Governor Joe Manchin kicked off the 2010 Legislative Session on Wednesday, January 13 with a State of the State address where he outlined his vision for the Session ahead.  His speech centered mainly around two topics, the economy and children.  Though health system reform is a huge topic on the federal front there was little related to health encompassed into his proposals. With so many states experiencing critical budgetary deficits, Governor Manchin touted West Virginia’s good financial planning as being the reason we are in the exclusive club of states not in financial crisis.  Our state’s budget is expected to experience shortfalls beginning in 2011 however.  The Governor is proposing that the budget be filled with the remaining federal stimulus dollars this fiscal year allowing the state to save current tax dollars and reserves to address future deficits. It is estimated that the economy will not recover to pre-downturn numbers until at least 2014. The Governor estimates that there is $818 million in reserves that can be used over the next four years to buoy the state budget until the economy fully rebounds.

The governor also focused a good portion of his speech on children.  He touted West Virginia’s efforts to expand coverage of the Children’s Health Insurance Program to 250 percent of the federal poverty level.  This has enabled West Virginia to cover nearly all children in state.  The governor also highlighted the Save the Children program that actress Jennifer Gardner has promoted to West Virginia.  The program helps kids thrive by improving their health, education and economic opportunities by helping to lessen the impact of poverty on children. The Governor dedicated $1 million to the program’s efforts in our rural counties.

The early days of the Session much discussion has circulated around that this will be a “slow Session” for two reasons.  It is an election year so by nature Legislators are less eager to stick their necks out on controversial issues.  Secondly, there is no money so new initiatives that would cost the state are being set on the back burner. 

The Governor has issued his Budget (HB 4025 and SB 213) for the 2010 fiscal year (July 1, 2010 through June 30, 2011) which does cut a number of current programs.  Of particular note, the budget cuts tobacco cessation (-$652,000), the Cardiac Project (-$150,000) and the fully eliminates the funding for the Osteoporosis/Arthritis Program, the Diabetes Education and Prevention Program and the Center for End-of-Life Care. 

The budget bill is always the last bill to pass, being pushed off into a special session dealing with just the budget the week following the last night of Session.  The budget will undoubtedly be a key issue of interest throughout the Session.

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The WVSMA's Legislative Committee has issued legislative policies for the 2010 legislative session.  Many of the the policies are carryovers from previous years while there are a couple new areas of interest for the current session. 

WVSMA President, Dr. Carlos Jimenez  and Government Relations Specialist, Amy Tolliver spent two days early this week meeting with legislative leaders (including the House Speaker, Senate President and chairs of the Health and Judiciary committees) discussing the policies and other legislative issues that are on the horizon for the session.

The following are the topics and summary positions.  For a copy of the full document click here.

Healthcare Reform Issues:
Protecting Medical Liability Reform Laws
The WVSMA strongly maintains the need to preserve the integrity of the Medical Professional Liability Act and to protect against any threats to erode the current statute.

Completing the Healthcare Provider Tax Phase-Out
The WVSMA strongly supports the continued phase-out of the healthcare provider tax with no interruption or slowdown.

Addressing the Impact of Federal Healthcare Reform on Medicaid
With the prospect of federal healthcare reform looming, and since the leading proposals call for a significant expansion of Medicaid eligibility, the WVSMA strongly supports fully funding the West Virginia Medicaid program to provide appropriate reimbursement to healthcare providers for their services. Adequate funding of the program is essential to ensure that Medicaid recipients enjoy continued access to medical care. 

Supporting State Health Care Reform Initiatives
The WVSMA supports efforts to achieve healthcare reform in West Virginia including a focus on Patient-Centered Medical Home Pilots, accelerated Practitioner Credentialing, Wellness and Prevention, Health Information Technology, and Research and Education.

Modifying the Open Hospitals Proceedings Act
The WVSMA supports legislation clarifying medical staff committees are not governing bodies under the Open hospitals Proceedings Act, the executive session topics enumerated in the Act are inadequate and at the least should be expanded, and that action on those topics should be permitted in executive session if the Act is to apply to any medical staff bodies.

Public Health Issues:
Strengthening Tobacco Control and Clean Indoor Air Initiatives
The WVSMA supports policies that protect public health by discouraging tobacco use and promoting clean indoor air. Such policies include significantly increasing the tobacco excise tax, allocating sufficient funding for education programs designed to reduce or eliminate tobacco use and exposure to secondhand smoke, and supporting counties’ indoor air regulations.

