March 14, 2016 VOLUME 28, ISSUE 9
Welcome to the 9th issue of award-winning Health Care Highlights for 2016. This year marks the 28th year of our unique health care publication. Our newsletter reaches more than 5,000 health professionals and health policymakers.
In this issue, we provide an EXECUTIVE SUMMARY of key health-related enactments during the 60-day session.
Hooray, it's over! The second regular session of the 82nd Legislature ended at midnight Saturday. Lawmakers return this week to work only on the state fiscal year 2017 budget during the three-day extended session authorized by Gov. Earl Ray Tomblin. Several important decisions will be made regarding funding of many health programs, and we will report the outcome on the Budget Bill to you next week.
During this year’s regular session, lawmakers introduced 1,180 bills in the House of Delegates and 700 bills in the state Senate. Of the 1,880 total bills introduced this session, about 291 were health care-related bills (15.4%). The Legislature enacted a total of 276 bills (15%) during the session. We profile in this issue the 51 (17.5%) health care bills that passed. Many already have been signed into law by Gov. Earl Ray Tomblin; others await his approval. Now that the regular legislative session has ended, the Governor has 15 days following the receipt of a bill to veto, sign or allow it to become law without his signature. On the other hand, there were 240 health-related bills that did not pass.
In addition, the Legislature considered 14 resolutions requesting health-related interim studies. These do not require passage by the Legislature or approval by the Governor. They simply “request” that the Legislature create interim study committees. The Legislature may decide to study any topic during the interim period between now and next January, even if there has not been a resolution proposed or adopted. Decisions on interim study topics will be made by the Joint Committee on Government and Finance in April or May. See inside this issue for a preview of the resolutions.
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1 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
Governor Issues Proclamation to Extend Session for Budget Bill Gov. Earl Ray Tomblin on Wednesday issued a proclamation, as required by the state Constitution, to extend the 2016 legislative session for three additional days until Tuesday (March 15) to allow for further consideration of the budget bill (SB 269). The proclamation specifies the Legislature shall only consider the budget bill during the extended session. If the Legislature is unable to complete budget work by then, the Governor could extend the session for a few more days, or call for a special session at a later date, to be determined (which is the best guess at the Capitol.0
Budget conferees named by the House of Delegates include Finance Committee chair Eric Nelson and Delegates Bill Anderson, Eric Householder, Carol Miller and David Perry. Budget conferees named by the Senate include Finance Committee chair Mike Hall and Sens. Robert Plymale, Roman Prezioso, Dave Sypolt and Chris Walters.
Amended APRN Bill Removes Schedule II Drugs A Senate floor amendment to HB 4334, which expands the scope of practice for advanced practice registered nurses (APRNs), removes prescriptive authority for Schedule II controlled substances such as oxycontin and morphine. It allows APRNS to apply for independent practice after three years of collaboration with a physician, establishes a 13-member Joint Advisory Council on Limited Prescriptive Authority, and allows APRNs to sign death certificates following training, along with certain other health-related documents.
The Senate passed a similarly amended version of the bill on Thursday on a 34-0 vote. The House had passed the measure on Feb. 27 on a 72-20 vote, with eight members not voting. The bill now goes to Gov. Earl Ray Tomblin.
“I think the bill could have been a little stronger, for both sides,” Sen. Tom Takubo said Thursday. “This has absolutely nothing to do with individuals; it has everything to do with experience.” Sen. Ron Stollings called the amended bill “an artful compromise” that “will help strengthen the entire health care delivery system in West Virginia.” Missing from the final version is any requirement for independent APRNs to practice in rural, medically underserved areas.
A House floor amendment Saturday evening established the Advisory Council as gubernatorial appointments. The Board of Examiners for Registered Professional Nurses, the WV Board of Medicine, the WV Board of Osteopathic Medicine and the state Board of Pharmacy will make selections to the Advisory Council for official appointment by the Governor.
The APRN Advisory Council will consist of 13 members, including:
Six APRNs with at least three years of full-time practice experience, and consisting of at least one certified nurse practitioner, one certified nurse-midwife, and one certified nurse anesthetist;
Two licensed allopathic physicians who are in a collaborative relationship with APRNs;
Two licensed osteopathic physicians who are in a collaborative relationships with APRNs;
One licensed pharmacist;
One consumer representative; and,
One representative from a school of public health or institution of higher education.
The council will choose its own chair and will meet at least biannually. It is charged with reviewing applications for APRNs to prescribe limited drugs without a collaborative agreement, and reviewing and advising on complaints against APRNs, among others duties.
The introduced version of the bill (which did not pass) would have expanded APRN prescriptive authority to include no more than a 72-hour supply of Schedule II drugs, up to a 30-day supply of Schedule III drugs and up to a 30-day supply of Attention Deficit Disorder medications. The bill also removed collaborative relationships with physicians as a continuing requirement of practice, but retaining the collaborative relationship requirement for a two-year period as a prerequisite to qualify for prescriptive authority, and permitted the signature of an APRN to have the same force and effect as that of a physician insofar as patient care documentation is concerned.
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Telemedicine Bill Sails Through Legislature A bill which permits, defines and establishes licensing requirements for physicians and podiatrists to utilize telemedicine technologies passed both the Senate and House of Delegates unanimously en route to Gov. Earl Ray Tomblin’s desk. The bill, HB 4463, also limits prescribing controlled substances by requiring a physical encounter and original prescriptions for Schedule II medications.
The legislation bill contains consumer protections and follows national standards in clarifying that the practice of medicine takes place where the patient is located. That means a provider must be licensed in West Virginia to treat West Virginia patients. Under amendments adopted by the House Committee on Health and Human Resources, the physician is required to inform the patient of his or her physical location and to provide contact information.
