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Special Session on Education Hits Road Block
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With much consternation expressed from the members of the WV House of Delegates over virtually every proposal from the Governor on Education reform, the Legislature ended their week long special session on Thursday without passing any of the education bills. Controversial bills including establishing charter schools, performing annual teacher evaluations, modifying personnel hiring polices and alternative training for teachers and principles received much backlash from Legislators and teachers alike.
Included in the slate of bills was one (HB 106) aiming to require every kindergartener, 3rd grader, 5th grader and 9th grader receive a comprehensive health screening. The law currently only requires the kindergarteners (or students first entering the WV school system) to receive a health screening. The Board of Education has been working on a proposal in conjunction with WV CHIP and the WV Chapter of the American Academy of Pediatrics and others to ensure children are seeing their medical home providers throughout the years, not just receiving a screening at the schools prior to kindergarten.
Even this bill came up against a firestorm of concerns over what information is required to be shared with the schools about the child's annual well child visit, who will pay for the visit, and are there enough doctors to see all the children.
All the bills have been placed on the back burner and the Governor has stated that he hopes to bring the Legislature back for round two in June. |
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High Risk Insurance Pool Bill Faces Partisan Politics
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The Governor and the Insurance commissioner attempted to pass a bill (HB 112 or SB 1011) during the Special Session which would have allowed the State of West Virginia to manage a High Risk Pool insurance plan with funding from the federal government. This legislation would have been the first policy to trickle down to the state from the passage of the federal health system reform. Many components of the comprehensive reform will take action by states to implement the programs.
Under the high risk pool provision, coverage is required to be offered on a temporary basis (through 2014) to persons who can not obtain coverage in the commercial market due to preexisting conditions. After 2014 no insurer will be allowed to restrict coverage based on preexisting conditions. States can elect to run the program or if not the federal government will. Over 75% of the states have indicated that they will run their own programs.
The bill proposed would have left the door open for multiple options for the Insurance commissioner to determine how to move forward with the plan. It would have allowed the plan to be offered by PEIA or the private market or the WV Health Insurance Plan which currently operates a high risk pool but without federal or state funding.
Though the bill moved through the Senate unscathed, it was hit with a firestorm of partisan politics when it came to the floor in the House of Delegates . The Republicans offered a few amendments aimed at disallowing the plan from covering abortion services which caused the Democratic leadership to recommit the bill to the House Judiciary committee for further consideration.
The bill languished there and died with the rest of the education bills. |
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Board of Medicine Institutes policy on Collaborative Relationships with Nurses
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On May 10, the WV Board of Medicine approved a new 3 page policy statement establishing guidelines for physicians in collaborative relationships with advanced practice nurses or certified nurse midwives. The Board has been working on this issue for over a year and has met with various stakeholders. The Board initially intened to introduce legislation establishing this policy in code but stepped back from that plan and redrafted it as a guideline.
The board states in the document that it is reasonable and necessary in the public interest to issue a policy detailing what it considers to be the standard of practice to inform and educate physicians in collaborative relationships as to what the Board considers to be the responsibilities of the physicians.
The guideline sets out various steps that the physicians must take when entering into a collaborative agreement with an advanced practice nurse or nurse midwife and additionally establishes "other considerations" for the physicians. Included in the policy is the requirement for annual "written, face to face and person to person" evaluations of the prescriptive practices and review of the written guidelines and protocols. Physicians in a collaborative agreement must be fully licensed without restrictions or limitation. Additionally, the Board strongly recommends that physicians not enter into collaborative agreements with more than 3 advanced nurse practitioners or nurse midwives but allows those in the hospital, free clinic, or FQHC settings to enter into agreements with up to 4 nurses.
The WVSMA strongly recommends all physicians in collaborative agreements with advance practice nurses or nurse midwives become knowledgeable on this Board of Medicine policy and on the rule (19CSR8) established by the WV Board of Nurses governing limited prescriptive authority for nurses in advanced practice. |
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$14 Million from Pharmaceutical Settlement to fund Mental Health and Substance Abuse Programs
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The House of Delegates approved yesterday SB 1010 which transfers $14.75 million from the State Attorney General's office to a new fund established under the Department of Health and Human Resources titled the "Behavioral Mental Health Services Fund". This money came from a settlement with Eli Lilly and Co. Inc., manufacturer of prescription drug Zyprexa and is required to be spent on mental health services.
