2006 Legislative Report

Oklahoma State Radiological Society

September, 2006
Prepared by: Lynne White

FUNDING FOR THE MEDICAID PROGRAM

Background: In the 2005 legislative session HB 1088 was enacted that appropriated $63 million for hospital and physician rate increases. HB 1088 also charged the Oklahoma Health Care Authority (OHCA) to identify $100 million in savings in waste, fraud and abuse in the system. During the summer and fall months of 2005 the House of Representatives Medicaid Task Force took up the challenge. While the Task Force did not find that amount in saving they did recommend reforms they claim could save millions of dollars in the future.
In the 2006 legislative session health care forces including the Oklahoma State Radiological Society, the Oklahoma Hospital Association, the Oklahoma State Medical Association and others worked to increase the $63 million appropriation from fiscal year 2005 by an additional $30 million for a total of $93 million. The goal was to earmark these funds for physician and hospital rates.
On June 19, the state Legislature convened in a special session to finalize the agreement the governor and legislative leaders had reached on tax and budget issues. The Medicaid funding agreement is as follows:
HB 1071xx – Medicaid Funding, Benge/Crutchfield, is the spending limit authorization for the state Medicaid program that will fund provider rates for hospitals, physicians and nursing homes.

Hospitals and physicians will continue to receive the $63 million for provider rates appropriated in fiscal year 2006 that began July 1, 2005.
Hospitals will receive an increase of $13.1 for upper payment limit funding to begin Jan. 1, 2007.
Physicians will continue to be funded at no less than 100% of Medicare.
Nursing homes and long term care facilities for the mentally retarded will receive $22.6 to begin July 1. The nursing home increase is about 13% of these funds and begins July 1 due to the fact that several nursing homes will close without immediate funding.

Funding for the hospital UPL was delayed until Jan. 1 because of other state obligations and new programs important to hospitals.

$8 million is needed to make-up the projected shortfall in tobacco tax revenues
$3 million for the emergency room residency program

Status: Signed by the Governor.
HB 2842, Medicaid Reform, by Rep. Kris Steele ®, Rep. Doug Cox ® and Sen. Tom Adelson (D) includes the following provisions:
1. Establishes a true pilot program for transitioning Medicaid into commercial insurance products:

Excludes populations older than 65 and those deemed uninsurable which is defined as when the cost of enrolling an individual in a private plan is more that the cost to the state of the individual remaining in the traditional Medicaid program.
Requires private Medicaid plans to be equal to or less than the cost of the existing Medicaid program;
Requires the results of the pilot to be shared with the legislature for review before the program can be expanded;
Requires enrollee education and choice counseling prior to enrollment into private plans;
Requires all benefit coverage to be no less than the O-EPIC/Insure Oklahoma program. This program was enacted in 2004 and funded with a portion of tobacco tax revenues. The program is a public, private partnership to permit low income, working Oklahomans and small businesses to purchase affordable health insurance.

Expands the O-EPIC/Insure Oklahoma program to include businesses with 50 or fewer employees and parents of low income children, if funds are available. Currently the program is limited to covering businesses with 25 or fewer employees.
Requires the Oklahoma Health Care Authority (OHCA) to develop programs for electronic medical records, e-prescribing, disease management, emergency room utilization enhanced by a 24 hour physician call line, alternatives to long term care, and reduction of claims error rates by OHCA.
Requires hospitals to have a discount program for patients with household incomes up to 300% of the federal poverty limit guidelines.
Requires the State Department of Health to include hospital acquired infection rate reporting in its annual quality indicators report. The report will be based upon hospital discharge data that is currently provided to the department. Hospitals with ICU beds will also be required to report ventilator-associated pneumonia and device-related blood stream infections.
Requires a task force on nursing homes to examine quality issues, staffing ratios and education, capital needs and liability insurance issues.
Creates a task force on nursing home insurance access to try to increase greater access to liability insurance.
Expands the community hospital authority board by four members.
Adds a pediatric representative to the OHCA’s advisory committee on medical care.

The Oklahoma Health Care Authority will seek a waiver from the U.S. Centers for Medicare and Medicaid Services for approval to implement this act.

