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Ohio ACEP convenes emergency meeting with Ohio Medicaid | New law requires OARRS registration before opioid prescribing
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In this issue
A Message From Ohio ACEP's Government Affairs Co-Chairs
State Begins Enforcement of Medicaid Policy
131st Ohio General Assembly Begins
Leadership Selected for the 131st Ohio General Assembly
House Health Committee Members for 131st General Assembly Selected
New Law Requires OARRS Registration, Checks Before Opioid Prescribing
130th General Assembly Adjourns; Business Left Unfinished
Extension of “I’m Sorry” Law Fails to Pass Senate During Lame Duck Session
Bill to Allow Ohioans to Set Off Fireworks Fails to Pass
GCOAT Gears Up to Create Another Set of Prescribing Guidelines
Trauma Board Proposal Update
Youth Athlete Concussion Update
Save the Date for April 21!
The Ohio ACEP Emergency Medicine Leadership Forum
Policy News & Opinion
Do You Know Your State Legislators?
Ohio ACEP engages with legislators all over the state—but there is just no substitute for the words, “I am a resident of your district, and I think…”

So find out who your State Representative and Senator are—it’s as easy as entering your ZIP Code!
Easy Advocacy Tip
Find your legislators on social media! 

It's a great way to stay up to date on state government and what your legislators are working on!
Policy News & Opinion
Increase in Ohio emergency room visits closely watched in wake of Affordable Care Act
ABC Newsnet 5 Cleveland
December 30, 2014

Even with Obamacare, patients will turn to the ER
By ACEP National President, Dr. Michael Gerardi, for The The Los Angeles Times
January 8, 2015

End of Medicaid fee bump could hurt patient access to doctors
Dayton Daily News
January 11, 2015

Study: Medicaid expansion boosts kids' incomes and government tax revenue
Vox
January 12, 2015

DeWine may sue feds over Obamacare tax on state, local governments
The Columbus Dispatch
January 14, 2015

The Costs of Stinginess in Medicaid
The New York Times
January 14, 2015

Centers for Medicare & Medicaid Services Releases Fee Schedule for 2015
ACEP Now
January 15, 2015

Medicaid Pay Hike Opened Doors For Patients, Study Finds
Kaiser Health News
January 21, 2015

High Court Considers If Providers Can Sue States For Higher Medicaid Pay
Kaiser Health News
January 21, 2015

Disneyland measles outbreak raises question of vaccine exemptions
USA Today
January 23, 2015

Obamacare 2.0: the White House's radical new plan to change how doctors get paid
Vox
January 26, 2015

Budget Office Slashes Estimated Cost of Health Coverage
The New York Times
January 26, 2015

Ohio House Speaker Cliff Rosenberger says he won't press to repeal Medicaid expansion
Cleveland Plain Dealer
January 26, 2015
Welcome to the First Issue of the Ohio ACEP Advocacy Update!
From Government Affairs Co-chairs, Brad Raetzke, MD, FACEP, and Matthew Sanders, DO, FACEP
Thanks for checking out the inaugural edition of the Ohio ACEP Advocacy Update! 

Time and again, our members tell us that one of the most important aspects of what Ohio ACEP does is advocacy—looking out for the best interests of Ohio’s emergency physicians with respect to legislation and regulatory policies affecting our members. 

So, in an effort to keep our members up-to-date on our advocacy activities, we launched this monthly update, a rundown of what we’ve been working on, how it affects you, and what’s on the horizon. Our goal is to make the Update accessible, relevant, and—whenever possible—free of “politico speak.” 

And what better time to begin our Advocacy Update than the beginning of a new session of the Ohio General Assembly? After a flurry of activity between the November elections and the end of the legislative session in December—known as the “Lame Duck Session”—the reelected and newly elected members of the Ohio House and Senate have been sworn in, elected their new leadership, and begun the new legislative session, the 131st General Assembly.

The 131st General Assembly is expected to be as busy as the 130th. The legislature will spend much of the first half of 2015 working on the State’s biennial budget bill. Medicaid eligibility levels will again be debated, with Governor John Kasich committed to convincing a skeptical legislature to maintain Medicaid expansion in Ohio.

