By Pele Fischer, JD
Action is unfolding at a brisk pace at the Capitol during the First Session of the 53rd Legislature in 2017. We’ve not seen a particularly large number of bills filed in the new session, but that is to be expected with a new freshman class and because of a House rule change to cut back on the use of so-called “vehicle” bills (for later striker amendments). On the health care front, however, there are already a fair number of bills introduced. Nearly 600 bills were introduced this session, and the Arizona Medical Association (ArMA) is following approximately 150. In this edition of Arizona Physician, I will share our process for determining a position on legislation and will highlight the high-profile legislation we are actively engaged on this session.
How we determine our action on legislation
The legislative work and advocacy by ArMA is driven by the policy set through the House of Delegates (HOD); the HOD is comprised wholly of physicians representing all areas of the state and specialty societies. The HOD meets annually and considers proposed policy and issue positions, and action items submitted in the form of resolutions. The resolutions are submitted by members and committees of ArMA, Maricopa County Medical Society, Pima County Medical Society, and individual physicians. Once the HOD has adopted a resolution, our Committee on Legislative & Government Affairs (L&G Committee) works with our advocacy team to determine what legislation is related to those issues; we then follow and engage as necessary on those bills throughout the session.
In general, we review legislation related to all health care and practice management issues. We use our existing HOD-established policy and guidance from the L&G Committee to determine our approach to each legislation.
The legislation we are seeing this year can be grouped into several categories: patient care and services, scope of practice, regulatory, and surprise billing.
Patient care and services
ArMA along with our dermatology and cancer advocates are working on two important bills related to skin cancer. HB 2194, sponsored by Rep. Heather Carter (R-LD15), bans minor children from using indoor tanning facilities. HB 2134, also sponsored by Rep. Carter, removes the ban on children applying their own sunscreen in schools and camps. ArMA has been fully engaged and helping advocate for both of these bills.
HB 2335, sponsored by Rep. Paul Boyer (R-LD20), seeks to decrease tobacco and nicotine addiction in Arizona by increasing the minimum purchasing age for tobacco products from 18 to 21 years old. ArMA, along with numerous other health-focused advocacy groups, is supporting the legislation.
SB 1080, sponsored by Sen. Barbara Fann (R-LD1), bans texting by teen drivers for the first six months of licensure. After years of unsuccessful attempts to address distracted driving, SB 1080 has some momentum. ArMA is supporting the legislation and we hope to see it over the finish line.
Scope of practice
SB 1336, sponsored by Sen. Nancy Barto (R-LD15), makes changes to the statute regarding the scope of practice of Certified Registered Nurse Anesthetists (CRNA). This is a contentious issue and ArMA has been working closely with the Arizona Society of Anesthesiologists (AzSA), CRNA leadership and legislators to find an acceptable agreement on the definition of “presence” and “direction” for physicians and surgeons. ArMA will oppose the bill if an acceptable definition cannot be reached.
SB 1269, sponsored by Sen. Barto, expands a pharmacist’s scope of practice to include: dispensing of emergency refills for certain medications; prescription and dispensing of tobacco cessation drug therapies (not Chantix and Zyban); and prescription and administration of oral fluoride varnish if outlined requirements are met. ArMA has been working closely with physician advocacy groups to ensure that the legislation includes adequate requirements needed to protect patient safety and to not improperly override the physician – patient relationship.
HB 2195, sponsored by Rep. Carter, is the Arizona Medical Board’s (AMB) bill to make helpful changes to improve efficiencies with the licensing statutes for MDs – a bill ArMA supports and has been helping to shepherd through the process.
SB 1028, sponsored by Sen. Barto, continues the Arizona Board of Osteopathic Examiners in Medicine and Surgery (Board) for eight years. ArMA, along with the Arizona Osteopathic Medical Association (AOMA), supports the bill.
SB 1452, sponsored by Sen. Barto, makes changes to the health licensing board statutes, particularly related to what portions of a health professional licensee’s disciplinary records must be posted on the licensing board’s website for public availability. It states that all disciplinary and final non-disciplinary actions and orders against a licensee are to be posted on the board’s website. Importantly, however, letters of concern and advisory letters are not to be posted (they still will be available if a member of the public requests them). The bill makes several other changes to the health regulatory boards – most of which have previously been implemented by the AMB.
SB 1439, sponsored by Sen. Barto, prohibits a person from discriminating against a health care entity because the health care entity does not provide, assist in providing or facilitate in providing any item or service that results in the death of an individual. It also permits a health care entity the right to civil action in superior court if the health care entity is subject to a discrimination violation. The wording of the bill is quite sweeping in scope, and ArMA is actively studying the bill’s impacts to determine whether a public position should be taken on this measure.
While this policy issue is often touted as surprise billing by physicians, it is predominately a symptom of a much larger set of problems that have resulted from changes in healthcare insurance products including:
- Narrow network plans
- Lack of network adequacy and coordination standards
- High deductible plans/lack of out-of-network coverage
- Inaccurate and out of date physician directories
These changes in health insurance have burdened patients in the form of unexpected and expensive out of pocket bills. There are several legislative measures attempting to address the issue. ArMA has been actively involved in stakeholder meetings investigating the issue of surprise billing and working to determine a solution that helps patients get surprise bills resolved, ensuring physicians receive fair and equitable payment, and that any solutions do not have unintended negative consequences for our healthcare market.
SB 1441, sponsored by Sen. Debbie Lesko (R-LD21), would set up an arbitration process to settle disputes over surprise bills. To date, there have already been numerous amendments to the bill and there is still a lot of work that needs to be done on the policy side and the technical side. ArMA is leading the effort to ensure that a reasonable solution is reached.
Arizona has a lack of verifiable data regarding surprise billing; attempting to find appropriate and adequate solutions is always difficult when you don’t know the extent of the problem and have not identified root causes. SB 1321, sponsored by Sen. Sean Bowie (D-LD18) would require the Arizona Department of Insurance to produce a report on surprise billing. ArMA supports the legislation. A report from DOI could help provide data to better inform the policy discussions of surprise billing.
If you are interested in learning more about any legislation, please feel free to contact Ingrid Garvey, firstname.lastname@example.org.