Idaho Legislative Report week of March 4-8, 2019
2019 IDAHO LEGISLATURE
March 4, 2019 through March 8, 2019
Michael McGrane, RN
This is the ninth week of the 2019 legislative session. Medicaid expansion is becoming the issue that will take the session to its end. Legislative leadership has targeted March 22nd to have all bills complete and the session to end, however many are predicting this year, with the controversial topic of Medicaid Expansion, it going into mid-April.
On Friday, the House Health and Welfare Committee held a public hearing on H249 that would place restrictions, or sideboards, on Medicaid Expansion. This is one bill to come out of the secret committee working through alternative proposals. The hearing went morning and afternoon. Public testimony overwhelmingly opposed any restrictions. No one, including the Freedom Foundation who oppose any expansion of Medicaid, spoke in support of this bill. In the end, the Committee held their vote and sent the bill back for revisions.
The other emotional issue of the week was the Senate Health and Welfare hearing on H109 which would create the Maternal Mortality Review Committee. After passionate personal testimony, the bill passed with only one senator opposing. It is scheduled for a vote by the whole Senate, then it will go to the Governor.
Medicaid Expansion became law when the voters approved Proposition 2 in November. The Department of Health and Welfare has submitted the Medicaid Plan to the federal Center for Medicare and Medicaid Services (CMS) for approval without limitations, and the legislative Joint Finance Appropriations Committee has approved the Governor’s Medicaid budget for unrestricted expansion. If the legislature takes no action, expansion as approved by the voters will become effective January 1, 2020 without any additional requirements or limitations.
H249, presented on Friday, would set seven requirements for Medicaid Expansion. Any requirements would need approval from CMS.
- Health Risk Assessment to collect participant information on substance abuse
- Limit retroactive Medicaid eligibility from 90 days to 30 days
- Provide an option for those between 100% and 138% of the federal poverty line who already participate in the Exchange to remain on their current coverage and keep their current provider
- Add a work and job training requirement with an exemption for parents of children less than 18 years old
- Provide Medicaid funding for behavioral health services
- Allow the legislature to nullify Medicaid Expansion in the event Congress alters the Medicaid law
- End Medicaid Expansion should federal funding fall below 90%
S 1100 – Medicaid Expansion – Introduced, Awaiting hearing in Senate H&W
The primary focus of the bill is a sunset provision that would end Medicaid Expansion and require legislative reauthorization in the event the federal/state 90%/10% funding share were to change. The bill sets a deadline for legislative review in 2023. Senator Souza said that would protect the state from a devastating financial impact if the program were to move to the 70%/30% share that currently stands for other state Medicaid programs. The bill would also authorize an optional work training program and have the Department of Health and Welfare explore waivers to make the Medicaid program more efficient to pay for substance abuse and mental health services.
H 109 – Maternal Mortality Review Committee (MMRC) – Passed House, Passed Senate Health and Senate Health and Welfare Committee, to Senate floor
H109 barely passed in the House on a single vote. Testimony was passionate when H109 was heard in the Senate Health and Welfare Committee. Those testifying included a senator, a physician and a nurse, each who narrowly survived complicated pregnancies and childbirth. An OB/GYN from Sandpoint described the death of a mother and her unborn baby as a consequence of eclampsia. Although the raw number of deaths in Idaho is low compared with the national average, when considering those impacted by the complications of pregnancy and other causes of maternal death the the MMRC would address, the numbers approach 100.
Idaho’s maternal death rate is 27.1 per 100,000 live births. The US has a maternal death rate of 26.4 compared with Canada at 7.3, UK 9.2, Germany 9, France 7.8 Spain 5.6, Italy 4.2 and Finland 3.8. The bill creates a Maternal Mortality Review Committee within the Department of Health and Welfare. Composition of the committee includes physicians, one midwife, a nurse midwife and one labor and delivery nurse. The committee would study the causes of death and provide recommendations to reduce the death rate. Funding would be entirely covered through a CDC grant.
H 180 – Syringe and Needle Exchange Act – Passed House, to Senate Health and Welfare Committee
The bill would allow groups to offer syringe and needle exchange programs.
H 181 – Definition of “Abused” in the Child Protection Act – Passed House, to Senate Judiciary and Rules Committee
This bill was proposed by a nurse, and member of ANA-Idaho. It is scheduled for a hearing in the Senate Judiciary and Rules Committee on Monday, March 11th. The bill would replace “subdural hematoma” with “head injury” in the definition of abused in the Child Protection Act. The current definition lists several physical signs including bruising, bleeding, fractures, etc. that when inflicted intentionally would suggest abuse. Included in the list is “subdural hematoma” which is a specific diagnosis. The definition does not include other diagnoses or symptoms of altered consciousness or head injury.
