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LEGISLATIVE UPDATE
Prepared for OAFP
February 12, 2017
SB 754 – Tobacco 21
Klamath Co. Commissioner Derrick DeGroot says a recent survey in Klamath County found that:
· 13.8% of 8th graders have used tobacco in last 30 days
· 14% of 11th graders are reported as regular tobacco users.
He told the Senate Health Committee, “Even though I’m a Republican from a very conservative part of the state, I strongly support” increasing the legal age to purchase tobacco from 18 to 21.
Two states (Hawaii and California) and more than 200 local jurisdictions have already raised to 21 the legal age to buy tobacco.
A number of physicians and cancer specialists described the threat of tobacco for young adults and the effectiveness of Tobacco 21 laws.
Brian Drucker, MD, director of the Knight Cancer Institute at OHSU, says that tobacco accounts for 1/3 of cancer deaths.
Dr. Drucker also told the committee that Needham, Mass saw a 47% decrease in high school students smoking one year after passing its Tobacco 21 ordinance.
Sen. Elizabeth Steiner Hayward (D-Portland), who is also a family physician, says she introduced the Tobacco 21 bill because, “preventing disease is better than curing it. One of the best ways we can prevent disease is to increase the age to purchase tobacco.” She says tobacco use costs Oregon Medicaid $1,500 per smoker.
Bud Pierce, MD, a cancer specialist and the Republican candidate for Governor last fall, testified that tobacco is one of the few legal substances that, “When used as directed is guaranteed to harm your health.”
Patrick Haggerty, DDS, representing the Oregon Dental Association, said, “The #1 risk factor for losing your teeth is smoking.”
This first hearing consisted of invited testimony in support of the bill. Another public hearing will be scheduled.
SB 235 – Retail Tobacco Licensing
Another strategy to help clamp down on underage smoking is a statewide effort to require retail licenses for anyone that sells tobacco.
Jennifer Vines, MD, Deputy Health Officer for Multnomah County, told the Senate Health Committee that retail licensing is “a best practice for cutting down on tobacco sales to minors.”
Multnomah County started a countywide licensing program in 2016. Each tobacco retailer must pay a $528 licensing fee.
Suzanne Kelso from Deschutes County represents the Oregon Retail Tobacco Association. “I am not in Multnomah County but paying $580 to be told I am not selling to minors is not a very good use of my resources.”
SB 235 sets minimum standards that each county would need to meet but counties like Multnomah and Lane, that have local laws with additional requirements, would be allowed to continue. Sen. Jeff Kruse (R-Roseburg) said, “I thought we were trying to develop one standard that works statewide.” Committee Chair Sen. Laurie Monnes Anderson (D-Gresham) said they tried that last session but could not find the votes to make that work this session.
A number of amendments are expected on this bill.
SB 217 – Concussion Release for Student Athletes
Sen. Arnie Roblan (D-Coos Bay) says, “We want to make sure that the people making the decision about who can return to play have the most up to date information on concussion protocols.” As written, this bill would open up who may sign concussion release forms to chiropractors, athletic trainers and naturopaths.
It would also require any provider who wants to sign these release forms to complete a training developed by the OHSU Center for Sports Medicine. Lastly, it would require that these providers obtain medical liability insurance of at least $1 million.
The Oregon Medical Association is supportive of requiring training for providers currently signing release forms. They oppose expanding who may sign these forms however.
HB 2114 – 7-Day Prescribing Limit for Opioids
This bill would limit the length of an opioid prescription that a physician may prescribe upon the first visit of a patient to 7-days. A practitioner could write a prescription for more than 7-days if in their judgment, the supply is necessary for the treatment of an acute medical condition, chronic pain, cancer related pain, or palliative care and the practitioner documented the indication. A practitioner who violated this law would be subject to a class-A misdemeanor, and potentially a penalty by the Oregon Medical Board.
Andris Antoniskis, MD, says the Oregon Medical Association is concerned about codifying a prescribing guideline, which by its very nature, allows for flexibility and modification as needed. They are also concerned about legislating the practice of medicine. Rep. Knute Buehler (R-Bend), who is an orthopedic surgeon, agrees that we need to be careful.
SB 48 – Suicide Continuing Education Requirements
Ann Kirkwood, Suicide Interventions Coordinator, Oregon Health Authority, told the Senate Human Services Committee that, “In 2015, 762 Oregon residents died by suicide. Suicide is the second leading cause of death for Oregonians between the ages of 15 and 34… Unfortunately, the very people we task with intervening and treating people contemplating suicide have little or no training in suicide assessment, management and treatment of suicide risk.”
This bill would require behavioral health providers, including school counselors, to take a 3-6 hour training once every 6 years. Physical health providers would be required to take a 6-hour training only once.
Both the Oregon Nurses Association and the Oregon Medical Association (OMA) say they support the goal of reducing suicides in the state, but expressed concern about the bill as written because of the mandated continuing education requirements. They say that requiring CME for all physicians is inappropriate.
Sen. Michael Dembrow (D-Portland) says he questions the effectiveness of a 3-hour training in changing the behavior of these providers.
HB 2465 – NP Medical Practice Ownership
Under current law, only physicians may have a controlling share of the ownership of for-profit medical offices and clinics. HB 2465 would amend the statute to allow nurse practitioners (NPs) to own half or all of these businesses.
