Second legislative week brings more activity
Rachelle Colombo; KMS Director of Government Affairs
The Legislature began their work in earnest this week introducing bills and holding committee hearings on a variety of issues. As expected, the advanced practice registered nurses have re-introduced their proposal which in effect removes any limitation on APRN scope of practice and eliminates the legal requirement that APRNs work in collaborative practice agreements with physicians. Their bills (SB 69 and HB 2122) have been introduced in both chambers, and the Senate Public Health and Welfare committee will hold a hearing on the APRN issue Thursday, January 29.
As we outlined in our meetings with the nurses during the past year, KMS remains opposed to their legislation because it allows APRNs-- who have a fraction of the training of physicians--to practice medicine and surgery without any physician collaboration, oversight or supervision. KMS believes meaningful collaborative practice agreements or protocols are essential to promote patient safety in most clinical situations, and that physician-led, team-based care is the best model to safely and efficiently meet the health care needs of our state, including primary care in rural and underserved areas. KMS also believes that the Board of Healing Arts should have a role in approving the regulations governing APRN practice because much of what APRNs do are delegated medical acts which constitute the practice of medicine.
The Senate Health Committee held an informational hearing on marijuana last week. Advocates focused on the hope they have in cannabinoids that might bring relief and improvement that other drugs have not delivered, particularly for children with dravet syndrome and other rare but debilitating diseases. The committee heard from non-advocates the following day, including Eric Voth, MD (Topeka) on behalf of KMS, who outlined the negative effects of legalizing marijuana, particularly of circumventing the FDA process of establishing medical efficacy, and instead approving medicines by popular vote. As with many issues that come before the legislature, the problem presented by the pro-marijuana advocates was complex and compelling. And as is also often the case, the solution presented was broad and rife with potential for abuse and unintended consequences. The Kansas Medical Society does not support circumventing the rigorous research required by the FDA process designed to protect patients.
Amendments to the School Sports Head Injury Prevention Act were introduced (HB 2016) which would allow chiropractors to clear and return injured students to practice or play after a concussion. The House Health committee has scheduled a hearing for this coming Wednesday, January 28. KMS opposes the bill.
The state's revenue shortfall has the potential to complicate the legislature's consideration of the proposed Medicaid expansion issue somewhat. Kansas is one of about 22 states that have not yet expanded Medicaid to take advantage of higher federal financial support that was made available under the Affordable Care Act. The state's difficult fiscal situation just adds more complexity to any issues that have budget implications. The Kansas Hospital Association has been working hard to build legislative support for an innovative approach which expands KanCare in a way that will cover more low-income working Kansans, bring in significantly more federal dollars and reduce the growing burden of providing uncompensated care by hospitals. KMS supports KHA's efforts to find a fiscally sustainable solution that covers more uninsured working Kansans, while providing critically needed financial support to ensure the viability of our state's community hospitals.
At its bi-weekly meeting the KMS Legislative Committee, chaired by Kevin Hoppock, MD (Wichita), considered HB 2004, the so-called "Right to Try" bill. The bill is part of a national effort (enacted thus far in five states) to establish state-based laws intended to help terminally ill patients obtain access to experimental (non FDA-approved) drugs and devices. It is unclear whether such bills will actually be effective, since federal laws control all drug/device approvals in the United States. In addition, federal law already allows "expanded access" to investigational drugs through an FDA administered program. KMS will be neutral on the bill, but will seek amendments to clarify the legal liability protections for physicians who participate under the bill's provisions.
Of note, Rep. Susan Concannon (R-Beloit), House Health Committee Vice-Chair and spouse of Craig Concannon, MD, was elected by her colleagues as Chair of the House Rural Caucus. In addition to helping to direct the focus of the Health Committee, Rep. Concannon will seek to educate and establish consensus among her peers on issues affecting rural parts of the state.
New bills are being introduced daily, some of which will advance, many more of which will languish. As issues affecting the practice of medicine emerge and move through the legislative process, we will keep you apprised. We always welcome your input, engagement and encourage your participation in the legislative process. If you have questions or comments about legislative matters, please contact KMS Director of Government Affairs, Rachelle Colombo.