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Interprofessional Legislative Update
The Ohio General Assembly has dedicated much of the winter and spring months to budget (HB 59) deliberations. With the new state fiscal year beginning on July 1st, 2013, legislative leaders will focus most of their attention not only on the fiscal operations of the state of Ohio, but also on the many policy changes made as amendments to state budget provisions.
APRNs and Physician Assistants
Language was considered that would have allowed advanced practice nurses and physician assistants to admit patients to hospitals. That provision is now being considered independently of the budget as HB 139.
A number of pharmacy provisions remain part of the budget as well. One of the provisions would require that Medicaid managed care organiza-tions provide 90 days notice to pharmacies being terminated as a network provider and extends the notice to all types of health care providers. In the case of pharmacies, similarly the budget would require that 90 days advance notice be given regarding the removal of a prescribed drug from the formulary or preferred drug list used by the organization or administrator or any change in the terms governing access to the drug. The amendment that we are opposing in the budget which is HB 59 dealt with remote dispensing.
The amendment would have allowed a pharmacy that is licensed as a terminal distributor of dangerous drugs to use a remote drug dispensing system at a nursing home or residential care facility. The pharmacist would not be required to be physically present where the system is used to dispense the drugs. COHCA has strong concerns regarding this provision and asked legislators to remove the language from the budget bill. The Ohio Senate did remove the language from the substitute version of the bill; however the bill will be amended next week and then be considered by a conference committee that could reinsert the language into the final version of the bill.
House Bill 44
HEALTH EMERGENCIES (McClain)
To require the Director of Health to develop protocols regarding the authority to administer, deliver, distribute, or dispense drugs during certain public health emergencies. This is currently pending in
House Health and Aging Committee where it has received two hearings.
Requires the Director of Health to develop one or more protocols that authorize certain licensed health professionals to administer, deliver, or distribute drugs during a public health emergency; requires the Director to develop protocols as well that authorize pharmacists and pharmacy interns to dispense limited quantities of dangerous drugs without a prescription or record of a prescription during a public health emergency; and provides that an individual who administers, delivers, distributes or dispenses a drug or dangerous drug in accordance with one or more of those protocols is not liable for, nor subject to civil damages, criminal prosecution, or professional disciplinary action, unless the individual’s acts of omissions constitute willful, wanton misconduct.
House Bill 60
MATERNITY UNITS (Huffman)
To require that rules governing maternity units, newborn care nurseries, and maternity homes include certain provisions pertaining to the authority to make decisions regarding the transfer of patients to other facilities and to specify procedures for granting variances or waivers of any requirement in the rules governing operation of such facilities.
Currently pending in House Health and Aging where it has received two hearings.
The bill codifies an administrative rule that authorizes the Director of Health to grant a variance from or waiver of any of the requirements of rules regarding the operation of a maternity unit, newborn care nursery, or maternity home; requires the Director to adopt rules regarding application forms to be used and procedures to be followed in applying for a variance or waiver; requires the Director to review all applications for variances and waivers and, not later than 90 days after receipt of an application, to determine whether to grant the variance or waiver and notify the applicant of the decision.
House Bill 83
PSYCHOLOGY LAWS (Hackett)
To make 14 major changes to the law that gov-erns the practice of psychology. Heard in the House Health and Aging Committee; reported out of committee; passed the House 96-1; currently pending in the Senate Medicaid, Health and Hu-man Services Committee.
House Bill 94
HEALTH PLANS (Gonzales)
To require a health insuring corporation, public employee benefit plan, or sickness and accident insurer to reimburse a board of health for any services provided to an individual by the board that is covered by a plan issued to the individual by the health insuring corporation, public employee benefit plan, or sickness and accident insurer upon request submitted by the Board of Health.
Currently pending in House Insurance Committee; has received two hearings.
House Bill 123
TELEHEALTH SERVICES (Gonzales, Wachtmann)
Regarding Medicaid and health insurance coverage of telehealth services.
Currently pending in House Health and Aging Committee where it has received two hearings.
The bill authorizes health care insurers to provide coverage of telehealth services provided by health care professionals and facilities, requires the Office of Medical Assistance to adopt rules establishing standards for Medicaid reimbursement of telehealth services provided by health care professionals and facilities; specifies that coverage of a telehealth service applies only if the service involves an immediate and direct interaction with a patient, is medically appropriate and necessary, and is provided by a licensed health care provider or facility; and requires that a health care provider seeking reimbursement for telehealth service maintain documentation of providing the service as part of the patient records the provider maintains.
