|The ISMS Legislative Action Hub tracks issues, ISMS actions, and recent votes in the Illinois General Assembly of importance to Illinois physicians. If you require additional information on an issue below or on one of the numerous bills in Illinois that impact medicine, please contact State Legislative Affairs Staff at 800-782-4767.
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From the ISMS House of Delegates ISMS Initiative
LEGAL SETTLEMENT RULES – Senate Bill 1912 (Sen. Raoul), an initiative of the Illinois Trial Lawyers Association, would impose new and unprecedented rules for legal settlements. ISMS opposes SB 1912 and is working with concerned organizations seeking amendments to SB 1912 that remove onerous provisions.
SB 1912 passed in the Senate and is under consideration by the House Judiciary Committee.
Medical Disciplinary Fund Shortfall
PHYSICIAN LICENSURE FEE INCREASES – 2013 began with intense negotiations with the Illinois Department of Financial and Professional Regulation (IDFPR) regarding physician licensure fee increases and how best to replace the $8 million that had been swept from the fund and transferred to the General Revenue Fund (GRF). This money has never been paid back and because of this, the Medical Disciplinary Fund experienced a shortage of funds.
To address the immediate funding crisis in the Medical Disciplinary Fund, ISMS introduced House Bill 1001 (Rep. Hays) and Senate Bill 1494 (Sen. Martinez) to transfer $9.6 million from the General Revenue Fund (GRF) to the Medical Disciplinary Fund. To ensure long term stability in the fund, the bills would have increased physician initial licensure and renewal fees 67% to $500. The bills also provided for a 10 year extension of the Medical Practice Act.
Unfortunately due to strong opposition from the Governor’s office and concern among legislators about the lack of state revenue in GRF and the poor fiscal condition in the state, neither S.B. 1494 nor H.B. 1001 were called for a vote.
In early February, Speaker Michael Madigan introduced House Bill 193, a bill to require physicians to restore money to the Medical Disciplinary Fund that was diverted to pay for other state programs. To make up this diversion, HB 193 would have raised initial and renewal fees for physician licenses to $750 and sharply raise other physician licensure fees as well. The licensure fees would have remained at $750 even after the money would have been paid back, creating a surplus of revenue in the Medical Disciplinary Fund, making it ripe for future sweeps.
An alternative to H.B. 193 was introduced in the Senate and passed on February 14.
Senate Bill 622 authorized the transfer of money into the Medical Disciplinary Fund and then beginning in 2014, and over two licensure cycles, require that the revenue to be paid back. Fees for initial and renewal fees would be increased from $300 to $700. After the temporary appropriation would be paid back, those licensure fees would be brought down to a reasonable level of $500.
Efforts to amend S.B. 622 in the Illinois House so that the bill would closely mirror H.B. 193 were averted due to ISMS opposition. The House approved an unamended version of S.B. 622 on March 7 and it was signed into law on March 8.
Although ISMS would have preferred restoration of previously swept funds from general revenues, it is good news that the licensure crisis is over.
MEDICAL PRACTICE ACT EXTENSION – The Illinois Medical Practice Act is scheduled to sunset on December 31, 2013. ISMS will continue to advocate for a 10 year extension of the Medical Practice Act (SB 1794, Sen. Martinez) which has been denied to the medical profession since the passage of medical liability reform in 2005. No other professional has a sunset period of less than 10 years.
FULL FUNDING FOR STATE HEALTH PROGRAMS – The state’s budget crisis continues to create significant payment delays for Medicaid and the state employees’ group health plan. ISMS will continue to advocate for increased funding for these programs so that past due bills are paid and future payment cycles are considerably shortened.
HOME HEALTH SERVICES BY OUT-OF-STATE PHYSICIANS – House Bill 2760 (Rep. Sosnowski) is an initiative of the Illinois State Medical Society and addresses home health care services ordered by an out-of-state physician. Current law does not expressly allow for home health care services to be ordered by an out-of-state physician, so this bill ensures that Illinois law allows for such orders and then provides a reasonable time frame for the patient to find an Illinois physician to order home health services
As drafted, there will be 90 days for a patient to transition to an Illinois physician. However, for those patients where home health services are needed to care for two or more medical conditions requiring intensive management by two or more physicians the transition period may be 180 days.
