2019 Medical Society General Session Hot topics

Pg 1 Budget Pg 2 Scope of Practice 2019 Legislative Summary Pg 3 WWAMI Day Pg 4 Child Protections OVERNOR Gordon offered Finally, it can’t go without saying Gclosing remarks after one that our physician advocates who o’clock am Wednesday morning to came to testify on legislation help Wyoming’s 65th Legislature or work the lobbies alongside adjourn the 2019 Session. After 35 our advocacy team made all days of early mornings and late nights the difference this year. Thank debating issues ranging from taxes you to the following physicians and block chain to mandating work who took time away from busy requirements for Medicaid eligibility practices and traveled sometimes and healthcare pricing transparency, snowy roads to be in Cheyenne the legislature called it a wrap. fighting medicine’s fight. Thank You! Wyoming Medical Society (WMS) advocates followed 49 legislative bills. The WMS Board of Trustees voted to support 19, remain neutral on 22 and Matt Dodds, MD oppose 8. We prevailed in persuading the Laryssa Dragan, MD majority of legislators to agree with our Lisa Finkelstein, DO position on almost 63% of issues and failed Bird Gilmartin, MD to find success on 20% of the bills. Anne Miller, MD

Jennifer Nottage, MD Our 2019 successes were due in large part to the grassroots efforts of our members. Andrew Rose, MD More than 50 separate emails were written Shaun Shafer, MD and sent to Wyoming lawmkakers using the WMS website platform with even more sent through the ophthalmology WMS President Lisa Finkelstein, DO, visits with advocacy tool. Additionally, more than Governor in the halls of Wyoming’s a dozen Wyoming papers ran articles temporary capitol. and letters to the editor regarding one of this year’s more lively scope of practice debates focused on eye care in the state.

Odd Numbered Years Bring Supplemental Budget

DD years are general session years for a general fund appropriation of Wyoming Agency budget. In 2008 Oand even years are years set aside increase of $112.9 million, $29.3 million the medical education budgets were for establishing the state’s biennium federal fund appropriation increase and separated from the full University budget. Policy issues must garner a another $67.7 million increase in other of Wyoming agency budget 067 to favorable vote from two-thirds of the funds. It further authorized an increase their independent agency budget 167. body to be introduced during budget of seven positions taking the state to Bringing the 167 agency budget back sessions but only need a simple majority a total of 7,692 authorized positions under the UW 067 achieves a variety of in general session years. It was clear to (7,386 full-time and 306 part-time). things not the least of which is formally see that 2019 was a general session year designating employees of the residency with 482 house bills and senate files and The Wyoming Department of Health programs and WWAMI as UW more than 20 joint resolution proposals. saw a total increase of $21,115,645 in employees enabling them to receive general fund, $22,312,093 in federal salary increases and other benefits the The supplemental budget is designed funds and $14,397,928 in other funds. same as other UW employees rather to provide emergency funding for than standing alone as a separate agencies that anticipate deficits in their The legislature also saw fit to revert agency. biennium budget appropriation. This the UW Family Medical Residency year’s supplemental budget provided Program back to the full University Scope of Practice Discussions Consume WMS Efforts