House Bill 131
TANNING REGULATIONS (Johnson, Stinziano)
To regulate chemical tanning and prohibit tanning facilities from allowing the use of sun lamps by certain individuals under 18 years of age.
Currently pending in House Health and Aging Committee where it has received three hearings.
Prohibits an operator or employee of a tanning facility from allowing an individual under age 18 to use the facility’s fluorescent sun lamp tanning services unless the individual presents a prescription issued by a physician; and requires the State Board of Cosmetology to regulate chemical tanning facilities.
House Bill 139
HOSPITAL ADMISSIONS (Gonzales)
To permit certain advanced practice registered nurses and physician assistants to admit patients to hospitals.
Currently pending in House Health and Aging Committee where it has received two hearings.
Current law allows only physicians, dentists and podiatrists who are members of the medical staff to admit patients to hospitals. The bill would add clinical nurse specialists, certified nurse midwives and certified nurse practitioners who have a standard care arrangement with a physician or podiatrist who is a member of the medical staff. The bill would also allow physician’s assistants, under the supervision, control or direction of a physician or podiatrist who is a member of the medical staff, to admit patients to hospitals. The bill also would require the APRN or PA to notify the collaborating or supervising physician or podiatrist not later than 12 hours after admitting a patient to a hospital.
House Bill 147
MASTECTOMY GUIDANCE (Patmon, Wachtmann)
To require a surgeon performing a mastectomy, lymph node dissection, or lumpectomy in a hospital to guide the patient and provide referrals in accordance with the standards of the National Accreditation Program for Breast Centers and to name this act the Lizzie B. Byrd Act.”
Currently pending in the House Health and Aging Committee where it has had two hearings.
The bill, in addition to the above would require the sur-geon performing a mastectomy or lumpectomy to refer a patient if breast reconstruction is appropriate, and requires the surgeon to offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards.
House Bill 159
DENTAL SERVICES (Hacket, Schuring)
To prohibit a health insurer from establishing a fee schedule for dental providers for services that are not covered by any contract or participating provider agreement between the health insurer and the dental provider.
Currently the bill is pending in the House Insurance Committee where it has had one hearing.
Prohibits a contracting entity from requiring a dental provider to provide services to plan enrollees at a fee set by or subject to approval by the contracting entity unless certain circumstances are met; makes setting or requiring the insurer’s approval of fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances are met; and makes the offering of a health benefit plan that sets fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances apply.
House Bill 165
HYPERBARIC TECHNOLOGISTS (Roegner)
Exempts certified hyperbaric technologists from the laws governing the practice of respiratory care.
Currently pending in the House Health and Aging Committee. Has not been heard.
House Bill 170
DRUG OVERDOSES (Johnson, Stinziano)
To provide that a licensed health professional authorized to prescribe naloxone, if acting with reasonable care, may prescribe, administer, dispense or furnish naloxone to a person who is, or a person who is in a position to assist a person who is, apparently experiencing or who is likely to experience an opioid-related overdose without being subject to administrative action or criminal prosecution, to provide that a person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opiod-related overdose is not subject to actions of professional licensing boards, administrative action, or criminal prosecution for a drug offense or practicing medicine without a license if the person acting in good faith, obtains naloxone prescription from a licensed health professional and administers it to a person for an opioid-related overdose, and to provide that peace officers and licensed emergency responders who are acting in good faith are not subject to administrative action or criminal prosecution for a drug offense or practicing medicine without a license for administering naloxone to a person who is apparently experiencing an opioid-related overdose.
Currently pending in the House Health and Aging Committee. It has not yet been heard by the committee.
Senate Bill 4
NEWBORN SCREENINGS (Manning, Oelslager)
To require a pulse oximetry screening for each newborn born in a hospital or freestanding birthing center.
Received two hearings in Senate Medicaid, Health and Human Services Committee, reported out of Committee; passed the Senate 33-0; referred to House Health and Aging Committee where it has received 5 hearings.
