2012 Legislative Session Overview
April 12, 2012
Nurse Leaders of Idaho represents its diverse membership of nurse leaders in service, education, community and regulation on a variety of health policy and legislative issues. Those issues include nursing education, workforce development, public health and safety, nursing regulation and practice, and access for Idahoans to quality and affordable health care. From the standpoint of NLI, the 2012 session was a successful one, with five key pieces of nursing legislation passing the legislature and being signed into law by the Governor.
The 2012 session was remarkable for the legislature’s management of a number critical issues, including redistricting, a revenue surplus, public education technology initiatives, child safety, implementation of the Affordable Care Act, ethics in government reform, tax breaks, and moral issues surrounding abortion and end of life care.
The session began with a sense of relief that hard decisions to further cut government services and pay would be unnecessary due to a projected budget surplus for the first time in a number of years. The discussion from the outset centered on restoring support and services, providing employee raises and tax relief. It’s resolution became the “going home” issue. In the end public schools received a 4.6% increase, colleges and universities 8.6%, Medicaid 8.7%, and correction 7.3%. $49.5 million was placed in the state’s cash reserves. State employees were given a 2% raise. $36 million in income tax relief for businesses and higher income earners passed. Those voting against the tax cut expressed concern that on-going tax cuts may not be sustainable if the economy fails to fully recover, in which case the state will find itself again in a cycle of inadequate revenues necessitating “holdbacks” and cuts in services and state employee pay.
Early on the debate over redistricting distracted the legislative leadership. The bipartisan redistricting commission’s initial plan was rejected by the Idaho Supreme Court, and then the head of the state Republican Party and the Speaker of the House attempted to remove two of the Republican commissioners. This effort was rejected by the Secretary of State and the commission went back to work on a new plan that split fewer counties. Given the shift in population from rural to urban centers in Idaho, inevitably the new districts have resulted in geographically larger rural districts and many primary legislative races that will pit incumbents against each other. Certainly, many of the 32 legislators who are retiring after this session are doing so as a result of redistricting. Some are predicting a 30-40% turnover in legislative seats this fall, which will have a significant impact on the “institutional memory” and experience of the 2013 legislative body.
Additional legislation enacting Superintendent Luna’s “Students Come First” initiative passed, and base teacher pay was increased. Public Colleges and Universities received increased funding this year for the first time in a number of years; however their budgets continue to be less than pre-recession levels.
In terms of child safety and health, some progress was made. Texting while driving will become unlawful on July 1, as will selling electronic cigarettes to minors. Legislation that will protect young athletes who may experience concussions passed, while legislation that would have prohibited children under 18 from using tanning beds was thwarted by lobbyists who insisted this would be an overreach of government. Child Preventable Death Review legislation also did not move forward again this year. The House Revenue and Taxation Committee heard a proposal brought by a coalition of consumers, stakeholders, and health care providers, including nursing, to increase tobacco taxes as a deterrent to youth smoking. Even with this unified effort, and overwhelming public support, the committee voted to not print the bill, essentially stopping it for this year.
In spite of the fact that a large coalition of health care providers and businesses came together in support of draft legislation to create a state health insurance exchange which would facilitate the enrollment in affordable health insurance for individuals and small businesses, the bill never was printed and was denied a public hearing. Legislative leadership failed to act because a majority in the legislature believes that the individual mandate in Accountable Care Act will be found unconstitutional when the Supreme Court rules on the mandate in June. Governor Otter had committed to receiving $20 million in Federal funds to set up the exchange, but the legislature removed spending authority for it. The consequence for Idaho will be the institution of a Federal Health Insurance Exchange, unless the entire law itself is repealed. There was very little, if any, discussion about what lawmakers would then do to address the issues of access to insurance and the affordability of health care.
The session began with some legislators expressing interest in pursuing legislative ethics reform, however little action was taken in spite of ethical misconduct allegations surfacing during the session. In the end, the Senate passed new ethics rules which its leadership admitted were only “baby steps”.
It is not unusual for legislation surrounding the issue of abortion to surface in an election year. This year a bill that would require women to undergo a vaginal ultrasound prior to having an abortion passed the Senate and became embroiled in controversy. It was the target of protests on the Capital steps by an opposition that questioned the right of government to dictate an invasive medical procedure. The bill was not given a hearing in the House. Two bills passed that amended the Medical Consent and Natural Death Act. The bill from the End of Life Coalition clarified how documents including the Physician Order for Standard Treatment (POST) interfaces with other end of life documents and added PA’s and APRN’s as providers authorized to sign the POST. The bill from Right to Life which was amended at the request of the IMA sought to protect a patients desire to have food and fluids administered and to prohibit care from being withheld because of disability, age or terminal illness.
To access the final report of the 2012 Legislative Session posted to the Idaho Legislature site follow this link: http://www.legislature.idaho.gov/sessioninfo/2012/sinedie.pdf

