2011 SINE DIE REPORT MARYLAND GENERAL ASSEMBLY Julia P. Worcester Legislative Consultant The Law Office of J. William Pitcher

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1 2011 SINE DIE REPORT MARYLAND GENERAL ASSEMBLY Julia P. Worcester Legislative Consultant The Law Office of J. William Pitcher Nurse Practitioner Association of Maryland (NPAM) IT S OVER! Happy Sine Die 1 NPAM members! The 2011 Legislative Session of the Maryland General Assembly came to a close at Midnight on Monday, April 11, Now our life, liberty and property are safe for another nine months. Minus a few bumps and bruises along the way, this was a great Session for you and everyone should be pleased with our accomplishments!! Many thanks go to Sandi for her leadership willingness to assist in letter writing, and of course Susan Delean-Botkin, Julie Stanik-Hutt and Lucia Minvielle for their knowledge and expertise throughout session and especially for the committee hearings. Governor O Malley held the traditional sine die bill signing where 163 bills were signed into law. Laws become effective on the date specified at the end of each bill. Three additional bill signings are scheduled for April 25 th, May 10 th and May 19 th, to begin at 10:00am in the Maryland State House. GENERAL ISSUES During the 2011 regular session of the General Assembly, legislators introduced a total of 2, 353 bills (998 from the Senate and 1,355 from the House of Delegates). Seventeen joint resolutions were also considered. By midnight on sine die, April 11 th, the General Assembly had passed 707 bills. Of the passed legislation, 319 were Senate bills and 388 were House bills. The most heavily debated issue of this session was the Same Sex Marriage bill (SB 116, HB 55, and HB 175) which failed in the House after passage in the Senate. This legislation would have made valid a marriage between two individuals who are not otherwise prohibited from marrying. Ironically, legislation that passed will no longer require parties in a divorce action to live apart and without interruption for two years; it has been reduced to 12 months and also repeals the existing law concerning divorce on the ground of voluntary separation of 12 months (HB 402/SB 139). BUDGET ISSUES Due to the economic crisis that not only Maryland, but the entire U.S. is facing, Maryland House and Senate Leadership has continued to review all legislation with a fiscal note of more than $1.00 be reviewed and approved by the Budget Committee Chairs before passing favorably out of the policy committees. This edict drastically slowed down and in many cases killed potential legislation this year. In past years of fiscal instability, fiscal notes of more than $250,000 were typically scrutinized. We expect this new process to continue until the State reaches a position of economic stability in coming years. The General Assembly s 2011 session fiscal package included the $34.1 billion Budget Bill (HB 70), the Budget Reconciliation and Financing Act of 2011 (BRFA) (HB 72) and the Maryland Consolidated Capital Bond Loan of 2001 (HB 71). 1 The term Sine Die from the Latin without a day means without any future date being designated for resumption" or "indefinitely". It is often used with reference to meetings or when an organized body's existence terminates. 1