2015 promises to be full of advocacy activity, and as that action heats up, we will keep you updated!

We want this e-bulletin to be a useful benefit of Ohio ACEP membership—so don’t hesitate to tell us what you think. Like the Update? Have suggestions for making it better? Let us know!  

Again, thanks for checking out the first edition of the Ohio ACEP Advocacy Update!

Best,
Brad Raetzke, MD, FACEP
Co-chair,
Government Affairs Committee
Matthew Sanders, DO, FACEP
Co-chair,
Government Affairs Committee 
State Begins Enforcement of Medicaid Policy
Ohio ACEP convenes emergency conference call with officials; Ohio Medicaid responds to concerns
Medicaid has started to enforce a new policy as a result of the Affordable Care Act. The policy would require Medicaid to deny claims for services that require an order, prescription, referral, or certification, if it is signed by a provider who is not enrolled in Medicaid. 

An Ohio ACEP member brought this important issue to our attention when a patient could not fill her prescription at a local pharmacy.

As many of our members no doubt know, the problem is that enrollment for providers in Medicaid can take many months. In an emergency department, where the providers do not necessarily know the coverage status of patients, care to these individuals could be denied.  

Ohio ACEP representatives had an emergency conference call with the Ohio Department of Medicaid on January 14. Medicaid was quick to address our concerns. As a result of the call with Ohio ACEP, Medicaid has set up an email address where emergency physicians can request an expedited enrollment, so patient care is not disrupted unintentionally. 
 
If you need a Medicaid enrollment expedited because of this issue, please contact Medicaid at:

Medicaid_provider_update@medicaid.ohio.gov  

 
Additionally, Medicaid will not be enforcing the pharmacy portion of this rule immediately. According to Medicaid: “The 1/12/15 enforcement date does not include pharmacy claims submitted through a point-of-sale vendor. Enforcement for FFS pharmacy claims submitted through a point-of-sale vendor will begin in the near future.”

Note: This policy does not apply to Medicaid managed care.
131st Ohio General Assembly Begins
Leadership Selected for the 131st Ohio General Assembly
At the beginning of each legislative session, members of the Ohio House and Ohio Senate select a slate of leaders to serve important functions in their respective caucuses.

Here are the leaders who were elected for the new legislative session and a brief explanation of what those leadership positions mean... 

Ohio House Republican Leadership:

Speaker of the House – Rep. Cliff Rosenberger
(91 – Clarksville)
The Speaker of the House is the senior-most leadership position in the Ohio House of Representatives. The Speaker appoints the members and chairpersons of all committees, directs legislative procedures, oversees administration of the House, and presides over daily House sessions.

Speaker Pro Tempore – Rep. Ron Amstutz
(1 – Wooster) 
Often abbreviated, “Speaker Pro Tem,” the representative who holds this position serves as temporary Speaker in the absence of the Speaker of the House.

Majority Leader – Rep. Barbara Sears
(47 – Sylvania)
The Majority Floor Leader is responsible for developing and implementing the party's legislative agenda.

Assistant Majority Leader – Rep. Jim Buchy
(84 – Greenville) 
The Assistant Majority Floor Leader assists the Majority Floor Leader in his or her responsibilities.

Majority Whip – Rep. Mike Dovilla
(7 – Berea) 
The Majority Whip is responsible for monitoring legislation and securing votes from members belonging to the majority party. Think of them as the “enforcers” of the party agenda, responsible for “whipping” members of the majority party to vote with the rest of their caucus. 

Assistant Majority Whip – Rep. Dorothy Pelanda
(86 – Marysville)
The Assistant Majority Whip assists the Majority Whip with his or her role in securing votes for party-supported legislation.
 
Ohio House Democratic Leadership:

Minority Leader – Rep. Fred Strahorn
(39 – Dayton)
The House Minority Leader is responsible for developing and implementing the party’s legislative agenda.

Assistant Minority Leader – Rep. Nicholas Celebrezze
(15 – Parma) 
The Assistant Minority Leader assists the Minority Leader in his or her responsibilities.

Minority Whip – Rep. Kevin Boyce
(25 – Columbus)
The Minority Whip is responsible for monitoring legislation and securing votes from members belonging to the minority party. Think of them as the “enforcers” of the party agenda, responsible for “whipping” members of the minority party to vote with the rest of their caucus.

