AMPHO/MPHA/MEHA 2015 Legislative Wrap-Up Report

AMPHO/MPHA/MEHA 2015 Legislative Wrap-up Report 5/14/2015 Prepared by Erin McGowan (Core Public Health, Budget) and Linda Stoll (Environmental Health)

Overview: The 2015 Legislature has adjourned and public health had a successful run—most of our priority bills/issues have been signed into law and we were able to push back against measures that would have threatened public health and safety. Perhaps most significantly, Medicaid Expansion was approved in the final days of the session allowing uninsured Montanans earning less than 138% of federal poverty to apply for health insurance coverage. Other items at the top of the list include blocking legalization of raw milk sales, passage of improvements to immunization statutes, and safeguarding funding for Title X funding for the next several sessions.

This report summarizes the activities of our joint committee during the 2015 legislative session. It should include all, or nearly all, of the legislation in which we took a position. This totals up to a whopping 39 bills! The first section of the report focuses on core public heath/prevention/access to healthcare (Erin McGowan--Lobbyist), and the second portion highlights our Environmental Health work (Linda Stoll--Lobbyist).

Budget and Health Policy Legislation:  HB 2 – budget: The DPHHS budget was closely tracked throughout the entire legislative session. We were fortunate that there were not attempts to strip funding for public health as we’ve seen in 2011 and 2013. All of the following items for the Public Health and Safety Division budget were approved: o New Proposal (NP) - 707003 Asthma Home Visiting Program: Increases funding by $90,000 (MSA – master settlement agreement funding) per year. The funds will be used to add additional sites across the state. This funding was not initially approved at the joint sub-committee level, however was added in Senate Finance and Claims. o NP - 707002 CVD and Diabetes Prevention Program: Increases funding by $100,000 (MSA) per year. The funds will be used to add additional sites across the state. This funding was not initially approved at the joint sub-committee level, however was added in Senate Finance and Claims. o NP - 707013 Cardiovascular and diabetes supplement: This is increased funding from CDC ($522,527) per year. These funds will be used for activities to improve hypertension and blood glucose control among persons with high blood pressure and diabetes. Also will be used for worksite health promotion activities. Approved at the joint sub- committee level. o NP - 707004 Colorectal cancer screening: Increases funding by $150,000 (MSA) per year. The funds will be used to support screening among Montanans with low incomes and to support quality improvement activities to increase screening in outpatient clinical settings across the state. Approved at the joint sub-committee level. o Present law adjustment - 707001 Tobacco Use Prevention Program. This is an increase of $1,000,000 (MSA) per year. This will support youth prevention activities, cessation and quit line enhancement projects, and to expand the smoke free housing work that is currently being performed. Approved at the joint sub-committee level.

Medicaid Expansion:

There were three major proposals regarding Medicaid Expansion or Medicaid reform. SB 405 (Senator Ed Buttrey) passed through the legislature in the final days of the session and has been signed into law by Governor Bullock. The bill accepts federal dollars in order to expand coverage, although it will not cover as many individuals as the Governor’s bill would have. Additional components include: tort reform, co-pays, and a pathway for independence from the federal government for both enrollees and the state of Montana. HB 249, which was sponsored by Representative Noonan on behalf of the Governor, would have accepted federal dollars to expand coverage to 70,000 Montanans. The Governor’s proposal failed on a party-line vote early in the session. Representative Nancy Ballance sponsored HB 455 on behalf of conservative Republicans, which would have extended coverage to only 10,000 to 15,000 Montanans. The bill died on the House Floor. AMPHO/MPHA/MEHA testified in support of both S.B. 405 and H.B. 249.

Immunization bills:  HB 73 (Rep. Casey Schreiner): immunization registry opt-out bill was tabled in House Human Services. At the hearing, information privacy was a concern. This is the second session we have tried and failed to get this bill passed.  HB 158 (Rep. Margie MacDonald): varicella and pertussis vaccine requirements for school admission were successfully amended to remove the personal exemption and the bill has been signed into law.  HB 300 (Sen. Fred Thomas): expanding pharmacists’ scope of vaccine administration was tabled in Senate Public Health. This is the second session that we have successfully defeated this bill.  HB 524 (Rep. Kathy Kelker): requiring DPHHS to publish vaccine schedule for school attendance and report to Legislature—tabled in committee.

