07/16/2020

Mid-Year Advocacy Update

As we move past the mid-point of the year, it is an understatement to say that 2020 has brought us all many unexpected challenges. OSMA commends Ohio physicians and their peers in other health care professions working on the frontlines of the COVID-19 crisis and providing care to maintain the health and well-being of Ohioans during this unfamiliar and stressful time. It is our pleasure to serve you, and we are prepared to continue to support your needs and keep on a steady path toward our ongoing advocacy goals as the face of the pandemic evolves.

The fall season—including the 2020 general election and another legislative session—is only a few months away. Together, we continue to be a strong collective force, and OSMA is pleased to have made progress with many of the year’s goals despite the disruptions caused by COVID-19.  As we look ahead to the remainder of 2020, our work to advocate on behalf of physicians will be more important than ever.

Here is a look back on the major physician and patient care advocacy issues we have worked on so far in 2020.

Major Legislative Initiatives:

“Surprise” Out-of-Network Billing

The issue of “surprise” billing has been a familiar issue on the OSMA advocacy agenda for several years, as our advocacy team has worked with a coalition of health care groups and other interested parties toward a reasonable and efficient solution for Ohio’s physicians and their patients. Initially, we had serious concerns about House Bill 388 – mainly due to its establishment of a statutory rate cap for physician reimbursements and for its potential to tip the balance too far in favor of insurers in the contracting process. Fortunately, OSMA raised the voices of the physician community to advocate for changes, and this spring, a new version of the bill was crafted with compromise language included to help alleviate physician concerns. This was accepted and it went to the House floor, where it passed with a favorable vote. The Senate will now consider the bill.

Mental Health Parity

House Bill 443, sponsored by Rep. Phil Plummer (R-Dayton) and Rep. Allison Russo (D-Upper Arlington), aims for expanded access to mental health and addiction treatment services in Ohio by updating and aligning state law with the Federal Parity Law. As a reminder, this bill and its companion in the Senate (SB 254) also contain reporting requirements that would give regulators more power to hold health plans and state officials accountable and enforce parity. Additionally, the legislation will facilitate easier access to medically necessary substance use disorder medications for Ohioans in need.

OSMA is supporting HB 443/SB 254 to give regulators a strong tool for enforcement of parity. In early June, we submitted supportive testimony on HB 443 during a proponent hearing in the House Health Committee. Our advocacy team continues to stress to legislators the need for parity compliance and enforcement. We expect to push for additional hearings for HB 443 and SB 254 this fall.

Racism & Public Health

OSMA submitted proponent testimony in June supporting Senate Concurrent Resolution 14, which would declare racism a public health crisis in Ohio and establish a working group to promote racial equity in Ohio. Health disparities based on factors such as disability, race, ethnicity, geography, and other social and demographic concerns persist in our communities, and the recent COVID-19 pandemic has shed even more light on health inequalities tied to race.

As you may recall, current OSMA President Dr. Anthony Armstrong is serving as a part of Governor DeWine’s Minority Health Strike Force, assembled in April to develop recommendations for how the state should act in response to health disparities and COVID-19. The OSMA is actively participating in efforts to address health equity, and dozens of advocacy organizations, health entities, public officials, and individuals across the state also submitted testimony in support of SCR 14.

Medical Liability – COVID-19 Pandemic

OSMA has been supporting the progress of two legislative proposals which seek to expand civil immunity for health care and service providers during the pandemic. In June, the Ohio House passed House Bill 606 and moved the bill into the Senate, and also in the Senate, legislators passed Senate Bill 308, which then went to the House. OSMA supports both pieces of legislation and provided testimony on behalf of Ohio’s physician community in the hearings held for both bills. Passing an expanded immunity bill is a legislative priority for OSMA, and although neither of these two proposals fully advanced to the finish line by the time legislators recessed the summer, they could be picked back up in a few months upon their return.

Telehealth

OSMA testified early last month regarding House Bill 679, a bill which would modify several requirements related to telehealth services. The legislation is intended to expand access to telehealth for more Ohioans and make it easier for providers to use telehealth to care for patients, in part due to the astronomical growth in utilization of telehealth during the COVID-19 pandemic. This bill was fast tracked through the House, passing just 2 weeks after introduction. OSMA is a long-time advocate for telehealth, but expressed several questions as to why the bill was drafted the way it was, as it could have led to negative unintended consequences. In addition, OSMA provided clarifying language for the bill to the sponsors in interested party testimony. The sponsors were willing to consider the suggestions from OSMA and made changes to the legislation in response to our inquiry. As a result, the OSMA now supports HB 679. We anticipate more movement on this issue this fall.

