As the end of the legislative session starts to come into sight, more bills are being pushed quickly through committees and on to votes. This week’s roundup of health care bills:
By Rose Hoban
As lawmakers get closer to the end of their legislative session, bills start to move quickly through committees on their way from one house to the other.
The reason for this is an event called “crossover,” a deadline that kills bills. Legislators need to rush proposed pieces of legislation through committees and votes in one house of the General Assembly before the crossover date of May 17. If bills don’t make it out of one house and into the other before that date, the bill dies.
This year, legislators have filed a large number of bills: 724 in the Senate and more than 1,000 in the House of Representatives.
As we approach crossover, many bills will move quickly, and North Carolina Health News will attempt to keep readers up to date with all of the health care bills.
Controlled Substances Reporting Bill
During Thursday’s House of Representatives floor session, legislators discussed a bill that would tighten requirements for pharmacists and physicians to more quickly report prescriptions such as opiod painkillers and mood-altering drugs to a state database. The bill also requires health care professionals to check when a patient is filling their prescriptions to see that they have not been “doctor shopping” to obtain painkillers.
Until now, checking the database has been voluntary.
The bill, a companion to Senate bill 222 , is part of an effort to reduce the number of deaths related to opiod overdoses.
“The controlled-substances reporting system is in place in this state, we just don’t use it,” said bill sponsor Rep. Craig Horn (R-Weddington). “That’s what this bill does, mandates using it, mandates a time period in which it is to be used, mandates who is to use it and, as well, discusses who has access to it.”
With that comment, Horn then proceeded to offer an amendment that would make it easier for sheriffs and their deputies to get access to the database in the course of an investigation.
The state sheriffs’ association has long looked for increased access to the database.
But with that proposal, movement on the bill quickly stopped, as Rep. Tom Murry (R-Morrisville) challenged Horn on the amendment. Murry is a pharmacist.
“My reading of the amendment is that this deletes the warrant language in the original bill,” Murry said, asking if this meant that a sheriff could walk into a pharmacy to look through the database in the course of an investigation.
Horn told Murry that the amendment would only require a subpoena, not a search warrant.
“I’m trying to make sure that the officer that is coming to the pharmacy has properly gone through a judicial hearing, and I think a warrant is a much stronger provision than a subpoena,” Murry said. “If we’re going to have sheriffs come into pharmacy, I’d rather them go to a judge and get a warrant.”
Horn later withdrew the amendment and stopped the bill from advancing to a final vote. He said he plans to work out issues with other legislators in the coming days and bring the bill back next week for a final House vote.
“The goal of the amendments is to ensure that everyone who needs access has access,” Horn said.
Epinephrine Pens in Schools
One of the most terrifying medical emergencies occurs when someone who is allergic to a substance – be it a peanut or the venom of a bee sting – has a severe allergic reaction. The most serious kind of reaction is called anaphylaxis, a rapid onset of hives, throat swelling and low blood pressure. Untreated, anaphylaxis can quickly proceed to death.
“The most challenging student is the student with a food allergy,” said Cheryl Herberg, a nurse with Union County Public Schools who is also the head of the School Nurses Association of North Carolina. “We have to really make sure that everybody’s very aware of the student’s allergy plan, where they can sit, what they can eat, what the emergency plan is.”
As the number of school children who have allergies to foods and insect stings increases, school nurses have looked to ease access to the first-line treatment: epinephrine. Until now, students have had to have their own epinephrine self-injection device with them, but a new bill would put additional “EpiPens” in schools for use by staff.
“The bill follows the lead of a number of other states, particularly Virginia, Illinois and Georgia, which require local boards of education to provide schools with at least two epinephrine auto-injectors for use by trained personnel to provide emergency medical aid to children or any staff members suffering from an anaphylactic reaction,” said bill co-sponsor Rick Glazier (D-Fayetteville).
Herberg said an additional danger for students with allergies occurs when school nurses cover more than one school, as she does. Her organization supports the bill.
“When you only work in a school two days a week, you lose a lot of control over what happens when you’re not there,” Herberg said.
The bill also requires that other staff members at schools be trained in use of the devices.
Bill co-sponsor Murry said the company that makes EpiPens, Bioridge Pharma, has a program that gives schools four devices at no cost. Replacements cost around $150 for a two-pack.
“We are requiring schools to develop a training program for teachers to recognize an allergic reaction,” Murry said. “I think this will help save lives, instead of the current situation where you have to have a patient-specific prescription epinephrine-injectable device per student.”
The bill passed on a unanimous vote and will be sent to the Senate.
Study and Encourage Use of Telemedicine
Many counties of North Carolina lack primary care providers, psychiatrists and specialists to deliver needed health care services. The need is particularly acute in rural counties in the eastern and western parts of the state, where populations are scattered and often poor.
In such counties, electronic communication via the telephone or Internet is a promising way to deliver health care services.
A bill to study the use of telemedicine, how to pay for it and how to bill for it passed the House unanimously.
“The study will attempt to develop consistent guidelines between providers, insurers and state agencies – Medicaid, for one example,” said bill sponsor Mark Brody (R-Monroe).
The bill would also address licensure requirements for professionals providing the service, infrastructure needs and other regulatory issues.
“There’s a broad spectrum of patient monitoring,” said Kim Schwartz, director of the Roanoke Chowan Community Health Center in Ahoskie. Her clinic has been offering remote monitoring of patients with multiple health problems using scales and blood-sugar monitors that send data over phone lines for about six years.
The programs run out of Schwartz’ clinic have monitored more than 1,700 patients from all over the state.
Schwartz studied her patient population and found tremendous savings for patients with multiple health problems who had had multiple emergency room visits and hospitalizations prior to her program.
“We had an independent audit that looked at a subset of 700 patients who were part of state-funded programs like Medicaid,” Schwartz said. “We found about $400 million in savings as a result of fewer ED visits, decreased hospitalizations and shorter lengths of stay in the hospital when they were admitted.”
The proposed study would also determine the best ways to fund telemedicine services.
“I think the whole broad spectrum of telehealth and telemedicine is an efficient and cost-effective tool for managing the disruptive change that needs to happen in health care,” Schwartz said.