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KMS Update: Legislative update; Advocacy Day survey; oral antivirals availability

A message from Rachelle Colombo
Thank you everyone who was able to attend the first annual KMS Advocacy Day last week. We recognize how difficult it is to take time away from practice and to navigate events in this environment. We were pleased to have a strong showing of physicians representing more than a dozen specialties join together to learn about legislation and meet with elected officials to advocate for the profession. In a time when so many proposals impact patient access and care, it is critical that physicians have relationships with their Representatives and Senators and can serve as a trusted source of factual information.

More than just the information that was learned and shared, the relationships formed through Advocacy Day have the potential to positively impact policymakers.  Whether or not you attended this year, I hope you will plan to join us next year — and perhaps bring a colleague who may be interested in learning how to be the most effective advocate for sound health care policy and the safe practice of medicine in our state.

If you were able to attend any part of Advocacy Day this year, please look for a separate email today with a link to a feedback survey. I hope you might take a moment to send us your feedback — it will help us improve next year's Advocacy Day.

                                                                                                                   
Legislative update
The 2022 legislative session is approaching its Feb. 24 turnaround deadline, when most bills must be approved by committees in their originating chamber or be exempted from deadlines in order to advance through the process.

There are a large number of issues impacting the practice of medicine that have surfaced this session, but those with the most traction so far seem to center on COVID-related care, expanding the scope of practice for non-physician providers and relaxing some of the regulations on telemedicine and encouraging pay parity for such services. Here are the bills we are monitoring most closely so far this session:

  • SB 381 — Removing disciplinary sanctions for prescribing off-label medications for preventing or treating COVID-19.  

Although there are no state or federal laws restricting a prescriber from off-label prescribing of an FDA-approved drug, SB 381 stipulates that a pharmacist must fill any off-label prescription for COVID-related treatments, such as, but not limited to ivermectin or hydroxychloroquine. Under the bill, a prescriber acting under these provisions would not be subject to any disciplinary action by the Board of Healing Arts and would be immune from liability. As written, SB 381 would single out and establish a different professional standard for off-label prescribing related to COVID than for any other other medical condition. While KMS strongly supports a physician’s ability to utilize off-label prescribing when appropriate, this legislation, though well-intended, goes too far. Except in the case of true emergencies, shielding prescribers with blanket immunity for any adverse outcomes of the care they provide could have the unintended consequence of eroding the standard of care, causing patient harm and making it impossible for the Board of Healing Arts to protect the public. KMS has suggested removal of the provisions which provide blanket immunity and tie the hands of the licensing agency. The Senate Public Health and Welfare Committee will vote on this bill Tuesday at 8:30 a.m.   

  • HB 2256 and SB 174 — Removing the requirement for a collaborative practice agreement between an APRN and a physician.

These bills have carried over from last year and remain a high priority for business groups such as the Kansas Chamber, as well as nursing programs, and other groups. A third bill has been introduced and will likely surface next week. These proposals allow an advanced practice registered nurse (APRN) to independently practice medicine without limitation as licensed and regulated by the Board of Nursing. Though nurse advocates claim that APRNs have adequately increased their training, will carry malpractice coverage, and will not exceed the scope of their training, these considerations are not reflected in the proposed legislation commensurate with requirements for medical practice. SB 174 was heard by the Senate Public Health and Welfare committee and could be scheduled for a committee vote, though we expect a hearing on the new bill is a more likely action. KMS opposes the independent practice of medicine by non-physicians.

  • HB 2552 — Provides additional regulation and restrictions for telemedicine services, and prohibits insurers from requiring physicians to utilize a specific telemedicine platform.

The Kansas Medical Society has worked with the Kansas Hospital Association (KHA) in reviewing regulations and reimbursement for telemedicine services. HB 2552 was introduced by KHA to relax some of the previously established requirements for telemedicine, such as conducting an in-person evaluation before beginning treatment via telemedicine. The bill also includes provisions requiring parity between telemedicine platforms and rate reimbursement, stipulating that insurers must use the same criteria to establish the rate of reimbursement for in-person and telemedicine services. KMS supports HB 2552. The bill has not yet been scheduled for a hearing.

  • SB 200 and HB 2385 — Expands a pharmacist's scope of practice, allowing independent initiation (prescribing) of drugs by pharmacists, for certain health care conditions.

These bills were introduced last year to allow a pharmacist to independently test for and “initiate treatment,” or prescribe, related to specific conditions as approved by the Board of Pharmacy. These conditions include, but were not limited to: influenza, strep, UTI, pre- and post- prophylaxis, and COVID. The Kansas Medical Society met with the proponents of the bill, mostly comprised of chain pharmacies and retailer Wal-Mart, to discuss our opposition to the bill. The chain pharmacy and retail proponents offered an amendment which was adopted by the Senate Public Health and Welfare Committee that would limit a pharmacist’s ability to test or treat patients outside of a statewide protocol, as established by a joint committee comprised of three appointees of the Board of Healing Arts and three appointees of the Board of Pharmacy. While the amendment lacks necessary definitions and regulations to ensure proper adherence to any established protocols, proponents have indicated a commitment to continuing to work towards a proposal ensuring appropriate physician involvement and oversight in the development and implementation of any protocols.

For information on the bills that we are monitoring the session, please see our bill tracker at: www.kmsonline.org/billtracker. We will update you in subsequent newsletters on relevant activity on these and other bills that are introduced. We expect the next few weeks to be busy as committees work to advance bills ahead of the first major deadline.]

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Oral antiviral availability
KDHE is working with pharmacy partners to expand availability of oral antivirals. While still limited, the goal is to add locations to spread geographic availability of such treatments, including paxlovid and molnupiravir. KDHE expects new sites to soon be available on https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ for providers to review when prescribing and seeking availability.

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As always, if you have questions about this update or other matters, please contact KMS Executive Director Rachelle Colombo: This email address is being protected from spambots. You need JavaScript enabled to view it..