Scope of Practice – APRN Independent Practice

OSMA has advocated for team-based care with the physician at the head of the care team for years in response to a variety of independent practice proposals for APRNs. Amid the pandemic, yet another approach to this surfaced, which sought to allow independent practice for both APRNs and physician assistants for the duration of the COVID-19 emergency.  After the physician and hospital community expressed objections to this substitute bill, it was pulled from committee and is no longer being considered.

OSMA will continue to oppose this legislation in its original form, and is urging legislators to support the physician-led team-based care model as part of a coalition of physician groups. We continue to stress concerns about termination of the standard care arrangement, including those related to patient safety.

Medical Price Transparency

Senate Bill 97 passed unanimously through the Senate last fall and is now being considered in the House Health Committee. The bill, if enacted, would require hospitals, using information provided by the patient’s health plan issuer, to provide a patient with a verbal or written cost estimate for health care services scheduled at least 7 days in advance.

OSMA has been working collaboratively with the legislature and other interested parties on the complex issue of medical price transparency for several years now, and continues to support this legislation. SB 97 gives patients valuable tools with which to request pricing information and would help Ohioans to make more informed decisions regarding their care by allowing them to better anticipate costs associated with the care they receive.

Tanning Ban for Minors

OSMA is supporting legislation that would prohibit minors from using tanning bed services, which has had several hearings so far. HB 329, sponsored by Rep. Brett Hillyer (R-Uhrichsville) and Rep. Mary Lightbody (D-Westerville), would protect the youth in our state from exposure to dangerous UV radiation that drastically increases the chance of developing skin cancer. OSMA gave joint proponent testimony with the Ohio Dermatological Association in support of HB 329 last December, and will be advocating for more hearings for this bill in the coming months.

Scope of Practice – CRNAs

As a reminder, when the legislature amended an existing bill to create a COVID-19 legislative response, one of the amendments in the bill, alongside provisions regarding employment, licensure, the primary election, taxes, schools and more, addressed the scope of practice of CRNAs. The language for this amendment was taken from the latest version of House Bill 224. Both the OSMA and the Ohio Society of Anesthesiologists (OSA) had taken a neutral position on HB 224 after years of work on the issue, seeing it as a reasonable solution which sensibly fits into the anesthesia care model and maintains the physician-led team-based approach to care.  

The compromise that was brokered allows a CRNA to order and administer tests, drugs and fluids ONLY during the pre-op and post-op time periods and ONLY pursuant to a facility protocol along with approval of the supervising physician. Although this section of the bill was not directly related to the COVID-19 health emergency, it was included in the bill following the compromise, and this change is now permanent law. 

Additional Important Legislation:

Step Therapy: Stage IV Advanced Metastatic Cancer Drugs

Senate Bill 252, an OSMA-supported bill which would prohibit the use of “fail first” step therapy coverage limitations with regard to stage four advanced metastatic cancer, was passed unanimously out of the Ohio Senate in early June. The Ohio House will now consider the legislation.

Death Penalty Exemption for Serious Mental Illness

House Bill 136, OSMA-supported legislation which would prohibit imposing the death penalty for aggravated murder when the offender had a serious mental illness at the time of the offense, passed out of the Senate Judiciary Committee recently, before the Senate recessed for the summer. Having already passed in the House, the bill now awaits a floor vote and favorable passage in the Senate. 

Non-Medical Switching

Non-medical switching occurs when patients are forced to switch to a less expensive treatment in the middle of a plan year for no medical reason. HB 418 would place restrictions on removing a medication from a prescription drug formulary during a plan year (would apply to both private plans and Medicaid). Additionally, it would prohibit private health plans from increasing patient cost-sharing or from moving drugs to a more restrictive tier during a plan year. OSMA is supporting HB 418, and we expect to continue to track this issue as it picks back up with the legislature this fall.

Co-pay Accumulator

Health plans and pharmacy benefit managers (PBMs) may apply copay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap. HB 469 would require health insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket costs, increasing predictability as vulnerable patients face high out-of-pocket costs for their prescriptions. OSMA supports this bill, introduced in January by Rep. Susan Manchester (R-Waynesfield) and Rep. Thomas West (D-Canton), and submitted proponent testimony hearing on June 2, 2020. The physician community has raised their voices about the devastating financial impact, and in turn, poor health outcomes patients face due to policies like copay accumulators.

OSMA is prepared to take the next steps on these and other issues as summer turns into fall. In the meantime, we thank you for your service to the patient populations you care for and encourage you to reach out to us if there are ways in which we may provide additional support to you at this time.

As always, if you have questions about our advocacy efforts or want to
learn more about how to get involved, email our Government Relations Team.