State Budget Passes

The Legislature has wrapped up its work on House Bill 166, the state’s biennial budget. They sent a final version to the Governor on July 17th, after missing their original June 30th deadline. The Governor released his veto message and signed the bill on July 18th. Below are provisions of interest to OPTA.

Price Transparency: The House included a complicated provision regarding “healthcare price transparency.” This would require hospitals and healthcare providers to provide cost estimates to patients prior to performing services. The Senate bill replaced the complicated House proposal with a workable solution that only applied to hospitals. During conference committee, they accepted the unfavorable House version. The Governor exercised his line item veto on these provisions, so they will NOT become law. The legislature is expected to work on this issue as stand alone legislation (see SB 97 below).

Prosthetics: The bill includes a provision to allow those engaging in the 3-D printing of open-source prosthetic kits to do so if the individual has been granted the authority to engage in that activity by the Ohio occupational therapy, physical therapy, and athletic trainers board. Such an individual shall not represent that the individual is authorized to practice prosthetics or orthotics and prosthetics.

Healthcare Provider Solicitation: A provision was added to prohibit certain healthcare providers (physicians, physician assistants, chiropractors, nurses, and psychologists; but not PTs) from soliciting business from a victim of a motor vehicle accident until 30 days after the accident. It only allows for solicitations after 30 days to be done by mail. Violations would be subject to Attorney General investigation, fines and license suspensions.

Regulation Reduction: This is a version of Senate Bill 1. It requires all agencies to review any of their regulatory restrictions that require or prohibit an action and prepare a base inventory of these regulatory restrictions that currently exist in rules. This must be done by December 31, 2019. It also prohibits these agencies, during FYs 2020, 2021, 2022, and 2023, from adopting a new regulatory restriction unless they simultaneously remove two or more existing regulatory restrictions. Not required to be included in this inventory are any emergency rules, internal management rules, or rules required to be adopted by state or federal law.

Bills Introduced Regarding Healthcare Provider Misconduct

Senators (R – Hilliard) and (D – Columbus), along with Representatives (D – Columbus) and Erica Crawley (D – Columbus), have introduced legislation to prohibit unlawful sexual contact between health care professionals and patients and provide a process to revoke professional licenses for criminal misconduct. These bills, Senate Bill 166 and House Bill 290, were introduced in response to an incident involving a chiropractor: https://www.dispatch.com/news/20190618/local-lawmakers-propose- more-protections-for-sexual-assault-victims-of-doctors.

The legislation applies to most licensed healthcare providers, including physical therapists.

The bill states that gross sexual imposition committed is a felony of the fifth degree. If the patient was 13-17 years old or if the patient was a person with a developmental disability, a violation is a felony of the third degree and there is a presumption that a prison term shall be imposed for the offense. If the patient was less than 13 years of age, a violation is a felony of the second degree and the court shall impose as the minimum prison term for the offense a mandatory prison term that is one of the minimum terms prescribed in division (A)(2)(a) of section 2929.14 of the Revised Code for a felony of the second degree.

The bill defines a violation to be when a licensed health care professional has sexual contact with another person who is a patient under the offender's care or supervision and one of the following applies: 1. The offender knows that the sexual contact is offensive to the patient, or is reckless in that regard; 2. The patient is less than sixteen years of age, whether or not the offender knows the age of the patient; 3. The patient is a person with a developmental disability, whether or not the offender knows that the patient is a person with a developmental disability.

The bills also add the following language to ORC 4755.47: (F) Any holder of a license issued under this chapter who has pleaded guilty to or been convicted of aggravated murder, murder, voluntary manslaughter, felonious assault, kidnapping, rape, sexual battery, gross sexual imposition, aggravated arson, aggravated robbery, or aggravated burglary, or any substantially equivalent criminal offense in another jurisdiction, is automatically suspended from practice under this chapter in this state and any license issued to the holder under this chapter is automatically suspended, as of the date of the guilty plea or conviction, whether the proceedings are brought in this state or another jurisdiction. Continued practice by an individual after the suspension of the individual's license under this division shall be considered practicing without a license. The physical therapy section shall notify the suspended individual of the suspension of the individual's license under this division by certified mail or in person in accordance with section 119.07 of the Revised Code. If an individual whose license is suspended under this division fails to make a timely request for an adjudicatory hearing, the physical therapy section shall enter a final order permanently revoking the individual's license.

SB 105 – Massage Therapy

Senator (R – Powell) has introduced Senate Bill 105 regarding massage therapy. The bill makes changes to how establishments offering massage can be regulated by townships. The OPTA board reviewed many components of this bill when it was introduced as HB 717 during the previous GA. That version of the bill didn’t include practitioners covered under ORC 4755 as legitimate practitioners of massage at all. OPTA had reached out to then Rep. Brenner at the time to make him aware of the error. So, this new version of the proposal corrects that. However, SB 105 contains previously un-included components regarding the scope of practice of massage therapists, including re-defining what massage therapy is.

The bill proposes changing the definition of massage therapy to:

(D) "Massage therapy" means any of the treatment of disorders of the human body by the manipulation of soft tissue through the systematic external application of massage techniques including touch, stroking, friction, vibration, percussion, kneading, stretching, following:

(1) The manual application of compression, and joint stretch, vibration, or mobilization of the body's organs and tissues, including the components of the musculoskeletal system, peripheral vessels of the circulatory system, and fascia; (2) Directed, assisted, resistive, or passive movements of the joints within the normal physiologic range of motion; and adjunctive thereto, the (3) The external application of water, heat, cold, topical preparations, and mechanical devices.

