OCEP Wins and Losses

The Oregon Chapter of the American College of Emergency Physicians advanced several priority bills and initiatives during the recent 2015 Legislative Session. A special emphasis was placed on policies, budget notes and bills that would improve care for people in mental health crisis. OCEP also opposed bills that could be detrimental to patient care and the practice of emergency medicine. To recap some of the highlights:

  • A budget note was approved, which requires the Oregon Health Authority to study the growing crisis of psychiatric boarding in hospital emergency departments and report back in February 2016 about possible solutions. OCEP has offered to be a resource to the OHA on this issue.
  • New investments were made in the mental health arena, including $1 million for Unity Behavioral Health, the psychiatric emergency department slated to open next year in Portland. OCEP also advocated for appropriations in the City of Portland and Multnomah County budgets that were approved.
  • OCEP supported legislation related to liability protections for sobering centers, which passed. The Legislature also appropriated $500,000 in initial start-up costs for a facility in Grants Pass.
  • OCEP teamed up with partners to stop bills that would have had a negative impact on emergency care including: Senate Bill 835, which would have required EDs to refer patients to primary care for non-emergency conditions; SB 186, which would have permitted public dispensing machines for epinephrine; and SB 409, a bill promoted by the trial lawyers to repeal the $500,000 statutory cap on damages recoverable in wrongful death actions. Despite successful efforts to block these bills, it’s possible they’ll emerge in future sessions.

 

In the loss column, a bill to prevent violence against health care workers in hospitals failed in the Senate Judiciary Committee, despite robust support from the health care community. The Legislature also approved an increase to speed limits in rural Oregon. Traumatic injury from speed-related crashes is one of the most frequent causes of injury for patients treated by emergency physicians. The National Highway Transportation Safety Act estimates that higher speed limits play a role in 30 percent of all fatal crashes. 

 

2015 Legislative Session Overview

Democrats pass key priorities, bi-partisan agreement on marijuana regulation, grand bargain for transportation fails

The 78th Legislative Assembly convened on Feb. 2 and adjourned on July 6, five days ahead of the constitutional deadline of July 11. Democrats held a super-majority in the Senate (18-12) — that’s the magic number necessary to pass revenue increases under Oregon law. The Democrats fell one vote shy of a super-majority in the House (35-25). These majorities allowed them to pass bills on clean fuels, paid sick leave, ‘Ban the Box,’ mandatory retirement plans and expanded background checks for guns. The Legislature negotiated the regulation and taxation of recreational marijuana passed by voters last year, but failed to reach consensus on a $364 million transportation package to fix Oregon’s crumbling roads and bridges.

 

Leadership changes in the first weeks of session

The Kitzhaber scandal overshadowed the opening days of the legislative session. The governor, facing an FBI criminal investigation and a state ethics review over the role of First Lady Cylvia Hayes, became both the longest-serving governor in state history and the first to resign amidst intense controversy. Only four governors have resigned in Oregon’s history.

 

Secretary of State Kate Brown was sworn in as Oregon’s 37th governor on Feb. 18.

 

A Smooth Transition

Gov. Brown, a former Senate Majority leader and lawyer, dove into the fray. Within weeks, she signed the controversial clean fuels legislation, the ‘motor voter’ bill that automatically registers drivers to vote, and appointed Jeanne Atkins, formerly a state director for U.S. Sen. Jeff Merkley, as Secretary of State. While Gov. Brown continued to support majority party priorities, she also pledged to restore trust in government and made ethics reform a centerpiece of her agenda, passing bills to expand the role of the Government Ethics Commission, ban speaking fees for the Governor and first partner, and audit how state agencies respond to public record requests.

 

Towards the end of the session, she used her clout to try to bridge Democrats and Republicans, the Senate and the House, to pass a transportation package similar to the $300 million package that passed in 2009. The Grand Bargain for transportation failed … for now. Look for this to be the defining issue of the 2017 Session.

