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Certificate of Need Reform Bill Introduced in Senate
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A bill to reform the state's Certificate of Need (CON) program was introduced in the Senate on Tuesday by Senators Talley, Hutto, Gambrell, Shealy, and Climer. Senate bill 1093, which is supported by SCHA and the hospitals in South Carolina, would limit the length of time an appeal of a CON award can extend to 18 months and make the Administrative Law Court the last point of review.
Additionally, the bill would increase dollar thresholds which would trigger the need for a CON to $5,000,000 for capital projects and $2,000,000 for equipment purchases. The dollar amounts would be indexed to the medical commodities component of CPI every five years.
The other change to the program in this legislation would eliminate the requirement for a CON for adding beds, up to a limit, when a CON has already been issued for the same bed type and eliminating the need for a CON for replacing equipment.
This is the third CON bill to be introduced in the Senate this year, joining Senate bills 990 and 1077 in the debate on the issue. S. 1093 is the only CON bill that has the consensus and support of all hospitals in South Carolina.
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House Panel Moves Opioid Legislation to Full 3M Committee
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On Tuesday, a House Medical, Military, Public and Municipal Affairs (3M) subcommittee heard public testimony pertaining to House bill 4355, amending restrictions on the use of methadone; authorizing pharmacists and nurses to administer and dispense, House bill 4711 adding section 44-53-361 to require prescribers to offer a prescription of naloxone to patients with high risk of overdosing, and House bill 4938 amending a section relating to electronic prescriptions to allow exceptions in certain circumstances.
This was the second time bill H. 4355 was discussed before committee and had many of the same proponents speak in favor of the bill again. They argued that the current legislation in place is stricter than federal law, other states have passed similar amendments and Florida's current model can be taken and easily applied to South Carolina. The subcommittee gave the bill a favorable report as amended to include federal law language in the state law.
H. 4711 was also previously discussed with more individuals speaking in favor of the bill than against. Those in favor of requiring a physician prescribing a patient a certain dosage of medicine that has the potential of overdosing to also prescribe naloxone, the antidote, explained that this amendment would only save lives. The subcommittee adopted amendment language that would change the bill to say that if the prescriber does not offer naloxone or proper education, they must be referred to the appropriate licensing board to may be referred to the appropriate licensing board. With this amendment, the bill received a favorable report.
The goal of H. 4938 is to add certain exceptions to electronic prescribing requirements in order to allow specific prescriptions to be written by hand. The legislative liaison for the Department of Mental Health (DMH) argued in favor of this amendment because by allowing written prescriptions for certain drugs, patients are able to "shop" for the best, most affordable price. The prescription would be written on paper that cannot be tampered with or copied in order to prevent potential abuse by a patient. DMH also stated that many rural pharmacies do not have the bandwidth to receive electronic prescriptions, meaning patients can only get their medicine if it is written. No one spoke in opposition of this bill and the subcommittee gave the bill a favorable report.
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CRNA Supervision Debate Continues
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A subcommittee of the House 3M Committee heard public testimony on H.4278, to amend the Nurse Practice Act by removing the supervision requirement from the definition of "approved written guidelines" for Certified Registered Nurse Anesthetists (CRNAs). The room was crowded with a myriad of CRNAs and Anesthesiologists speaking in favor and in opposition to the bill respectively.
The bill's primary sponsor Representative Lowe started the meeting off, requesting his colleagues reduce the burden of supervision by allowing CRNAs to practice independently, as many of them currently are. He was followed by Dr. Allison Estep, a veteran working in a community hospital, who stated that she works only with CRNAs and no anesthesiologist as there is not one within 50 miles. She went on to explain that removing supervision does not add or take away anything from patient safety. Dr. Estep argued that having a 4:1 ratio of CRNAs to anesthesiologists is not realistic or helpful, comparing it to a pilot and co-pilot, asking, "have you ever seen a pilot fly four planes at once?" Another CRNA spoke, hammering home some of the same points and addressing the issue of education, explaining the CRNAs are considered experts in anesthetics and air-passage control. More CRNAs spoke reading letter from physicians they work with in support of this bill. The Subcommittee asked who the leader in the operating room would be if the language is revised. CRNAs explained that the surgeon would be the one in charge but CRNAs would be responsible with administrating anesthesia and monitoring the patient.
Many of the anesthesiologists that spoke offered anecdotes describing situations where their presence saved a patient's life. The physicians were quick to say that CRNAs are qualified and highly educated, but they do not have the knowledge or experience that medical school and residency can provide. The physicians explained that a team model, anesthesiologist and CRNA working together, is the best model for patient safety because "four hands and four eyes" are better than two. Dr. Al Thornton, who practiced as a CRNA before becoming an anesthesiologist, emphasized the difference in education between CRNAs and anesthesiologists. He expressed that while CRNAs are qualified, they should not be allowed to work independently and that patients are safer with an anesthesiologist present.
The discussion was back and forth between CRNAs arguing they are qualified to work alone and anesthesiologists arguing that a care team model is the best practice. After hearing from all wishing to testify and a passionate testimony from Representative Ridgeway, a physician, the subcommittee adjourned debate on the bill.
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Committee Action
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- Emergency Prescription Refills: A conference committee on S. 16 met Wednesday morning to work out the final details on a bill increasing the length of time for which an emergency prescription refill may be given. The bill increases the supply from ten-days to fourteen-days and allows for medications that only come in a vial or similar packaging for one month to be given in the case of an emergency.
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Intros of Interest
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- House bill 5123 (West, et al): A bill to increase the length of time the Department of Mental Health (DMH) has to restore an individual found unfit to stand trial was introduced in the House bill week. H. 5123 came as a recommendation from the Legislative Oversight Committee after their review of DMH last year found that other states have much more time, resulting in more individuals eventually being restored and able to stand trial. The bill was referred to the House Judiciary Committee.
- House bill 5229 (Sandifer): This bill would require a person to seek help for another person who is experiencing a drug or alcohol related overdose and prohibit the person who seeks help from tampering with the body. The penalty for failing to seek help for another person who is overdosing is a felony under this legislation. The bill was referred to House 3M Committee.
- Senate resolution 1110 (Alexander): A concurrent resolution to recognize May 2020 as Mental Health Month to raise awareness for mental illness and the need for appropriate treatment was introduced in the Senate this week.
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February 14, 2020
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