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2022 Regular Legislative Session is a Wrap
On June 6 at 6 PM, the Louisiana Legislature constitutionally adjourned Sine Die, ending the 2022 Regular Legislative Session! In a session that saw 6 significant scope bills, 38 anti-vaccine bills, 4 noncompete bills, 2 medical malpractice bills, 1 anti-trust bill, an embedded veto session and so much more, organized medicine is breathing a sigh of relief that we were able to fend off so many bills that would have negatively impacted you. However, we are happy to share that we did successfully pass several bills aimed at easing some of your administrative burdens related to insurance. A huge thank you to the many physicians who joined us at the Capitol to testify for and against legislation. While there, they often served as volunteers for the First Aid Station, too! We hope to have many of you join us again and encourage those of you with an interest to reach out for opportunities that help you stay involved. We’ll start with the embedded veto session – not because we were involved in that session but because that is the day the Physician’s Coalition hosted White Coat Wednesday. The 109 physicians and guests who attended this year’s advocacy day got to witness history in watching as both bod ies overturned Gov. John Bel Edwards’ veto of congressional redistricting maps. Our thanks to the many lobbyists and staff members who helped pivot on short notice to accommodate the necessary changes required by the veto session’s schedule. The event proved very successful in giving member physicians the ability to discuss medical issues with legislators. While we don’t currently have a date for 2023, we are already working on plans for next year’s event and encourage you to watch for updates in early January once the Speaker’s office releases the event calendar.
Session. Scope. Repeat.
This year’s six scope bills were offered allowing for the practice of medicine by advanced practice registered nurses, physician assistants and pharmacists.
The nurses offered two pieces of legislation this year:
- SB 175 by Sen. Regina Barrow would have allowed independent practice of nurse practitioners after fewer than 6 months under a collaborative practice agreement. - HB 543 by Rep. Joe Stagni would have allowed independent practice of nurse practitioners after less than a year under a collaborative practice agreement. It created a new category of collaborator s called a “consulting practitioner” which would have included other nurse practitioners. The bill further included language granting “global signature authority” to nurses.
Neither bill was moved.
The physician assistants brought one bill, SB 158, authored by Sen. Jay Luneau which sought to: - Eliminate direction, control and supervision by a physician - Replace clinical practice guidelines with a collaborative practice agreement establishing a scope rather than allowing for physician delegation - Eliminate physician inform ed concurrence of the physician assistant’s actions - Remove all required physician engagement during a declared state of emergency - Allow physician assistants to be employed by an “other health care organization or entity.” SB 158 did receive a hearing in Senate Health and Welfare and was reported favorably. It was returned to the calendar on the Senate floor. However, the author was very adamant that he would be back next year if we don’t all work together to find a solution to the scope battles. The biggest scope challenges this year actually came from the pharmacists who proposed 3 aggressive bills aimed at moving pharmacists directly into the field of medicine. The first of the 3 bills was authored by Senate Health and Welfare Committee Chair Fred Mills. SB 329 would have: - Allowed a pharmacist to render any patient care services approved by a protocol development committee housed under the Louisiana Board of Pharmacy - Allowed a pharmacist to order, administer and interpret laboratory tests
- Allowed a pharmacist to prescribe and dispense non-controlled prescription medications, prescription devices and durable medical equipment.
SB 329 was reported out of committee before being returned to the calendar on the Senate floor where it died upon adjournment. Sen. Regina Barrow offered SB 296 which allowed for pharmacist clinical services within Medicaid. Because of a very large fiscal note, the bill was dually referred to both Senate Health and Welfare and Senate Finance. Ultimately the bill died without receiving a hearing in Senate Finance. On the House side, Rep. Chris Turner brought HB 424 which would have allowed pharmacists, pharmacy interns and certified pharmacy technicians to give any immunization to any child over the age of seven. This bill was reported favorably from House Health and Welfare. It was brought up on the House floor for a vote where it failed to pass by 1 vote. Despite heavy lobbying from the chain pharmacies, we were successful in keeping the bill from being reconsidered. It remained on the House calendar and died at adjournment.
Vaccine-palooza.
Nearly 40 anti-vaccination bills were filed in Louisiana this year. Due to the sheer volume of bills, we’ve provided a separate list . However, it is noteworthy to mention that for the first time, the words vaccine and criminal justice committee were used together. HB 54 by Rep. Larry Bagley would have criminalized anyone who asked vaccination status of persons seeking entry to any premises. This would have included everywhere from hospitals and physician offices to public properties to home-based businesses. The original penalties included both jail time and monetary fines. The legislation was amended throughout the process eventually being finally passed in a posture which: - Is limited to governmental entities and public educational institutions - Prohibits discharging an employee from employment within the above solely for refusing a COVID vaccine - Creates a liability for damages if an employee is discharged in violation of the statute - Provides an exemption for healthcare providers under federal mandates to ensure all employees are vaccinated as a condition of Medicare or Medicaid participation.
