11/07/2024

OSMA Legislative “Lame Duck” Preview

Now that the 2024 election is over – the Ohio legislature will return to Columbus for its “lame duck” legislative session. From now until the end of the year, there will be a whirlwind of activity at the Statehouse, as any bills not passed through both chambers by the end of this year must start all over again at the beginning of the legislative process in January during the 136th General Assembly.

OSMA’s Advocacy team is prepared to be all hands on deck through the last day of session in December. Lame duck can be an unpredictable time, but we do have a general idea of what issues may be in focus, and where our priorities will be in the coming weeks.

Here is a brief summary of some of the major issues OSMA expects to see movement on, or work on during lame duck:

HB 97/SB 60 – Certified Mental Health Assistants

The Latest: In exchange for the sponsor making all the amendments we requested to the original proposal, OSMA is now neutral on this legislation. Before legislators left town for the summer, Senate Bill 60 passed out of the Workforce and Higher Education Committee and was then passed out of the full Senate. We are monitoring any progress it could make through the House during lame duck and ensuring our changes remain intact and no other concerning provisions are added in any deliberations that could take place.

The Background: As you may recall from our summer update, OSMA and the Ohio Psychiatric Physicians Association (OPPA) were able to get significant changes incorporated into this legislation, which would create a new mid-level mental health profession - Certified Mental Health Assistant. We had serious concerns about lack of training and education, lack of specificity, as well as concerns around ensuring proper patient protections. Thankfully, when we identified our top ten concerns with the bill, the sponsor of this legislation, the chair of the Senate Workforce and Education Committee, and members of the committee worked with us to address all ten items we requested. Stopping SB 60 entirely was not possible, and after years of work, this compromise was preferable to the alternative of seeing the bill progress forward with none of our major concerns revised. We are glad to have secured this victory and await to see if this bill will make it across the finish line before the lame duck deadline.

HB 102 – Advanced Practice Respiratory Therapists

The Latest: A substitute version of this legislation, which would establish and license advanced practice respiratory therapists (APRTs) in Ohio, passed out of the House Health Provider Services Committee before the summer recess. OSMA and the Ohio Society of Anesthesiologists worked tirelessly on this issue for months, and because we were able to secure major changes to the bill, OSMA now has a position of neutrality on HB 102. This is a satisfying conclusion after significant work—but OSMA is still on standby to monitor the bill in case it moves during lame duck.

The Background: We initially opposed this legislation, because the original version caused us to have numerous serious concerns about its vague language and potential patient risk associated with the proposed scope of practice. Our advocacy efforts led to big changes to the language of HB 102, including:

• Added language which requires that the APRT must practice only in a hospital-based setting;
• Added language which requires the APRT to be supervised by a physician and that the supervising physician must be present on location where the APRT is practicing;
• Added language which prohibits APRTs from prescribing controlled substances.
  
  

HB 130 – Prior Authorization Gold Card

The Latest: Before the summer recess, the prior authorization gold card legislation, HB 130, had another hearing in the House Insurance Committee. This legislation remains our top proactive advocacy priority and we will be continuing our push for progress on the substitute version of HB 130 during lame duck.

The Background: As a reminder, HB 130 would create an exemption system that rewards Ohio healthcare providers who consistently receive a high prior authorization approval rate for a specific service in the prior 12-month period. These providers would receive a “gold card” exempting them from the burden of prior authorization for that specific service. OSMA is leading a large coalition in support of House Bill 130, comprised of dozens of groups—which include numerous other health care organizations—as well as patient advocacy groups. We spearheaded major work on this bill in the past two years and assembled a huge grassroots effort to support it. The substitute version of HB 130 contains several compromises we made in order to respond to pushback our coalition has received from the insurance industry and to improve the bill’s ability to move through the legislative process. Thankfully, even with the changes made, we still believe this bill, in enacted, would result in meaningful impact in reducing prior authorization burden on physicians and practices.

HB 169/SB 59 – Ban on Indoor Tanning Use for Minors

The Latest: We have been advocating alongside the Ohio Dermatological Association for years for further movement on a proposal regarding prohibiting the use of indoor tanning by minors in Ohio. This legislative cycle, the bill encountered enormous obstacles in the form of opposition about parental rights. The latest version of the legislation, rather than outright banning indoor tanning use for minors, would require not only parental consent to be given for each time a minor utilizes tanning services, but also for the parent to be present on-site at the time the services are rendered. We hope to see progress made on this initiative during lame duck as a result of the compromise language.  

The Background: Changes made to this legislation do not sacrifice its core goal by still establishing additional hurdles which highly discourage use of tanning services for individuals under the age of 18. Passage of further limitations or an outright ban on indoor tanning services for minors in Ohio has been a shared goal of OSMA and ODA for years, in order to protect our state’s youth from exposure to dangerous UV radiation that drastically increases the chance of developing skin cancer. Dr. Shannon Trotter has testified on behalf of OSMA and ODA in support of both bills on multiple occasions during this general assembly.

HB 291 – Non-Medical Switching

The Latest: OSMA believes there may be movement during lame duck on legislation which would limit the ability of insurers to engage in non-medical switching. The latest version of HB 291 does not outright ban non-medical switching like the original version proposed to do, but would still prevent non-medical switching in the majority of circumstances faced by patients. It contains compromise language which allows for potential changes by the insurer only if the cost of a medication increases by 5% or higher in a calendar year. This was added during deliberations in order to promote the bill’s progress and reduce opposition from the insurance industry. We will continue to support this legislation and push for any opportunity for it to advance.

