67th Legislative Assembly in Action Past Week Activity

67th Legislative Assembly in Action Past Week Activity

 

QUICK LINK REFERENCE:

JANUARY 11 - 15

JANUARY 18 - 22

JANUARY 25 - 29

FEBRUARY 1 - 5

FEBRUARY 8 - 12

FEBRUARY 15 - 19

FEBRUARY 22 - 26 - CROSSOVER

NDMA Legislative Highlights

Week of February 15-19

It has been an aggressive week on both the House and Senate floors as legislators scramble to meet the crossover deadline of Friday, February 26th. The Senate is expected to get through bills by mid-week, with the House expecting to take the full week.

It's important to know that bills that get a PASS will transition to the next half of the second half of the session. Bills that are DEFEATED are no longer considered and are officially dead.

Although this summary is not inclusive, some of this week's priorities included:

SB 2331 Relating to election of the state health officer and human services commissioner.

NDMA opposed SB 2331 - a bill that would make the state health officer an elected position. Making the health officer position elected, rather than appointed, changes the essence of the role of a physician.

Many physicians who would be excellent health officers may not have political interests, experience or skills. Public health, like other health professions, requires a life-time commitment and focus to acquire and maintain expertise. Having to engage in the politics of elections would greatly detract from the time required to focus on the ever­changing science of public health.

Furthermore, concepts of election and constituency have the potential to sway focus away from medical expertise and best-practice.

NDMA OPPOSED this bill, which was successfully DEFEATED on the Senate floor (YEAS 3, NAYS 44).

SB 2224 Relating to medical assistance coverage of metabolic supplements.

NDMA supported HB 2224 - a bill the provides reimbursement for metabolic supplements by North Dakota Medicaid.

NDMA Executive Director Courtney Koebele serves on the the subcommittee of the Medicaid Medical Advisory Committee (MMAC), which offers recommendations for Medicaid coverage. The subcommittee established a scoring process to determine need and found that coverage for metabolic supplements scored high as they are life sustaining.

NDMA SUPPORTED this bill, which successfully PASSED on the Senate floor (YEAS 46, NAYS 1).

SB 2179 Relating to health insurance coverage of telehealth: payment parity.

NDMA along with some of its partners supported efforts for telehealth payment parity; however, because of opposition from health insurance companies as well as the North Dakota Insurance Commission, this bill was amended and reduced to a mandatory study.

Payment parity – or equal reimbursement rates - would ensure patients have increased access to timely, value-based, and integrated care, especially for rural and underserved communities throughout the state. Under current law, health plans reimburse telehealth services 20% to 40% lower than in-person services.

Although the bill was amended, NDMA SUPPORTED this bill, which PASSED on the Senate floor (YEAS 44, NAYS 3) - This provides an opportunity for NDMA and its partners to continue pushing forward by encouraging amendment action to bring it back to coverage.

SB 2284 Pediatric prescribing of medical marijuana.

Another bill successfully defeated this week was SB 2284 - a bill that would have expanded medical marijuana pediatric use to include cannabis in a combustible form.

Though anecdotal accounts have shown that certain cannabinoids could benefit children with certain chronic debilitating diseases, there are no published studies on the effects on cannabinoids on the pediatric population.

NDMA OPPOSED the bill, which was successfully defeated on the Senate floor (YEAS 0, NAYS 47).

HB 1472 Relating to unlicensed, certified or registered alternative health care practitioner: not in violation of a law for services.

Another bill successfully defeated this week was HB 1472, which would have allowed alternative medicine practitioners to engage in treatment. Alternative health care is largely based on natural products and how they interact with and heal your body. Much of alternative medicine isn’t approved by the U.S. Food and Drug Administration.

NDMA OPPOSSED the bill, which was successfully defeated on the House floor (YEAS 16, NAYS 72).

Week of February 8-12

The battle of the bills has been intense as legislators push to address the remaining bills during the next two weeks to crossover. Monday, February 15th marks the twenty-eighth day of the session leaving only 10 days of work to the February 26 crossover deadline.

Although this summary is not inclusive, some of this week's priorities included:

Tobacco bills

As in previous years, bills have come forward to increase the tobacco tax. NDMA supports efforts to increase tobacco taxes, based on the 2013 resolution that sites increasing the price of tobacco is a proven way to prevent youth tobacco initiation, encourage a reduction of adult tobacco use, reduce health care costs and provide an overall benefit to public health.