HB 2760 passed out of the House Health Care Licenses Activities and awaits further action on the House Floor.
SEXUAL HEALTH EDUCATION – House Bill 2675 (Rep. Lilly) and Senate Bill 2354 (Sen. Steans) would create a standard for existing sexual health education courses, ensuring that only medically accurate, age-appropriate, and complete information is taught as part of public school sex education curricula. This would include information on reducing unintended pregnancies, STDs and STIs, and would stress abstinence. This proposal applies to grades six through 12, ensuring that whenever public schools choose to teach sex education, their programs must be medically accurate and developmentally and age appropriate.
Pursuant to ISMS HOD policy, ISMS supports the bills. House Bill 2675 was approved in the House Human Services committee and is awaiting further debate on the House Floor.
– Senate Bill 73 (Sen. Steans) and House Bill 1052 (Rep. Bradley) would allow all types of advanced practice nurses, including certified nurse anesthetists, to provide medical care completely independent of physicians. Current Illinois law emphasizes a team approach in patient care, requiring physician input and collaboration.
ADVANCED PRACTICE NURSES
SB 73 was never called for a vote in the Senate Licensed Activities committee. ISMS successfully amended HB 1052 with language retaining the collaborative agreement between a physician and an APN. The amendment instead eases some of the current restrictions in collaborative agreements.
Specifically, the ISMS language clarifies that a written collaborative agreement outside of an employment arrangement may not restrict categories of patients or APNs from contracting with Medicaid, Medicare or other health plans nor limit geographic practice locations. It further clarifies that the agreement may include services the collaborating physician provides or may provide, but chooses not to. And finally, the amendment provides that, notwithstanding the collaborative agreement, an APN may provide primary health care services such as health screenings, histories and physicals, women’s health exams and school physicals as part of their routine practice or on a volunteer basis.
There are no changes to prescribing or to anesthesia services included the bill as amended. HB 1052, as amended, passed out of the House Health Care Licenses Committee and awaits further action on the House Floor.
PRESCRIPTIVE AUTHORITY FOR PSYCHOLOGISTS – Senate Bill 2187 (Sen. Harmon) and House Bill 3074 (Rep. Bradley) would allow psychologists, who receive very little medical training, to prescribe mind-altering psychotropic drugs for patients suffering from mental, emotional, and psychological illnesses.
Illinois is one of 48 states that currently prohibit psychologists from prescribing drugs. Allowing professionals without medical training to prescribe dangerous psychotropic drugs will put patients at risk. For these reason, ISMS strongly opposes SB 2187 and HB 3074.
HB 3074 was never assigned to a standing committee. SB 2787 passed out of the Senate Public Health committee and awaits further debate on the Senate Floor.
DENTISTS – Senate Bill 1217 (Sen. Haine) would allow dentists to administer vaccinations after they complete “appropriate training” on how to address contraindications and adverse reactions. ISMS is opposed to this legislation. The requirement for additional training is inadequate and will not protect patients, especially those who suffer from chronic illnesses, experience allergic reactions and/or those who are on other drugs that may negatively interact with an immunization.
Because of ISMS’ opposition, the language permitting dentists to provide immunizations was removed and replaced with language that minor changes to the Dental Practice Act. ISMS is neutral on the bill as amended, which passed out of the Senate Licensed Activities committee and awaits further action on the Senate Floor.
DIRECT-ENTRY MIDWIVES – House Bill 1194 (Rep. Berrios) and House Bill 2685 (Rep. Morrison) would allow individuals who receive little to no medical training to provide unsupervised home birthing services by licensing direct entry midwives as "certified professional midwives” (CPMs). CPMs do not consider obstetrical care to be medical care, yet these bills would allow them to perform histories and physicals, provide prenatal care, dispense drugs, treat hemorrhages and other emergencies, and treat the infant and woman postpartum. All of these activities are medical in nature and should only be performed by the professionals who are adequately trained to do so.
