- The Georgia Orthopaedic Society is asking our members to contact the state legislature regarding an issue on an out of network issue. On Monday, March 12, opponents to our comprehensive and fair solution to surprise medical bills in Georgia sprung a legislative maneuver that would halt our progress and instead provide a shortcut to … →Take Action »
Indiana Surgeons Contact Your Legislator: Length of Stay Should be Determined Between a Patient and Physician, Not the LegislatureThe Indiana Orthopaedic Society is urging its members to express serious concerns with Senate Bill 243 to their state lawmakers. The bill puts certain hospitals at risk for being shut down by requiring that any hospital with less than 2.0 average length of stay over a 12-month period be denied a license. These requirements … →Take Action »
Maryland Surgeons Contact Your Legislator: Help Us Oppose Bill Allowing Podiatrists to Use the Title PhysicianThe Maryland Orthopaedic Association (MOA), representing 236 surgeons, is asking our members to write in opposition to HB 1430 in Maryland. Please scroll down to take action and contact your legislator. This bill allows podiatrists to use the title “physician.” The AAOS and MOA oppose the use of the title “physician” by non-physician clinicians … →Take Action »
- Governors across the country have declared June to be Scoliosis Awareness Month! We must increase the public’s awareness of scoliosis and help children, parents, adults, and health care providers understand, recognize and treat the complexities of spinal deformities such as Scoliosis. An abnormal curvature of the spine, with no known cause (idiopathic), is a condition affecting 2-3% … →Take Action »
What we are monitoring in Ohio:
|Bill: 2015 H.B. 200, introduced by Representative Christina Hagan (R) on Physician Dispensing. Status: Final Enacted|| Final version (10/7/2015): Allows authorized physicians and pharmacists to dispense epinephrine auto injectors pursuant to a prescription issued in the name of an authorized entity.
Allows an authorized healthcare provider to prescribe epinephrine auto-injectors to authorized entities where allergens capable of causing anaphylaxis may be present. Requires authorized entities who obtain a supply of epinephrine auto-injectors through prescription to have the epinephrine auto-injectors readily accessible during emergencies.
Final version (10/7/2015): http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb200/RH?format=pdf
Introduced version: http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb200/IN?format=pdf
|Bill: 2015 S.B. 129, introduced by Senator Randy Gardner (R) on NETWORK ADEQUACY,Physician Dispensing,Scope of Practice (Chiropractor). Status: Final Enacted|| Final version (5/24/2015): Stipulates that health plan issuers must permit health care practitioners to access prior authorization forms through the applicable software system. States that a health plan issuer, or other payer acting on behalf of the issuer, must accept prior authorization requests through a secure electronic transmission. Specifies that for prior prescription benefit authorization requests, the health plan issuer must use NCPDP SCRIPT standard ePA transactions. Specifies further that for prior medical benefit requests, the health plan issuer must use standards established by the Council for Affordable Quality Health Care on Operating Rules for Information Exchange. Prohibits a proprietary payer portal for prescription drug requests that does not use NCPDP SCRIPT standard nor a facsimile are considered a secure electronic transmission.
Requires health plan issuers to issue an electronic receipt acknowledging a prior authorization request has been received and respond to prior authorization requests in a timely manner. Specifies for urgent care services, the health plan issuer must respond within 48 hours from the time the request is received by the health plan issuer with all information necessary to support the request. Specifies for any prior authorization that is not related to an urgent care service, the deadline is ten calendar days. States that these deadlines do not apply to emergency services. Specifies that these provisions apply to private insurance policies issued on or after January 1, 2018 (the effective date of these provisions for Medicaid plans is January 1, 2018).
Requires health plan issuers, for a prior approval related to a chronic condition, to honor a prior authorization request for a drug for the lesser of the following:
(i) 12 months from the date of the approval and
(ii) the last day of the cover person in question's eligibility under the health plan.