Vital Statistics:  SB 217 – revising vital statistics laws so that information collected for medical, health, or administrative use is optional and may only be collected after securing parental consent. Governor Bullock vetoed this bill on 4/29/2015, however a veto override poll of legislators is currently being conducted. Electronic Cigarettes:  S.B. 66 (Sen. Diane Sands): This measure passed with a strong vote after amendments regarding definitions of vape products were added in the Senate committee. S.B. 66 prevents sales to children in Montana of electronic smoking devices and their component parts – i.e, e-cigarettes, e-cigars, e-pipes, e-hookahs, vape pens, cartridges containing liquid for vaporizing and inhaling, etc. Our committee retained our supportive position in the House despite amendments that may not be ideal regarding definitions.

Title X Family Planning:  H.B. 606 (Rep. Christy Clark)— Provide statutory appropriation for Title X funding. Provides DPHHS authority to accept and administer the Title X grant in accordance with federal laws and regulations. Through the year 2021, Title X Funding will be appropriated as a statutory appropriation, rather than through the standards legislative budgeting process (H.B. 2). This legislation passed with a strong majority vote in both houses and has been signed into law.

Other General Public Health Bills:  S.B. 352—Sen. Ed Buttrey-- Create offense related to assault on healthcare and emergency providers—Tabled in Senate Judiciary Committee.

 H.B. 636—Rep. Debra Lamm-- Require legislative approval for acceptance of federal assistance funds—Tabled in House Appropriations Committee.

 S.B. 242—Sen. Roger Webb-- Revise laws related to providing alcohol to minors— Tabled in House Judiciary Committee.

 H.B. 297—Rep. Virginia Court-- Prohibit texting while driving—Nearly made it through the process, but died on the Senate floor with a fairly close vote.

 S.B. 291—Sen. Brad Hamlett-- Revise laws on use of seatbelts and child safety restraints; primary enforcement—Tabled in Senate Judiciary Committee.

 S.B. 407—Sen. Chas Vincent-- Revise tax-exempt status requirements for certain nonprofit pharmacy operations—Tabled in Senate Finance and Claims Committee.

 H.B. 349—Rep. Kathleen Williams-- Address discriminatory health insurance policy practices—Died on the House Floor.

 HB 568—Rep. Ed Lieser – providing suicide prevention and training for healthcare providers (including nurses) passed the House Human Services committee, however was amended on the House floor and the amended version failed on a 48-52 vote. Legislative Interim Work:

It will be important to continue to have a presence in the legislative process in-between sessions (Interim) in some of the following areas:  Continuing to develop relationships with legislators, DPHHS, MACo, and other key stakeholders.  Keeping abreast of the work of the CFHHS interim committee and the studies they may be assigned.  Engaging in Medicaid expansion waiver process as appropriate, and  Planning to consider policy initiatives for consideration by the 2017 legislature.

Environmental Health Legislation – Linda Stoll

Despite having started out with high numbers of bill draft requests, the environmental health legislation list was fairly short compared to other sessions. The intensity and duration of some of them – raw milk, in particular – was high and long, but as sessions go, this could have been worse.

The bad bills are dead and of the bills that passed, they can be “lived with” for a couple of years and tweaks looked at for the 2017 session.

There is only one of the bills from our list that is currently not yet “disposed of”, legislatively speaking, and I will update that prediction (SB 387) if it’s something other than what I offered in the report below. And the fate of two money issues (funding for the diagnostics lab and funding for the groundwater program) are not absolutely certain to me at the time of this writing. However, I believe both of them to be contained in HB 2 but with all of the wheeling and dealing and changing around of funding sources and projects, that occurred in the last 72 hours of the session I can’t say for absolutely certain. I’m still checking into that and will follow up if I hear otherwise.