H 182 – Pharmacist Prescribing – Passed House, to Senate Health and Welfare Committee
Broadens the ability of pharmacists to prescribe without the specific authorization by the Board of Pharmacy, so long as the practice conforms to the following criteria:
- Does not require a new diagnosis;
- Is for a minor or self-limiting illness;
- Has a CLIA waived test to support a diagnosis, or
- The patient’s health and safety may be threatened if not provided immediately.
H 196 – Naturopathic Medicine – Passed House Health and Welfare, to House floor, then returned to Health and Welfare Committee
H 196 initially passed the Health and Welfare Committee and was sent to the House floor. There, it was relegated to the bottom of the third reading calendar, the final step before a vote by the entire House. On Wednesday, the bill was sent back to the Health and Welfare Committee essentially killing the bill. It is unlikely to get a second chance in the committee. The bill would have established licensing for naturopathic physicians under a subsection of the Board of Medicine and allow them to practice as primary care providers. It distinguished between licensed and non-licensed naturopaths.
S 1099a - Adolescent Residential Treatment – Passed Senate, to House Health and Welfare Committee
In discussion with the Attorney General’s office and the Department of Health and Welfare, the bill was amended, with some sections moved to other sections of law and department rules. The bill seeks a waiver to Department of Health and Welfare rules that prohibit adolescent residential treatment programs for substance abuse. In Idaho, adolescents do not have access to crisis centers or adult treatment programs. This bill would allow centers who segregate adolescents to provide residential drug treatment with parental approval.
H 143 – Occupational Licensing Reform Act – Passed House Business Committee, to House floor
Reduces barriers to licensing, accepts relevant military education and training and expedites licensure for members of the military, their spouses and veterans.
H 116 - Rape Kit Testing – Passed House, Passed Senate Judiciary and Rules Committee, to Senate floor
The bill clarifies the procurement and retaining of sexual assault kits and the submission of DNA results to a national database. Sexual assault kits would be processed by the Idaho State Laboratory, DNA data entered by the state and the kits returned to the law enforcement agency for retention of not less than 10 years.
H 64 - Changes to the Complications of Abortion Reporting Law – Sign by Governor, becomes Law
The controversial law was passed in 2018 to require healthcare providers, physicians and nurses, to report on any complications of abortion including divulging patient information. The law also directs the Board of Nursing to take license action against nurses who fail to report. The law is being challenged in federal court as it requires the reporting of confidential patient information protected under federal law. The changes presented by Representative Greg Chaney of Caldwell is meant to address legal concerns by clarifying legislative intent and replacing the requirement to report any complication with a requirement to only report treatments that are, within the medical provider’s judgement, the result of having had an abortion.
HCR 4 - Reject Immunization Rules – Referred to House Ways & Means
Representative Giddings of White Bird introduced a bill to reject the Department of Health and Welfare Meningitis Immunization rule that requires high school graduates receive the second immunization. The bill has been held in the Ways and Means Committee essentially killing the bill.
H 133 – Immunization Exemptions – Passed House, to Senate Health and Welfare
The bill introduced by Representative Giddings would require daycare facilities and schools provide immunization exemption forms to parents and guardians.
Religious Exemption to the Child Protection Act
A draft bill was circulated early in the session that would have limited the religious exemption to the Child Protection Act in cases where serious illness, disability or the child’s life is in danger. A bill was never introduced. As the deadline for bill introduction has passed, there will be no action this year to address children who die by not having medical care.
H 9 – Physician and PA Licensing – Signed by the Governor, becomes Law
The Medical Practice Act was last updated in 1997. The bill simplifies licensing requirements.
H 12 - Opioid Antagonists – Signed by the Governor, becomes Law
The new law becomes effective in July and will allow access to naloxone to anyone without a prescription. Naloxone is a very safe drug, and this bill would put it in the hands of families and friends of those at risk of opioid overdose.
S 1033 – Notification for Organ Donation – Passed Senate, to House Health and Welfare
Requires EMS, law enforcement, coroners to notify state communications center upon determining death for the purpose of alerting organ retrieval centers.
H 59 - Age for Organ Donation – Signed by Governor, becomes Law
Lowers the age for organ donation to 15.
HJM 1 – 611 Crisis Hotline – Adopted
Introduced by Representative Caroline Troy, this bill would establish “611” as the Crisis Hotline focused on mental health, domestic violence and suicide.
S 1034a – Oral Chemotherapy – Passed Senate, to House Health and Welfare Committee
The bill would require insurance coverage for oral chemotherapy the same as IV or injectable chemotherapy. Amended to reset the implementation date to January 1, 2020.
S 1028 - First Responder Workers Compensation Coverage for PTSD – Passed Senate and House and sent to the Governor
Under current law, PTSD is covered only if it is also associated with physical injury. The bill would allow Workers Compensation coverage for PTSD alone for first responders, EMS, Fire, Law Enforcement.