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1 The 64 th Legislative Assembly started on Tuesday January 6, Article IV, Section 7, of the Constitution of North Dakota limits regular sessions to 80 natural days during a biennium and defines a natural day as a period of 24 consecutive hours. House and Senate Rules 104 provide that a legislative day begins at 7:00 a.m., so each legislative day ends at 7:00 a.m. the following day. Therefore, the 80 th day of this session was set at April 29, However, there were two days where no floor sessions were scheduled and the 80 th day was advanced to May 1, When we started planning for the 64 th Legislative Session our platform established by the legislative committee was: Medicaid Reimbursement o A 4% inflator for all hospital services o Rebasing of RHC s o Maintain current Critical Access Hospital payment system (cost-based) Legislative funding for Hospitals o Infrastructure o Low interest loans o Bad debt Behavioral Health & Substance Abuse When the Governor was putting the Executive Budget together the price of oil was over $90 per barrel. To be on the conservative side OMB used a price of $72 per barrel for the revenue projects. In December when the Legislative Organizational Session was taking place oil was about $60 per barrel and on January 6 th the price of oil was below $45 per barrel. The drop in oil created a short-fall in projected revenues in excess of $4 billion; this was a combination of sales tax revenue and oil production tax revenue. The legislative assembly moved to a very conservative operational mode. What we were told was if it was not in the Executive Budget it was not going to be considered, and if it was in the budget it was going to be reduced. Oil drilling information: The cost of drilling a well and putting it into production is between $7 and $9 million. The sales tax off of one well is between $250,000 and $330,000. In September there were 195 active drilling rigs; on January 8 th there were 166, by the end of January the number was down to 147 and the last I heard the number was fewer than 100 drilling rigs. Each rig supports and estimated 170 jobs. As the Session started there were 11,892 wells producing approximately 1.2 million barrels of oil per day. In the last few days of the session, Leadership in both the House and Senate made statements that no one will be receiving less money than they did in 2013; however, agencies/organizations will not be receiving what they had requested.

2 The 64 th Session ended Sine die on Wednesday April 29 th the 78 th day. Sine die, a Latin phrase going back to 1607 is translated to without day, meaning without any future date being designated. The Session ended without passing the final bill, SB 2022 relating to the North Dakota Employees Retirement System. Information on the Legislative Council s website states that The Legislative Assembly will reconvene pursuant to North Dakota Century Code Sections and at a date determined by the Legislative Management to continue the work of the Sixty-Fourth Legislative Assembly. They need to resolve the differences between the House and Senate regarding the amendments; benefits will not be affected. Overall I would say we did well. Had oil not dropped to under $50 per barrel during the session we would have done better. On a positive note, had the drop in oil come after the session we would be in serious trouble having to make adjustments. Legislative information for the 64 th Session: There were a total of 854 bills introduced, 476 in the House and 378 in the Senate. There were a total of 84 Resolutions introduced, 60 in the House and 24 in the Senate. There were two Memorial Resolutions introduced, one in each chamber. All bills were to be introduced by the end of January. In the House there were 13 new members out of a total of 94 Representatives. In the Senate there were 4 new members out of a total of 47 Senators. Final bill update: Bills monitored by NDHA averaged about 72. During the session some of the bills we were tracking merged into other bills, some were short lived and then there were a couple that were added late in the Session. Highlighted bills: HB 1003: State Board of Higher Education. This bill contains the balance of the money, $62 million, for the Medical School building in Grand Forks as well as the operational costs for all the universities. The funding was approved. HB 1004: The Department of Health bill was passed. It has a budget total of $195,692,644 and includes 365 total employees. HB 1037: Requires the Department of Human Services to report to Legislative Management on the Medicaid and Medicaid Expansion Program. In January of 2017 the State becomes responsible for 5% of the Medicaid Expansion costs. The additional costs in this budget cycle to the State from January to July when our Medicaid Expansion Program sunsets will be upwards of $8.2 million. The legislature wants to know if Medicaid Expansion was a benefit and if the program did reduce uncompensated care to hospitals. There were a number of loan repayment bills: 1. HB 1049: Allocates $200,000 for a revolving loan fund for individuals participating in substance abuse treatment facilities. Governor signed.