 

2015 Budget 

Forecast is up, kicker will kick

Rising revenue forecasts allowed lawmakers to pass increased budgets for K-12 education and all-day kindergarten, make new investments in mental health and affordable housing, and use more than a billion dollars in state bonds for projects such as seismic upgrades in schools. Although the comprehensive transportation package failed, $90 million was invested in transportation infrastructure, including safety improvements throughout Oregon. 

 

Mental health and addictions investments

Leadership invests an additional $22 million dollars for mental health and addictions

Budget highlights include:

 

  • $1 million appropriation for psychiatric emergency services.
  • $1.5 million for the Oregon Psychiatric Access Line for Kids (OPAL-K), 
  • $6 million for increased capacity for addictions treatment and recovery, including sobering facilities;
  • $7 million for crisis services, including mobile crisis services; 
  • $6.5 million for jail diversion; 
  • $7 million for supported housing (rental assistance) and peer-delivered services;
  • $4.1 million to fund Aid and Assist restoration services in the community, in order to reduce the number of patients sent to the Oregon State Hospital for that purpose;

 

Budget notes instructed the Oregon Health Authority to report to a legislative committee in September 2015 and February 2016 on the plan for investing the new resources in mental health and addictions. The department was also instructed to report to the legislature in February 2016 about the problem of psychiatric boarding for patients with mental illness in hospital emergency departments. A list of related budget notes are included at the end of this report.

 

2016 Session Preview 

Transportation Package, Minimum wage increase, PERS, Wrongful Death Cap

The Legislators will return for the short 35-day session in February to address unfinished business. It’s also possible they will resume negotiations on a transportation package to set the stage for the longer 2017 legislative session. 

 

House speaker Tina Kotek also has announced intentions to take up the issue of an increase in Oregon’s minimum wage, now set at $9.25. Advocates already are working on a proposed ballot measure to increase the minimum wage to $15 per hour by 2019.

 

The Supreme Court ruling on PERS (provisions of the 2013 Grand Bargain to reduce PERS liabilities by cutting cost-of-living increases for retirees) doesn’t impact the 2015-17 budget but will create a hole of as much as $300 million for the 2017-19 and 2019-21 budgets.

 

A coalition of health care associations and the insurance industry successfully blocked SB 409, a repeal of the statutory cap for wrongful death actions. While there wasn’t support for an repeal, legislators may be willing to raise the cap to double or triple the amount. Advocates may take another run at this bill during the short session.

 

The deadline for legislators to submit measure requests to Legislative Counsel is November 24, 2015. The 2016 session convenes February 1, 2016.

 

Summary of OCEP Priority Bills

State agencies already are working to implement bills with emergency clauses. All other bills will take effect January 1, 2016. Nearly 2,800 bills were introduced during the 2015 session and OCEP tracked 145 health-related bills. OCEP testified in support and opposition on priority legislation. Many of those bills will require interim participation in stakeholder activities such as rule making and work groups. Here are summaries of OCEP’s top bills:

 

Priority One 

HB 2303 Out of Network Billing

Status: Died in Committee

What the bill does: Requires health care professionals and hospitals to notify patients and prospective patients when physicians billed separately from the hospital.

Background: The State of New York passed a law last year to regulate out-of-network services, including billing, reimbursement and consumer disclosure for health care services provided to patients by “out-of-network” health care providers who do not participate in a patient’s health insurance plan. The legislation was reportedly intended to protect patients from excessively high provider charges. The bill went into effect in April of 2015. Since then, other states, including Oregon, have introduced bills to increase price transparency.

OCEP Position: OCEP supports the intent of price transparency and to protect consumers from excessive bills when a patient unknowingly receives services from a physician not part of their health care plan’s network of provider but opposes this bill which places an undue burden on emergency physicians, who are subject to EMTALA regulations.

 

HB 3502 Mental Health Payment Reform

Status: Died in Committee

What the bill does: Clarifies the state’s responsibility for cost of care for committed patients who are in community hospitals awaiting placement to the Oregon State Hospital or other secure community facilities. Updates statutes to remove or reduce barriers that compromise care, resources and access for psychiatric patients seeking care in emergency departments and acute care units.