Assistant Minority Whip – Rep. Nickie Antonio
(13 – Lakewood)
The Assistant Minority Whip assists the Minority Whip with his or her role in securing votes for party-supported legislation. 
 
Ohio Senate Republican Leadership: 

Senate President – Sen. Keith Faber
(12 – Celina) 
The President of the Senate acts as the chamber’s presiding officer, which includes recognizing members in debate, preserving order, initiating votes, and signing all acts.
 
President Pro Tempore – Sen. Chris Widener
(10 – Springfield)
Often abbreviated, “President Pro Tem,” the senator who holds this position serves as the temporary president in case the Senate President is absent.

Majority Leader – Sen. Tom Patton
(24 – Strongsville)
The Majority Leader is responsible for developing and implementing the party's legislative agenda.

Majority Whip – Sen. Larry Obhof
(22 – Medina) 
The Majority Whip is responsible for monitoring legislation and securing votes from members belonging to the majority party. Think of them as “enforcers” of the party’s agenda, responsible for “whipping” members of the majority party to vote with the rest of their caucus.
 
Ohio Senate Democratic Leadership:

Minority Leader – Sen. Joe Schiavoni
(33 – Boardman)
The Senate Minority Leader is responsible for developing and implementing the party’s legislative agenda.

Assistant Minority Leader – Sen. Charleta Tavares
(15 – Columbus) 
The Assistant Minority Leader assists the Minority Leader in his or her responsibilities.

Minority Whip – Sen. Edna Brown
(11 – Toledo) 
The Minority Whip is responsible for monitoring legislation and securing votes from members in the minority party. Think of them as “enforcers” of the party’s agenda, responsible for “whipping” members of the minority party to vote with the rest of their caucus.

Assistant Minority Whip – Sen. Lou Gentile
(30 – Steubenville) 
The Assistant Minority Whip is elected by all members of the Senate and assists the Minority Whip with his or her role in securing votes for party-supported legislation.
House Health Committee Members for 131st General Assembly Selected
The members of House Health & Aging Committee have been selected. In good news for Ohio ACEP members, the Committee will include newly elected representative, Dr. Steve Huffman, an emergency physician from Tipp City whom Ohio ACEP was pleased to support! 
 
House Committee on Health & Aging
Majority members:
Rep. Anne Gonzales (19 – R); Chair
Rep. Stephen Huffman (80 – R); Vice-Chair
Rep. Tim Brown (3 – R)
Rep. James Butler (41 – R)
Rep. Mike Duffey (21 – R)
Rep. Tim Ginter (5 – R)
Rep. Terry Johnson (90 – R)
Rep. Sarah LaTourette (76 – R)
Rep. Ron Maag (62 – R)
Rep. Kirk Schuring (48 – R)
Rep. Barbara Sears (47 – R)
Rep. Robert Sprague (83 – R)
Minority members:
Rep. Nickie Antonio (13 – D); Ranking Minority
Rep. John Barnes (12 – D)
Rep. Heather Bischoff (20 – D)
Rep. Christie Bryant Kuhns (32 – D)
Rep. Michele Lepore-Hagan (58 – D)
Rep. Dan Ramos (56 – D)
Rep. Emilia Strong Sykes (34 – D)
New Law Requires OARRS Registration, Checks Before Opioid Prescribing
Ohio ACEP successfully fought to exempt prescriptions not exceeding seven days; Board of Pharmacy to help providers implement law
Ohio House Bill 341, which was signed by Gov. John Kasich and takes effect this year, requires a check of the Ohio Automated Rx Reporting System (OARRS) before prescribing an opioid analgesic or benzodiazepine. Also included in the law is a requirement that physicians certify to their respective licensing board that they have registered for an OARRS account upon renewing their license. 

There is an exception to the mandatory OARRS check when an opioid or benzodiazepine is prescribed or personally furnished in an amount indicated for a period not to exceed seven days.

