12/15/2023
OSMA December Legislative Update
The Ohio Legislature has completed its activities and recessed until the New Year, and the past several weeks at the Statehouse have been a whirlwind of hearings, meetings, and legislative sessions as legislators prepared to wind down for the holidays.
Here’s a review of important and recent updates on issues your OSMA advocacy team has been involved in this year and a brief peek at what these developments mean for our advocacy agenda in 2024:
Scope of Practice - Certified Mental Health Assistants (CMHAs)
In the past couple of weeks, there was a significant push to get SB 60—the Senate version of legislation which would create a new practitioner called a certified mental health assistant—voted out of the Senate Workforce and Higher Education Committee and to the Senate floor for a full chamber vote. OSMA jumped into action, not only with our advocacy team working in-person at the Statehouse to stop this from happening, but also by spearheading a grassroots campaign that led to nearly 400 individuals in the medical community (many of whom were OSMA members) reaching out to their Senators to urge them not to support the bill.
Thank you to everyone who responded to our call to action and emailed and/or called their elected officials about SB 60. Thankfully, our efforts paid off in a timely and meaningful way. SB 60 stalled and did not advance out of committee. This is a significant victory for us, and together we have prevented this legislation from gaining more momentum for now; however, we expect this issue will continue to remain a big priority on OSMA’s advocacy agenda in 2024.
As a reminder, the certified mental health assistant does not exist in any other state. This legislation (Senate Bill 60 and House Bill 97) contains vague, nonspecific language regarding the education, training, and scope of practice of this practitioner - just one of many major concerns OSMA and others in the medical community have expressed. Further, the bill grants CMHAs prescriptive authority (including controlled substances), and because the CMHA does not exist anywhere else in the country, no national organization or credentialing body exists to oversee their training/education and licensure standards.
OSMA gave opponent testimony on Senate Bill 60 multiple times this year, emphasizing the patient safety risk posed by this proposal. Stay tuned in the New Year for any updates on this issue.
Gender-Affirming Care
Although there was significant pushback on House Bill 68, legislation seeking to ban medical professionals in Ohio from providing gender-affirming care for minors, it was still able to clear the Senate this Wednesday afternoon in a vote of 24-8, and hours later, the House concurred in a vote of 61-27.
HB 68 will now go to Governor DeWine’s desk and requires his signature if it is to become law.
OSMA has been among a coalition of medical organizations opposing HB 68, as OSMA policy supports individualized, gender-affirming, evidence-based treatment and clinical practices in caring for transgender and gender minority patients. It also opposes efforts to ban administration of evidence-based care to patients when determined to be clinically indicated by their physician, including the administration of evidence-based gender-affirming care.
Our advocacy team has testified against the bill several times, concerned about it being detrimental to the physician-patient relationship, criminalizing necessary medical care, and creating a hostile environment for young people and their families—as well as for the healthcare professionals from whom they seek guidance and care.
Non-Medical Switching
OSMA was pleased to provide supportive testimony in a recent hearing in the House Insurance Committee on House Bill 291, regarding non-medical switching.
This is a returning issue for OSMA from past general assemblies. As a reminder, non-medical switching occurs when health plan issuers or pharmacy benefit managers (PBMs) force patients to switch from a medication they rely on to treat their condition to a different medication (that is potentially less effective), for a non-medical reason. HB 291 would prohibit insurers and PBMs from the practice of non-medical switching, protecting patients from disruptions in treatment which can lead to negative health outcomes and dangerous adverse health events.
In the New Year, this legislation will remain among our top priorities, and we will advocate to advance HB 291 through the legislative process.
Physician Noncompetes
Recently, OSMA also gave proponent testimony in support of Senate Bill 126, which would restrict nonprofit hospital requirements for a physician, physician assistant, or advanced practice registered nurse, as a condition of employment, to enter into a postemployment noncompete agreement. SB 126 would authorize such a postemployment noncompete agreement only if the noncompete terms are limited to six months and the surrounding 15-mile area.
Over the years OSMA has heard concerns from our physician members over the use of noncompete agreements (also known as restrictive covenants) in employment contracts. Some of the frustrations physicians have voiced include restrictions on the medical profession, interference with the physician-patient relationship and continuity of care, and furthermore, exacerbation of physician shortages in certain regions or communities.
We fundamentally believe that Ohio’s patient population has a right to receive health care services from the physician of their choice, and to that end, employment contracts should not interfere with access to their doctors. OSMA is encouraging legislators to support SB 126 with a goal of reducing the burden of restrictive covenants on health care delivery in Ohio, and will continue to do so in 2024.