As in previous years, these bills failed to pass in spite of support from many health-related entities: NDMA, NDHA, Sanford Health and more.  

HB 1403 Relating to an increase in the tax on cigarettes; and to provide an effective date. Increase on cigarettes from seventeen to seventy-two mills. FAILED (YEAS 25, NAYS 66)

HB 1422 Relating to the tax imposed on cigarettes and tobacco products; and to provide an effective date. Increase from twenty-eight to ninety-two percent of wholesale purchase price; snuff from sixty cents to one dollar and ninety-six cents; chewing tobacco sixteen cents to fifty-two cents. Removes transfer to state general fund and creates a community health trust fund. FAILED (YEAS 33, NAYS 58)

HB 1205 Relating to establishing the maternal mortality review committee and to provide for a continuing appropriation.

HB 1205 is a priority bill for NDMA. The bill establishes a maternal mortality review committee along with an appropriation. In January, Dr. Tom Arnold of the North Dakota Maternal Mortality Review Committee (MMRC) and the Vice Chair of the University of North Dakota School of Medicine and Health Sciences Department of Obstetrics and Gynecology provided testimony in support of the bill.

Dr. Arnold testified that the existing ability of the ND MMRC to investigate the cause of these type of maternal deaths is less than optimal and outlined how the proposed changes would enhance the committee's ability to reduce future maternal mortality.

NDMA SUPPORTED this bill, which successfully PASSED on the House floor (YEAS 93, NAYS 1)

SB 2274 Relating to the scope of practice of a naturopath; authorizes naturopaths to prescribe, dispense or administer prescription drugs.

A bill that was successfully defeated in two prior legislative sessions - 2015 and 2017 - has once again surfaced for this session. The bill allows naturopaths to prescribe legend medications and testosterone.

NDMA OPPOSES the bill for the following reasons:

  • Naturopaths are not trained to prescribe medications safely and effectively. Patients can easily be misled into thinking that an ND (naturopathic doctor) license is the same as an MD, especially if naturopaths are allowed to prescribe medicine without sufficient medical training.
  • Naturopath education is fundamentally different from a NP, PA, and dentists in that they don’t follow the medical model. They use numerous unproven therapies, diagnose illnesses not accepted by the medical mainstream, and don’t have the same patient encounters in training and lack oversight. Pharmacology classes aren’t a barometer for the ability to prescribe meds.
  • Furthermore, the naturopath licensing board is not equipped to regulate prescribers. This bill would allow them to do this without supervision.

Senate legislators were met with a great deal of force from naturopaths as legislators were bombarded with email messages asking for naturopath prescribing privileges.

NDMA and many members provided testimony in OPPOSITION; however the bill PASSED on the Senate floor on Thursday, February 11th with 31 yeas and 16 nays.

SB 2284 Pediatric prescribing of medical marijuana.

Another hearing on Monday dealt with pediatric medical marijuana use. The bill is proposing to expand pediatric use to include cannabis in a combustible form. NDMA believes in using the usual Food and Drug Administration process instead of medical marijuana laws. Though anecdotal accounts have shown that certain cannabinoids could benefit children with certain chronic debilitating diseases, there are no published studies on the effects on cannabinoids on the pediatric population.

NDMA testified in OPPOSITION to the bill. The bill is still in committee.


WEEK OF FEBRUARY 1-5

Monday, February 8th marks the twenty-third day of North Dakota's 2021 67th Legislative Session leaving only 15 days of work to get to crossover, which is February 26. To make the time frame even tighter, committees have only 12 working days - until February 23 - to review and vote on the remaining bills.

The lengthy list of bills being tracked by NDMA is narrowing, as this week many of the bills being tracked had met their fate on the floor - take a look at this weeks summary:

VACCINE BILLS


If you've been following the session closely, it is obvious to see that the pandemic has brought vaccine issues into the limelight. On Thursday, February 4th, six vaccine priority bills were heard on the House floor resulting in all six bills failing.