Legislation of Interest to Nurses which Passed:
S1260 NURSING – BOARD POWERS AND DUTIES- grants the Board of Nursing the statutory authority to develop and implement alternatives to discipline, including a practice remediation program to educate and rehabilitate a nurse when a practice deficiency can best be addressed without resorting to formal discipline.

S1261 NURSING – BOARD POWERS AND DUTIES -The bill also amends existing law relating to nurses to provide that the Board of Nursing shall have the power and duty to evaluate and develop, or to enter into contracts or agreements with others to evaluate and develop the education, distribution and availability of the nursing workforce for the purpose of improving the delivery of quality health care. These initiatives would be funded with existing nurse license fee revenue. This legislation is in response to an NLI request to the Board of Nursing.

S1262 NURSING – MEDICATION ASSISTANT - amends existing law relating to nursing to require that all applicants for original certification or certification reinstatement as a certified medication assistant submit to a fingerprint-based criminal history check and to provide requirements relating to such criminal history check. The bill is proposed due to an FBI audit that revealed a deficiency in the statue.

SB1273 NURSING – LICENSING AND ADVANCED PRACTICE- proposed legislation will not alter existing advanced practice nurse roles or scopes of practice. Instead, the legislation will refine titles, change the membership of the current board of nursing APRN advisory committee and create a statutory framework for identifying by rule educational requirements for licensure, criteria for educational programs and grandfathering of advanced practice nurses currently licensed in Idaho as well as advanced practice nurses licensed in other states applying to endorse into Idaho based on previous requirements.

HB405 ELECTRONIC CIGARETTES Regulating the sale of electronic cigarettes to minors.

HB393 RURAL HEALTH CARE ACCESS AND PHYSICIAN INCENTIVE – Amends and repeals existing law relating to rural health care access and physician incentive to provide for the Rural Health Care Access and Physician Incentive Fund. The fund will provide incentive for physicians to serve in federally designated primary health care professional shortage areas.

HB609 PUBLIC ASSISTANCE LAW – Restores cuts to Medicaid made during the 2011 Legislative Session in HB 260.The services being restored relate to preventative dental services, duplicative skill training for individuals with mental health and developmental disabilities, and the removal of tiered individual budgets for adults.

HO548 CUNCUSSIONS Provides for coaches, referees, athletic trainers, parents and youth athletes to receive information regarding the signs and symptoms of concussions and the risks associated with continued play after a concussion. It also provides a protocol for players suspected of sustaining a concussion by exhibiting outward signs or symptoms of concussion to be removed from play and not returned to play until receiving written medical clearance from an appropriate medical professional trained in the evaluation and management of concussions.

