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Practice Issues and Implications
2013 Long Session
NC General Assembly
Joanne Stevens, MSN, RN, CHRM
Impact of Affordable Care Act on NC
Better Options:
•93 % of uninsured would be eligible for tax
credits to purchase coverage in the Marketplace
or enroll in expanded Medicaid
•New coverage options for younger adults
•No discrimination for pre-existing conditions
•No discrimination of providers
Better Value:
•80/20 rule
•Scrutinizing premium increases
•No lifetime limits
Better Health:
•Increased emphasis on primary care
•Support for community health centers
•Preventing illness and promoting health
Building a stronger Medicaid program:
•Medication affordability
•Preventative services
SB4 and HB16
No exchange/ No Medicaid expansion
an act (1) to clarify the state's intent not to operate a
state-run
or "partnership" health benefit exchange, (2) to provide
that
future Medicaid eligibility determinations will be made by
the
state rather than the federally facilitated exchange, and
(3) to
reject the affordable care act's optional medicaid
expansion
• Rejected federal plans to expand
Medicaid in NC ( 500,000 paid by Feds
for 3 yrs)
• Plans for privatization of existing
Medicaid plan by 2015
• Federally managed health insurance
marketplace to open 10/01/13
Even without expanding Medicaid:
•Billions of $ in federal funds
•A projected increase in utilization
•Health Insurance Marketplace
There is an emerging market to:
•Study
•Enter
•Protect
2013 New Provider Legislation…
Chiropractic Assistant Certification
Immunizing Pharmacists
Certified Professional Midwives
Naturopathic Physicians
HB 371
Chiropractic Assistant Certification/fee
An Act Authorizing the State Board of Chiropractic
Examiners to Establish and Enforce Educational Standards
for Clinical Assistants
Primary Sponsors: Rep. Rob Bryan(R) Attorney Mecklenburg,
Rep. Debra Conrad (R) Forsyth County, Owner of Conrad
Marketing Specialist
Signed By Governor 7/18/2013
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SB 106/ HB 154
Short Title: Home Birth Freedom Act
A BILL TO BE ENTITLED AN ACT TO ESTABLISH
THE CERTIFIED PROFESSIONAL MIDWIVES
LICENSING ACT
SB 106/HB 154-CPM
Action: SB 106 is in Senate Rules Committee and HB 154
is in House Health Care Committee
House Sponsors: Rep. Winkie Wilkins- Retired
Granville and Person and Rep. Pat Hurley-Clerk
of Courts, Randolph.
Senate Sponsors: Sen. Thom Goolsby,Wilmington Attorney, Sen. Dan ClodfelterAttorney from Mecklenburg and Sen. Stan
Bingham, Lumber company owner from
Davidson & Montgomery
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SB 107/HB 155
A BILL TO BE ENTITLED AN ACT ALLOWING PERSONS PRACTICING AS
CERTIFIED PROFESSIONAL MIDWIVES IN THIS STATE TO CONTINUE TO
PROVIDE MIDWIFERY SERVICESWITHOUT BEING SUBJECT TO CRIMINAL
PENALTY
Decriminalize Direct Entry Midwifery
Same Sponsors as SB 106 and HB 154
Action: Senate bill is in Senate Rules and the House bill Rereferred to Committee on Health Care
The end
HB 832 immunzing pharmacists
RATIFIED BILL H832
AN ACT TO PROTECT THE PUBLIC HEALTH BY INCREASING
ACCESS TO IMMUNIZATIONS AND VACCINES THROUGH THE
EXPANDED ROLE OF
IMMUNIZING PHARMACISTS
Signed by Governor 7/03/2013
HB 832
Expand Pharmacists’ Immunizing Authority
Primary Sponsors: Rep. Marilyn Avila (R)
Wake Former Chemist & Business owner
Rep. David Lewis (R)Harnett, Farm
Equipment Dealer & Former Rep. Valerie
Foushee (R) Durham & Orange-Retired
Police Admin.- Resigned 9.25.13 and
serving in Senate, Rep Rick Glazier,(D) (end)
Attorney Cumberland County
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HB 995/ SB 349
A BILL TO BE ENTITLED AN ACT TO ESTABLISH THE
NORTH CAROLINA NATUROPATHIC DOCTORS
LICENSURE ACT.