Background: The Oregon Association of Hospitals and Health Systems convened a mental health workgroup to review Oregon’s mental health statutes and to develop strategies to improve care for people in mental health crisis.

OCEP Action: Participated in OAHHS interim workgroup, supported recommendations.

 

SB 132, Violence Against Health Care Workers

Status: Died in Committee

What the bill does: Expands crime of assault in third degree to include physical injury to health care providers in hospitals.

Background: 35 states have enhanced criminal penalties for assaults against hospital employees.

OCEP Action: Testified in support. Participated in interim meetings.

 

SB 409 Increase/repeal of cap on wrongful death actions

Status: Died in Committee

What the bill does: Increases the current $500,000 limit on noneconomic damages recoverable in wrongful death actions to $1,500,00.

Background: Currently, Oregon law allows a plaintiff in a wrongful death action to recover for economic damages, such as loss of income, health care costs, and property repair costs. A plaintiff may also recover for non-economic damages, such as pain, mental suffering, companionship, and interference with normal and usual non-employment activities. Recovery for non-economic damages is limited to $500,000.

OCEP Action: Provided statement of opposition for the record, coordinated with the Oregon Medical Association and other physician associations. Met with legislators to urge their opposition to the bill.

 

SB 835

Status: Died in Committee

What the bill does: Requires hospital emergency departments to refer patients to primary care if they present at an ED but do not have a condition requiring emergency services.

Background: A perception exists that emergency departments are overcrowded due to people seeking care for non-acute issues. However, the Centers for Disease Control estimated in 2011 that only about 4 percent of visits to the ED are for non urgent problems. Federal EMTALA obligations require a medical screening exam and appropriate stabilizing treatment, be performed on every patient that presents to the ED for care, regardless of the patient’s ability to pay.

OCEP Action: OCEP strongly opposed this bill and worked in coordination with Washington ACEP to craft a response. Sen. Alan Bates, the sponsor, agreed to withdraw it at the the request of OCEP. He also had liability concerns with the bill.

 

Priority Two Bills

HB 2023 and HB 2948 Discharge planning/disclosure of protected health information for patients in mental health crisis

Status: Passed. Effective date July 1, 2016

What the bill does: HB 2023 directs hospitals to adopt and enforce discharge policies for individuals that have been treated for mental health treatment. The policies must be publicly available and encourage the patient to sign an authorization for the disclosure of information that is necessary for a lay caregiver to participate in the patient’s discharge planning and to provide appropriate post-discharge support. HB 2948 allows physicians to share health-related information in certain circumstances, with family members involved in the care of a person in mental health crisis, without subjecting the health care provider to civil liability

Background: The bill was introduced on behalf of a parent who lost his child to suicide. 

OCEP Action: Participated in Rep. Keny Guyer’s interim workgroup, testified in support. Advocated for amendments to reduce administrative burden on emergency departments.

 

HB 2294 Health Information Technology Program

Status: Signed into law

What the bill does: Establishes the Oregon Health Information Technology Program in the OHA

Background: The Office of Health Information and Technology (OHIT) was established in 2011 as part of the Oregon Health Authority to support the adoption of electronic health records, the secure exchange of health information, and to support the use of initiatives throughout the state. OHIT is a resource for both state programs and other public and private users of health information, providing planning, coordination, policy analysis and the development of public/private partnerships including the Emergency Department Information Exchange.

OCEP Position: Support

 

HB 2936 Sobering Centers

Status: Passed. Effective July 6, 2016

What the bill does: Extends criminal and civil immunity to sobering facility and staff, registered with Oregon Health Authority (OHA) before January 1, 2016 for acting on probable cause in good faith without malice. Extends criminal and civil immunity to sobering facility and staff registered with OHA on or after January 1, 2016 for acting on probable cause in good faith without gross negligence. Defines sobering facilities and requirements. Requires OHA to establish registry of sobering facilities. 

Background: The American College of Emergency Physicians estimates that anywhere from 1-5 percent of all ED visits are alcohol-related. 

OCEP Action: Testified in support, provided OCEP logo for floor letter.

