OHA Advocacy Network

Advocacy Report • Tuesday, December 4, 2007

Despite being on recess most of the past few months, the legislature has continued to focus attention on a number of issues impacting the OHA membership. The following are highlights of those issues, as well as an overview of OHA’s advocacy activities.

OHA Board to Discuss Response to Delay in Medicaid Update
OHA and other provider groups are requesting a meeting with Gov. Strickland following the announcement that hospitals will not receive the expected inpatient Medicaid reimbursement increase Jan. 1. OHA responded to the delay immediately by requesting an indefinite suspension of the pending Medicaid recalibration (which the governor agreed to delay until April), and next week the OHA Board will discuss why the update was delayed as well as the pros and cons of possible legislative or executive action.

The Legislative Service Commission estimated the update would have meant $36 million to hospitals in enhanced fee-for-service payments (Jan. 1, 2008 through June 30, 2009). According to OHA’s analysis, if the update were also applied to managed care payment rates, Ohio hospitals stood to receive a combined total of over $106 million in enhanced Medicaid payments throughout the biennium.

The administration will move forward with eligibility expansions for select vulnerable populations, though they also will be delayed: 1,600 kids ages 18-21 emancipating from foster care (Jan. 31), approximately 3,000 pregnant women between 150-200% FPL (Jan. 31), a buy-in program for children in families making above 300% FPL who are difficult to insure (April 1), and the Ticket to Work program for workers with disabilities (April 1). The Medicaid expansion for children from 200-300% FPL has been delayed due to funding gridlock at the federal level. (Bridget Gargan, bridgetg@ohanet.org)

Nurse Executives Lend Grassroots Support to Staffing Plan Legislation

OHA continues to push for enactment of “common sense” nurse staffing legislation, consistent with the OHA Board of Trustees’ September action. House Bill 346, sponsored by Rep. Jim Hughes (R-Columbus), recently received its second hearing in the House Health Committee, hearing support from the hospital community. Linda Stoverock, chief nursing officer and senior vice president for patient services at Nationwide Children’s Hospital in Columbus, testified in support of the bill on behalf of OHA and the Ohio Organization for Nurse Executives (OONE).

HB 346:

Ų Requires hospitals to create a hospital-wide nursing care committee, which is charged with developing recommendations for a written nursing care staffing plan guiding the assignment of nurses. Direct care nurses representing all types of nursing services offered by the hospital will serve on the committee as will the hospital’s chief nursing officer.

Ų Requires hospitals to create a staffing plan, giving significant regard to the committee recommendations. The nursing services staffing plan, which must be consistent with current governmental and private accreditation standards, must then be provided to all staff nurses.

OHA is coordinating regional meetings with OONE members who have legislators on the House Health Committee . About 25 nurse executives from the Dayton area in early November met with House Health Chair John White (R-Kettering) while another 30 Akron-area nurse executives met last week with committee members Scott Oelslager (R-North Canton), Bob Otterman (D-Akron) and Brian Williams (D-Akron).

In a related matter, the National Nurses Organizing Committee (NNOC), an arm of the California Nurses Association, is up in arms about the legislation. In an e-mail to its Ohio members, NNOC noted its anger that OHA is touting HB 346 as a common-sense staffing bill because it does not mandate staffing ratios. NNOC is conducting grassroots opposition to the bill, urging members to contact their legislators and spread the word about the union’s yet-to-be-introduced legislation to require nurse-to-patient staffing ratios. (Jeff Klingler, jeffk@ohanet.org)

Work Continues on Specialty Hospital Legislation

Sen. David Goodman’s (R-Columbus) proposed legislation, Senate Bill 120, would require all new hospitals to include 24/7 emergency departments. The theory of this approach is that it would complicate the business model of small specialty hospitals, particularly those ambulatory surgery centers that want to add a few inpatient beds and thus become hospitals. For larger specialty hospitals, they would at least be required to take some share of the uncompensated care admitted via emergency departments and to take some share of money-losing emergency department cases.

