WEEK ONE--Idaho Legislative Report
2019 IDAHO LEGISLATURE UPDATE
January 7, 2019 through January 11, 2019
Michael McGrane, RN
Our new Governor, Brad Little, described this as a new era for Idaho. Not only is there a new Governor this year, but a quarter of Senators and House Representatives are new. Many of the old faces at the capitol are gone. This represents a fresh start with new energy. Politically the tone has shifted more toward the center. There appears to be more interest in collaboration between parties and segments of the legislature. There will still be a libertarian bent, but not as dramatic as has been over the past several years.
Governor’s State-of-the-State Address
The 2018 legislative session opened this Monday, January 7th with the Governor's State-of-the-State address. This is Governor Little’s first address to the full legislature. Education and healthcare were the focus topics. Here are highlights of Governor Otter's message and budget as it related to healthcare:
- Work toward the goal of 60% of high school graduates go on to complete a degree or technical certificate
- Opportunity scholarships to retain Idaho’s youth in Idaho
- Additional $1.65M for graduate medical education to add 19 positions for medical residents
- Funding for mental health, opioid abuse and suicide prevention
- Commitment to implement Proposition 2, passed by 60% of voters to expand Medicaid coverage for those caught without health insurance coverage. The budget included $400M to cover Idaho’s share of added cost for expansion.
- Commitment to make healthcare accessible and affordable. The Governor highlighted his executive order as Lieutenant Governor to allow individuals to purchase health plans at a lower cost but do not cover all ACA mandated conditions.
Proposition 2 became law when it was passed by the voters in November. However, the legislature must appropriate money to cover the state’s portion of the cost. The Governor’s budget requested $400M. Under the Affordable Care Act, the Federal government covers 90% of the cost, and Idaho would cover 10%. For Idaho’s share, $10.8M would come from the Millennium Fund, money the state receives through the tobacco settlement, and the remainder from saving realized by expanding Medicaid, including reducing the Catastrophic Fund that covers the uninsured. The Governor’s budget does not include money for added restrictions some legislators have suggested such as a work requirement, that cannot be covered by federal funds.
The Idaho Freedom Foundation is challenging the legitimacy of Proposition 2 suggesting that the law gives the Department of Health and Welfare too much discretion and allows the legislature to relinquish too much control to the federal government. The Idaho Supreme Court is scheduled to hear the case on January 29th. Another federal court in Texas has issued a decision that the Affordable Care Act, which includes Medicaid expansion, is unconstitutional. This case may go to the U.S. Supreme Court for final decision. Some legislators are suggesting a delay in appropriating funds until these cases can be decided. ANA-Idaho and NLI, along with other advocacy groups are urging the legislature to appropriate the necessary funds to implement the will of the people now.
In Idaho rules promulgated by the Departments and Professional Boards are presented at the beginning of each session for approval by the legislature. In 2015, Idaho citizens passed a Constitutional Amendment giving the Legislature authority to approve or reject, in whole or in part, agency administrative rules. House and Senate Health and Welfare Committees are meeting daily during the first two weeks of the session to process rules.
Restraint & Seclusion Rules
In 2017, Nurse Leaders of Idaho petitioned the Department of Health and Welfare to change the hospital rules regarding the ordering of restraints. The current rule requires a physician’s order, which can be difficult to obtain in a timely manner as many facilities (psychiatric facilities, SNF, etc.) do not have on-site physicians. The new rule aligns with the CMS, which would allow nurse practitioners to order restrains. In addition, thought collaboration with Disability Rights Idaho, an advocacy group for the disabled, the new rules address the conditions and requirements for restrains and seclusion, again aligning with CMS standards. The House H&W Committee unanimously passed the rule change. It now goes to the Senate H&W this next week for approval. Once this endorsement is confirmed, the new rule becomes effective at the end of the legislative session at the end of March.
The form used for parents to decline immunizations for their children became a hot topic during the 2018 legislative session. Over the summer, with the input of parents, the Department of Health and Welfare drafted rules to allow parents to use a modified form posted on the Departments website, a form developed by the school, or any form produced by the parent to decline immunizations. Previously students would not be allowed to attend school without having immunizations except under limited circumstances. The only requirements for the new form are that it includes the child’s name and birthdate and the parent/guardian signature. Several parents who oppose immunizations testified at the House hearing.
Another rule change would require high school seniors prior to graduation to receive a buster for the meningitis vaccination. The State Epidemiologist reported that there is a 76% compliance in receiving the initial meningitis vaccine at age 12, but it drops to 21% for the booster shot at age 17. The rule is intended to improve compliance. As with other vaccinations, parents have the option of declining the vaccination. There again were several parents who testified against vaccinations in general and against any requirement that students receive a vaccination even if the parents could opt-out. The new rule barely passed the committee 7-6. It now goes to the Senate Health and Welfare Committee.
Religious Exemption to the Child Welfare Act
This exemption allows parents to deny medical care to their children for religious reasons, even in life-threatening circumstances. Bills have been considered over the past three years to eliminate or limit the religious exemption without success. Protect Idaho Kids, an advocacy group, will be presenting a documentary and hosting a discussion Wednesday evening, January 16th at 5:30 PM in the Lincoln Auditorium at the Capital.
Board of Nursing Administrative Rule
The Board of Nursing has a single proposed rule with three parts. Its hearing has not been scheduled yet.
Change Definition of “Nurse Apprentice”
This would allow recent nursing program graduates who are employed as CNAs to continue to work in an unlicensed capacity for three months beyond completion of the nursing program. Nurse Apprentice should not be confused with Graduate Nurse or Nursing Residency.
Remove a Section of the Rules Addressing Multistate Licensure
Since adoption of the Enhanced Interstate Nursing Compact, language in the rules is obsolete and needs to be removed.
Prescriptions Written by APRNs
The current rules require information to be provided by APRNs ordering prescriptions that are not required of other providers authorized to write prescriptions. The rule revision removes those additional requirements to align with those of other providers.
CALL TO ACTION
Familiarize yourself with the Idaho Legislature website: www.legislature.idaho.gov
The site includes information on who your legislators are (you can search by your address), and how to contact them. In addition is information on House and Senate Standing Committees, with photos and background information on each legislator. The site also has links to Committee agendas and meeting minutes.