 

HB 3402, Speed limit increase

Status: Passed, Effective March 1, 2016

What the bill does: Increases speed limit on specified portions of certain highways

Background: The National Highway Transportation Safety Act (NHTSA) estimated 10,219 lives were lost in speed-related crashes in 2012. Higher speed limits play a role in 30 percent of all fatal crashes because it reduces the ability of passenger restraint systems and roadway safety guardrails to protect the driver and passengers in the vehicle.

OCEP Action: Testified in opposition. OCEP also opposed SB 459 which would have increased interstate highway speed limit to 70 miles per hour for most vehicles. That bill died in committee.

 

SB 71 Prescription Drug Program Monitoring

Status: Signed into law, Effective date January 1, 2016

What the bill does: Requires pharmacies to electronically report to Oregon Health Authority no later than 72 hours after dispensing a prescription drug.

Background: The Prescription Drug Monitoring Program (PDMP) was established in 2009 by Senate Bill 355 to manage prescriptions. The PDMP is a web-based system for Oregon’s licensed retail pharmacies to submit data on prescriptions for all Schedule II, III and IV controlled substances. These are drugs designated by the federal government to have low to high potential for abuse and psychological or physical dependence. This includes drugs such as morphine, oxycodone and methadone. In 2013, 156 Oregonians died due to prescription opioid poisoning and 1,510 were hospitalized due to unintentional or undetermined drug poisoning.

Currently, PDMP prescribers have no later than one week to submit information after dispensing the drug (ORS 431.964). 

OCEP Position: Support

 

SB 79 CPR Training In Schools

Status: Signed into law, Effective date July 1, 2015

What the bill does: Requires school districts to provide cardiopulmonary resuscitation instruction. 

Background: Out-of-Hospital Cardiac Arrest claims the lives of 3,000 Oregonians each year. Studies show that bystander CPR is one of the critical determinants in surviving out-of-hospital cardiac arrest. And cities that have the highest such survival rates, also have mandatory, Hands-On CPR training as part of the K-12 curriculum.

OCEP Action: Testified in support.

 

SB 186 Epinephrine dispensers

Status: Died in Committee

What the bill does: SB 186 would provide a legal mechanism for a public access prescription drug dispensing device. It would allow for a device that dispensed epinephrine auto injectors at the remote command of a practitioner when requested by a layperson. It would furthermore allow epinephrine in be administered by an untrained layperson with consultation from a practitioner by the communication device in the machine.

Background: This bill was introduced by Mylan Pharmaceuticals, makers of the EpiPen® epinephrine Auto-Injector. 

OCEP Action: Sent letter of strong concern to committee members. Contacted legislators to discuss concerns. Testified about concerns in committee and provided informational testimony to clarify epinephrine is not a harmless drug, public drug dispensaries are not like AEDs and epinephrine is currently available to individuals with allergies through prescription by their health care providers, through the 911 system, and through laypersons (such as parents or guardians) under ORS 433.825.

 

SB 227 Traumatic Brain Injury

Status: Signed into law. Effective date, January 1, 2016

What the bill does: This bill establishes a registry of information related to traumatic brain injuries, using existing information in the Oregon Trauma Registry. The purpose of the registry will be to use the data to design system improvement and prevent traumatic brain injuries.

Background: The American College of Emergency Physicians estimates there are more than 1 million emergency department (ED) visits per year for traumatic brain injury in the United States. The majority of these injuries are the result of falls and motor vehicle crashes. A traumatic brain injury registry will add to our collective understanding of these injuries in Oregon, improve clinical decision-making and assist in developing paths to prevention.

OCEP Action: Provided statement of support for committee.

 

SB 495 Safety Belts

Status: Died in Committee

What the bill does: This bill eliminates the exception to safety belt laws that allows person not to use a safety belt if all seating positions in the vehicle are occupied.

Background: Safety belts are effective in reducing deaths and injuries caused during impact.In a 55 mph crash, unbelted passengers of average size fly forward with a force of 3,000 pounds — enough to cause serious injury or death. Passengers in the backseat are just as vulnerable as those in the front. Safety belts provide the greatest protection against ejection in a crash. Seventy-five percent of people ejected from cars are killed. In 2009, more than 2.3 million adult drivers and passengers were treated in emergency rooms as a result of vehicle crashes.

