WEEKS THREE and FOUR--Legislative Update
2019 IDAHO LEGISLATURE
January 21, 2019 through February 1, 2019
Michael McGrane, RN
The past two weeks have concluded the review of Administrative Rules. Rules are heard in committee in both the House and Senate. If approved, the rules become effective at the end of the legislative session which typically adjourns by the end of March. A few bills are now beginning to be introduced.
This Friday, February 8, 2019, the Senate and House Health and Welfare Committees will hold a joint hearing from 9:00 AM – 11:00 AM in the Lincoln Auditorium which is in the lower level of the Capitol.
Each year the Committees invite the public to speak about their concerns relative to healthcare. With the passage of Proposition 2 to expand Medicaid to those 60,000 Idahoans who make too much to qualify for Medicaid assistance but too little to qualify for subsidies to purchase health coverage on the Idaho Exchange, most of the testimony will be about funding to implement what 61% of Idaho voters approved in November. ANA-Idaho and NLI will be submitting written testimony to the committees to encourage full funding to expand Medicaid, to avoid additional work or other requirements, and to avoid unnecessary delay in implementing what is already the law.
On January 29th the Idaho Supreme Court heard the case brought by the Freedom Foundations questioning the constitutionality of Proposition 2. They argued that Proposition 2 gave the Idaho Department of Health and Welfare too much authority to set rules for Medicaid participation and that the Idaho Legislature, by expanding Medicaid relinquished too much authority to the federal government. Arguments against the lawsuit mostly questioned procedural elements of the lawsuit, asking the Court to dismiss the suit. The Court did not dismiss the lawsuit citing the high level of interest in Proposition 2 and the need to provide the Department of Health and Welfare some direction to proceed or not in implementing expansion. The Department is set to submit the Idaho Medicaid Plan to CMS by February 18th. The Court will issue a written decision.
Board of Nursing Administrative Rule - Passed
The Board of Nursing rules have passed both Health and Welfare Committees. The rules become effective at the conclusion of the legislative session.
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.
Restraint & Seclusion Rules - Passed
The change to the Department of Health and Welfare Hospital Licensing Rules will allow Nurse Practitioners to order restraints and seclusion. Previously only a physician was authorized to order restraints. These changes align with CMS requirements and were done to protect the safety of patients and staff. ANA-Idaho/NLI worked alongside Disability Rights Idaho and the Department to draft the new rules. The rules passed both the House and Senate Committees and will become effective at the end of the legislative session.
Rules Requiring Insurance Coverage for Children’s Hearing Aids and Speech Therapy – Passed
Immunization Form - Passed
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 Department’s 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.
Meningitis Immunizations - Passed
Another rule change requires high school seniors prior to graduation receive a buster for the meningitis vaccination. Immunizations are very controversial for those who see it as an intrusion on personal liberty. As with other vaccinations, parents have the option of declining the vaccination. There 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 House Committee 7-6 and the Senate Committee 5-4.
HCR4 - Representative Giddings of White Bird has introduced a bill to reject the Meningitis Immuration rules.
HB 64 - Changes to the Complications of Abortion Reporting Law
The controversial law was passed in 2018 to require healthcare providers, physicians and nurses, to report on any complications of abortion including divulging patient information. The law also directs the Board of Nursing to take license action against nurses who fail to report. The law is being challenged in federal court as it requires the reporting of confidential patient information protected under federal law. The changes presented by Representative Greg Chaney of Caldwell changes clarifies legislative intent and would add requirements to report on a women’s follow-up care after an abortion even when the woman fails to follow-up.
Maternal Mortality Review Committee (MMRC)
The Idaho Medical Association will be introducing a bill this week to create a Maternal Mortality Review Committee within the Department of Health and Welfare. This follows a national trend. The US has a maternal death rate of 26.4 per 100,000 compared with Canada at 7.3, UK 9.2, Germany 9, France 7.8 Spain 5.6, Italy 4.2 and Finland 3.8. Idaho’s maternal death rate is 27.1. Composition of the committee includes physicians and a nurse. The committee would study the causes of death and provide recommendations to reduce the death rate.
Religious Exemption to the Child Protection Act
A draft bill is being circulated that would limit the religious exemption to the Child Protection Act in cases where serious illness, disability or the child’s life is in danger. The bill could get sidetracked if assigned to the State Affairs Committees or Judiciary and Rules rather than Health and Welfare. Leadership assigns committee hearings. Those Committees are more likely to table hearings or vote to oppose changing the law.
New Bills Introduced
HB9 – Physician and PA Licensing – Last updated in 1997, simplifies licensing requirements.
HB12 - Opioid Antagonists
The bill introduced by Representative Fred Wood, a retired physician from Burley, would open access to naloxone to anyone without a prescription. Naloxone is a very safe drug, and this bill would put it in the hands of families and friends of those at risk of opioid overdose.
HB64 - Age for Organ Donation – Lowers the age for organ donation to 15.
HJM1 – 611 Crisis Hotline – Introduced by Representative Caroline Troy, this bill would establish “611” as the Crisis Hotline focused on mental health, domestic violence and suicide.
S1034 – Oral Chemotherapy – Would require insurers to cover oral chemotherapy.
Governor Little – Executive Orders
Governor Brad Little issued two executive orders to reduce the burden of government on individuals and businesses. The first order is to eliminate or significantly reduce administrative rules. For every new rule, two rules must be eliminated or reduced. Each state department or agency must have a Rules Review Officer to identify obsolete, costly or ineffective rules and provide an annual report. The second order is “The Licensing Freedom Act of 2019.” This follows a review and recommendations last year on license requirements, and sets “sunrise” and “sunset” provisions on new and recurring licensure.
Governor Little is requesting an additional $1M in Suicide Prevention Funding with a goal of reducing suicides by 20% by 2025. The creation of the Suicide Hotline, required training, public service campaigns, gun locks, information distributed through gun stores and mental health intervention have already saved lives.
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.