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12/14/2016

Lame Duck Session: Healthcare & Employment Bill Wrap-Up

There was nothing LAME about this lame duck session. As promised, it was a very busy session! The legislature returned from their summer break for the general election on Tuesday, November 16 and worked until 4AM on Friday, December 9. The 131st General Assembly did not adjourn sine die, saving that for the end of the month.

Please note that SB 165 (Lehner) MOLST did not pass during the lame duck session, and therefore is dead. It will need to be introduced in the next General Assembly for consideration. Following are the bills of interest to LeadingAge Ohio, which did pass or were amended into other bills and are currently awaiting the Governor’s signature:

Health Care Related Legislation

HB 216 (Pelanda) APRN

This bill pertained to licensure changes that will primarily allow a licensed APRN prescriptive authority through licensure and eliminate the existing requirement of additional training, and increased from 3 to 5 the number of licensed APRNs with whom a physician may have a collaborative agreement. The bill was amended before being reported out of Senate Health Committee. The bill passed the Ohio Senate 32-0 and the House concurred with the Senate amendments 88-1. At the time of this report, the bill was being enrolled to send to the Governor for his signature. The following are key provisions included in the bill:

  • Requires the Board of Nursing to establish an exclusionary drug formulary specifying the drugs an APRN is not authorized to prescribe;

  • Allows an APRN to continue to practice under an existing standard care arrangement for not more than 120 days if the physician or podiatrist terminates the collaboration and the nurse notifies the Board of the termination;

  • Establishes the Advisory Committee on Advanced Practice Registered Nursing to advise the Board on the practice and regulation of APRNs;

  • Bill extends DNR authority to the other two types of APRNs that are not currently permitted, which are certified nurse-midwives and certified nurse anesthetists and grants the same immunity from civil liability that is granted to physicians and certified nurse practitioners and clinical nurse specialists;
  • Report of death may now be made to an APRN in addition to a physician;

  • Instead of current law, the bill requires that for an LPN to administer adult intravenous therapy they must either complete 1) a course of study approved by the Board or 2) a continuing education course or program approved by the Board;

The diabetes assessments bill was rolled into this bill, which requires the state to assess the prevalence of all types of diabetes in Ohio, establish goals to reduce prevalence and provide biennial reports to the General Assembly.


HB 290 (Sprague) Terminally IllRight to Try Bill”

This bill would permit a physician to treat a terminally ill patient with a drug that is not approved by the United States Food and Drug Administration and permit a drug manufacturer to provide such a drug to the patient or physician. LeadingAge Ohio monitored the bill closely which provided comments on the bill, which were incorporated into the final version. The bill passed the Senate 31-0 and the House concurred Senate amendments 86-0. The bill provides the following:

  • Use of an investigational drug, produce, or device that is still under clinical investigation, and has not been approved for general use by the United States Food and Drug Administration, to treat an eligible patient suffering from a terminal condition;

  • Qualified immunity to a physician;

  • Authorizes, but does not require, the manufacturer to provide an investigation drug, product, or device to an eligible patient or the patient’s treating physician;

  • Coverage for such services is not required;

  • Permits certain health care providers to receive continuing education credits for providing health care services without compensation to indigent and uninsured persons if certain conditions are met.

HB 470 (Schuring) Palliative Care Facilities

This bill requires the Ohio department of Health (ODH) to regulate palliative care facilities through a licensing process that is similar to ODH’s licensure of hospice care programs. This bill was brought forward by a religious order that wants to provide palliative care services to its members in its existing facility but could not qualify for a licensure under existing law. LeadingAge Ohio worked with Representative Schuring to address concerns with the bill, and the suggested changes were included in the Sub Bill in the House Health and Aging Committee. The bill passed the Senate 31-0 and the House concurred Senate amendments 92-0.

This bill:

  • Defines “palliative care” as treatment for a patient with a serious, chronic, or life-threating illness directed at controlling pain, relieving other symptoms, and enhancing the quality of the patient and the patient’s family, particularly with psychosocial support and medical decision guidance, rather than treatment for the purpose of cure;

  • Defines “palliative care facility” as a facility operated by a person or public agency that provides inpatient palliative care on a continuous basis, 24 hours a day and seven days a week, the medial components of which are under the direction of a physician;

  • Defines “palliative care patient” as a patient who has voluntarily requested and is receiving care from a person or public agency licensed to operate a palliative care facility;

  • Specifies that a “hospice program” or a “pediatric respite care program” does not include a palliative care facility;

  • Bill states that it should not be interpreted that palliative care can be provided only in a palliative care facility or as a component of a hospice care program or pediatric respite care program;

  • Outlines exemptions of unlicensed activities including a hospital, a nursing home, a residential care facility, a hospice program, a home health agency, a respite care home among others;

  • Outlines licensure process, license renewal;

  • Requires inspections by ODH for initial licensure and not less than three years thereafter;

  • ODH must promulgate rules to establish a license fee, license renewal fee, and inspection fee; establish requirements for palliative care facilities and services; provide for granting licenses to accredited or certified to operate palliative care facilities; establish guidelines for quality assessment and performance improvement programs administered by palliative care facilities;

  • Extends hospice care program law to palliative care facilities;

  • Extends hospice care program law to health care professionals of palliative care facilities;

  • The bill permits a licensed hospice care program that operates an inpatient facility or unit to provide palliative care to any patient, notwithstanding any provision of Ohio law governing hospice care programs that limits such programs to providing services to hospice patients;

  • Amended to make criminal sanctions for physician assisted suicide in a palliative care facility;

  • SB 314 Hospital Inpatient After care amended into the bill (see below);

  • Amended at the request of ODH to establish rules to govern the layout of the facilities;

  • Amendment requires the Director of Aging and the Director of Health to jointly develop recommendations regarding the establishment of standards and procedures for the operation of memory care units, as well as quality of care metrics for such units.

