2016 IDAHO LEGISLATURE

UPDATE

January 25, 2016 through January 29, 2016

Throughout the 2016 Idaho Legislative Session, Nurse Leaders of Idaho and the Idaho Nurses Association will provide periodic updates on legislation and activities of interest to nurses, especially in the area of healthcare policy. In addition to these Updates, e-mail communications will alert NLI and INA members to take action in communicating to legislators about bills of interest.

Located at the end of the Updates,is a Call to Action section that will provide background information to assist in communicating with legislators. This week’s Call to Action reviews the process a bill goes through from introduction to passage.

Week 3

The focus this week has been on Education with presentations to the Joint Finance Appropriations Committee from each of Idaho’s Colleges and Universities and State Schools Superintendent, Sheri Ybarra on public elementary and secondary education. Most State Agency rules have been heard and a few bills are beginning to work their way through committees to floor hearings this week. With bills coming forward, next week should be much more active.

Governor’s Office Monday Briefing – Education

Monday, the Governor’s staff began a weekly briefing to clarify the Governor’s agenda and solicit input on pertinent legislative issues. Being Education week for JFAC, the focus was on education. Here are key points relative to nursing:

  • K-12 Task Force Recommendations including $40M to create a career ladder to increase pay and reward excellence for teachers, counselors and school nurses.
  • Create a School Nurse Task Force.
  • College and Career Advising $5M to encourage high school graduates to pursue postsecondary education including nursing education.
  • College and University Funding $25M to expand research, workforce development and educational opportunities at Colleges and Universities including expansion of Idaho State University Health Sciences program.
  • Opportunity Scholarships – Add $5M for total of $10M to award 1,825 new $3,000 scholarships and renew1,572 ongoing college and university scholarships. Requirements include 3.0 GPA, first degree, 70% based on need and 30% based on merit.
  • Completion Scholarships $5M to encourage those who have attended some college to return and complete their degree. Qualified applicants could receive $3000 per academic year for up to eight consecutive semesters. 28% of Idaho adults have some college education but no degree or certificate.
  • Tuition Lock would cap tuition at a student’s beginning tuition rate. This would allow students to predict college costs and prevent tuition increases over a four-year period. Although the State Board of Education may increase tuition rates, the impact would not be felt by current students.
  • WWAMI Medical Education funding to create four additional seats for physician training bringing a total of 40 positions for Idaho.
  • Physician Needs Task Force - The Governor has directed the State Board of Education to work with the medical community higher education to bring forward a plan to address future physician needs for Idaho.

Primary Care Access Program (PCAP) Details

Dick Armstrong, the Director of the Department of Health & Welfare, presented more detail to the House and Senate Health and Welfare Committees this week.

PCAP would provide primary care coverage for 78,000 adults (19-64) who are in the gap between Medicaid eligibility (eligibility limit for Medicaid is under $350/month for household of 2) and health insurance subsidy under the federal Affordable Care Act (income below 100% federal poverty line: $981/month for one/$1,328/month for two).55% are female/45% male. 65% live in households with at least one child. While the parent(s) does not have coverage, the child is usually on Medicaid. 25% are single, 17% with two-member household and 58% with three or more. 77% have some income/65% low wage earners. Many experience episodes of poverty where a loss of a job, family changes or emergency will pull them into situations where they have difficulty recovering. They frequently wait until conditions escalate before seeking care resulting in greater cost but least effective care. He noted that if the minimum wage were increased, it would have a dramatic effect of lifting many out of poverty. 50,000 of the 78,000 in the gap are known to rely on hospital emergency care, community health centers, rural health clinics. For those uninsured who qualify, counties bear the first $11,000 of indigent costs, and the state Catastrophic Fund covers the remaining costs.

PCAP provides forprimary care, preventive services, acute care, clinic based behavioral health (22% of patients have behavioral health issues), andbasic X-ray, laboratory and drug coverage aimed at maintenance for chronic illness. Drugs are deeply discounted through community health clinics or pharmacy contracts. Chronic illness accounts for 75% of healthcare costs. PCAP provides ongoing case management, regular monitoring and visits. PCAP does not provide for hospitalization or specialty care which would continue to be covered throughcounty indigent programs and the state’s catastrophic fund. Under the plan, the state will pay enrolled providers $35/month per patient. Participants will pay on a sliding scale between $4 - $25/month based upon income. Participants must remain compliant with their treatment plans. The plan is based upon a Medical Home model using primary care teams for overall coordination of care with a target of managing care early before requiring costly emergency or inpatient services. Enrolment will be through the Health Insurance Exchange where eligibility for Medicaid or the Exchange will be determined prior to enrollment in PCAP. The state conducts annual enrollment in the fall, so that if a participant becomes eligible and is certified sometime during the previous 12 months becomes ineligible, if no other eligibility triggers are discovered, they would fall off the program during the annual recertification period. Ongoing there are ways for providers to note if a patient is no longer participating or is no longer following their plan of care which would disqualify them for the program.

