OKLAHOMA NURSES ASSOCIATION - LeadingAge Oklahoma



OKAHSA

2006

ANNUAL LEGISLATIVE REPORT

By Vickie W. Rankin

Vickie White Rankin Political Consulting

vwrankin@

Introduction

Partisan posturing weighed down the 2006 Legislative Session, as the second wave of term limits rose closer to the shoreline, and the 2006 campaign season approached high tide. A record percentage of introduced bills never made it to final passage, as hundreds of bills were left on the desks in both houses of the legislature while the leadership and both caucuses argued over appropriations and tax cuts in the wake of unprecedented new revenue gleaned from soaring gas prices with a limited life expectancy.

During this session, the second of the 50th Legislature, the House and Senate considered over 2,000 new and carryover bills, 46 Joint Resolutions, 54 Concurrent Resolutions and 71 Simple Resolutions. Of these measures, only 333 bills made it as far as the Governor’s desk! Of these, 327 were signed into law, while three House bills and three Senate bills were vetoed. An additional two proposed constitutional amendments were filed with the Secretary of State for consideration on a general election ballot, and 83 additional simple or concurrent resolutions made it to the Secretary of State’s office to be recorded.

Legislators were perhaps more preoccupied than ever with the upcoming elections and the potential that those elections have for changing the partisan political balance at the capitol. Many elected officials hoped to position their own party for the greatest political advantage in the upcoming elections with each vote, while other individual legislators were more preoccupied with their own individual political races. In any case, such political agendas appeared to stall the process of reaching any agreement on the issues of tax cuts and appropriations. While legislators argued and legislative partisan caucuses met repeatedly over these issues, the limited hours in which they had to work on other legislation slipped quietly away. Hundreds of bills died with little but a whimper, left on legislative desks without a hearing, midst the noisy discord and public posturing over taxes and expenditures.

The constitutional deadline for sine die came and went without a budget agreement. Despite the fact that this is an election year (or in fact because of it) the Second Extraordinary (“Special”) Session of the 50th Legislature was called and convened on May 25th to consider tax, budget and fiscal matters. Attempts at negotiations and a great deal of behind-the-scenes work continued non-stop for nearly a month to finalize an agreement between both houses of the legislature that the Governor would also sign off on. Once the details of the agreement were reached, the Legislature reconvened, completing the budget process. They finally adjourned sine die late in the evening on June 23, 2006.

Despite the partisan rancor, and the failure to move hundreds of important pieces of legislation, the Legislature still managed some significant positive accomplishments during its 2006 legislative session. Some of the most significant accomplishments are detailed in the body of this report.

Appropriations and Funding

As a direct result of the skyrocketing gasoline and oil prices, Oklahoma’s state government found itself flush with revenue this fiscal year. Our state’s tax base is heavily reliant upon oil and natural gas products, precariously stacked upon this highly volatile source of revenue. Throughout our state’s history, various legislatures have seen fit to pass permanent tax cuts in income taxes and other non-oil based taxes during the flush years, only to have to raise taxes again when the oil booms go bust. This time, however, the scenario is quite different. While we are enjoying some benefits of the increase in oil prices, we will have no easy way to raise taxes to restore lost revenue if the oil boom bubble is ultimately burst, as it surely will be if history is any predictor. Since Oklahoma passed State Question 640 over a decade ago, the Legislature is constitutionally prohibited from passing any tax measure without a vote of the people or a super majority, rendering it impotent to respond to a budget crisis with a revenue raising measure.

As a result of this history, many longtime legislators were reluctant to go along with the deep tax cuts proposed by relatively young, newly elected members of the Legislature. Much of the session was spent wrangling over the issue of tax cuts vs. spending for a variety of programs, services and infrastructure needs that had been cut or under-funded during the budget crises of 2001-2004.

Ultimately, the Legislature resolved the issue, but not until the next political campaign season began. They had to come back into Special Session after the completion of the 2006 Regular Legislative Session to resolve their differences, pass a tax cut package, and a budget for FY2007.