OCEP Action: Testified in support

 

SB 626 Prescription Drug Monitoring Program (PDMP)

Status: Died in committee

What the bill does: SB 626 A-Engrossed allows “push notifications” to practitioners logging into the Prescription Drug Monitoring Program, instead of simply “pulling out” stale information. The push notifications will alert physicians and pharmacists of potentially danger drug interactions, as well as multiple practitioners to a patient, so that care and prescribing can be coordinated.

Background: Oregon has a prescription opioid abuse epidemic. In 2013, 156 Oregonians died due to prescription opioid poisoning. The overall rate of poisoning due to prescription opioids increased 364 percent between 2000 and 2006.

OCEP Action: Expressed concerns about original provisions that would require physicians to use the PDMP. Supported the amended bill and wrote a floor letter to use to advocate for the bill.

 

SB 839 Medical Amnesty for 911 callers

Status: Signed into law. Effective date January 1, 2016

What the bill does: This bill allows immunity for people who seek medical assistance for themselves or another person due to a drug-related overdose.

Background: Emergency physicians are frequently called upon to provide care for people of all ages who have experienced a drug overdose. The chances of surviving an overdose generally depends on how fast one receives medical assistance. Over 300 Oregonians die each year due to unintentional or undetermined drug overdose. Legal immunity for ‘Good Samaritans’ may help save lives.

OCEP Action: Testified in support.

 

SB 840 Licensed independent practitioners/mental health holds

Status: Signed into law. Effective date June 16, 2015

What the bill does: This bill allows Psychiatric Mental Health Nurse Practitioners (PMHNP) the ability to provide certain care and services in emergency departments and acute care inpatient psychiatric units for psychiatric patients. 

Background: SB 840 was one of the recommendations from the OAHHS Mental Health workgroup to improve care for people in mental health crisis. Emergency department visits for psychiatric illness or addictions account for 6-9 percent of all ED visits. Allowing PMHNPs the ability to perform involuntary 2-person mental health holds, instead of limiting this function to physicians only, will help reduce wait time for patients and help free up emergency department beds for patients suffering from conditions such as heart attack or stroke.

OCEP Action: Testified in support.

 

SB 874 Adrenal Insufficiency Education

Status: Signed into law. Effective date January 1, 2016

What the bill does: Directs Oregon Health Authority (OHA) to compile information on the dangers associated with adrenal insufficiency, how to identify a person suffering an adrenal crisis and the types of medications used to treat adrenal insufficiency. Requires OHA to disseminate information to health care professionals and the public. Directs OHA to consider most effective manner of providing information to emergency medical service providers and health care professionals who work in emergency departments.

Background: The original bill would have requires the Oregon Health Authority to provide training for certain individuals and to establish by rule protocols for treatment of adrenal insufficiency in hospital emergency departments. Adrenal insufficiency is an endocrine or hormonal disorder that occurs when the adrenal glands (located above the kidneys) do not produce enough of certain hormones.

OCEP Action: Testified in opposition to the original bill because it would have codified medical evaluation and treatment of patients in statute. Worked with the National Association of EMS Physicians, the Fire Chief’s Association, the Oregon Association of Hospitals and Health Systems and the Oregon Health Authority to develop the alternate educational proposal. Met with legislators in opposition to amendments to restore the original bill on the House side.

 

SB 891 Price Transparency

Status: Died in Committee 

What the bill does: SB 891 requires health care facilities to post their prices publicly for the most frequent 100 outpatient and inpatient services and provide real-time estimates for consumers.

Background:The Emergency Medical Treatment and Active Labor Act (EMTALA) requires all Medicare-participating hospitals with emergency departments (EDs) to provide certain standards of emergency care, including screening; stabilization; and in certain cases, in coordination with another facility to transfer a stable or unstable patient for a higher level of care not available at the original receiving ED. The purpose of this law, which was enacted in 1986, is to ensure immediate help. Therefore, the law bars hospitals from delaying the provision of these services to inquire about either method of payment or insurance status. In other words, physicians are legally bound to provide emergency care to patients.