Director Armstrong emphasized that PCAP is not insurance, providers are paid on a per member/per month basis for primary care, and it is not an entitlement program. The program requires participants to be legal residents, they must contribute to the plan and must engage in their treatment plan and preventative care. It is limited to available funds and a 5-year sunset provision requiring the Legislature to reevaluate the program.

If approved, the program will begin July 2017.

The PCAP proposal has been assigned to the House Tax and Revenue Committee and the House Health and Welfare Committee.

Alternative Funding Proposal for PCAP

Under the Governor’s proposal, $30M dedicated funding for PCAP would come from Cigarette and Tobacco Taxes. Cigarette and tobacco taxes have been used to pay GARVY highway bonds which are now paid. Through this mechanism there would be no loss in funding from existing programs.

House Speaker Scott Bedke suggested funding for PCAP should come from the Millennium Fund, the trust fund created by the tobacco settlement in 2000 and from savings to the Catastrophic Healthcare Fund. This week JFAC and the Senate voted to approve a $29M transfer from CAT fund savings back to the general fund.

Minimum Wage Proposal

A bill to raise the minimum wage from $7.25/hour to $8.50/hour and to $9.75/hour in 2017 was held without hearing in the Senate State Affairs Committee. 5.1% of Idahoans earn less than the minimum wage.

Medicaid Expansion – Senator Schmidt

Senator Dan Schmidt, a physician from Moscow, introduced two bills late last week to expand Medicaid in Idaho. Medicaid expansion was a component of the federal Affordable Care Act that provides federal funding for full health insurance coverage, including hospital and specialty care, for those in the gap between Medicaid eligibility and health insurance subsidy under the Affordable Care Act. The bills were introduced under a provision that allows lawmakers to present personal bills.

One of his proposals would enact the “Healthy Idaho Plan” that would expand Medicaid for those up to the federal poverty level ($981/month for one/$1,328/month for two), then use federal Medicaid funds to purchase private health insurance from the Health Insurance Exchange for those making up to 138% of poverty. Last year, 54,000 applied under the health insurance exchange but were turned away because they made too little to qualify for coverage.

Senator Schmidt’s other proposal is to fully expand Medicaid coverage for all below the 138% of poverty, the level at which subsidies under the Affordable Care Act kick in. Both proposals would be funded entirely by the federal government, saving the $30M the Governor is proposing for PCAP.

The bills will be heard in the Senate Health & Welfare Committee on Tuesday, February 2nd.

H341 – Patient Freedom of Information Act

The bill updates the Patient Freedom of Information Act to consolidate reporting of licensed healthcare providers, including nursing, into the IDACARE database as the sole repository for license information. Also access to the IDACARE database must be available to the public on the licensing boards websites.

Board of Nursing Legislation –Proposed

The Board of Nursing is proposing three bills:

  • Nurse Licensure Compact
  • Advanced Practice Nurse Licensure Compact
  • Revision to the Definition of Nursing

The two licensure compact bills adopt new language to align Idaho’s compact agreement adopted by the National Council of State Boards of Nursing to recognized those holding a valid nursing license in another compact state to obtain an Idaho license. The Nursing Compact has been in place since 2001 for RNs and LPNs. The Advanced Practice Nursing Licensure Compact is new for APNs.

The bill to revise the definition of nursing adopts language that is more descriptive of the broad role of nursing practice that the previous antiquated language:

“Practice of nursing” means assisting individuals or groups of individuals to promote, maintain or restore optimal health throughout the life process by assessing and evaluating their health status, planning and implementing a strategy of care to accomplish defined goals, and evaluating responses to care and treatment the autonomous and collaborative performance of acts and services requiring specialized knowledge, judgement, and skill that assist individuals, groups, communities or populations to promote, maintain or restore optimal health and wellbeing throughout the life process. Nursing practice encompasses a broad continuum of services delivered in, but not limited to, areas of clinical practice, education, administration, research, and public and volunteer services. Nursing practice occurs at the physical location of the recipient.

The three bills are scheduled for next Tuesday, February 2nd in the Senate Health & Welfare Committee.

CALL TO ACTION

The Process of Getting a Bill Passed

Once bills are introduced (first reading), they go through an assignment by leadership to a House or Senate Standing Committee for hearing and action (pass, do not pass, etc.) or to the floor for a second reading. A bill can die in committee. Once a bill is reported out of a committee, it is read for the second time, then a third reading on a separate day where there is debate and vote on passage. If a bill passes in the House, it is sent to the Senate where a similar process takes place. When passed by both houses, the bill is sent to the Governor for signature or veto. It is quite a process, and anywhere along the way a bill can get derailed and die. A good bill can be derailed for a number of reasons, some out of lingering issue concerns, language concerns, constitutionality or compatibility issues, or to make a political statement. Some bills may be referred back to committee to be reworked. Other significant legislation may be negotiated and compromised through an interim committee that meets between legislative sessions preparing bills for reintroduction to the next session.

Nursing is highly respected by legislators. NLI and INA may take positions on bills and work with House and Senate members to educate them on the issues and to advocate for nursing and improving healthcare in Idaho.

As you hear of issues or have question about the legislature, please let Mike know by e-mail at .