Permits a health plan issuer to require a health care practitioner to submit information indicating that the patient's chronic condition has not changed no earlier than six months and no later than seven months after the initial prior approval request was submitted. Requires the frequency of information to be consistent with medical or scientific evidence, but not more frequently than quarterly.
Requires the request for information and the response to be in an electronic format, which can be by email or other electronic communication. Stipulates that if the health care practitioner does not respond to the request for information within five calendar days from the date of receipt, the health plan issuer may terminate the 12-month approval.
Excludes the following from 12-month prior approvals:
(i) Medications that are prescribed for a nonmaintenance condition;
(ii) Medications that have a typical treatment of less than one year;
(iii) Medications that require an initial trial period to determine effectiveness and tolerability, beyond which a one-year or greater, prior authorization period will be given and
(iv) Medications where there is medical or scientific evidence that do not support a 12-month prior approval.
(v) Medications that are Schedule I or II controlled substance under continuing Ohio law or any opioid analgesic or benzodiazepine and
(vi) Medications that are not prescribed by an in-network provider as part of a care management system.
Permits, but does not require, a health plan issuer to provide a 12-month approval for a drug that meets all of the following characteristics:
(i) The drug is prescribed or administered to treat a rare medical condition (a condition that affects fewer than 200,000 people in the United States) and pursuant to medical or scientific evidence.
(ii) The drug is not a Schedule I or II controlled substance or any opioid analgesic or benzodiazepine
Establishes that a health plan issuer may require a health care practitioner to submit information indicating that the patient's chronic condition has not changed.
Stipulates that nothing in the bill's provisions regarding 12-month approvals prohibits the substitution of any drug that has received a 12-month prior approval when there is a release of an FDA-approved comparable brand product or a generic counterpart of a brand product that is listed as therapeutically equivalent in the FDA Orange Book.
Requires a health plan issuer to establish an appeal process. Requires an appeal to be considered within the following timeframes: (a) or urgent care services, 48 hours after receipt of the appeal and (b) for all other matters, ten calendar days after receipt of the appeal.
Permits the covered person or an authorized representative of the covered person to request an external review of the relevant law, to the extent the relevant law is applicable with respect to health plans that are not related to Medicaid.
Stipulates that except in cases of fraudulent or materially incorrect information, prohibits a health plan issuer from retroactively denying a prior authorization for a health care service, drug, or device when all of the following are met:
(i) The health care practitioner submits a prior authorization request to the health plan issuer.
(ii) The health plan issuer approves the request after determining that (1) the patient is eligible under the health benefit plan, (2) the service, drug, or device is covered under the plan, and (3) the service, drug, or device meets the health plan issuer's standards for medical necessity and prior authorization.
(iii) The health care practitioner renders the service, drug, or device pursuant to the approved prior authorization request and all of the terms and conditions of the practitioner's contract with the health plan issuer.
(iv) On the date the health care practitioner renders the prior approved health care service, drug, or device, (1) the patient is eligible under the health benefit plan, (2) the patient's condition or circumstances related to the patient's care have not changed, and (3) the health care practitioner submits an accurate claim that matches the information submitted by the health care practitioner in the approved prior authorization request.
States that any provision of a contractual arrangement between a health plan issuer and a health care practitioner or health plan beneficiary that is contrary to the bill's provisions is unenforceable.
Requires all participating health care practitioners to promptly notify the health plan issuer of any changes to the practitioner's electronic mail or standard mail address.
Permits the Superintendent of Insurance and the Director of Medicaid to adopt rules in accordance with the Administrative Procedure Act as necessary to enforce the bill's provisions.
Final version (5/24/2016): http://statelink.stateside.com/Attachments/-1_sb129_06_EN FINAL.pdf
Amended version (12/1/2015): http://statelink.stateside.com/Attachments/233092_SB_129_PS.pdf
Introduced version: https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-SB-129
|Bill: 2015 H.B. 188, introduced by Representative Ron Maag (R) on Medical Malpractice. Status: Final Enacted|| Final version (11/18/2015): Stipulates that a pharmacist is unable to obtain authorization to refill a prescription if the drug sold or dispensed is not a controlled substance and the patient has been on a consistent drug therapy program and the amount of the drug dispensed does not exceed a thirty day supply.
