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Scope of Practice Bill Draws Passionate Witnesses
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The scope of practice bill was discussed this week within the Senate Medical Affairs Subcommittee. S.345 (Davis) expands the autonomy of nurse practitioners in South Carolina by updating the current law. The goal is to modernize and modify the language to reflect the ability and training of APRNs. This bill as written does not give the nurse practitioner complete autonomy, keeping the collaborative supervision at its core, although not specifically defined. This bill also eliminates the mileage proximity as well as the ratio required for APRNs to practice, which is currently 45 miles and a ratio of 3 to 1.
S. 345 was met with many testimonies from physicians, nurse practitioners, a medical student and other healthcare professionals.
One doctor proclaimed his support of the bill and belief in a nurse practitioner's abilities, as long as they continue to receive proper training and credentialing. A geriatrician out of Beaufort explained that he believes this bill to be very beneficial to his practice and could save the state money by keeping people out of the emergency room if he were able to hire more APRNs.
A nurse practitioner testified that they are already practicing in a collaborative matter, and it is simply time to update the language to reflect the practice. The consensus of those in favor of the bill seem to agree that the increased scope of practice allows the APRNs to prevent ER visits as well as serve the community at the level of care they are trained for and already do.
Those speaking against the bill brought a different, but no less passionate, perspective. A past president of the SC Medical Association stressed that there needs to be a healthcare team model lead by a physician to coordinate high quality care, with the medical home model as the goal. Another argument came from a founder of the SC Gastroenterology Association, who stated that he supported some points within the bill, could not support the end result of more autonomy for APRNs because of their education and training differences. A current student at MUSC addressed the committee stating that as a nurse himself undergoing years of ICU experience, he is now going through medical school and he does not agree that the education he is now enduring is matched by the education nurse practitioners receive.
Senator Davis pointed out that those on both sides of the issue agree that quality care is the goal. He also noted that changes in the practice of medicine through telemedicine and population health have made it necessary to update the law to reflect the current landscape. He adjourned the meeting and carried the bill over with the intention to discuss this bill in with more stakeholder with hope that middle ground can be reached. |
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Alcohol Exclusion Repeal Clears First Hurdle
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The alcohol exclusion law, which allows insurance providers to deny claims for services for an injury or other medical need that results from excessive alcohol or drug use. S.9 (Hutto) aims to repeal the current law, which has been on the books since the 1940's and is opposed by many groups, including the National Association of Insurance Commissioners that pushed it 70 years ago.
The legislation passed a subcommittee of the Senate Banking and Insurance committee which is chaired by Senator Bennet and includes Senators Hutto, Setzler, Davis, and Gambrell. The bill as written had some fiscal impact to the state as it would require the Department of Insurance to re-review each policy to ensure compliance with the new law. To reduce the fiscal impact, an amendment to insert a date after which any new or renewing policies will be prohibited from having an alcohol exclusion in their policy was approved. Insurance companies say that the law may result in premium increases as they underwrite the claims denied under this law.
The subcommittee gave a favorable report as amended and it will go to the full Senate Banking and Insurance Committee.
SCHA supports the alcohol exclusion repeal as part of a behavior health agenda. Alcohol exclusion laws threaten the stability of emergency care services by undermining the financial basis for trauma care. Current law may discourage emergency room providers from asking about or noting if a patient has been drinking or using drugs because services can be excluded for coverage. The result is patients with alcohol or drug use disorder being released after treatment only for physical ailments without being identified and treated for behavioral health issues. |
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In Other News
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- Bill Updates Lewis Blackman Act: A bill introduced in the House this week, H.3885 (Bannister), aims to update the Lewis Blackman Hospital Patient Safety Act to extend requirements beyond hospitals. Under current law, healthcare practitioners providing care in hospitals are required to wear name badges that include their names, job title, applicable training information, and the licensing board under which they are regulated. The legislation adds other healthcare facilities, such as physician practices and urgent care locations, to those which are required to follow the name badge requirement. The bill has been introduced and referred to the House Judiciary Committee.
- Crisis Stabilization Units: S.354 (Alexander) is on the agenda for a Senate Medical Affairs subcommittee meeting on Tuesday, March 7. The legislation defines crisis stabilization units and outlines that they are not subject to the certificate of need requirements. SCHA strongly supports the legislation as part of a behavioral health agenda as they are better able to serve the needs of patients needing immediate attention for psychiatric disorders than hospital emergency departments. The proposed legislation creates a new licensure category by DHEC to allow for a seamless process in getting authorization to open and operate crisis stabilization units, which are a key component of the continuum of care needed to treat behavioral health patients.
- Mental Health Month: A resolution was introducted in the Senate this week to declare May 2017 "Mental Health Month" in South Carolina. The resolution identifies the need for appropriate and accessible services for people with mental illness and recognizes the Department of Mental Health for their efforts in improving mental healthcare in South Carolina.
- Federal Health Reform Grows Legs: The leaked healthcare plan from the Congressional republicans is a starting point for the model the House GOP hopes to pass. The calendar is shrinking for Congress to act on the current reconciliation bill - the Senate needs to act by the end of March. SCHA has been paying close attention to the federal debate and has stayed in close contact with our Congressional delegation. You can read the latest here.
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Chamber Action
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- S.351 (Alexander) - allows an income tax credit for each clinical rotation served by a physician, advanced practice nurse, or physician assistant - carried over in Senate
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Committee Action
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- S.9 (Hutto) - defines 'medical expense policy' and provides that the optional intoxicants and narcotics exclusion does not apply to such policies - favorable as amended, Senate Banking and Insurance subcommittee
- S.14 (Bryant) - Expands the participation in HMOs to "Any Willing Provider" - carried over in Senate Banking and Insurance subcommittee
- S.179 (Hutto) - provides limited immunity for a person seeking medical assistance for another person experience a drug or alcohol-related overdose - favorable as amended, Senate Medical Affairs committee
- S.345 (Davis) - expands the scope of practice for certain nursing professionals - carried over in Senate Medical Affairs subcommittee
- S.264 (Peeler) - establishes the Board of Genetic Counselor Examiners and criteria for licensure of Genetic Counselors - favorable, Senate Medical Affairs subcommittee
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Intros of Interest
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Pharmacy
- S.497 (Cromer) - modifies standards for Minimum Good Compounding Practices in pharmacies - referred to Senate Medical Affairs committee
Workforce
- H.3885 (Bannister) - Updates the Lewis Blackman Hospital Patient Safety Act to add that healthcare practitioners in facilities other than hospitals must also comply with the identification badge display requirements - referred to House Judiciary Committee
- H.3891 (J.E. Smith) - prohibits discrimination in employment based on sexual orientation or gender identity, adding to race, religion, color, sex, age, national origin and disability - referred to House Judiciary Committee
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March 3, 2017
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