Reversing West Virginia’s Poor Perinatal Health
The WVSMA supports initiatives to improve the health of pregnant women and children in West Virginia.

Combating Poor Oral Health
The WVSMA supports efforts to make policy changes which foster improved oral health for West Virginia’s children and families.

Encouraging Routine Voluntary Screening for HIV
The WVSMA recommends the West Virginia HIV testing laws be updated and modified to require simple consent for routine voluntary HIV testing.

Public Safety Issues:
Protecting Patients from Non-physician Practitioner Scope of Practice Expansion
The WVSMA opposes the scope of practice expansion of non-physician practitioners without the appropriate education, training and supervision. Safety and protection of the patient is of utmost importance.

Strengthening the All-Terrain Vehicle Safety Law
The WVSMA strongly supports strengthening West Virginia’s All-Terrain Vehicle safety law.

Protecting the Motorcycle Helmet Law
The WVSMA strongly supports maintaining West Virginia’s motorcycle helmet law for motorcycle operators and riders of all ages.

Addressing Substance Abuse: Balancing Treatment and Prevention
The WVSMA supports policies that discourage diversion of prescription drugs and that facilitate treatment opportunities for individuals suffering from substance use disorders. Such policies must be balanced with policies that promote the physicians’ ability to provide comprehensive and compassionate care, and an individual’s ability to access appropriate treatment.

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The optometrists have introduced bills in the House and Senate (HB 4131, SB 230) that would dramatically expand their scope of practice in West Virginia.  The bills have also skirted the Health Committees in both houses, a move nearly unheard of, and were single referenced to the Government Organizations Committees.  It would appear the bills have been “greased” for easy passage. 

Last legislative session one of the biggest battles for medicine was the attempted scope of practice expansion by the optometrists.  The WV Academy of Ophthalmology, supported by the WVSMA, waged a good battle in killing the legislation.  The issue was then placed into a study resolution for the legislature to review during the interim (time between the 2009 and 2010 sessions).  The House and Senate Government Organization Committees studied the issue intensively and decided to not move forward with legislation for the 2010 session.  This was a big win for medicine again.  However, that didn’t stop the optometrists from introducing their own bill and maneuvering it around the Health committees where it would have faced staunch opposition.

The bills are fairly comprehensive, they allow optometrists, to perform 100 different surgeries (not just laser); order laboratory or diagnostic tests; give injections into and around the eye; and to prescribe, administer and dispense a wide variety of prescription medications.  All of these protections are specifically prohibited under current law.

The bills also remove patient protections from current law such as standards implemented by legislative rule for education and training for optometrists to prescribe limited drugs; prohibition on emergency rules for a drug formulary; limits on prescriptions for certain drugs and the requirement of the Board of Optometry to consult with the Board of Pharmacy, Board of Medicine or Board of Osteopathy on any allowable drugs.  The bill also removes the statutory prohibition on optometrists performing surgery; prohibition on injections into and around the eye; statutory language for referral and consultation.

The bill also allows optometrists to order expensive and potentially invasive diagnostic tests such as CAT scans and MRIs, and laboratory analysis.

The Senate is likely to take up their bill the week of February 1.  The WVSMA will be working closely with the Ophthalmologists to oppose the bill.  Physicians of all specialties are being requested to contact their Senators to ask them to vote NO on the bill.  Go to www.wvsma.com then click on Government Relations for more information.

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In an effort to provide a better understanding of how healthcare policy is made and its direct impact on the working physician, WVU School of Medicine has added a legislative medicine rotation to the platter of opportunities for fourth-year medical students. The brain child of Dr. Michael Stitely, the program is now underway with it’s first of three medical students lined up for this session. The rotations are two weeks each and provide the students with hands on opportunities to observe and participate in the makings of legislation and healthcare policy and to shadow various Senators and Delegates.  The WVSMA has embraced this rotation and is working collaboratively with WVU to provide a comprehensive experience for each student. Josh Cusick-Lewis, the first student to elect the rotation is a senior at WVU's Charleston Division and in the combined MD/MPH program. He is also a Family Medicine Rural Scholar. Christopher Deskins and Isaac Hurst are scheduled to rotate through this program in the coming weeks.

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