HB 505 (Huffman) Biologics

This bill relates to the regulation of biological products and the substitution of interchangeable biological products when dispensed by pharmacists. While LeadingAge Ohio did not have a position on the bill, an amendment was included in Senate Health. The provision makes a change to SB 129 (Gardner) Prior Authorization bill, which was passed in the spring. It removes the 72-hour requirement of providers, and creates a hard start for the 10-day response time for health insurers.  Another amendment would delay the expiration of certain collaborative agreements between physician assistants and physicians. (This amendment is effective immediately). The bill passed the Senate 32-0 and the House concurred senate amendments 90-1.


SB 311 (Patton) Influenza Vaccine

This bill requires health care facilities to post information about flu vaccines in their facilities. It requires the Ohio Department of Health to create an information sheet on influenza vaccines and older adults and make it available on its website. It would also require long-term care facilities to post this information sheet in a conspicuous place, but there is no penalty for the facility if it is not posted. LeadingAge Ohio was neutral on the bill. The bill passed the House 69-15.


SB 314 (Lehner) Hospital Inpatient Aftercare

This bill would allow the designation of a lay person to provide after-care to a hospital patient and also allow that lay person to participate in discharge planning. LeadingAge Ohio provided written proponent testimony on the bill.  The bill was amended into HB 470 above. The bill does the following:

  • Requires hospitals to give a patient or the patient’s guardian the option of designating a lay caregiver for the patient;

  • Requires hospital to create a discharge plan and review the plan with the patient’s lay caregiver;

  • Requires the discharge plan to include a live demonstration of each task to be performed under the plan if the attending deems necessary;

  • Grants the physician immunity from criminal or civil liability of the physician’s determination that a patient’s lay caregiver should or should not participate in the review of the patient’s discharge plan;

The Ohio Department of Health may adopt rules to implement.


Employer Related Legislation

There were several employer-related pieces of legislation that were making their way through the General Assembly and were amended or rolled into other bills during the final days of the lame duck session. Following is a brief summary of the issues that are of most interest to our members.

Autism Coverage Passes

After 8 years of trying to get the legislation approved by the Ohio General Assembly, HB 350 (Grossman) Autism Coverage was amended into HB 463 and passed on the last day of session. The bill requires health plan issuers to provide coverage for autism disorder for the screening, diagnosis and treatment of the disorder. It also prescribes minimum coverage requirements for autism spectrum disorder, and allows health plans to review an autism disorder treatment plan on an annual basis. Ohio is the 44th state to require health insurance coverage for autism spectrum disorder. While there was support for the amendment for the autism coverage amendment, there was concern raised by democrats over a provision they believed was a change to housing discrimination cases before the Ohio Civil Rights Commission. However, Senator Seitz argued the bill only aligns Ohio with federal law by forbidding administrative-proceeding punitive damages and making the collection of actual damages and attorney fees discretionary instead of mandatory when a party is found guilty of housing discrimination. The bill passed the Senate 26-5 and the House concurred Senate amendments 72-21. The bill will be sent to the Governor for his signature.

Unemployment Insurance System

The legislature was working towards an agreement on how to fix Ohio’s broken unemployment compensation system, however, an agreement between the business community and organized labor could not be reached.  A temporary measure was agreed to by both parties and included in SB 235. The agreement repeals an existing surcharge penalty that would have been imposed on employers if the fund became insolvent and the state was forced to borrow federal funds to pay benefits. Also there was an agreement to raise the taxable wage base on which employer contributions are based from $9,000 to $9,500 for two years, beginning in 2018, and employee benefits will be frozen for the same two-year period. Both groups have agreed to work towards a long-term fix for legislative action by April 1, 2017. The bill passed the House 81-9 and the Senate concurred House amendments 29-2. The bill will be sent to the Governor for his signature.

Local Employment Benefit Rules

The legislature took action and added two amendments to SB 331 to address a growing number of local ballot initiatives to impose employment-related mandates on employers. Local governments will be prohibited from establishing a minimum wage that is higher than the rate required under Ohio’s Constitution.  This will in effect block the vote from occurring on the labor-backed proposal in Cleveland that was scheduled to appear on the May ballot, which would have asked voters to raise the minimum wage in Cleveland to $15 per hour.

To address other local ballot initiatives, an amendment was included to permit employers to determine policies on their own or through agreements with employees, concerning hours and location of work, scheduling and fringe benefits, unless otherwise required by state or federal law. The bill passed the House 55-42 and the Senate concurred House amendments 21-10. The bill will be sent to the Governor for his signature.

Bill Passes to Allow Guns in Employees’ Cars

A concealed carry bill for active duty members of the US Armed forces was making its way through the legislature during lame duck session. An amendment added to the bill in the House State Government Committee delayed passage of the bill, which would make concealed-carry permit holders a protected class under the Ohio Civil Rights Act. The business community opposed the provision and was able to get it removed from the bill before final passage. However, a provision that is referred to as “parking lot carry” was included and part of the final bill.

Under Ohio’s current law, employers’ rights are protected and employers may prohibit concealed weapons on their property, including in vehicles. However, changes in SB 199 states that employers may not establish policies that prohibit employees who have a valid concealed handgun license from transporting or storing a firearm or ammunition as long as the firearm and all ammunition is locked within the trunk, glove box, or other enclosed compartment within the person’s privately owned motor vehicle and the vehicle is in a place it is permitted to be located.  The business is granted immunity from any civil lawsuit if a person’s actions involving a firearm or ammunition under this provision of the bill. The bill passed the House 68-25 and the Senate concurred with House amendments 22-8. The bill will be sent to the Governor for his signature.

 

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