It is understood that the state of West Virginia will use a good portion of the funds to settle an almost 30-year old court case (the Hartley Consent Order) regarding the provision of behavioral health services to state citizens. Additionally, the DHHR has indicated that part of the funding will be used in continuing to address substance abuse issues in the state.
It is understood the money will fund capitol projects around the state and that funds will be made available to the Healing Place in Huntington, the Braxton Fellowship Home and to a facility to be located in McDowell County. The total cost of these projects will amount to approximately $1.5 million.
It is understood that many of the various facilities to be constructed with the Zyprexa money will be used, at least partially, to deal with substance abuse issues. |
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AMA and AOA Sue FTC Over Red Flags Rule
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In the latest challenge to the contentious “red flags rule,” the American Medical Association, the American Osteopathic Association and the Medical Society of the District of Columbia filed a lawsuit in federal court today alleging that the Federal Trade Commission has exceeded the powers delegated to it by Congress by applying the red flags rule to physicians.
The complaint, prepared by the Litigation Center of the AMA and State Medical Societies, targets the contentious “red flags rule,” which requires creditors to implement safeguards against identity theft. The medical societies charge that the FTC’s rule exceeds the powers delegated to it by Congress and that its application to physicians is “arbitrary, capricious and contrary to the law.”
“This unjustified federal regulation of medicine treats physician practices like banks, credit card companies and mortgage lenders,” said AMA President-elect Cecil B. Wilson, M.D. “The extensive bureaucratic burden of complying with the red flags rule outweighs any benefit to the public.”
“The final red flags rule provided no indication from the FTC that physicians fell within the definition of creditor,” said AOA President Larry A. Wickless, D.O. “The FTC’s decision to apply the rule to physicians is both misguided and inconsistent with its regulatory power.”
“Physicians are already ethically and legally responsible for ensuring the confidentiality and security of patients’ medical information,” said MSDC President Peter E. Lavine, M.D. “It is unnecessary to add to the existing web of federal security regulations physicians must follow.”
Today’s suit follows two years of communications to the FTC from the AMA and AOA regarding the unintended consequences of the red flags rule. On January 27, the AMA and AOA joined other groups to petition the FTC to exclude physicians from the red flags rule. The FTC responded on March 25 saying it could not accommodate the request.
The AMA, AOA and MSDC strongly disagree with the FTC’s view that any physician who does not require payment at the time of providing medical services to patients is required to comply with the red flags rule beginning on June 1. Today’s lawsuit on behalf of physicians does not suspend the looming deadline. While litigation seeking to free physicians from the unlawful enforcement of the red flags rule proceeds, physicians can turn to online resources from the AMA to help them comply with the FTC’s rule. |
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Medicare Physician Payment Cut Update
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The U.S. House of Representatives plans to vote on an “extenders bill” that is expected to include a new proposal to avert the 21 percent cut in Medicare physician payments that is scheduled to take effect on June 1. Elements of the proposal are:
- 1.3 percent Medicare payment update for the remainder of 2010
- 1.0 percent payment update in 2011
- Updates for 2012-13 established under two expenditure targets
- SGR formula resumes in 2014 to reflect current law
The two expenditure targets are patterned after those proposed in H.R. 3961, which passed the House last year. An expenditure target for evaluation and management and preventive services will be set at GDP plus two percentage points; a separate expenditure target for all other physician services will be set at GDP plus one percentage point. These targets are more generous than the current SGR, which is set at GDP with no additional growth allowance. During the two-year period when the twin targets are in place, an update floor will be set at zero to prevent any conversion factor cuts in 2012-13.
In 2014, the current SGR formula will resume, with a conversion factor that is expected to be considerably lower than it is today. The cost of repealing the SGR formula will also be higher.
The proposal is similar to one outlined earlier this week, scaled back to due to objections raised in the Senate over cost. We are also told that a small reserve fund may be set aside for the remainder of 2010, in the event that Congress chooses to revisit the issue and make further adjustments to the payment formula.
The SGR proposal is being incorporated into H.R. 4213, “The American Jobs and Closing Tax Loopholes Act of 2010,” which is planned for consideration on the House floor early next week. The Senate is expected to take up the bill shortly after it is passed by the House.
The AMA has issued a statement criticizing the plan, saying that an intervention to delay a looming Medicare physician payment cut will provide temporary stability for seniors and their physicians, but they're deeply disappointed that Congress will once again fail to permanently correct the Medicare physician payment formula.
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May 21, 2010
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