Even though the permanent tax cuts were enormous, the increase in oil and gas revenue, combined with cuts to other agency’s budgets, there was still enough revenue to fund increases in a variety of programs this year. Health and Social Services saw an 11% gain, while Human Services agencies experienced a 9.2% increase in revenue. Of course, not all of that revenue went to programs for seniors. (Notably, Health and Social Services was given the highest percentage increase of any category. Even Education only had a 10% increase! Human Services was third highest with 9.2%! Some programs and agencies like general government and transportation, as well as natural resources were actually given budgets that were significantly smaller than in previous years in order to accommodate he tax cuts and our increases).

SB80XX – Health Care Authority Funding: This bill appropriated $701 million to the Oklahoma Health Care Authority. This is a whopping increase of $67 million new dollars or 10.5% more than last year’s appropriation! $22 million of that will be used to fully fund the 13.2% increase in nursing home reimbursement rates and the 10% increase in rates for ICF/MR facilities. New Medicaid rates for nursing facilities range from a low of $113.86 to a high of $119.21. These rates are re-based annually. This year’s new revenue will be combined with next year's appropriation, then reallocated to determine next year's rate. The ICF/MR rate increased from $103.38 to $114.05. These facilities still utilize a flat rate payment system, although some members of the legislature and the Oklahoma Health Care Authority continue to consider the possibility of moving these programs to the nursing facility model for facility specific reimbursement. The new funding in SB80XX will trigger the implementation of facility-specific nursing home rates, a system that will, for the first-time in the history of our state’s Medicaid system, reimburse facilities based on actual direct care expenditures that is expected to improve the quality of life for residents of such facilities.

In addition, this measure funds $13 million new dollars for hospital and physician rate increases for 6 months, allowing hospitals and physicians in Oklahoma to be reimbursed at the Upper Payment Limit. It also provides 622,806 for High Risk OB patients for the enhanced prenatal care and treatment of pregnant women.

SB42XX - Human Services Funding: The Department of Human Services (DHS) was appropriated $535.8 million for FY07, representing an 11.1% increase over the FY06 appropriation. The funding increase is to be utilized for the following:

o Replacement of federal funds lost due to the $5.3 million reduction in Oklahoma FMAP funding, and the denial of federal matching funds for a rate increase that had previously been provided to therapeutic foster homes.

o $9.2 million in subsidies to help provide access to high quality child care for the children of low-income working parents.

o $6.6 million for the ADvantage Waiver Program, providing home health care as an alternative to nursing home services. Advantage services received a rate increase, as well as an increase to cover the dramatic growth in enrollment in the program.

o $2.0 million was provided for DDSD services to cover those currently on a waiting list. A rate increase was also provided to DDSD providers, commensurate with the rate increase provided for Advantage service providers and Personal Care service providers.

o $4.4 million was provided to help with the costs of providing foster care for children who have been removed from their homes due to abuse or neglect.

o Another $907,000 was provided for families who choose to adopt special needs children.

o $300,000 was appropriated to expand the 2-1-1 call centers in three additional communities, providing a single point of access for Oklahomans in need of social services and financial assistance.

o $699,001 was appropriated for group homes and services for the mentally retarded charged with dangerous crimes but found incompetent to stand trial.

Nursing and Staffing Issues

SB 1394 by Paddack and Cox: Creates the Health Care workforce Resources Center, the purpose of which is to coordinate, facilitate and communicate statewide efforts to meet supply and demand needs for Oklahoma’s health care workforce, including nurses. The act establishes the focus of the center and provides a variety of funding options, although it does not appropriate any state revenue to the center at this time. It creates the governing board for the center and delineates the duties of that board. The act provides that the center will be housed in the Oklahoma Department of Commerce. Effective November 1, 2006.

Medicaid

HB 2102 by Cox and Paddack: Prohibits the member representing the pharmaceutical industry on the Medicaid Drug Utilization Review Board from voting on action items involving drugs or classes of drugs. Effective November 1, 2006

HB 2842 by Steele and Adelson: The Oklahoma Medicaid Reform Act of 2006. The Medicaid Reform proposal contains a variety of diverse provisions, some controversial, some questionable, and some badly needed and long overdue. The first phase of the program will be a pilot, which will not be expanded statewide unless the Governor and the Legislature determine that access to health care, health care outcomes and cost efficiency have improved under the waiver. As with most legislation, the “devil will be in the details”, and we will have a better understanding of the manner in which this will impact our patients, the public and health care professionals, after the rules have been put into place implementing many of the broadly outlined provisions in this measure. The general provisions of the bill are outlined below. Very little detail was actually set forth in the bill, with most specific direction to be developed by the Health Care Authority with the input of advisory committees. The Medicaid Reform bill went into effect on June 9, 2006.