Allows pharmacists to enter into a consult agreement with one or more physicians if each physician has an ongoing physician-patient relationship with each patient whose drug therapy is being managed.
Stipulates that within a consult agreement, a pharmacist is authorized to manage drug therapy treatment by changing the duration of treatment or adjusting a drug's strength, dose, dosage form, frequency or administration and to order and evaluate blood and urine tests.
Prohibits civil liability for pharmacists or physicians for injury or loss to a person allegedly arising from the pharmacist or physician's change in a drug for a patient whose drug therapy is managed under the consult agreement.
Includes a telemedicine provision requiring the State Medical Board to adopt rules governing a physician's ability to prescribe or personally furnish controlled and non controlled substances to a person that has never been clinically assessed by the physician and who is at a location remote from the physician.
Final version (11/18/2015): http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb188/EN/05?format=pdf
Adopted Amendment (6/24/2015): http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb188/RH?format=pdf
Introduced version: http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb188/IN?format=pdf
|Bill: 2015 H.B. 4, introduced by Representative Robert Sprague (R) on Good Samaritan Laws. Status: Final Enacted|| Final version (6/16/2015): Stipulates that a pharmacist or pharmacy intern may dispense naloxone without a prescription to an individual who is experiencing or at risk of experiencing an opioid-related overdose.
Allows physicians to authorize another individual to personally furnish a supply of naloxone if an individual is believed to be experiencing an opioid-related overdose. Eliminates civil liability for a physician who authorizes an individual to administer naloxone to an individual is believed to be experiencing an opioid-related overdose.
Final version (6/16/2015): http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb4/PS?format=pdf
Amended version (5/27/2015): http://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_131/bills/hb4/RS?format=pdf
Amended version (2/25/2015):https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA131-HB-4
|Bill: 2013 H.B. 341, introduced by Representative Ryan Smith (R) on Physician Dispensing. Status: Final Enacted|| Current Version (5/28/2014): Prohibits a controlled substance that is a schedule II drug or contains opioids from being prescribed or dispensed to a patient without review of the patient's information in the State Board of Pharmacy's Ohio Automated Rx Reporting System (OARRS). Requires system users to check a box in the OARRS to confirm that they are qualified to use the system.
Current Version (5/28/2014): http://www.legislature.state.oh.us/BillText130/130_HB_341_PH_Y.pdf
Introduced version: http://www.legislature.state.oh.us/BillText130/130_HB_341_I_Y.pdf
|Bill: 2013 H.B. 366, introduced by Representative Robert Sprague (R) on Prescription monitoring Programs. Status: Final Enacted|| Final version (5/28/2014): Requires hospice care programs to establish procedures to prevent diversion of controlled substances containing opioids that are prescribed for a patient. Stipulates that a hospice care program must: designate an individual who is employed by or affiliated with the program to be responsible for the controlled substances; require the controlled substances to be kept in a place that can be accessed only by an authorized person using a key; maintain records of the receipt and disposition of the controlled substances, including accurate counts of the numbers dispensed and used and dispose of controlled substances maintained in the patient's home that are no longer needed by the patient. Allows hospice to first investigate any signs of suspedted diversion becoer having to report those results to the local law enforcement agency. Removes the provision providing immunity for community physicians tht prescribe opiates to hospice patients.