H0541- MEDICAL STAFF CREDENTIALING AND PRIVILEGES Effective July 1, the law now states that hospitals can establish their own criteria for medical staff membership, but they cannot deny medical staff membership to someone merely because that provider also practices elsewhere, has an ownership interest in another facility, or because that provider is a competitor of other providers on the medical staff. ( IMA)
H0441- CATASTROPHIC HEALTH CARE COST PROGRAM. This legislation authorizes county commissioners and the board of the catastrophic Health care Cost Program to pay for authorized expenses to manage the health care costs of indigent persons. H0574 funded the program to pay anticipated bills for 2012.
S1194- MEDICAL CONSENT AND NATURAL DEATH ACT This legislation clarifies the law dealing with the Physician Orders for Scope of Treatment (POST) document and gives APRN’s and PA’s the authority to sign it as health care providers. (End of Life Coalition)
S1348A-MEDICAL CONSENT AND NATURAL DEATH ACT This legislation protects patients from the involuntary denial of food and fluids and from involuntarily denial of life-preserving treatment when the denial is discriminatorily based on disability, age, or terminal illness. (Right to Life Idaho)
S1260 INJURY TO CHILDREN – REPORTING ABUSE – Amends existing law to reduce the age of a child from 18 to 16 in the context of this statute. The law also increases the penalty of not reporting abuse, abandonment or neglect to a felony. The Judiciary will then have more options (misdemeanor or felony) to charge individuals who fail to report abuse.

SB 1337 SEXUAL EXPLOITATION OF A CHILD- This legislation provides updated language that addresses multiple new ways children are being exploited, so that the charged crime more accurately describe the illegal behavior and associated penalties considering the current and potential future technology.

S1252 MOTOR VEHICLE – TEXTING WHILE DRIVING- The legislation defines texting and imposes a $50.00 fine for texting while operating a motor vehicle. The subsequent fine will be $100.00. Exceptions for emergencies and law enforcement are also outlined.

2012 Idaho Legislature
Week in Review
March 20th, 2012
This week marks the 11th and perhaps last week of the legislative session. While many health issues and initiatives are nearing the final stages of deliberation, others have been abandoned. The 4 Idaho Board of Nursing Bills have passed both houses and are on their way to the Governor. Though ethics legislation was not addressed this session, Sen. Pearce (R-New Plymouth), the chairman of the Resources Committee is facing an ethics committee for voting 22 times without disclosing a conflict of interest; the senator has oil or gas leases on his property. The controversial HB464 OIL AND GAS BILL passed the Senate on a 28-6 vote. The “going home bill” will likely be some sort of tax relief for top earning individuals and/or businesses. The debate between the Republicans and the 2 houses seems to center on tax relief vs restoring salary cuts to teachers, and the wisdom of doing either with “one time money”. Legislation that would cap expenditures at 5.33% of revenues has passed the House, complicating these decisions further. Proponents of the spending cap argue that it would ensure that government is small; opponents argue that the services provided by government are important and increasingly costly.
A high profile bill, SB1358 STUDENT HARASMENT AND CYBERBULLYING has passed the senate (25-8) after the bill’s committee hearing received numerous testimonies. The bill must now past through the House. Likewise, SB129 MESSAGE THERAPY LICENSING has also passed the Senate and the House Commerce Committee. The bill would establish a licensing process for therapists as there is currently no regulation.
The House has deliberated on many health issues as well. HB551 CORONER UNCLAIMED BODIES passed the house (66-2) and would allow coroners to cremate unclaimed bodies. The bill makes exceptions for veterans. HB632 YOUTH ATHLETES/ CONCUSSION GUIDELINES met success in the House with a passing vote (59-7), while HB486 MINORS, PHOTOTHERAPY AND TANNING DEVICE has now gone back to committee twice for amendments. The bill now requires medical consent under age 15, and parental consent and evidence of age between 16 and 18.
Committee hearings have been intense these last two weeks, with high attendance and strong emotional public testimony. SB1349 ABORTION has passed both houses and awaits the signature of the Governor. He can veto it, sign it , or allow it to become law without his signature. Media editorials have highlighted what would appear an inconsistent ideology among policy makers when it comes to individual rights vs government mandates. The bill would require women to receive ultrasounds before receiving an abortion. SB1348a MEDICAL CONSENT AND NATURAL DEATH ACT that forbids health care providers from withholding food and medications against the wishes of a dying patient has been amended by the Idaho Medical Association and has passed the Senate.
Tobacco Tax
After a strong effort on the part of the American Cancer Society and its allied organizations, including the IPHA, the Tobacco tax increase will not be heard on either of the floors this year. The draft legislation did not get enough votes to have it printed, essentially killing the bill without an opportunity for a public hearing. After the hearing, Rep. Schaefer was singled out for writing a strongly worded, negative email to individuals who urged him to support the bill.
Health Insurance Exchange
There is still some talk about running a bill to establish a state Health Insurance Exchange. With limited time, it would seem unlikely, but it is possible to get things done quickly when the political will is there. Rep Nonini’s resolution, HCR45 PRIVATE HEALTH INSURANCE EXCHANGE- has passed the House on a 49-13 vote. The resolution encourages private health insurance agencies in Idaho to create their own health insurance exchange. SJM104 HEALTH AND HUMAN SERVICES REGULATION, which opposes the Patient Protection and Affordable Care Act’s mandate that requires coverage of contraceptive in acceptable plans, has been adopted by the Senate.
Legislation of Interest
To view summaries and updates of additional legislation IPHA is following throughout the 2012 session, click HERE. To be routed to a full text version of each bill, click on the bill’s title in blue. The Idaho Legislature home page also offers a free bill tracking service that provides email alerts regarding any status changes. To sign up, click HERE

