2015 ONA Legislative Update

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Legislative Agenda

Final Session Report 2015

Oklahoma Nurses Association is the professional association representing the state’s registered nurse population. ONA is involved in the shaping of public policy relating to health care, which is consonant with the goals of nurses, nursing and public health. ONA is committed to ensuring that the registered nurse is an essential provider in all practice settings and advocates for access to quality health care services for all individuals. 

The Mission of the Oklahoma Nurses Association is to
 empower nurses to improve health care in all specialties and practice settings by working as a community of professional nurses.

  

Therefore, Oklahoma Nurses Association will support legislation and health care policy which: 

  • Facilitates the development of a system of health care delivery that emphasizes prevention, health promotion and appropriate monitoring of quality and user satisfaction
  • Supports a basic core of essential health care services that are accessible to all citizens of Oklahoma 
  • Incorporates nurses at all levels of policy-making and decision making regarding the health care system
  • Assures funding to meet health care needs including recognition and remuneration for services rendered by nurses 
  • Assures the delivery of health care by duly qualified providers as a means to protect the consumer 
  • Recognizes the Oklahoma Board of Nursing as the sole regulatory authority for professional nursing practice, including adequate resources for the agency
  • Promotes funding for professional nursing education and research at both the basic and advanced levels

2015 Legislative Priorities

v Funding

  • Ensure adequate funding for vital health care related services, including direct care, disease prevention and health promotion.  Shortfalls in health and behavioral health services will increase costs in other areas of the state’s budget, and will lead to dire negative consequences for individuals, families, and communities, placing all at risk. When funding falls below critical levels, every other health priority for nurses is negatively impacted. Nursing is one of the few professions in Oklahoma providing care to our citizens from cradle to grave.

During the 2015 Legislative Session, it became apparent that a revenue shortfall of $611M had developed to fund state services in FY2016 at the same level as the state had in FY15.  The Legislature struggled throughout the session with the issue of protecting critical core services while managing such a shortfall against the demands of large blocks of vocal voters for lower taxes at home.

State Agencies were asked to prepare multiple budget scenarios for consideration by the Legislature that ranged from “flat” funding to 5 and 10 percent cuts.  Nursing organizations and other associations were warned that the largest budget shortfall existed in the Health Care Authority Budget, as a result of the loss of federal funds and the change in Oklahoma’s funding formula based largely upon our state’s healthy economy and ability to pay.   As session began, $148 million of the shortfall was in the Medicaid budget alone!  As session progressed, the Medicaid shortfall was mitigated somewhat with Congress’ approval of SCHIP funds. 

 

After weeks of wrangling, and a great deal of lobbying, our Governor, House and Senate reached a budget agreement that sought to do its best to protect health and behavioral health services.  Even after tapping the Rainy Day Fund, state agency revolving fund accounts and the Unclaimed Property Fund, our state’s budget of $7.1 billion fell $611 million short of FY15.  The Department of Mental Health will receive a full $2 million more dollars in revenue for FY16, while the Health Care Authority, with a larger clientele, will receive an increase of $18 million new dollars. 

 

While the increases to the health agencies are modest relative to the shortfall and the need, they nonetheless represent the positive effects of lobbying and education by ONA and others on the Legislature's understanding of the importance of healthcare to the economy, growth and well-being of the state of Oklahoma. In this shortfall, when most agency budgets were cut or held flat, any large increase in the health care-related agencies is a victory that has the potential to protect nurses’ positions in many places, and, just as importantly, to protect needed patient care. 

 

Even an $18 million increase to OHCA’s budget leaves an approximate remaining $40 million deficit for FY16.  These days, the Legislature leaves it up to the state agency to determine where cuts will be made. OHCA proposed a realignment of provider reimbursement rates to 85% of the physician fee schedule issue for APRNs, which will be considered by the OHCA Board, as one of several rate reductions. OHCA continues to work to mitigate this proposed rate reduction, as they examine available revenue for the upcoming fiscal year.

 

It is important to remember that reimbursement rates are just one piece of the very large health care pie, across multiple agencies.  We have nurses employed in all of the state agencies whose budgets we worked hard to protect from cuts.  Not only do we hope that all nurses salaries and rates will be protected, we hope that their very jobs will be protected as well. The care, health and well-being of Oklahomans is heavily dependent upon registered nurses employed in multiple settings!

 

ONA is working to ensure that ALL nurses employed by providers and agencies are also retained to provide the programs and services provided by those agencies.  ONA, out of service to all of its members is concerned not only with single type nurse reimbursement, we must also be concerned with deleterious cuts to hospital and other employer provider reimbursements as that in part funds RNs working in hospitals and other employer settings. There are more nurses working in more programs as employees and contract providers, across more state agencies, than any other licensed professional group.