Co-pay Accumulator
OSMA has also worked in the past several months to support House Bill 177, legislation dealing with co-pay accumulator policies. This is another issue OSMA also supported in the previous general assembly. Health plans and pharmacy benefit managers (PBMs) may apply co-pay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap.
This legislation which would require insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket cost will be reintroduced this year. OSMA believes this is essential to increasing predictability as vulnerable patients face high out-of-pocket costs for their prescriptions. This legislation will also remain a key item on our advocacy agenda in the New Year.
Prior Authorization “Gold Card”
OSMA has done significant background work this fall on House Bill 130, which was introduced in March 2023 by Rep. Kevin Miller (R-Newark). We hope to use this progress to push HB 130 further through the legislative process in early 2024, and passing this legislation will be one of OSMA’s major advocacy priorities in the coming year.
OSMA has taken the lead in the formation of a huge coalition in support of HB 130, made up of many medical organizations and patient advocacy groups. We testified in support of this legislation during a proponent hearing in June, and since that time, have been working closely with the sponsor and other interested parties in the interest of moving the bill forward.
As a reminder, this legislation would create an exemption system that rewards Ohio healthcare providers who consistently receive a prior authorization approval rate of 80% or more for a specific service, device, or drug 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, device, or drug.
Other Major Insurance Reform
OSMA has also done significant groundwork this fall in preparation for the introduction of another major insurance reform initiative. The goal of this additional legislation will be to take meaningful action on several other insurance-related issues, including automatic downcoding of claims and retroactive takebacks.
Members have provided us with a lot of feedback, ideas, and information about these issues and how they lead to significant administrative burden on practices, and we are working to formulate legislation that will generate changes to alleviate these difficulties for Ohio physicians. OSMA will aim to introduce this legislation in the coming year.
Public Health Issues
- AEDs in Schools:
OSMA recently gave testimony for a hearing in the Senate Health Committee in support of legislation which would require automated external defibrillators (AEDs) in schools—specifically each public and chartered nonpublic school, and in each public recreational facility/sports and recreation location. HB 47 represents an opportunity to have meaningful impact toward improving the likelihood of survival for individuals with sudden cardiac arrest.
In addition, passage of HB 47 would complement Lindsay’s Law, which was passed in Ohio in 2017, and mandates awareness education in schools related to sudden cardiac arrest. HB 47 includes provisions requiring schools and youth athletic programs to hold informational meetings about the signs and symptoms of sudden cardiac arrest for all ages of students and athletes.
This legislation has already passed in the Ohio House and must now advance through the committee process in the Senate and out of the full Senate with a floor vote. OSMA will continue to monitor the progress of this bill in the coming months.
- Sale of tobacco to minors:
OSMA also recently provided supportive testimony for a hearing in the House Criminal Justice Committee regarding House Bill 258, which would increase penalties and fines for repeat offenders caught selling cigarettes, tobacco, or other alternative nicotine products to minors and make those retailers who repeatedly violate the law regarding sale of these products to minors subject to Ohio’s public nuisance law.
It is the policy of OSMA to support stricter regulation of substances linked to vaping-associated lung injury, as well as to support restriction of sale of e-cigarette flavors that appeal particularly to minors.
While the problem of Ohio children using tobacco and vape products is multifaceted and complex, OSMA believes HB 258 is a reasonable step to take in order to better address one major aspect of the issue—poor regulation of tobacco sales to minors.
- Ban on tanning for minors:
OSMA continues to work closely with the Ohio Dermatological Association (ODA) on legislation to prohibit Ohio minors from utilizing indoor tanning services. This general assembly, this legislation was introduced in the Senate as Senate Bill 59 and in the House as House Bill 169.
Recently, an amendment was added to the bill in response to significant pushback the sponsors and proponents of these bills have heard, regarding the concept of parental rights. Now, rather than outright banning indoor tanning use for minors, it 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 are hopeful that this compromise will give this proposal the boost it needs to move forward in the legislature, while still putting in place additional hurdles that will highly discourage use of tanning services for individuals under the age of 18.
As a reminder, SB 59 is sponsored by Senator and physician Terry Johnson, DO (R-McDermott), and was introduced in mid-February of this year and referred to the Senate Health Committee. HB 169 was introduced in the House on May 9, sponsored by Rep. Brett Hillyer (R-Uhrichsville). Dr. Shannon Trotter testified on behalf of OSMA and ODA in hearings for both SB 59 and HB 169 this year.
OSMA will continue to advocate for passage of this legislation in the coming year.
Please stay tuned when the legislature returns in January for continuous updates from OSMA on activity that impacts you and the practice of medicine! Thank you for another great year, and we look forward to continuing to serve you in 2024!