2012 Idaho Legislature
Week in Review
March 9th, 2012
Budgets and bills continue to make headway as we enter the 9th week of the 2012 legislative session. On Friday the Medicaid budget , the last and one of the largest agency budgets, was passed unanimously out of JFAC. Super Tuesday caused a lot of excitement as the Republican Party held their first Idaho Presidential caucus; Romney won the majority of counties and thus the state’s 32 caucus votes. In other news, it appears as though the legislative ethics committee has not and probably will not reach consensus, making the reality of ethics reform this session bleak.
The Joint Finance and Acquisitions Committee (JFAC) has been busy deciding the budgets for various health related programs. The Joint Millennium Fund Committee’s recommendations were unanimously agreed upon and $5.7 million will be allocated to health and tobacco cessation projects. JFAC denied funding to attract rural physicians and also rejected a measure to increase funding for foster parents. Substance abuse treatment programs received a 0.9% increase which may prove inadequate to address some of the wait-listing issues these programs face. The State Hospital South, a state funded mental health facility was approved for 10 additional direct care personnel as well as some equipment upgrades. The hospital has faced enormous shortages to the point its accreditation was considered to be in jeopardy. Overall, Mental Health budgets received a 2.4% increase. The Medicaid budget was set with a 8.7% increase over last year, and funding was included for HB 609 which restores some of the Medicaid services for the disabled.
HB609 PUBLIC ASSISTANCE LAW has passed the house (65-0-5). This bill will restore $1.5 million of the $35 million in Medicaid cuts from last year. Preventative dental services, duplicative skill training for individuals with both mental and developmental disabilities have been restored and the tiered individual budgets for adults removed.
H0393 RURAL HEALTH CARE ACCESS AND PHYSICIAN INCENTIVE has passed both the House (66-2-2) and the Senate (33-0-1) and awaits the Governor’s signature. HB405 ELECTRONIC CIGARETTES has also passed both the House (68-0-2) and Senate (34-0-0) and has been signed into law. As of 07/01/12 minors will not be able to legally purchase electronic cigarettes.
HB548 YOUTH ATHLETES – CONCUSSIONS has passed the State Affairs Committee. Former BSU football player, Matt Kaiserman, has been a vocal supporter of the bill which passed committee on a 15-3 vote. Kaiserman himself suffers from headaches as a result of head injury.
SB1348 DISCRIMINATION IN DENIAL OF LIFE-PRESERVING TREATMENT ACT, by Sen. Nuxoll (R- Cottonwood) will be heard on Monday in Senate State Affairs. The sponsor says that the purpose of this legislation to protect patients from the involuntary denial of food and fluids.
SB1349 ABORTION , which would require a woman to have an ultrasound before receiving an abortion, was the target of protesters on the Capital steps this week. The bill, sponsored by Senator Chuck Winder (R-Boise) and others, will be heard on Wednesday in the Senate State Affairs Committee.
Health Insurance Exchange
HCR45 PRIVATE HEALTH INSURANCE has passed the business committee (14-3). This concurrent resolution encourages private health insurance companies to use their reserves to set up a health insurance exchange. The committee vote fell along party lines.
Nursing Legislation
SB1260, SB1261, SB1262, and SB1273 all passed unanimously from the House Health and Welfare Committee on Thursday. They now await a final vote by the full House. SB1294 IDAHO MEDICAL CONSENT ACT which revises the POST document to include Advanced Practice Registered Nurses and Physician Assistants, has passed the Senate and will be heard in the House Health and Welfare Committee on Monday, March 12 in the afternoon.

