EMERGENCY HEALTH CARE SERVICES
EXPANDED HEALTH CARE ACCESS
PRESCRIPTION DRUG ACCESS
HEALTH CARE DELIVERY
Nationally, post-9/11 legislative responses indicate growing
concern about the adequacy of emergency health care service delivery systems.
Health facility closures, increasing uncompensated care, declines in providers,
liability issues, increasing regulatory standards, and funding are only
a few of the factors affecting such systems. Of these factors, funding
tends to be the driving consideration in forging out solutions.
Recognizing that the availability and delivery of hospital emergency and
trauma care services by community hospitals is crucial, the Oklahoma Legislature
enacted several significant pieces of legislation resulting from the work
of a 2003 Task Force on Hospital Emergency Services and Trauma Care that
studied and assessed data on the availability and delivery of hospital
emergency services and trauma care in this state. The study covered:
- emergency health care system development
- the cost of providing emergency health
care services to specific categories of patients, including uninsured
and traumatically injured patients,
- the effect of new facilities on the staffing,
operational, and financial capacities of existing facilities,
- geographical distribution of facilities
and the number of people requiring twenty-four-hour emergency or trauma
care services, and
- sources of funding.
The task force findings and recommendations
included adjustments to existing programs and services, and basic infrastructure
enhancements to improve service delivery. A similar task force studied
issues related to homeland security.
Summary of Actions
The Legislature addressed needed changes in the emergency health care
delivery system, and other health-related issues such as expansion of
access to coverage, strengthening the indigent health care safety net,
prescription drug access and affordability, health disparities, cancer
screening and treatment, and pain management. In addition to a major focus
on Tort Reform in 2004, Legislators also addressed ways to potentially
minimize liability actions through improvements in patient safety.
Although the session saw improved revenue
collections, the Legislature is looking to a vote of the people [SQ 713/The
Tobacco Tax (HB 2660)] for an additional $149.3 Million for health care
- A $50 Million Medicaid expansion for
coverage of approximately 100,000 uninsured Oklahomans through an employer-based
private insurance premium assistance program.
- $2 Million for increased Medicaid reimbursements
to emergency room physicians.
- $17 Million of an estimated additional
$42 Million needed to pay for uncompensated trauma care. This amount
would also generate additional federal matching funds.
- $7 Million for establishment of a comprehensive
cancer center in Oklahoma City, $7 Million for establishment of a telemedicine
center in Tulsa, and $1 Million additional for funding breast and cervical
cancer treatment for uninsured women.
- $1.5 Million for smoking cessation programs.
Introduced during the 1st Session of the 49th Legislature, SB 677
(2003) by Monson would have required insurance coverage of comprehensive
tobacco cessation programs but was defeated in the Senate.
Trauma Care Legislative Measures
SB 1554 (Robinson/Hilliard) creates the Oklahoma Trauma
Systems Improvement and Development Act to enable hospitals and emergency
medical service providers to provide an organized system of trauma care.
- Requires the State Board of Health to
promulgate rules that specify provisions for trauma care according to
location, capacity and capability;
- Creates the Oklahoma Trauma Systems Improvement
and Development Advisory Council to make recommendations about the State
Health Department’s (OSDH) role under the Act;
- Provides for OSDH recognition of trauma
systems by geographic region;
- Establishes regional trauma advisory boards
by hospital and ambulance service providers, whose purpose shall be
to provide regional representation and continuous quality improvement.
Allows funding of such activity as funds become available;
- Provides for review of and reporting on
trauma patient care and continuous quality improvement activities by
the Medical Audit Committee, an appointed committee of licensed physicians,
and requires OSDH to provide funding and administrative support. Information
pursuant to such review is confidential and shall only be used for trauma
patient care improvement;
- Establishes trauma transfer and referral
centers in certain geographic areas, based on population, to manage
emergency medical care needs. Allows operator reimbursement of such
centers as funds become available;
- Makes ambulance service providers and
physicians eligible for reimbursement for uncompensated trauma care;
- Allows transfer of Trauma Care Assistance
Revolving fund monies to the Oklahoma Health Care Authority in order
to maximize Medicaid reimbursement for trauma care and, in combination
with federal matching funds, to reimburse hospitals, ambulance service
providers and physicians for trauma care to severely injured Medicaid
participants. Effective 6-4-04.
HB 2600 (Hilliard/Monson)
assesses special trauma care fees ranging from $100 to $200 for certain
traffic, controlled dangerous substance and drug trafficking violations
for deposit into the Trauma Care Assistance Revolving Fund. Effective
HB 2250 (Paulk/Robinson)
imposes an additional $100 fine, increases certain fees by $10 and $100,
and apportions certain amounts of existing fines for various traffic-related
infractions for deposit to the
Trauma Care Assistance Revolving Fund. Requires annual reports detailing
fund disbursements. Effective 6-3-04.