Final version (5/28/2014): http://www.legislature.state.oh.us/BillText130/130_HB_366_RS_Y.pdf
House version (2/11/2014): http://www.legislature.state.oh.us/BillText130/130_HB_366_RH_Y.pdf
Introduced version: http://www.legislature.state.oh.us/bills.cfm?ID=130_HB_366
|Bill: 2013 H.B. 394, introduced by Representative Ryan Smith (R) on Prescription monitoring Programs. Status: Final Enacted|| Final version (12/9/2014): Requires the State Board of Pharmacy to prepare a semi-annual report regarding prescription of controlled substances containing opioids. Stipulates that the information shall be an aggregate database of the number of prescribers who issued controlled substance prescriptions, patients to whom the prescriptions were dispensed and the average quantity of controlled substances dispensed. Prevents personal information and medical records of individuals recorded to be aggregated in the report.
Final version (12/9/2014): http://www.legislature.state.oh.us/BillText130/130_HB_394_PS_Y.pdf
Introduced version: http://www.legislature.state.oh.us/BillText130/130_HB_394_I_Y.pdf
|Bill: 2013 S.B. 230, introduced by Senator Gayle Manning (R) on Physician Dispensing. Status: Final Enacted|| Provides that a pharmacist or pharmacy intern cannot dispense a drug for the treatment of cancer that is non-self injectable to a patient, the patient’s representative, the patient’s private residence, a licensed health professional authorized to prescribe drugs who prescribed the drug to the patient, an employee or agent of the prescriber or the parent or guardian or other person who has care or charge of the patient. Provides that the drug can be dispensed to the patient's private residence if their private residence is an institutional facility or health care facility or if the patient, a licensed health professional who prescribed the drug to the patient or the parent, guardian or other person who has care of the patient has notified the pharmacist or pharmacy intern that the patient is a hospice patient or client of a home health agency and an employee of that program or agency will be administering the drug.
|Bill: 2014 H.B. 367, introduced by Representative Denise Driehaus (D) on Physician Dispensing,Prescription monitoring Programs. Status: Final Enacted|| Final version (12/10/2014): Stipulates that the state medical board shall establish standards and procedures to be followed by physicians in the use of controlled substances to treat opioid dependence or addiction. Specifies controlled substances as schedule III, schedule IV or schedule V drugs.
Dictates that beginning April 1, 2015, a business entity shall hold a license as a terminal distributor of controlled substances, containing burprenorphine, that are used for the purpose of treating drug dependence or addiction.
Final version (12/10/2014) :http://www.legislature.state.oh.us/bills.cfm?ID=130_HB_367_RS
Introduced version: http://www.legislature.state.oh.us/bills.cfm?ID=130_HB_367_I
|Bill: 2014 H.B. 552, introduced by Representative Peter Stautberg (R) on Prescription monitoring Programs. Status: Final Enacted|| This measure was amended out of your issue scope December 11.
Final version (12/11/2014): Requires health care professionals to provide prenatal or postnatal patients with information regarding down syndrome.
Final version (12/11/2014): http://www.legislature.state.oh.us/BillText130/130_HB_552_PS_Y.pdf
Amended version (12/9/2014): http://www.legislature.state.oh.us/BillText130/130_HB_552_RS_Y.pdf
Introduced version: http://www.legislature.state.oh.us/BillText130/130_HB_552_I_Y.pdf
|Bill: 2014 S.B. 276, introduced by Senator Shannon Jones (R) on Prescription monitoring Programs. Status: Final Enacted|| Final version (12/3/2014): Requires the State Board of Pharmacy to prepare a semi-annual report regarding prescription of controlled substances containing opioids. Stipulates that the information shall be an aggregate database of the number of prescribers who issued controlled substance prescriptions, patients to whom the prescriptions were dispensed and the average quantity of controlled substances dispensed. Prevents personal information and medical records of individuals recorded to be aggregated in the report.
Final version (12/3/2014): http://www.legislature.state.oh.us/BillText130/130_SB_276_PH_Y.pdf
Amended version (5/28/2014): http://www.legislature.state.oh.us/BillText130/130_SB_276_RS_Y.pdf
Introduced version: http://www.legislature.state.oh.us/BillText130/130_SB_276_I_Y.pdf