With the exception of HB 1469, NDMA OPPOSED all vaccine bills, since many interfered with patient care and went against the standard of practice for recommending vaccines. Here is the summary:

HB 1468 Relating to informed consent and notice of risks associated with vaccines. When providing immunizations, the vaccine information statements and exemption information must be provided. Upon request, the package inserts must be provided: FAILED (YEAS 46, NAYS 47)

HB 1377 Relating to immunization exemptions. Creates vaccine safety standards at an unreasonable level; eliminates vaccine requirements for school age children and health care institutions; requires posting vaccine injuries by ND Dept. of Health: FAILED (YEAS 21, NAYS 72)

HB 1469 Relating to exemptions from vaccine requirements before admission to school. Creates an allowance to present a state dept. of health immunization exemption form and develop an online vaccination education module; rules will be adopted by the ND Health Council: FAILED (YEAS 14, NAYS 80)

HB 1306 Interrelationship between sudden infant death syndrome, vaccines, and autism. A bill to provide a legislative management study of the interrelationship between sudden infant death syndrome, vaccines, and autism spectrum disorder in children: FAILED (YEAS 11, NAYS 82)

HB 1307 A bill for an act to prohibit public accommodations from refusing services to an individual because the individual has not been vaccinated; and to provide a penalty. Public accommodation may not refuse service for failure to vaccinate: FAILED (YEAS 24, NAYS 68)

HB 1320 Relating to limitations on vaccinations requirements. A state or local elected official, the state, or a political subdivision of the state may not mandate an individual in this state receive a vaccination including for school or daycare: FAILED (YEAS 8, NAYS 84)

Many of the vaccine bills opposed by NDMA would not make good policy for these reasons:
  • Bills dictated how healthcare providers must practice and is an overreach of government into the practice of medicine.
  • Healthcare providers recommend vaccines for patients; they do not force patients to be vaccinated.
  • The federal government already requires informed consent for vaccination through the use of the Vaccine Information Statement.
  • Package inserts are readily available online, yet many providers will provide the package insert, when asked, without hesitation. Requiring healthcare providers to provide them to patients who request them is not needed.
  • Requiring healthcare providers to mention exemptions goes against the standard of practice for recommending vaccines.
  • Certain vaccines are recommended for pregnant women. The safety of vaccines during pregnancy has been studied.
 

SB 2274 RELATING TO THE SCOPE OF PRACTICE OF A NATUROPATH; AUTHORIZES NATUROPATHS TO PRESCRIBE, DISPENSE OR ADMINISTER PRESCRIPTION DRUGS.

Monday kept NDMA juggling between hearings. SB 2274 - which would allow naturopaths to prescribe prescription drugs - was met with a great deal of testimony both in support and opposition.

NDMA spoke in opposition of SB 2274.

In addition to NDMA Executive Director Courtney Koebele providing testimony, NDMA Members present and providing opposition testimony were Dr. Parag Kumar, Dr. Gabriela Balf-Soran, and Dr. Michael Quast.

NDMA supports licensure of professions within the scope of their training and to do so otherwise endangers the safety of patients. NDMA takes the position that naturopaths are not adequately trained to prescribe.

ACTION: URGE A DO NOT PASS

This bill is still in committee - NDMA urges you to contact the Senate Human Services Committee and request a DO NOT PASS. You can find contact information here.

SB 2334 RELATING TO THE LICENSURE OF EXTENDED STAY CENTERS.

As surgical techniques improve, surgery centers move toward increasingly complex procedures in patients that require longer recovery times. This bill allows surgery centers to keep patients for up to 48 hours.

There is a continuing trend shifting from inpatient to outpatient procedures, and the extended care center model allows for parallel care in a safe setting.

NDMA provided testimony and SUPPORTED this bill, which successfully PASSED on the Senate floor on Thursday, February 4 with 44 yeas, and 3 nays.

HB 1415 RELATING TO END-OF-LIFE HEALTH CARE DECISIONS; AND TO PROVIDE A PENALTY. 

Another hearing on Monday dealt with physician assisted suicide. In 2017, the NDMA House of Delegates adopted a resolution formally adopting the position against physician-assisted suicide and euthanasia stating this act is fundamentally incompatible with the physician’s role as healer.