▪ Authorizes the Oklahoma Health Care Authority (OHCA) to create a pilot program in which private health insurance providers may provide coverage to Medicaid consumers.

▪ Implements a cost-sharing method and/or benefits within federal guidelines for persons between 133% and 185% of the federal poverty level.

▪ Directs OHCA to design a database of electronic medical records.

▪ Requires OHCA to implement an electronic prescribing program for all prescription medications.

▪ Instructs OHCA to develop an incentive – or graduated - reimbursement plan for nursing facilities that keeps the provisions passed in SB1622, but includes certain quality of care indicators, as well. We have some concerns about this section of the bill (Section 5), as the graduated reimbursement plan could render the SB1622 provisions impotent, depending upon the subsequent development of rules for implementation.

▪ Requires OHCA to negotiate base provider reimbursement rates.

▪ Directs OHCA to develop a program for disease management.

▪ Instructs OHCA to develop alternatives to long-term care.

▪ Instructs OHCA to administer a program encouraging primary care services.

▪ Allows OHCA to develop a program to provide educational interventions.

▪ Requires OHA to implement a pilot telephone health information line program to reduce emergency room visits.

▪ Directs OHCA to deter abuse and reduce errors by utilizing technology and accountability measures.

▪ Requires OHCA to reduce the payment error rate.

▪ Instructs OHCA to extend benefits to Medicaid eligible students up to the age of 23 who go on to attend college.

▪ Directs hospitals to establish a discount program for qualified self-paying patients.

▪ Creates the Task Force on Nursing Home Insurance Access. Modifies the membership of the Community Hospitals Authority.

▪ Requires the Oklahoma Hospital Advisory Council to include quality indicators in annual reports!

▪ Expands the premium Assistance Program to include employers with up to fifty employees, as long as the expansion is accomplished within current funding levels. This, however, will not happen without an infusion of millions of new dollars!

▪ Expands the eligibility for the premium assistance program to include parents of children eligible for Medicaid, contingent upon the existing program not consuming more than 75% of the dedicated funding. This, however, will also not happen without an infusion of millions of new dollars!

Nursing Facilities

SB 1707 by Myers and Duncan: Requires the Department of Corrections to make a list of registered sex offenders available to the commissioner of health. Authorizes the Commissioner to distribute information from the sex offender registry to any nursing home or long term care facility. Effective July 1, 2006.

SB 1850 by Cain and Denney: Changes “Nursing Home Administrators” to “Long term Care Administrators”. Deletes provisions regulating mental retardation professionals. Authorizes the Board of Examiners for Long-Term Care Administrators to warn, censure and impose administrative fines. It further allows the Board to collect costs associated with a hearing. Allows the Board to grant short-term professional licenses, and authorizes the Board to order a summary suspension of licenses or permits. Effective July 1, 2006.

SB 1971 by Riley and Peters: Exempts initial application fees, first year license fees, permanent license fees, renewal of permanent license fees and late renewal fees for hospices from fee limitations. Effective November 1, 2006.

Other Long Term Care Issues

SB 1640 by Johnson, Connie and Balkman: Adds residential care homes to the list of facilities that may participate in the Board of Pharmacy’s program through which unused prescription drugs are transferred from certain facilities to pharmacies operated by a county. Effective November 1, 2006.

SB2017 by Johnson, C. and Balkman: This bill extends the life of the Strategic Planning Committee on the Olmstead Decision until July 1, 2007. In addition, it creates the “Opportunities for Independent Living Act”, establishing a three-year pilot program to assist qualified individuals with disabilities living in institutions to transition into the community. It establishes the Health Care Authority as the lead agency in developing the pilot, with the assistance and cooperation of the Department of Human Services. The Legislature expects this effort to yield a much greater number of disabled individuals living more comfortably in their homes and communities, receiving Advantage Waiver, Adult Day Care, and other services in home and community settings, rather than in institutions, at a lower cost to the state.

