2020 Nursing Legislative Update Week ONE January 10
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2020 IDAHO LEGISLATURE
January 6, 2020 through January 10, 2020
Michael McGrane, RN
Monday, January 6th, marked the beginning of the 2020 legislative session. The disagreement between the House and Senate at the end of last year’s session caused the routine procedure of reauthorizing administrative rules to fail. Other than emergency rules, all administrative rules expired. For Governor Little this was an unprecedented opportunity to review and update thousands of administrative rules. In his first year in office, Governor Little issued two executive orders, the Red Tape Reduction Act and the Licensing Freedom Act with direction to state agencies to simplify and eliminate outdated, redundant or burdensome rules and open opportunities for citizens without the burden of government. The result was the elimination of over 75% of agency and board rules, hundreds of restrictions, thousands of pages and hundreds of thousands of words. All prior existing rules are now up for approval by the legislature. The House and Senate each hear the revised rules and can accept or reject any of them. This first week of the session, legislators are struggling with the volume of rules to review. To move quickly, the Speaker of the House has issued a deadline for the House to complete rules review by the end of week two. Some committees are approving the newly revised rules in mass, others are working through them line-by-line. To make the process even more difficult, since the rules were not reauthorized last year, they are all new rules, so changes from previous versions cannot be easily compared.
Governor’s State-of-the-State Address
Governor Little began the session with his State-of-the-State address on Monday. Here are the highlights:
- $30M funding for literacy and teacher salaries
- Teacher school safety training
- Greater collaboration between colleges and universities
- $6M technical education funding for high schools and community colleges
- Higher education affordability with a state university and college tuition freeze and opportunity scholarships to retain Idaho’s graduates in Idaho
- $1.5M for 25 new medical residency positions
- Acknowledged the success of new regional behavioral crisis centers
- Funding for community-based recovery centers
- $30M in federal grant funds to address and prevent opioid abuse
- Ongoing funding without impact to the state budget for Medicaid Expansion with offsets from the Departments of Health and Welfare and Corrections, the Catastrophic Health Care Fund, the Millennium Fund, and Counties.
- Availability of “enhanced short-term” lower-cost health insurance plans
- Improving the state’s broadband infrastructure to expand telehealth and pharmacy access
- $100M highway improvements
- $35M grocery tax relief
Under Medicaid Expansion, beginning January 1st, 53,000 Idahoans with income under 138% of the poverty level are now covered under Medicaid. This is fewer than the 91,000 who were projected to be eligible under expansion. 14,000 who were previously covered under the Idaho Healthcare Exchange moved into Medicaid. A waiver request to allow those who were covered under the exchange but now qualify for Medicaid was denied by CMS.
The state is still waiting on a decision from CMS on a number of other waiver requests including the addition of a work requirement, limitations on family planning services, and coverage for mental health treatment at freestanding psychiatric facilities (coverage is currently limited to full-service hospitals).
Under the Affordable Care Act, the costs for Medicaid Expansion are covered 90% by the federal government and 10% ($40M) by the state.
Board of Nursing Rules
Russ Barron, Executive Director of the Board of Nursing, presented the proposed changes to the House Health and Welfare Committee Wednesday:
- Removal of an entire section of rules regarding Medication Assistants Certified (MAC). While the Board retains statutory authority to regulate Medication Assistants, there has been only one person affected by this section. The Board is removing the rules with the option of reposting the rules if necessary.
- Transfer of authority and rules for Nursing Assistants and Nursing Assistant education to the Department of Education.
- Eliminate the additional $100 fee for a limited license. Limited licenses are issued to those whose license is temporarily restricted due to disciplinary action. This follows an earlier change in the way disciplinary actions are handled.
- Eliminate a $25 Emeritus license fee. An Emeritus License is issued to a retired, non-practicing nurse who wishes to continue to use the RN designation.
Restraint & Seclusion Rules
In 2019, at the request of Nurse Leaders of Idaho and Disability Rights Idaho, an advocacy group for the disabled, the Department of Health and Welfare changed hospital rules regarding the use of restraints and seclusion. The previous rules required a physician’s order. The new rule aligns with the CMS, which would allow nurse practitioners to order restraints. An unintended consequence was confusion over the frequency of patient monitoring. The new rule requires patients, “who are not violent or self-destructive, shall be observed at intervals of not greater than 15 minutes.” In reviewing CMS conditions of participation, interpretive guidelines and training requirements, three different standards are cited, including the 15-minute rule. At the request of ANA-Idaho, because of this confusion, the Department of Health and Welfare will be reopening the Restraint and Seclusion rules for negotiated rulemaking to clarify the standard. This process will begin within the next two weeks.
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.