These bills are a step backward in this effort as it would allow the least-trained individual to independently provide one of the most critical services to women in Illinois.
HB 1194 was not called for a vote in committee. HB 2685 failed to advance out of the House Health Care Licenses committee. We expect this issue to surface again sometime this session.
LICENSURE OF NATUROPATHIC PHYSICIANS – Senate Bill 1168 (Sen. Martinez) would license “naturopathic physicians” under the Illinois Medical Practice Act and allow them to provide many aspects of primary care to Illinois patients. Naturopaths are not adequately educated and trained to care for patients as physicians do and there is little research on the scientific validity of their treatments, which is focused on botanical medicine and homeopathy.
BILLING FOR ANATOMICAL PATHOLOGY SERVICES – Senate Bill 1630 (Sen. Haine) would restrict certain health care professionals’ ability to bill for services related to anatomic pathology services. The bill was amended to include language allowing physicians to charge for acquiring or processing a patient’s specimen.
SB 1630, as amended, passed out of the Senate Insurance committee and awaits further action on the Senate Floor.
MEDICAL LIABILITY REFORM – ISMS will advocate for legislation re-enacting provisions related to expert witness standards and the certificate of merit, along with lowering the post judgment interest rate. Senate Bill 2160 (Sen. Barickman) would reenact many of the provisions from Public Act 94-677 (the medical liability reform law of 2005), with the exception of caps on awards for non-economic damages. Specifically, the bill would:
a) Strengthen the affidavit of merit by requiring the disclosure of the consulting physician’s name and that the physician be an expert in the area of medicine that is the subject of the lawsuit;
b) Limit 90-day extensions for filing the affidavit and written report to situations where the affiant was unable to obtain consultation because the consultation could not be obtained before the statute of limitations expired;
c) Allow the use of annuities for the payment of portions of the award for medical costs;
d) Increase the standards for expert witnesses by requiring them to be board certified or board eligible in the same specialty as the defendant. The expert would also have to devote a majority of time to the practice of medicine, teaching or research. Retired experts would have to be current with continuing education requirements;
e) Extend Good Samaritan immunity to retired physicians providing free care;
f) Allow a free medical clinic to receive reimbursement from the Department of Public Aid, provided the reimbursements would only be used to pay overhead expense of operating the clinic and not to provide compensation to the health care professional receiving civil immunity;
g) Provide that the interest rate on judgments would be automatically increased or decreased by a percentage equal to the percentage change in the consumer price index during the preceding 12 months (currently, the 9% interest rate is not annually indexed); and
h) Delay the accrual of interest in certain cases where a federal Medicare lien may exist against the judgment by providing that in such cases, the interest would be computed from the day after the federal Medicare program provides confirmation of any lien against the judgment rather than from the day the judgment is entered.
ADVANCE DIRECTIVES; SIMPLIFIED HEALTH CARE POWER OF ATTORNEY – House Bill 2373 (Rep. Williams) would create a more patient friendly power of attorney for health care. One of the main goals of this legislation will be to provide a notice and form in simpler language that will be more easily understood by the general public. This form will be designed with the intent to increase the use of these instruments and encourage individuals to designate a person to make health care decisions for them when they can no longer do so themselves. Our legislation would preserve the individual right to use any other “non-statutory” form but specify for the first time the minimum requirements for an alternate form to be considered acceptable under the Illinois Power of Attorney Act.
EASING OF FOUR-DRUG LIMIT FOR MEDICAID PATIENTS – Last year the Illinois General Assembly instituted a limit of four drugs that would be covered as a Medicaid benefit for many patients. This limitation has caused great concern among physicians and patients alike, as many patients have gone without essential medications. While the Department of Health and Family Services has attempted to minimize some of the difficulties caused by this legislation, physicians believe more should be done to address physician and patient concerns.
House Bill 2352 (Rep. Cassidy) would do the following: require the department in consultation with statewide organizations representing prescribers to develop a protocol that expedites review and approval of prescriptions for psychiatric conditions and chronic conditions such as asthma, hypertension and diabetes; and, allow the department to exempt prescriptions for antibiotics and other categories of drugs simply by using its rulemaking authority.