In adopting this position, NDMA determined that allowing physicians to engage in either would ultimately cause more harm than good, sending a message that suicide or euthanasia is a socially acceptable response to aging, terminal illness, disabilities, depression, and financial burdens.

NDMA testified in OPPOSITION to the bill. The bill is still in committee.

HB 1472 RELATING TO COMPLEMENTARY AND ALTERNATIVE HEALTH CARE; A NOT LICENSED, CERTIFIED OR REGISTERED AS A HEALTH CARE PROFESSIONAL OR PRACTITIONER IS NOT IN VIOLATION OF A LAW FOR PROVISION OF SERVICES.

Another bill addressed this week was HB 1472 which would allow alternative medicine practitioners to engage in treatment. Alternative health care is largely based on natural products and how they interact with and heal your body. Much of alternative medicine isn’t approved by the U.S. Food and Drug Administration.

NDMA provided testimony in OPPOSITION to HB 1472. This bill is still in committee.
 

SB 2205 RELATING TO MEDICAID MEDICAL ASSISTANCE COVERAGE OF INTERPRETER SERVICES.

SB 2205 - coverage for Medicaid medical assistance of interpreter services - is essential to the safety, health and wellbeing for the patients that do not speak English or have hearing impairments.  Although professional providers and community agencies are legally and ethically required to provide interpreter services for their patients, currently there is no direct cost reimbursement for this service provision.  This becomes a significant barrier for smaller clinics and rural portions of the state in order to provide appropriate care to all.  Without this reimbursement, access to basic medical, dental and mental health care could be severely compromised in our state.  

NDMA provided testimony in SUPPORT of this bill, which successfully PASSED on the Senate floor on Wednesday, February 3 with 42 yeas, and 5 nays.
 

HB 1465 RELATING TO FREEDOM OF CHOICE FOR HEALTH CARE SERVICES.

NDMA supports HB 1465 which provides that an insurer may not deliver, issue, execute, or renew a policy if that policy denies a health care provider the right to participate as a participating provider for any policy on the same terms and conditions as are offered to any other provider of health care services under the policy. Similar legislation has been enacted in several states. This legislation supports the idea that any provider willing to meet reasonable standards of care and quality set by the insurance plan should be able to care for the plan's beneficiaries.

NDMA provided testimony in SUPPORT of this bill. The bill is still in committee.


Week of January 25 - 29

Monday, February 1st marks the eighteenth day of North Dakota's 2021 67th Legislative Session and NDMA is extremely busy tracking 185 bills. Typically, we track roughly 150 bills each session, but this year's anomaly has brought an increase in requests - many of which are the result of the pandemic.

NDMA encourages you to take a look at the NDMA BILL TRACKER and familiarize yourselves with what we are up against. This session is proving to be eventful in several areas. When it comes to marijuana, there are six bills to contend with - and one bill - HB 1420 is proposing is legalize recreational marijuana. Some priority Medicaid bills include SB 2205 - requesting coverage of interpreter services; HB 1288 requests coverage of continuous glucose monitors; and SB 2224 requests coverage of metabolic supplements.

Following are some of this weeks highlights:

SB 2224 Relating to medical assistance coverage of metabolic supplements

On Monday, January 25, NDMA Executive Director Courtney Koebele testified on the importance of Medicaid coverage for children needing metabolic supplements. Ms. Koebele serves on the the subcommittee of the Medicaid Medical Advisory Committee (MMAC), which offers recommendations for Medicaid coverage. The subcommittee established a scoring process to determine need and found that coverage for metabolic supplements scored high as they are life sustaining.
 

SB 2205 Relating to Medicaid and medical assistance coverage of interpreter services



Gabriela Balf-Soran, MD

Anne Keating, MD

Another bill heard on Monday was SB 2205. Dr. Gabriela Balf-Soran and Dr. Anne Keating testified in support of the bill as well as NDMA Executive Director Courtney Koebele.

Koebele, Keating and Balf-Soran all testified that service is essential to the safety, health and wellbeing for patients that do not speak English or have hearing impairments. Although professional providers and community agencies are legally and ethically required to provide interpreter services for their patients, currently there is no direct cost reimbursement for this service provision.

