Med Journal July 2021 Final 2 | Page 16

Arkansas addressed this through the private option and Arkansas Works , and most recently the ARHOME Plan . “ There aren ’ t good fiscal reasons to fight it ,” said Smith . “ That ’ s why it took a few votes . The holdouts wanted to be able to go back home and say they voted against it , voted against it , voted against it , but then they had to vote for it . Legislators know it ’ s a good deal for Arkansas ( paid for largely by the federal government ) that supplies health insurance to 300,000 Arkansans who otherwise wouldn ’ t have health insurance .”
Coverage of Breast Cancer Diagnostic Examinations ( SB 290 / Act 553 ) AMS supported this legislation , which adds a 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 ( SB 395 / Act 891 ) This Society-supported bill , sponsored by Sen . Missy Irvin , will change the current $ 500 cap for diagnostic and radiology services to have two separate $ 500 caps , one for diagnostic services and the other for radiology services . “ It ’ s important to note that the cap language (‘ at least ’) is a floor ,” said Smith . “ Any laboratory or diagnostic procedure considered an essential health benefit does not count toward the cap .”
Compromising for the Sake of Patients
Here is a look at bills that passed only after the Society was involved in adding considerable compromises made to protect physicians or patients .
APRN Full Practice Pathway ( HB 1258 / Act 412 ) This bill represents a pathway to full practice authority for APRNs . AMS worked closely with the Arkansas Academy of Family Physicians on this . Eventually , after discussions with Rep . Lee Johnson , MD , who sponsored and was able to amend the bill , the Society ’ s position was neutral . “ It ’ s important to know what we started with ,” explained Wroten . “ We started with another bill ( SB 186 by Sen . Kim Hammer ) that would have allowed APRNs to have independent practice and full prescribing authority after just 1,000 hours of collaborative practice with a physician or another APRN .
DAVID WROTEN , AMS EXECUTIVE VICE PRESIDENT
“ We ended up with a bill that allows APRNs , after 6,240 hours practicing under a collaborative agreement , to apply to a panel of eight – four physicians , four APRNs – who will decide if the applicant should be granted full practice authority . If approved , it allows them to practice without a collaborative agreement . It doesn ’ t convey anything else to them , and even this privilege can be revoked if they don ’ t meet the requirements set forth by the committee . The first bill would ’ ve applied to all categories of APRNs , but Dr . Johnson ’ s bill applied only to certified nurse practitioners .”
Wroten also stated that associated committees were stacked with legislators favoring scopeof-practice expansion . “ In fact ,” he said , “ one legislator made the comment that he would support giving a license to witch doctors . That tells you what we were up against . Thankfully , Dr . Johnson did an excellent job at relaying the importance of putting safeguards in place related to this bill .”
Pharmacists Treating Health Conditions ( HB 1246 / Act 503 ) “ This started as an awful bill ,” said Smith , “ but by the time amendments were made , we were able to support it . Family physicians were engaged with the APRN bills , and they were engaged in this pharmacy bill as well . We had concerns from many kinds of physicians on this .”
Originally sponsored by Rep . Ken Bragg , the bill would have allowed pharmacists to diagnose and treat for flu , strep , skin conditions , lice , allergic rhinitis , motion sickness , and more . That long list of conditions was removed , with only flu and strep remaining .
“ This bill is a good example of the importance of physicians being involved in the Legislature ,” said Smith . “ Once again , Dr . Johnson was a catalyst . He told Bragg , ‘ I can ’ t support it , let ’ s work out a compromise ,’ and he was able to work with AMS to formulate suitable compromise legislation that allows pharmacists to diagnose and treat flu and strep only through CLIA-waived tests , and then only under protocol developed jointly by the Medical Board and the Pharmacy Board .”
Wroten added , “ The revised bill allows only flu and strep ; it does create a pathway for other CLIA-waived tests , but only with the approval of the Medical and Pharmacy Boards . In return , we were able to get an expanded level of physician dispensing . Currently , physicians must have a special permit from the Medical Board to be able to dispense from their office . Current law allows them to dispense oral contraceptives , topical medications , and Naloxone without going through hoops to show need . Through this legislation , we have added acute care medications ( to treat infections , inflammation , nausea , allergies , and cough ) and initial treatment for maintenance medication for hypertension , diabetes , and high cholesterol .”
AMS also agreed to amend Arkansas ’ s current therapeutic substitution statute to treat therapeutic substitution the same as generic substitution . This means that pharmacists may make a one-time substitution of a therapeutically equivalent product “ if ” it saves the patient money . Physicians remain in control of these substitutions simply by writing “ do not substitute ” on the prescription . Previous law allowed therapeutic substitution only if the physician authorized it on the prescription . After these changes , AMS supported the bill .
Clear Face Mask Mandate ( HB 1502 / Act 697 ) AMS initially opposed this bill that would have required clear face masks for all physicians and staff , hospital employees and volunteers , fire fighters , and police when encountering those who are Deaf , deaf , or hard-of-hearing . “ Rep . Charlene Fite came to us with a draft bill and asked for our input ,” said Wroten . “ We suggested
16 • The Journal of the Arkansas Medical Society www . ArkMed . org