Trauma Care Appropriation Measures
SB 982 (Morgan/Mitchell) appropriates $39,029,342.00
to the University Hospital Authority, $3,065,639.00 of which is for continuation
of Level 1 trauma services at the OU Health Sciences Center. These funds
will also be used to reimburse OUHSC for indigent care and to provide
state matching funds for Medicaid programs that benefit other teaching
hospitals in the state.
Service Referral System Legislative
SB 1405 (Williams/Lindley) designates the Oklahoma 2-1-1
Advisory Collaborative as the state coordinating entity for 2-1-1 Call
Centers, the vehicle to develop an integrated service map, and the certifying
body for information and referral providers. Effective 6-3-04.
HB 2280 (Paulk/Wilkerson)
enacts the Oklahoma Homeland Security Act, including creation of the Oklahoma
Office of Homeland Security, and regional planning and coordination advisory
councils for homeland security. A gubernatorially appointed director will
establish strategic security objectives and a plan for a statewide emergency
all-hazards response system.
Service Referral System Appropriation
HB 2042 (Mitchell/Morgan) appropriates $600,000.00 to
operate a trauma referral call center within the State Health Department’s
budget of $57,563,226.00.
Prescription Drug Legislative
HB 1866 (Gilbert/Cain) creates the Utilization of Unused
Prescription Medications Act and expands the scope of a pilot program
statewide, effective January 1, 2005. Under the program, unused prescription
drugs, other than controlled dangerous substances, may be transferred
from nursing facilities, assisted living centers or pharmaceutical manufacturers
to specified pharmacies for distribution to medically indigent Oklahoma
residents. Specifies criteria to be used in accepting and dispensing unused
prescription drugs, including a provision that such items dispensed for
purposes of a medical assistance program or drug product donation program
may also be accepted. Participation by sending entities is voluntary.
Exempts specified persons and entities from criminal or civil liability
in relation to the program, and specifies contents of rules to be promulgated
by the Board of Pharmacy. Amends the Oklahoma Pharmacy Act to exempt program
donated drugs from prohibitions related to the selling, offering for sale
or bartering of professional samples, and to provide that it is unlawful
to possess dangerous drugs without a valid prescription or a valid license
to possess such drugs. Effective 6-3-04.
Prescription Drug Legislative
HB 2321 (Wilson/Corn) requires prescription labels to
include the purpose or symptom for which a drug is being prescribed, if
a patient so requests, but allows a pharmacist to fill the prescription
even if the information is not provided. Includes non-laser surgery procedures
in the definition of the practice of Optometry. Effective 4-28-04.
SB 369 (Shurden/Stanley)
amends Enrolled House Bill No. 2321 by making placement of the symptom
or purpose for which a prescription is written permissive rather than
mandatory. Also updates obsolete references in the Oklahoma Pharmacy Act.
Other amendments to the Oklahoma Pharmacy Act include other definition
updates to comply with federal law; conducting of pharmacy/pharmacist
surveys by pharmacy compliance officers; clarification of language related
to establishment of and maximum amounts for fees for training components,
score transfers, late filings, permits and reinstatement; and clarification
of procedures for licensure, regulation and permits. It addresses various
provisions in the Allopathic Medical and Surgical Licensure and Supervision
Act, the Medical Licensure and Supervision Act, the Osteopathic Examiners
Act and the Orthotics and Prosthetics Practice Act. Establishes term ending
dates for the Oklahoma Licensed Behavioral Practitioners Advisory Board
and extends by three years the time period for completion of education
requirements for licensure. Provides that a doctor who renders medical
care on a voluntary basis at a free medical clinic or an educational sporting
event is not liable for any civil damages with certain exception. Effective
SB 1372 (Monson/Nations)
requires the Oklahoma Health Care Authority to annually report savings
realized and costs incurred in the implementation of any drug cost containment
programs. Effective 11-1-04.
Prescription Drug Appropriation
SB 978 appropriates $18.7 Million for prescription drugs
for FY'05 in the Oklahoma Health Care Authority (OHCA) base appropriation
bill. OHCA, administrator for the state's Medicaid program, received $482,256,505.00,
a 9.9% increase over its FY'04 appropriation that compensates for cuts
in funding that year.
Safety Net Assurance Legislative
HB 2667 (Askins/Monson) addresses the impact of increased
uncompensated care on the state’s indigent care facilities by creating
the Uncompensated Care Equalization Committee. This committee is to develop
and recommend by February 1, 2006, a formula to equalize the burden of
uncompensated care that takes specific factors into account. The Act requires
health care facilities that have not received approval to construct a
new facility by July 1, 2006, to provide documentation that at least 30%
of net revenues are from Medicare and/or Medicaid, with allowances for
uncompensated care, and state corporate tax contributions. Facilities
that fail to meet the 30% threshold shall be assessed a fee, provided
the fee shall not be calculated prior to the effective date of the Act
and shall be prospective. Fees collected shall be deposited into the Uncompensated
Care Equalization Revolving Fund established in the Act. Effective 6-4-04.