OCEP Action: Testified about possible conflict with EMTALA regulations. Posting prices of services in the ED may violate EMTALA if they discourage individuals from remaining for further evaluation. Other provisions of the bill may be problematic in the emergency department. Providing an estimate of the payment amount established within the consumer’s insurer and whether the facility or involved practitioners are part of the health plan’s network, may delay care, especially when an on-call specialist is needed for specialities such as plastic surgery, hand surgery or neurosurgery.

Note: SB 900, a price transparency bill supported by the Oregon Association of Hospitals and Health Systems passed. This bill has an emergency clause and goes into effect upon signature.

 

Major Health Legislation of Interest

  • E-cigarettes will be regulated in the same way as traditional cigarettes as a result of HB 2546. This bill will keep e-cigarettes out of the hands of minors and prohibit their use in indoor public places and places of employment.
  • House Bill 2879, a bill sponsored by physician Rep. Knute Buehler, allows pharmacists to provide birth control to women over age 18, with out a physician’s prescription, after a risk-screening assessment.
  • HB 3343 which would require all health insurance providers to reimburse a provider or pharmacy for dispensing a full 12-month supply of prescription contraception.
  • Public school students ages 7 or younger  will be required to have dental screenings prior to starting school. (HB 2972)
  • HB 3100, establishes a framework and minimum standards for public health services throughout the state. This bill is product of the Task Force on Public Health that convened as a result of legislation in 2013.
  • Cover Oregon (SB 1) was abolished as a public corporation.
  • SB 79 requires school districts to teach Hands on CPR. 
  • SB 144 requires insurance coverage of telemedicine services.
  • SB 213 requires the Early Learning Council to develop metrics for funding Early Learning Hubs.
  • The Oregon Toxic Free Kids Act (SB 478) requires the OHA to establish and maintain list of designated high priority chemicals of concerns for children’s health used in children’s products. This bill also requires manufacturers to incrementally those out potentially dangerous chemicals from children’s products.
  • SB 520 permits pharmacists to vaccinate children ages seven and older.
  • SB 895 will require schools and daycare centers to post immunization rates for their facilities.

 

Mental Health Budget Notes

SB 5526 OHA Budget Addictions and Mental Health

The Oregon Health Authority will report to the 2016 legislative session regarding the problem of “boarding” of patients with mental illness in hospital emergency departments while patients wait for a bed in an appropriate setting. The report will contain a thorough description of the system and process as it works now and why, including relevant statutes and reimbursements. It will also include data to describe the magnitude of the problem. Finally, the report will contain an analysis of the reasons for the “boarding”, such as gaps in necessary services within the system, and proposals for potential solutions.

 

SB 5507 Budget Reconciliation Bill

The Oregon Health Authority shall conduct a minimum of five community meetings in a variety of geographic locations across the state. The goal of the community meetings is to capture, understand, and report to the Legislature on the experience of children, adolescents, and adults experiencing mental illness and their ability to access timely and appropriate medical, mental health and human services to support their success in the community. The meetings shall not be restricted to publicly financed services or individuals eligible for public benefits. The focus will be on the entirety of the Oregon mental health system, both public and private. Issues to be considered should include but not be limited to:

• Access to child and adolescent services 

• Boarding in hospital emergency rooms 

• Access to housing, addiction, and recovery services 

• Family support services 

• Waiting periods for services 

• Workforce capacity 

• Affordability for non-covered individuals to access mental health services 

• Coordination between behavioral health and physical health services
The Oregon Health Authority shall consult and coordinate with stakeholders to plan and conduct the community meetings. The Oregon Health Authority is expected to report progress and findings to the appropriate legislative committees and the 2016 Legislature. 

 

For more information about these bill or any other legislative issues, please contact Katy King Government Relations and Public Affairs at KatyKing01@gmail.com or (503) 274-9518.

For more information about the legislative process, please contact Katy King.

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