Lobbyist Report

Gally Report

2017 Maryland General Assembly Session Overview
2016 Maryland General Assembly Session Overview
2015 Maryland General Assembly Session Overview

The 2017 Maryland General Assembly session finished on April 10 and the Governor is in the process of deciding whether to sign or veto each piece of legislation on his desk. He also has the option of allowing a bill to become law without his signature. The Governor’s last bill signing is scheduled for May 25 and he will do most of the signings at that ceremony. Here is where our priority legislation stands at the moment: 

Slowing Prescription Drug Price Increases — The General Assembly considered two major bills this year attempting to address rising prescription drug prices. They passed HB 631 which prohibits a manufacturer or wholesale distributor from engaging in “price gouging” in the sale of an “essential off-patent or generic drug.” Medicaid may notify the Attorney General when specified price increases occur. On request of the Attorney General, the manufacturer of an essential off-patent or generic drug must submit a specified statement. The Attorney General may require a manufacturer or wholesale distributor to produce any records or documents relevant to determining if a violation of the prohibition on price gouging has occurred. On petition of the Attorney General, a circuit court may issue specified orders, including compelling a manufacturer or wholesale distributor to provide certain statements or records, restraining or enjoining a violation, requiring restitution, and imposing a civil penalty of up to $10,000 for each violation.

The Governor has not indicated what he intends to do with this bill at the May 25 signing but I would anticipate that he will sign it due to its extreme public popularity.

For more on this legislation see the Maryland General Assembly’s fiscal note at http://mgaleg.maryland.gov/2017RS/fnotes/bil_0001/hb0631.pdf

The General Assembly also considered SB 437/ HB 666 which would have required the manufacturer of an expensive drug to file an annual report and give notice to DHMH before certain price increases can take effect. This bill did not pass in standalone form but the General Assembly created a commission to study and react to any future changes in the Affordable Care Act and ordered that commission to study the prescription drug transparency issue as part of its charge. That legislation — SB0571 / CH0017 – was signed by the Governor already and is law.

Tobacco Control Funding – SB 113/HB 703 — This legislation would have increased funding for the state’s tobacco control prevention and cessation program from a minimum of $10 million per year to a minimum of $21 million per year (which is what the program was originally funded at when it was created in 1999.) Legislators in both chambers were very sympathetic to the bill and its intended outcomes but were not willing to increase the funding that much while they were facing a $600 million budget deficit. We have been told to keep making the case and there will be a chance for an increase when the operating budget is in better shape.

Allowing Creative Reimbursement Models — Over the years our state has created strict laws banning physician self-referral. While many of these laws were well-intended and have been helpful in eliminating fraud, they have also prohibited moving forward with creative outcomes-based reimbursement models. The Maryland Patient Referral Law (SB 369/HB 403/Chapter 226/Chapter 225) signed by Governor Hogan provides exemptions from portions of the self-referral law for practitioners with certain federally-permitted provider models. A health care practitioner who has a compensation arrangement with a health care entity is exempt from the prohibition against self-referral if the compensation arrangement is funded by or paid under (1) a Medicare Shared Savings Program accountable care organization (ACO); (2) an advance payment ACO model, a pioneer ACO model, or a next generation ACO model, as authorized under federal law; (3) an alternative payment model approved by the federal Centers for Medicare and Medicaid Services (CMS); or (4) another model approved by CMS that may be applied to health care services provided to both Medicare and non-Medicare beneficiaries.

Fighting the Spread of Antibiotics Resistance — SB 422/HB 602 Prohibits use of medically important antimicrobial drugs in routine farm animal feeding. The Maryland General Assembly passed a fairly-strong compromise version of this legislation near the end of session. Several major opponents of the legislation have been lobbying Governor Hogan to veto this legislation and he has not yet indicated what he intends to do. We will have to wait to see this bill’s fate.

Optometrists Scope of Practice — SB 611 /HB 807 — Establishes a license category of Therapeutically Certified Optometrist II and scope of practice 

Action: We provided written testimony in the House and Dr. Jos Zebley testified in the Senate.

This bill has been referred to interim study by both committees which effectively kills it for this year but leaves open the possibility that it may come up next year. Historically bills that are sent for summer study are done, but recently some bills have been revived through this process. But the bill is definitely dead for this year. 

Prohibiting Formulary Changes during an insurance plan year or open enrollment period.

SB 768/HB 1128 would have prevented insurers from major prescription drug formulary changes in the middle of a plan year. The bill was withdrawn by the sponsors the day before the hearing. The broad coalition behind this legislation intends to regroup this summer and develop a new action plan on this issue.