Miscellaneous

SB1040 by Riley and Peters: This bill requires that DHS and certain other agencies providing services, maintain an Internet website upon which application forms for the services they provide to be accessed and downloaded by individuals wishing to apply for the services. It further requires that each agency provide a link to each other agency required to provide forms on their website in order to improve accessibility for Oklahoma citizens needing services. This measure is expected to help many of the clients our providers serve, and will goes into effect on November 1, 2006.

SB 1624 by Lamb and Ingmire: This bill actually rolls two major issues together. (1) The first issue deals with Emergency Response Systems, allowing stretcher aid van services in counties of over 300,000. (2) The second issue addresses the Oklahoma Advanced Directive Act, or the Oklahoma Living Will Law, modifying state law as it relates to advanced directives for health care including changes in the definitions and forms authorized for execution in Oklahoma. It modifies the decisions individuals are allowed to make with respect to the withholding of life-sustaining treatment and the artificial administration of nutrition and hydration. It also modifies the conditions under which the presumption of desire for nutrition and hydration does not apply. This bill was written after Attorney General Drew Edmondson issued a legal opinion regarding the constitutionality of our previous living will statutes, in order to ensure that Oklahoma’s Living Will Law passes constitutional muster. The previous law was unconstitutional for restricting an individual’s right to refuse artificially administered food and hydration. Under the new law, SB1624, Oklahomans would be allowed to choose through an advanced directive whether they would be sustained through such nutrition and hydration, or whether they would choose not to be given food or hydration through artificial means. The Governor signed this bill and it became effective on May 17, 2006.

SB 1793 by Justice and Richardson: Exploitation of the Elderly Bill: Establishes the crime of exploitation of the elderly or disabled person. It sets a penalty by dollar amount of exploitation and defines an elderly person as 62 years of age or older. It includes financial exploitation in the statute of limitations to be prosecuted within five years. Effective on July 1, 2006.

HR 1075 by Perry and Staggs: This is a resolution that encourages our State Department of Public Safety to partner with local Law Enforcement agencies and statewide media outlets to implement a statewide warning system much like the “Amber Alert” program, to locate missing senior citizens more quickly than we are able to today. This system, called “Silver Alert” would help expedite the location of seniors who might have strayed from their homes, become disoriented, and be at risk. While not a mandate, it raises awareness and encourages local communities and law enforcement entities to work together to protect our vulnerable elderly.

Other Notable Legislative Events

The 2006 legislative session seemed to produce, at least temporarily, a greater awareness of the need to adequately fund health care and to better compensate health care providers. While tax cuts in the Special Session that occurred this summer were indeed significant, and will reduce the amount of revenue coming into the state’s general revenue fund once gas prices taper off, there is enough revenue today that the legislature was able to pass some long overdue increases in health care.

Increases in Medicaid rates for nursing facilities, Advantage Waiver and Personal Care services, DDSD, as well as physician and APRN rates were among significant rate increases affecting the quality of Oklahoma’s Health care system that passed this year.

Conclusion

Despite these successes, however, we have a great deal more still to accomplish. The future of long term care in Oklahoma is heavily dependent upon adequate revenue to fund long term care, now and in the future.

Continued cuts in federal funding for Medicaid services loom ever larger on the horizon as the federal deficit grows and revenues are diverted to other areas of congressional priority. As federal commitment to care for our vulnerable and medically needy wanes, the state will have to carry a great deal more of the burden. Our members will need to be politically engaged at both the state and national levels to advocate for the programs that provide health care to the populations we serve.

Aging advocates and providers of aging services will have to educate the advocates for dramatic tax cuts of the need for continued and expanded state support of aging services and the role that such services play in our economic well being. In leaner years, when gas prices fall, and revenue is down, our providers will have to compete with other entities like prisons and a deteriorating transportation infrastructure for adequate funding.

Appropriations for nursing facilities, home health care adult day care and assisted living, will be a perennial concern in a state with a rapidly aging population and one of the lowest tax bases in the nation.

Our members will need to become more involved in the Association and more engaged in the elective, grassroots and legislative process in order to effect change that will benefit the well-being of the aging citizens of this state.

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