2016 IDAHO LEGISLATURE

UPDATE

January 18, 2016 through January 22, 2016

Throughout the 2016 Idaho Legislative Session, Nurse Leaders of Idaho and the Idaho Nurses Association will provide periodic updates on legislation and activities of interest to nurses, especially in the area of healthcare policy. In addition to these Updates, e-mail communications will alert NLI and INA members to take action in communicating to legislators about bills of interest.

Located at the end of the Updates, is a Call to Action section that will provide background information to assist in communicating with legislators. This week’s Call to Action provides information on how to know who your State Representatives and Senators are.

Week 2

In their second week, House and Senate Committees continued to hear agency rules. In Idaho, rules promulgated by state agencies and boards must be approved or rejected by legislative committees. Both houses hear each rule. Few bills have been introduced so far. With 2016 being an election year, legislators will look toward an early end to the session allowing time for campaigning prior to the May primary elections. Education and the Governor’s alternative to Medicaid expansion, the Primary Care Access Program, have become the dominant issues so far.

Joint Finance Appropriations Committee (JFAC) – Health & Welfare

Monday began Healthcare week for JFAC which sets the 2016 state budget. Dick Armstrong, Director of the Department of Health & Welfare, presented an overview of Department’s priorities for the fiscal year asking for a 6.2% increase over 2015. 4% of that increase is for the Governor’s Primary Care Access Program. Medicaid represents 80% of H&W budget with 85% of the total H&W appropriation paid to private providers mostly Idaho providers

Primary Care Access Program (PCAP)

The alternative to Medicaid Expansion will provide primary care coverage for 78,000 adults (19-64) who are in the gap between Medicaid eligibility and health insurance subsidy under the federal Affordable Care Act. PCAP provides for primary care, preventive services, acute care including mental health, and basic X-ray, laboratory and drug coverage aimed at maintenance for chronic illness. Chronic illness accounts for 75% of healthcare costs. PCAP does not provide for hospitalization or specialty care which would continue to be covered through county indigent programs and the state’s catastrophic fund. Under the plan, the state will pay enrolled providers $35/month per patient. Participants will pay on a sliding scale between $4 - $25/month based upon income. Participants must remain compliant with their treatment plans. The plan is based upon a Medical Home model using primary care teams for overall coordination of care with a target of managing care early before requiring costly emergency or inpatient services. Enrolment will be through the Health Insurance Exchange where eligibility for Medicaid or the Exchange will be determined prior to enrollment in PCAP. If approved, the program will begin July 2017. Dedicated funding for the $30M program would come from the state’s cigarette and tobacco tax.

The PCAP proposal has been assigned to the House Tax and Revenue Committee and the House Health and Welfare Committee.

H&W Employee Pay and Retention

The Department of H&W has seen a 15% workforce turnover this year. With lower unemployment, availability of other higher paid positions is drawing state employees. In employee surveys, pay was identified as the most significant reason for leaving the department.

Lawmakers are considering a 3% pay increase together with an offset for increased insurance premiums for employees.

Third Community Crisis Center

The Department is asking $1.7M to add a third center in Southern Idaho. This builds upon the success of centers in eastern and northern Idaho in creating a better alternative and lower costs to emergency departments or jail in addressing acute mental health issues.

Medicaid Supported Living Services

In 2012, the state was ordered by Federal Court to increase payments to Medicaid providers to match federal levels. The ruling was appealed, and in 2015, the U.S. Supreme Court ruled in favor of the state allowing Idaho to set rates independent of federal rates. However, according to Director Armstrong, the lack of sufficient payment for support services to Medicaid enrollees will likely lead to the failure of providers of Living Support Services. In an effort to keep providers whole, the state is initiating temporary rates and surveying provider costs to determine new equitable rates.

Idaho Healthcare Exchange

Since inception the Healthcare Exchange as enrolled over 93,000 with 77,000 receiving tax credit.

Office of Performance Improvement Report on Behavioral Health

The Office of Performance Evaluation conducted a study of the Idaho Behavioral Health Plan. A pilot began three years ago with a $300M contract with Optum Idaho to move to a managed care model for behavioral health. Costs for rehabilitative care had previously sored from $8M in 2001 to $76M in 2012. Over the past three years, under contract with Optum Idaho, costs have fallen to $44M with improved coordination and family participation in behavioral rehabilitation.

Catastrophic Healthcare Program (CAT Fund)

For those who can’t pay for healthcare, counties cover the first $11,000 with the remainder paid by the states catastrophic fund. With more being insured under Idaho’s Health Insurance Exchange, dependence on the catastrophic fund has plummeted by $17M in 2015. With excess in the fund, JFAC authorized a one-time transfer of $29M from the CAT fund to the general fund leaving enough to cover anticipated costs in the CAT fund for 2016.

Board of Nursing Rules

The rules have been passed by the House and Senate Health and Welfare Committees. These rules become effective July 1, 2016. The Continuing Education Requirement will be effective with the 2018 nursing license renewal.

Continued Competence Requirements for Renewal of an Active License

 The rules add requirements for continuing education and/or clinical practice when renewing a nursing license. A licensee must complete at least two learning activities within the two year licensure renewal period:

o Practice: Current nursing specialty certification or 100 hours of actual or simulated clinical practice

o Continuing Education:

. 15 contact hours . 1 semester credit hour from college or university

. Board recognized refresher course

. Participation in or presentation of a workshop, seminar, conference or course relevant to nursing practice by a recognized organization.

 The rule specifies requirements for documentation and the retention of records.

Licensed Registered Nurse Functioning in Specialty Areas

Current Board of Nursing rules address additional requirements for specialty practice for Flight/Transport Nurses and Nurse First Assistants. Since the rules were adopted in 1993, the practice of nursing has expanded to a variety of specialty areas including oncology, hospice, diabetic education, public health, and others with their own national standards and education and certification requirements.

Rather than create a long list of specialty areas in rule, the Board of Nursing proposed changes to rule that accommodate nursing specialties in general and aligns rule with national standards for additional education, continuing competence and standards for specialty practice.

EMS Rules

The EMS Bureau presented a number of rules for approval this week. All rules have been adopted by the House and Senate Health & Welfare Committees and become effective July 1, 2016. Two rules have some impact for nursing:

Nurses participating with an Ambulance Service

The Bureau clarified in rule, that an ambulance agency utilizing nurses or physician assistants, acting as ‘Ambulance Based Clinicians” do not require the addition of a paramedic to conduct interfacility transports. However, prehospital responses continue to require licensed EMS personnel, EMT or paramedic. Other minimal ambulance staffing requirements must also be met.

Critical Care Paramedics

Addressing concerns related to the qualification of paramedics conducting interhospital transports of complex, critical patients, the EMS Physicians Commission presented rules that change the paramedic scope practice, require additional training for Critical Care Paramedics and certification by one of two nationally recognized certification bodies for critical care paramedics.

CALL TO ACTION Know who your State Representatives and Senators are:

Here’s a little homework. Use the maps on the following link to find your legislative district: http://legislature.idaho.gov/about/idmap2.pdf

Then go to the legislature website: www.legislature.idaho.gov

Along the left column is a tag “Contacting Legislators.” There you will find lists by name or by legislative district with name and contact information. Reach out to introduce yourself to your legislator. Let them know that you are interested in what they are doing, and that you can be their contact for any nursing or healthcare related issues. Most legislators do not have an expert contact, let alone an nursing constituent that they know. This is a great opportunity to open that door for them.

As you hear of issues or have question about the legislature, please let Mike know by e-mail at [email protected].