Advances in broadband technology, coupled with telemedicine, are expected to expand access to care for a variety of medical specialties into rural areas of the state. The Interstate Medical Licensure Compact, which currently supports medical licensure portability between 12 states, will also aid in expansion of telemedicine.
Early Eye Drop Rx Bill Passes Unanimously The Early Eye Drop Prescription Refill Bill (HB 4038), which allow patients to request a refill on their prescription after at least 70% of the predicted days of use, or on day 21 of a 30-day prescription, passed both House of Delegates (Jan. 26) and the Senate (on Friday) by unanimous vote en route to Gov. Earl Ray Tomblin.
If signed by the Governor, West Virginia will join 18 other states (including surrounding states Maryland and Kentucky) in adopting the legislation. States where early eye drop prescription refills already are allowed include: Alaska, Connecticut, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Missouri, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Washington and Wyoming. Five other states have bills under consideration, including Louisiana, Massachusetts, Nebraska, North Carolina and South Carolina.
The goal of the legislation, an interim bill recommended by the Joint Committee on Health, is to prevent gaps in care that could result in a regression in the treatment of serious eye conditions such as glaucoma and other degenerative eye diseases. The legislation assures the continuation of quality patient care for those who suffer from these conditions and are required to use daily eye medication. The medications are essential for the preservation of sight, but often, prescription eye drops run out well before the refill date.
The West Virginia Academy of Eye Physicians & Surgeons (ophthalmologists) strongly supported this legislation, which is modeled after a bill introduced late in the 2015 session. The legislation also has been supported by the West Virginia Association of Optometric Physicians, the West Virginia Academy of Family Physicians, the American Academy of Ophthalmology and the American Glaucoma Society. In addition, the U.S. Centers for Medicare & Medicaid Services issued a policy memorandum or “guidance” in support of the concept in June 2010.
Air Ambulance, UPL Bills Await Signature An air ambulance bill (HB 4315) spotlighted by Gov. Earl Ray Tomblin in his State of the State address in January arrives back on his desk for signature after the Senate approved the measure on the session’s final day. The House had passed the bill in February. The legislation prohibits air transportation or related emergency services providers operating in West Virginia from collecting more for service from PEIA beneficiaries than the currently allowable Medicare reimbursement rate. HealthNet Aeromedical Services is the only air ambulance company with a PEIA contact and fully supports the bill.
This bill, seen as a consumer protection measure, prevents other air ambulance providers who do not have a PEIA contract from balance billing PEIA beneficiaries. A provider that has entered into a subscription service agreement with a PEIA insured must accept that fee as payment in full.
Meanwhile, the health care provider tax bill, affecting eligible acute care hospitals, likewise awaits Gov. Tomblin’s signature after passing the Senate last Tuesday. The bill, HB 4209, was originated in the House Committee on Health and Human Resources, and passed the House on Feb. 17. The bill extends the tax until June 30, 2017, increases the tax rate for the Upper Payment Limit (UPL) program from .72% to .88% and provides for disbursement of any funds remaining in the Eligible Acute Care Provider Enhancement Account. The tax is used to draw down matching federal funds. 3 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
Senate Removes Amendments, Passes CON Bill The Senate on Thursday removed amendments approved earlier in the week by its Committee on Health and Human Resources and passed a bill (HB 4365) which streamlines West Virginia’s certificate of need process. The amendments would have removed an exemption for behavioral health services, and added an exemption for imaging and surgical procedure services in private physician offices and facilities. This bill now awaits Gov. Earl Ray Tomblin’s approval.
The bill is designed to create a new simplified CON and exemption process, including shortened timelines for processing CON and exemption applications. The WV Behavioral Health Care Providers Association lobbied against the behavioral health exemption, saying it would open the door to “cherry picking” of limited state resources and result in a concentration of services in urban areas.
A similar exemption in the 1990s resulted in bankruptcy for two of the state’s comprehensive behavioral health center, including Shawnee Hills, Sen. Jeff Kessler said during Thursday’s floor debate. Moving behavioral health back under CON requirements has worked well since then. “I would suggest that when it’s not broken, it doesn’t need fixed,” he said.
Sen. Ryan Ferns, however, argued that West Virginia currently has inadequate behavioral health treatment options, particularly in rural areas. He said the amendment, “would not be in the best interests of our citizens, who desperately need help. Good providers should never fear competition. We are not trying to tear down but rather build up services.”
Sen. Tom Takubo argued in favor of the physician office and facilities amendment, saying the CON process is expensive, cumbersome and unnecessary. Ferns, however, said the bill as presented represented six months of interim and stakeholder meetings. Sen. Mitch Carmichael noted, “We felt the bill represented the best product of the work group.”
West Virginia is one of 35 states with a certificate of need program, including all border states except Pennsylvania.
HCA / Hospital Merger Bill Ironed Out in Conference A Senate bill that has implications for the pending merger of Cabell Huntington Hospital and St. Mary’s Medical Center received the Legislature’s approval Saturday after a conference committee ironed out differences between House and Senate versions. The conference committee included Delegates Joe Ellington, Patrick Lane and Don Perdue, and Sens. Ryan Ferns, Craig Blair and Robert Plymale. The bill has been sent to the Governor for his approval.
The original version of SB 597 would have placed the West Virginia Health Care Authority within the state Department of Health and Human Resources. It also would have eliminated rate review from the HCA’s duties; created an executive director’s position within DHHR; required a part-time, five-member board; and required a comprehensive study of the certificate of need program – including possible elimination of CON.
But the House Health Committee overhauled the bill, scrapping much of the language pertaining to the HCA and refocusing the bill on oversight of academic medical center “cooperative agreements.” Under the bill, actions of the HCA shall be exempt from antitrust actions under state and federal law. Further, “Any actions of hospitals and health care providers under the board’s jurisdiction, when made in compliance with orders, directives, rules, approvals or regulations issued or promulgated by the board, shall likewise be exempt. … It is the intention of the Legislature that this chapter shall also immunize cooperative agreements approved and subject to supervision by the authority … from challenge or scrutiny under both state and federal antitrust law.”