This becomes a significant barrier for smaller clinics and rural portions of the state in order to provide appropriate care to all. Without this reimbursement, access to basic medical, dental and mental health care could be severely compromised in our state. Not only does the provider receive no reimbursement, but many times it costs them to see Medicaid patients that require interpretation services.

HB 1205 Relating to establishing the maternal mortality review committee

Tom Arnold, MD
Representative Vicky Steiner

Another hearing on Monday dealt with HB 1205 -establishing the maternal mortality review committee and to provide a continuing appropriation.

Dr. Tom Arnold, Chair of the North Dakota Maternal Mortality Review Committee (MMRC) and the Vice Chair of the University of North Dakota School of Medicine and Health Sciences Department of Obstetrics and Gynecology provided testimony in support of the bill. He testified that the existing ability of the ND MMRC to investigate the cause of these type of maternal deaths is less than optimal. He outlined how the proposed changes would enhance the committee's ability to reduce future maternal mortality in North Dakota by enhancing the ability to identify, explain, and categorize maternal deaths, which would initiate corrective measures to reduce maternal mortality.

Vaccine Bills

NDMA President Misty Anderson, DO

As we had mentioned in last week's update, there are at least eight bills that impact vaccines - some of which have the potential to undo North Dakota's progress on protecting children from being subjected to a lifetime of debilitating disease.

Three bills were heard this week. NDMA testified against HB 1377 and HB 1468, and testified in support of HB 1469. 

HB 1377 Relating to immunization exemptions. This bill creates vaccine safety standards at an unreasonable level; eliminates vaccine requirements for school age children and health care institutions; requires posting vaccine injuries by ND Dept. of Health.

HB 1468 Relating to informed consent and notice of risks associated with vaccines. Requires the whole package insert to be given to patients; does not allow for vaccine mandates; repeals sec.23-07-17.1 of NDCC as it relates to tuberculosis treatment and care.

HB 1469 Relating to exemptions from vaccine requirements before admission to school; and to provide an appropriation. NDCC reference to 23-07-16.1 which adds advanced practice registered nurse, or physician assistant; also makes allowances to present a state dept. of health immunization exemption form and develop an online vaccination education module; rules will be adopted by the ND Health Council.

Three bills were heard last week:

HB 1306 Interrelationship between sudden infant death syndrome, vaccines, and autism. A bill for an act to provide for a legislative management study of the interrelationship between sudden infant death syndrome, vaccines, and autism spectrum disorder in children.

HB 1307 A bill for an act to prohibit public accommodations from refusing services to an individual because the individual has not been vaccinated; and to provide a penalty. Public accommodation may not refuse service for failure to vaccinate.

HB 1320 Relating to limitations on vaccinations requirements. A state or local elected official, the state, or a political subdivision of the state may not mandate an individual in this state receive a vaccination including for school or daycare.

All of these bills are still in the House Human Services Committee, but we expect them to be voted on next week. Watch for an action alert for when the vote will occur so you can urge a DO NOT PASS on these bills.


Week of January 18 - 22

NDMA encourages you to take a look at our NDMA BILL TRACKER and familiarize yourselves with what we are up against. This session is proving to be eventful in the vaccine area, as there are seven bills that we are paying attention towards. One bill in particular is concerning - HB 1468. This bill is a very concerning interference between the physician/patient relationship and dictates how physicians must practice. The bill requires detailed informed consent that MUST mention exemptions and offer the exemption form. Physicians MUST talk about vaccine safety studies in pregnant women with a witness present. Anyone who deviates from the requirements will be guilty of an infraction.

Many more intense weeks are sure to follow, as the session is expected to continue for 80 days, scheduled to convene on April 30th.

Following are some of this weeks highlights:


HB 1139 - Relating to Workforce Safety & Insurance (WSI) Opioid Therapy.




On Monday, January 18, Dr. Michael Booth provided testimony to the House Industry Business and Labor Committee in opposition to the proposed bill relating to duration limits for opioid therapy and termination of coverage of WSI.

Dr. Booth testified that stating that rather than imposing arbitrary statutory limits on opioid and benzodiazepine prescriptions, WSI - empowered through its existing formulary and case review program - should develop guidelines for the use and regulation of these medications, with appropriate input from medical professionals.

