2020 Nursing Legislative Update Week TWO January 17
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2020 IDAHO LEGISLATURE
January 13, 2020 through January 17, 2020
Michael McGrane, RN
This is the second week of the session. Normally rules review goes quickly but methodically. This year, with the deluge of rules to approve (every single administrative rule must be reviewed), committees have elected to review and approve rules in mass or trod through them line-by-line. In some committees the process has become confusing and painful. To their credit, the Health and Welfare Committees that had the most of any committees to review is finished.
A secondary fight over the rules process continues. Prior to the legislative session, leadership came to a compromise on how the rules process in subsequent years will work, giving the legislature more authority than the Governor over administrative rules. That compromise has now fallen apart, setting up the possibility that again this year, rules will not be reauthorized, and the entire process of recreating all the rules happens again.
To complicate matters further, Thursday, Governor Little issued two new executive orders, one putting a moratorium on all state agencies in creating any new rules until December 31st. One way agencies and boards deal with necessary rules between legislative sessions is to create temporary rules that become immediately effective then reviewed for approval during the following legislative session. This option has now been eliminated. The Governor continues to push for limited government through limited rulemaking.
Board of Nursing Rules - Passed
Russ Barron, Executive Director of the Board of Nursing, presented the proposed changes to the Board’s rules on Monday. Now that both the House and Senate have approved the rules, they will go into the package of approved rules to be considered in whole when the legislature votes at the end of the session. If fully approved, rules become effective upon adjournment of the legislature.
- 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.
- Elimination of the $30 fee for license verification. Verification can now be done on-line without cost.
- Elimination of 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.
- Elimination of the $25 Emeritus license fee. An Emeritus License is issued to a retired, non-practicing nurse who wishes to continue to use the RN designation.
Department of Health and Welfare Rules – Passed
All rules expired at the end of the 2019 session as the legislature failed to adopt them. So they all needed to be renewed this session. The “omnibus” rules for the Department of Health and Welfare occupy thousands of pages that include some controversial issues. These include rules regarding immunizations and parental exemptions, the requirement that high school seniors receive the second meningitis vaccination prior to graduation, the mandatory requirements for newborn screening, foster care rules and department assisted adoption of foster children, and Child Protective Services investigations and religious and privacy rights. The Department rules passed quickly Monday in the Senate Health and Welfare Committee packaged with a single vote and no testimony, but Tuesday’s hearing in the House Health and Welfare Committee brought out the anti-vaccination groups and others who opposed governmental intrusion. In the end the rules passed. They will go forward into the larger bill to approve all rules at the end of the session.
Gender Identity – Vital Statistics Rules
Another hot topic, gender reassignment and gender identity on birth certificates, was withheld from Committee consideration although a few people showed up to testify. The decision by the Committee Chairman, Representative Fred Wood, was to hold consideration of the Vital Statistics gender identity rules to allow two pending bills, one in the House and one in the Senate to move forward before the rules. This will be an ongoing issue that generates passionate debate this session.
211 Suicide Hotline
Governor Little announced the creation of the 211 Suicide Hotline, a partnership between the Idaho Suicide Prevention Hotline and the Department of Health and Welfare Careline. The hotline has long been accessible through a direct 10-digit phone number and a toll free 800 number. Now those who need help can dial 211, option 3 to go directly to the Suicide Prevention Center. This was an effort by Senator Fred Martin of Boise and the Suicide Prevention Coalition.
Under the Governor’s executive order, a joint resolution of both houses of the legislature and a proclamation from the Idaho Supreme Court, the Behavioral Health Council is being formed to coordinate efforts to address mental illness. The combined efforts of all three governmental branches will provide coordination and collaboration. In his State-of-the-State address, Governor Little committed additional attention and funding toward mental health. The Chief Justice of the Idaho Supreme Court described mental illness and the “most intractable social issue.”
Religious Exemption to the Child Protection Act
A bill to narrow the religious exemption to the Child Protection Act is being introduced by Representative John Gannon of Boise. For several years attempts to eliminate the exemption have failed. Idaho law requires parents to “furnish necessary food, clothing, shelter, and medical attendance for his or her child or children” except for allowing parents to refuse medical care based upon religion. The law was enacted int 1972 under pressure from the federal government to support religious rights. Religious exemptions survive in only a handful of states. Since the law was enacted, nearly 200 Idaho children have died from treatable illnesses where parents have chosen prayer over treatment. The bill introduced this year would require parents to seek medical attention for their child specific to serious illnesses that could cause disability or death. Testimony at a program by Protect Idaho Kids demonstrated how religion has been used not only to deny medical care, but to shield physical, sexual and psychological abuse from discovery.
H0318 – Division of Occupational and Professional Licenses
There are many, many trade councils and professional boards that exist in state government from the State Historical Society, the Idaho Potato Commission, the Idaho State Bar to the Boards of Nursing, Medicine and Dentistry. Under the law first enacted in 1974, The Bureau of Occupational Licenses manages several independent boards. H0318, if passed, would rename the Bureau to the Division of Occupational and Professional Licenses under the responsibility of the Director of the Division. It would also give the Governor full authority to reorganize the structure of the Division and the Boards that are part of the division. The objective is to create efficiencies by streamlining operations and create greater opportunities for better coordination between boards with similar missions such as healthcare. Under the Division, the Boards would be grouped with each group having oversight by a single executive director. The concern is that current freestanding boards like nursing and dentistry could lose autonomy and identity.
State Nursing Salaries
State employee wages in Idaho have lagged the market. This year Governor Little proposed a 2% increase for all state employees and a 3% pay scale increase to help move compensation closer to the market. This week the Change in Employee Compensation Committee (CEC), a legislative committee, recommended an additional 2% increase for 20 high demand positions including nursing. The CEC’s proposal will go to the Joint Finance Appropriations Committee for budget approval.
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 restrains. 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.