HB 995/SB 349
Naturopathic Doctors Licensing Act
• Action: House bill is in Rules Committee and
Senate bill is in Rules Committee
Primary Sponsors: Rep Jeff Collins (R), Franklin
& Nash Financial Consultant and Rep. Susan
Fisher (D), Buncombe Professional Legislator,
Sen. Fletcher Hartsell (R), Cabarrus Attorney,
Sen. Thom Goolsby (R), New Hanover
Attorney
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Historical Reference: HB 1286 (2010)
A BILL TO BE ENTITLED AN ACT ALLOWING
CHRISTIAN SCIENCE NURSES TO PRACTICE
CHRISTIAN SCIENCE NURSING UNDER THE LAWS
REGULATING THE PRACTICE OF NURSING.
Advanced Practice Legislation and
Changes in Oversight…
Certified Nurse Midwives
Certified Nurse Anesthetists
Nurse Practitioners
HB 204/SB 499
Update/Modernize/Midwifery Practice Act
• Action: House Bill is in Rules Committee and
Senate Bill is in Health Care Committee
• The Budget Bill authorized a Study Committee
• Primary Sponsors: Rep. Sarah Stevens (R); Attorney
Surry/Wilkes, Rep. Justin Burr (R) Montgomery/Stanley;
Bail Bondsman, Rep. Glazier (D) Cumberland; Attorney,
Rep. Susi Hamilton (D) Brunswick/New Hanover;
Business Consultant, Senator Hartsell (R) Attorney
Cabarrus, Sen. Randleman (R) Retired Clerk of superior
court, and Sen. Josh Stein (D) Attorney Wake.
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HB 204/SB 499 Became A Study
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Nurse Midwives Study Committee
• Presentations by American College of NurseMidwives reviewing the major reasons for
implementing legislation in 2014 on collaboration
and eliminate “Supervision” requirement now
presently in law. 1)Lack of OB/GYN physicians in
more than 32 counties across the State, 2)lower
costs and3) sound medical care by educated
specially trained nurse midwives are three key
arguments for changing the law.
• NC Medical Society argued the need for Supervision
and the existing law is good and should not be
modified.
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Nurse Midwives Study Committee
• NC Obstetrical and Gynecological Society addressed
the continued need for supervision of nurse
midwives to protect the health of the baby.
• NC Board of Nursing shared data on status of nurse
midwives across NC.
• NC Medical Board noted NC law provides all
the flexibility necessary for nurse midwives to
practice their profession. No changes to the
law is needed.
• Final Committee Report was March 11, 2014.
end
HB 181/ SB 256
A BILL TO BE ENTITLED AN ACT TO CONFIRM THAT
NORTH CAROLINA LAW REQUIRES PHYSICIAN
SUPERVISION OF ALL NURSES PROVIDING
ANESTHESIA SERVICES
HB 181/SB 256
Physician Supervision Required/Nurse Anesthetist
• ACTION: House bill is in Senate Rules and Senate Bill
is in Senate Rules
• Primary Sponsors: Rep. Nelson Dollar (R) Wake
Media Consultant, Rep. Mark Hollo (R) Alexander,
Wilkes, Yadkin US Air Force Reserve, Rep. Tim Moore
(R) Cleveland Attorney, Rep. Michael Wray (D)
Halifax Northampton Business Owner, Sen. Bob
Rucho (R) Mecklenburg Dentist
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HB 380/ SB 179
BILL TO BE ENTITLED AN ACT TO PROVIDE A DEFINITION
FOR CERTIFIED REGISTERED NURSE ANESTHETISTS UNDER
THE NURSING PRACTICE ACT
HB 380/ SB 179
• Action: House bill is in Health Committee and
Senate bill is in Rules Committee
• Primary Sponsors: Rep. Jeff Collins (R),
Franklin & Nash; Financial Consultant. Sen.
Jim Davis (R) Cherokee, Clay, Graham,
Haywood, Jackson, Macon, Swain;
Orthodontist.
