prescriptive authority of PAs while prescribing Schedule II medications in limited settings.
CPR Education Bill Advances
A bill adding CPR education to state high schools’ health curriculum, was also advanced by a Senate Education subcommittee last week. This legislation is supported by the American Heart Association and physician specialties and is aimed at preparing high school students with the requisite CPR skills to save lives with minimal cost to school districts. S. 160 (Malloy) moves to the full Education Committee for consideration.
“Adult Health Care Consent Act” Legislation Passes House and Senate, Respectively
H. 3366 (J. Smith), a bill supported by the National Alliance for Mental Illness (NAMI) and originally strongly opposed by the SCMA due to its burdensome and intrusive administrative requirements for providers, has since been amended to lessen this concern and received third and final reading in the House of Representatives last week. The bill has been sent to the Senate for consideration. The Senate companion bill, S.117 (Hayes) also passed the Senate and has been referred to the House 3M Committee.
Both bills were amended to allow providers to modify their current patient information disclosure forms by adding the phrase: “DO YOU WANT TO DESIGNATE A FAMILY MEMBER OR OTHER INDIVIDUAL WITH WHOM THE PROVIDER MAY DISCUSS YOUR MEDICAL CONDITION? IF YES, WHOM?”, instead of mandating a newly created "Patient Disclosure Authorization" form duplicative of federal HIPPA law, as well as an administrative burden on practices. The new amendment also exempts nursing homes, who are currently mandated by law to provide the form, and dentists’ offices. The bill was further amended to allow the form be provided electronically and an overall implementation date of 2014.
Medicaid Expansion Attempt Fails in Senate Finance Discussion
DHHS Director Tony Keck was subjected to intense questioning last week during the Senate Finance Committee budget process about the agency’s position on not expanding Medicaid and supporting the House’s alternative funding plan ($83million) for specific health care priorities, referred to as “Healthy Outcome Initiatives”.
Director Keck completed several hours of Q&A on the pros and cons of accepting ACA funding and how the state would address its growing health care needs without it. Ultimately, Sen. Nikki Setzler (D-Lexington) introduced a proviso to expand the Medicaid program in the budget bill. With what was expected to be a partisan vote, but was closer than expected due to the acceptance of proxy votes by absent Republican members, the attempt failed by 13-10.
The full committee adopted its budget plan to be discussed in two weeks by the full Senate.