PCMS REPS ATTEND ANNUAL LEGISLATIVE RECEPTION: Society officers and several of its Board members attended last week’s annual Legislation Reception. The reception is held each year in partnership with ArMA, Maricopa County Medical Society and PCMS.
The reception is a unique event held in order to facilitate physicians and legislators learning more about each other, policy initiatives, health care issues, and identifying opportunities to work together in a welcoming atmosphere.
GOVERNOR PROVIDES INPUT ON “REPEAL AND REPLACE” LEGISLATION: In a 15-page letter to House Majority Leader Kevin McCarthy, Govenor Ducey last week urged congress not to repeal Obamacare until a well-developed replacement plan was enacted.
Last December McCarthy had requested from governors on how to “repeal and replace” the ACA.
Ducey’s recommendations includeded:
- Eliminate many of the basic insurance requirements and allow states to again set their own insurance rules
- Keep tax subsidies for individuals for now to keep the marketplace from melting down, stating he doesn’t want to see “any Arizonans have the rug pulled out from under them.”
- Offer states flexibility in managing their Medicaid plans, including limiting coverage in lean times and requiring healthy individuals to work or seek jobs to retain coverage
- Repeal taxes that pay for health insurance subsidies and other costs of Obamacare. He says the fees are just passed onto patients and states
- Allow insurers to lower plan costs for people who quit smoking, lose weight or meet other incentive goals
- States should take over regulation of small business and employer plans, with tax deductions for employers that provide health insurance be retained and extended to the self-employed
- Wants federal rules that keep older people from having to pay much, much more than younger people eliminated to lure younger people to buy insurance
Last Friday, February 17, marked the last day bills filed in the House and Senate had to clear all the standing committees to which assigned. If a bill did not make it out of all the committees the bill is essentially dead for this session, with some special exceptions such as a “Striker Amendment.” However, the legislature has taken steps to limit such tactics.
HB 2194 – Would prevent minor children (under 18) from using indoor tanning facilities and prohibit facilities from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. PASSED THE HOUSE now moves to Senate.
HB 2195 – Streamlines the AMB’s physician license application processes, including changes on primary source verification, testing, substance abuse programs, and compensation to board members. PASSED THE HOUSE now goes to a final House vote.
HB 2030 – Will add urology services required to be covered in the telemedicine insurance parity statutes. PASSED HEALTH COMMITTEE (8-1).
HB 2090 – requires hospitals to offer patients 65 and older a flu vaccine prior to discharge; there is already a CMS requirement on this. PASSED BY THE HEALTH COMMITTEE.
HB 2134 – a bill empowering parents to send their kids to school or camp with sunscreen and allows them to apply it. Dermatologists are spearheading the passage of this measure. PASSED BY THE HEALTH COMMITTEE.
HB 2180 and HB 2182 – police unions want to make it harder for physicians to perform independent medical exams for workers comp. NO ACTION.
HB 2195 – The Arizona Medical Board wants to streamline changes to their license application processes. The bill includes changes on primary source verification, testing, substance abuse programs, and board member compensation. PASSED BY THE HOUSE. Now goes to a final vote.
HB 2333 – A broad language bill covering all types of health care providers that forbids the payment of patient referral “inducements” with violators facing criminal penalties. NO ACTION.
HB 2359 - Would change the structure of the state's three universities by doing away with the core functions of the Arizona Board of Regents and be replaced by separate governing boards at each university. REMOVED FROM THE FEDERALISM, PROPERTY RIGHTS & PUBLIC POLICY COMMITTEE AGENDA.
HB 2382 – Was amended and approved by the House HHS Committee. It allows a pharmaceutical manufacturer or its representative to engage in truthful promotion of an “off-label use of a drug, biological product or device. The amendment adds a provision that prohibits the state from enforcing federal statues prohibiting drug misbranding or otherwise prosecuting a pharmaceutical manufacture or its representative for doing so.
HB 2522 – A measure that would allow the sale of insurance products in the state by companies outside the state. Filed late, so it was not assigned to a COR and is probably dead.
SB 1023 – Will add schedule V controlled substances to the state’s prescription drug monitoring program. APPROVED AND SENT TO THE HOUSE.