The amended bill states, “The Legislature encourages cooperative agreements if the likely benefits of such agreements outweigh any disadvantages attributable to a reduction in competition. When a cooperative agreement, and the planning and negotiations of cooperative agreements, might be anticompetitive within the meaning and intent of state and federal antitrust laws, the Legislature believes it is in the state’s best interest to supplant competition with regulatory oversight by the Health Care Authority. … The authority has the power to review, approve or deny cooperative agreements, ascertain that they are beneficial to citizens of the state and to medical education, to ensure compliance with the provisions of the cooperative agreements relative to the commitments made by the qualified hospital and conditions imposed by the Health Care Authority.”
A certificate of need application regarding the merger remains pending before the HCA. In addition, the Federal Trade Commission had scheduled an April hearing on potential anti-trust issues. The status of that hearing is not clear. 4 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
State Hospitals Study Among Bills Failing in Final Week Last week, we reported that there were 219 health care bills that would likely not receive any further legislative action this session because they failed to meet the time period to be passed in their chamber of origin. This week, we list 22 additional bills that passed one chamber before the "crossover" date, but died last week in the other chamber before final adjournment of the regular legislative session.
Among the notable bills that failed in the final week was HB 4352, which would have required the state Department of Health and Human Resources to hire a consultant and prepare a plan to sell, renovate or lease Hopemont Hospital in Preston County, Jackie Withrow Hospital in Raleigh County, John Manchin Sr. Health Center in Marion County and Lakin Hospital in Mason County. The Senate rejected the bill on Friday by a vote of 12 in favor, 22 opposed.
The original legislation would have required DHHR to develop a plan to sell the facilities outright. However, during an emotional public hearing Feb. 9, speakers wondered about the fate of long-time state employees and residents of the four facilities. The House Committee on Health and Human Resources significantly amended the bill later that same day. The amended bill required Cabinet Secretary Karen Bowling to submit a plan to the Governor and the Joint Committee on Health by Nov. 30. During that February Health Committee meeting, Delegate Patrick Lane cautioned that a 2013 Legislative Auditor’s report estimated the cost of repairs and upgrades at the facilities at more than $51.6 million.
The Senate Committee on Health and Human Resources late Thursday declined to advance HB 4470, which would have expanded newborn testing to include testing for adrenoleukodystrophy, a rare condition which often goes undetected until later in life. Treatment involves a bone marrow transplant. However, DHHR Deputy Secretary Jeremiah Samples said adding the test would cost an additional $180,000 to $200,000 for already cash-strapped state labs. The condition affects about one in 17,000 newborns and doctors often detect its presence through other physical malformations.
The Senate on Friday referred to the Rules Committee a bill (HB 4035) that would have permitted pharmacists to furnish naloxone hydrochloride, essentially killing the legislation. Standardized procedures and protocols developed by both the WV Board of Pharmacy and the WV Board of Medicine would have ensured education of the person to whom the drug was furnished, including opioid overdose prevention, recognition and response, safe administration of naloxone hydrochloride, potential side effects or adverse events, and the imperative to seek emergency medical care for the patient. The Senate also referred to the Rules Committee a bill (HB 4243) that would have extended an exemption for certain nonprofit community groups from the state’s moratorium on new nursing homes beds. The bill referred to a nursing home project in Wirt County; the moratorium exemption would have been extended until July 1, 2017.
Here is the full list of health-related bills that died during the final week: SB 488 Takubo+ Creates Leland’s Law, requires WVSSAC emergency action plans to manage hypertrophic cardiomyopathy SB 628 Takubo+ Permits treating physician to direct palliative or emergent treatment for patients under authority of DHHR HB 2795 Westfall+ Permits release of medical records without court order HB 4002 Howell+ Establishes sunset provisions for legislative rules HB 4031 Frich+ Requires agencies to respond to public comments received during the rule-making process HB 4035 Stansbury+ Permits pharmacists to furnish naloxone hydrochloride HB 4183 Stansbury+ Requires EMS to report opioid overdoses to Board of Pharmacy HB 4197 Kelly+ Allows required HIV and hepatitis testing to protect law enforcement officers HB 4240 Marcum+ Increases penalties and mandatory minimum sentences for drug traffickers HB 4243 Border+ Extends exemption for certain nonprofit community groups from moratorium on nursing home beds HB 4248 Rohrbach+ Regulates methadone and opioid treatment programs HB 4352 Nelson+ Allows DHHR to sell certain state-owned health care facilities HB 4358 Statler+ Exempts physician or surgeon traveling with a sports team from state licensure HB 4438 Summers+ Allows providers to involuntary hold and examine patients experiencing a psychiatric emergency HB 4470 Rohrbach+ Expands newborn testing to include Adrenoleukodystrophy HB 4480 Walters+ Limits prescribing products with buprenorphine, with or without naloxone HB 4577 Overington+ Creates additional penalty for using a firearm in a drug offense HB 4578 Weld+ Creates criminal offense of conspiracy to violate drug laws HB 4685 Ihle+ Prohibits lay members from having a license from the boards they serve HB 4696 Howell+ Creates unlicensed practice review board HB 4727 Ellington+ Requires legislative oversight of the I/DD waiver program HB 4731 Rohrbach+ Requires comprehensive drug awareness and prevention program in public schools 5 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
West Virginia Legislature ACTIVE* Health Care Bill Status as of 3/13/16 *Only ACTIVE bills are listed as all others failed to be passed by the legislative chamber of origin by March 2. To review current status, visit www.legis.state.wv.us
To find a particular bill, look below for the bill number under a general health category. A description of the bill is provided along with the bill's lead sponsor, additional information about the bill, committee references and other legislative action. For those receiving this newsletter electronically, please note that bill numbers are web-links to the bill text, so you may click on the blue bill number while holding down the control key and information on the bill will open in your web browser.