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HB 878
Certified Registered Nurse Anesthetists in Counties
with Critical Access Hospital
An act to allow for nurse anesthetists to provide
anesthesia services in collaboration with certain health
care providers in a county in which a licensed critical
access hospital is located
H 878
• CRNAs in Counties with Critical Access
Hospital
• Rep. Carla Cunningham, Mecklenburg; RN
• & Michael Setzer, Catawba; VP of Smith Setzer
& Sons
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SB 555
A BILL TO BE ENTITLED AN ACT AMENDING
THE NURSING PRACTICE ACT TO AUTHORIZE THE BOARD OF NURSING TO
REGULATE NURSE PRACTITIONERS AND TO ESTABLISH CERTAIN NEW FEES
RELATED TO REGULATING NURSE PRACTITIONERS
SB 555
Nursing Bd./Regulate Nurse Practitioners/Fees
• Action: Senate Rules Committee
• Primary Sponsors: Sen. Ralph Hise (R),
Madison, Mc Dowell, Mitchell, Polk,
Rutherford, Yancey; Statistician,
• Sen. Eleanor Kinnaird (D), Chatham and
Orange Attorney- Resigned 8/19/13
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SB 555
Nursing Board/Regulate Nurse
Practitioners/Fees
All nursing bills in the Senate found a
home in the Senate Rules
committee, the first was the House
Anesthesia bill (HB 181) The bill was
sent to Rules on April 1, 2013.
Additional Nursing Legislation…
SB 371
A BILL TO BE ENTITLED AN ACT TO ENHANCE
PATIENT SAFETY IN HOSPITAL AND AMBULATORY
SURGICAL FACILITY OPERATING ROOMS BY
REQUIRING AT LEAST ON CIRCULATING NURSE TO
BE PRESENT IN EACH OPERATING ROOM DURING
EACH SURGICAL PROCEDURE.
SB 371
Patient Safety In Operating Rooms
• North Carolina Operating Room Nurses Legislation Introduced
in 2013 by Senator Bingham
KEY POINTS:
• Keep NC a Leader in Medical Care
• Patient Safety in the Operating Room
• Provide Consistency of Care During Surgery
• Educated and Fully Registered and Qualified Circulator Nurse
present in the operating room during patient surgeries.
• Legislation was not heard as part of issue in the Senate with
all “Scope of Practice Bill” The bill is not eligible to pass in
short session in its present form.
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Epinephrine Auto Injectors in
Schools
HB 824/SB 700
HB 824 passed the House and is in
the Senate and eligible for passage
in 2014
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Prevent Hazardous Drug Exposure
• House Bill 644- passed House, in Senate
Health
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Prevent Hazardous Drug Exposure
• House Bill 644- passed House, in Senate
Health
• An act relating to the handling of hazardous
drug to prevent disease & injury caused by
exposure
• NCHA appears to have agreed to a bill that is
limited to Chemo drugs. end
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2014-What to Expect for Nurses…
• Study Commission recommendations on Nurse
Midwife practice legislation
• HB 181 Physician Supervision. Required/nurse
Anesthetist still “live” for short session,
• Closer examination of “Scope of Practice” legislation,
• For NPs and CRNAs
What to expect in 2014
• Board reviews by program committee, has
been very active.
• Could include NCBON
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What We Are Up Against…
• NC Medical Society (Feds and NC)
• 26 MD Anesthesia PACs, “underground river of
money”
• Dozens of specialty and practice specific MD PACs
• Allied Health Disciplines PACs
• Well-funded Public Relations Campaigns to protect
“Turf” and manage resources
As Nurses…
• PACs x3
• Face to Face Meetings
– 1 encounter has more power than all other relative
information
– Live interaction trumps digital in ALL cases
• Get the Right People on Our Side
• Show your Passion, share your stories
• Stay Informed-Know your Stuff
What’s Next in 2014
•The General Assembly Short Session reconvenes May 14,
2014 to make modifications to the State budget and possibly
pass eligible bills that did not pass in 2013.
•Governor Mc Crory plans to give Teachers a Pay raise in
2014, but what about other State employees is the question
?
•Governor announced a pay increase on January 25, up to 4
percent for State Agency employees in shortage areas and
this included 1,200 nurses. ****
•2014 Elections year with 170 House and Senate members
up for re-election with the filing deadline of February 10 and
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close on February 28.
What’s Next in 2014
•2014 Short Session will see a fight for House Speaker as
Speaker Tillis plans to campaign for US Senate Seat.
There are 6-8 House members vying for the job.
•Medicaid budget uncertainty and how much extra
funding will be needed in 2014 due to inability of DHHS
to track cost implications with their new technology
system, NC Tracks.
•Ongoing issues with DHHS management and
technology.
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Thank you
• Question and Answers.
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