HB 1835 (Lindley/Cain) expands
the scope and membership of the Task Force to Eliminate Health Disparities
to include representation for mental health and substance abuse. Effective
HB 2548 (Sullivan/Aldridge)
creates a Task Force on Men’s Health and provides for membership.
The Act creates the Oklahoma Anatomical Organ Donor Identification Act
to provide procedures for individuals wishing to remove the organ donor
designation from a driver license or identification card. It establishes
an Oklahoma organ, eye and tissue donor registry within the State Department
of Health. Effective 7-1-04.
(Morgan/Roberts) addresses environmentally based health disparities. The
Lead-Impacted Communities Relocation Assistance Act will relocate young
children living in the Tar Creek Superfund Site in far northeastern Oklahoma.
Families with a child six years old or younger may voluntarily apply to
a local trust authority to purchase their home or, if the family rents,
to be eligible for 12 months, comparable rental payments. Additionally,
such families are eligible for a small stipend to assist with moving expenses.
The Act prohibits use of houses or rental properties affected by the buyouts
for occupancy by young children until deemed safe by the State Commissioner
of Health. Companion bill SB 2060 appropriated $3 Million to fund the
activities of the trust authority. Effective 9-1-04.
SB 1546 (Robinson/Hilliard)
authorizes the Oklahoma Health Care Authority to conduct a pilot premium
assistance plan to assist small businesses and/or their eligible employees
to purchase employer-sponsored health coverage, or to buy-in to a state-sponsored
plan. This state law coincides with a new optional federal waiver program
called the Health Insurance Flexibility Act (HIFA). HIFA allows matching
federal dollars to be used as premium assistance for employer-sponsored
insurance and offers new opportunities to cover more low income working
people. Funding for this health insurance expansion is dependent on the
approval of State Question 713, the increased tobacco tax proposal slated
for a November 2004 vote.
Safety Net Assurance Appropriation
HB 2042 (Mitchell/Morgan) appropriates $100,000.00 to
the state’s community health center network.
Pain Management Legislative Measures
HB 2305 (Hamilton/Shurden) requires nursing facilities
to include and chart pain as part of a nursing home resident’s vital
signs assessment. It also creates the Advisory Council on Pain Management
to provide advice and recommendations to the Legislature on pain management
policy in this state. The Council is to submit an interim report by November
30, 2004, and the final report by April 1, 2005, at which time the Council
expires. Effective 6-3-04.
Cancer Screening/Treatment Legislative
SB 1609 (Monson/Winchester) adds cervical cancer to all
references in the renamed Oklahoma Breast and Cervical Cancer Prevention
and Treatment Advisory Committee. The Act contains and clarifies various
provisions related to appointments, membership and terms of the advisory
committee members, and meeting schedules and frequency. The Act clarifies
certain dates for income tax checkoff purposes to the Breast and Cervical
Cancer Act Revolving Fund. Effective 5-4-04.
HB 2552 (Hilliard/Leftwich)
creates the Belle Maxine Hilliard Breast and Cervical Cancer Treatment
Revolving Fund, to be budgeted and expended by the Oklahoma Health Care
Authority pursuant to the provisions of the Oklahoma Breast Cancer Act,
to provide screening, diagnosis and treatment of breast and cervical cancer
for uninsured, Medicaid eligible women in Oklahoma. Effective 11-1-04.
SB 587 (Cain/Hamilton) adds
routine annual obstetrical/gynecological exams to mandated health insurance
coverage. It further provides that such coverage shall not diminish or
limit any other diagnostic benefits of a plan. The Act specifies that
coverage is not contingent upon the examination’s performance by
an obstetrician, gynecologist or an obstetrician/gynecologist. It defines
the term “health benefit plan,” and makes the Act’s
provisions inapplicable to group coverage for fewer than 50 employees.
Cancer Screening/Treatment Appropriation
SB 978 appropriates $2.5 Million to the Oklahoma Health
Care Authority for breast and cervical cancer screening, diagnosis and
treatment. This amount will qualify for 4-to-1 federal matching funds,
resulting in a total of $12.5 Million in funding to provide services for
an estimated 88 breast, 8 cervical and 35 pre-cancer cases.
HB 2660 sends State Question
713, the tobacco tax, to a November 2004 vote of the people. Passage could
mean an additional $1 Million in funding to further enhance breast and
cervical cancer treatment to under- and uninsured, low income women in
Patient Safety Legislative Measures
SB 1569 (Monson/Askins) creates until January 31, 2005,
the Joint Legislative Task Force on Patient Safety to study the feasibility
of legislative or regulatory efforts to improve patient safety. Adds the
clinical practices of accredited allopathic and osteopathic state medical
schools to the definition of a health care facility. Effective 6-9-04.
The Oklahoma State Senate, Senate Staff
Senator Cal Hobson, President Pro Tempore