APPROPRIATIONS & BUDGET SB 269 Cole+ Budget Bill SFY 2017 Governor’s bill. Of note: More than 20% of all state expenditures are allocated for Health and Human Resources. (see HB 4017) To conference committee Budget conferees named by the House of Delegates include Finance Committee chair Eric Nelson and Delegates Bill Anderson, Eric Householder, Carol Miller and David Perry. Budget conferees named by the Senate include Finance Committee chair Mike Hall and Sens. Robert Plymale, Roman Prezioso, Dave Sypolt and Chris Walters.
SB 342 Cole+ Decreasing appropriation to DHHR This bill decreases SFY 2016 appropriations to the Division of Human Services by $46.3 million and to the Bureau of Senior Services by $7.6 million. Completed legislation, approved by Governor, effective from passage.
SB 360 Cole+ Supplemental appropriation to DHHR Division of Human Services Governor’s bill to provide $10.09 million to DHHR Division of Human Services from State Excess Revenue Lottery Fund Completed legislation, approved by Governor, effective from passage.
SB 450 Cole+ Supplemental appropriation to DHHR Governor’s bill to provide $3.2 million to the Division of Health and $1.2 million to Division of Human Services Completed legislation, approved by the Governor, effective from passage.
HB 4017 Armstead+ Budget Bill SFY 2017 Governor’s bill. Of note: More than 20% of all state expenditures are allocated for Health and Human Resources. (see SB 269) To conference committee
HB 4150 Armstead+ Supplemental appropriation to DHHR Governor’s bill for Medicaid funding. Completed legislation, pending approval by the Governor
HB 4155 Armstead+ Supplemental appropriation to DHHR Consolidated Medical Service Fund Governor’s bill to provide $3.2 million to the WV Birth-to-Three program and $4 million to the Medical Services Trust Fund. Completed legislation, pending approval by the Governor
BOARD LICENSURE AND REGULATION SB 47 Ferns Rewrites licensure for medicine, surgery and podiatry Completed legislation, pending approval by the Governor
SB 619 Blair+ Regulatory Reform Act Completed legislation, pending approval by the Governor
HB 4340 Howell+ Lynette’s Law requires medical licensing boards to place disciplinary actions on public websites Completed legislation, pending approval by the Governor
HB 4463 Rohrbach+ Authorizes the practice of telemedicine This legislation permits, defines and establishes licensing requirements for physicians and podiatrists to utilize telemedicine technologies. The bill also requires a physical encounter and original prescriptions for Schedule II medications. It clarifies that the practice of medicine takes place where the patient is located. The physician is required to inform the patient of his or her physical location and to provide contact information. Completed legislation, pending approval by the Governor
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HB 4654 Summers+ Removes Nursing Board exec. secretary’s experience requirements This bill removed required qualifications for the executive secretary’s position with the Board of Examiners for Registered Professional Nurses. Completed legislation, approved by the Governor, effective from passage.
HOSPITALS SB 68 Ferns+ Removes hospital rate review and rate setting from Health Care Authority Completed legislation, pending approval by the Governor
HB 4209 Ellington+ Extends expiration date for UPL health care provider tax on eligible acute care hospitals The bill increases the tax rate for the Upper Payment Limit (UPL) program from .72% to .74%, and extends the program until June 30, 2017. Provides for disbursement of any funds remaining in the Eligible Acute Care Provider Enhancement Account. Supported by the WV Hospital Association. Completed legislation, pending approval by the Governor
HB 4315 Armstead+ Setting maximum amount for PEIA-paid air ambulance fees Under this Governor’s bill, any air-ambulance provider that does not have a contract with PEIA and provides services to an insured member may not collect from PEIA and the insured a combined amount for those services that exceeds the reimbursement level in effect for the federal Medicare program. An air-ambulance provider that has entered into a subscription service agreement with a PEIA insured must accept that fee as payment in full. HealthNet supported this bill. Completed legislation, pending approval by the Governor
HB 4388 Rohrbach+ Requires Bureau for Public Health to designate certain hospitals as stroke centers The bill calls for establishment of a stroke network, similar to the state’s current network for trauma. Hospitals would apply to DHHR to be recognized and certified as a comprehensive stroke center, a primary stroke center or an acute stroke-ready hospital, based on criteria from the American Heart Association, the Joint Commission or other nationally recognized organizations. DHHR would establish pre-hospital care protocols related to assessment, treatment and transport of patients identified as stroke patients. DHHR would provide a list of designated hospitals by June 1 of each year. The legislation also requires OEMS to establish protocols to treat and transport stroke patients. Completed legislation, pending approval by the Governor
HB 4520 Hanshaw+ Clarifies that nonprofit hospitals have only one governing body The medical staff of a hospital, the executive committee of the medical staff, and any other committee or subcommittee are not a governing body of the hospital unless it is vested with and exercises independent decision-making authority. Completed legislation, pending approval by the Governor
INSURANCE & HEALTH COVERAGE SB 278 Ferns+ Clarifies Physicians Mutual Insurance Co. is not a state or quasi-state agency Completed legislation, pending approval by the Governor
SB 404 Ferns+ Allows Bureau for Public Health and local health departments to bill for HIV and STD testing Completed legislation, pending approval by the Governor
SB 517 Gaunch+ Clarifies PEIA plans are exempt from regulation by the Insurance Commissioner Completed legislation, pending approval by the Governor
HB 4038 Ellington+ Permits early refill of topical eye medications (see HB 4146) Bill recommended by the interim Joint Health Committee. Allows patients to request a refill on their prescription after at least 70% of the predicted days of use, or on day 21 of a 30-day prescription, as recommended by CMS and already enacted in 18 states. Completed legislation, pending approval by the Governor
HB 4146 Ellington+ Requires insurers to cover abuse-deterrent opioid analgesics (see HB 4038) Beginning Jan. 1, 2017, insurers must provide coverage for at least one abuse-deterrent opioid analgesic drug product for each active opioid analgesic ingredient. This bill was recommended by the Joint Committee on Health and is similar to legislation introduced in 2015. Completed legislation, pending approval by the Governor
HB 4655 Walters+ Prohibits insurers, vision care plans or discount plans from requiring provider discounts Completed legislation, pending approval by the Governor 7 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
MEDICAL LIABILITY SB 7 Leonhardt+ Establishes wrongful conduct rule prohibiting recovery of damages under certain circumstances This bill prohibits the recovery of damages by a plaintiff whose injuries are caused, in whole or in part, by the plaintiff’s commission or attempted commission of an illegal or immoral act or transaction, as long as the provider has not illegally dispensed or prescribed a controlled substance to that person. Supported by WVSMA and WVAFP. Completed legislation, approved by Governor 3/2, effective 90 days from passage
SB 15 Boso+ Adopting learned intermediary doctrine as defense in civil actions Completed legislation, approved by Governor 2/25, effective 90 days from passage.