"Massage therapy" does not include the manipulation of the reproductive organs, perineum, rectum, or anus unless the action is undertaken pursuant to a prescription issued by a person who is authorized under this chapter to practice medicine and surgery or osteopathic medicine and surgery or the action is performed under the supervision of such a physician.

OPTA has identified issues in this new definition. We met with the bill sponsor and proponents of the bill and expect a redrafted version of the definition to be adopted as the bill moves forward.

SB 57 – Hemp Bill

Legislation sponsored by Senators Brian Hill (R – Zanesville) and Steve Huffman (R – Tipp City) will legalize and regulate the growing and selling of hemp and products derived from hemp. Last year the State Board of Pharmacy issued a released clarifying the sale of products derived from hemp, mainly CBD, is illegal because the products are marijuana under the State Medical Marijuana program. Several businesses had been selling CBD products and were forced to take them off their shelves as a result of the ruling. Since the release from the Pharmacy Board, the federal government moved hemp off of the scheduled drug list, allowing states to do the same. SB 57 would do that in Ohio.

The bill is supported by the Ohio Farm Bureau and the Hemp Roundtable among other large state groups. The American Massage Therapy Association, Ohio Chapter also gave supportive testimony, as their members have been using CBD/hemp products in their practices. This bill was finalized by the legislature and sent to the Governor on July 17th. It includes an emergency clause, so when signed by Governor DeWine, it will be effective immediately.

APRN Independent Practice and Youth Concussion Legislation

House Bill 177 has been introduced by Representative Tom Brinkman (R – ) to remove a requirement that advance practice registered nurses work under a standard care agreement with a physician. This would give APRNs independent practice in Ohio. The bill also includes a provision to allow any licensed healthcare professional who is 1) designated by a school district and 2) meets the requirements set by their licensure board, to assess and clear student athletes after a concussion. This bill is under consideration by the House Health Committee.

Price Transparency

Representative and practicing physician Steve Huffman (R – Tipp City) has introduced Senate Bill 97, which is a reintroduction of legislation he pursued during the last General Assembly. The bill addresses healthcare price transparency. SB 97 provides that beginning September 1, 2019 a healthcare provider must, on the request of a patient or the patient's representative, provide to that individual a reasonable, good faith estimate of the cost for each scheduled service. Under the bill, "scheduled service" means a health care service or procedure that a patient or the patient's representative has scheduled at least seven days before the service or procedure is to occur.

The estimate may be given in writing, electronically, or verbally and must include the following:

• If the patient is insured, the estimate shall specify the amount the healthcare provider expects to receive as payment from the patient's health plan issuer for each scheduled service. • The estimate shall specify the amount that the patient or party responsible for the patient's care will be required to pay to the healthcare provider for each scheduled service. • The estimate shall include a disclaimer that the information provided is only an estimate based on facts available at the time the estimate was prepared and that other required health care items, services, or procedures could change the estimate. • If applicable and known to the healthcare provider at the time the estimate is given, the estimate shall include a notification that the provider is out-of-network for the patient.

The estimate required must be based on information available at the time the estimate is provided and need not take into account any information that subsequently arises, such as unexpected additional services or procedures. The legislation also provides that the patient is responsible for payment of the healthcare service or procedure even if they do not receive a cost estimate.

These requirements would not apply in either of the following circumstances:

1. The patient is insured and the health plan issuer fails to supply the necessary information to the health care provider within 48 hours of the provider's request to the issuer for that information. In that case, the health care provider may notify the patient or the patient's representative of the health plan issuer's failure. 2. The scheduled service the patient is to receive requires preauthorization from the patient's health plan issuer. In that case, section 3726.03 of the Revised Code applies.

SB 97 will be considered by the Senate Health, Human Services and Medicaid Committee. During the last General Assembly, the bill was supported by the Ohio Hospital Association and the Ohio State Medical Association. Opposing the measure was the Ohio Association of Health Plans.

Bill Regarding Military Occupational Licenses Passes Respective Chambers

Senators Peggy Lehner (R – Kettering) and Bob Hackett (R – London) have re-introduced legislation that would ease the ability of military personnel and their spouses to be licensed in Ohio. This bill was favorably considered in the previous General Assembly, but did not make its way through the entire legislative process before the end of the term. Therefore, it was not enacted. In this General Assembly, the bill is Senate Bill 7, which means it is a top 10 bill, and therefore a priority for the .

The bill will require a department, agency, or office of this state to issue a temporary license or certificate to practice a trade or profession to an individual for not more than three years. The board would have to waive all license fees for these applicants. The applicant must be a licensee in good standing in another state. The bill does allow agencies and boards to deny these military applications under certain circumstances under the bill.

The legislation was passed by the Ohio Senate unanimously in March and is pending hearings in the House Armed Services and Veterans Affairs Committee. Companion legislation has been introduced in the House by Representatives (R – Beavercreek) and (D – Hudson). HB 133 bill has been passed by the House unanimously. It has yet to be referred to a Senate Committee.

Copies of legislation – Go to www.legislature.state.oh.us

How to Contact Your Lobbyist

Amanda Sines Government Advantage Group 17 South High Street, Suite 750 Columbus, Ohio 43215 614-221-7157 [email protected]