Pharmacists Prescribing and Dispensing of Contraceptives – HB 613/SB 363 —

Establishes a procedure for pharmacists to prescribe and dispense FDA approved contraceptive medicines or devices via specified procedures, including having the patient fill out a self-assessment tool. This bill passed but does include language requiring pharmacists to include written information about the importance of the patient seeing their primary care provider or reproductive health care provider in the near future for recommended tests and screenings. This bill is also awaiting the Governor’s signature or veto.

2017 MD General Assembly Session Overview

With two weeks left in session, below is an update on the priority bills that we’ve been tracking. 

SB 113 (2/1) / HB 703 (2/21), Public Health – Tobacco Control Funding –

Increases tobacco control funding from $10 million to $21 million per year

Action: We testified live at both hearings. Will be difficult to restore this money in such a difficult budget year. Also met with leadership from both committees.

 Don’t expect passage this year. Hasn’t moved in either chamber.

 SB 369 (FWA 2/23) / HB 403 (2/23), Maryland Patient Referral Law – Compensation Arrangements Under Federally Approved Programs and Models –

Adds an exemption from patient referral restrictions for practitioners with certain Federally permitted compensation arrangements

Action: This bill will help adjust Maryland’s patient referral law in a way that will help set up comprehensive primary care and other innovative primary care models. It is about to pass the Senate and is expected to pass the House as well.

This bill is one step away from final passage and should be enrolled Monday or Tuesday.

SB 415 (2/15) / HB 631 (2/23), Public Health – Essential Generic Drugs – Price Gouging – Prohibition

Prohibits a manufacturer or wholesale distributor from price gouging in sale of an essential generic drug

Action: Eric Gally testified live in the Senate hearing and Dr. George Leon testified at the House hearing. Bill is expected to pass.

This bill has passed the House but has yet to secure passage by the Senate Finance Committee. It is expected they will vote the bill out sometime this week but not guaranteed. This has been a very tough battle. Big PHARMA is pushing back hard. 

 Read More:  Click Here for Complete Report

SB 437 (2/15) / HB 666 (2/23), Public Health – Expensive Drugs – Manufacturer Reporting and Drug Price Transparency Advisory Committee 

Establishes the advisory committee and requires the manufacturer of an expensive drug to file an annual report and give notice to DHMH before certain price increases

Action: Eric Gally testified live in the Senate hearing and Dr. George Leon testified at the House hearing.

This bill has gotten stuck and neither committee has taken action. There is some thought that the bill will be paired down a lot later this week and passed. But there are no guarantees. This bill definitely needs work.

SB 422 (2/14) / HB 602 (2/15), Keep Antibiotics Effective Act of 2017

Prohibits use of medically important antimicrobial drugs in routine farm animal feeding

Action: Eric Gally testified at the Senate and House hearings.

A compromise version of this bill has passed both chambers in identical form, so it is 99 percent likely the bill will be enrolled and sent to the Governor for his signature or veto. The provisions in the bill remain essentially the same though data collection and reporting that was required in the original version has been removed.  

SB 611 (2/22) / HB 807 (2/21), Health Occupations- Requirements for the Practice of Optometry – Miscellaneous Revisions

Establishes a license category of Therapeutically Certified Optometrist II and scope of practice 

Action: We provided written testimony in the House and Dr. Jos Zebley testified in the Senate.

This bill has been referred to interim study by both committees which effectively kills it for this year but leaves open the possibility that it may come up next year. Historically bills that are sent for summer study are done, but recently some bills have been revived through this process. But the bill is definitely dead for this year.

SB 768 (3/8), HB 1128 (3/9), Health Insurance – Prescription Drugs – Formulary Changes

Prohibiting Formulary Changes during an insurance plan year or open enrollment period.

This bill was withdrawn by the sponsors the day before the hearing. The broad coalition behind this legislation intends to reground this summer and develop a new action plan on this issue.

HB 613, SB 363 Pharmacists Prescribing and Dispensing of Contraceptives

Establishes a procedure for pharmacists to prescribe and dispense FDA approved contraceptive medicines or devices via specified procedures, including having the patient fill out a self-assessment tool.

This bill is steamrolling toward passage but does include language requiring pharmacists to include written information about the importance of the patient seeing their primary care provider or reproductive health care provider in the near future for recommended tests and screenings. 