Legislative support has been very difficult to garner, particularly among Republicans who are sympathetic to the small business/entrepreneurial efforts of physicians. The fact that no other non-CON state has enacted any restriction on specialty hospitals and the appearance (via new construction projects, etc.) of financial prosperity at many hospitals also makes passage of the legislation more difficult.

Currently, there is a slim majority of “yes” votes for SB 120 in the Senate, including all Democrats and a handful of Republicans. Sen. Goodman and key supporter Sen. Steve Stivers (R-Columbus) are working for an opportunity to get the bill considered by the full Senate. Any opportunity would likely present itself in the first quarter of 2008. (Bridget Gargan, bridgetg@ohanet.org)

Bill Regulating Pharmacy Technicians Under Consideration

Hearings have begun on legislation requiring the licensing of pharmacy technicians in the state. Senate Bill 203, sponsored by Sen. Tim Grendell (R-Chesterland), would require as conditions of licensure that techs be 18 years of age or older, have a high school diploma, complete a criminal records check and pass an examination administered by the Board of Pharmacy or by their employer or complete an educational program approved by the board and complete a minimum number of hours of pharmacy tech training established by the board. The bill also would impose a 3-to-1 pharmacist-to-technician ratio.

OHA opposes the legislation because it is not consistent with the association’s “Principles for Licensing Healthcare Workers,” and is working with a group of other entities opposed to the legislation, including the Ohio Board of Pharmacy, the Ohio Pharmacists Association, the Ohio Association of Retail Merchants and individual retail pharmacies. (Jeff Klingler, jeffk@ohanet.org)

Senate Panel Considers Physician Credentialing, Managed Care Contracting Bill

OHA continues to work with the Ohio State Medical Association in support of legislation to simplify the physician credentialing process used by health plans and provide relief from burdensome and, in some cases, unfair contracting practices used by some insurers.

House Bill 125, sponsored by Rep. Matt Huffman (R-Lima), includes numerous provisions around physician credentialing and contracting issues, including the following requirements:

Ų A standard credentialing form for credentialing providers (the form must be the one used by the Council for Affordable Quality Healthcare);

Ų Timeframes within which insurers must credential providers;

Ų Procedures for amending a health care contract;

Ų A two-year prohibition on most favored nation clauses in contracts;

Ų Certain prohibitions on third party payers selling, renting or giving provider network information to any other person;

Ų Inclusion with a health care contract a summary disclosure form disclosing the compensation or payment terms and claims processes;

Before the bill passed the Ohio House of Representatives, OHA was successful in extending some of the contracting protections to hospitals, as the original legislation only applied to physicians and other individual providers. OHA continues to garner support from the Senate Judiciary Committee on Civil Justice to enact the bill and to support and expand the prohibition of most favored nation clauses. (Jeff Klingler, jeffk@ohanet.org)

Maternity Licensure Bill Heard

In October 2005, OHA convened a task force of nursing leaders from obstetric and newborn services to address issues involving the licensure and regulation of maternity services. The task force adopted several measures of success, which include the need for evidence based regulations, surveyors with expertise in obstetrics, a streamlined application process and a statewide mechanism to evaluate and compare data. As a result of their work, Rep. Mark Wagoner (R-Toledo) introduced HB 331, which streamlines the licensure process. The bill has received two proponent hearings and no opponents have come forth. OHA continues to educate members of the House Health Committee on this legislation. (Bridget Gargan, bridgetg@ohanet.org)

Radiologist Assistants Bill Proposes Licensure

Legislation licensing radiologist assistants is under consideration in the Senate Health, Human Services and Aging Committee. Senate Bill 229, introduced earlier this month by Sen. Randy Gardner (R-Bowling Green):

Ų Creates licensure requirements for radiologist assistants, including requirements:

o That the applicant is at least 18 years of age and of good moral character;

o That the applicant is licensed as a radiographer under Chapter 4773. of the Revised Code;

o That the applicant has a baccalaureate degree or post baccalaureate certificate from an advanced academic program that encompasses a nationally-recognized radiologist assistant curriculum that includes a radiologist-directed clinical preceptorship;

o That the applicant is certified in advanced cardiac life support;

