Quarterly State and Territorial Legislative Update
ASTHO continues to track the 2017 state legislative sessions and analyze bills impacting public health and state health agencies, including legislation addressing substance misuse and addiction, environmental health, communicable diseases, emergency preparedness and response, public health workforce, health information and data, community health, and disease and injury prevention.
Below is a summary of some of the bills we have tracked through March.
SUBSTANCE MISUSE AND ADDICTION
Access to naloxone continues to be addressed by state legislatures. Pharmacists are now allowed to dispense naloxone pursuant to a state health official’s standing order (VA), under a statewide protocol (AR), and to third parties pursuant pharmacy board rules (WY). Legislation in Mississippi allowing standing orders to be issued by pharmacists is awaiting the governor’s signature. A bill to codify an emergency rule allowing standing orders for naloxone was introduced in Georgia. If passed, a New Mexico bill would require healthcare providers to counsel patients on the risks of opioid overdoses and the availability of naloxone and offer a naloxone prescription. Bills allowing schools to stock and administer naloxone are also cropping up this year (IN, MT, TN, WV, WI, and UT).
For more information about the state legislatures, the District of Columbia, and the territories, please visit the National Conference of State Legislature’s State Legislative Websites Directory.
Neonatal Abstinence Syndrome (NAS)
Virginia passed a law requiring the state board of health to include NAS as a reportable disease. If passed, a bill in Washington would create licensure for "pediatric transitional care centers" (i.e., non-hospital environments for NAS treatment) while a bill in New York would require newborn screening for NAS and for the state health agency to share information on NAS screening, intervention, and counseling on a departmental website.
Prescription Drug Monitoring Programs (PDMPs)
Bills expanding the scope of PDMP users and allowing access to PDMP information are being considered. Arkansas enacted a law to share PDMP information with the Medicaid Prescription Drug Program. Bills requiring all providers (MS) and pharmacists (UT) to register with the PDMP were also enacted. In Colorado, a bill was introduced allowing any provider to check the PDMP. Tweaks to Georgia’s PDMP were also introduced (e.g., 24 hour updates of information, checking PDMP for first prescription and every 90 days thereafter (exemption for hospice, cancer patients, etc.)). Bills allowing access by Medicaid fraud investigators (IN), requiring the entry of drug conviction into the PDMP (KY), and integrating the PDMP with pharmacy records (SD) were also introduced. A bill to establish a state PDMP has made its way through the Missouri Senate, the only state without a PDMP.
After a number of states enacted initial opioid prescription limits in 2016, several states this year have similar bills limiting the amount of opioids a provider can first prescribe a patient (GA, HI, IN, KY, MT, OR, WA). Requirements for provider continuing education on prescribing opioids (MN, NY, WA) and education and awareness in public schools (KY, MA, VA) are also being considered. Finally, in Kentucky, a bill would impose a 1 cent tax per opioid dose on each distributor and mail order pharmacy to finance addiction prevention and treatment activities.
Legislatures continue to explore medication assisted treatment (MAT) for opioid addiction. A bill in Kentucky would establish licensure for opioid treatment programs and MAT while a Massachusetts bill would require insurance coverage for MAT. Other bills would require collaboration between the state health agency, that the director of state mental health and substance abuse services create guidelines for nonresidential treatment with buprenorphine (TN), require that the state health agency to develop ways of getting emergency buprenorphine until patients can access comprehensive treatment (VT), allow a state health agency to develop rules for opioid treatment providers (WV), and require the state health agency to create and fund opioid treatment programs in underserved areas (WI). In Missouri, a bill was introduced to prohibit state Medicaid program from contracting with methadone treatment programs and in New York, a proposed bill would restrict how close a non-hospital based treatment center can be located to a school, religious institution, park, etc.
Cannabidiol (CBD) is being addressed in several states. Virginia expanded the medical use of CBD and THC oils for the treatment of intractable epilepsy. Georgia is considering modifications to its CBD law while a bill in Indiana is considering allowing the use of CBD intractable epilepsy and creation of a patient and caregiver registry. If passed, a South Dakota measure would remove CBD from the definition of marijuana and if passed in Arizona, a bill would reschedule any CBD drugs approved by FDA.
Both North Dakota and Arkansas passed bills to extend the implementation dates for their voter approved medical marijuana laws. Arkansas also passed a law prohibiting the use of telemedicine by patients seeking to qualify for medical marijuana while a bill introduced in North Dakota would prohibit worker’s compensation to pay for medical marijuana. Bills to establish medical marijuana programs have also been introduced in Indiana, Iowa, Kentucky, Mississippi, South Carolina, Texas, and Virginia. Bills to add conditions that qualify for medical marijuana were introduced in Colorado, Minnesota, New Hampshire, and New York. A qualifying condition being discussed in New Hampshire is opioid addiction. In Minnesota, a proposed bill would remove the health commissioner’s ability to add to the list of qualifying conditions if passed. A proposed bill in Washington would require school districts to permit students who are medical marijuana patients to use medical marijuana on school grounds.
Proposed bills in several states and Guam would allow retail sales and adult-use of marijuana (AZ, CT, HI, KY, MO, NH, NM, PA, TX, and VT). In Maine, a law was passed to delay the implementation of certain provisions of the state’s new retail marijuana law. If passed, a bill in Colorado would allow the operation of private marijuana clubs while in Oregon, a bill would allocate 20 percent of the tax revenue from the retail sale of marijuana to the state health agency. Washington also had a bill looking at marijuana edibles and packaging issues.
Montana and Georgia have authorized their departments of agriculture to implement the provisions of the Federal Food Safety Modernization Act (FSMA) while a similar bill in New Mexico passed the state representatives chamber.
