The nurse practitioners have attempted to use the legislative process to again press for "independent scope of practice" authority in Oklahoma. SB 570 (Griffin/Cockroft), which was a carry-over bill from 2017 dealing with cosmetology, has been stripped and replaced with Advanced Practice Nurse Independent Licensure language similar to last year’s HB 1013.
Although this process is within the rules, many legislators consider this a tactic which avoids the transparency required for the process of open government. OSMA sent a “Call For Action” to our members to assure legislators understand this issue is about Patient Safety.
We all know that the practice of medicine is truly a "team effort" and must be guided by those professionals having the greatest training, knowledge and experience. Nurses are a vital part of the health care team and are strongly supported by physicians, but they simply do not possess the same level of training and clinical expertise as a medical doctor. Nurse independent practice will not significantly help rural health access and will create a two-tier health care system.
At a time when we already have a crisis of addiction to opioids and other powerful drugs, the Legislature should not expand prescriptive authority and allow hundreds of new practitioners to prescribe dangerous medications.
2% PROVIDER RATE INCREASE PASSES MAJOR HURDLE
The recent revenue raising measures (designed to increase common education funding) combined with general revenue increases due to economic growth has provided some budget flexibility to the legislature for the first time in nearly a decade. A $7.6 billion budget has been sent to the Governor; however, several specific appropriation measures still must be considered. SB 1605 (David/Wallace), specific to the Oklahoma Health Care Authority (OHCA) provides a 2% increase in provider rates for those servicing SoonerCare patients. Passed Senate Floor; awaiting to be set on House Floor Agenda.
The deadline for bills to get out of the opposite house (House Bills off the Senate Floor and Senate Bills off the House Floor) was April 26. Now we know what’s left for the legislature to consider.
Pharmaceutical Related Legislation
The Oklahoma Commission on Opioid Abuse, Chaired by Attorney General Mike Hunter and included Kevin Taubman, MD, OSMA President as an active participant, provided legislative recommendations to combat this national public health issue. The medical community was made well aware that substantial reform was at hand. In an effort to address some of the Commission recommendations and retain significant influence on legislation content, OSMA was pro-active and requested the filing of several pharmaceutical related bills specific to the opioid overdose epidemic.
E-Prescribing: HB 2931 (Mulready/David) Requires the implementation of a statewide e-prescribing system effective January 1, 2020. The measure allows for physicians who do not have the technical capability to accommodate such a system to request an exemption through their respective licensure board. – Passed Senate as Amended; back to the House to accept Senate Amendments
Pill Limits: SB 1446 (Sykes/Derby) Some members on the Commission requested to completely eliminate access to opioids while others desired a maximum prescription of 3-days. Due to negotiations spearheaded by OSMA, this measure allows for an initial 7-day prescription of opioids or Class II narcotics for acute pain associated with post-surgery, post-injury, or disease. A second 7-day prescription may be written but could not be filled until after the first prescription expires. Subsequently, if deemed necessary by the physician, 30-day prescriptions associated with a pain management plan and three-month “course of treatment” reviews must be established – Sent to the Governor
SB 1128 (Yen/Derby) This legislation revises the pill limit measure. Similar to SB 1446, this bill would allow the initial prescription for post-surgery to be 14 days. Passed House; to Senate to consider House Amendments
Pain Management Clinic Regulation: SB 1124 (Yen/Derby) Similar to the qualification that attorneys are required to own law firms and engineers are required to own engineering firms, pain management clinics should be owned by MD’s or DO’s and should be licensed and regulated. Currently, they can be owned by non-physicians and provide limited oversight. OSMA requested Sen. Yen, MD, to author a Pain Management Clinic Regulation bill. – Not heard on the House Floor – Bill Failed
Good Samaritan Law: When a person is attempting to help another in the case of a suspected overdose of a Schedule I or Schedule II controlled dangerous substance and that person cooperates with emergency responders and peace officers at the scene, they would be immune from prosecution based solely on an offense of drug possession or use. OSMA requested Sen Yen, MD, to author this “Good Samaritan Law”, SB 1367 (Yen/Derby), which is a Medical Student Advocacy Bill. – Passed House; to Senate to Consider House Amendments OSMA SUPPORTS
Other Legislation of Importance to the Medical Community
Scope of Practice: SB 1329 (Scott/Teague) This “scope of practice” measure would have expanded the scope of radiologist assistants and technicians by allowing for independent licenses and certifications. Not heard in House Rules Committee – Bill Failed OSMA OPPOSES
Sunscreen for Students: SB 950 (Stanislawski/Rogers) requires public schools to allow a student to possess and self-apply sunscreen regulated by the Food and Drug Administration (FDA) without previous written authorization. This measure is another Medical Student Advocacy Bill. – Sent to Governor OSMA SUPPORTS
Appointment Authority: HB 3036 (Lepak/Treat) provides that the State Board of Health shall become an advisory board only. The bill provides that the State Commissioner of Health, appointed by the Governor with the advice and consent of the Senate, shall have complete authority over the Department of Health and may be removed or replaced by the Governor without cause. Passed Senate; to House to consider Senate amendments OSMA OPPOSES
Occupational Licensing: SB 1475 (Pugh/Osburn) creates an Occupational Licensing Advisory Commission designed to review each occupational or professional licensing act every four years and make recommendations to the legislature on whether a license should be maintained, modified or repealed. An amended measure specifying a representative of the medical community serve on the Commission was passed in House Rules Committee (Passed Senate; passed House Rules as amended; awaiting to be assigned to the House Floor Agenda) OSMA OPPOSES
HB 2933 (Mulready/David) provides for a first-year license fee waiver for low-income individuals. The measure exempts the health care community at the industry’s request. Passed Senate; to House to consider Senate Amendments – OSMA NO POSITION