SB 602 Trump Closes the Patient Injury Compensation Fund and satisfies the liability of the fund The PICF is closed effective July 1 for claims filed. There is an assessment on hospital trauma patients of $25 each for four years and an assessment on physician licensure of $125 each renewal period for the next two cycles. There is an assessment on the recovery of malpractice settlements or awards of 1%. All of these assessments go to the PICF. Completed legislation, pending approval by the Governor
MISCELLANEOUS SB 338 Trump+ Compiles and maintains central state mental health registry Completed legislation, pending approval by the Governor
SB 384 Takubo Requires Medicaid to seek waiver for 30-day waiting period for tubal ligation Completed legislation, pending approval by the Governor
SB 387 Karnes Allows shared animal ownership agreements to consume raw milk Completed legislation, signed by the Governor 3/3, effective 90 days from passage.
SB 597 Ferns+ Creates position of Executive Director of the Health Care Authority (see HB 4365) Amendments to this bill remove Health Care Authority provisions except for academic medical center cooperative agreements. Completed legislation, pending approval by the Governor
HB 4040 Kelly+ Regulating step therapy protocols in health benefit plans The West Virginia Academy of Family Physicians and the West Virginia State Medical Association support this bill. Completed legislation, pending approval by the Governor
HB 4314 Rohrbach+ Prohibits the sale of powdered or crystalline alcohol Completed legislation, pending approval by the Governor
HB 4365 Ellington+ Creates simplified and expedited CON process (see SB 597)) This bill originated in the House Health Committee. It streamlines the certificate of need process, including shortened timelines for processing CON and exemption applications. WVHA supported this bill. . Completed legislation, pending approval by the Governor
HB 4659 Ellington Authorizes local health departments to bill insurance plans for services Health care service fees are billable at the maximum allowable rate and no longer require approval from the commissioner of the Bureau for Public Health is no longer required. Completed legislation, pending approval by the Governor
PRESCRIPTION MEDICATIONS & DRUG USE/ABUSE/DIVERSION SB 6 Ferns+ Requires drug screening and testing for TANF applicants Interim bill recommended by the Legislative Oversight Commission on Health and Human Resources Accountability. Completed legislation, pending approval by the Governor
SB 123 Stollings Allows expedited partner therapy treatment for sexually transmitted disease Completed legislation, approved by Governor 2/25, effective 90 days from passage.
SB 416 Takubo+ Allows terminally ill patients access to investigational drugs Completed legislation, pending approval by the Governor 8 | P a g e Health Care Highlights Volume 28, Issue 9 March 14, 2016
SB 431 Cole+ Allows pharmacists and pharmacy interns to dispense opioid antagonists Governor’s bill would allow dispensing without a prescription, subject to a protocol developed by the state Board of Pharmacy. It requires reporting by the Board of Pharmacy to the Joint Committee on Health, the Legislative Oversight Committee on Health and Human Resources Accountability, and the state Bureau for Behavioral Health and Health Facilities. Completed legislation, pending approval by the Governor
SB 454 Kessler Requires Rx for opioid antagonists be logged into Controlled Substances Monitoring Database Governor’s bill also creates a new “Fight Substance Abuse Fund.” Completed legislation, pending approval by the Governor
SB 627 Takubo+ Permits physicians to decline to prescribe controlled substances Completed legislation, pending approval by the Governor
HB 4176 Stansbury Permits regional jails to participate in addiction treatment pilot program If the Regional Jail and Correctional Facility Authority is selected to participate in the pilot program by DHHR, the authority shall select only persons who are serving a sentence for a felony or misdemeanor who are determined to be at high risk using assessment criteria for the pilot program. Participants must either be eligible for Medicaid, or eligible for a state, federal or private grant or other funding source that provides for the full payment of the treatment necessary to participate in the pilot program. Completed legislation, pending approval by the Governor
HB 4347 Ellington+ Gives priority to pregnant women for substance abuse treatment Under this legislation, substance abuse treatment or recovery service providers that accept Medicaid shall give pregnant women priority in accessing services and shall not refuse access to services solely due to pregnancy as long as the provider's services are appropriate for pregnant women. Completed legislation, pending approval by the Governor
HB 4537 Stansbury+ Regulates chronic pain clinics This bill redefines terms such as “chronic pain” and “pain management clinic.” It removes facilities which are affiliated with accredited medical schools at which training is provided as an exempt pain management facility subject to the requirements of the bill. It also clarifies notice procedures with regard to regulation of chronic pain clinics. Completed legislation, pending approval by the Governor
PROFESSIONALS: HEALTH & MEDICAL SB 658 Gaunch+ Allows licensed professionals to donate time to care for indigent patients in a clinical setting Completed legislation, pending approval by the Governor
HB 4033 Ellington+ Adds criminal penalties for unauthorized practice of pharmacist care Completed legislation, pending approval by the Governor
