Practice Issues and Implications2013 Long Session

NC General Assembly

Joanne Stevens, MSN, RN, CHRM

Better Options:•93 % of uninsured would be eligible for tax credits to purchase coverage in the Marketplace or enroll in expanded Medicaid•New coverage options for younger adults•No discrimination for pre-existing conditions•No discrimination of providers

Better Value:•80/20 rule•Scrutinizing premium increases•No lifetime limits

Better Health:•Increased emphasis on primary care•Support for community health centers•Preventing illness and promoting health

Building a stronger Medicaid program:•Medication affordability•Preventative services

Impact of Affordable Care Act on NC

SB4 and HB16No exchange/ No Medicaid expansion

an act (1) to clarify the state's intent not to operate a state-run

or "partnership" health benefit exchange, (2) to provide that

future Medicaid eligibility determinations will be made by the

state rather than the federally facilitated exchange, and (3) to

reject the affordable care act's optional medicaid expansion

• Rejected federal plans to expand Medicaid in NC ( 500,000 paid by Feds for 3 yrs)

• Plans for privatization of existing Medicaid plan by 2015

• Federally managed health insurance marketplace to open 10/01/13

Even without expanding Medicaid:•Billions of $ in federal funds •A projected increase in utilization•Health Insurance Marketplace

There is an emerging market to:

•Study•Enter•Protect

2013 New Provider Legislation…

Chiropractic Assistant CertificationImmunizing Pharmacists

Certified Professional MidwivesNaturopathic Physicians

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HB 371 Chiropractic Assistant Certification/fee

An Act Authorizing the State Board of Chiropractic Examiners to Establish and Enforce Educational Standards

for Clinical Assistants

Primary Sponsors: Rep. Rob Bryan(R) Attorney Mecklenburg, Rep. Debra Conrad (R) Forsyth County, Owner of Conrad

Marketing Specialist

Signed By Governor 7/18/2013

SB 106/ HB 154Short Title: Home Birth Freedom Act

A BILL TO BE ENTITLED AN ACT TO ESTABLISH THE CERTIFIED PROFESSIONAL MIDWIVES

LICENSING ACT

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SB 106/HB 154-CPM

Action: SB 106 is in Senate Rules Committee and HB 154 is in House Health Care CommitteeHouse Sponsors: Rep. Winkie Wilkins- Retired Granville and Person and Rep. Pat Hurley-Clerk of Courts, Randolph.Senate Sponsors: Sen. Thom Goolsby,- Wilmington Attorney, Sen. Dan Clodfelter- Attorney from Mecklenburg and Sen. Stan Bingham, Lumber company owner from Davidson & Montgomery 8

SB 107/HB 155A BILL TO BE ENTITLED AN ACT ALLOWING PERSONS PRACTICING AS

CERTIFIED PROFESSIONAL MIDWIVES IN THIS STATE TO CONTINUE TO PROVIDE MIDWIFERY SERVICESWITHOUT BEING SUBJECT TO CRIMINAL

PENALTY

Decriminalize Direct Entry MidwiferySame Sponsors as SB 106 and HB 154Action: Senate bill is in Senate Rules and the House bill Re-referred to Committee on Health CareThe end

RATIFIED BILL H832

AN ACT TO PROTECT THE PUBLIC HEALTH BY INCREASING ACCESS TO IMMUNIZATIONS AND VACCINES THROUGH THE

EXPANDED ROLE OFIMMUNIZING PHARMACISTS

Signed by Governor 7/03/2013

HB 832 immunzing pharmacists

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HB 832Expand Pharmacists’ Immunizing Authority

Primary Sponsors: Rep. Marilyn Avila (R) Wake Former Chemist & Business owner

Rep. David Lewis (R)Harnett, Farm Equipment Dealer & Former Rep. Valerie Foushee (R) Durham & Orange-Retired

Police Admin.- Resigned 9.25.13 and serving in Senate, Rep Rick Glazier,(D) (end)

Attorney Cumberland County

HB 995/ SB 349A BILL TO BE ENTITLED AN ACT TO ESTABLISH THE

NORTH CAROLINA NATUROPATHIC DOCTORS LICENSURE ACT.