2 As enacted an effective on the day of passage, the Budget Bill increases spending for Fiscal Year 2012 by 2.6% more ($858 million) than FY The bill reduces general fund expenditures from the amount submitted by the Governor by $453 million, of which $78 million are reductions that were not also incorporated in the Governor s budget proposal, and reduced special fund expenditures by $179 million. Of the general fund reductions, $389.4 million are contingent upon provisions of the BRFA. The enacted budget leaves a general fund balance of $50 million. Among the major aspects of the Budget Bill are: K-12 education aid of $5.8 billion (level funding $6,694 per pupil), Medical Assistance receives $6.9 billion an increase of $840 million more than FY 2011, Stem Cell Research Fund receives $12.4 million, and the Maryland Biotechnology Investment Tax Credit Reserve Fund receives $8 million with an additional $3.8 million for the Maryland Biotech Center. A balanced budget is contingent up changing the allocation of revenue, reducing expenditures, and increasing revenue. The BRFA authorized the transfer of more than $236.7 million from special funds to the general fund and reduced mandated appropriations by $389.4 million. Highlights from the BRFA include: a cap on the Medicaid hospital assessments at 1.25% for averted uncompensated care to pay for the Medicaid expansion. There is also the requirement that $390 million be generated by a combination of assessments and remittances on hospitals and reductions in Medicaid spending. Other BRFA requirements include the increase of the nursing facility quality assessment from 4.0% to 5.5%, the transfer of $60 million in the Transportation Trust Fund revenues to the general fund and $40 million to the Rainy Day Fund plus a requirement for reimbursement to the Trust Fund within 5 years of transfers. The Maryland Consolidated Capital Bond Loan authorizes $949.1 million in state obligation bonds. Among the major projects in the bill: public school construction is allocated $312.4 million including $47.5 million from HB 1213 which increased the sales tax on alcoholic beverages from 6% to 9%. Also, the Federally Qualified Health Centers Grant Program is allocated $2 million in general obligation bonds. NPAM LEGISLATIVE PRIORITIES HB 166/ SB 182: Maryland Health Benefit Exchange Act of 2011 SB 182/HB 166, which establishes the Maryland Health Benefit Exchange ( Exchange ), models the Exchange design promoted by the National Association of Insurance Commissioners (NAIC). The Maryland Exchange is a framework which implements the basic requirements of the Accountable Care Act (ACA) with several exceptions. The Exchange will be an independent government entity until A conversion to a nonprofit will be studied by the Exchange Board of Trustees in the interim. The Board of Trustees is comprised of 9 members: 3 public officials (Secretary of Health and Mental Hygiene; the Insurance Commissioner; The Executive Director of the Maryland Health Care Commission) 3 employer/consumer representatives (appointed by Governor with Advice and Consent of the Senate) 3 with professional expertise (appointed by Governor with Advice and Consent of the Senate) Unlike the original version, the final version of the Exchange legislation creates a formal Advisory Committee that will consist of representatives from a variety of stakeholders including providers, small business owners, and consumers. It also permits any other stakeholder identified by the Exchange as having knowledge or representing interests relevant to the functions and duties of the Exchange to be appointed to the Advisory Committee. In addition, the legislation formally requires the Exchange to meet with and advise the Board of Trustees. The Advisory Committee will provide an opportunity for stakeholders to participate in the decision making processes of the Exchange. HB 1213 / SB 994 Alcohol Tax Outcome: Passed 2

3 The original legislation (HB 121 Lorraine Sheehan Act) was put aside for much of the legislation session while the debate continued as to whether or not to raise the alcohol tax via an excise tax which would greatly affect the distributors and retailers in Maryland. In the final days of session, two new pieces of legislation were introduced that changed the excise tax to an increase in the sales tax from 6% to 9%. As passed, HB 1213 appropriates $47.5 million for public school construction for FY 2012 only. SB 994 appropriates $15 million for the Waiting List Initiative in the Developmental Disabilities Administration (DDA). Under the Maryland Constitution, the General Assembly may increase an appropriation but must do this via separate bills that raise revenue to fund the increased appropriation; a bill may only concern a single appropriation. HB 14, HB 16, & HB 17 Telemedicine Bills HB 14 would require health insurance carriers to reimburse licensed health providers for covered services rendered by telemedicine in a medically underserved area or population. HB 16 would have established a Task Force to study the use of telemedicine in medically underserved populations and areas. HB 17 would have required the Secretary of DHMH to give priority to medically underserved area of the State when using federal funds for medical devices and telemedicine. All three bills failed due to funding issues and timing. The Governor s priority this year was to establish the Health Benefit Exchange and its Governance structure before expanding any other additional health initiatives such a telemedicine. This legislation is expected to return in coming years and will likely receive more support and possible federal matching dollars. Action Item: NPAM should continue to be active in the development of these bills and possible incentives for NPs to be included. OTHER BILLS OF INTEREST HB 82/ SB 203: Health Care Decisions Act - "Medical Orders for Life-Sustaining Treatment" Form This bill repeals provisions of law relating to the Instructions on Current Life-Sustaining Treatment Options form and requires the Department of Health and Mental Hygiene (DHMH), in conjunction with the Maryland Institute for Emergency Medical Services Systems (MIEMSS) and the State Board of Physicians, to develop and periodically revise a Medical Orders for Life-Sustaining Treatment form and instructions for its use. In developing a Medical Orders for Life-Sustaining Treatment form and instructions, DHMH must consult with the Office of the Attorney General, the State Board of Nursing, and the State Advisory Council on Quality Care at the End of Life. The form must be suitable for containing a physician s or nurse practitioner s written medical orders relating to a patient s medical condition, including orders regarding the use of life-sustaining procedures. Health care facilities which include assisted living programs, home health agencies, hospices, hospitals, kidney dialysis centers, and nursing homes are required to accept and update or complete the form as specified by the bill; other health care providers are authorized, but not required, to accept and update or complete the form. A Medical Orders for Life-Sustaining Treatment form containing an order that resuscitation not be attempted must be given the same effect as an emergency medical services do not resuscitate order. The form is not an advance directive. HB 97: Behavioral Health Integration of Mental Health & Addiction Treatment Services SB 567: Health Guidelines for Providing Mental Health Treatment to Individuals with Co-Occurring Disorders Position: Monitor with Interest These bills were not cross filed, but were of such similar nature they are being discussed together. SB 567 would have required DHMH to develop guidelines for the provision of mental health treatment to individuals with co-occurring disorders so that the treatment does not cause additional harm to an individual who also needs treatment for a substance abuse disorder. 3