HB 4334 Summers+ Expands prescriptive authority for APRNs Amendments to this bill remove prescriptive authority for Schedule II controlled substances such as oxycontin and morphine, allow APRNS to apply for independent practice after three years of collaboration with a physician, establish a 13-member Joint Advisory Council on Limited Prescriptive Authority, and allow APRNs to sign death certificates following training, as well as certain other health-related documents. The APRN Advisory Council will consist of 13 members, including six APRNs with at least three years of full-time practice experience, and consisting of at least one certified nurse practitioner, one certified nurse-midwife, and certified nurse anesthetist; two licensed allopathic physicians who are in a collaborative relationship with APRNs; two licensed osteopathic physicians who are in a collaborative relationships with APRNs; one licensed pharmacist; one consumer representative; and, one representative from a school of public health or institution of higher education. The original version of the bill was strongly opposed by the West Virginia State Medical Association, the WV Board of Medicine, the WV Board of Osteopathic Medicine, the WV Academy of Family Physicians, the WV Osteopathic Medical Association, the WV Association of Physician Assistants, the West Virginia Sheriff’s Association and the Medical Advisory Coalition. Completed legislation, pending approval by the Governor
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HB 4428 Householder+ Clarifies optometrists’ prescriptive authority after reclassification of hydrocodone Allows optometrists to prescribe hydrocodone and hydrocodone products for no more than three days. Optometrists had this prescriptive authority since 1998 before hydrocodone was rescheduled as a Schedule II medication. Completed legislation, pending approval by the Governor
REPRODUCTIVE RIGHTS & ABORTION SB 10 Sypolt+ Unborn Child Protection from Dismemberment Abortion Act This bill outlaws a second-trimester abortion procedure known as a “dilation and evacuation,” which physicians believe is the safest procedure for the rare occasions it is used. The West Virginia State Medical Association and the West Virginia Section of the American Congress of Obstetricians and Gynecologists strongly opposed this bill. Completed legislation, vetoed by the Governor 3/9, overridden by House and Senate 3/10, effective 90 days from passage.
RESOLUTIONS FOR LEGISLATIVE INTERIM STUDY The following resolutions may be considered by the Joint Committee on Government and Finance during its April or May meeting for assignment to various legislative interim study committees:
SCR 48 – Addition of medical review panels in medical malpractice cases SCR 52 – Tax credits for elderly/disabled home modification SCR 71 – Line item reporting of TANF spending HCR 60 – State background checks for new employees/volunteers at caregiving facilities HCR 73 – Funding methodology for at-risk children and families to receive treatment services HCR 78 – Professional and occupational licensing boards HCR 79 – State agency websites HCR 99 – Senior citizen financial abuse HCR 106 – Direct primary care HCR 107 – Civil commitment laws HCR 108 – Surprise medical bills HCR 111 – Needs and challenges facing senior citizens HCR 112 – Interscholastic student athlete safety issues HCR 126 – Health care work force
RULE MAKING & LEGISLATIVE REVIEW State agencies, boards and commissions are often given statutory authority to promulgate rules. These are known as “legislative review” during the interim period by the Legislative Rule-Making Review Committee, and if approved, then are introduced for legislative consideration in individual rules bills. The rules bills are then assigned to various committees, eventually ending up in the Judiciary Committees of the Senate and House of Delegates. There, they are bundled into categories of rules bills. SENATE RULES BILLS SB 195 Rules Bundle. Authorizes the Department of Health and Human Resources (DHHR) to promulgate legislative rules. This rules bill bundle now includes these individual rules previously contained in the following bills: Completed legislation, pending approval by the Governor DHHR SB 186 Emergency medical services (see HB 4112) DHHR SB 192 Certification of opioid overdose prevention, treatment training (see HB 4111) DHHR SB 193 Chronic pain management licensure (see HB 4115) DHHR SB 194 Neonatal abstinence centers (see HB 4116) SB 159 Rules Bundle. This rules bill bundle now includes these individual rules previously contained in the following bills: Completed legislation, pending approval by the Governor DENTAL BOARD SB 170 Continuing education requirements (see HB 4100) DENTAL BOARD SB 171 Duties of dental hygienists and dental assistants (see HB 4101) MIRT BOARD SB 221 Licensure and practice (see HB 4067) MEDICAL BOARD SB 223 Limited licensure at state veterans’ nursing homes (see HB 4125) The House Health Committee amended the bill to allow physicians to prescribe the amphetamine Vyvanse to treat binge eating disorders. NURSING HOME BOARD SB 225 Licensure and practice (see HB 4128) PHARMACY BOARD SB 227 Licensure and practice (see HB 4129)
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PHARMACY BOARD SB 228 Uniform Controlled Substances Act (see HB 4130) PHARMACY BOARD SB 229 Recordkeeping and automated data processing systems (see HB 4131) PHARMACY BOARD SB 230 Licensure of wholesale drug distributors, 3rd-party logistics providers and manufacturers (see HB 4132)
TAXES, FEES & LOANS SB 421 Kessler Terminates the Behavioral Health Severance and Business Privilege Tax (see HB 4486) Replaces the tax with an equivalent tax yield of $14 million to $15 million on durable medical equipment for a two-year period. Completed legislation, approved by the Governor 3/8, effective 90 days from passage
Zika Case Confirmed in WV The state Department of Health and Human Resources, Bureau for Public Health last week received laboratory confirmation of the state’s first case of the Zika virus. The case involves a Clay County man who traveled to Haiti and who no longer exhibits symptoms. Dr. Rahul Gupta, state health officer and BPH commissioner, said Zika virus is not circulating in West Virginia. Indeed, there has been no local transmission of disease reported in the United States. Cases in the U.S. have only been found in return travelers who were bitten by the infected mosquito while traveling abroad.