Following its passage, many physician groups did request a veto from Gov. John Bel Edwards. The veto was granted. If the legislature chooses to convene a veto override session, HB 54 can be brought up for a vote. If the bill is not brought up or fails to receive the requisite number of votes to override the Governor, it will not become law.
Noncompetes are a Non-starter.
Four noncompete bills were filed in 2022 to include a LSMS requested one. Sen. Jay Morris filed SB 385 specific to physician contracts at our request. Unfortunately, legislative leadership did not have an interest in seeing any noncompetition legislation move and successfully kept them all bottled up in committee where they died upon adjournment: - SB 385 by Sen. Jay Morris was requested by LSMS and was specific to physicians. - SB 238 by Sen. Cleo Fields was very broad and addressed the full spectrum of employee contracts. - SB 427 by Sen. Franklin Foil was specific to physicians employed by state entities. - HB 1037 by Rep. Mandie Landry also addressed all noncompete clauses and very closely mirrored the White House’s Executive Order on noncompetes.
MedMal Matters.
The arguments related to standard of care under emergency situations are many and complex. SB 220 by Sen. Katrina Jackson and SB 346 by Sen. Jimmy Harris both focused on how to make the standard of care relate to the actual emergency. After many meetings between the interested parties and two hearings before the Senate Judiciary A Committee, the authors pulled back their bills and agreed to continue working towards language for legislation next year. Thank you to Dr. Jeff White from Shreveport for testifying before the committee and working with the stakeholders to offer alternative language.
Anti-Trust Protections Get Controversial.
SB 276 by Senate Insurance Committee Chairman Kirk Talbot started as a “placeholder” bill but was amended during its committee hearing to become one of the most controversial bills of the session. As amended, it exempted all managed care organizations from any provision of the law including Louisiana anti-trust statutes. It also included retroactive language which would have removed Louisiana’s largest health insurer from a lawsuit currently moving through the courts. The bill failed to pass by a vote of 14 to 20. The author gave notice of reconsideration which allowed it to be considered for a second vote at a later date. Despite intense lobbying efforts to pass the bill and amendments to address concerns of legislators, the insurance companies fell one vote short.
Abortion and Louisiana Trigger Laws.
On June 24, 2022, the US Supreme Court released its opinion in Dobbs v. Jackson. The ruling overturned Roe v. Wade and held, “The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.” Until this ruling, Roe v. Wade which was decided in 1973 governed policies related to abortion. Thus, any discussions regarding restrictions on elective abortions in Louisiana (and elsewhere) had been largely hypothetical. Now, the conversation is very real. Louisiana has had “trigger laws” on the books for years (laws that would only go into effect if Roe were overturned or a change occurred at the federal level allowing the states authority to further restrict abortion). Sen. Katrina Jackson passed SB 342 during the session which creates mandatory imprisonment and fines for physicians who perform elective pregnancy terminations in most circumstances. Physician advocates worked throughout the legislative process to tighten language that was considered unclear and to add an exception for a medically futile pregnancy. While the author did not support this effort, she did not fight the will of the legislature in providing both clarity and the additional exception. Other exceptions include life or serious bodily injury to the mother and both the removal of and use of methotrexate for ectopic pregnancies. A number of amendments were proposed and failed, including an exception for rape and incest. Unfortunately, on the House floor during debate, language was adopted that added another layer of complexity. Rep. Barry Ivey’s amendment requi res the Louisiana Department of Health to promulgate rules establishing an exclusive list of anomalies, diseases, disorders and other conditions to be deemed medically futile. [NOTE: As this edition of the Journal is going to press, LSMS is reviewing the Supreme Court's decision. We will be working with other groups to provide a more comprehensive report specific to this issue in a supplement.]
Relieving Burdens.
On the positive side of the equation, LSMS and other groups did successfully work together on and pass a package of bills aimed at easing administrative burdens. Act 432 (SB 112) by Sen. Robert Mills mirrored the Texas “gold card” bill and would have provided relief from prior authorizations in certain circumstances. Despite compelling testimony from physicians and amendments requested by the insurance companies, the Senate Insurance Committee was not inclined to report the bill as written. When reported, the bill had been amended to require each insurance company to develop
and post its own version of prior authorization relief for providers. While this is a unique step forward, we remain committed to bringing legislation in the future if this does not provide you with results. Act 166 (HB 339) by Rep. JP Coussan focuses on coordination of benefits and prohibits health plans from pending, delaying, or denying payment to a provider on the basis of the insured’s failure to provide notice of another insurance policy. SB 59 by Sen. Fred Mills and Rep. Larry Bagley prohibits a Medicaid MCO from requiring any enrolled providers to participate in a prepayment review unless the review is implemented directly by the Louisiana Department of Health and is in accordance with the provisions of the Medical Assistance Programs Integrity Law. Act 143 (HB 286) by Rep. Chris Turner stipulates that any healthcare provider who maintains hospital privileges or is a member of a hospital medical staff with a licensed hospital shall be considered to have satisfied and shall otherwise be exempt from having to satisfy any credentialing requirements of a Medicaid managed care organization.
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