In response to Barbara’s query about interim activities, there are a couple of thoughts I’d like to leave you with: First, I strongly advise engaging over the interim with the opposition on the raw milk issue. For whatever reason, more and more people want to consume raw milk and they want to be able to do it more easily. Serious thought needs to be given to a version of a bill that would require inspection, regulation, testing and labeling. And maybe some thought needs to be given to a public health education campaign about raw milk. I listened to a radio program recently that seemed to indicate that in some of the states in which raw milk was legalized, it was done so at the behest of public health advocates who wished to better regulate it. I have yet to compare whether or not those are the same states in which outbreaks increased as a result of legalization or not. The other item to be aware of over the interim is a study bill (SB 390) that will be occurring with respect to licensing boards which are attached to the Department of Labor (including the Board of Sanitarians). Finally, I urge everybody to keep track of any issues as they arise over the interim that are associated with HB 478 (cottage foods). The state will be drafting rules and setting fees (though in an e-mail from Jim Murphy he indicated they might be putting that off because of the tight time frame) but I expect those discussions will reveal the need to fine-tune some of the 478 language. I have requested of the state office to be included in any of the relevant e-mail discussions that might be held on that topic so I can be kept in that loop.

New laws  HB 168 (Fitzpatrick) – Define “combined appropriation” regarding exempt wells - Effective immediately, this legislation grandfathers the water rights of the subdivisions for which applications were pending at the time the Sherlock decision was made in the Clark Fork Coalition V. Tubbs case that sent the DNRC’s rule regarding the definition of “combined appropriation” back to the 1987 rule.  HB 285 (Flynn) – Revise definitions in guest ranches – Effective immediately, the definitions of “seasonal establishment” and “small establishment” have changed with regard to the number of guests allowed before triggering food safety requirements. Seasonal establishments are allowed no more than 40 people on average per day and the small establishment trigger is no more than 24 people on average per day.  HB 478 (Williams) – Cottage food – Effective October 1, 2015, significant changes to Montana’s food code will take place to address “cottage foods.” These changes also include changes to temporary food service establishment requirements and farmer’s market requirements, both in terms of the statutory language but also as it regards the definitions associated with each of those venues and products that may be sold at those venues. In fact, much of the policy contained in the bill is contained in the definition changes and all are encouraged to take a close look at the definitions section of 50-50-102.

The DPHHS has been given broad rule-making authority in this bill – authority for adopting fees, for rules related to appeals and statewide standards –and much work will be occurring before the October 1st effective date.  SB 31 (Whitford) – Exempt raw honey from farmer’s market licensing requirements – Effective immediately, raw honey that is packaged in a clean container, labeled and not mixed with other products is exempt from licensing requirements.  SB 49 (Keane) – Expand use of petroleum mixing zones – Effective immediately, this bill expands the language in 75-11-508 addressing boundaries of mixing zones. The new law adds “restrictive covenant” and “another institutional control approved by the Department” to the instances when such boundaries are allowed to expand beyond the property boundary of property upon which a petroleum release occurred.  SB 102 (Ankney) – Revise air quality fee structure – Effective October 1, SB 102 provides that persons who register their emitting actions (in lieu of obtaining a permit) must pay a fee to fund the DEQ’s administrative costs. The same language is also then applied to 75-2-301 allowing local air pollution control programs to also collect for registration.  SB 387 (Smith) – Revise water quality violation penalties – Effective October 1*, this new law establishes maximum fines and penalties for violating state water quality laws that do not otherwise harm human health. (*As of this writing, the bill is still sitting on the Governor’s desk and has not been signed, but I predict he’ll let it go, without his signature, where it would join these.)

Dead Bills  HB 243 (Dunwell) – Public disclosure of fracking chemicals  HB 245 (Ballance) – Raw milk  HB 395 (Moore) – Revise rules, laws related to swimming pools, spas  HB 399 (Hertz) – Revise milk laws (change sell by date to expiration date)  HB 435 (Hayman) – Revise consumer laws related to perishable products  HB 452 (Williams) – Revise motor vehicle title salvage laws  HB 613 (Manzella) – County review of wood stove regulation  HB 465 (Manzella) – Preserve Montanan’s right to burn wood  SB 239 (Kary) – Limit local government’s animal ordinance to prohibit breed specific  SB 268 (Sands) – Revise laws related to storm drainage sumps  SB 286 (Smith) - Limit agency rule making if it burdens private property rights