“Four out of five persons who have the Zika virus experience no symptoms at all, and of those who do experience symptoms they are usually mild and recover fully,” Gupta said. “However, if you are pregnant or are considering becoming pregnant around the time you will be traveling to parts of the world where Zika virus is occurring, you should consider postponing trips to those areas at this time.”
The state has received 27 calls since late January from individuals concerned about Zika infection; 15 specimens have been collected and sent to the Centers for Disease Control and Prevention for testing. Three results have been received, and this is the first positive test. To date, eight pregnant women have had specimens sent for testing, but their results are still pending.
Pregnant women infected by the Zika virus could have babies with microcephaly, a neurodevelopmental disorder in which an infant’s head is significantly smaller than children of the same age. Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. For those who become ill, the most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes).
Health Centers Receive Substance Abuse Funding U.S. Sens. Joe Manchin and Shelley Moore Capito last week announced that five community health centers across West Virginia will receive more than $1.7 million to improve and expand substance abuse services. This U.S. Department of Health and Human Services funding will help health centers better address the substance abuse treatment needs in their communities, with a focus on treating opioid use disorders.
The five community health centers receiving awards are: Valley Health Systems, Inc. in Huntington - $406,250; Change, Inc. in Weirton - $370,204; Cabin Creek Health Center, Inc. in Dawes - $317,650; Womencare, Inc. in Scott Depot - $325,000; and Community Care of West Virginia in Rock Cave - $352,083.
“The opioid epidemic has ravaged our state and it is critical we improve and expand services in West Virginia to effectively treat and address opioid addiction,” Manchin said. “We must continue to do everything in our power to stem the tide of substance abuse and this funding is crucial in our fight.”
Capito added, “Expanding treatment options for those struggling with addiction is one of the biggest challenges we face in the fight for a drug-free West Virginia. Community health centers serve one in five West Virginians and could see an influx of patients because of the drug epidemic.”
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Tracy Hendershot: Nurse Practitioners Have Rejected Compromise
[The following column appeared in the Charleston Gazette-Mail last Wednesday, the day before the Senate voted to accept a compromise amendment and passed HB 4334. The headline is as it appeared in the newspaper.]
By Tracy Hendershot, M.D.
An opinion columnist recently declared that passage of House Bill 4334, expanding the scope of practice for advanced practice registered nurses (APRNs), would help ease rural health care shortages in our Mountain State (“Deregulate the nurse practitioners,” Feb. 2).
As a past Paul Ambrose Health Policy Fellow and a family doctor serving in a rural community, I can attest that the assumptions leading to this belief are not based in reality.
West Virginia APRNs currently can serve anywhere they choose. A review of the WV Rural Health Association’s annual report will show they choose to locate in the most populated areas. They yield to the same economic realities that all professionals face in West Virginia.
HB 4334 severs the APRN’s relationship with the physician but that will not increase the availability of care in underserved areas. Proof of this can be found in looking at states that have passed similar proposals.
A report by the Kaiser Family Foundation has shown that of the seven states with the highest primary care shortage areas, four have full APRN practice authority.
Further, a study just completed in Arizona, one of the states with severed relationships, concludes that APRNs are still just as likely to graduate and practice in urban areas.
What the legislation will do is allow nurse practitioners the privilege and responsibility of prescribing controlled medications at the levels currently reserved for physician providers.
This proposed expansion stands in defiance of West Virginia’s current opioid overdose epidemic. There is no rationale for the addition of up to 2,000 new opioid prescribers in the state. It is frustrating that this proposal comes at a time when state Board of Pharmacy data reveals that West Virginia finally has begun to see a reduction in opioid prescriptions.
Proponents of this bill loudly tout that a few western states where APRNs have severed physician collaboration have lower opioid prescription rates. They assume this is because APRNs are more fearful of using opioids and thus avoid writing for these prescriptions.
Again, this is not supported by fact. One need only look to Tennessee to find that last year, 35 of the top 50 prescribers of opioids in the state were APRNs.
Obviously, the physicians of West Virginia largely opposed the original language of HB 4334. Again, mainly because it will not likely increase care in rural WV, and it will increase the amount of opioid prescribers.
However, the Senate Committee on Health and Human Services found middle ground that solves these concerns and allows the APRNs many of the goals they sought. This type of compromise should be commended.
We at the Academy Of Family Physicians appreciate our collaborative partners in health delivery. West Virginia deserves a unified health care delivery approach, and we look forward to moving past the rancor and strife this legislation has created.
[Publisher’s Note: Dr. Hendershot is president of the West Virginia Academy of Family Physicians.]
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Governor’s Abortion Bill Veto Dismembered West Virginia’s Senate and House of Delegates on Thursday voted to override Gov. Earl Ray Tomblin’s veto a day earlier of SB 10, which outlaws a second-trimester abortion procedure known as a “dilation and evacuation.” The Senate voted 25-9 and the House voted 85-15 to override the Governor’s veto – the fourth such override of the session.
Tomblin, in his veto message, said he was, “advised that the bill is overbroad and unduly burdens a woman’s fundamental constitutional right to privacy.” He noted that for reasons of patient safety, the procedure is preferred by physicians.