The exception for prescriptions not exceeding seven days was the result of Ohio ACEP leaders' work with lawmakers on the House Opiate Addiction Treatment & Reform Subcommittee. As first proposed, HB 341 would have required any prescription of an opioid analgesic or benzodiazepine be preceded by an OARRS report. Emergency physicians raised concerns that a mandatory check of OARRS for each prescription would negatively affect an emergency physician’s ability to quickly and compassionately relieve acute pain.

Ohio ACEP was one of the first medical specialties at the table when the state began to confront its prescription opioid abuse epidemic. Working with the Governor’s Cabinet Opiate Action Taskforce (GCOAT), Ohio ACEP was instrumental in developing the Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances (OOCS) Prescribing Guidelines. But when appropriate, Ohio ACEP has also opposed bills that would substitute the clinical judgment of emergency physicians in favor of arbitrary prescribing restrictions.

In order to assist healthcare professionals to implement HB 341, the Ohio State Board of Pharmacy has developed a frequently asked questions document
130th General Assembly Adjourns; Business Left Unfinished
The 130th General Assembly has come to a close. Because each legislative session lasts for two years, any legislation that did not pass by the end of the 130th General Assembly is now “dead.” To have a chance to be considered again, any bills that didn’t pass in the last legislative session will need to be reintroduced in the new legislative session, the 131st General Assembly. 

Here’s an update on the bills we were tracking during the period between the November election and the end of the 130th General Assembly—known as a “Lame Duck Session.”
Extension of “I’m Sorry” Law Fails to Pass Senate During Lame Duck Session
Ohio already has a law prohibiting a physician’s statement of sympathy or apology to be used against him or her in a medical malpractice suit. In order to extend and clarify that law, Rep. Peter Stautberg (R – Cincinnati) introduced House Bill 276. 

Working with Rep. Stautberg, Chairman of the House Judiciary Committee, and other interested parties, Ohio ACEP was able to help remove a provision in the bill which specified that a healthcare facility is not liable for any damages if a malpractice suit is brought against a provider not directly employed by the facility.

With Ohio ACEP’s concerns having been addressed, we were pleased to support HB 276. The amended bill went on to easily clear the House. While being deliberated by the Senate Civil Justice Committee, Ohio ACEP President-Elect, Dr. Michael McCrea prepared to provide formal remarks in support of the bill. However, the Committee failed to schedule another hearing for the legislation before the end of the session, effectively killing the bill. 

Ohio ACEP expects this legislation to be re-introduced in the 131st General Assembly. 

Thank you to Ohio ACEP members who responded to the call to action in advance of the House floor vote! 
Bill to Allow Ohioans to Set Off Fireworks Fails to Pass
Currently, Ohio law allows Ohioans to purchase fireworks in-state, but prohibits them from igniting the fireworks within Ohio’s borders. In the final days of the 130th General Assembly, Sen. Dave Burke (R – McDermott) introduced Senate Bill 386, and Rep. Lynn Wachtmann (R – Napoleon) introduced legislation, House Bill 677, which would have allowed Ohioans to set off fireworks in Ohio. 

Despite opposition from public safety organizations and medical associations—including the Ohio Academy of Family Physicians and Ohio ACEP—it appeared as though the legislation would be passed in short order. SB 386, the Senate version of the bill, cleared the Senate, and HB 386, the House version of the bill, was given a vote in the House Health & Aging Committee. However, a procedural error called into question the legitimacy of the House Health Committee vote, so the full House did not take up the issue before the end of the session.  

Expect this issue to be raised again in 2015. 
GCOAT Gears Up to Create Another Set of Prescribing Guidelines
The Governor’s Cabinet Opiate Action Team (GCOAT) has reconvened to begin creating another set of prescribing guidelines. GCOAT is the taskforce that first created the Ohio Emergency & Acute Care Facility Opioids & Other Controlled Substances (OOCS) Prescribing Guidelines (with direct input and endorsement from Ohio ACEP).  Then they also created the 80 mg Morphine Equivalent Daily Dose Trigger Threshold clinical guidelines, along with educational tools for physicians.

Next, GCOAT will work to create a set of prescribing guidelines for opiate prescriptions for acute pain. Ohio ACEP representatives on the committee will work to ensure that any new guidelines created do not conflict with the current guidelines for emergency settings. The committee began meeting in January and plans to meet monthly on the 1st Monday of the month. 