Health Jobs Workforce

SB 1394 – Health Care Workforce Resources Act, Paddack/Cox, is legislation to address the work of the Governor’s Health Care Workforce Resources Task Force created by Executive Order on Sept. 1, 2005. The bill creates a Health Care Workforce Resources Center that shall act as a clearinghouse of information and activities focused on health care workforce supply and demand. The bill requires all state programs to coordinate efforts and resources with the Center. A governing board is established that shall hire or contract for an executive director as public or private funds become available. The 19-member governing board is essentially the same appointment structure as the one created in the 2005 Executive Order with the addition of a state senator and a state representative for a total of two elected officials from each house of the Legislature. Status: Signed by the governor. Effective date: 11/1/06.

Tobacco Tax

Tobacco Tax - 25 Mile Rule – This provision, if enacted, would dramatically decrease the tobacco tax in areas within a 25 mile radius of any tribal smoke shop. HB 3116 and SB 1717, Fisher/Peterson, were introduced to address unresolved issues related to the proper use of tribal tax stamps. Supporters of the tobacco tax vigorously opposed the 25 mile rule while supporting other provisions in the bills.

HB 3116 contained provisions requested by Governor Henry that would allow the Tax Commission to open to the public records regarding tobacco tax collections and would clearly establish that the tax is applied at the wholesale level. The measure provides that fines would be imposed for buying and selling tobacco products that do not have the proper tax stamp. The bill was amended to include a provision that would allow non-tribal retailers to tax less for tobacco products by either charging 10 cents or 10 percent more than any tribal store within a 25-mile radius.

SB 1717 also contained provisions that would serve to equalize the price of tobacco products among retail outlets by addressing tobacco tax enforcement and compacting issues. While supporting this bill tobacco tax supporters were concerned that SB 1717 could be amended with the 25 mile rule. The Senate leadership did not support including the 25 mile rule in this bill.

In the last weeks of the regular ession other tax and budget matters became the focus of session and these bills along with many others died.

Health advocates urged legislators to reject the 25-mile rule by reminding them that the people of Oklahoma voted to increase the tobacco tax in 2004 and dedicate the revenue to fund health care programs for Oklahomans. By enacting a 25-mile rule the Tax Commission projected that the loss of revenue would be about $61.2 million annually. As of May tobacco tax revenues were in excess of $116 million. Since the enactment of the tobacco tax over 30,000 Oklahomans have quit smoking.

SB 343 – Colorectal Cancer Examinations, Cain/Cox, makes it mandatory, rather than at the insured’s option, for health benefit plans that provide medical and surgical benefits to provide coverage for colorectal cancer examinations for any nonsymptomatic covered individual who is at least age 50 or is less than 50 years of age and at high risk for the disease. Status: Dead - passed the Senate, failed to receive a hearing in the House Committee on Health.

SB 1308 – Oklahoma Breast and Cervical Cancer Prevention and Treatment Advisory Committee, Leftwich/Cooksey, increases the membership of the committee from 18 to 20, to include two members from the Oklahoma Health Care Authority. Status: Signed by the Governor. Effective Date: 11/1/06.

HB 2373 – Tax Checkoff - Leukemia and Lymphoma, Newport/Myers, creates an Oklahoma Leukemia and Lymphoma Revolving Fund and authorizes an income tax check-off for donations to the fund. Any monies generated from donations to the fund would be used by the Department of Health for supporting voluntary health agencies dedicated to curing leukemia, lymphoma, Hodgkin’s disease and myeloma. Status: Signed by the Governor. Effective Date: 11/1/06.

Lawsuit Reform

SB 1874 – Senate Lawsuit Responsibility Act, Laster/Braddock, requires courts to prepare a discovery schedule after a trial date has been set in a civil case. Medical liability provisions include eliminating any liability for physicians for merely prescribing pharmaceutical products approved by the federal Food and Drug Administration and eliminating excess liability for physicians whose practice consists of 50 percent Medicaid and Medicare patients and who carry $2 million in malpractice insurance. Status: Dead - failed in the Senate.
HB 3120 – Common Sense in Courtroom Act of 2006, Hiett/Coffee, authorizes a court to decline jurisdiction over civil actions under certain circumstances. The bill specifies factors a court could consider in deciding whether to grant a motion to stay or dismiss an action. Status: Dead.
SB 1657 – Lawsuit Reform Act, Coffee/Morgan, was another effort by the House leadership to revive lawsuit reform. The bill passed the House Committee on Judiciary when lawsuit reform language was amended into the vehicle of SB 1657. The bill passed committee and the House in late April but was voted down in the Senate on May 9 by a vote of 23 – 22. Status: Dead – failed in the Senate.