States continue to explore ways to strengthen their mandatory school vaccination requirements. In Utah, Connecticut, and Oklahoma, proposed bills would require the state health agency to develop educational information for parents seeking a nonmedical exemption to the vaccination requirements. Bills were introduced in Arkansas, Iowa, New York, and Oklahoma to eliminate nonmedical exemptions while in Iowa, Mississippi, Rhode Island, and West Virginia there are bills to add or expand nonmedical exemptions. Other bills being considered would require nonmedical exemption requests to be signed under oath or by affirmation (IA), require the exemption to be renewed at certain grade levels (MN), require the disclosure of information about whether children with exemptions are enrolled at a school (NV) or the vaccination rate in schools (TX and NY). In New York, another bill may deny parents of children with nonmedical exemptions a state tax credit which would instead go to the state health agency for immunization awareness and programs.
Montana enacted a law expanding the scope of practice for pharmacists to provide pneumococcal conjugate vaccine to individuals who are 18 or older. In Indiana and Kentucky, bills would also expand the scope of pharmacists to administer certain vaccinations.
Emergency Preparedness and Response
In Connecticut, a bill was introduced to overhaul the state’s quarantine laws and allow the state health agency to issue public health orders mandating the quarantine of, isolation of or other restrictions. A proposed bill in Minnesota would provide employment protections for persons under an isolation or quarantine order while in New Jersey a proposed bill would provide certain health care and public safety workers who are isolated or quarantined with full pay. In North Dakota, if passed, a bill would extend some worker’s compensation coverage to emergency volunteers.
HEALTH SYSTEMS TRANSFORMATION
In Arkansas, a bill to join the Interstate Medical Licensure Compact passed both legislative chambers and is awaiting the governor’s signature. A proposed bill in Mississippi would eliminate the requirement that a nurse practitioner have a collaborative practice requirement with a physician.
Health Information and Data
Arkansas expanded its telemedicine laws this year (e.g., now a patient can access telemedicine services from his or her home or other remote location). Utah passed a law that better defines and expands the scope of telemedicine and allows mental health through telehealth services. In Wyoming, a bill allowing licensure boards to adopt rules related to telehealth was approved.
In health equity, we are tracking a variety of bill in the United States. In Illinois, we are following a resolution opposing sales tax increases on food and OTC drugs. In Minnesota, bills were introduced to create a paid family and medical leave insurance program and a program for doula services in minority populations to reduce birth disparities. A bill in Mississippi, if passed, would establish universal pre-K system in the state. Bills in Missouri would create a publically financed statewide insurance program and provide loans for grocery stores in food deserts. Finally, in West Virginia, a bill was introduced to create an advisory committee for minority health focused on health equity and social determinants of health.
COMMUNITY HEALTH AND PREVENTION
Many states are focused on tobacco taxes and the spending of tobacco settlement funds. In Idaho, a bill allowing pharmacists to prescribe FDA approved tobacco cessation products passed both legislative chambers. Bills to require tobacco cessation benefits in health plans (KY), raising the minimum age of tobacco use to 21 (IN), defining "outdoor public place" in which localities may ban or restrict smoking (VA), and allowing municipalities to increase the number of cigars bars registered with local boards of health (NJ) were approved by one state legislative chamber.
Puerto Rico enacted a law providing employment protections for mothers who breastfeed their children. Bills in Alaska and South Dakota would require certain employers to provide reasonable accommodations for breastfeeding mothers. In Kentucky and Rhode Island, bills providing enforcement mechanisms for employer breastfeeding laws were introduced. Both Illinois and Nebraska saw bills that would extend breastfeeding accommodations to schools.
A few states have seen the introduction of bills requiring insurance coverage for breastfeeding needs such as breast pumps (CT) and donor breast milk (NJ, NY), while in Puerto Rico and Massachusetts, bills requiring hospitals to establish positive breastfeeding policies were introduced.
In Texas, a bill would expressly authorize breastfeeding anywhere a mother child are allowed to be and prohibits interference or restrictions on breastfeeding while in Kentucky, a bill would allow local health departments to fine anyone who interfered with a mother’s right to breastfeed.
In Virginia, a bill was passed requiring health plans to cover 12 months of contraceptives dispensed at one time while other states (MT, NV, WA) have seen similar proposals. Bills in several other states would require private and/or public health plans or the state health agency to cover or provide long acting reversible contraceptives (LARC) or other forms of contraception (CT, MA, MN, NJ, NY, OR, RI, TN, VT, and WY). Bills allowing pharmacists to prescribe and dispense contraceptives were introduced in Hawaii, Illinois, Iowa, Maryland, Missouri, New York, and South Carolina.
Adverse Childhood Experiences (ACEs)
Several measures have been introduced on the topic of ACEs, including a requirement for primary care providers to use an ACEs questionnaire to assess health risks (MO), the screening for ACEs when developing accommodations for schoolchildren (NM), a state health agency based web portal for information on childhood development (PR), requiring a statewide response to ACEs (VT), establishing specialized care for children with trauma and childcare provider training (WA).
Nutrition and Physical Activity
Several states are considering legislation dealing with sugar consumption. Bills to impose additional taxes or fees on sugar sweetened beverages were introduced in Arizona, Hawaii, Illinois, Massachusetts, New York, and Washington. Bills requiring warning labels about obesity, tooth decay, and diabetes on sugar sweetened beverages or advertisements for the beverages were introduced in California, Hawaii, Massachusetts, New York, and Vermont.
Currently, ASTHO is tracking approximately 1,800 pieces of state legislation. Nearly 4 percent of the tracked legislation has been enacted while 13-16 percent has passed at least one legislative chamber. As the 2017 legislative year progresses, we expect more legislative activity on these public health issues to occur.