SB 1028 – A bill to continue the Arizona Board of Osteopathic Examiners in Medicine and Surgery. APPROVED BY THE SENATE and now moves to the House.
SB 1080 – A bill that would ban texting by new teen drivers for the first six months of licensure. APPROVED BY SENATE now moves to the House.
SB 1133 -- clarifies the collaboration requirement in current law for nurse practitioners and to separately regulate certified nurse midwifes. APPROVED, now moves to the House.
SB 1235 - The bill allows podiatrists with proper training to perform toe and partial foot amputations. PASSED BY SENATE now moves to the House.
SB 1269 – Will allow pharmacists to dispense oral fluoride rinse, prescribe nicotine replacement drugs in conjunction with tobacco cessation programs, and do short term emergency refills on medications for chronic conditions when the prescriber cannot be reached. APPROVED BY THE SENATE HHS COMMITTEE.
SB 1336 - Will allow CRNAs scope-of-practice expansion. Unresolved issues concerning the definition of “direction” for physicians and surgeons and anesthesiologists, and on the limitations on CRNAs for providing chronic pain services remain.
The Committee voted to allow SB 1336 to move forward, but with a stated understanding that negotiations on the bill’s language would continue and efforts to reach an accord will be exhausted before the bill moves to the Senate floor.
SB 1367 – If a human fetus or embryo is “delivered alive,” the physician performing the abortion is required to document and report to DHS the measures the physician performed to maintain the life of the fetus or embryo. APPROVED BY SENATE HHS COMMITTEE.
SB 1398 - Adds urology services to telemedicine insurance coverage. NO ACTION.
SB 1436 - Among other things, prohibits pharmacy benefits managers from prohibiting contracted pharmacies from mailing or delivering prescriptions to patients. FAILED IN COMMITTEE.
SB 1439 – Forbids discriminating against a health care entity on the basis that the entity does not provide, assist in providing or facilitate in providing any health care item or service for the purpose of causing or assisting in causing the death of any individual. APPROVED BY SENATE HHS.
SB 1452 - Makes changes to the health licensing board laws, particularly related to what protions of a health professional licensee's disciplinary records must be posted on the licensing board's website. APPROVED BY THE SENATE HHS COMMITTEE.
GOVERNOR/LEGISLATURE: Governor Ducey has released his budget. It calls on the state to spend an additional $176M during the coming year. Much of the increase, $129M, will go to education initiatives including $15M for state universities. He is also keeping his promise of cutting taxes each year by indexing the state’s personal tax exemption for individuals to inflation.
His budget also includes:
- $500,000 for public health emergency funding.
- 350,000 more for the Student Loan Repayment Program, for physicians and other health professionals serving in health care shortage areas (This additional appropriation will allow DHS to apply for $1 million in federal matching funds.).
- $1.6M for adding coverage for adult emergency dental services under AHCCCS.
- $220,000 for 5 additional FTEs in AHCCCS for drug abuse-related positions.
- $30M infusion into the Health Care Trust Fund for the state employee benefit plan.
HB 2030 – will add urology services required to be covered in the telemedicine insurance parity statutes.
HB 2090 – requires hospitals to offer patients 65 and older a flu vaccine prior to discharge; there is already a CMS requirement on this.
HB 2134 – a bill empowering parents to send their kids to school or camp with sunscreen and allows them to apply it. Dermatologists are spearheading the passage of this measure.
HB 2180 and HB 2182 – police unions want to make it harder for physicians to perform independent medical exams for workers comp.
HB 2194 – another ban on minors using tanning beds.
HB 2195 – The Arizona Medical Board wants to streamline changes to their license application processes. The bill includes changes on primary source verification, testing, substance abuse programs, and board member compensation.
HB 2333 – a broad language bill covering all types of health care providers that forbids the payment of patient referral “inducements” with violators facing criminal penalties.
SB 1023 – will add schedule V controlled substances to the state’s prescription drug monitoring program.
SB 1133 -- clarifies the collaboration requirement in current law for nurse practitioners and to separately regulate certified nurse midwifes.
For those interested, you may read the full text of bills and follow a bill’s progress here.
GOVERNOR'S ADDRESS: Education took center stage during Gov. Doug Ducey’s Monday State of the State address. He called on the Arizona Legislature to join him in giving public-school teachers a raise, expanding all-day kindergarten in low-income areas, and adopting other policies he said will help poor Arizonans. He did not outline how he would pay for his 15 new education proposals other than vowing not to raise taxes.
