Legislation Update: MAPA 2012

MAPA was busy in 2011 advocating for the many legislative and regulatory issues that impact physician assistants and the services we provide to patients. From return to play regulations to legislation dealing with reimbursement issues, MAPA was present to educate decision makers and to ensure our voice was heard. The issue of healthcare reform is an issue second only to the budget crisis. Many members of congress are spending endless hours drafting cost – containment language.
MAPA is doing everything we can to ensure PAs are included and recognized as providers in any newly drafted legislation.

Containing medical costs in Massachusetts is a top legislative priority of the Governor and House and Senate leadership. The Governor filed his cost-containment bill in February, 2011 and feedback on the bill was taken by the Joint Committee on Health Care Financing in May, 2011. MAPA was there to provide comments and suggestions on how the legislation can be more inclusive of PAs. Since then, the Committee has spent a great deal of time meeting with stakeholders, including MAPA, and is expected to release their version of cost containment legislation in early winter. The bill will likely shift to a global payment system and will encourage
the creation of Accountable Care Units (ACOs). MAPA is working hard to make sure that PAs are recognized providers under the bill. We have been meeting with policy makers in the hopes that portions of Chairman Sanchez’s bill (see below) will be included in the legislature’s cost containment legislation. A great deal of the Legislature’s activity will center on cost containment legislation in 2012. MAPA looks forward to continuing our involvement and advocacy on this issue in the months ahead.

PAs in Primary Care
HB1520, “An Act Encouraging Nurse Practitioner and Physician Assistant Practice of Primary Care,” sponsored by Public Health Committee House Chair
Jeffrey Sanchez, is currently before the Joint Committee on Public Health.
The bill aims to regulate and expand the definition of primary care provider to become a general term, inclusive of any health care professional who delivers qualified general medical care and other services, such as physician assistants.
MAPA voiced support for this legislation during a Public Health Committee hearing in April, 2011 as well as in meetings with legislators on Beacon Hill.
The bill received a favorable report by the Public Health Committee and is now before the Joint Committee on Health Care Financing. The legislation will continue to be a priority for MAPA in the year ahead.

In October, 2011, MAPA appeared before the Joint Financial Services Committee to testify in support of HB2057/SB403, An Act relative to physician services provided by physician assistants, sponsored by two of the PA field’s ardent champions, House Speaker Pro Tempore Patricia Haddad and Senate Majority Leader Fred Berry. Many major health insurers consider PA’s covered providers while others do not list them as providers. This means that billing is not uniform and allows insurers to add a stipulation to billing for PA services, such as unnecessary supervision requirements, which do not follow state or federal law. This legislation would modernize the law and prevent health care insurers from denying payment for services solely because those services were provided by a PAs. The bill has been favorably passed out of the Public Health Committee during consecutive legislative sessions and now resides in the Joint Committee for Healthcare Financing.

Ionizing Radiation
MAPA pushed for changes to ionizing radiation practices through both legislative and regulatory means and have been actively pursuing these changes for past three years. For years, Radiation Control agreed that the Board of Registration in Medicine’s (BORIM) regulations allowing physicians to delegate “any medical service he or she wishes to a professional who is skilled to perform that service,” superseded DPH’s regulations prohibiting PAs from utilizing ionizing radiation. For this reason, MAPA called on the state to clarify imaging regulations by supporting HB1542/SB1067, “An Act relative to Ionizing Radiation,” and working with the Department of Public Health (DPH) on the matter.

On September 6, 2011, MAPA testified in support of DPH’s Radiation Control proposed regulations to expand imaging regulations to include PAs. We commend DPH on this action and foresee that these changes will alleviate any confusion as well as
ensure that patients receive quality and timely care. The BORIM also released their proposed changes to ionizing radiation regulations around this same time. BORIM’s proposal permits PAs to preform fluoroscopy, but only under the “direct or personal” supervision of a physician. MAPA testified in front of BORIM later the same month, requesting that this supervision requirement be changed to general supervision in order to allow for greater flexibility among PA-physician teams. We are happy to report this language was removed! Please see update 1-2012 for more details.

Returning Athletes to Play
MAPA provided comments on DPH’s exclusion of PAs as providers who may return athletes to play following head injuries in proposed changes to regulation 105 CMR 201.000, “Head Injuries and Concussions in Extracurricular Athletics.”
Despite our feedback, as well as similar comments by parents, health care
professionals and other organizations, DPH selected to carry this exclusion into the final regulations. In response to this, MAPA wrote DPH in June, 2011 asking to discuss the decision further. We met with high level officials in DPH including Lauren Smith, MD the Medical Director, in September on the matter, and were able to provide some more detailed insight into the rigorous training and broad capabilities of PAs. As we all know, PAs are more than qualified to make return to play decisions.
Since then, we have been working hard to educate decision makers about our capabilities to perform this assessment as well as urging DPH and state lawmakers to reverse this decision. MAPA will continue this effort in 2012.

2011 Political Changes
In other state news, 2011 saw changes to legislative and Congressional district maps as well as State House leadership. In November 2011, the Legislature approved redrawn district maps of the state’s 160 House districts and 40 Senate districts. Massachusetts also lost one of its ten Congressional seats due to population shifts nationwide. As a result, U.S. Reps. William Keating and Stephen Lynch were put in to the same Congressional district south of Boston, with a new incumbent free district created in the Cape Cod area and an elimination of a seat in Western, Mass. Long-time Western Massachusetts Congressman John Olver announced his retirement prior to these changes, while Congressman Barney Frank announced his plans to retire after their release. Rep. Keating has also announced his plans to move to Cape Cod and run for the newly drawn district seat.

The Speaker of the House’s leadership team also experienced some changes in 2011. In early 2011, Representative Charles Murphy was reassigned from his position as the Chair of the House Ways & Means Committee to House Majority Leader. In December, 2011, Rep. Murphy resigned from that post following reported disagreements with the Speaker.
Rep. Byron Rushing was named to replace Rep. Murphy, with several other members of the House gaining Committee leadership positions. In the Senate, Senator Fredrick Berry, the Senate Majority Leader, announced him retirement after serving almost 30 years in the Legislature. Senator Berry has been a long-time champion of PAs and will be missed by MAPA.

We would like you:
1.to contact MAPA regarding issues of concern to your practice,
2.to talk to the physicians you work with and ask them to communicate their support of the PAprofession and the PA-MD team to the Mass Medical Society,
3.to contact MAPA if you have a relationship with someone in government that you think could be helpful to the PA profession,
4.to share your stories and ideas with all policy makers to make sure they become familiar with this growing and important profession MAPA remains committed to advancing the issues that make the quality of work and life better for physician assistants and look forward to keeping you informed about relevant policy efforts in our state.

This document was prepared by
Heather Trafton MS, PA-C, Legislative Chair, MAPA
Charles Glick, Charles Group Consulting, MAPA Lobbyist

Posted in Legislation.