The Arkansas Medical Society is a community of Arkansas physicians made up of every medical specialty from all over the state. Whether it’s connecting members with resources, education, or information, advocacy is essentially at the core of everything that we do. With all the different ways to advocate to and for our members, some often wonder if advocating with legislators is worth it. The answer is simple: yes, it is worth it.
Despite all the challenges that were presented during the 2021 Legislative Session, the Arkansas Medical Society worked tirelessly with member physicians, pro-medicine legislators, and other organizations to reach the best outcome possible for the patients of Arkansas.
The Arkansas General Assembly convened on Tuesday, January 12, and legislators hit the ground running. By the time the legislature went into recess on April 28, 2021, there had been a total of 1675 bills filed, of which 1112 had passed into law. AMS actively tracked almost 240 of those bills throughout the session, and although there were laws passed that we did not support, the AMS Governmental Affairs Team was able to reach a favorable compromise on several other bills. The following bills represent some of the more high-profile issues AMS successfully fought for and closely monitored bills that may have an impact on you, your patients, and your practice.
Telemedicine Act (Act 829/HB 1063 by Jim Dotson)
This amendment to the Act addresses:
- The establishment of a physician/patient relationship if the physician has a “patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone…”;
- Continuing health insurance payment to physicians for services provided by telephone; and
- Prohibiting any requirement that an enrollee choose a telemedicine service provider rather than enrollee’s regular doctor.
Medical Marijuana Telehealth Certification (Act 1112/SB 703 by Greg Leding)
Will allow physicians to provide medical marijuana certification through telemedicine.
APRN Full Practice Pathway (Act 412/HB 1258 by Lee Johnson, MD)
Will allow certified nurse practitioners with 6,240 hours of collaborative practice with a physician to apply to the “Full Independent Practice Credentialing Committee” (made up of 4 physicians and 4 certified nurse practitioners) for full practice. Does not expand prescription authority.
Certified Nurse Midwife Independent Practice (Act 607/HB 1215 by Mary Bentley)
Provides certified nurse midwives with “full practice authority” and was amended to maintain physician collaboration for schedule II prescriptions, and a requirement to identify a physician or facility (or both) with which a referral and consultation has been made in the event of a medical complication for deliveries outside of an accredited facility.
Pharmacist Oral Contraceptive Dispensing (Act 408/HB 1069 by Aaron Pilkington)
Allows pharmacists to dispense oral contraceptives for up to six months without physician prescription, under a statewide protocol, to 18 and older.
CRNA “In Consultation” (Act 449/HB 1198 by Clint Penzo)
Changes the requirement that CRNAs administer anesthetics “under the supervision of” a physician (21 other states mention supervision or “under direction of”) to administering anesthetics “in consultation with” a physician (28 other states neither mention “under supervision of” nor “under direction of”).
Pharmacists Treating Health Conditions (Act 503/HB 1246 by Lee Johnson, MD)
The Act will:
- Allow pharmacists to treat influenza and pharyngitis caused by streptococcus A only under a statewide written protocol, along with other health conditions that can be screened with a CLIA-waived test “that may be adopted by rule of the Arkansas State Board of Pharmacy, in consultation with and upon approval of the Arkansas State Medical Board”;
- Create a formulary of drugs that a pharmacist may prescribe for treatment of the previously stated conditions (again, only with the Arkansas State Board of Pharmacy in consultation with, and approval from the Arkansas State Medical Board);
- Allow for therapeutic substitution (with limitations…physician remains in control, only if cheaper for the patient); and
- Allow for physician dispensing of acute care medication (to treat infections, anti-inflammatory medications, antinausea medications, antihistamines, and cough medications) or the initial treatment for maintenance medication (not a controlled substance, prescribed no more than 30 days and used to treat hypertension, diabetes mellitus or hypercholesterolemia).
Medicaid Recognizing APRNs as PCPs (Act 569/HB 1254 by Jeff Wardlaw)
Will require Medicaid to recognize APRNs as a “primary care provider authorized to carry out the duties of a primary care case manager…” (except for “owning a patient-centered medical home”), including “acting as the team leader of family practice professionals and the patient-centered medical home…”
Clear Face Mask Mandate (Act 697/HB1502 by Charlene Fite)
During an emergency declaration, and when encountering those who are Deaf, deaf or hard of hearing, all physicians and staff, hospital employees and volunteers, firefighters and police…“shall wear upon request a clear face covering, a partially clear face covering, a face shield, or briefly remove the face covering or face shield if no other means of reasonable accommodation are available.”
Coverage of Breast Cancer Diagnostic Examinations (Act 553/SB 290 by Greg Leding)
Adds definition of “breast magnetic resonance imaging” and states that a “healthcare insurer shall ensure that an individual’s cost-sharing requirement under a health benefit plan that is applicable to a diagnostic examination for breast cancer, including breast magnetic resonance imaging, is no less favorable than the cost-sharing requirement that is applicable to a screening examination for breast cancer.”
Medicaid Diagnostic and Radiology Services Cap (Act 891/SB 395 by Missy Irvin)
Will change the current $500 cap for diagnostic and radiology services to two separate $500 caps, one for diagnostic services and the other for radiology services. The cap language (“at least”) is a floor. Any laboratory or diagnostic procedure considered an essential health benefit does not count toward the cap.
Physician Assistants (Act 634/SB 152 by Kim Hammer)
Adds a physician assistant to the Arkansas State Medical Board, changes prescription authority to mirror APRNs on schedule II, allows pronouncement of death and other supervision clarifications.
ARHome/Arkansas Works/Private Option (Act 843/SB 55)
Perennial appropriation fight for Medicaid expansion, which requires 75% vote. Passed the House on the fifth attempt.
Telemedicine for Group Therapy (Act 767/HB 1068 by Aaron Pilkington)
Clarifies that home can be an originating site and allows for group therapy if approved by CMS for those over 18.
Multi-year License (Act 803/HB 1582 by Monte Hodges)
Requires the Arkansas State Medical Board to offer a multi-year license option for physicians.
Step Therapy Amendments (Acts 97 and 645/ SB 99 and SB 446 by Cecile Bledsoe)
Act 97 provides a detailed step therapy process for insurers, and Act 645 clarifies that Act 97 is applicable to Medicaid Private Option (Arkansas Works/ARHome).
Medicaid Coverage of Continuous Glucose Monitoring (Act 643/SB 521 by Brianne Davis)
Requires Arkansas Medicaid to cover continuous glucose monitoring for those with diabetes.
Medicaid Coverage of FDA Approved Products and Label Expansions (Act 745/SB 143 by Missy Irvin)
Requires Arkansas Medicaid to provide coverage for new products and label expansions approved by the United States Food and Drug Administration, or outpatient drugs with a federal rebate agreement in place, if the product is prescribed according to approved indications or medically accepted indications.