Prior authorization and PDMP reviews can and should be put in place to identify potential situations where diversion of drugs may be happening. These measures may also be used to encourage providers to consider alternate pain management strategies to hopefully steer patients away from courses of treatment that might be more likely to eventuate in addiction or abuse.

For the record, a similar bill was defeated in 2019 during the 66th legislative session by the good work done by NDMA member Dr. Booth.

In spite of our efforts, this bill received a 'do not pass' recommendation from the House Human Services Committee.


HB 1320  Relating to Limitations on Vaccinations Requirements.




On Tuesday, January 19 HB 1320 was heard in front of the House Human Services Committee. Dr. Paul Carson and NDMA, along with others provided testimony in opposition to the bill. The bill would remove immunization requirements for entry to school or day care.

Dr. Carson testified that it is imperative that North Dakota continues to require immunizations for school entry. Vaccines protect those being vaccinated, and very importantly, also protect children who cannot be vaccinated. Vaccines prevent disease from spreading in schools and daycares. If immunization requirements are removed for school and daycare entry, North Dakota would become the only state in the country that doesn’t require immunizations for school.


SB 2179 Relating to Health Insurance Coverage of Telehealth: Payment Parity.

On Wednesday, January 20, NDMA along with some its partners provided support testimony on SB 2179 to the House Human Services Committee. This bill requires health plans to reimburse providers for all covered telehealth services delivered to patients at reimbursement rates not less than in-person services.

Due to the pandemic, increased flexibilities and broader insurance coverage for telehealth services made it possible for health care professionals to continue treating patients and increase access to care.

  • Payment parity – or equal reimbursement rates - would ensure patients have increased access to timely, value-based, and integrated care, especially for rural and underserved communities throughout the state. Under current law, health plans reimburse telehealth services 20% to 40% lower than in-person services.

While telehealth cannot replace all patient care, the extension of telehealth benefits in recent months has rapidly changed the way health care professionals see patients. The advancements provided a push for innovation that now allow health care providers to safely increase access to high quality care, particularly in the rural health care setting.

A list of 16 organizations signed onto a letter in support of telehealth payment parity; those organizations include: ND Psychiatric Society, Essentia Health, CHI St. Alexius, Trinity Health, Altru Health, Mid Dakota Clinic, The Bone and Joint Center, ND Academy of Physician Assistants, Physical Therapy Association of North Dakota, ND Federation of Families for Children’s Mental Health, Mental Health America of North Dakota, the Mental Health Advocacy Network and NDMA.

Together, this group supports telehealth payment parity legislation that will require health plans to reimburse providers for covered telehealth services delivered to patients at reimbursement rates not less than in-person services.

 

Week of January 11-15
SB 2060 Sports Physicals.
On Monday, January 11, Dr. Parag Kumar and Dr. Dawn Mattern testified against SB 2060.

Section 12 of SB 2060 would allow chiropractors to conduct sports physicals. The North Dakota High School Activities Association (NDHSAA) by-laws provide for MD/DO/NP/PA right now. However, if this bill passes, the chiropractors could petition the NDHSAA to conduct sports physicals.

Dr. Kumar testified that NDMA members are concerned that many adolescent medical issues could be missed if the preparticipation physical is not conducted by a physician or other qualified medical provider. He educated the committee that a good preparticipation physical includes screening for heart disease and performing a cardiovascular exam, screening for neurologic, musculoskeletal and genetic disorders that may affect an athlete’s ability to safely participate in sports.

The bill is still in committee, but will likely be voted on next week. Because chiropractors may conduct FAA and DOT physicals, the committee found their request to be reasonable. NDMA is working very hard to sway that opinion.

 

SB 2004 ND Dept. of Health Budget.
On Thursday, January 14, NDMA submitted written testimony on the ND Department of Health budget, urging the appropriations committee to include medical student loan repayment for the next biennium.

The state needs to continue this program to support our healthcare workforce.

As of June 2020, about 94% of counties in North Dakota are fully or partially designated as health professional shortage areas for primary care. Without continued funding for new slots to be awarded to physicians, there will not be any incentives to offer in recruiting physicians in our rural and defined health professional shortage areas and physician shortages will remain in underserved areas. 66% of physicians that received student loan repayment have stayed in the state after their contracts were concluded.
 

Sorry no Tweets at this time

Follow Us!