EALTHCARE profession A legislative proposal to Optometry’s desire to Ophthalmology’s position Hlicensure debates took on establish licensure for amend their practice act to prevailed this year in part by new life this year with members naturopath providers failed to allow access to therapeutic stressing the inherent dangers of the Senate and House willing get a hearing as did another lasers and advanced scalpel of any invasive procedure to invest personal political piece of legislation designed procedures quickly dominated and the emphasizing the capital to see results of certain to open a new license type hallway conversations among role that hands-on residency outcomes. The tone was set called Associate Physician for lawmakers and lobbyists alike. training plays in differentiating early when Senate President physicians who graduated Legislators felt compelled by physicians from other high- Drew Perkins (R - Casper) from an accredited medical optometry’s ask to update a 25 trained healthcare providers. prioritized scope expansion school but failed to complete year-old practice act to bring for healthcare providers in his a residency. Physical Therapy greater access opportunities Thank you to all of you who opening remarks by saying successfully set their eyes on to Wyoming patients. For engaged on these tough issues that, “we need to look at lifting restrictions to patient many, allowing optometrists to this year. Medicine has our allowing healthcare providers direct access which WMS perform YAG laser procedures work cut out for us and we the opportunity to allow their helped support based on a such as capsulotomies, and look forward to continuing practice acts to expand to the former agreement with the trabeculeplesties, as well as these important conversations. extent of their training. We association to work together advanced scalpel procedures have to look at, and embrace, to ensure physical therapists on and around the eye seemed overlapping healthcare would back away from like a reasonable request. provider disciplines as a chance practicing specialty medicine to enhance competitiveness by employing electrodiagnostic and access to medical care in testing methods without Wyoming without having to sufficient training to do so. recruit a single new healthcare provider just by allowing “We can enhance Opioid Fears Force Action them to perform the services competitiveness and in which they are trained.” ENATOR Eli Bebout (R-Riverton) championed access to medical Slegislation in 2018 to establish a statewide opioid WMS listened carefully to care without having addiction taskforce. Legislators were appointed to serve lawmakers who shared their to recruit a single alongside healthcare professionals and law enforcement thoughts echoing those of the new healthcare experts to come up with solutions that would help address growing concerns surrounding opioid abuse and addiction. Senate President. The struggle provider just by between convenience and safety was the focus of many allowing providers WMS physicians served on the taskforce working diligently heated debates as lawmakers to perform the to find meaningful solutions that would strike a fine balance grappled with a myriad services in which between protecting prescribers from undue burdens and closing gaps in controlled substance regulations. Of the of bills all seeking in one they are trained” way or another to redraw myriad of taskforce recommendations, the Labor, Health and the lines of the provider ~ Senate President Social Services Committees championed and ran two bills practice lanes in Wyoming’s Drew Perkins aimed at impacting controleld substance abuse in the state. healthcare delivery highway. Senate File 46 limits prescribers to seven-day prescriptions to opioid-naive patients, defined as anyone who has not had an active opioid Rx in the preceding 45 day period, for purposes of treating acute pain.

Senate File 47 directs the following changes to controlled substance prescribing effective July 1, 2019.

n Directs the Wyoming Board of Medicine to require licensees who are registered with the board of pharmacy to dispense a controlled substance to complete one hour of continuing education related to the responsible prescribing of controlled substances or the treatment of substance abuse disorders every two years.

n Mandates that all controlled substance prescriptions be through electronic means on and after January 1, 2021.

n Requires prescribers to search the Rx Drug Monitoring Program (PDMP) prior to prescribing any schedule II-V Members of the Joint Labor, Health and Social Services Committee meet at substance and shall repeat the search every three months the end of Session to propose and discuss topics of interest for interim study thereafter for as long as the controlled substance remains part and consideration. The conversation drew a crowd with whispers of excitement from onlookers to move back to Wyoming’s historic Capitol. The Legislature is of the patient’s treatment. expected to convene a Special Session to commemorate the opening of the Capitol in July of 2019. WWAMI Day at the Capitol PASSED EBRUARY 19 was yet healthcare, answered the nearly fell over themsleves LEGISLATION Fagain a highlight of the Governor’s questions and to come out to the gallery session with Wyoming’s got the opportunity to to meet and visit with the • PT Direct Access WWAMI students spending ask a few of their own. students. With an almost their day at the capitol. 70% return rate to the state, - Support Amended After lunch with members This year was no different WWAMI continues to • Midwife reimb. in of the House and Senate than any in recent past in play an invaluable role in Medicaid - Oppose the medical students spent seeing first hand just how recruiting new physicians the afternoon listening fond the legislature is of this to live and practice in • PBM Rx Cost Notification to the Senate debate a wildly successful program. Wyoming. - Support contentious block chain WWAMI has been making bill and enjoying formal Wyoming lawmakers LASS of E-2018, you • Reporting of Abortions individual introductions proud since 1997 when Cmake us proud. Keep -Oppose until Amended in both chambers. The the program began and up the good work and know • State ID Medical Alert day concluded with a that pride was on display that Wyoming will happily meeting with Governor this year when the students be here to welcome you - Support Gordon where students were introduced and both back . • FM Residency & FQHC shared their thoughts on chambers stood, cheered and - Support • Opiate antagonist revision - Support • Opioid Mandated CME - Support • Opioid Rx Limits - Support • Protection of Children - Support • Medicaid Expansion Study - Support