Legislation of Interest

SB 990 – Licensure - Genetic Counselors, Cain/Cox, provides administrative authority of the State Board of Health and creates a Genetic Counseling Advisory Committee for the board. The bill requires the board to establish continuing education requirements for genetic counselors as a condition of renewal or reinstatement of licenses. Compromise language between the representatives of the genetic counselors and the Oklahomans for Life organization include that genetic counselors are not required to mention, discuss, suggest, propose, recommend, or refer for, abortion, or to agree or indicate a willingness to do so, nor shall licensing of any genetic counselor be contingent upon acceptance of abortion as a treatment option for any genetic or other prenatal disease, anomaly, or disability. It prohibits any cause of action against any person for failure to mention, discuss, suggest, propose, recommend or refer for abortion, unless the abortion is necessary to prevent the death of the mother. Status: Signed by the Governor. Effective Date: 11/1/06.

SB 1026 – OB/GYN Coverage, Gumm/Carey, requires health benefit plans providing coverage for individuals or groups with fewer than 50 employees to include coverage for routine annual obstetrical/gynecological examinations. Status: Dead -passed the Senate, failed to receive a hearing in the House Committee on Insurance.

SB 1459 – Fit Kids – Healthy & Fit Kids School Advisory Committees, Cain/Winchester, requires the State Department of Education in consultation with the State Department of Health to make certain information available to schools to address program development in nutrition, childhood obesity, physical education, prevention of diet related chronic diseases and school wellness policies. The Healthy and Fit Kids Advisory Committees shall be involved in the monitoring, implementation and evaluation of programs to limit access to foods of nutritional value. Status: Signed by the Governor. Effective Date: 11/1/06.
HB 2655 – Fit Kids – Farm to School Program, Winchester/Lawler, is legislation initiated by the Fit Kids Coalition that creates the Oklahoma Farm to School Program within the Oklahoma Department of Agriculture, Food and Forestry. The program will coordinate activities among state agencies, farmers and school districts, encourage school districts to develop and improve school nutrition plans using locally grown farm-fresh products among other activities for the purpose of encouraging healthy eating habits among Oklahoma school students. Status: Signed by the Governor. Effective Date: 11/1/06

SB 1495 – Kyle Williams Boating Safety Education Act, Corn/Miller, defines certain persons who may operate powered motor or sail powered vessels and establishes requirements for operating such vessels. The measure authorizes the Department of Public Safety to promulgate rules for boating safety education certification. Status: Signed by the Governor. Effective Date: 1/1/07.

SB 1056 – Comprehensive Diabetes Center, Hobson/Balkman, exempts bond obligations issued by the Oklahoma State Regents for Higher Education for refund or defeasance from being approved by the Legislature. The measure also requests the Board of Regents of the University of Oklahoma to establish a comprehensive diabetes center with operations in Oklahoma City and Tulsa. Status: Passed both Houses – to the Governor . Effective Date: 5/26/06.

SB 1624 – Stretcher Aid Van & Living-Will, Lamb/Ingmire, modifies the requirements for stretcher aid van services to include municipalities contiguous to those with populations exceeding 300,000 people. The bill was amended and states that an advance directive could not be deemed to authorize the withholding or withdrawal of nutrition and/or hydration unless it is specifically stated in a separate section. Among the options in the sample directive is one specifying the intention that a person does not wish for his or her life to be extended by life-sustaining treatment but does want artificially administered nutrition and hydration. Another option states the intent that a person wants neither life-sustaining treatment nor artificially administered nutrition and hydration. Advance directives in effect prior to this act are affective however, persons should be encouraged to up-date according to the new act. Amendments were agreed to by the Attorney General’s Task force on End-of-Life Health Care and Oklahomans for Life. Status: Signed by the Governor. Effective Date: 5/17/06.

SB 1830 - ATV Helmets, Cain/Nations, if enacted would have established a misdemeanor for parents, legal guardians or persons having responsibility for children under age 18 found riding an all-terrain vehicle without a helmet. The measure provided an exemption of ATV’s used for agricultural purposes. Status: Dead