 

Many of the sources of revenue used to construct the FY16 budget will not necessarily be available to sustain the budget at these levels for FY17, leaving us to ponder how to balance future budgets critical to the health of all Oklahomans. Nurses have a tremendous opportunity to play a positive roll in the future process.

v Governance – Preserving the Board of Nursing’s oversight and regulation of nursing practice

Nursing is the largest group of healthcare providers; LPN, RN and APRN, each one with its own unique scope of practice, is already a consolidated Board.  Ensuring professional nursing oversight of this board provides for the critical health and safety of the public.  This self-sustaining, non-appropriated Board contributes revenue to the state general fund while providing for efficient, focused regulation of the nursing profession.

ONA Opposed:

SB 829 (Dahm) Authorized the Governor to appoint executive directors of state agencies/boards including Health Care Authority, Dept of Health, Dept of Mental Health, Pharmacy, Medical, Nurses, Veterinary and others.  Terminates current ED for 10 agencies with Governor to appoint as of 1/1/2016.  Heard in Committee but after the deadline for bills to be heard in committee in House of origin.  DORMANT

SB 127 Authorized the Governor to appoint the executive director of state agencies/boards including Health Care Authority. DORMANT

v Nursing Practice

  • Access to efficient, competent health care is supported when licensed Nursing professionals practice to the full extent of their scope of practice.  Competent nursing practice ensures the health and safety of every Oklahoman.

ONA Supported:

HB 2158 (Echols/Griffin) Allows APRNs to have prescriptive authority for Schedule II.  Laid Over

HB 1081 (Ownby/Simpson) Board Request Bill - Expedites BON discipline process for routine issues/orders.  A step toward “Just Culture”.  Signed by Governor

HB 1562 (Hall/Standridge) Adds APRNS to the list of providers to order restraints. Signed by the Governor.

SB 542 (Quinn/Derby) Epinephrine Auto-injectors – stored in Emergency Public Access.  Amended to include APRNs in the Title 62 of the bill that allows APRNs to write scripts to entities. Signed by the Governor

SB 787 (Standridge/Derby) Pharmacy Practice Act – Amended to define APRNs as prescribers not mid-level providers. Signed by the Governor.

HB 1566 (Mulready/David) Medicaid – authorizes Health Care Authority to request proposals for Care Coordination for Blind, Disabled etc.  Engrossed back to the House-awaiting acceptance of Senate Amendments. Signed by the Governor.

ONA Opposed:

SB 640 (Treat/Cox) Oklahoma Medicaid Program providing new standards/criteria for elderly to receive in-home care. Dormant

SB 559 (Marlett/Hall) The bill creates a misdemeanor for causing a child to be born addicted to or harmed by a narcotic drug due to the child’s mother while pregnant. The bill creates a felony if the illegal use of a narcotic drug by the pregnant woman results in fetal death.  Defines punishment for misdemeanor and felony. Dormant

v Public Health – Improving Oklahoma’ Health Status

  • Improving Oklahoma’s health status will improve the physical, emotional, and economic well being of the individual, the family, and the community.

ONA Supported:

SB 250 (Paddack/Denney) Diabetes bill – requires establishment of benchmarks and developing goals for improving health care services for those with diabetes. Signed by Governor

HB 1515 (Cooksey/Sharp) Proton Therapy Coverage – Insurance parity. Signed by the Governor

HB 1085 (Ownby/David) Adds Palliative Care to the existing council and expands council to Home Care, Hospice and Palliative Care Advisory Council adding responsibilities and additional members, which includes a nurse.  Signed by the Governor.

ONA Opposed:

HB 1326 (Biggs and Loveless)– required double reporting of Child Abuse by health care workers over and above what is already required.  Died on the Senate Floor

v Education

  • Support only those educational proposals that do not put the emotional and physical well being of school children at risk.

ONA worked hard to protect nurses from budget cuts.  In the $611 million budget shortfall, Common Education was protected from any cuts this year, with $2.484 billion in state aid, the same amount it received in FY15.  ONA has concerns about the continued lack of funding for school nurses and the affects of a flat budget as student populations continue to increase.

  • Nursing education is an important and critical component in the development of Oklahoma’s nursing workforce, but also in ensuring lifelong learning and continued competency for all nurses in Oklahoma.


Career Techs and Higher Education provide integral components to nursing education.  The state’s career tech system saw a cut of 3.5% ($4.8 million), while Oklahoma’s colleges and Universities experienced a cut of $24.1 million.  It is hopeful that the cuts will be born in such a way so as not to directly impact nursing education.  The Career Tech and Higher Ed systems themselves will determine where to make strategic cuts.


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