- Increasing teacher salaries by a couple percentage points.
- Offer a $1,000 signing bonuses for teachers who pursue careers in low-income schools.
- Expansion of full-day kindergarten in lower-income areas.
- Called on the state's public universities and community colleges to create a program known as the Arizona Teachers' Academy to erase debt for students who commit to teach in Arizona public schools.
- Continue work on federal legislation that would revisit the idea of restructuring the 9th Circuit so that the state could count on swifter and more efficient judicial service.
- Expansion to two years of the cash benefit the state pays low-income families, as long as recipients are actively looking for work.
- Under his proposal, Ducey would revert the TANF (welfare) program back to two years. Arizona currently has a one-year limit.
- Ax certain state licensing fees for those who are living in poverty and want to start new careers.
- Reduce "job-killing” regulations by wiping out 500 total regulations by the end of the year.
- Wants one hour of the forty physician CME hours be dedicated to the subject of drug addiction.
- The governor proposed the state test all babies for Severe Combined Immuno Deficiency, a rare genetic disorder that can be deadly if not detected.
- Called on Congress to focus on “replace” for the ACA as well as the law’s repeal.
- Issued a new executive order allowing inmates with an addiction and leaving prison the chance to enter a treatment program to help during the transition.
Read more about his address here.
PIMA DERMATOLOGY OPENS NEW SATELLITE CLINIC: Pima Dermatology is accepting patients at their new TMC Rincon Health Campus, 10350 East Drexel Road, Suite 120 from 8 a.m.-5 p.m. each Thursday. Matthew Beal, MD and physician assistant Jennifer Allison, will be alternating assignments at the new facility.
Services include skin checks for suspicious lesions, moles and possible skin cancer. Treatment and assessment of many skin conditions such as acne, psoriasis, eczema, rashes, rosacea, warts and other dermatology services are available. Call 795-7729 to schedule an appointment.
Dr. Beal joined Pima Dermatology and PCMS in 2013. Allison is licensed by the Board of Medical Examiners and has practiced at Pima Dermatology for 15 years.
TMC’S MEGA RAFFLE RETURNS: Tucson Medical Center’s TMC Mega Raffle is back for its fifth year. The 2017 event will award more than 5,600 prizes, with net proceeds benefiting patient care programs and services. Tickets are available to the public beginning Thursday, Feb. 9.
This year there are two grand prize packages. The first is an elegant A.F. Sterling custom home located in the 253-acre Stone House community, adjacent to the Santa Rita Mountains or the winner can choose the cash option of $600,000. Grand prize #2 is a 2017 Lincoln Continental plus cash or $150,000 cash.
Each raffle ticket has a one in 20 chance of winning a prize. Participants that enter before midnight, March 9, will be eligible to win the two Early Bird prize packages both valued at more than $60,000. Early Bird prize #1 is a 2017 Toyota 4Runner 4x4 SR5, a six-night luxury vacation package for two to explore the Greek Islands and $16,000 in cash. Early Bird prize #2 is the 2017 Toyota Avalon XLE, a five-night retreat at the luxurious Moorea Manava Beach Resort and Spa, plus $15,500 in cash.
In addition to the Grand Prize and Early Bird packages, the 50/50 raffle is back, which totaled $595,880 last year. Participants will also be eligible to win a host of new cars, luxury vacation packages, cash prizes along with a popular selection of electronics, jewelry, and home accessories.
The final cut-off for purchasing tickets is Thursday, March 30. Grand prize winners will be announced by early April.
Tickets are $100 each with a limited number of three-ticket packages available for $250. To purchase tickets, visit www.TMCmegaraffle.org or call (800) 395-8805.
LEGISLATIVE REVIEW OF 2017 SUNRISE APPLICATIONS BEGINS: Arizona law (A.R.S. § 32-3104, 32-3105) requires health professions seeking regulation or an increase in scope of practice to submit a written report (sunrise application) on or before September 1 to the President of the Senate and the Speaker of the House of Representatives.
The report is reviewed by a Health Committee of Reference which will make a recommendation whether the health profession should be regulated or whether a request for an expanded scope practice be approved. There are several factors that must be addressed in sunrise applications including how the proposal will protect and benefit the public as a result of the new regulations or expanded scope of practice.
