State of Affairs - May 1

They’re BAAACCKK ….. The IL General Assembly returned to Springfield after their Spring Break in hopes of completing their spring session by May 31st with the passage of a FY16 budget.  The final deadline for third reading of all House bills in the Senate and all Senate bills in the House is May 22nd.

FY15 Budget Cuts dig deeper - Cuts to Medicaid will make up about one-third of the $300 million in spending reductions by Gov. Rauner's office as part of a budget fix for this fiscal year. The annualized cut is 16.75% effective DOS May 1 through June 30.  The cuts will be applied to all physician services except those specific codes or serviced protected by the Memiovski suit. Hospital and mental health services will be exempt from reductions. Details of the cuts to various agencies come about a month after lawmakers approved legislation to close a $1.6 billion budget gap in the FY15 budget.  The governor's budget office has also pointed out that the FY 2015 across the board 2.25 percent cuts weren't producing the originally projected $300 million in savings because the money was simply gone in several agencies, and so they had little choice but to look around for more places to slash.  

There may be some good news. According to Capitol Fax, officials with the General Assembly's Commission on Budget Forecasting and Accountability (COGFA) testified to the Senate Revenue Committee that state revenues for this fiscal year could be $300-500 million higher than expected.  
If that projection holds up it would take serious pressure off the governor's office to make further cuts.  The state has noticed higher than expected revenue, but won't be able to make any final determinations until sometime around the middle of May.

No word yet on how this will impact current negotiations on the FY16 budget beginning July 1.

While Cook-Witter is monitoring more than 220 bills (and all accompanying amendments) for IAFP, approximately 25% are actively being watched, opposed, or supported.  The following are highlighted on our radar:

Spring Into Action Report – An article and photos will appear in the May issue of Family Physician which will also contain many great pictures that captured our 70+ attendees meeting with more than 50 legislators! Here is just a snippet summarizing that week.  Photos are on the IAFP’s Facebook page.

Family medicine stormed the Illinois General Assembly in three consecutive days of Spring Into Action (SIA) advocacy days April 21, 22 and 23.  Several priority bills were in play – on third reading in the Senate - giving IAFP members plenty of topics to talk about at the Capitol.

Quick Stats:
76 total members attended
48 residents
7 medical students
5 Past Presidents
8 Board members and 8 Government Relations members
Visits with 24 State Representatives
Visits with 24 State Senators

Spring Into Action 2015 also included a strong showing from the future of family medicine.  This year more than two-thirds of the participants were residents and students.  Seven different residency programs sent delegations to represent family medicine and develop important advocacy and leadership skills through their Academy.  
IAFP President Janet Albers, MD is also Chair of Family Medicine at SIU School of Medicine and led their delegation of more than 20 residents and faculty on Wednesday, April 22.  The good will of the Academy and the medical school led to a very sincere welcome by Sen. Andy Manar who announced to the Senate that IAFP and SIU were in the senate gallery, which generated a great round of applause.  

“I don't know if I ever really took into consideration how I could help make a difference in medical decision making for laws that directly affect my patient's lives. Now I know,” says SIU Springfield resident Kelly Luciano, MD. “Today was an awesome experience.”

Legislation On the Move – IAFP remains engaged in either supporting or opposing the following bills as they move through the legislative process.  All the fact sheets are on the IAFP Government Relations page

Mandated Hepatitis C screening passed the Senate – SB661 (Sen. Mulroe D-10) – Mandated Hep C Screening passed out of the Senate on April 24th and may be heard in a House Committee as early as May 5th. We have been strong opponents of mandated screening since the bill was first introduced last year and IAFP President Janet Albers, MD testified against it in committee.  In fact, during IAFP’s Spring Into Action, our top priority was to let Senators know of our opposition and share the fact sheet. Of note, the usually apolitical IL Chapter of the American College of Physicians also joined in opposition and is included in the fact sheet.  And most importantly, Donald Lurye, MD was able to secure a quote from a former USPTF member that validates our argument:
“The U.S. Preventive Services Task Force is an independent panel of experts in primary care and prevention who systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. These reviews are published as U.S. Preventive Services Task Force recommendations. The USPSTF recommendation statements present health care providers with information about the evidence behind each recommendation, allowing clinicians to make informed decisions about implementation. The intent of these recommendations is guidance, not to be construed as mandated by law.” Barbara Yawn, MD

Combating this in the House is crucial. We hope this additional information, along with the fiscal impact on the state’s budget if all Medicaid patients in the birth cohort were screened will defeat the bill.