HB 995/SB 349Naturopathic Doctors Licensing Act

• Action: House bill is in Rules Committee and Senate bill is in Rules Committee

Primary Sponsors: Rep Jeff Collins (R), Franklin & Nash Financial Consultant and Rep. Susan Fisher (D), Buncombe Professional Legislator, Sen. Fletcher Hartsell (R), Cabarrus Attorney, Sen. Thom Goolsby (R), New Hanover Attorney

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A BILL TO BE ENTITLED AN ACT ALLOWING CHRISTIAN SCIENCE NURSES TO PRACTICE

CHRISTIAN SCIENCE NURSING UNDER THE LAWS REGULATING THE PRACTICE OF NURSING.

Historical Reference: HB 1286 (2010)

Advanced Practice Legislation and Changes in Oversight…

Certified Nurse MidwivesCertified Nurse Anesthetists

Nurse Practitioners

HB 204/SB 499Update/Modernize/Midwifery Practice Act

• Action: House Bill is in Rules Committee and Senate Bill is in Health Care Committee

• The Budget Bill authorized a Study Committee

• Primary Sponsors: Rep. Sarah Stevens (R); Attorney Surry/Wilkes, Rep. Justin Burr (R) Montgomery/Stanley; Bail Bondsman, Rep. Glazier (D) Cumberland; Attorney, Rep. Susi Hamilton (D) Brunswick/New Hanover; Business Consultant, Senator Hartsell (R) Attorney Cabarrus, Sen. Randleman (R) Retired Clerk of superior court, and Sen. Josh Stein (D) Attorney Wake.

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HB 204/SB 499 Became A Study

Nurse Midwives Study Committee• Presentations by American College of Nurse-

Midwives reviewing the major reasons for implementing legislation in 2014 on collaboration and eliminate “Supervision” requirement now presently in law. 1)Lack of OB/GYN physicians in more than 32 counties across the State, 2)lower costs and3) sound medical care by educated specially trained nurse midwives are three key arguments for changing the law.

• NC Medical Society argued the need for Supervision and the existing law is good and should not be modified. 18

Nurse Midwives Study Committee• NC Obstetrical and Gynecological Society addressed

the continued need for supervision of nurse midwives to protect the health of the baby.

• NC Board of Nursing shared data on status of nurse midwives across NC.

• NC Medical Board noted NC law provides all the flexibility necessary for nurse midwives to practice their profession. No changes to the law is needed.

• Final Committee Report was March 11, 2014.

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HB 181/ SB 256A BILL TO BE ENTITLED AN ACT TO CONFIRM THAT

NORTH CAROLINA LAW REQUIRES PHYSICIAN SUPERVISION OF ALL NURSES PROVIDING

ANESTHESIA SERVICES

HB 181/SB 256Physician Supervision Required/Nurse Anesthetist

• ACTION: House bill is in Senate Rules and Senate Bill is in Senate Rules

• Primary Sponsors: Rep. Nelson Dollar (R) Wake Media Consultant, Rep. Mark Hollo (R) Alexander, Wilkes, Yadkin US Air Force Reserve, Rep. Tim Moore (R) Cleveland Attorney, Rep. Michael Wray (D) Halifax Northampton Business Owner, Sen. Bob Rucho (R) Mecklenburg Dentist

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HB 380/ SB 179

BILL TO BE ENTITLED AN ACT TO PROVIDE A DEFINITION FOR CERTIFIED REGISTERED NURSE ANESTHETISTS

UNDER THE NURSING PRACTICE ACT

HB 380/ SB 179

• Action: House bill is in Health Committee and Senate bill is in Rules Committee

• Primary Sponsors: Rep. Jeff Collins (R), Franklin & Nash; Financial Consultant. Sen. Jim Davis (R) Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain; Orthodontist.