3 2. HB 1115: Behavioral health, was amended into HB HB 1282: Provides $200,000 to the Department of Commerce for matching funds for individuals providing health services in rural areas. Governor signed. 4. HB 1396: Funding for State Health Council to provide for a Student Loan Repayment and Physician Loan Repayment program. Governor signed. Details in the bill: Section 6 of the bill establishes payment over the earlier of the full repayment of the health care professional s student loan, or 5 years for the following four professional categories: 1) physicians maximum loan repayment $100,000; 2) clinical psychologists maximum loan repayment $60,000; 3) nurse practitioner, physician assistant, or certified nurse midwife maximum loan repayment $20,000; and 4) behavioral health professionals maximum loan repayment $20,000. Governor signed. 5. HB 1433: Student Loan Repayment grants for high-demand occupations. This bill failed in the House. HB 1286: Medical facility infrastructure loan program was killed. Amendments were added to HB 1443 then moved to HB 1014, the State Industrial Commission. The Bank of North Dakota created a Medical PACE program for Critical Access Hospitals. The Bank will buy the interest down to 1 ½ % on a maximum of $7 million. HB 1323: Provides for the creation of a stroke system. Governor signed. HB 1376: Provides political sub-divisions the authority to donate funds to a non-profit health care facility for construction projects. Governor signed. HB 1401: Sales and use tax exemption for purchases made by a contractor or sub-contractor on behalf of an exempt entity. Bill was converted into a study. Governor signed. HB 1458: Requested grants to offset bad debt. This bill was killed and an amendment, Section 4, was added to HB Section 4 provides $10 million in the biennium for uncompensated care to Critical Access Hospitals in oil producing counties and contiguous counties. SB 2012: Is the Department of Human Service s budget which includes a 3% inflator for each year of the biennium for medical services. This bill is huge; it is 12.8% over the current expenditures and totals $3,515,609,581 for the biennium. Each 1% equates to $22,607,673; this breaks down to $12,175,326 general fund money and $10,432,347 federal. Hospitals will receive $9,822,507 and physicians will receive $5,502,903. A majority of the dollars will go to Long Term Care. Behavioral Health bills include: 1. HB 1040: Under rules adopted by the department, screening of an individual to a public treatment facility for observation, diagnosis, care, or treatment for mental illness or chemical dependency must be performed, in person, whenever reasonably practicable, by a regional human service center. This screening must be performed in the region where the individual is physically located. Governor signed.

4 2. HB 1272: During the interim, the University of North Dakota School of Medicine and Health Sciences Advisory Council shall use the resources of the University of North Dakota School of Medicine and Health Sciences Center for rural health to study the feasibility and desirability of licensing medical psychologists. Bill failed. 3. SB 2046: Beginning January 1, 2016, the Department of Human Services shall allow licensed marriage and family therapists to enroll and be eligible for payment for behavioral health services provided to recipients of medical assistance, subject to limitations and exclusions the department determines necessary. Governor signed 4. SB 2047: The Department of Human Services shall issue a license for the operation of a psychiatric residential treatment facility for children upon showing that all criteria have been met. Governor signed 5. SB 2048: Relating to teacher licensure requirements and mental health training provided by school districts; to provide appropriations to the Department of Human Services for improving behavioral health services and for substance abuse treatment services. Governor signed. 6. SB 2049: During the interim, the Department of Human Services, in consultation with the State Department of Health and other stakeholders, shall study statutory references to mental health professionals to determine whether changes in the law may help to more fully utilize these professionals within their scope of practice, as it relates to the responsibilities of the Department of Human Services to provide services or license facilities. In addition, the Department of Human Services shall study statutory language and report recommended changes in alignment with the most current professional standard or with most current diagnostic and statistical manual. Governor signed. SB 2236: This bill addresses the regulation and licensure of technical personnel who perform medical imaging and radiation therapy treatments. One of the issues presented was with Medicare reimbursement. If the State did not have this language in statute hospitals could not be reimbursed for services order in these areas. Governor signed. There were a number of bills that addressed drugs: 1. HB 1039: Relating to insurance coverage of substance abuse. Failed. 2. HB 1072: Relating to coverage of cancer treatment medications. Governor signed. 3. HB 1149: Relating to administrative rules governing the monitoring of prescription drugs. Governor signed. 4. HB 1430: Legalizing the use of medical marijuana. Failed 5. SB 2060: Worker s compensation coverage of chronic opioid therapy. Governor signed. 6. SB 2086: Drugs provided by outsourcing facilities. Governor signed. 7. SB 2100: Scheduling of controlled substances. Governor signed. 8. SB 2104: Immunity from liability related to opioid antagonists and limited prescriptive authority for Naloxone rescue kits. Governor signed.

5 There were three bills we were opposed to: 1. HB 1241: This was a Natural Resource bill that dealt with hunting and imbedded in the bill was a restriction that forbids health care personnel from asking if a person owned or had access to a firearm. I heard from behavioral health workers and emergency room staff that this was not a good practice. Working with the North Dakota Medical Association, we had Section 4 removed from the bill. 2. HB 1279: This was a bill presented by AARP to require all hospitals, within 24 hours of admission and upon discharge, to identify in the medical records a care taker who would continue with care as designated in the medical record after the patient left the hospital. This bill would have created additional liability to hospitals beyond their control. Hospitals already have discharge planners who provide education and coordinate care upon discharge. We opposed the bill from the stand point that this would be an unfunded mandate; the bill would create an additional expense and would create additional liability. The bill was turned into a study. 3. HB 1370: This bill did pass. Language from the bill: a. As used in this section, the term "facility" means a hospital, outpatient department, clinic, radiology practice, mobile unit, or office of a physician or other facility as determined by the state department of health, which conducts breast cancer screening or diagnosis through mammography activities. b. If a facility at which a mammography examination is performed categorizes a patient as having heterogeneously dense breasts or extremely dense breasts based on a breast imaging reporting and data system approved by the state department of health, such as the system established by the American College of Radiology, the facility shall include in the summary of the written report that is sent to the patient a notice that the patient has dense breast tissue, that this dense breast tissue may make it more difficult to detect cancer on a mammogram, and that this dense breast tissue may increase the patient's risk of breast cancer. c. The North Dakota Department of Health shall notify all registered owners of mammography equipment of these changes, along with the State Board of Medical Examiners, the North Dakota Medical Association, the North Dakota Board of Nursing, and the North Dakota Nursing Association. The North Dakota Department of Health shall encourage these boards to include information about these changes in the next publication of their professional journals.

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