Dollars & Sense: The State Budget
Earlier this week, the state budget became a bill on Capitol Hill—or at least on Capitol Square in Columbus, Ohio. The OSMA has completed an initial review of the bill language for the state budget of Ohio, HB 166, and is glad to report the budget is overall positive for physicians in Ohio. This week, we breakdown the dollars and sense of HB 166.
The bill will be debated over the next couple months and must be passed by the Legislature and sent to the governor by June 30.
Here is a brief review of the other main provisions from the budget bill that the OSMA will be tracking:
Telemedicine: Namely, the OSMA’s priority language around coverage for telemedicine services, which might be familiar from last general assembly (HB 546), is included in the budget bill! The OSMA is thrilled to see this included in the budget and will be working in the coming deliberations to ensure that this language remains in the final version of the bill.
Ohio Physician Loan Repayment Program: The bill includes funding increases to the current Ohio Physician Loan Repayment Program for participants who renew commitment to practice in underserved areas and who are providing medication-assisted (MAT) treatment.
Substance Use Disorder Professional Loan Repayment: Language in the budget creates a substance use disorder professional loan repayment program, to expand the drug treatment workforce through development of a student loan repayment program specifically for providers of these services.
CPC Program: The bill includes an expansion of the current Ohio Comprehensive Primary Care (CPC) program to include investments in pediatric care.
Medicaid Coverage Following Childbirth: Language in the budget requests that a waiver be submitted to the Centers for Medicare and Medicaid Services (CMS) to allow pregnant women on Medicaid to have 12 months of continuous coverage following the birth of a child. Current Ohio law only requires coverage for 6 weeks post-delivery.
Minimum Age to Purchase Tobacco/Vape Products: The bill includes provisions that would prohibit anyone under the age of 21 from purchasing tobacco or other tobacco products, such as vape pens.
Project DAWN & Naloxone Access: The budget bill increases community access to naloxone by providing funding for Project DAWN sites across all 88 counties in Ohio.
Mental Health and Addiction Services: The bill contains specific efforts to provide consumers with education and resources in order to better understand coverage for mental health and addiction services.
CME Requirements: The budget language proposes to change physician CME requirements to remove the 60 hour category II requirement, and to increase by 10 hours the requirement for category I.
Chancellor’s Task Force on Physician, Nursing, and Allied Health Care Work Force: The budget bill proposes the creation of this task force with a goal of finding ways to train and retain health care workers in key shortage areas. The task force will include representatives from medical schools, the state medical board, hospital administrators, physician and nursing organizations, and other allied health professionals.
The bill also continues funding, at the previous levels, for graduate medical education (GME), medical education, clinical teaching, primary care residencies, and long-term care research to ensure Ohio’s supply of well-trained medical professionals.
There is also a sizable increase to the hospital franchise fee.
One issue the OSMA plans to examine in-depth and discuss at the legislative task force meeting at the 2019 OSMA Annual Meeting on April 5 is a proposed change to create a single preferred drug list for all the Medicaid plans in Ohio. A preferred drug list (PDL) is a list of medications that are covered without the need to request prior authorization (PA). While terms such as PDL, formulary, and drug coverage are often used interchangeably, PDL is the proper Medicaid term. Here are a few of the potential advantages of a single PDL:
- Streamlines prescribing and the prior authorization process and offers a standardized response to best evidence-based medication requests, which would minimize paperwork and time delays for needed drugs.
- Providers will no longer need to learn six different PDLs, which may decrease medical errors, and providers will easily have more thorough knowledge of a smaller group of preferred drugs.
- Limits frequency of PDL changes; a single PDL would be reviewed quarterly with major changes implemented yearly.
- Supports CPC program and adherence efforts, as clinicians have long identified confusion in conflicting payer policies and processes as part of the barriers impeding ideal adherence to medications (ex. currently large variation among preferred Respiratory Agents).
- Allows for a standard process to support population health initiatives (including but not limited to opioid prescribing and MAT access).
- Minimizes member movement across MCPs; members are less likely to change plans due to drug coverage preferences.
- Decreases member abrasion; easier transition of care if member changes plan.
Lastly, the OSMA will be meeting with elected officials to see if there may be an opportunity to add language that would remove prior authorization across the board for MAT drugs.
Stay tuned for updates as the advocacy team learns more details and continues through the budget process. As always, OSMA members are welcome to reach out to the advocacy team with questions.