Opioids:  In the wake of a large increase in heroin-related overdose deaths, Rep. Lou Lang (D-16 Skokie) introduced HB1 which creates the Heroin Crisis Act, viewed as the most comprehensive legislation on opioids to date.  Providers have been meeting with other interested parties and the sponsors of this legislation in an attempt to arrive at an agreed upon bill.  Listed below are proposals offered by the Illinois State Medical Society as the lead negotiator as an alternative to various elements of House Amendment #1 to HB 1.  IAFP has offered comments and participated in the negotiations.

1. The clinical director of the PMP shall select no more than five members, three physicians and two pharmacists, of the PMP Advisory Committee to serve as members of the Peer Review Subcommittee. The deliberations, information and communications of the Peer Review Subcommittee are privileged and confidential and shall not be disclosed in any manner except in accordance with current law.
2. The Peer Review Subcommittee shall periodically review the data contained within the PMP to identify those prescribers or dispensers who may be prescribing or dispensing outside the currently accepted standards in the course of their professional practice.
3. The Peer Review Subcommittee may identify prescribers or dispensers who may be prescribing or dispensing outside the currently accepted standards in the course of their professional practice and send the identified prescriber or dispenser a request for information regarding their prescribing or dispensing practices.  This request for information shall be sent via certified mail, return receipt requested.  A prescriber or dispenser shall have 30 days to respond to the request for information.
4. The Peer Review Subcommittee shall refer a prescriber or a dispenser to the IDFPR in the following situations:
a)    If a prescriber or dispenser does not respond to three successive requests for information;
b)    In the opinion of a majority of members of the Peer Review Subcommittee, the prescriber or dispenser does not have a satisfactory explanation for the practices identified by the Peer Review Subcommittee in its request for information; or
c)    Following a request of the Peer Review Subcommittee, the prescriber or dispenser does not sufficiently rectify prescribing or dispensing practices in the opinion of a majority of the members of the Peer Review Subcommittee.

5. The IDFPR may initiate an investigation and discipline in accordance with current laws and rules for any prescriber or dispenser referred by the Peer Review Subcommittee.
6. HB 1 as amended attempts to restrict prescriptions to a 10-day supply of Schedule II controlled substances or allow prescribers to authorize three sequential 30-day prescriptions if the prescriber documents the reason for the longer prescription on the prescription itself.  This documentation, of course, is not possible.  To address this issue the Council recommends that the prescriber be required to document the reason for the three sequential 30-day prescriptions for opioids in the medical record.

The most recent 10-page summary is on the Government Relations page.

APN bill for independent practice – HB421 passed the House after negotiations by the bill’s sponsor (Rep. Feigenholtz D-12 Chicago) brought a compromise with physicians and APNs. The IL Hospital Association was in support of the legislation from the beginning while physician groups were opposed.
The following changes to the Nursing Act are in the agreed bill:

•    Maintain the current requirement that APNs must have a collaborative agreement with a physician if they are practicing outside of a hospital, hospital affiliate or ASTC where they would be required to be credentialed by the medical staff.
•    Make no changes whatsoever to the APN Act with respect to the provision of anesthesia services by CRNAs.
•    Make no changes to the law requiring delegation of prescriptive authority by a physician, but allow APN’s other than CRNA’s to prescribe at a hospital affiliate such as an urgent care center if credentialed by the medical staff to do so.  
•    Eliminate specified content in the collaborative agreement and allow the physician and the APN to more broadly determine their collaborative practice within the specialty area of the APN and the physician.   
•    Eliminate contractual barriers that might prevent APN’s from participating in Medicaid.  
•    Allow for a 90 day transition period when for any reason a physician discontinues a collaborative agreement with an APN.  
•    The proposal would also delete references in approximately 28 different Acts where APNs and physician assistants are allowed to perform various functions only if they are specifically mentioned in the collaborative agreement or the supervisory agreement with physician assistants.

Most written collaborative agreements do not enumerate the particular patient services, but collaborating physicians routinely allow such services to be performed by the APN even though enumeration is required by the law.  Nothing will prevent a physician from including any restrictions on practice or requirements for communication within the collaborative agreement.  The bill is in the Senate now and expected to pass.
Medical Reserve Liability Protection (HB2628 and SB1498) These bills amend the Good Samaritan Act to provide liability protection for Volunteer Medical Reserve Corps members assisting certified local health departments during emergencies that are not declared disasters. Both bills passed their original chamber of origin and are on 2nd Reading respectively in the House and Senate.  IAFP is listed as a supporting organization on the fact sheet.