There are nine sunrise applications submitted for the upcoming legislative session:
Proposed Regulation of Health Profession
Applicant - Arizona Community Health Workers Association
Establish voluntary certification and standardization of practice for community health workers
Applicant - Art Therapy Association
Establish licensure of the practice of art therapy
Applicant - Dental Care AZ
Establish licensure and regulation of dental therapists
Applicant - Lauren Moore - Phlebotomist
Establish phlebotomy as a specialty to allow independent billing
Proposed Scope of Practice Expansion
Applicant - Arizona Pharmacy Association
- Allow pharmacists to administer oral fluoride varnish to eligible patients according to national guidelines.
- Allow pharmacists to administer the Tuberculin Skin test (TST) and interpret the results for the purposes of referral for treatment following a positive test according to national guidelines.
- Allow pharmacists the ability to prescribe over the counter nicotine replacement products as well as FDA approved prescription products indicated to aid in smoking cessation treatment for eligible patients according to national guidelines.
- Allow pharmacists the ability to prescribe FDA approved prescription medications to eligible patients testing positive for influenza or strep throat consistent with current clinical guidelines.
- Allow pharmacists the ability to extend a routine, non-controlled, chronic medication for an additional 30-60 days.
Applicant - Arizona Naturopathic Medical Association
Allow intravenous administration of antibiotics
Applicant - Arizona Naturopathic Medical Association
Allow ability to sign medical exemptions for students from Arizona K-12 school immunization requirements
Applicant - Certified Registered Nurse Anesthetists
- Remove the “direction and presence” requirement to provide analgesic services
- Clarify the ability to “prescribe” a medication instead of “order” a medication; applicant states this will restore the ability to prescribe analgesics and is not a scope of practice expansion
Applicant - The Core Institute
Allow doctors of podiatric medicine to perform amputation of toes, would still exclude foot and leg.
LEGISLATIVE HEALTH COMMITTEE APPOINTMENTS ANNOUNCED: The following House and Senate members will serve on their respective health committees during the 2017 session.
House Health Committee
Chair – Heather Carter, R-LD15
Vice Chair – Regina Cobb, R-LD5
Jay Lawrence, R-LD23
Tony Rivero, R-LD21
Maria Syms, R-LD28
Michelle Udall, R-LD25
Kelli Butler, D-LD28
Oteniel Navarrete, D-LD30
Pamela Powers Hannley, D-LD9
Senate Health and Human Services Committee
Chair – Nancy Barto, R-LD15
Vice Chair – Kate Brophy McGee, R-LD28
Debbie Lesko – R-LD21
Steve Montengro, R-LD13
Kimberly Yee, R-LD20
David Bradley, D-LD 10
Katie Hobbs, D-LD 24
PRE-MED STUDENT MENTORING: The UA Pre-Health Advising office offers an internship called Med Mentor for undergraduates in Tucson. Through this internship, students have the opportunity to experience hospital, specialty, and group practice settings, develop mentoring relationships with health care professionals and explore career options. The success rate of admission into medical schools for the students who participate in this internship is more than 90%. The students are carefully screened for maturity, professionalism, capability and because they have demonstrated a commitment to becoming excellent physicians. They have been selected from a large pool of applications as this is one of the most sought-after internships on campus. These students understand the value of your time and experience and are thrilled to observe and learn from you. If you are a participating physician, you would host 2 students, one at a time, during the months of Feb-April, 2017. The first student would be with you for 6 weeks beginning Feb. 1 and the second would begin with you in mid-March through the end of April. If you are interested in joining or learning more about the program, please contact Vanessa Perez at VanessaPerez@email.arizona.edu.
WALK-WITH-A-DOC: The Society is teaming with the Arizona Chapter of the American College of Physicians (ACP) to host and provide physician leaders for the monthly Walk-With-A-Doc outings. Walkers sign in at the ramada east of Swan Bridge on the south bank.PCMS physicians are encouraged to urge patients to participate in the program. Each walk begins with a brief discussion on a health topic and includes a one- or two-mile walk on level ground. Please contact Dennis Carey at 795-7985 or email@example.com for more information or if you have questions.