Ų Authorizes a licensed radiologist assistant to perform certain radiologic procedures under the direct supervision of a physician specializing in radiology, including:

o Perform fluoroscopic procedures;

o Assess and evaluate the physiologic and psychological responsiveness of patients undergoing radiologic procedures;

o Evaluate image quality, make initial image observations, and communicate observations to the supervising radiologist;

o Administer contrast media or other medications prescribed by the supervising radiologist;

OHA is processing the bill with the OHA Quality Improvement and Accreditation Committee, which evaluated it last week against the OHA Principles for Licensing Healthcare Workers. The committee did not oppose the concept of the bill, as it is not a new licensure requirement but rather expands the scope of practice of an existing licensed professional (similar to recent legislation regarding physician assistants and advance practice nurses). However, the committee did raise concerns with the Ohio Department of Health serving as the regulatory entity overseeing radiology assistants. (Jeff Klingler, jeffk@ohanet.org)

Shaken Baby Syndrome Education Enacted

Gov. Ted Strickland this week signed Senate Bill 144, sponsored by Sen. Steve Stivers (R-Columbus), legislation that would establish the Shaken Baby Syndrome Education Program within the Ohio Department of Health (ODH).

Under the provisions of the bill, ODH will convene a work group of child abuse prevention advocates, infant care experts, hospital maternity unit directors and others to develop educational materials for parents, and would require hospitals that operate maternity units, obstetricians, pediatricians and others to download the materials from the department’s Web site and provide it to new parents. The bill also establishes a tracking system whereby the state can monitor the effectiveness of the educational program and revise materials as needed through data reported by public children’s service agencies. OHA lent its support to the bill, and will work to educate maternity unit directors on the new requirements closer to when the education materials are ready for distribution. (Jeff Klingler, jeffk@ohanet.org)

Booster Seat Requirements Considered

Under current law, a child who is less than four years old or who weighs less than 40 pounds must be secured in a federally-approved child restraint system when being transported in a motor vehicle. Two pending bills – Senate Bill 27 (Eric Kearney, D-Cincinnati) and House Bill 320 (Shannon Jones, R-Springboro) – would require children between the ages of four and eight years old and less than four feet nine inches tall to be secured in a booster seat. Additionally, HB 320 would require that all children under age 18 wear a seat belt (current law is age 16).

Under the new legislation, violations of this requirement would result in a fine of at least $25, which would be directed to the Child Highway Safety Fund, which is used to administer a child highway safety program to educate the public about child restraint systems and also includes a process for providing child restraint systems to persons who meet certain eligibility criteria.

Because of the potential increase in public safety, OHA’s Foundation for Healthy Communities has voted to recommend a policy position of support for this legislation. The Foundation has also voted to recommend OHA endorsement of the Boost Ohio Kids Coalition, a partnership of AAA clubs, public health agencies, private businesses and public safety advocacy groups dedicated to protecting and preserving the lives of young passengers on Ohio’s roadways (including support of above-mentioned booster seat legislation).

OHA staff will recommend that the OHA Board of Trustees approve the Foundation’s position to support Senate Bill 27, House Bill 320 and endorsement of the Boost Ohio Kids Coalition at its December 14 meeting. (Stacey Conrad, staceyc@ohanet.org)

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The OHA Advocacy Network is a service of the Ohio Hospital Association, 155 E. Broad St., Columbus, OH 43215-3620, 614-221-7614, 614-221-4771 (fax)

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Direct questions on OHA’s advocacy agenda to:

Bridget Gargan, Vice President, State Policy & Advocacy (bridgetg@ohanet.org)

Jeff Klingler, Director, State Policy & Advocacy (jeffk@ohanet.org)

Jean Scholz, RN, Director, Health Policy (jeans@ohanet.org)

Rick Sites, General Counsel (ricks@ohanet.org)

Stacey Conrad, Specialist, State Policy & Advocacy (staceyc@ohanet.org)

Jonathan Archey, Manager, Federal Relations (jonathana@ohanet.org)

Laura Landis, Executive Assistant, State Policy & Advocacy (laural@ohanet.org)