Smoke-free Illinois Clean Up – HB3531 eliminates confusing/contradictory statutes and requires places of employment to be smoke free, including licensed child care facilities.  The bill passed the House unanimously and is assigned to Public Health in the Senate. IAFP is listed as a supporting organization on the fact sheet.

Health Care Right of Conscience Act (HCRCA) – SB 1564 provides that health care providers can assert religious objections to providing care and information if they have in place protocols designed to ensure that a patient gets the information needed to make an informed medical decision and to obtain needed care. Amendatory language addressed concerns raised by the Illinois State Medical Society, the Catholic Conference of Illinois, and the Illinois Catholic Health Association to the original bill and removes the opposition of those organizations. Furthermore:

•    The Amendment does not change the core purpose of Senate Bill 1564, which is to ensure that patients are given complete and accurate information about their medical conditions, treatment options and where they can get the care they need regardless of their provider’s religious commitments.

•    The Amendment makes clear that providers can still refuse to participate in care to which they object on religious grounds but that they must do so in accordance with protocols that are designed to ensure that such objections to do not harm patients and that set forth procedures to assure that objections will be addressed in a manner that facilitates patient access to care and information.

•    The protocol requirement will create clarity about how conscience-based objections will be addressed in a given health care facility.  This protects both patients and providers by reducing confusion and the attendant delays in accessing health care that are caused by such confusion.  

The bill passed the Senate and is waiting assignment in the House. Numerous IAFP members (both Board and otherwise) expressed their support and advocacy on this issue.  IAFP is listed as a supporting organization on the fact sheet.

Immunizations –  SB1410 (Senate Amendment #1) makes a change in the existing process by creating a Certificate of Religious Exemption. In addition to detailing the grounds for objection by the parent or guardian and the specific immunizations and/or examinations to which they object, as currently required by state statute, the signed certificate would also reflect the parent or legal guardian’s understanding of their school’s exclusion policies in the case of a vaccine preventable disease outbreak or exposure.   The Certificate must be signed by the authorized examining health care provider responsible for the performance of the child’s health examination, confirming that they have provided education to the parent on the benefits of immunization and the health risks to the student and to the community of the communicable diseases for which immunization is required. These recommendations were developed and supported by the Illinois Department of Public Health’s Illinois Immunization Advisory Committee.   

The amended bill passed the Senate and is waiting assignment in the House.  An updated fact sheet is on the Government Relations page. In addition, three resolutions (HR144, HR184 and HJR26) addressing tightening of religious exemptions were adopted in the House.

Funding Restored to the Quitline –  Gov. Rauner zeroed out funding for the IL Tobacco Quitline for the remainder of FY15. IAFP was one of more than 50 organizations to sign a letter to the Governor urging that the funds be restored to help Illinois’ smokers quit, as thousands call the Quitline for assistance. And it worked!  As of April 30th, the funding has been reinstated through June 30th.

Supporting Care and Services for Medicaid -  The IAFP supports high quality care and maintenance of basic essential health services for Medicaid recipients.  As the General Assembly and the Governor deliberate the FY16 budget, it is important to note that primary care is the foundation for cost containment and quality improvement, especially for vulnerable populations. IAFP’s statement shares some proven principles and suggested solutions.

Legislation Held in Committee – IAFP worked with the IL State Medical Society and other providers to oppose the bills below.  In addition, individual IAFP volunteer leaders voiced their opposition and made a difference with their advocacy in keeping these bills at bay for the remainder of this session.
•    SB 1700 proposes the repeal of Part 21 of Article VIII of the Code of Civil Procedure which would have removed all protections long-afforded to physicians and hospitals engaging in peer review, research, and medical studies.  This bill will remain in Senate Judiciary.
•    HB 4032 would place mandates on physicians to disclose anticipated health care costs to the patients, and act as insurance navigators for the patient. This bill was re-referred to House Rules.
•    SB 1601 would amend the Medical Practice Act of 1987and provide for the licensure of naturopathic physicians provides the licensure of naturopathic physicians. This bill was re-referred to Senate Assignments.

Conclusion:  The next GR Update will depend on the General Assembly’s adjournment.  IAFP staff is grateful for the tireless support provided by Cook-Witter, our lobbying firm as we work hard to reflect family medicine’s views and speak on your behalf in Springfield.  It is a privilege representing you.