Weekly Legislative Update: Februrary 15, 2019

With the new legislature, more than three-fourths of the members have two-year’s experience or less. Combined with new leadership in key committees, OSMA has already been faced with significant challenges. The Chair of the Senate Health and Human Services Committee, Sen. Jason Smalley (R-Stroud), has authored both CRNA (SB 801) and APRN (SB 839) independent practice legislation. In the first meeting of his committee, SB 801 was heard and passed by a vote of 9-4. SB 839 is anticipated to be heard next week. As a measure authored by the Chair of the Committee, this measure is anticipated to pass as well. OSMA is deep in negotiations with all independent  practice measures.

Scope of Practice: The delivery of health care is a TEAM EFFORT! When determining diagnosis and treatment, physicians have the highest level of training and experience to lead that team. M.D.s and D.O.s must remain at the helm of that structure. Several “scope of practice” measures have been filed, including the following:

HB 1027 (Rep. McEntire) – Requires that nurse anesthetists administer anesthesia and certain controlled substances in collaboration with, not under the supervision of, a physician. (House Rules) OSMA OPPOSES

HB 2349 (Rep. Chad Caldwell) – A “Waiver of Supervision” for an APRN may be authorized by the Board of Medical Licensure under certain conditions: 5 years supervision by physician; 10,000 clinical hours; Supervising physician must attest to prescriptive authority; Designated an “Unsupervised Advanced Practice Registered Nurse”; Must serve in counties with less than 25,000 population; Maintain medical malpractice insurance; Maintain CME requirements established by Medical Licensure Board; May not maintain oversight over other nurse practitioners. (House Public Health) OSMA NEUTRAL

SB 801 (Sen. Smalley) – Requires that nurse anesthetists administer anesthesia and certain controlled substances in collaboration with, not under the supervision of, a physician. (DO PASS: Senate Health & Human Services Committee; To Senate Floor) OSMA OPPOSES

SB 839 (Sen. Smalley) – A “Waiver of Supervision” for APRN may be authorized by the Board of Nursing under certain conditions: Current CNP with 7 years’ experience may request waiver of supervision; Does not allow for Schedule II prescriptive authority. (Senate Health & Human Services) OSMA OPPOSES

SB 917 (Sen. McCortney) – A “Waiver of Supervision” for an APRN may be authorized by the Board of Nursing under certain conditions: Redefines Certified Nurse Practitioner as APRN meeting requirements to obtain waiver of supervision; Expands prescriptive authority for APRN’s and CRNA’s; Allows for advanced assessment and diagnosis; Waiver of supervision may be provided by the Board of Nursing; Direct supervision by MD/DO of 10,400 hours in seven years; Letter of recommendation from supervising physician must be provided; Must receive Board of Medical Licensure certified CME; Current CNP with 7 years’ experience may request waiver of supervision; “Licensed Practitioner” re-defined to include APRN with prescriptive authority; Shall maintain or employer maintain $1M/$3M Malpractice Insurance. (Senate Health & Human Services) OSMA OPPOSES

HB 2194 (Rep. Randleman) – Expands the definition of “physician” to include psychologist, therapist or counselor. (House Business & Commerce) OSMA OPPOSES

Pill Limits/Pain Management:

SB 848 (Sen. Rader) – There continues to be misunderstanding regarding the intent of the language housed within last year’s “Pill Limit” bill, SB 1446. The intention was to address initial prescriptions dealing with acute pain. This measure clarifies language and also incorporates Oklahoma Bureau of Narcotics Emergency Rules passed last year which confirm the ability of a physician to write a second 7-day script at the same time as the initial script is written. (Senate Health & Human Services) OSMA SUPPORTS

SB 242 (Standridge/C. Caldwell) – Pain Management Clinics in Oklahoma should be licensed and regulated. Currently, they can be owned by non-physicians and provide limited oversight. Clinics should be owned by an individual or group of M.D.’s or D.O.’s and should designate a physician who is responsible for complying with clinic operations. (DO PASS: Senate Health and Human Services Committee with Title Stricken; To Senate Appropriations) OSMA SUPPORTS

HB 2368 (Kannady) – Provides for the re-creation of the Commission on Opioid Abuse, to exist until July 1, 2023. (DO PASS: House Judiciary) OSMA SUPPORTS

Legal Reform:

SJR 17 (Sen. Weaver) – Creates a State Question placing “Certificate of Merit” to a vote of the people. This concept maintains that a plaintiff declaring negligence in a civil action must present expert witness testimony showing there was a “breach of duty” by the defendant which resulted in harm to the plaintiff. Despite legislative efforts to do so, the Oklahoma Supreme Court has consistently overturned the law as unconstitutional as either “special law” or “denying access to the court system”. OSMA SUPPORTS

Vaccinations: There are several measures dealing with vaccinations. Proper immunization is in the best interest of Oklahoma’s public health.

HB 1098 (Rep. Kevin West) – Prohibits employers or potential employers to discharge or refuse to hire employees for opting-out of vaccinations, except for influenza, until overwhelming scientific consensus indicates an immediate danger to the public if unvaccinated. (House Rules) OSMA OPPOSES

HB 1112 (Rep. Kevin West) – Requires the legislature to approve any revisions to state immunization requirements. (House Government Efficiency) OSMA OPPOSES

SB 924 (Sen. McCortney) – Requires immunization education to be provided at assisted living centers. (Senate Health & Human Services) OSMA SUPPORTS

Insurance Reform: Physicians are constantly faced with administrative obligations by health insurance plans. These requirements can play a key role in the health outcomes of all Oklahomans.

HB 2638 (Rep. Munson) & SB 509 (Rader) – Provides for guidelines and requirements on insurers offering step therapy protocols, requiring such therapy protocols to be based on clinical practice guidelines. (House Insurance) OSMA SUPPORTS

SB 508 (Sen. Newhouse) – Requires insurance companies that have received an appeal of a denied claim by a healthcare provider to provide written details of the reason for claim denial. (DO PASS: Sen. Retirement & Insurance with Title Stricken) OSMA SUPPORTS

SoonerCare Budget: The Oklahoma Health Care Authority (OHCA) FY2020 Budget Request restores Medicaid reimbursement rates back to 100% of Medicare levels…a level not realized since 2009. OSMA SUPPORTS

Medicaid “Expansion” Funding: Federal tax dollars from Oklahoma are being reallocated to other states in support of their Medicaid delivery systems. Governor Stitt as well as Legislative leadership have indicated an interest in pursuing federal dollars to help support Oklahoma’s SoonerCare program.

Graduate Medical Education (GME) Funding: Oklahoma is no longer receiving federal matching dollars to help fund GME Residency program funding. The State of Oklahoma is now responsible to appropriate those dollars which will help develop more Oklahoma physicians. OSMA SUPPORTS

An afternoon at the Capitol
Legislative Reception at OSMA