 

2016 MD General Assembly Session Overview

The Maryland General Assembly adjourned it’s 2016 session on Monday April 11 and the Academy had its fair share of wins and losses when the gavel banged at midnight. It was a good showing considering the myriad of obstacles our priority bills faced entering session.

Case in point was our successful creation of a Community Preceptor Tax Credit program (HB1494/SB411). In January, legislators were wedded to a commission report that recommended eliminating most tax credit programs and a moratorium on creating new ones. In addition, as has been the case the past several sessions, any bill that costs money was considered to have a target on its back.

But Academy members lobbied the bill hard during our advocacy day and many more weighed in via email and phone calls. We worked with the sponsor to reduce the cost as much as possible, found a dedicated funding source that essentially pays for the program and in the end convinced both committees of jurisdiction this bill should get an exemption from the “no new tax credits” mantra.

As passed our bill creates a tax credit against the State income tax for a licensed physician or nurse practitioner who serves without compensation as a preceptor in an approved preceptorship program. Each year, the Department of Health and Mental Hygiene may issue up to $100,000 for each of the physician preceptorship credits and nurse practitioner preceptorship credits.

Money for the physician program comes from the Health Personnel Shortage Incentive Grant (HPSIG) Program, which has had a surplus in recent years. The nurse practitioner program comes from a new $15 surcharge for the renewal of an advanced practice registered nurse.

To qualify, the licensed physician or nurse practitioner must have worked at least three rotations with each rotation consisting of 160 hours of community-based clinical training and in an area that DHMH, in consultation with the Governor’s Workforce Investment Board, has identified as having a health care workforce shortage. DHMH must issue a credit certificate of $1,000 for each student for whom the licensed physician or nurse practitioner served as a preceptor without compensation, not to exceed $10,000 per physician or nurse practitioner.

Huge thanks to Senator Adelaide Eckhardt who led the charge on this bill and Delegate and Delegate Kerie Sample-Hughes who was our sponsor in the House.

We had other victories among our priority bills this session, most notably the increase, most notably the Contraceptive Parity Act. (HB 1005/SB848)

The bill as passed prohibits insurers, nonprofit health service plans, and health maintenance organizations (collectively known as carriers) from applying most copayment or coinsurance requirements for a prescription contraceptive drug or device that is approved by the U.S. Food and Drug Administration (FDA). Carriers, as well as Medicaid and the Maryland Children’s Health Program (MCHP), must provide coverage for a single dispensing of a six-month supply of prescription contraceptives with specified exceptions. The bill takes effect January 1, 2018, and applies to all policies, contracts, and health benefit plans subject to the bill that are issued, delivered, or renewed in the State on or after that date.

We weighed in heavily on this legislation, which helps prevent unwanted pregnancies and most of all, helps guarantee that cost isn’t a barrier for this important health care service.

A third victory includes a bill Maryland Medical Assistance Program – Specialty Mental Health and Substance Use Disorder Services – Parity (SB899/HB 1217) that requires the Department of Health and Mental Hygiene to adopt regulations ensuring that Medicaid is complying with a federal mandate to place mental health coverage on par with other health services.

As in any session, we weren’t able to pass everything on the Academy’s agenda. Despite very strong public support and strong lobbying from the majority of public health organizations around the state, the General Assembly failed to act on the Healthy Maryland Initiative (HB71/SB514), which would have increased the state’s cigarette excise tax by $1 per pack and used the money to fund a variety of important public health measures. A majority of legislators favor the bill but they were reluctant to enact a measure that would almost certainly be vetoed by Gov. Hogan and be highlighted as yet another tax passed by Democrats in the General

Trial Lawyers helped shut down the effort to create a No Fault Birth Injury Fund (HB377/SB513). The legislation would have provided fair compensation to victims while protecting physicians from ever-increasing medical malpractice expenses.

In similar fashion the very powerful Delmarva Poultry Industry alliance was able to kill a bill (HB829/SB607 — Agriculture – Cattle, Swine, and Poultry – Use of Antimicrobial Drugs) which would have restricted use of antibiotics in livestock except for medical need. Currently some producers regularly pump low doses of antibiotics into their livestock. This mass use of the drug when disease isn’t present is thought to lower resistance in animals and humans.

There were many other bills and budget items impacting the practice of primary care medicine and public health during this General Assembly session. The Governmental Advocacy Committee and especially Chair Matt Burke did a great job of vetting all these bills and coming up with priorities for the 2016 session. This focus and energy is a major factor in our success.