4 HB 97 would have required DHMH to develop a plan to integrate the provision of mental health treatment and addiction treatment services and also convene a workgroup of stakeholders. SB 567 did not receive a committee vote. HB 97 was withdrawn by the sponsor. HB 570: Health Care Providers Training Eating Disorders Position: Oppose This bill would have codified continuing education credits for specific providers, including physicians, nurses, psychologists, dentists and social workers, to complete course work or training on the early recognition of and intervention for eating disorders. The provider committee testified to the merits of the legislation that would set an unconventional precedent of CE credits in the state statute. The provider committee commented that they are sensitive to the problems of eating disorders with their patients and that they typically receive training in their various degree programs and will proactive seek out additional training when it is offered. HB 730: Task Force to Study Access of Individuals with Mental Illness to Regulated Firearms The language originally called for the regulation of firearms sold to individuals who had been treated within the last 5 years for a mental disorder. The language was strongly opposed by many in the firearm community as well as the mental health community for many reasons including HIPAA concerns and the possibility that individuals would avoid mental health treatment if their private information were to be disclosed to a firearm dealer. The language was altered to create a Task Force to study the subject under the Governor s Office of Crime Control and Prevention. Unfortunately, the bill did not reach passage when it crossed over to the Senate Judicial Proceedings Committee who felt that they did not want to create another Task Force at this juncture. Action Item: NPAM Psychiatric NPs should continue communication during the interim with the GOCCAP and facilitate dialogue on this subject with the Joint Committee on Access to Mental Health Services. HB 736/ SB 722: Electronic Health Records Incentives for Health Care Providers Regulations Position: Monitor This bill is the enabling language for the Maryland Heath Care Commission (MHCC) to allow a state-regulated payor to provide incentives to health care providers to promote the adoption and certain use of electronic health records. While the language of the bill is provider neutral, the Maryland Health Care Commission has stated that the regulations will only apply to primary care physicians at this time as they are following the federal regulations with the same language. Until the program incentives are fully implemented and outcomes measures are tracked, MHCC will restrict the incentive program to primary care physicians. Should the incentive program prove to be a success, HB 736/SB 722 will already be established in statute thus only a regulatory change will be necessary for MHCC to include other providers. Action Item: NPAM should continue to monitor the incentives program on a national level so that Maryland can expand the program to other providers. HB 818: Manufacturers of Prescribed Products Payments to Health Care Practitioners Prohibition Position: Monitor with Concern Outcome: Withdrawn This bill would have prohibited a manufacturer from offering or giving any gift to a health care professional. A violation of the prohibition is subject to existing criminal and civil penalties under the Maryland Food, Drug, and Cosmetic Act. 4

