If you follow the local news, then you are well aware that the 2019 budget process was anything but typical. The Ohio Legislature dove into the budget process earlier this year in earnest, but despite months of intensive deliberations, for the first time in a decade, lawmakers missed the June 30 deadline for a final, approved bill to hit Governor Mike DeWine’s desk. In the eleventh hour, when it was clear that an agreement between the House and Senate would not be reached regarding a multitude of outstanding issues, a temporary spending agreement was passed ensuring the state’s programs would run at current funding amounts until July 17th.
The Ohio State Medical Association (OSMA)’s Government Relations team has been engaging with legislators on health care-related budget items since the governor’s initial proposal was released, and has been on-hand to follow and participate in the ongoing debates about a number of health policy decisions that were inserted into the budget bills in the House and Senate. We have summarized the major items from the state budget bill, several of which were the subject of contention over the past several weeks. See how the issues impacting the practice of medicine in Ohio turned out – after months of OSMA advocacy work – and what this means for physicians and patients in our state.
Ohio Governor, Mike DeWine, issued 25 vetoes to the state budget on July 18, 2019. The following healthcare-related items passed both chambers of the General Assembly and before signing them into law were vetoed or partially vetoed by the Governor. The OSMA is very grateful to Governor DeWine for his leadership on these issues and understanding this is the right step towards assuring physicians in Ohio are able to continue delivering the high-quality and efficient medical care that all patients deserve.
DeWine removed the language regarding reimbursement for out-of-network providers at an in-network facility. He has requested for the relevant state agencies to collaborate with stakeholders to continue to work on this important effort so patients are not burdened with surprise medical bills.
This item was vetoed to avoid placing duplicative or burdensome regulations on health care providers. Governor DeWine supports the notion of providing consumers the information necessary to make informed decision about their healthcare.
A major priority for the OSMA for several years has come to fruition in this year’s budget process. The bill contains provisions which require insurance coverage of telemedicine services to be on par with services performed in-office. We can only truly understand the full potential of telemedicine in helping Ohioans access care for issues like mental health conditions, chronic diseases, and drug addiction if insurers provide coverage for care delivery via telemedicine. This passage aligns Ohio with 35 other states in the U.S. which have already passed and enacted state laws guaranteeing telehealth parity.
When filling a prescription, if a pharmacist has information indicating that the cost-sharing amount required by the patient’s health benefit plan exceeds the amount that may otherwise be charged for the same drug, the pharmacist must inform the patient and the patient must not be charged the higher amount.
The budget authorizes the Department of Health (ODH) to establish a loan repayment program specifically for medical professionals who provide treatment for substance use disorders. Through this program, ODH may repay a portion of or the entirety of the principal or interest of an educational loan taken by a professional who, in exchange, commits to serving in an area of the state with limited access to addiction treatment. The budget also authorizes ODH to create a program through which physicians providing medication-assisted treatment (MAT) in a health resource shortage area may receive financial assistance if they participate in the existing Ohio Physician Loan Repayment Program.
The House passed version of the budget wanted to limit the amount of tax-free income on small business to $100,000, instead of the current $250,000. The final version restored the current $250,000 level on tax fee income and lowered the rate to 3 percent on the remaining income. The new budget also contains a 4% across the board state income-tax cut.
Language in the budget specifies that an agreement to provide health care does not constitute insurance, if the agreement is in writing, and is between a patient or that patient’s legal representative and a health care provider. The agreement must also meet an additional set of criteria in order for this passage to apply. It must also clearly state that the agreement is not health insurance and does not meet any individual health insurance mandate that may be required under federal law.
The bill raises the legal age for a person to receive or purchase cigarettes, other tobacco products, alternative nicotine products, or papers used to roll cigarettes from 18 to 21. Provisions regarding this age policy change also include a requirement for clear and visible signage to be posted where these products are sold indicting the new legal age for receiving or purchasing them.
During the budget process in the House, it was proposed that revisions be made to current statute that requires the Department of Medicaid to include alcohol and drug addiction as well as mental health services in the Medicaid managed care system. These services have been required to be included in the Medicaid MCO system since July of 2018, and the proposed language would permit such inclusion rather than require it. Thankfully, after the OSMA and other groups raised concerns about this change, it was removed and Medicaid MCOs will still be required to include these services in their system.
The budget continues the Hospital Care Assurance Program (HCAP) for an additional two years, rescheduling the program completion from October 16, 2019 to October 16, 2021. Under HCAP, hospitals are annually assessed an amount based on total facility costs, and government hospitals make annual intergovernmental transfers. The Department of Medicaid distributes money generated by the assessments and intergovernmental transfers along with federal matching funds, and any hospital compensated under the program must provide basic, medically necessary, hospital-level services without charge to Ohio residents who are not recipients of Medicare or Medicaid whose income does not exceed the federal poverty line.
Additionally, the budget bill extends another assessment for an additional two years. The hospital franchise permit fee, like HCAP, raises money to help pay for the Medicaid program. It will now be scheduled to end on October 16, 2021, rather than October 16, 2019.
Under current law, when a psychiatrist prescribes Medicaid patients anti-depressants or anti-psychotic medications, prior authorization is not needed. The Governor’s introduced version of the budget mistakenly removed this exemption, however the final passed version restore the exemption, thus reverting back to current law.
The budget creates the Ohio Physician and Allied Health Care Workforce Preparation Task Force to study, evaluate, and make recommendations according to health care workforce needs in Ohio. The Chancellor will appoint task force members with representation from the State Medical Board, medical school deans, hospital administrators, federally qualified health centers, physician and nursing organizations, and other allied health personnel. The task force will convene and issue a report by March 1, 2020.
For physicians and podiatrists, the bill reduces the number of hours of continuing education (CME) required to be completed every two years to be eligible for license renewal from 100 to 50. This additionally applies to the 3-year renewal period of clinical research faculty physicians. It also limits the number of hours of CME a physician or podiatrist may earn through provision of health care services as a volunteer to 3 hours.
For physician assistants (PA), the bill eliminates the 100-hour continuing education requirement for two-year license renewal and instead requires that the PA complete the necessary continuing education for maintaining certification from the National Commission on Certification of Physical Assistants. The 12 hour advanced pharmacology requirement present in current law remains in effect.
The OSMA successfully advocated for removal of the following provisions from the budget bill.
Facility fee:
Language was added to the bill which proposed to prohibit a physician, physician’s assistant, or advanced practice registered nurse from charging a facility fee, origination fee, or any fee associated with the cost of equipment. The OSMA had concerns about the ramifications this prohibition might have had upon Ohio physicians and certain care facilities. Thankfully, after the OSMA and other groups voiced serious concerns, this provision was removed from the finalized version of the bill.
ER-Medicaid Diversion:
The OSMA helped to eliminate a proposed line-item in the budget bill that sought to prohibit Medicaid rates for nonemergency medical services provided in hospital emergency department from exceeding payment rates for such services when provided in another care setting.
Non-Opioid Directives:
In the House-passed version of the budget bill, the State Board of Emergency Medical, Fire, and Transportation Services would have been required to develop a nonopioid directive form. This form would have specified that the patient of whom it is a subject desires not to be offered, prescribed, administered, personally furnished, or otherwise provided with an opioid analgesic. These provisions were removed in the proceedings following, and the language was not added back into the final budget.