 

2015 Maryland General Assembly Session Overview

The 2015 General Assembly session was very memorable as a new Governor and dozens of new legislators took their seats of power in Annapolis. All that “fresh blood” provided interesting opportunities and unique challenges along the way.

In the end the results were pretty typical as we won some and lost some. Here is an overview of where we ended up on key legislation:

Nurse Practitioners Authority to Practice: As first drafted, Senate Bill 723/House Bill 999 (Certified Nurse Practitioners – Authority to Practice) would have simply eliminated the requirement that a nurse practitioner must provide an attestation naming a physician with whom they will collaborate.

We objected to removing this provision because the bill would have given nurse practitioners a quicker and easier path to opening their own practices than physicians. But rather than fight over the attestation itself, which has proven rather toothless to this point, we worked with MedChi and specialty societies to craft new language that has a lot more teeth. Our proposed amendment required nurse practitioners to have a mentorship with a physician or experienced nurse practitioner and clarified that Ma nurse http://essayonlinewriter.com/dissertation-writing-services/ practitioner who failed to collaborate according to practice guidelines could be subject to punishment by the Board of Nursing.

We originally proposed that the mentorship last two years and the nurse practitioners insisted on one. In the end the two committee chairs forced agreement on 18 months and passed the legislation with our language. Another part of the agreement was that this issue would not come up again during the rest of this four-year legislative cycle. This is one of those rare cases where both sides seem to be pleased with the end result.

Medicaid Reimbursement Cuts: In the waning weeks of his Administration, former Governor Martin O’Malley proposed reducing Medicaid reimbursement for evaluation and management (E&M) codes as a means to balance the current year’s budget. Governor Hogan followed suit with his proposal for next year’s budget – calling for funding at 87 percent of current Medicare rates instead of the 100 percent funding level that had been agreed upon a couple years ago. We worked closely with the two budget committees to restore as much money as possible. In the end they agreed to increase rates up from 87 percent to 92 percent and cordoned off money for the reimbursement. Governor Hogan will make the final decision about the 5-percent difference. He can spend the appropriated money for that purpose or just leave it in the treasury unspent. At this point he has not indicated what he will do.

The Academy prioritized a series of public health measures to work on this session. It was a tough year for this type of legislation because the 2014 election campaign had focused on reducing government intervention and taxes. It was also difficult to educate dozens of new legislators about these issue during their first session. I believe that given another year to educate folks we will make more progress on these measures and help save lives and prevent suffering.

Senate Bill 152/House Bill 56 (Tanning Devices – Use by Minors – Prohibition) would have restricted the use of commercial tanning salons by those under the age of 18. We worked with a strong coalition of like-minded proponents on this legislation and failed by a 6-5 margin in the Senate Finance Committee. The vote would have been equally close in the Health and Government Operations Committee had they voted straight up or down on the matter. The coalition intends to come back next year with this proposal and hopes to pick up the one vote in Finance needed to move us through the Senate.

Senate Bill 37/House Bill 108 (Tobacco Taxes – Healthy Maryland Initiative) proposed raising Maryland’s tax on tobacco by $1 and earmarking some of the money for tobacco control and Medicaid expansion. The anti-tax message that dominated the 2014 campaign made this bill a very long shot in 2015 and prospects for passage in the near future remain cloudy at best.

House Bill 26 (Clean Indoor Air Act – Use of Electronic Smoking Devices – Prohibition) would have prohibited using electronic smoking devices in all of the places where smoking cigarettes is currently prohibited. The House Economic Matters Committee was interested in this bill but didn’t have time to vet all the issues in the first session of the four-year cycle. We expect this issue will come back and will eventually pass with enough effort.

The Generally Assembly did take some action on Electronic Cigarettes by passing legislation (HB489/SB7) that places all of the components and accessories of electronic cigarettes under existing law that prohibits sales to minors. Advocates and officials had received disturbing reports of teenagers purchasing the liquids that go into the electronic devices and drinking it straight up, which has resulted in numerous emergency room visits.

One issue that came up late in session was a measure to allow DHMH to use “extrapolation” when determining potential Medicaid fraud, waste and abuse. “Extrapolation” essentially means taking a sample of billings or reimbursements and using them to estimate potential fraud and abuse over a much larger body of work. House Bill 1101 (Department of Health and Mental Hygiene – Health Program Integrity and Recovery Activities) was introduced very late in session and quickly caught fire in the House and Government Operations Committee. Though the Chairman ultimately agreed that there wasn’t enough time to vet important issues surrounding this bill, he does intend to push the dialog this summer and come back with a viable proposal next year.

 

 

 

 

 

 

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