5 Gift means any payment, food, entertainment, travel, subscription, advance, service, or anything else of value provided to a health care professional without fair market value reimbursement. Health care professional is an individual licensed or certified under the Health Occupations Article and authorized to prescribe or recommend prescribed products. Health care professional includes partnerships or corporations composed of health care professionals or an officer, employee, agent, or contractor of health care professionals. Manufacturer means a pharmaceutical, biological product, or medical device manufacturer or any other person engaged in the production, preparation, propagation, compounding, processing, packaging, repackaging, distributing, or labeling of prescribed products. Action Item: This bill was withdrawn, however, DHMH has proactively decided to study this independently during the interim and report back to the Governor and General Assembly by the end of the calendar year. NPAM should take an active role in communicating with DHMH on this study. HB 858/ SB 771: Education - Public Schools and Youth Sports Programs - Concussions This bill will require the Maryland State Department of Education (MSDE) to develop policies and procedures in conjunction with DHMH, the Brain Injury Association of Maryland (BIAM), the Maryland Athletic Trainers Association (MATA), the Maryland Public Secondary Schools Athletic Association (MPSSAA), and the county boards of education and interested providers to implement a statewide concussion management program that includes return-to-play criteria for student athletes. The legislation also requires MSDE to create an informational document on concussion awareness that shall be signed by the parent of guardian of a student who will be playing sports at a public school. This awareness document is also required to be signed for individuals who will be playing sports through local county or municipal youth sports programs that operate on public school grounds. The legislation also requires written clearance by a licensed health provider trained in the evaluation and management of concussions. The bill becomes effective on July 1, 2011 in advance of the upcoming school year. HB 1063/ SB 561: Health Insurance Health Care Providers Payment of Claims for Reimbursement by Carriers Position: Monitor This bill would have altered the language of the statute governing the prompt payment of provider claims for reimbursement and would have expanded the carriers and providers of health care services that are subject to the provisions of the law. While this legislation appeared to be provider-friendly, there was much concern due to the nature of insurance carriers management not only on a state level but more on a national level. In many cases, each carrier operates independently in each state though they are owned and ultimately managed by the national entity. The provider committee was split in their support/interest in this legislation. The committees stated that now is not the time for any sweeping health insurance changes in the midst of implementing the Federal Healthcare Reform Act. HB 1229/ SB 883: Prescription Drug Monitoring Program Position: Monitor with Interest One of the Governor s top priorities this legislative session was to establish a statewide prescription drug monitoring program to monitor the prescribing and dispensing of Schedule II through V controlled dangerous substances. The legislation also establishes an Advisory Board to assist in the design, implementation, and evaluation of the program. The Advisory Board includes 4 physicians and 1 nurse practitioner to be appointed by the Secretary of DHMH. 5

6 The criteria for nomination states that the physicians and nurse practitioner must have expertise in clinical treatment using controlled dangerous substances, including pain management, substance abuse, and behavioral disorders. Note: There is one technical error in the legislation during the course of amendments being drafted and redrafted by committee staff, the wrong nominating information was added to the bill with regard to the nurse practitioner. It states that the nurse practitioner shall be nominated by the Maryland Nurses Association (not NPAM). We have already spoken with MNA who has said they will submit the NPAM nomination on our behalf with the information coming directly from NPAM. We apologize for the error during the final hours of session, but can thank our long term relationship with MNA for working together regardless of the technical error. WRAP UP NPAM s input is very valuable to the legislators and they want to hear from you, the experts, when considering health care legislation. As your lobbyists, we will be your eyes, ears, and advocates on the ground in Annapolis, but nothing compares to your experience as health care providers. So we encourage all of you to come to Annapolis and contact your legislators and tell them how you feel about issues that are important to nurse practitioners and health care in Maryland. Please contact me or Bill, if we can assist you in any legal or lobbying matters. I have been honored to represent your organization for the past four legislative sessions and I look forward to the future of representing this association in many different capacities and possible new legislation in coming years. We are looking forward to an exciting new year in Maryland! Take Care, Julia Julia P. Worcester Legislative Consultant Law Office of J. William Pitcher 27 Maryland Avenue Annapolis, MD Office julia@marylandlobbying.com 6

7 Copyright, 2011 by Julia Worcester and the Law Offices of J. William Pitcher. This material and the work product contained herein may not be distributed, published or reproduced without the express written permission of the author/copyright holder. 7