Lame Duck 2013 Gubernatorial Action – Two Successes for Physicians
Lame Duck 2013 Legislative Action
(the Governor has 10 days to sign or pocket veto all bills signed at the end of the two year legislative session)
APN Scope of Practice
Despite our protest, both houses have passed a bill that would permit Advanced Practice Nurses to certify cause of death. MSNJ opposes this bill because cause of death is in fact a medical diagnosis and should be provided only by a physician. Read MSNJ’s opposition letter. We are hoping for a pocket veto by the Governor, as he did two years ago when the Legislature rushed the bill through in an identical manner.
A3251, the bill allowing pharmacies to administer vaccines has passed both houses and awaits action by the Governor. The bill allows pharmacies to administer to patients 18 and older a vaccine (1) pursuant to a prescription, (2) in immunization programs authorized by a prescriber’s standing order for the vaccine or (3) in immunization programs and programs sponsored by governmental agencies that are not patient specific . Under the bill, a pharmacist may administer an influenza vaccine to a patient who is seven years of age or older. For a patient who is under 18 years of age, a pharmacist shall not administer a vaccine except with the permission of the patient’s parent or legal guardian. For a patient who is under 12 years of age, a pharmacist shall not administer a vaccine unless pursuant to a prescription by an authorized prescriber. A patient 12 years of age or older does not need a prescription for an influenza vaccine. MSNJ, NJAFP and NJAAP opposed this bill in its original form, but softened when the vaccines for children were limited to flu. This bill still represents a scope of practice expansion of concern to MSNJ.
Physician Loan Redemption
The Legislature passed S162, which establishes a Physician Loan Redemption Program. The bill awaits action by the Governor. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form. With our input, the bill now provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage.
Pain Medicine Restrictions
The Senate Budget Committee approved a bill that would limit insurers from using step therapy protocols for pain medication. Though the bill had already passed the Assembly, the Senate failed to vote on it, so it died at the end of the legislative session. MSNJ supported this bill and will work with legislators on the issue in 2014. Our larger goal is to balance drug abuse reduction with proper access to pain medicine for patients who need it.
Medicaid Provider Rates
Both houses passed S2241, which would prohibit Medicaid managed care organizations from reducing certain provider reimbursement rates without approval from DHS. The bill stems from an attempt by Horizon last year to slash home care provider rates after the Governor began moving most Medicaid services from fee for service to managed care. The insurance companies oppose the bill and stated that the bill would create a regulatory situation that is not used by any other state and that it will ultimately increase costs to the state. They also stated that the record of managed care in New Jersey is very good and the system is fair. MSNJ supports the bill, which awaits action by the Governor.
Higher Education Epinephrine Emergency Treatment Act
Both houses passed S2448, which allows public and independent institutions of higher education in New Jersey to develop a policy for the emergency administration of epinephrine to a member of the campus community for anaphylaxis when a medical professional is not available. Institutions of higher education that develop such policies must designate an appropriately licensed physician, physician assistant, advanced practice nurse, or registered nurse to serve as the “licensed campus medical professional,” who will oversee the institution’s epinephrine administration and train designees in the administration of epinephrine via a pre-filled auto-injector mechanism. The Secretary of Higher Education is to establish guidelines for the development of a policy for the emergency administration of epinephrine, which will be disseminated to the president of each institution of higher education. In addition, the bill provides immunity for a licensed campus medical professional, a trained designee, and a prescribing physician for good faith acts or omissions committed in accordance with the bill’s provisions. MNSJ supports this bill, which awaits action by the Governor.
State Trauma Plan
Both houses passed a bill that provides for the establishment of a formal Statewide trauma care system plan, which will include all health care facilities in the State providing care to injured patients in the State, to the extent that their resources and capabilities allow. The Department of Health sought counsel with the American College of Surgeons Trauma System Evaluation and Planning Committee regarding the State’s trauma system. This bill incorporates the recommendations that resulted from that interaction. The commissioner is required to appoint a State Trauma Medical Director to oversee the planning, development, ongoing maintenance, and enhancement of the formal trauma system in collaboration with a multidisciplinary advisory body called the State Trauma System Advisory Committee (STSAC). The STSAC is required to study the State’s trauma care system, collect data, and provide a report on the development of a formal Statewide trauma system plan. The STSAC’s recommendations will provide the basis for the commissioner’s development of regulations implementing the plan. The STSAC’s initial report, containing the formal Statewide trauma system plan, is due within one year. Thereafter, the STSAC will be required to systematically review strategies to maintain and improve the State trauma system, submit an annual report to the commissioner and the director on its activities, and provide recommendations it determines are necessary to improve the State trauma system. MSNJ is neutral on this bill, which awaits action by the Governor.
Both houses have finally passed the final version of A2022/S792, which now awaits action by the Governor. MSNJ worked on this bill in great detail. The bill 1) requires insurance companies to cover certain screenings, 2) requires physicians to provide information to certain patients regarding breast density and 3) requires study of breast cancer risk factors. Radiology facilities must distribute to certain patients a notice that reads as follows: “Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider. A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology, www.acr.org.” The bill states that it does not impose a standard of care obligation upon a patient’s health care provider. The bill requires the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact. The bill requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options. Though we may have improved the bill, MSNJ remains concerned about legislative interventions into the physician-patient relationship, in general, and notification mandates, specifically.