Legislation of Interest
To view summaries and updates of additional legislation IPHA is following throughout the 2012 session, click HERE. To be routed to a full text version of each bill, click on the bill’s title in blue. The Idaho Legislature home page also offers a free bill tracking service that provides email alerts regarding any status changes. To sign up, click HERE

2012 Idaho Legislature
Week in Review
March 3rd, 2012
In the legislature’s eighth week, the ending date for the session has been targeted to be sometime between March 23 -30. With less than a month to go, the Legislature will move fast to complete its work. The Senate GOP held leadership elections to replace Sen. McGee (R-Caldwell) who resigned, and they welcomed his replacement to the chamber. Governor Otter appointed Jim Rice of Caldwell as McGee’s successor. Important revenue decisions were made this week. The House rejected a bill which would have taxed internet sales, and then passed legislation (49-20) which would give a $35.7 million tax cut HB563 INCOME TAXATION. The tax cut lowers the top marginal individual rate to 7.4% and business tax rate from 7.6% to 7.4%. Members of both parties debated unsuccessfully against the tax cut because of concerns that the on-going tax cut would deplete state resources and limit its ability accumulate “rainy day funds” which can be tapped into in the years ahead when revenue may come in below expenditures. After the last tax cut in 2001, the Legislature had to deal with inadequate revenue by cutting services and raising the sales tax permanently to 6%.
Some public health initiatives have successfully traversed the policy process, while many issues still remain in discussions. After passing the House last week, the S1252 MOTOR VEHICLE – TEXTING WHILE DRIVING ban has since unanimously passed the Senate. The House is now working on amendments to the bill that will revise the law enforcement and emergency vehicle exemptions to the law. Many such agencies already have texting bans as organization policies.
The Joint Finance and Appropriations Committee (JFAC) has also agreed to allocate $100,000 to fund a suicide hotline. This will be added to the $50,000 in funding from the Health and Welfare Department’s budget as well as the $20,000 in private donations. The hotline’s funding is within the Division of Veteran’s Services of the Health and Welfare Department.
HB486 MINORS, PHOTOTHERAPY AND TANNING DEVICE has been sent back to committee after a last minute email from a Freedom Foundation lobbyist pointed out that dermatologists sometimes refer patients to tanning beds. The email supposes dermatologists may have a financial interest in passing this bill that has not previously been discussed. The bill will receive another hearing in the Health and Welfare Committee.
Also, the contentious HB464 OIL AND GAS which outlines exploration and production of oil and gas in the state has run into more controversy. The Senate Resource Committee must deal with accusations that the oil and gas companies that drafted this bill pressured counties, inferring that Counties must cooperate with the bill in order to receive any oversight control.
SB1348 DISCRIMINATION IN DENIAL OF LIFE-PRESERVING TREATMENT ACT, which may be confusing for both providers, patients and their families, was printed in the Senate. Its sponsor, Sen. Nuxoll (R, Cottonwood) says that the purpose of this legislation to protect patients from the involuntary denial of food and fluids, and from involuntary denial of life-preserving medical treatment when that denial is discriminatorily based on disability, age, or terminal illness. However, according to the legislation, a competent patient or surrogate’s denial of treatment could also be ignored by health care providers based on two value judgements related to age, length of life and disability.
Heath Insurance Exchange
JFAC has unanimously voted to fund the Medicaid Readiness project. While this is the first phase towards potentially setting up the Health Insurance Exchange, no ensuing phases were funded and probably will not be until after the Federal Supreme Court hears the state’s cases against the Patient Protection and Affordable Care Act mandates this summer. $400,000 in state general funds will match 90% (at $3.6 million) federal funds. The program will address creating a paperless system and is intended to increase efficiencies that will benefit the state regardless of future federal rulings on the issue.
 