Look for updates in future editions of our monthly Advocacy Update. 
Trauma Board Proposal Update
The American College of Surgeons, Ohio Chapter, has been working with Rep. Cheryl Grossman (R – Grove City) on developing legislation that would create a State Trauma Board. Earlier this year, Rep. Grossman hosted three interested party meetings on the proposal. One focused on hospitals, one focused on providers, and one focused on EMS. Ohio ACEP had representation at both the provider and EMS meetings. 

At the meetings, groups were asked to submit comments and suggest changes to the draft legislation. Ohio ACEP submitted comments with three specific amendment suggestions:
  1. Additional representation of emergency medicine on the committee;
  2. Remove provision that would allow any new Trauma Board to establish standards for providers of trauma care in hospital and non-hospital emergency departments, including both trauma and non-trauma centers; and
  3. Add a provision to allow physicians who specialize in emergency medicine to develop courses offered through an EMS training program or an EMS continuing education program on trauma.
A new version of the legislation has been drafted, and some of ACEP’s comments were incorporated into the latest version. This bill will continue to be worked on in 2015.
Youth Athlete Concussion Update
House Bill 487, the education portion of the Mid-Biennial Review package, has been signed into law. As some of our members will remember, while being considered by the Senate Education Committee, an unrelated amendment was quietly slipped into the bill to allow chiropractors and other non-physician healthcare professionals to clear youth athletes to play after suffering a concussion.

The language of the bill directs the Ohio Department of Health to create a committee on concussions and head injuries. The committee consists of: 2 physicians, 2 chiropractors, a representative of both the State Medical Board and the State Chiropractic Board, and the Director of the Department of Health. 

This committee has 180 days to make recommendations regarding minimum education requirements to assess and clear youth athletes to return to play after suffering a concussion. These education requirements could apply to physicians as well as other healthcare providers. The provision also gives rule-making authority to licensing boards who want their licensees to have this authority. Their rules can be stronger than the guidelines developed by the committee.

Ohio ACEP has been engaged in the committee created by the Ohio Department of Health. On Friday, November 7, 2014, Dr. Bradley Raetzke, Ohio ACEP Government Affairs Committee Co-chair, provided testimony before the study committee on behalf of the Chapter. The committee also heard testimony from several other interested parties. During the course of the hearing, several witnesses, chiropractors, and athletic trainers noted the role the physicians do play in the process of treating youth athletes with concussions. There was some debate that these providers could already be in compliance with the original law because the work in “consultation with a physician; pursuant to the referral of a physician; in collaboration with a physician; or under the supervision of a physician.”

The committee again met on January 16 and came up with questions to be researched and resolved for the following meeting:
  • Should a Certified Diplomate Chiropractor be authorized to grant clearance to student athletes?
  • What is the most effective way to write guidelines? Is it most efficient to follow the Zurich guidelines that are already established, or should each specialty conform to guidelines, which are consistent with Zurich, and also best match their practice?
  • If Zurich guidelines are recommended, should there be an educational requirement to ensure providers are up-to-speed with the standards?
There appeared to be wide agreement from committee members that chiropractors with diplomate status are qualified to independently decide when a youth athlete may return to play. Committee members also seemed to agree that any guidelines adopted by the committee should not be over-prescriptive to providers and their respective licensure boards.

The next meeting will take place on February 19, 2015. Draft recommendations are likely in the next few weeks. All committee members will have an opportunity to comment in advance of voting on the final recommendations. Also, the public and interested parties will be able to comment on the draft recommendations at the February 19 meeting.

Look for updates from that meeting in the February edition of the Ohio ACEP Advocacy Update. 
Save the Date: April 21
The Ohio ACEP Emergency Medicine Leadership Forum
Looking to maximize your impact as an emergency medicine physician, leader, and advocate?
Join us, April 21 for the Ohio ACEP Emergency Medicine Leadership Forum!
Stay tuned for registration!

                    

Ph: (614) 792-6506   |   TF: 1 (888) 642-2374   |   Fax: (614) 792-6508   |   Email: info@ohacep.org

Ohio ACEP
3510 Snouffer Rd, Ste 100
Columbus, OH 43235

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