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HB 878Certified Registered Nurse Anesthetists in

Counties with Critical Access Hospital An act to allow for nurse anesthetists to provide

anesthesia services in collaboration with certain health care providers in a county in which a licensed critical

access hospital is located

H 878

• CRNAs in Counties with Critical Access Hospital

• Rep. Carla Cunningham, Mecklenburg; RN• & Michael Setzer, Catawba; VP of Smith Setzer

& Sons

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SB 555A BILL TO BE ENTITLED AN ACT AMENDING

THE NURSING PRACTICE ACT TO AUTHORIZE THE BOARD OF NURSING TO REGULATE NURSE PRACTITIONERS AND TO ESTABLISH CERTAIN NEW FEES

RELATED TO REGULATING NURSE PRACTITIONERS

SB 555Nursing Bd./Regulate Nurse Practitioners/Fees

• Action: Senate Rules Committee

• Primary Sponsors: Sen. Ralph Hise (R), Madison, Mc Dowell, Mitchell, Polk, Rutherford, Yancey; Statistician,

• Sen. Eleanor Kinnaird (D), Chatham and Orange Attorney- Resigned 8/19/13

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SB 555 Nursing Board/Regulate Nurse

Practitioners/FeesAll nursing bills in the Senate found a home in the Senate Rules committee,

the first was the House Anesthesia bill (HB 181) The bill was sent to

Rules on April 1, 2013.

Additional Nursing Legislation…

SB 371A BILL TO BE ENTITLED AN ACT TO ENHANCE

PATIENT SAFETY IN HOSPITAL AND AMBULATORY SURGICAL FACILITY OPERATING ROOMS BY

REQUIRING AT LEAST ON CIRCULATING NURSE TO BE PRESENT IN EACH OPERATING ROOM DURING

EACH SURGICAL PROCEDURE.

SB 371 Patient Safety In Operating Rooms

• North Carolina Operating Room Nurses Legislation Introduced in 2013 by Senator Bingham

KEY POINTS:• Keep NC a Leader in Medical Care• Patient Safety in the Operating Room• Provide Consistency of Care During Surgery• Educated and Fully Registered and Qualified Circulator Nurse

present in the operating room during patient surgeries.

• Legislation was not heard as part of issue in the Senate with all “Scope of Practice Bill” The bill is not eligible to pass in short session in its present form.

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Epinephrine Auto Injectors in Schools

HB 824/SB 700

HB 824 passed the House and is in the Senate and eligible for passage

in 2014

Prevent Hazardous Drug Exposure

• House Bill 644- passed House, in Senate Health

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Prevent Hazardous Drug Exposure

• House Bill 644- passed House, in Senate Health

• An act relating to the handling of hazardous drug to prevent disease & injury caused by exposure

• NCHA appears to have agreed to a bill that is limited to Chemo drugs. end

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2014-What to Expect for Nurses…

• Study Commission recommendations on Nurse Midwife practice legislation

• HB 181 Physician Supervision. Required/nurse Anesthetist still “live” for short session,

• Closer examination of “Scope of Practice” legislation,• For NPs and CRNAs

What to expect in 2014

• Board reviews by program committee, has been very active.

• Could include NCBON

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What We Are Up Against…

• NC Medical Society (Feds and NC)• 26 MD Anesthesia PACs, “underground river of

money”• Dozens of specialty and practice specific MD PACs• Allied Health Disciplines PACs• Well-funded Public Relations Campaigns to protect

“Turf” and manage resources

As Nurses…

• PACs x3• Face to Face Meetings

– 1 encounter has more power than all other relative information

– Live interaction trumps digital in ALL cases

• Get the Right People on Our Side• Show your Passion, share your stories• Stay Informed-Know your Stuff

What’s Next in 2014

•The General Assembly Short Session reconvenes May 14, 2014 to make modifications to the State budget and possibly pass eligible bills that did not pass in 2013.•Governor Mc Crory plans to give Teachers a Pay raise in 2014, but what about other State employees is the question ?•Governor announced a pay increase on January 25, up to 4 percent for State Agency employees in shortage areas and this included 1,200 nurses. ****

•2014 Elections year with 170 House and Senate members up for re-election with the filing deadline of February 10 and close on February 28. 40

What’s Next in 2014

•2014 Short Session will see a fight for House Speaker as Speaker Tillis plans to campaign for US Senate Seat. There are 6-8 House members vying for the job.

•Medicaid budget uncertainty and how much extra funding will be needed in 2014 due to inability of DHHS to track cost implications with their new technology system, NC Tracks.

•Ongoing issues with DHHS management and technology.

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Thank you

• Question and Answers.

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