For Profit Hospital Reporting
After two years of amendments and negotiations, a bill regarding for profit hospitals is finally settled. The Governor rejected a bill in 2012 that would have required detailed financial reports by for profit hospitals, which were growing in numbers at the time. On the last day of the two year session, the Legislature accepted the watered down rewrite of the bill by the Governor. The bill now requires the Commissioner of Health to undertake a review of New Jersey’s hospital financial reporting requirements and shall report any findings and recommendations directly to the Governor no later than six months from the date of enactment of. Specifically, the Commissioner shall examine the impact of, and make recommendations on, the following areas for all entities receiving Health Care Subsidy Fund payments from the State: Internal Revenue Service filings, Securities and Exchange Commission filings, and audited financial statements. The bill takes effect immediately.
Vaccines for Healthcare Workers
Both houses passed A2172, sponsored by Chairman Herb Conaway, which requires health care facilities to annually offer influenza vaccination to their health care workers and require the implementation of an annual influenza vaccination program in accordance with the current recommendations of the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention and any rules and regulations adopted by the Commissioner of Health. In lieu of receiving the vaccine at work, a health care worker would be permitted to present acceptable proof, including an attestation by the health care worker, of a current influenza vaccination from another vaccination source, or sign a written declination statement. Each facility would be required to maintain a record of influenza vaccinations, retain each signed attestation and declination statement, and report to the Department of Health (DOH) the vaccination percentage rate of its health care workforce as part of its program or by other means as attested to by the health care worker. Each facility would also be required to provide an educational component to its influenza vaccination program and annually evaluate the program with the goal of improving the rate of vaccination among its health care workers. The bill awaits action by the Governor, who pocket vetoed the bill last year.
Both houses passed S2318, a bill that requires newborn infant screening for tongue tie. MSNJ was neutral on the bill. The bill awaits action by the Governor.
Both houses passed the “Autumn Joy Stillbirth Research and Dignity Act,” which requires DOH to establish protocols for stillbirths and establishes a stillbirth research database. The bill awaits action by the Governor.
Pediatric Respite Care
Both houses approved A3558, which would provide for licensure of pediatric respite care facilities. The facilities will provide end-of-life care for children up to age 21 with limited life expectancies or complex, life-limiting illnesses and support for their families, and employ interdisciplinary teams to assist in providing curative treatment when possible, palliative care, and supportive services to meet the physical, emotional, spiritual, social, and economic needs of children and their families during illness, as well as during dying and bereavement if no cure is attained. The bill awaits action by the Governor.
Drug Adherence Efforts
Both houses passed A1214, which requires the State Health Benefits Commission and the State Health Benefits Plan Design Committee to establish a three-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design under the State Health Benefits Program (SHBP). The value-based benefit design will target the following chronic health conditions: diabetes, high cholesterol, hypertension, and asthma. The coverage design will utilize explicit financial incentives to increase the employee’s interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee’s chronic health condition. The value-based benefit design pilot program will assign a participating employee to a pharmacist, who, in collaboration with the employee’s primary treating physician, will be responsible for coordinating medication therapy management services within the scope of the pharmacist’s license to practice pharmacy in the State of New Jersey.
The following financial incentives directly related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program will be provided:
(1) all tuition costs for any education class attended by the employee which provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist;
(2) all costs for private visits with the employee’s assigned pharmacist;
(3) all costs for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;
(4) all costs for laboratory testing; and
(5) waiver of all copayments for any prescription drug..
This bill is based on the well-known Ashville Project. The bill will most likely be approved by the Senate and head to the Governor’s desk in lame duck.
Reconstructive Breast Surgery
Both houses passed S374, which grants a state sales tax exemption for services prescribed by a doctor in conjunction with reconstructive breast surgery. The procedures, currently subject to the 7 percent tax rate, are utilized to restore the appearance of the breast. The bill addresses a current loophole where insurance providers cover the costs of the procedures but pass on the cost of the sales tax to the patient. The bill awaits action by the Governor.
Both houses passed A765, which requires that a registered qualifying patient’s authorized use of medical marijuana be considered equivalent to using any other prescribed medication and not the use of an illicit substance that would otherwise disqualify a qualifying patient from needed medical care, including organ transplantation. The bill awaits action by the Governor.
Lame Duck 2013 Veto Action
Gender Changes on Birth Certificates
The Senate and Assembly have both passed A4097/S2876, which allows more people to change their birth certificates. To obtain the amended certificate, a person would be required to submit: 1) a form provided by the State registrar of vital statistics and completed by the person’s licensed health care provider which indicates that the person has undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition; and 2) a certified copy of a court order indicating the person’s name change, if the person has changed his or her name. Under current law, a person is required to undergo sex reassignment surgery to receive an amended birth certificate.
Declarations of Death
The Governor signed a bill that removes the statutory authority of the Department of Health (DOH) and the State Board of Medical Examiners (BME) over medical standards governing declarations of death upon the basis of neurological criteria. The bill requires that a declaration of death upon the basis of neurological criteria be made by a licensed physician professionally qualified by specialty or expertise, based upon the exercise of the physician’s best medical judgment and in accordance with currently accepted medical standards. Joint DOH/BME regulations would no longer be needed to set forth currently accepted medical standards (including criteria, tests, and procedures) to govern declarations of death upon the basis of neurological criteria. If they are used, the regulations concerning the declaration of death upon the basis of neurological criteria may not require the use of any specific test or procedure in the declaration of death upon the basis of such criteria. MSNJ supports this bill.
The Governor signed a bill which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a “clean up” to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009.