The West Virginia State Medical Association and the West Virginia Section of the American Congress of Obstetricians and Gynecologists are among those who opposed the bill. Similar bills are enjoined from implementation in Kansas and Oklahoma. Opponents see the measure as unnecessary interference with the physician-patient relationship.
In Other Health Care Highlights … … Gov. Earl Ray Tomblin on Wednesday took note via Twitter that the 1-844-Help4WV hotline has now connected more than 1,000 callers with substance abuse treatment services in West Virginia. Tomblin and the state Department of Health and Human Resources launched the 24/7 help line last September to offer assistance not only to those suffering from substance abuse issues, but also to assist families and loves ones. Frankly, we hope that call rates start to decline, but only for the right reasons – that our state has made headway in the battle against addiction. …
… Sen. Ron Stollings, M.D., a 1982 graduate of the Marshall University Joan C. Edwards School of Medicine, is one of eight people to have been awarded the American Medical Association's 2016 Nathan Davis Award for Outstanding Government Service, according to a recent report in The Herald-Dispatch. Stollings, who is board-certified in internal medicine and practices in Madison, has served in the Legislature since 2006. He currently serves on four legislative committees, including Health and Human Resources and Finance. Nominated by Congressman Evan Jenkins, former executive director of the West Virginia State Medical Association, Stollings said he is honored to receive the award. “I am so grateful to be able to serve my community as a physician and through public service in the state Senate,” Stollings said. “In addition, I am extremely grateful to have wonderful mentors including Dr. Charlie McKown, Dr. Mabel Stevenson, Dr. Bertie Marshall, Dr. Skip Turner, Dr. Martha Mullett, Dr. Bill Neal, Dr. Pat Brown, Dr. Tino Amores and others. And I know these individuals share my belief that physician begins with "PH" for public health. Further, I appreciate my partners, especially Dr. Robert Atkins and staff, for working harder to allow my public service.” …
… Here’s a “Save the Date” item to place on your calendars: The Appalachian Addiction & Prescription Drug Abuse Conference- Pain & Addiction, Best Practices & Proper Prescribing will take place Oct. 20-22 at the Embassy Suites in Charleston. There are many topics of interest relative to addiction, proper prescribing, addressing the stigma of addiction, safe prescribing with comorbid conditions, physician burnout and wellness, alternative non-addictive treatment of pain, physiology of addiction, current overdose statistics, infectious disease and marijuana. CME credit will be available for multiple disciplines including that which is required by many of the licensure boards. Dr. P. Bradley Hall, a key organizer of the event, is executive medical director of the West Virginia Medical Professionals Health Program. …
… Count West Virginia Sens. Joe Manchin and Shelley Moore Capito among those applauding Senate passage of the Comprehensive Addiction and Recovery Act of 2015 (CARA) as a “good first step” in combating the nation’s opioid epidemic. The bill now goes to the House of Representatives for consideration. “I am glad that my consumer education amendment to ensure that advocacy groups have access to funds they need to raise awareness about the risks of opioid addiction and overdose was included in the final bill,” Manchin observed. Capitol likewise co-sponsored an amendment that would provide follow-up services to those who receive opioid overdose reversal drugs, MetroNews reported. The amendment also would improve treatment programs for pregnant women and mothers who have a substance use disorder. “Let’s have some follow up to see what’s happened to the addictive person,” Capito told the statewide radio network. “Are they just having another overdose? Leading to another overdose? So we can actually use the administration of Naloxone as an entry into maybe helping this person seek treatment.” …
… Congressman Evan Jenkins announced that New River Health Association, a federally qualified health center in Scarbro, is receiving more than $2 million from the U.S. Health Services Resources Administration to expand behavioral, dental and preventive care services in Fayette County. Marshall University, meanwhile, is receiving a grant of more than $500,000 from the National Science Foundation to study how the brain reacts to antibacterial substances. …
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Health Care Highlights© Thom Stevens, Publisher A Comprehensive Newsletter Covering Activities of the West Virginia Legislature and State Government Your Best Source for West Virginia Legislative & Governmental Health Information
Quotes of the Week: … “We have no advocates in the room, we don’t know what it’s going to cost, and I’m sure we’re going to pass it.” . Sen. Robert Plymale, during discussion in Senate Health on an addiction treatment pilot program for Regional Jail inmates.
… “My experience in Judiciary is the House is where my bills go to die.” . Sen. Robert Karnes, during a Senate floor session Thursday.
… “In answer to your question, which I’ve kind of forgotten in all this verbiage …” . Sen. Mike Hall, chairman of the Senate Finance Committee, answering questions Thursday regarding SB 269, the budget bill.
… “We believe in miracles, or we wouldn’t be here.” . Sen. John Unger, arguing against the Senate budget bill, which he said contained “fictional” revenue projections.
… “I hope I fare better than that last amendment.” . Sen. Tom Takubo, arguing in favor of an amendment to the certificate of need bill. Alas, his amendment also failed.
Inside Health Care Highlights This Issue Welcome to the 9th Issue in 2016 Governor Issues Proclamation to Extend Session for Budget Bill Amended APRN Bill Removes Schedule II Drugs Telemedicine Bill Sails Through Legislature Early Eye Drop Rx Bill Passes Unanimously Air Ambulance, UPL Bills Await Signature Senate Removes Amendments, Passes CON Bill HCA / Hospital Merger Bill Ironed Out in Conference State Hospitals Study Among Bills Failing in Final Week Family Physicians Celebrate 27th year of “Doc for a Day” Program Complete Analysis of all Health Care Bills Zika Case Confirmed in WV Health Centers Receive Substance Abuse Funding Tracy Hendershot: Nurse Practitioners Have Rejected Compromise Governor’s Abortion Bill Veto Dismembered In Other Health Care Highlights . . . Quotes of the Week
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