The Background: This is an issue OSMA has been working on for years, hoping to enact safeguards which will help protect patients and allow them to continue utilizing the best treatments available to them for their conditions. We believe it is essential to avoid disruption of a physician’s ability to exercise their medical expertise and help their patients caused by abrupt and unwarranted treatment changes.
 

HB 319 – Anti-Vaccine Legislation

The Latest: Right before the summer recess, OSMA and a large coalition of healthcare and business groups submitted a statement in opposition to HB 319, an anti-vaccine proposal. The bill has already had several hearings and we will be poised during lame duck to advocate in opposition to its passage, citing major risks to the health and well-being of Ohioans.

The Background: As a reminder, this legislation would prohibit discrimination against an individual for the refusal of certain medical interventions for reasons of conscience, including religious convictions. This bill is mainly targeted at vaccinations, and specifically includes vaccine requirements for college admission and employment. It would also, for example, prevent health facilities from implementing policies such as those that require readily-accepted vaccines in the clinical environment (like tuberculosis) or require unvaccinated employees to wear a mask during flu season in certain areas of a hospital.
 

HB 362 – CRNA Scope of Practice

The Latest: OSMA is pushing back against any possible movement on legislation which would revise the scope of practice of certified registered nurse anesthetists in Ohio by removing the requirement that CRNAs be supervised by a physician, and instead replace this with language requiring them to “consult with” a physician. Further, it would allow for CRNAs to direct other individuals to perform certain clinical and patient care-related tasks, even if the CRNA is not present on-site where the tasks are to be performed. OSMA has serious concerns about these proposed changes, including risks to patient safety. We will be on top of active opposition efforts against this bill during lame duck.

The Background: This legislation would erase the compromise language OSMA worked for years on regarding the scope of CRNAs, which went into effect in 2020. It reverts back to an expanded scope of practice similar to what was originally proposed before said compromise, including granting CRNAs hospital-based prescriptive authority.
 

HB 452 – Hospital Violence Prevention

The Latest: HB 452, an initiative to help prevent hospital violence, passed out of the House Public Health Policy Committee and then out of the full House chamber before the legislators left town for the summer. It must advance through the full legislative process in the Senate by the end of the year to become law, and OSMA will advocate for it to complete its legislative journey before the clock runs out during lame duck.

The Background: This legislation aims to address prevention of hospital violence and contains various provisions regarding training, security plans, and incident reporting. OSMA is a part of a coalition of hospital and health care groups supporting HB 452.

SB 129 – Optometrists Scope of Practice

The Latest: OSMA will continue its work in cooperation with the Ohio Ophthalmological Society (OOS) in opposition to SB 129, regarding the scope of practice of Ohio optometrists. Although we are optimistic about how well-received our testimony against the bill was in a hearing this spring, we will continue our work in opposition to this bill during lame duck and stress to legislators that any legislation that makes changes to the eye care model in Ohio must demonstrate clear benefit to patients avoid unnecessary risk.

The Background: SB 129 would allow optometrists in Ohio to perform certain surgical procedures. Specifically, it would allow them to perform laser surgery consisting of capsulotomy, trabeculoplasty, or peripheral iridotomy; the incision and curettage of a chalazion; the removal and biopsy of a skin lesion; the excision or drainage of a conjunctival cyst or concretion; any suturing other than corneal and scleral suturing; any injection, other than an intravenous or intraocular injection, of a drug; and, administer, prescribe or dispense punctal plugs and ocular inserts. We have emphasized to elected officials that optometrists also do not receive the extensive medical education and training that is necessary in order to ensure patient safety and to facilitate high-quality outcomes of surgery. Even allied practitioners that do work under the supervision of physicians are not permitted by their scope of practice to perform surgery in Ohio.

SB 196 – APRNs

The Latest: SB 196 passed out of the Senate Health Committee and the full Senate in late June, and must now advance through the House during lame duck if it is to become law. As a reminder, this is a piece of legislation which OSMA was able to take a Neutral position on after the sponsor approached us with a draft before introduction and sought our feedback. OSMA took a position of Neutral on SB 196 as a result. OSMA’s advocacy team believes this bill could move further during lame duck and will monitor it during the upcoming sessions.

The Background: As mentioned above, Sen. Kristina Roegner, SB 196’s sponsor, approached OSMA prior to the introduction of SB 196 with a draft of what would become the bill. It contained hundreds of provisions which affected all physician specialties. OSMA broke down the draft and split up the issues based on impacted specialties and met with physician members and specialty societies to get specific feedback on each of these provisions. Once we had gathered all of our feedback, it was shared with Sen. Roegner, and she was thankfully extremely open to our recommendations. Not only did she accept all our suggested changes, but she ensured all provisions of the bill stated “under the direct supervision of a physician,” so that any “new” authority would have to be granted by the APRN’s supervising physician. This was an example of incredible cooperation on a scope of practice bill, and we were thankful for the sponsor’s willingness to consider and include all of our recommendations in the bill before it was introduced. 

OSMA will provide updates on these and any other issues that arise during the uproar of activity we expect to see during Ohio’s lame duck legislative session.

As we prepare to conclude the 135th general assembly, we hope to continue to advance OSMA’s advocacy agenda and build a foundation for the important work we will do starting next year in 2025 with the new class of legislators coming in to the Statehouse!