Requires hospitals and freestanding birthing centers to conduct a pulse oximetry screening on each newborn (unless a parent objects on religious grounds) for purposes of detecting critical congenital health defects; requires the Director of Health to adopt rules establishing standards and procedures for the pulse oximetry screenings.
Senate Bill 43
CIVIL COMMITMENT (Burke)
Makes a number of changes to the laws governing the civil commitment of and treatment provided to mentally ill persons.
Currently pending in Senate Criminal Justice Committee. It has received one hearing.
Senate Bill 99
CANCER MEDICATIONS (Oelslager, Tavares)
Regarding insurance coverage for rarely administered cancer medications.
Pending in Senate Insurance and Financial Institutions Committee where it has not received a hearing.
Neurosurgery Physician Assistant at Akron Children’s
Combines the Best of Care and Cure
Holly Zeller, PA-C sits down with Julie Tsirambidis, CNP to go over privilege delineation forms at Akron Children’s Hospital. This is one of their many overlapping moments where NP and PA practice comes together. Becoming more frequent is this visibility- that NPs and PAs sit side by side with their physician counterparts to enhance patient care. After years of working in silos, these disciplines agree the time to work together is long overdue. Hence, the Center for Advanced Practice at Akron Children’s Hospital was formed in April 2011. The goals are vast, but include the practice and regulatory oversight of APNs and PAs, on boarding programs, and integration with medical staff leadership to name but a few.
Zeller, who is a board certified physician assistant, works in partnership with Dr. Roger Hudgins, director of the Division of Neurosurgery at Children’s Hospital. When she is not examining patients during office hours, Holly assists Hudgins in the operating room and shares on-call duties with him for after-hours emergencies. Additionally, on a daily basis, Zeller rounds on all inpatients, formulates plans of care, interprets imaging, triages new patient referrals, and completes various types of different procedures in the NICU, PICU, patient floors and ER. At the end of each day, all “Mommy Call” questions which have accumulated throughout the day are addressed by calling the parent of the patient back to address their questions. “Every day is a little bit different,” she says. Zeller, 44, of Richfield,Ohio, is one of now 18 physician assistants (PAs) who work all across Akron Children’s Hospital. There are over 150 advanced practice providers at Akron Children’s with a director leading the way. The center actually oversees and brings together Advanced Practice Nurses (CRNA, CNP, and CNS) and Physician Assistants under one umbrella. The director, Julie Tsirambidis, CNP, truly believes this is the way of the future. “We have more in common that we have separate. Coming together to promote our professional needs, despite our regulatory difference truly sets us apart, and brings improved understanding to our patients, families, and hospital staff.” “Many years ago, MDs and DOs, would not even work together in the same hospital, and see how far they have come- this journey is a similar beginning, in my opinion.” Tsirambidis said.
As part of their master’s degree program, PAs can elect a surgical track that prepares them to work in the operating room. After college, Zeller worked in the pharmaceutical field before taking a break to stay home with her children. When she decided to return to work, she wanted a job in the medical field but didn’t want to travel anymore. She embarked upon graduate school education and completed the PA program. The PA education is very similar to that of the medical school model.
Zeller initially practiced with the congenital heart surgical team at Rainbow Babies and Children’s Hospital inClevelandbefore joining Akron. When Dr. Hudgins joined Children’s two years ago, he requested a PA for his team. He has especially relied on Zeller to share the patient load since the death this summer of the hospital’s only other neurosurgeon, Dr. Henry Bartkowski. When Dr. Bartkowski became ill, Dr. Hudgins and Zeller formulated a plan to continue the quality care provided to the neurosurgery patients, by trying to split the evening and weekend call, thus allowing the other some “off time.” The two divide and conquer on office days, with each visiting patients and talking with families. They frequently huddle to compare notes and examine patients’ images and other test results. Zeller will assist in the OR on surgery days, and often performs the closing procedures. This teamwork allows Hudgins to dictate this post-operative notes and get ready for the next patient while Zeller finishes the procedures. “It really becomes a seamless way for getting a lot more work done than you could by yourself, plus the families love her,” Hudgins said
For information, or to join our neurosurgery team, check us out at
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in Patient Care
COHCA, a interprofessional group, are partners in patient care: better care, lower costs, a partnership that will help improve the quality, safety, and affordability of health care for all Ohioans. Nationally, healthcare initiatives are fostering partnerships in patient care.