 2012 Idaho legislature
Week in Review
February 24th, 2012
The session is at least two thirds over at this point. Politics are heating up, budgets have begun to be set , and some bills are nearing final votes. It’s getting close to the filing period for those who are going to run in the election this Fall. As a result, this week a number of legislators announced their intent to retire, or their intent to leave the House and run for the Senate instead. The Governor signed the Anti-Occupy Boise legislation that requires occupiers to vacate the capital mall by Monday, February 27th. In response, the movement filed suit with the Federal court and has been granted a hearing. A member of Senate leadership resigned after allegations of sexual harassment were made, while a bi-partisan workgroup examining potential ethics legislation has divided over whether to create an expanded legislative committee or an independent commission.
The Catastrophic Healthcare program (CAT) was fully funded this year by JFAC with an increase of just over 3% compared with last year’s total spending for the program. The CAT fund pays for qualifying indigent health care services. JFAC’s decision to add a 2% state employee, on-going, pay increase to all agency budgets was controversial as this departed from the Governor’s recommendation for a 3% on-time raise, and left the rest of the legislature out of this decision.
S1260, S1261, S1262 and S1273 by the Board of Nursing all passed out of the Senate and are now in the House Health and Welfare Committee.
H486, prohibiting minors from using tanning beds, was sent to the House floor with committee amendments brought by the Idaho Medical Association (IMA). HB548 which would establish safeguards against concussions in children engaged in contact sports was held while compromise language is being considered, and H543 which would lower the age for legal possession of a firearm from 12 to 10 was.
The IMA also introduced HB541 - ECONOMIC CREDENTIALING which would prohibit a health care organization from limiting a physicians ability to be credentialed at the organization for economic reasons. Rep. Nonini introduced HB565 -ANY WILLING PROVIDER would allow all health care providers to contract with health care companies and managed care organizations and the IMA introduced HB503 that would allow a prescriber to prescribe medications in certain limited instances without the establishment of a patient-provider relationship.
S1252 MOTOR VEHICLE – TEXTING WHILE DRIVING has passed the Senate this week with a 29-6 vote. Although the bill has been introduced every year for the past three years, this is the first time it has passed the Senate. Previously inattentive driving laws were considered sufficient, but the high (73%) percentage of teens admitting to texting while driving, as well as the death of an 18 year old woman as a result of texting while driving, proved to be successful arguments for the bill. The bill must now go before the House.
People filled the hearing room and overflowed into the halls during last Monday’s House Health and Welfare Committee meeting. Dozens of individuals testified regarding the House Joint Memorial, HJM010 RESPECT FOR RIGHTS OF CONSCIENCE ACT and HB530 DISABILITY INSURANCE POLICIES which each address an employer and/or insurance company’s right to deny coverage of “abortifacients, sterilization and contraceptives”. The Memorial, essentially a letter to Congress which was passed out of committee and then passed the full House, expresses support for a Federal law that would allow employers to refuse to cover health services that violate their conscience. Since the PPACA identifies contraceptive services as part of the preventive health care benefit , HB530 would not require insurance policies in Idaho to offer benefits for abortion, sterilization and contraception”, in essence superseding the requirement of the federal law. It has been held in committee to give the sponsor time to consider changes to the bills language.

Health Insurance Exchange
In related news, the Joint Finance and Appropriations Committee (JFAC) set the Department of Insurance budget. Interestingly, the $20 million in federal grant money to create a state insurance exchange was absent from the budget. It remains uncertain if the legislators will decide to use this money, or wait for the Federal Court decision this summer, or establish an exchange using state only funds.
HB555 -FEDERAL HEALTH CARE REFORM OVERSIGHT COMMITTEE would provide legislative oversight, policy direction and recommendations for legislation concerning compliance and implementation of any federal health care initiative including
the Patient Protection and Affordable Care Act (PPACA) passed out of the House Health and Welfare Committee and is awaiting a vote by the full House.