Nurse practitioners are however able to own a clinic offering nursing services. The problem arises when a nurse wishes to purchase a practice from a physician. Under current law, they are not able to own and operate that practice under the same license. This bill seeks to fix that problem.
Rep. Bill Kennemer (R-Oregon City) says, “It seems to me completely appropriate that these licensed medical practitioners are allowed to own a medical practice. In my mind we have set an obsolete barrier to parity (between physicians and NPs).”
Courtni Dresser, Oregon Medical Association, says they are supportive of NPs owning practices and purchasing them from physicians. However, there is a technical issue in the way that the bill is written that is problematic. She says they are willing to sit down and figure this out.
HB 2303 – Primary Care Reporting Deadlines
David Simnitt, the Health Policy Director for the Oregon Health Authority, says this bill changes the due date for CCOs to submit primary care spend data, as required by SB 231, from December 31st to October 1st. The change will allow the Oregon Health Authority the time necessary to produce and validate the annual primary care spending report.
There was no opposition to the bill.
HB 2395 – Adds Purpose of Drug to Rx Label
Rep. Rob Nosse (D-Portland) introduced this bill on behalf of a constituent. It would allow a patient to ask a physician to add the purpose of a drug to the label of their prescription. This would help people managing multiple prescriptions.
Rep. Mitch Greenlick (D-Portland) asked, “Is there anything preventing a patient from doing this now?”
Rep. Nosse responded that he did not think so, but that this bill may provide an extra layer of support.
Fiona Carbowitz, Consultant to the Board of Pharmacy, says a pharmacist would indeed include this info on the label if it were included in the prescription.
The committee seemed to agree that it could be helpful to have this information included on prescriptions, but it is unclear whether they think they need to pass a law to make that happen.
Fair Health Database Informational Hearing and Surprise Billing
Recently, there have been issues with patients receiving bills for services rendered at in-network facilities by out-of-network providers, usually emergency physicians and anesthesiologists. These bills are unexpected and often very expensive. The Oregon Chapter of the American College of Emergency Physicians would like to deal with this by setting a benchmark at some percentage of the average cost of a claim.
The Fair Health National Data Repository is a non-profit health claims database. They say they are an “independent, robust data source” that provides unbiased data in order to help groups make decisions.
Hans Notenboom, MD, President of the American College of Emergency Physicians, says that if we solve balanced billing improperly, we run the risk of limiting access because providers aren’t being reimbursed appropriately. They believe Fair Health is a transparent, unbiased benchmark to deal with this issue.
HB 2340 – Discontinued Areas of Coverage
Currently, if an insurer discontinues offering health benefit plans in part of the state, there is a 5-year ban on re-entering that area. This bill would allow the Department of Consumer and Business Services (DCBS) some discretion in reducing that ban after reviewing market conditions and the reasons an insurer left a market.
Insurance Commissioner Laura Cali-Robison says it is important to incent carriers to stay in a market. But there are certain times when an insurer leaves a market, that it may be in the public’s best interest to allow that carrier to re-enter the market sooner than 5 years. For example, if a carrier needs to shore up business so as not to overextend themselves. “It is simply another tool in our tool box,” says Commissioner Cali.
Technical amendments are coming but there is no opposition.
SB 271 – Small Group Definition passes Committee
Tom Holt from Regence did a good job of presenting SB 271 as a “housekeeping” bill that is needed to disconnect Oregon’s small group definition from the ACA. “The Insurance Division has changed its rule. But the Oregon law is cross-referenced to the Affordable Care Act,” a law that, as we all know, might change. “What this bill does is really just finally settles the matter and puts this policy decision back where it belongs in the Legislature’s hands going forward.”
Sen. Laurie Monnes Anderson (D-Gresham) remarked, “I appreciate meeting with businesses in my district that would be harmed by changing how small group is defined.”
With no discussion, the Senate Health Committee approved the bill, sending it to the Senate floor for debate.
HB 2341 – Small Employer HRA
This bill makes a handful of technical fixes in order to better align Oregon law with federal law. But one of those fixes could dramatically alter Oregon’s small group market. It would allow small group employers to shelter pre-tax dollars for employees to spend on insurance from the exchange as an alternative to offering a small group plan. Congress recently passed this law, known as Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).
Insurance Commissioner Laura Cali-Robson says that even with the potential changes looming at the federal level, it is still important to align state law with already existing federal law so as to protect consumers and give insurers clarity.
HB 2341 – Insurance Alignment Bill includes Mental Health Parity
This bill is described as simply aligning Oregon’s insurance statutes with federal law.
Buried in the bill, is new mental health parity language. It prohibits:
“Applying a treatment limitation on the reimbursement of mental health or substance abuse disorder services that is more restrictive than the predominant treatment limitations applied to medical and surgical services reimbursed by the insurer.”
The bill had a brief hearing in the House Health Care Committee.
HB 2342 – DCBS Placeholder
Pat Allen, Director, Department of Consumer and Business Services says that this is a placeholder bill in case of changes at the federal level.
Some of the changes being considered are shortening grace periods and allowing reinsurance by states for high-risk patients. If something changes at the federal level before the rate-filing deadline on May 1st, they may try to run a bill to deal with those changes.
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