FAILED

Pictured above, left to right: Ryan Winchell - Cody, Amanda Golden - Cody, Ranae Wollman LEGISLATION - Laramie, Elliot Trott - Jackson, Allana Hall - Laramie, Reno Maldonado - Laramie, Sean McCue - Cody, Jacob Zumo - Cheyenne, Trey Thompson - Cheyenne, Reed Ritterbusch - Sheridan, Daulton • Use of Hemp Extracts Grube - Rock Springs, Alexis Anderson - Jackson, Governor Mark Gordon, Adam Blaine - Gillette, - Support Caleb Brackett - Big Piney, Logan Taylor - Sinclair, Rida Fatima - Rock Springs, Conner Morton - Casper, Aleksandra Zarzycka - Cheyenne, Jesse Hinshaw - Encampment, Marcus Couldridge - • Gunshot/Stab Reporting Casper. - Support Amended • Naturopathy Licensure - Oppose • Abortion Waiting Period Medicaid - Monitor • Tobacco Tax EVERAL bills kept Medicaid policies in the spotlight this year. As of July 1, 2019, state Medicaid - Support Swill reimburse certified midwives for home birth deliveries, but efforts to require that existing • Medicaid Expansion Medicaid recipients work, volunteer or get a certain number of hours of education to maintain eligibility were ultimately thwarted when the House defeated the measure on third reading. - Support • Associate Physician Lic. While Medicaid expansion surfaced in policy debates again with a bill to fully expand and - Oppose another to simply study the issue further, the really interesting conversation happened surrounding air ambulance services in the state. In what Senator Charlie Scott referred to • Medical Marijuana as a “stroke of genius” majority floor leader Barlow may have found a way to skirt federal - Oppose regulations prohibiting state regulation of air amublance rates by creating a mechanism by which Medicaid would deem all air ambulance rates. House Bill 194 allows for any resident • Abortion Penalties of Wyoming to be retroactively granted Medicaid eligibility for purposes of submitting a - Oppose claim within 90 days of air ambulance transport for that air ambulance transport to state • Optometry Expansion Medicaid for reimbursement. It allows for the Department of Health to set a copay that is proportionate to income to be paid to any air ambulance service provider. - Oppose • Mental Health Scope Exp - Oppose THANK YOU TO OUR DOCTORS AND PAs OF THE Child Abuse Protections Become Law

DAY! YOMING’S physicians won a critical battle in fighting to gain an additional tool in Wprotecting Wyoming’s children with the passing and signing of enrolled act 51. Thanks • Steven Beer, MD to a few dedicated pediatricians, the support of the Wyoming Chapters of the American Academy of Pediatrics and the American Academy of Family Physicians and the tireless work of • Kristina Behringer, MD a few incredible legislators, children living in the same home as a child suffering abuse will have • Jake Behringer, MD the opportunity to be examined by a physician to assess their physical health and well-being. Senator Wendy Schuler (R-Evanston) had a vision to make a positive impact for vulnerable • Kimberly Broomfield, MD children and recruited the help of her colleagues to make the vision a reality. Special thanks to Senators Affie Ellis, and Liisa Anelmi-Dalton for their support in the Senate as well as House • JJ Chen, MD Members , , , , Shelley Duncan and Pat • Dustin Durham, MD Sweeney for their work and leadership in carrying this bill through the second chamber.

• David Fall, MD Because of this legislation, physicians and law enforcement can partner to ensure that when • Lisa Finkelstein, DO one child is removed for reasons of abuse, other children residing in that same home can be taken into temporary protective custody for a physical examination to ensure their safety. • John Healey, MD Dr. Bird Gilmartin saw a problem and did what it took to fix it. This success is a testament to • Lynn Horton, MD what physicians can do when we work together. Wyoming’s children are better for this effort • Larry Kirven, MD and we are deeply grateful to all those who worked to bring this to fruition. Thank you! • Ron Malm, MD • Greg McCue, MD • Matt Mitchell, MD • Evan Norby, MD • Doug Parks, MD • Amy Shaw, PA • Kristy Van Kirk, MD

Governor Gordon signs Enrolled Act 51 - Protection of Children into law February 26, 2019

OUR PROCESS AND HOW TO GET INVOLVED Ever wonder how the WMS determines positions on legislation or how you can do more to get involved? Each member is represented by a county medical society trustee who carries the voice of physicians in their area to the state board of trustees where policies are debated and decisions made about how and where WMS will focus efforts each legislative session. Disagree with something we did, or didn’t do? We want to hear from you! Please never hesitate to contact your county trustee, listed on the WMS website at www.wyomed.org, or reach out to your WMS staff in Cheyenne.

WYOMING MEDICAL SOCIETY Tel: 307-635-2424 | Email: [email protected]